Q. Why a new hospital?

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1 Q. Why a new hospital? Our existing facilities are not built to properly deliver the high quality care we presently provide. Additionally, our current facilities are outdated and in need of costly repairs and operating costs for the old buildings exceed the cost of operating a new, smaller, more efficient building. St. Mary s of the Lake Hospital is an outdated facility that does not adequately meet the needs of today s patients. For example, although one of its specialties is rehabilitation, many of the rooms are not wheelchair accessible. When it was established in 1946, most patients were bedridden and did not use the modern wheelchairs that are common today. There is little space to store this kind of equipment and it can be difficult to get around the hallways. As well, the physiotherapy gym is too small to meet the needs of the patients we serve. Many of the rooms at Mental Health Services are designed to have eight patients per room and shared washrooms yesterday s ward-style living conditions are out of step with today s approach to mental health treatment and recovery. There are 11 kilometres of hallways making it difficult to navigate, and inefficient to heat and maintain. As well, there is no air conditioning in the summer. A new hospital will meet the changing needs of our community in the years to come. Our project is part of an overall joint hospitals redevelopment plan that has already seen the redevelopment of Kingston General Hospital and Hotel Dieu Hospital, in order to meet the needs of the communities we serve well into the future Q: When will the current hospitals close? Following the transfer of all patients, clients and services to the new site upon completion, the current hospital sites for St. Mary s of the Lake and Mental Health services will close. Q. What will happen to the existing buildings?

2 The new facility will bring together the programs from our St. Mary s of the Lake Hospital and Mental Health Services site to a brand new hospital to the rear of the existing building at Mental Health Services site on King Street West. One wing of the existing Mental Health Services building will need to be decommissioned to make way for the new hospital construction, however the rest of the building will remain in operation until we move to the new facility. The safety and comfort of our patients and clients will remain a key priority throughout the process. Once the move is completed the existing Mental Health Services building will be will be torn down and re-landscaped. The St. Mary s of the Lake site will remain in operation until the move to the new building when it will revert to the Sisters of St. Vincent DePaul who own the property. Q. What are the plans for the rest of the King Street West property? The Ontario Infrastructure and Lands Corporation (formerly Infrastructure Ontario and the Ontario Realty Corporation) is in the process of completing a Master Plan study for the land at King St. West, referred to as the Kingston Provincial Campus. For more information on this process, visit: Features and Design Q. What services will be provided in the new hospital? How many beds will there be for each program? Have you considered future population needs? Providence Care Hospital will provide complex continuing care, end-of-life/palliative care, specialized geriatrics, rehabilitation and specialized mental health (adult treatment and rehabilitation, geriatric psychiatry and forensic psychiatry). These are the programs currently provided at St. Mary s of the Lake Hospital and Mental Health Services. Bed breakdown: Complex Continuing Care (includes palliative and specialized geriatrics) 100 Rehabilitation 50 Specialized Mental Health 120 Part of the Master Program/Master Plan process has been to consider the needs of our region over both the short and long term. These numbers have been developed with those considerations in mind, and by using a formula that takes into account demographics and other population-related statistics. The new hospital will also be designed so there is flexibility, and options for future expansion. Q. What are the benefits to building a new Providence Care hospital?

3 Maximizes operating efficiencies and care delivery by consolidating hospital programs Reduces square footage of hospital facilities by over 30% Supports best practice and provides appropriate space for patient care that meets current planning standards (infection control, accessibility standards, etc.) Decreases stigma to clients of mental health services, who will be integrated with other hospital patients Lowest capital, operating and life-cycle costs (compared to renovation) Eliminates investment in old, dysfunctional buildings Q. Will parking be free? The cost to build and maintain parking areas at hospitals is not covered by the Ministry of Health and Long-Term Care, and therefore there will be a fee to park at the new facility. This is consistent with other hospitals and public buildings in Kingston. We are also hoping to work with the City to integrate municipal bus service to the site. Q. What type of parking will be built at the new hospital surface, parking garage or underground? We are planning to build a surface parking lot, which is the least costly option. Constructing and maintaining parking lots at public hospitals is not funded by the Ministry of Health and Long-Term Care. Many hospitals implement parking fees to help cover the expense. Q. Will there be single patient rooms? Each unit will accommodate 100 per cent private rooms, and each room will have a private three-piece patient washroom. Each patient room will be equipped with a patient lift and be fully wheelchair accessible. There will be nine inpatient units in the new hospital (270 beds in total). Each unit will be divided into 10-bed clusters, and each cluster will have its own space for dining, recreation and therapy activities. Three 10-bed clusters make up a unit. One of the design principles for the new hospital is to maximize natural lighting and views throughout. The current plan provides inpatient spaces and patient rooms that maximize the view of the lake and natural spaces on the grounds. Each unit will also have direct access to the outdoors, either through ground-level access or a terrace. Q. Will there be large space indoors and outdoors for hospital-wide recreation programs? Our current planning includes a large lecture/event space, as well as a cafeteria and outdoor eating area. Each inpatient unit will have direct access to the outdoors through

4 grade or a terrace. More specific planning of these spaces will be determined as we continue through the design process. Q. Will there be any space for family and friends to visit at the new hospital? The patient-centred approach that drives our planning recognizes the importance of family and friends in the care team. Each inpatient unit has planned areas that allow for family and friends to visit comfortably, and single-patient rooms provide a quiet environment in which to visit. Q. Will Providence Care Hospital be air-conditioned? Yes, the new hospital will be air-conditioned throughout, to ensure the comfort of patients, clients, visitors, staff and volunteers when it is warm outside. Q. Will the doorways and hallways be extra-wide to accommodate wheelchairs and scooters? The new hospital will be built according to accessibility standards, and to ensure we are able to meet the needs of our patients, clients and their families. There may be areas where a large corridor makes it easier for two or three people to stop and have a short discussion, or more enjoyable to walk from one area of the hospital to another. Q. Where will the different programs, services and departments be located? The exact location of programs, services and departments in the new building is not yet decided. Generally, we are working with a strategy to locate public services nearer to the main entrance. These would include Volunteer Services, the University Hospitals Kingston Foundation, various education or multipurpose spaces, and retail space. Outpatient clinics, the Day Hospital and other clinical areas may also be located closer to the main entrance, so that they re more accessible to those patients and clients who are only at the hospital for a short period of time. Inpatient clinical areas will be located farther away from the main entrance, to provide increased privacy for patients and clients. Inpatient dining areas, living space and treatment areas will be located on the units. Other spaces, such as the cafeteria, the pool, and administration, will be located so that they are accessible both for public and inpatient populations. Q. Will the new hospital have a public entrance (for patients, clients and visitors) and a staff entrance? The main entrance to Providence Care Hospital will be accessible from the parking area and will lead into the lobby of the new building. Our strategy is to locate services which

5 may be used by the patients/clients, the public and staff (such as the gift shop, Foundation, and education space) in this area of the facility. Outpatient clinics may also be closer to the front entrance. There will also be designated entrances for patients and clients arriving at the hospital by patient transfer, or to the Forensics program specifically, as well as for shipping and receiving. The precise number of entrances and their locations will be determined as the planning continues. Q: Will there be a Tim Horton s or Starbucks in the new hospital? There is a secondary food outlet space allocated in the planning for the new hospital, but the type of service offered in that space is not yet established. The studies done for the Retail Strategy for the new hospital have determined that we will not have the traffic flow necessary to attract major franchises. Q. What green or environmentally-friendly technology will be incorporated into the new hospital? One of the key planning principles in designing Providence Care Hospital is to be environmentally responsible. That means that we are considering everything from the overall footprint of the facility and the energy it will require to operate, to the types of materials that will be used to build it. At this stage in the planning, we have made the commitment that the new hospital will meet a LEED Silver standard. Specific design elements will be determined as the planning continues. For more information on this element, visit our Environmental and Landscaping Initiatives page. Planning and Construction Q. How will patients and clients be involved in the hospital design process? Providence Care is committed to providing up-to-date information to our patients, clients and residents, their families, and our community through forums and other channels. Our patients, clients and family have an important voice and perspective to share as we design the Providence Care Hospital, and representatives are participating in various user group sessions throughout the planning process. Regular updates are available in our redevelopment newsletter. Q. When will construction begin? When will the new hospital be open? Planning for the new Providence Care Hospital is no small feat It takes a long time and a wealth of expertise and knowledge from our partners to reach our goals in the

6 progress to a new hospital. Construction for the new hospital is expected to begin in late 2013 and expected to take approximately three years to complete. Q. Will it be business-as-usual during hospital construction? Yes and no. The project specifications given to the proponent has strict requirements for maintaining our operations fully functional throughout the construction period. This includes requirements for such things as noise control, access control, parking, dust/dirt control, and safety procedures amongst others. However, there is no doubt that building a new hospital on the Mental Health Services site while existing operations there continue will create some changes. It is premature to comment on specifics, since review and determination of those impacts is still being determined with the proponent. We do know that one wing of the existing Mental Health Services building will need to be decommissioned to make way for the new hospital construction, while the rest of the building will remain in operation until we move to the new facility. There is no doubt that we will see such things as temporary parking lots and construction in fairly close proximity to some areas of the existing building. Experience has shown that if properly controlled and managed, the potential inconveniences some construction operations may cause can be outweighed by the excitement and anticipation generated by the reality of the new hospital being built. As we build our new hospital over the next few years, we will be posting important updates and construction notices to our website keep you up-to-date with what s going on. Funding Q. How is the new hospital project being funded? The Provincial government has determined that Providence Care Hospital will be a Design, Build, Finance and Maintain (DBFM) project under the Alternative Finance and Procurement (AFP) model. The DBFM procurement model transfers responsibility to a developer to design and construct the hospital, arrange construction-term financing and then maintain the building for a 30 year period. The hospital project will be managed jointly by Providence Care and Infrastructure Ontario, and built by a team of companies who have come together to specifically for this project. Q. What is Alternative Financing and Procurement (AFP)?

7 AFP is an innovative way of financing and procuring large public infrastructure projects. It makes the best use of private-sector resources and expertise to provide on-time, onbudget project delivery. Under AFP, the public sector (Providence Care) establishes the scope and purpose of the project while the construction work is financed and carried out by the private sector. In our case, the private sector will also be responsible for the maintenance of the physical building. AFP provides the opportunity to transfer project risks to the private sector, which commits to delivering projects on time and on budget. AFP allows the government to deliver more infrastructure projects sooner by tapping into alternate sources of capital. Q. What is DBFM? DBFM stands for Design, Build, Finance and Maintain. The team of companies will be paid on a monthly basis over 30 years (only after construction is completed) for the cost to design, build, finance and maintain the new Providence Care Hospital. The developer will take on the risks to provide these four components and determine those costs over the construction and the subsequent 30-year maintenance period. Q. Why was the AFP approach chosen for this project? The AFP approach is generally suitable for large, complex projects like our new hospital. The AFP approach brings in private-sector expertise, ingenuity and rigour to the process of managing and renewing public infrastructure, but preserves public ownership of core public assets. AFP is focused on: Minimizing cost and schedule overruns; Better coordination between design, construction, long-term maintenance and building services; More accountability throughout the planning, construction and maintenance phases of the project; and Building infrastructure that will last. Q. How is AFP being used? Under this new model of financing, the private sector is responsible for the design, construction, financing and 30?year maintenance of the building. The hospital will pay for the project over a 30 year term, beginning after substantial completion, a bit like paying a mortgage. The hospital will remain publicly owned, publicly controlled and publicly accountable.

8 Q. This project is privately financed. Won t that cost more? The total cost of the project needs consideration, not just this one element. The costs of private-sector borrowing are offset by the risks the contractors assume for the project. Under AFP, key risks that would have been retained by the public sector under the traditional procurement approach are now contractually transferred to developers, including: scheduling, project completion and delays site conditions permits and development approvals availability of mechanical and electrical systems material and labour cost escalation quality of design and construction Q. How much will the project cost? The project contract, including cost with the successful bidder, will be released publicly following financial close and be made available on Infrastructure Ontario s website at We are not in a position to discuss costs at this time. Doing so could jeopardize the competitive procurement process underway, as well as harm our efforts to obtain the most favourable, cost-effective proposals from bidders. It should be noted, performance standards are included in the contract with an agreedto mechanism for measuring this performance. Payments can be withheld if performance standards are not met. It is also important to note, the contract will be a fixed price, fixed date agreement. The developer will be financially penalized for late delivery of the new hospital. The procurement model builds on the expertise of both the public and private partners to best meet the defined need for the new hospital. Under traditional procurement there is little or no relationship between payment for the new hospital and how the hospital performs when it is built. Under this model, the successful company of teams assumes financing and risk for the delivery and the performance of the hospital, from its design, architectural and structural plan to its long-term hard maintenance. Q. Are AFP and previous P3 models used in Ontario the same? There are a number of fundamental differences between the AFP model and previous P3 models used in Ontario, including: Guiding principles that protect the public interest

9 Increased due diligence and analysis More appropriate risk transfer to the private sector Enhanced accountability and transparency measures No soft facility management services Payments based on performance Q. What are the differences from traditional procurement? Payment to the developer occurs only after construction is completed: incentive for builder to remain on schedule developer s lenders bring additional due diligence to achieve on-time, on-budget delivery More opportunity for design, construction and financing innovations Long -term building maintenance concession tied in with building team 30 year warranty to hospital and Province that the facility will be available and well maintained long term Integration of design and construction with building maintenance and life cycle costs The old way of building hospitals was not working. It led to cost overruns that put the taxpayer on the hook and resulted in projects that were over budget and late. The private partner assumes the risk of cost overruns not the taxpayer. The developer is NOT responsible for patient care. Q. If private sector companies are involved in designing, building, financing and maintaining the new hospital does this mean it is a privatized hospital? No, it does not. Providence Care and the new Providence Care Hospital will remain publically owned, publicly controlled and publically accountable. The new hospital project will be managed jointly by Providence Care and Infrastructure Ontario, working with the successful team of companies who have come together specifically for this project. Providence Care Hospital will be a public hospital under the Public Hospitals Act and will operate in accordance with the Canada Health Act and the Commitment to the Future of Medicare Act. Any claims made about privatization of the new hospital are completely inaccurate.

10 Q. Why are there private companies involved in hospital redevelopment at all? Private sector construction firms have always been used to build public projects. Whether through design, construction or other services, they ve always played a role. In the past there has been a lack of coordination between these private sector activities. This lack of coordination can lead to unsuccessful projects, projects that go over budget or that do not meet their expected timelines. Under the AFP delivery model these private sector activities are brought together under one project umbrella producing better overall results on time and on budget. As this approach has delivered savings to the government, it has provided them with more resources to allocate to other health care priorities. Q. Have other hospitals gone through this delivery model before? Many hospital and other infrastructure projects have been completed on time and on budget using the AFP delivery model, including ones in our own city. Phase one of the $196 million dollar redevelopment project at Kingston General Hospital (KGH) was completed on time and on budget under a similar AFP delivery model. Hamilton Health Sciences Juravinski Hospital and Cancer Centre site redevelopment and the Centre for Addiction and Mental Health have recently reached successful completion under this model, while the Niagara Health System will reach substantial completion later this year. For a complete list of projects that have been successfully completed using an AFP delivery model, visit Infrastructure Ontario s website at Q. What is the local share? How much does the community have to contribute? The local share is the portion of funding for which a hospital is responsible and the community can contribute. Since the ministry s capital cost-sharing policy for hospital projects does not cover 100 per cent of all costs incurred, not all elements of a project are eligible for ministry cost-sharing. The provincial portion consists of: 90 per cent of eligible construction costs 100 per cent of eligible costs for longer term mental health. Hospitals are responsible for: 10 per cent of the eligible construction costs and associated ancillary costs

11 100 per cent of components of the project that are ineligible for ministry costsharing, such as retail space, parking facilities and other revenue generating areas 100 per cent of the costs associated with the purchase of new and replacement furniture and equipment, excluding some radiation therapy equipment, longerterm mental health and chronic kidney disease equipment Q. Where is the funding coming from for the redevelopment positions? The redevelopment Planning Team positions are included in the redevelopment projectspecific budget, as part of an allowable project management expense. Redevelopment is funded by the government separately from our operational budget, which covers the day-to-day expenses of running Providence Care.