NEW KAROLINSKA SOLNA. Memorandum of Information PPP procurement October Unofficial translation for information purposes only

Transcription

1 NEW KAROLINSKA SOLNA Memorandum of Information PPP procurement October 2008 Unofficial translation for information purposes only

2 Copyright: Stockholm County Council

3 Contents Contents 1 INTRODUCTION The purpose of the Memorandum of Information (MOI) Disclaimer and confidentiality SUMMARY STRATEGIC FRAMEWORK Introduction Health care in Sweden Stockholm County Council Background Drivers for change Karolinska Institutet DESCRIPTION OF THE PROJECT Introduction The New Karolinska University Hospital assignment Vision Project goal Project programme November Project goal 1: Integration between health care, research and education Project goal 2: Attractive and human environments Project goal 3: Efficient health care processes and optimal resource utilisation Project goal 4: Solutions for general applicability and flexibility Project goal 5: The role of the hospital in the city Project goal 6: Sustainability perspective Specifications for New Karolinska Solna, NKS Health care operations - volume City planning issues Detailed town plan issues Implementation issues Investment budget PRIVATE SECTOR OPPORTUNITY Introduction NKS size and scope Design and build Hard FM services Soft FM Services Other commercial opportunities Medical equipment PROCUREMENT PROCESS Introduction Structure of the contract and project agreement Land issues Obligations of the PPP Company Stages and overall timetable Procurement process in detail Data room PROCURING BODY Introduction Project Organization Project Advisors APPENDIX A COUNTY COUNCIL ASSEMBLY S RESOLUTION APPENDIX B STOCKHOLM COUNTY COUNCIL APPENDIX C KAROLINSKA UNIVERSITY HOSPITAL TODAY APPENDIX D PROJECT PROGRAMME, NOVEMBER APPENDIX E THE CURRENT HOSPITAL AREA new karolinska Solna Memorandum of Information 1

4 GLOSSARY OF TERMS In this Memorandum of Information and in the Pre-Qualification Questionnaire, the following terms have the meanings detailed in the table below, unless otherwise stated or otherwise evident from the context. Glossary of Terms Term Abbreviation Explanation Candidate Bidder Official Journal of the European Union EUT Company, or group of economic actors, applying for being invited to tender having applied by submitting the PQQ and relevant documentation. Candidate invited, after Pre-Qualification, to submit a tender. The journal, in which public contracts are notified in the supplement. Facility Management FM Services related to property maintenance or operational support. FM services are divided into two categories, hard and soft services respectively. Research, Development and Education Committee Financial close R&D Committee The R&D Committee prepares issues concerning research, development and education as well as those pertaining to social medicine within SCC. The Committee also manages issues concerning NKS. The point in time at which the final financial terms and conditions are determined and the financing of NKS is ensured. Invitation to Tender ITT A series of documents providing information about the scheme and output specifications issued to Bidders. Pre-Qualification Questionnaire Hard FM Services Memorandum of Information PQQ MOI A document containing questions to be answered by the Candidate and which outlines the rules for pre-qualification. Services directly related to property management issues such as maintenance and operation. This Memorandum of Information, designed to allow an overview of the project and the procurement procedure. Karolinska Institutet KI One of Europe s leading medical universities and centres for medical training and research. Karolinska University Hospital Karolinska Solna Karolinska Stockholm s regional university hospital, located in Solna and Huddinge. Its main areas include health care, as well as research and training in connection with KI. The Karolinska University Hospital's original structures and location. 2 new karolinska Solna Memorandum of Information

5 GLOSSARY OF TERMS Term Abbreviation Explanation The Royal Institute of Technology The Swedish Public Procurement Act Soft FM services Nya Karolinska Solna University Hospital NKS administration Public-Private Partnership PPP Company/SPV Pre-Qualification Relevant organization KTH LOU NKS PPP Sweden s largest university of technology, located in Stockholm. Law (2007:1091) on coordination of procedures for the award of public works, public supply and public service contracts. Services that support clinical operations, such as cleaning and laundry services. The planned new university hospital in Solna forming the subject of this procurement process. The administrative body within SCC responsible for managing the implementation of the NKS project. Partnership between the public and private sectors, which aims at securing the funding, implementation, administration and/or maintenance of an infrastructure asset or the provision of a service. The company founded by the winning bidder, who signs the project agreement. Also called special purpose vehicle, SPV. The process by which the Candidates to be invited to submit tenders are selected. Pre-Qualification is based on information and answers provided by the Candidates in the Pre-Qualification Questionnaire attached to the invitation to apply, which forms the basis for SCC s evaluation of the Candidates' economic and financial conditions, ability and technical capability as regards the execution of the NKS project. Term for all companies and organizations associated with a tender. Stockholm County Council Winning bidder SCC Stockholm County Council is the regional authority in Stockholm County, primarily responsible for health services and public transport. The bidder selected to be the contractor of NKS. new karolinska Solna Memorandum of Information 3

6 1 INTRODUCTION 1.1 The purpose of the Memorandum of Information (MOI) The purpose of this MOI is to summarise the business opportunity entailed by the PPP procurement of the Nya Karolinska Solna University Hospital (NKS). It is also intended to enable parties interested in the procurement to assess whether they have the ability and capacity to submit a tender. This MOI should not be considered to be a comprehensive document. More details will be made available in the supporting documentation issued to Bidders selected in the prequalification process All Candidates, relevant organizations and their advisors are responsible for and shall bear all costs arising in connection with their answers or actions in respect of this Memorandum of Information This Memorandum of Information has been prepared in both a Swedish and an English version, with the sole purpose of the English version being to support non-swedish interested parties. The Swedish version is legally binding and applicable Information and requirements regarding pre-qualification are presented in the invitation to apply for pre-qualification. 1.2 Disclaimer and confidentiality The project information in this MOI may not be considered to be comprehensive. Neither Stockholm County Council (SCC) nor any of its advisors assume any responsibility or liability regarding the completeness of this MOI This Memorandum of Information is provided only for the purpose specified above and shall not, in any manner, be considered to be a supporting document for any investment purpose. This implies that this MOI shall not be regarded as an investment recommendation from SCC or any of its advisors. Each individual entity receiving this MOI must make an individual assessment of the project after undertaking all of the examinations and receiving all of the professional advice they deem necessary The information included in this MOI regarding future stages of the process or the procurement in general shall only be considered to be indicative. SCC reserves the right to make amendments or additional clarifications in later stages of the procurement process Candidates and their advisors must return or destroy any and all confidential information, including copies, that may have been provided by or for SCC, if or when required in writing by SCC All pre-qualified Candidates (Bidders), relevant organizations and their advisors advancing to the ITT stage will be required to undertake specific commitments regarding confidentiality. 4 new karolinska Solna Memorandum of Information

7 introduktion, 2 SUMMARY 2 SUMMARY 2.1 Background New Karolinska Solna, NKS, is one of the most comprehensive projects ever undertaken by the Stockholm County Council, SCC. A completely new, state of the art university hospital is to be built at the Karolinska Hospital area in Solna, with its opening planned for 2015/ Since the end of the 1990s, SCC have developed a strategy for how the County s future hospital health care structure is to be organised. A series of investigations and intermediate decisions have led to the decision to construct a completely new, world-class university hospital in Solna as a Public Private Partnership (PPP) During the first years of the millennium, a number of studies were undertaken, amongst others the 3-S investigation, and all of these concluded that there is a large need for a new university hospital, connected to the Karolinska Institutet (KI) in Solna, in order to meet future health care requirements and the demands for increased integration between health care, research and training Consequently, in May 2005 the SCC decided to initiate a design contest in order to start planning for a new university hospital in Solna. Just over a year later, the County Council determined that the winning contribution, Forum Karolinska, from White Arkitekter AB, is to provide the basis for the continued development of NKS, and that a project programme should be produced The County Council Assembly subsequently resolved, in April 2008, to construct NKS in accordance with the proposed project programme and, in June 2008, the County Council Assembly decided that the procurement of NKS should be a Public Private Partnership (PPP) Ambitions are high in every respect. The role of NKS as a highly specialised and research-intensive university hospital in close relation to Karolinska Institute (KI), the Royal Institute of Technology (KTH) and the medical technology and biotech industry in the region shall be further strengthened. The new hospital will serve as a knowledge hub in the development of health care in both the Stockholm Region and in Sweden. 2.2 The design of Nya Karolinska Solna The new hospital will be constructed at the southwest area of the current Karolinska Solna site. Operations at the current hospital will continue, in parallel with this construction Basic data for the new hospital: a) Approximately 600 beds, including intensive care/post-op, plus an additional approximately 200 outpatient/hotel beds. b) Exclusively single-bed rooms for in-patient care. c) Approximately 1,600 1,800 patient visits per day, of which approximately percent emergencies. d) The total framework of the building will cover 335,000 square metres, according to the resolution of the County Council Assembly. e) The total investment expenditure may not exceed SEK 14.1 billion, calculated on the basis of 2007 nominal values, according to the resolution of the County Council Assembly. f) The new hospital is planned to be opened in 2015/ As noted above, the County Council has undertaken a design contest. The following goals are applicable for the design of the new hospital: a) Health care, research and education shall be integrated to effectively support the development and dissemination of new knowledge for the care of the seriously ill and injured patients. b) The project shall create an attractive and human environment of high architectural value, both within the hospital and in connection with the hospital. c) Health care processes shall be streamlined and the utilisation of resources shall be optimised. d) As far as is possible, the project shall use general solutions allowing continuous operational development. e) The hospital and its activities shall be given a clear, prioritised role in the city. f) On all levels, the project shall function on the basis of to a sustainability perspective. new karolinska Solna Memorandum of Information 5

8 2.2.4 The winning proposal, Forum Karolinska, has been developed into a project programme to form the starting point of the continued development work regarding the hospital Central programme issues concern both the general applicability of the buildings, as well as their flexibility. The strategy is to design generally applicable buildings to enable the flexible utilisation of premises, allowing the buildings to be adapted to future requirements and medical technological developments at a low cost. 2.3 Opportunities for the bidders The County Council is now inviting interested parties to submit tenders for a contract to design, build, finance and operate NKS Most hard and soft FM services, as well as a patient hotel and parking garage, are included in the PPP procurement The County Council wishes to encourage innovation and life cycle considerations and expects parties submitting tenders to present proposals regarding alternative and improved solutions, allowing the project programme to be further developed in accordance with the stated project goals The contract period will be at least 30 years following financial close The compensation model will follow international practice for PPP agreements within the health care sector Medical equipment and clinical services will not be included in the PPP procurement. 2.4 Procurement process The procurement will be a negotiated procurement with advance notification, in accordance with the Swedish Public Procurement Act. Notification was sent to Official Journal for publication on 2 October The main agreement of the project will be a project agreement between SCC and the PPP Company to participate in pre-qualification. The principles developed over time for the procurement of PPP projects in the UK and other countries will serve as a model for the agreement. Swedish contract law, practice and custom will be applicable Allocation of responsibility and risk in the agreement will be in line with practice in this area and will facilitate project financing. SCC does not intend to transfer the implementation risks connected with the detailed town plan (Swedish: detaljplan) and the coordination processes regarding the Norra station area, to the PPP Company The Invitation to Tender (ITT) will be prepared in both Swedish and English. The Swedish version is the legally prevailing version The procurement process will consist principally of three stages: a. Stage 1: Pre-qualification of Bidders. b. Stage 2: Preparation of tender. c. Stage 3: Evaluation, negotiation, appointment of the winning bidder, and signing of agreement The total timeperiod for the procurement is expected to be 18 months and will be completed in April Management of the project The County Council has formed a special administrative body, NKS administration, with responsibility for executing the NKS project NKS administration is responsible for the design, procurement, construction and operation of the new hospital, and reports to the County Council s Research, Development and Education Committee (the R&D Committee) NKS management has created a special project organization in order to execute the PPP procurement. The following consultants have among others been attached to this organization: a) Architect and technical advisor White arkitekter AB. SCC will allow the winning Bidder to contract White in the implementation phase of the project, thereby taking advantage of White s knowledge of the project. b) Financial/commercial advisor Pricewaterhouse- Coopers. c) Legal advisor Mannheimer Swartling Advokatbyrå AB. 6 new karolinska Solna Memorandum of Information

9 2 SUMMARY, 3 STRATEGIC FRAMEWORK 3 STRATEGIC FRAMEWORK 3.1 Introduktion NKS is a pioneering project within the public sector in Sweden, both as regards to the procurement model and the contract model, as well as the scope of the project. NKS will be the first hospital in Sweden constructed using PPP. The conceptual formulation is also groundbreaking due to its general applicability and flexibility, which enables NKS to fulfil future requirements for highly specialised health care Besides the construction of NKS there are plans for several hospital redevelopment projects in Sweden, in a concerted effort to achieve a more modern and individualised health care. There currently exist plans for the expansion of Stockholm South General Hospital and Danderyd University Hospital at an estimated cost of approx. SEK 3 billion. The redevelopment of a number of hospitals in other counties, including Sahlgrenska University Hospital in Gothenburg, is also underway Similar to many other countries in Europe, Sweden is facing a substantial demographic challenge with an aging population. This will require a more efficient health care system. Sweden is a leading country within health care and is ranked highly internationally in effectiveness, due to the fact that Swedish health care has demonstrated impressive medical results. The primary challenge facing Swedish health care consists of shortening waiting time and providing better access. 3.2 Health care in Sweden Health care in Sweden is decentralised and run by the regional county councils. The aim of the county councils is to ensure that local residents have access to health care and public transport, as well as to work towards the prevention of health problems The government is responsible for the overall political direction of health care and negotiates with the regions, county councils and municipalities through the employer s organization, the Swedish Association of Local Authorities and Regions (SKL). The governmental actors within health care are primarily: The Ministry of Health and Social Affairs The National Swedish Board of Health and Welfare The chain of pharmacies wholly-owned by the government, Apoteket AB (under restructuring and partial privatisation) Health care costs are equivalent to approximately 9 percent of Sweden s GNP. The predominant proportion, approximately 70 percent, is financed through county council taxation. The county councils are free to set the tax rate independently. Only a minor portion of health care income, on average 15 percent, consists of state subsidies. 3.3 Stockholm County Council (SCC) The activities of SCC covers one-fifth of Sweden s population, making it Sweden s largest county council. The geographical area covered by the County Council includes 26 municipalities of various sizes, with a total of 1.9 million citizens. Significant characteristics of the SCC are: Responsible for health care, dental care, and public transportation. Public transportation consists primarily of the underground, commuter trains and busses. Has a total of 45,000 employees, of which 90 percent work within health care. Of these, approximately 80 percent are women. Owns and operates Karolinska and an additional four emergency hospitals, as well as the predominant proportion of other health care services. A large portion of primary care, as well as one emergency hospital, is run privately, with the County Council procuring health care services. SCC its own decision-making and taxation rights. The County Council tax in Stockholm amounts to 12.1 percent of taxable income. Net profit for the Group exceeded SEK 1 billion based upon a total turnover (calculated as operating income, tax revenue and similar items) 1 Svensk sjukvård i internationell jämförelse ( Swedish health care in an international comparative context ), Swedish Association of Local Authorities and Regions, new karolinska Solna Memorandum of Information 7

10 amounting to SEK 6.2 billion. Approximately 80 percent of total turnover consisted of County Council tax. Credit rating AA+ according to Standard & Poor s The County Council Assembly is the County s highest decision-making body, and sets the budget and tax rates, as well as patient s fees and traffic tolls. The Stockholm County Council Assembly consists of 149 representatives who are publicly elected every fourth year. Next election will be in September The County Council Assembly appoints the County Council s Executive Board which functions as the executive body. In turn, the County Council Executive Board consists of various separate units which are run as committees, administrative organizations or Council-owned companies (for an overview of the organizational structure of SCC, see Appendix C) The Stockholm Region is one of Sweden s most expansive and prosperous regions. The number of citizens is expected to increase by approximately 11 percent between 2007 and In addition, the region also has the largest gross regional product in Scandinavia and is one of the 15 fastest growing metropolitan regions in the EU. As a result of this strong growth, extensive investments in infrastructure are being planned in roads, railroads and residential areas During 2007, Standard & Poor raised its credit rating for the County Council s long-term borrowing from AA to AA+, as the County Council has demonstrated strong finances over a long period of time. Consequently, the Stockholm County Council has one of the highest credit ratings of Sweden s municipalities and county councils Presented below is a summary of Stockholm County Council s consolidated income statement for In 2007, the County Council reported revenues of more than SEK 1 billion, due to careful financial management over a long period of time. The negative result for 2006 is largely attributed to a large non-recurring item affecting comparability. The one-off cost consists primarily of a reestimation of pension provisions, in which changes in anticipated life expectancies and lower discount rate resulted in total pension provisions for 2006 increasing by SEK 1.4 billion. There were also additional costs associated with the adoption of a new pension agreement. Stockholm County Council Consolidated Income Statement 2007 (Figures in MSEK) Operating income Operating expenses Depreciation Net operating expenses Of which items affecting comparability Tax revenue General government grant Revenue and cost balancing Tax revenue, government grant, balance Financial income Financial expenses Net finance Net profit/loss for the year new karolinska Solna Memorandum of Information

11 3 STRATEGIC FRAMEWORK Income Expenses 3% 9% 8% Tax in come, general state subsidies and equalisation State subsidies and other subsidies 22% 5% Health care, including dental Traffic Patient s fees and traffic tolls Other Other income 73% 80% Type of cost 4% 18% 37% Personnel costs Purchased health care 9% 14% 18% Purchased traffic Pharmaceutical products Other costs Depreciation SCC s complete annual report is available on the Internet: arsredovisning_2007.pdf 3.4 Background Drivers for change Since the beginning of 2000, the County Council has analysed the current and future needs within the County s health care system and has conducted an extensive review of the structure of health care in Stockholm County. In 2001, planning was initiated regarding a new university hospital in conjunction with the so-called SNUS (Stockholm s New University Hospital) report. This report established that there is a clear need for a new, modern university hospital which can provide highly specialised health care, extensive research and training of the highest quality. The report also demonstrated that the continued strong relationship between medical care and research, as well as between Karolinska Institutet and Karolinska University Hospital in Solna, argues for the placement of the new university hospital near Karolinska University Hospital in Solna The SNUS report has been followed by a number of reports, including the 3-S investigation into the structure of health care in the County of Stockholm and special investigations into the existing properties located in the Karolinska area in Solna. All of these investigations have confirmed the conclusion of the SNUS report, namely that there is a clear need for a new university hospital in order to better meet the requirements of health care and medical research A strong contributing factor to the need for a new university hospital is that the current Karolinska University Hospital is no longer considered to adequately satisfy the new requirements which will be placed on future health care. The current Karolinska University Hospital in Solna is in need of modernisation, as: The current buildings have been modified several times and it is neither appropriate, nor financially justifiable, to continue rebuilding the existing structures. The costs for renovating the Karolinska University Hospital in Solna have been estimated at approximately SEK 7 billion over a ten-year period. new karolinska Solna Memorandum of Information 9

12 The hospital is currently spread over a large area, with negative impact on patients. The distance between the current buildings and the absence of efficient links between them also implies that the various units are isolated and cannot operate at the desired level of efficiency NKS will solve several of the problems while, at the same time, increasing the likelihood of effectively running a new, modern and a more individualised health care. The driving forces behind NKS are to create an environment which allows: More rapid medical developments. Health care and medical technology develop very quickly. The exchange of knowledge between health care and research is steadily intensifying and breakthroughs in research are taking place within many areas. Due to advances in medical treatment, an increasing number of surgical operations are being performed as outpatient surgery. Even advanced surgical procedures are not being carried out on an outpatient basis. At the same time, new needs are arising among patients, personnel and researchers for the hospitals of the future to be able to provide a more modern, attractive, pleasant, personal and integrated health care environment. All in all, this requires new, innovative solutions for the organization, logistics and physical environment of NKS. Closer collaboration between units. In as much as the various components of the new hospital will be connected, NKS will allow for more efficient cooperation in a manner that the current Karolinska University Hospital cannot provide. NKS will create close physical connections between reception areas, nursing wards, x-ray/functional diagnostics, clinical laboratories, operating theatres, etc. Close connections and effective transport systems will also be created between health care and research premises, both within NKS and in direct connection with Karolinska Institutet. 3.5 Karolinska Institutet (KI) Karolinska Institutet s two primary functions are to carry out medical research and education. The goal is to be one of Europe s leading medical universities by 2010, as well as the leading innovation centre within the area of life sciences for the Nordic region. The operations are divided between Karolinska Institutet Campus Solna and Karolinska Institutet Campus Huddinge. In addition, several institutes rent premises in various hospitals within Stockholm municipality, among others, at Karolinska University Hospital Approximately 80 percent of Karolinska Institutet s operations consist of research within the areas of cell therapy, brain research, infection and immunology, cancer, inflammation and allergy, metabolic diseases, international health, aging, and public health. The operations are primarily financed by direct state subsidies and in 2007, total income amounted to SEK 4,166 million. During 2007 Karolinska Institutet had 3,687 employees Since 1901, the Nobel Prize in physiology or medicine has been awarded by the Nobel Committee at Karolinska Institutet. Karolinska Institutet also has the largest medical library in the Nordic region, which functions as a national library of expertise within medicine, odontology, health care sciences, as well as health care Karolinska Institutet is expected to rent major parts of its required laboratory spaces from SCC which, in turn, is expected to rent the corresponding space from the PPP Company. Joint use of resources. At NKS, favourable conditions shall be created for the rapid transfer of knowledge between basic research, clinical research and specialised care. The connection between these care areas makes it necessary to concentrate and make joint use of resources and competence. 10 new karolinska Solna Memorandum of Information

13 3 STRATEGIC FRAMEWORK, 4 DESCRIPTION OF THE PROJECT 4 DESCRIPTION OF THE PROJECT 4.1 Introduction NKS is planned as an entirely new university hospital with a new role implying greater emphasis on highlyspecialised health care, research and education. Consequently, NKS will not be a replacement building for the current Karolinska Solna In May 2005 the SCC decided to organise a design contest in order to develop a tangible plan for a new university hospital in Solna. Just over a year later, the County Council decided that the winning contribution, Forum Karolinska, from White Arkitekter AB, should constitute the basis for the continued development of NKS, and that a project programme would be produced The County Council Assembly subsequently decided, in April 2008, to construct NKS in accordance with the proposed project programme. The County Council Assembly also set boundaries regarding the size of the new construction to be a maximum of 335,000 square metres, and that the maximum amount of the investment for construction is to be SEK 14.1 billion, based on 2007 nominal values In June 2008, the County Council Assembly decided to execute the NKS procurement as a Public Private Partnership (PPP). 4.2 The New Karolinska University Hospital assignment NKS will constitute the hub of a nationally and internationally competitive university health care system, assuming a central role in the development of the Stockholm region into a biomedical powerhouse. The overall aim and direction is for the hospital to be a specialised hospital for the region, with a focus on highly specialised care NKS will conduct health care, research and education of substantial scope and the highest quality. The health care assignment must be balanced against the research assignment as efficiently as possible. Simultaneously, the educational assignment shall be related to the operation s research and health care assignments. Technology and resource-intensive health care will be concentrated in the hospital, which will be developed to become a referral/reference hospital for the entire region/country. This is due to the increasingly important connection between the research and development of specialised health care, as well as, the need to concentrate resources and competence. A large portion of the equipment and competence must be shared, at the same time as conditions must be established for the rapid transfer of knowledge between basic research, clinical research and health care. 4.3 Vision The vision for the New Karolinska University Hospital will be formulated in the following manner in the competition programme. The hospital shall be: integrated but independent changeable yet constant efficient yet respectful and human a successful union of creativity, productivity and care NKS shall have close ties, not only with Karolinska Institutet, but also with the Royal Institute of Technology, Stockholm University and with biomedical and medical technical industries. As such, the Stockholm region has a unique possibility to develop knowledge, research and innovation possibilities relating both to the city, with its urban qualities, and to Nationalstadsparken, with its scientific traditions as well as various nature and cultural values. Thus, NKS constitutes a strategic piece of the puzzle in the important growth process for the Stockholm and Mälaren region as a knowledge region for Sweden and Europe. 4.4 Project goal The NKS project is based upon the following six general project goals. Health care, research and education shall be integrated to such an extent that they efficiently support the development and dissemination of knowledge for the treatment of severely ill and injured patients. The project shall create attractive and humane environments with high architectural values, both within and around the hospital. new karolinska Solna Memorandum of Information 11

14 The health care processes shall be made more efficient, and the utilisation of resources shall be optimised. The project shall work as much as possible with generally applicable solutions permitting continuous operational development. The hospital and its activities shall be allotted a prioritised and clear role in the city. The project shall work on all levels from a sustainability perspective. 4.5 Project programme November As a basis for the work with the NKS project, and for the PPP procurement, there is a conceptual proposal entitled Project Programme November The project programme also formed the basis for the County Council Assembly s decision in April The Project Programme has been developed in several stages, the first being the design competition which was initiated in The purpose of the design competition was to encourage the submission of proposals for the conceptual design of the new hospital and to find a creative partner for the continued work. According the competition programme, the design competitors were to present a solution in which issues regarding the relationship between the operations, layout, sustainability, traffic and logistics are developed in an integrated manner, and, with the support of modern technology, can fulfil the requirements of health care and research in the context of unforeseeable changes and future developments The winning design proposal, Forum Karolinska, has been refined in the Project Programme, and also constitutes the NKS area as part of the detailed plan NKS will be situated in the south west part of the current Karolinska University Hospital area, east of the Karolinska Institutet campus. This strategic location, in connection with the growing area at Norra station, provides possibilities for integration between the hospital and the city. A main square shall be created between the hospital s entrance in the north, Karolinska Institutet s entrance in the west, and the new Norra Station area in the south. A new Metro station will be constructed with access to the main square The project programme s concept is based on a simple, rectangular district structure which constitutes a continuation of the city district. This concept entails that the hospital will have an elongated structure, with a row of five health care core districts connected by a transparent shell structure in glass between the Karolinska Hospital park in the east, and the street Solnavägen in the west. Parallel with, and north of the care districts, is the research district, which has a similar construction. Between the care district in the south, and the research district in the north, is an Academic Passage which connects the Karolinska area in the east and the Karolinska Institutet campus in the west, with a park superstructure over Solnavägen After the assembly s decision regarding the project programme, a decision has been made to rotate the plan of the hospital clockwise. This permits a larger building district (the Thorax district) to remain operative during the construction phase. R&D / Laboratories Education Staff zone Therapy / Diagnostics visitors zone Teaching Patient hotel conceptual model of the nks hospital site. 12 new karolinska Solna Memorandum of Information

15 4 DESCRIPTION OF THE PROJECT i l lus t r at i o n o f t h e n k s s i t e w i t h t h e s q u a r e a n d p a t i e n t h o t e l (a t t h e r i g h t ) a c c o r d i n g to t h e p r o j e c t p r o g r a m m e. s i t u at i o n a l p l a n o f n k s a c c o r d i n g to t h e p r o j e c t p r o g r a m m e w i t h r e g a r d to t h e ro t a t i o n o f t h e h o s p i ta l f a c i l i t y. t h e p l a n s h o w s n k s in i t s c o m p l e t e d s ta g e a s r e g a r d s t h e n o r t h e r n l a b o r at o r y buildings. new karolinska Solna Memorandum of Information 13

16 4.6 Project goal 1: Integration between health care, research and education The design of the new hospital shall strengthen the co-operation and exchange between health care, research and education, primarily through the benefit of physical connections and proximity and a well developed infrastructure Joint research environments are to be established in close proximity with the hospital, where researchers and clinicians can cooperate and where the connection between research and health care is made very clear. Research activities which today are performed at laboratories in the Karolinska Institutet area, as well as the Royal Institute of Technology and Stockholm University, among other places, should be able to be transferred to NKS, depending on the need for multi-disciplinary cooperation with clinically active researchers, and on the need to be in close proximity to health care operations. Some functions, such as administrative premises, libraries, lecture halls and assembly halls, can be coordinated in common areas Research closely related to patients should be able to be performed in an integrated manner with health care operations as the premises for research documentation and less complex analytical work will be interspersed within the health care premises. Research requiring special equipment and resources will be conducted in separate premises. The research buildings should also include other types of premises, in addition to laboratories, offices, conference halls and educational premises. In cooperation with Karolinska Institutet, an animal department is being planned with high demands on security and seclusion. The new research laboratories shall be planned in as generally applicable a manner as possible in order that they may be adapted to the special requirements of specific research areas. In that the research laboratories are situated in close vicinity to the clinical laboratories, an efficient use of competencies and the joint use of advanced equipment are facilitated. Furthermore, the transfer of scientific observations to the clinical laboratory diagnostic is also facilitated In order to become an attractive teaching it shall be planned with stimulating and flexible educational environments. Modern medicinal teaching methods are dependent on premises for individual work, as well as for work in smaller groups, premises for clinical training with simulators, as well as access to lecture halls and seminar rooms Akademiska Hus AB, in consultation with Karolinska Institutet and within the framework of integration of care and Research and Development, is planning to construct a larger assembly hall and conference rooms. A number of smaller lecture halls and conference rooms, as well as teaching premises, shall be built next to the main entrance of the new hospital and by the so-called Academic Passage between the health care and laboratory buildings. 4.7 Project goal 2: Attractive and human environments Fundamental to the design of the new hospital is a strengthening of the patient s position in health care. The environment should be accessible, safe and stimulating, as well as supportive of the patient s participation. Each patient shall be allowed a high degree of integrity and good possibilities shall be provided for the involvement and support of relatives and close friends Patients and relatives shall be met by a welcoming environment in the hospital entrance. The entrance shall be designed in a way that is accessible and easy to navigate, especially by individuals with disabilities. It should be easy to orientate oneself further within the hospital starting from the entrance. 14 new karolinska Solna Memorandum of Information

17 4 DESCRIPTION OF THE PROJECT The hospital rooms shall be planned as single bed rooms, which increases the patient s degree of integrity, and facilitates examinations, as well as conversations due to the privacy of the environment. Special consideration shall be taken in the continuing work in regards to the specific needs of children when designing hospital rooms and the local environment. All hospital rooms shall have exposure to daylight with a view of the exterior green environment, good ventilation and effective sound screening. Great importance should be placed on the size of the room, as well as on the choice of materials and colours The hospital should offer an attractive and creative environment for hospital personnel, researchers and students. Located within the Academic Passage, which will run in an east-west direction and will connect the hospital park with Karolinska Institutet, are meeting places, conference rooms and offices for researchers, students and hospital personnel. The premises shall receive a great amount of daylight and connect to green patios The hospital shall be designed to separate the public and professional zones. In this way, a highly secure work environment is created for personnel along with facilitating the patients integrity. The care and treatment rooms shall be dimensioned to provide plenty of room for advanced technical equipment, lifting devices and surveillance. Good public transport to the hospital, special personnel parking under the hospital and attractive changing rooms and fitness activities should contribute to the good work environment. These are also supported by the hospital becoming an integrated part of the townscape, with an extensive offering of stores, restaurants, banks and post offices. illustration of design concept for one-bed patient room according to the project programme. new karolinska Solna Memorandum of Information 15

18 4.8 Project goal 3: Efficient health care processes and optimal resource utilisation The new university hospital s design, matrix structure and efficient communication layout, shall contribute to efficient health care processes based on the individual patient s needs. Such a working method assumes the joint utilisation of many resources within the hospital, for example, operating theatres, intensive wards and diagnostic methods within x-ray and functional medicine Acute and elective flows of patients, outpatient care and inpatient care and public and professional zones shall be all separated. The hospital services will include day health care and outpatient care The design of the hospital shall imply that the emergency services provided during nights and weekends can be efficiently organised. That is, that the hospital can relatively easily be re-arranged from a daytime hospital to a night-time hospital. This is important as health care after normal working hours is both more expensive and more difficult to organise than health care during daytime hours The reception areas, the outpatient operations, and the surgery and x-ray services shall be organised to be able to provide care in 16 hour shifts The focus on a general design for single bed rooms for patients staying at the hospital will significantly diminish the need to move patients. Patient examinations and treatment can, to a certain degree, take place in the patient s room and the patient will usually not need to be moved when there is a change in required health care. This also decreases the need for special rooms for examinations, private dialogue and for visiting family members NKS is to be built according to a module concept in which the various functional units are designed in a generally applicable manner and with separate technical supplies. This shall allow for future adaptation of the premises to new operations without serious disruption to other parts of the hospital Short distances between units enables an enhanced utilisation of medical technical equipment and other advanced aids and tools, which decreases the need for multiple investments Future food services will be better adapted to the individual patient s requirements. In accordance with previous resolutions undertaken by the County Council Assembly, food will be externally produced and delivered to a central kitchen situated near to the goods entrance. Once food has been ordered, it will be distributed via the transport system to the respective department kitchens where it will be finally prepared prior to being served to the patients. 4.9 Project goal 4: Solutions for general applicability and flexibility There is a clear need to be able to adapt the operations of the new university hospital to the rapid changes characterising health care and research. The concepts of general applicability and flexibility are, as such, central. The completed university hospital will continually need to be adapted to changing requirements The premises in a generally applicable building should be able to be utilised or organised in a large variety of ways and it is important that they are not locked into a specific use. Even heavy operations and operations requiring equipment, such as surgery and x-ray diagnostics should be able to be transferred to different premises within the buildings. To meet this requirement, several floors in the health care buildings shall be designed with a standard ceiling height, standard bearing capacity and standard technical supplies However, the general applicability shall not be used in all areas. Certain areas will be fixed for specific functions such as the helicopter landing pads, rooms for radiation therapy, entry areas (main entry and emergency entry), elevator shafts and the underground areas for parking, goods entrance and technology Project goal 5: The role of the hospital in the city In addition to being a new, modern and internationally competitive university hospital, NKS will comprise an important part of a larger environment. The new university hospital will be a part of the extensive renewal projects and changes characterising the entire the Karolinska-Norra station area. NKS will also be one of the most important cornerstones in the 16 new karolinska Solna Memorandum of Information

19 4 DESCRIPTION OF THE PROJECT implementation of the Vision 2025 which has been presented by the County Council, the Royal Institute of Technology, Stockholm University, the Stockholm School of Economics, pharmaceutical companies, etc. The vision is to create the world s foremost location for life sciences with an environment which is a major attraction to both people and companies With the street overbuild of the North link highway, the streets Gävlegatan, Hälsingegatan and Dalagatan can be extended from the Vasastan area towards the existing Karolinska Solna and the hospital park. The planned city district will be a mixed environment with premises for health care, research, corporate activity, housing, cultural and commercial services Streets from nearby parts of the city lead up to the main square (called Karolinska plan) and make it easy to reach the hospital area. Exits from the Metro lead directly to the main square and surrounding the square are bus stops. The main square has shops and restaurants and entry areas on the lower floors. Since health care and research meet here together with housing areas, shopping and culture, conditions are created for a rich community life with a large flow of people passing through the environment Project goal 6: Sustainability perspective The conservation of resources and choice of environmentally friendly alternatives are important principles for the NKS project. It is, therefore, important that all parts of the new hospital embody long-term sustainability. An environmental consequences report in accordance with the regulations governing the detailed plan has been produced in the NKS project. shall be designed with a good climate shell, energyefficient installations and a high level of energy recycling. The supply system shall be designed to utilise renewable energy sources. By using a rock strata both heating and cooling can be stored between seasons and utilised with the help of heating pumps. The decreased energy requirement combined with renewable energy sources can lead to significantly reduced greenhouse gasses compared with the current situation. As technical developments within energy supply are developing rapidly, new technology and methods are continually coming to the fore. Therefore, it is very important that the hospital is prepared for and built in a generally applicable manner in order that it can be easily adapted to new innovations As the basis of all systems and material choices a lifetime cycle costs calculation (LCC) shall be produced. It is important to be able to make the best long-term choices when it comes to energy utilisation and resource consumption In order to facilitate a good level of health care and a favourable working environment, it is important to identify, at an early stage, the important aspects impacting the interior environment and the internal air quality. Humidity, noise and choice of materials are some of the important aspects to be addressed. The materials to be used should be well tested and durable, and should also be based on renewable and recyclable raw material. A complete list of contents with environment control of all included materials and products will be required for the entire building Public transportation to NKS will be developed with a new connection to the Metro and close vicinity to commuter trains. There are also plans for good connecting walking and bicycle paths when the E4/E20 highway and railway are covered by an overbuild. In order to achieve a good flow and coordination of goods transport to and from the hospital, a common goods entrance is planned and a central waste disposal center is also planned for the entire building. This central area will be combined with a well-developed and efficient form of internal transport In order to minimise the negative impact on the environment, the buildings and their supply systems new karolinska Solna Memorandum of Information 17