FAQs

The basement is well above sea level. We had a number of challenges put to us by BHB to ensure that it will always be water tight and it will not be subjected to flooding. We have the appropriate mechanisms in place to make sure that happens. Note that all the major electrical equipment and the central computer areas, per BHB requirements, are located on upper floors.

BHB are increasing the car parking spaces on the campus. As the project develops BHB will take into consideration how staff and visitors require parking and allocate towards those areas.

While the entrance to the CCU will be subtly changed, the new building project doesn’t include any modification to the existing building. The structure is designed so that a remodeled CCU building or a new building can be connected to the new wing in the future if the Hospital wishes to do so.

The surgical suites will stay where they are in the existing building. However, Obstetrics will move adjacent to the OR suites in the existing hospital, to provide swifter access to operating rooms if required.

There will be a cast room in the new emergency section but the Fracture Clinic will remain where it is.

The Palliative Care building, Agape House, is not part of this design. BHB knows that Agape House is not satisfactory at the moment and BHB is working to see whether it will be renovated or demolished and rebuilt. Another option being looked at is whether Palliative Care will go in one of the vacated spaces in the existing KEMH building when the current services move out.

Bermuda Hospitals Board (BHB) is pleased to report that the design and construction related cost of the new facility being built by Paget Health Services (PHS) is $247 million. This is $13 million less than the original estimate of approximately $260 million in the 2008 Johns Hopkins Medicine International Report.

BHB has chosen to deliver the new facility through a public private partnership (PPP) that transfers many of the project’s risks, such as cost overruns and on time completion, to the private partner. The PPP model also allows for cost certainty, and frees funds to be used by BHB now to improve patient care and facilities because the first payment on the new building will not be made until 2014. How the money is raised by PHS is confidential and commercially sensitive to the team.

The main staging area would be the parking lot so there’s a great area to receive materials. We’re also thinking about building the structure using reinforced concrete which we believe to be more user-friendly as opposed to structural steel which has a lot more noise associated with cutting and attaching etc. We’re going to use tower cranes which are electrically powered and this will cut down on the noise as well. The site will be completely hoarded to present a safe and secure boundary.

Before any work commences, BHB’s Infection Prevention and Control department must approve ICRAs (Infection Control Risk Assessments) by the contractor, who must comply with infection control and prevention measures for the safety of patients, staff and the general public.

We’ve taken many steps to mitigate the use of water and so we’ve incorporated the use of the water catchment on Berry Hill. Grey water and water that comes out of showers and basins will be recycled and used for flushing toilets etc. We’re also looking at ways to capture the water collected from roof tops as well as other grey water that is not potable and using it to irrigate the roof decks.

There are a variety of “green” measures incorporated into the design. For example, the building is designed to minimize solar gain and will absorb heat due to its thermal mass. Water will be captured from the building to be recycled and re-used. The building will have solar panels on the roof that can assist in the heating of domestic hot water coming out of the taps. The new electrical plant will be more efficient than the current one and will cut down on power usage. Lights within the building will be set on motion detection.

The unloading and set down area for construction materials will be entirely within the hoarded area of the construction site. There will not be a situation where materials are being unloaded from the street as you see in the more restricted sites in Hamilton.

The new building is six storeys high and is in the same range of the existing building but is slightly higher.

The highest point of the new building, measured from sea level, is 44 feet less than the Special Planning Act maximum set at 215 feet above mean sea level.

The building facade itself is designed to withstand 150 mph winds and the basement will be waterproof with the Plant Room positioned above the water tanks. The resilience of major electrical services will be enhanced by strategically locating sub-stations, generators and mains panels on different levels within the redevelopment.

We are putting in a new sewage treatment plant that will be underground in the new building’s car parking area itself. We have been given very stringent levels of effluent treatment that we have to adhere to. We are incorporating very stringent ‘Secondary Treatment’ level as agreed with the Environmental Authority.

PVC solar was considered, but current data suggests that it is not incredibly efficient and they do break down relatively quickly in a saline environment like Bermuda where the PV panels degrade a lot faster. We looked at them and felt there were better opportunities that would give a greater benefit to BHB and in how the building operates. We know that we can do a very good job with solar hot water and have taken other measures to provide a very energy conscious building.

There have been geological studies done on the site. Yes, there is some hard rock present on the site. BHB has had prior experiences at both the CCU and at the Central Utility Plant. As BHB were able to remove the rock pneumatically, they were able to remove it without using blasting techniques which would likely be a greater risk in damaging adjacent properties. That is something that we will have to gauge as the construction continues and we will also engage our Insurance companies should there be any significant issues.

We will be working within the accepted Bermudian codes for noise discharge.

There have been traffic assessments of the redevelopment proposal and surveys of all the existing trees and landscaping. We have a program in place to harvest appropriate landscaping material for replanting; some specimen trees are now secured in an off-site store and will be used as key elements within the final landscaping proposal.

Of course, the strategy for trying to bring the Botanical Gardens into the KEMH site was central to the development of the building. Part of the strategy was to create as green a building as possible and we have provided “green” roofs and landscaped deck areas throughout all levels of the building, including the major deck south of the patient bed block.

Whether in regards to parking, landscaping or the inclusion of landscaped garden decks into the building, we tried to integrate the redevelopment works into the existing landscape as much as possible.

Construction will run six days a week and there will be some weeks where activity will happen over a seven day cycle. The type of construction that we are looking at is largely reinforced concrete which utilizes electric tower cranes. The impact of noise will be mitigated with this type of construction. Hours of work will follow the usual patterns and if Sunday work is necessary, neighbours will be notified by an email titled “Construction Alert”.

We are reusing many of the specimen trees from the site; they are currently in store and being looked after by an experienced horticulturist.

PHS will have a designated person who will liaise with the community. BHB’s Information Line (239 5959) will remain operational with construction updates and we have arranged for specific “Neighbor Alerts”, to identify key activities or potential issues. It is important to leave a message with your email contact details if you wish to receive this information.

A large part of the site will be planted with native and endemic trees including the new building’s garden areas.

The design was made to sustain 150mph winds.

Yes, geothermal cooling will be used.

Yes, all the rooms are single. Surveys show that people prefer private rooms and it also improves infection control. There are also isolation rooms located on each floor. Of note, rooms in the new building are for acute care, and best practice indicates that single-occupancy is the right choice for acutely ill patients. The rooms are not “private” in terms of tiered insurance coverage for private versus semi-private or ward rooms. They are all single occupancy due to clinical necessity.

Solar is going to be used; we have solar collectors on the roof to heat the domestic hot water. We are not using wind power because it might be deemed too great a visual intrusion into the area.

The area of the building is approximately 250,000 square feet. The current KEMH, excluding the Continuing Care Unit, is approximately 350,000 square feet.

The trucks will be the normal Bermuda construction vehicles currently used across the island. We are looking for LEED Certification, so we will be cleaning the trucks and minimizing dust. We will try when possible to deliver materials at off peak times.

There will be ninety single beds in the new facility. Medical / surgical beds are current in Perry, Cooper, Curtis and Gordon wards. All Wards are accumulative to 140 beds in the existing KEMH hospital. Medical /surgical patients are going to move into the 90 beds in the new building. That will then allow BHB to renovate some of the old wards and reduce the occupancy in those rooms by over a half. BHB is not reducing beds; initially we will have more beds.

Yes, there are designated elevators for the public and elevators specifically for patients that are not accessible to the public.

Yes there is. Rooms are located at each corner that could be used for multiple purposes.

Isolation rooms are throughout the building in the ER, Renal Dialysis and Oncology and there are two on each patient floor designed with the necessary mechanical system to create an isolation room, with a vestibule separating them from the general circulation.

Yes, there is a plant that is going to be in the basement area and we will have sufficient capacity to run the new building as well as the existing buildings on site.

Yes, we have retained the spaces that the Taxis currently have.

It would have cost significantly more than parking at ground level. BHB’s concern was to put as much of the capital funds available as possible into the actual clinical facility. We’re gaining over 100 spaces with the new Springfield car park at the corner of Berry Hill and Point Finger roads, and the additional parking that will be available next to the new building.

There is a substantial area designated for retail space, including a Pharmacy.

Traffic data was analyzed and the local consultants are satisfied that the position of the junction won’t create any undue problems.

Yes, a major element of the brief requires that the building be fully accessible for the physically challenged.

The main traffic at the front of the new building is strictly for public accessibility purposes. The final balance between staff and public parking spaces will be reviewed as the larger Master Plan is developed alongside future uses of the buildings that BHB are vacating and the incorporation of the new Springfield staff car park. Being that it is a redevelopment project and not a new development, we will have limited impact on traffic on Berry Hill Road and Point Finger Road. We have carried out traffic studies which have been submitted as part of our planning application.

It was looked at as an option but one of the quandaries is that it could interfere with the dedicated ambulance entrance and if we were to continue the roadway into the car park it could cause a traffic snarl. The traffic engineers recommended that we circuit the public traffic back on to the main road and the volume of traffic is not so great that it should cause a problem at all.

The dedicated ambulance entrance has to be adjacent to the building but there is a barrier for the safety of pedestrians between the ambulance entrance and the walkway.

During the construction period, it will be a staging area. The parking lot will not be available to the public until the new Hospital building is finished and open.

A sidewalk will be created on BHB land. It will not take any space away from private residences. Point Finger Road will be re-shaped in front of the new building to accommodate two bus lay bys instead of the current single bus lay by, for example.

The Emergency Department has a very large canopy on the southern edge of the building which is the ambulance access point. That canopy is designed to not only cover the parking spaces for the ambulances, but also the surrounding area and landscape. The intention would be that this covered protected area would become a triage/evaluation zone for patients before admission into the Hospital and to the appropriate treatment protocols.

The Main Entry Plaza can also be utilized as it can be closed off and the loop road off Point Finger Road allows vehicles to drop passengers at the plaza itself. Importantly, the vestibule into the reception pavilion can also function as triage and the reception area itself can be converted into a staging area.

As part of submissions to the Department of Planning, a very detailed construction program has been put forward by BCM McAlpine. The site will be a fully hoarded, safe area. Materials will be stored off the road in a safe area. This information is detailed within our Planning Supplemental documentation which is in Planning Department’s office.

This wasn’t something that that was in the initial brief and is not part of this design.

It is a very good idea and we will give it some thought.

While there are no moving walkways, there is a direct stairway as well as public elevators and a ramp for the physically challenged that connects the existing hospital to the new one.

There was no proposal for changing the removal of clinical waste; it will remain the same.

After evaluating each of the competing teams against the same pre-established criteria, the team which best meets evaluation criteria while offering the best value for BHB will be chosen as the preferred bidder. The preferred bidder and BHB then work to finalise the contract. It is expected that this will occur near the end of this year. At that point, the preferred bidder will become BHB’s private partner, and work will begin shortly after. The private partner is responsible for designing, financing, building the new acute care hospital building, and then maintaining it for 30 years.

Paget Health Services (PHS) is a consortium formed specifically to deliver the KEMH project. It will be structured in a similar way to other consortia created to deliver PPP schemes in Canada and the United Kingdom. Paget Health Services will be owned and controlled by a small group of Bermudian and international investors who are committed to the long term success of the new facility. This mix of investors will ensure the KEMH project benefits from the investors´ extensive experience of PPP projects for hospitals and other sectors while ensuring that PHS meets the uniquely Bermudian requirements of the project.

Paget Health Services was selected as BHB´s preferred bidder on 29 September, 2010 (see press release).

BHB has implemented a plan to ensure we can meet the payments to our private partner. BHB is funding payments for the new facility through government-approved fee increases, internal operational savings and a contribution from the Bermuda Hospitals Charitable Trust (BHB’s independent fund-raising arm).

The cost to upgrade the existing KEMH will be borne by BHB itself. The construction cost of the new facility will be borne by BHB’s private partner. BHB will only begin repaying the private partner after construction of the new facility has been completed in accordance with BHB’s specifications, in 2014.

After the building is complete, BHB will pay the private partner back over 30 years. The payments include the cost of financing, construction and construction management as well as the cost of maintaining the new facility. The payments for the thirty years are set at the point the contract is agreed, prior to construction.

Following a competitive procurement process, BHB expects to enter into an agreement with a private partner late in 2010, which would be followed by groundbreaking. It is expected that the first patients will be served in the new facilities in 2014.

o Request for Qualifications (RFQ) issued: summer 2009 (COMPLETE)

o Request for Proposals (RFP) issued: late 2009 (COMPLETE)

o Proposals submitted and evaluated: summer 2010

o Preferred bidder named: fall 2010

o Commercial/Financial close: fall 2010

o Design and construction: winter 2010 ‐ winter 2013

o Operating phase commences: 2014

The newly constructed space will contain 90 single-occupancy en suite rooms. This standard of care is in line with international leading practice to help prevent the spread of infection and improve patient dignity, privacy and comfort. The new facility will house a larger emergency room and a diagnostic imaging department. Out-patients will have new areas to provide convenient access to testing, treatments and educational advice. A new central utility plant (CUP) will also be contained in the new facility, which provides services like chilled water, steam generation and waste treatment. It will handle the needs of both the renovated and the new facility. Once complete, the new build will allow BHB to re-assign space in the renovated KEMH building. This gives BHB more options in terms of providing high-quality health care to our patients.

The Johns Hopkins Medicine International (JHMI) Phase II Report reviewed BHB’s 2005 Estate Master Plan and advised that Bermuda needed more space for its acute care services in order to provide the quality and range of services Bermuda requires over the long term. The report is available in full on this website.

BHB has approval to construct new space to house various acute care services, including 90 single-patient rooms, a new emergency department, diagnostic imaging, ambulatory care services including oncology, same-day surgery and dialysis, and a central utility plant over the next several years on the King Edward VII Memorial Hospital (KEMH) site. At the same time BHB will upgrade the existing hospital building. Together, the new and upgraded facilities will offer the additional acute care space required to provide Bermuda with the acute care services it needs. The entire project is called the KEMH Redevelopment Project.

BHB hired KPMG, a leading financial services firm, to develop a business case that, among other things, assessed traditional and Public Private Partnership (PPP) delivery models for the new build. The delivery model KPMG recommended is a form of PPP called Design, Build, Finance and Maintain.

Following a competitive procurement process, BHB will enter into an agreement with a preferred private partner. This is a way of managing very complex project risks around a major construction project so that no one group bears the full risk of the project, and responsibility for certain risks is placed with either BHB or the private partner, whichever is best placed to manage them.

In this project, the private partner assumes most of the design and construction risk associated with the project. For example, cost over-runs would be borne by the private partner, not BHB or Government.

BHB retains ownership and control of all land, buildings and all clinical services.

Local:

– KPMG—business and finance

– Conyers & Associates—architecture

– Onsite Engineering—engineering

– Bermuda-Caribbean Engineering Consultants—town planning

– Atlantic Building Consultants—quantity surveying

– Conyers Dill and Pearman—legal

International:

– KPMG—business and financial

– Mott MacDonald—clinical

– Stantec—technical

– Davis LLP—legal

A Request for Qualifications (RFQ) was issued on schedule on 29 June and closed on 19 August 2009. After an extensive evaluation, three bid teams were shortlisted from the evaluated submissions. A Request for Proposal (RFP) was issued to shortlisted bidders on the 23 December 2009, on schedule.

The preferred private partner will be selected following a rigorous and competitive process based on international procurement best practice, and the partner offering the best value to BHB and Bermuda will be selected.

To view the shortlisted bid teams´ membership, please see the press release on this site "BHB Releases Request for Proposal to Shortlisted Bidders" dated 23 December, 2009.

PPP stands for Public Private Partnership. Essentially it means BHB will enter an agreement with a private consortium (“partner”) to develop the new facilities at KEMH for a period of 25 to 35 years. This is a way of managing the very complex project risks around a major construction project so that no one group bears the full risk of the project, project risks are allocated to the party best able to manage those risks and all parties are focused on delivering quality buildings on time and on budget. KPMG has developed a business case which assesses the delivery options and recommends PPP as the preferred delivery model.

The particular form of PPP that is to be used is called Design, Build, Finance and Maintain (DBFM). The DBFM delivery model was chosen for the development of the new facilities after a rigorous assessment. Some key benefits of DBFM are:

- The first payment for the new facilities is in about five years, once the buildings are completed to BHB’s specifications

- Many of the risks associated with the project are largely transferred to the private partner, including potential construction delays or cost-overruns

- The new buildings are constructed to BHB’s performance specifications which means it will meet Bermuda’s long term healthcare needs

- BHB retains ownership of the facilities and maintains direct control over all operations that touch the patient, allowing BHB to improve patient care

- Payments are spread over many years, easing the financial burden of such a large project on the island’s population.

- The quality of the buildings are maintained by the PPP partner at a mutually agreed standard over a lengthy concessionary period, giving the partner a vested interest in building quality facilities

This is Bermuda’s first DBFM project and Bermuda Hospitals Board considers it a flagship for other infrastructure projects in Bermuda that are suitable for PPP delivery.

The Project Board that will advise BHB regarding the addition of new facilities at KEMH is chaired by BHB Chairman, Mr. Herman Tucker. Mr. Tucker’s role on both Boards establishes a clear and strong line of authority through the BHB to the Ministry of Health, underlines the importance BHB places on the governance of the building project and will instil confidence in the international PPP bidders market. Other Board Members are Mr. Warren Jones, Permanent Secretary, Ministry of Health; Mr. Anthony Manders, Assistant Financial Secretary, Ministry of Finance; Mrs. Wendy Augustus, Executive Director of the Bermuda Hospitals Charitable Trust and Mr. David Hill, CEO of Bermuda Hospitals Board (non-voting).

BHB is currently in Phase 1 of the KEMH Redevelopment Project, the project initiation stage. BHB is in the process of identifying clinical advisors, with other advisors still to be sourced. Phase 2 will include further developing the output specifications, developing commercial terms for the project and planning the overall procurement strategy.

We are about two years away from groundbreaking. Between now and groundbreaking, BHB will finalize clinical and technical specifications and undertake an international selection process to identify the private partner that offers the best value to Bermuda.

Phase 1 Spring 2009 - Project initiation • Set governance structure • Establish project development plan • Assemble project team

Phase 2 Summer 2009 - Develop business, regulatory and procurement model • Resolve policy, commercial, technical and legal issues • Refine project definition • Develop proposed risk allocations, payment mechanism etc.

Phase 3 Summer 2009 - Drafting • Project agreement, procurement documents, technical specifications

Phase 4 Summer 2009 - Request for qualifications

Phase 5 Autumn 2009 – Summer 2010 - Request for proposal and selection of preferred bidder

Phase 6 Autumn – Winter 2010 - Transaction finalisation and closing, groundbreaking

First of all to review our Estate Master Plan which was drawn up in 2005. We then asked Johns Hopkins to recommend a phased development of our acute care hospital site over the long term. They also revisited the option of renovating our current facility and building new patient wings as a possible shorter term project to ensure that we can provide the quality and range of healthcare services needed by Bermuda.

We now have a long term development plan for KEMH, and the overall Estate Master Plan has been structured as a series of smaller projects which is more manageable for BHB and Bermuda.

The first improvements will be the renovation programme at KEMH, most significantly our four medical and surgical wards. We are still right at the start of the new build project, and expect to be about two years away from breaking ground.

We are at least 18 months away from final designs, because we are at such a preliminary stage of the new build project. We need to establish a project team, undertake detailed studies of our site and find a developer.

The construction costs of the new builds (the Ambulatory Care Centre, Patient Tower and Central Utility Plan) are estimated to be about $260 million. Renovations to KEMH will cost about $55 million.

Our plan is to renovate MWI over time. Areas of MWI such as the new Child & Adolescent Services wing have shown what can be achieved. Now that the review is complete we will be working on a plan of renovations, which will be funded by Government grant over time as the renovations at MWI today are.