About the new health-care complex and Walker Family Cancer Centre in St. Catharines

• Will function as an acute-care community hospital, serving residents of St. Catharines, Thorold, Niagara-on-the-Lake and surrounding communities
• Will replace the aging St. Catharines General and Ontario Street Sites
• Will provide increased capacity for up to 375 beds, with a projected 2,005,160 outpatients, inpatients and day cases each year
• Acute and critical inpatient services, surgical, emergency and ambulatory services will all be available under one roof
• The new health-care centre will accommodate regional programs that have never been available in Niagara, including:
• Comprehensive cancer care at the Walker Family Cancer Centre
• Cardiac Catheterization services at the Heart Investigation Unit
• Longer-term mental health beds
• The facility will also act as the hub of regional dialysis services, supported by the permanent dialysis unit recently constructed in Welland and being planned for in Niagara Falls
• To be built at First Street and Fourth Avenue in St. Catharines
• Eighty percent of all rooms will be single patient rooms, reducing the risks of infections and increasing privacy for patients and their families 
• The rooms in the new facility will better designed to effectively accommodate family, staff and hospital equipment
• The new health-care complex will be environmentally friendly and has been designed to achieve LEED certification.  Environmental features include energy efficient lighting, cooling and heating, which will help to reduce greenhouse gas emissions.
• The new health-care complex will have a campus-style feel and will have gardens, ponds and walking paths
• With 1,400 spots for car parking, and a bus stop with sheltered passage waiting area nearby, it will be easy to get to the new health-care complex
• The new health-care complex is being delivered under the provincial government's alternative procurement and financing model.  Under this model, the public sector, the Niagara Health System, continues to operate the new health-care facility and to provide all core clinical services, staffing and training while the private sector, Plenary Health Niagara, will design, build, finance and maintain the new building for a 30-year period.
• Plenary Health Niagara is a special purpose partnership formed by Borealis Infrastructure and Plenary Group
• Groundbreaking and construction to start April 28, 2009
• Substantial completion targeted late 2012

In order to fully appreciate how much the new health-care complex project has evolved from the Province's original intent to co-locate two existing hospitals in St. Catharines to a single state-of-the-art facility, it is necessary to review the changes in health-care policies and funding levels over the last 12 years.  As well, it is necessary to consider the recommended changes to hospital facilities as a result of SARS and C. difficile crises. Please see below for a chronology of the evolution in planning for this modern facility.

Timeline overview

Late 1990s: Establishment of the Health Services Restructuring Commission

• In 1996, the Health Services Restructuring Commission (HSRC), an arm's-length body was established by the Ontario Government
• The HSRC's purpose was to facilitate and expedite the process of hospital restructuring and to advise the government about changes needed to improve the accessibility, quality and cost-effectiveness of health-care services provided to the people of Ontario
• Through recommendations made by the HSRC, hospitals could be directed to amalgamate, transfer or accept programs, change their volumes, cease to operate or to make any other changes considered to be in the public's interest

1999: Hospitals in St. Catharines to be redeveloped

• In 1999, $56.4 million was designated by the HSRC to improve hospital facilities in St. Catharines
• As the funds did not cover the future needs of the community, hospital officials began looking for a solution to create a long-term strategy for advanced care in the Niagara Region
• As part of the HSRC's directives, the Niagara Health System and Hotel Dieu were given approval to build a new community hospital

2002: Co-location Model

• In 2002, a concept was developed to have a co-located hospital site for the Hotel Dieu Hospital and St. Catharines General Site of the Niagara Health System in St. Catharines
• The rationale: Having the two organizations together on one property would be an effective means to build new infrastructure, while maintaining separate identities
• Restrictions led hospital officials to pursue a better model that would serve the community for future generations

2003: Budget speculation begins

• In 2003, plans heat up to co-locate the brand new hospital on either the existing Queenston or Ontario Street hospital properties
• The size of the new hospital was planned to be approximately 700,000 square feet, with a capacity for 375 beds
• The existing sites were deemed inappropriate and the MoHLTC requests a review and submission on the basis of a greenfield redevelopment
• An early cost speculation was approximately $305 million on the basis of a very high level Master Plan for both the previous Hotel Dieu and St. Catharines General Site of the NHS with no contingency or growth factored in

2005: Infrastructure renewal makes big news in Ontario

• Good things come to those who wait: In 2005, the Ministry of Public Infrastructure Renewal (PIR) was created to deal with the infrastructure deficit across the Province of Ontario. In 2008 it became the Ministry of Energy and Infrastructure (MEI)
• Infrastructure Ontario (IO), an arm's-length Crown agency, was created in November of that year to deliver alternative financing and procurement (AFP) projects under the ReNew Ontario platform to execute large infrastructure projects on time and on budget, with a strong consideration for value for money

2005: NHS project evolves into the first DBFM hospital

• The NHS project was revealed in its more current form as the first Design-Build-Finance-Maintain (DBFM) hospital to be built under the Ministry's new AFP model 
• AFP has many benefits; most importantly, it uses private sector resources and expertise to build projects on time and on budget, in an open and transparent manner 
• Using the DBFM model allows the NHS to construct a building that will respond to current and future health-care needs, 50 years from now
• AFP also transfers from the public sector building risks that could lead to cost and schedule overruns on large infrastructure projects. These risks, which can significantly increase construction costs, are now transferred to the contractor
• Construction risks include design errors and omissions, project management and sub-contractor coordination, increases in construction material prices and labour costs, schedule and project completion delays, and other related construction risks
• Under this model, the private sector also becomes responsible for maintaining the hard facilities of the new hospital for the first 30 years; ensuring high quality materials are used. Hard facilities maintenance includes roofing, elevator, electrical and ventilation services and grounds maintenance
• The public sector has built in a 30-year guarantee for these physical features, which previously had a one-year guarantee only
• The hospital remains responsible for soft maintenance services (housekeeping, laundry and waste service) and non-clinical support services (patient transportation, patient food services and medical equipment maintenance)

2006: Changes in the Ministry of Health's funding formula

• In June 2006, the Ministry of Health and Long-Term Care (MOHLTC) simplified the provincial government's hospital capital funding formula and boosted its capital cost share to 90 per cent, from a previous 50 to 80 per cent (depending on the project)
• The provincial government now pays for 90 per cent of eligible construction costs, meaning that more funding is now available to accommodate the health-care needs of the community
• Hospitals are responsible for construction costs not eligible for funding (excluding radiation therapy equipment) and the costs associated with the purchase of new and replacement equipment

2009: The project today
The project has grown significantly from the co-location model to a state-of-the-art facility, with new elements that reflect the needs of the community today and into the future.  Comparing today's project cost to earlier cost speculations would be unsound; previous concepts for the NHS considered construction only and did not include the following elements:

• Expanded and/or changing patient services based on medical and technological advances, as well as growing health-care needs in Niagara
• Best practices in infection prevention and control
• Design plans for the building and surrounding property
• Energy and environmental design, or "greening" of the project
• Financing for the new complex
• A 30-year maintenance agreement covering all maintenance and repair of the building's roof, elevators heating and cooling systems and other physical components, ensuring the facility is in good working order for the entire 30 years

A changing health-care environment

There have been distinct changes in the evolution of this project since it first surfaced as a redevelopment project in the 1990s. Over the years, the project has adapted to dramatic changes in health-care delivery, to become more focused on patient safety and infection control since the SARS crisis.  It is within only the last five years that the importance of sustainable design and best practices in patient safety and infection control have been introduced.

The original project idea for a co-located building on an existing site included only the construction costs of the building and did not incorporate many new elements, which now form part of the overall project costs.

Innovative features and benefits as a result of consultation in best-practice health-care delivery

More than 300 front-line staff, including nurses, physicians, and experts in hospital design participated in the design and planning process for the new health-care complex. Their contributions will make the new complex one of the most innovative facilities in the province.

Comparison of innovative features and benefits for new health-care complex as determined prior to (2002) and after (2008) planning and consultation

• The new health-care complex design was based on guiding principles gained from community consultation, which included:
• Wayfinding
• Clarity and distance of entrances
• Compact building mass
• Natural light/nature
• Separation of public/staff flow
• Patient care environment - park land
• Flexibility and logical growth replenishment strategy
• Patient centred care and community access and support
• Patient safety

Patient Dignity and Privacy

• The new health-care complex will have separate entrances for the community hospital, cancer centre and mental health units
• Numerous places of rest for patients, visitors and staff will be available throughout the health-care complex. This means more lounges for patients to spend time with family and more quiet rooms for family to have private discussions with doctors and other staff treating their loved ones.
• The facility will include a multi-faith centre
• Simplified way-finding
• Patient-controlled lighting

Staff Attraction and Retention benefits

• Healthcare is a competitive industry and there are shortages of doctors, nurses and other medical professionals across the country. This new world-class health-care complex will set the standard for healthcare throughout Ontario and across the country, becoming a coveted place to work and attracting the best and brightest to the Niagara region
• Windows throughout the health-care complex will provide ample daylight and views for staff during their work day, increasing morale and productivity
• With the LEED certification, the new health-care complex will be a healthier working and living environment, contributing to improved employee health and comfort
• The new health-care complex has been designed for user-efficiency, meaning shorter travel distances for staff, allowing for more time with patients
• Wide corridors will provide enough room for patient beds, staff and equipment
• The new facility will include ATMs, retail services and a range of healthy food options
• There will be approximately 1,400 car parks and 50 bike spaces with shower and change facilities
• Staff rooms and lockers
• A design that facilitates good visibility of patients
• Lots of natural light and view to the park and nature
• Very safe and secure environment

Gardens and walking paths

• The new health-care complex will have a campus-style feel and will have gardens, ponds and walking paths.
• Clear signage
• Roadways ringed with sidewalks and pathways and parking areas will be set amidst trees
• Materials native to the Niagara region will enhance the building exterior (stone, wood, brick, metal panels precast)
• The grounds and the buildings have been designed with the community in mind, and include education and wellness programs, and an auditorium to serve the greater community.
• Courtyards, light wells and outdoor terraces penetrate the building mass

Health and Wellness

• Large interior public spaces offer artful design and well-lit voluminous space with natural and tactile materials
• Numerous gardens and landscape views
• Healing Garden and labyrinth garden to provide patients, visitors and staff with a means for therapeutic meditation and reflection
• Small rest areas, alcoves and quiet/family rooms provide places of respite
• Strategically designed space and access to natural light contributes to well-being of individuals and promotes healing and mental wellness
• Inpatient rooms and corridors enhanced with natural light
• All patient rooms have a window
• Provides daylight and views

The Contract with Plenary Health Niagara
Plenary Health Niagara has signed a contract with the Niagara Health System (NHS) to design, build, finance and maintain the new health care complex in St. Catharines and will receive annual payments from the NHS over a 30 year period.   These payments cover:

• design
• construction
• lifecycle repair and renewal (building maintenance for 30 years)
• project financing

The contract with Plenary Health Niagara is for a fixed price of $759 million in today's dollars, to be delivered by a fixed completion date.  The contract agreement also makes Plenary Health Niagara responsible for design errors and omissions, project management and sub-contractor co-ordination, increases in construction material prices and labour costs, schedule and project completion delays, and other related constructions risks.  In the past, the public sector was responsible for the risks outlined above.  However, the Alternative Financing and Procurement (AFP) model now transfers these risks to Plenary Health Niagara - the private sector.

The hospital's 30-year maintenance agreement with Plenary Health Niagara will ensure its new facility's roofing structure, windows, floors, elevators, heating and cooling systems and other physical components are kept in excellent working condition over the term of the agreement.  In the past, the public sector was responsible for repair and renewal of the building but now the private sector has this responsibility.  Under the project agreement, if the hospital needs a new roof or a new boiler, the private sector replaces and pays for it.  The public sector has built in a 30-year guarantee for these physical features, which previously had a one year guarantee only. 

The hospital remains responsible for soft maintenance services (housekeeping, laundry and waste service) and non-clinical support services (patient transportation, patient food services and medical equipment maintenance).

Annual Payments to Plenary

The annual payments are like a fixed-rate mortgage with maintenance and repair expenses included. For example, if a homeowner signs a mortgage agreement today, he commits to the cost of the house in today's dollars (this is known as the net present value). However, over the lifetime of the mortgage, the homeowner pays monthly mortgage payments plus the costs of updating and maintaining the house during that period.  This cumulative cost is called the nominal cost. In the case of the NHS project, while the cost of the contract in today's dollars is equivalent to $759 million, after 30 years, this will total approximately $1.42 billion.

Annual payments to Plenary Health Niagara are performance-based.  Payments can be withheld if Plenary Health Niagara does not meet the agreed to performance standards.

Additional Project Costs
In addition to the contract costs with Plenary Health Niagara, the hospital will pay for other non-capital and fixed costs such as:

• replacement furniture
• equipment
• permits
• architectural and engineering fees
• transaction fees
• project management fees

Including these other costs, the total cost of the Niagara Health System project is approximately $1.56 billion. 

For more information, please visit www.infrastructureontario.ca.

LOCAL SHARE

• The provincial portion of eligible construction costs is 90 per cent (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
• 100 per cent of components of the project that are ineligible for ministry cost-sharing, otherwise known as the local share
• 100 per cent of the costs associated with the purchase of new and replacement furniture and equipment, excluding some radiation therapy equipment and longer-term mental disease equipment.

The $116.9 million local share plan for Niagara is supported as follows:

• Fundraising - $25 million (of the $40 million It's Our Time Campaign)
• Retail/commercial opportunities and other funding sources -$27.1 million
• Regional/Municipal tax levies - $60 million 
• Other grants/funding sources - $4.8 million

The commitments from the Region of Niagara, City of St. Catharines, City of Thorold and Town of Niagara-on-the-Lake have been confirmed to support the hospital:  

• Region of Niagara ($21 million)
• City of St. Catharines ($31.2 million)
• City of Thorold ($4.3 million)
• Town of Niagara-on-the-Lake ($3.5 million)

Cost breakdown: regional versus community

• Regional programs represent approximately 30 per cent of the total cost of the project. 
• The remaining 70 per cent is related to the new community hospital for the residents of St. Catharines, Thorold and Niagara-on-the Lake.

Regional programs represent approximately 30 per cent of the total cost of the project.  The remaining 70 per cent is related to the new community hospital for the residents of St. Catharines, Thorold and Niagara-on-the Lake.

The split in local share is:

• Regional Programs: $ $35.07 million
• Community Hospital: $81.83 million
• Total: $116.9 million
  

The Niagara Health System's new health-care complex project will provide a sizeable boost to the regional and Ontario economies during construction by directly and indirectly supporting and creating approximately 5,400 jobs, many of which will be in the Niagara region. At the peak of construction activity, about 1,000 workers are expected on the site daily. 

Economic impact highlights:

• The new health-care complex will have a major impact on the economic development of the Niagara Region 
• At the peak period during construction, up to 1,000 workers are expected be on site daily.  Skilled trades, subcontractors and suppliers from across the region will also benefit from the construction project 
• Will bring increased demand for restaurant meals, retail space and other services in and around St. Catharines.
• Hospital employees and visitors will bring millions of dollars worth in additional spending to St. Catharines and surrounding areas

• Where possible, local materials will be used to construct the new health-care complex.
• Retail and other business opportunities in the new facility will be available to local entrepreneurs.

Sub-trades

PCL intends to maximize the use of local sub-trades and has indicated that the majority of the sub-trade work will go contractors in the Golden Horseshoe Area

Highlights:

• Wherever possible, PCL will use local sub trades. 
• As an example, our Mechanical contractor, Sayers & Associates has a significant presence and office in St. Catharine's.  In a hospital project, the mechanical costs account for a substantial amount of the total project costs.
• PCL normally uses a tendering process to select their sub contractors

Lessons Learned: Best practice planning initiatives planned for our other NHS sites
Building a brand new hospital is a once-in-a-lifetime opportunity. This project has influenced and transformed the way healthcare is delivered across all of Niagara with considerations in best practices in service delivery, innovation, technology, and building design. The NHS is taking advantage of the opportunity of planning for the new health-care complex by examining how infrastructure and services at all seven of its sites can be enhanced to deliver the best possible care to all of Niagara's 434,000 residents.
In preparing for the new facility, the NHS is analyzing how best-practice and workflow analysis can be implemented across all programs and sites in order to improve service delivery and accommodate new health-care trends across the board
Some examples of critical prerequisites for our sites to ensure successful transition into the new facility:

• A workflow analysis project is currently underway in two of our EDs that has already made recommendations on influencing the way we deliver care and which will be implemented in the coming months
• The implementation of PACs (picture archiving and communication systems) technology
• The ground work for the organization to adopt an 80 per cent paperless record management system
• Automated medication dispensing at all acute care sites
• Several committees  

Region-wide fundraising campaign: The It's Our Time Campaign
Planning for the new health-care complex has provided the NHS with an opportunity to invest in our other hospital sites, improving the facilities and purchasing new equipment for cancer care, emergency care and other services. In the planning development stages of the new health-care complex it was recognized that in order to sustain the delivery of current health-care services and provide new programs throughout the region, infrastructure and equipment improvements at other NHS hospital sites were also deemed urgently needed.
This big-picture view led to the creation of the It's Our Time Campaign and the Niagara Health System Foundation (NHSF). Working in partnership with each of the local NHS hospital foundations, NHSF coordinates and manages the first region-wide health-care fundraising campaign.
The campaign is structured into three teams of volunteers with a cumulative $40 million goal to make improvements at NHS sites and aid in the construction of the new building. This includes the new community hospital and facilities to support the three new regional programs to provide treatment to patients with cancer, heart and mental health disease. The site will also act as the hub of regional dialysis services, to be supported by permanent dialysis units being constructed in Welland and Niagara Falls.
The $40 million campaign is currently at the 63 per cent mark, with over $25 million raised in cash and pledges. 

Click here to be redirected to the It's Our Time Campaign website for an overview of the regional fundraising campaign.

Construction of the new facility is on schedule to begin May 2009 and will be completed by the end of 2012, which means the new health-care complex will open its doors to patients in 2013.

Signs of development to take place on site in next few weeks:

• Perimeter security and silt fencing
• Site surveying
• Stripping of topsoil - stockpiled for reuse
• Construction of access roads, parking and lay-down areas
• Drainage and storm water management pond to control surface water
• Installation of buried services including sanitary and storm drainage and utility supply lines

Groundbreaking will take place April 28, 2009.

Important Construction Dates:

Visit www.infrastructureontario.ca or here for more information