Boreal Health Partnership is the private partner consortium selected to design, build and partially finance the Stanton Territorial Hospital and maintain it for 30 years. The equity investor partners are Dexterra, HOCHTIEF PPP Solutions North America Inc. and Bird Capital Limited. The industry partners who will design and build the hospital include: Bird Design Build Construction Inc, Clark Builders, and Kasian Architecture Interior Design and Planning Ltd. The engineering teams include Crossey Engineering Ltd. and Weiler Smith Bowers Consulting Structural Engineering. Dexterra will maintain the hospital.
Frequently Asked Questions
Boreal Partnership Group
Who is Boreal Health Partnership?
How was Boreal Health Partnership selected?
The Government of the Northwest Territories followed a competitive bidding process to select the private partner. Proposals were rigorously evaluated for the private contractor’s financial, technical and organizational capacity to complete the project and to ensure bids provided good value for dollars spent. Based on this analysis, Boreal Health Partnership was selected as the preferred proponent and ultimately signed the Project Agreement with the Government of the Northwest Territories.
Who will own and operate the new hospital?
The new Stanton Territorial Hospital will be owned by the Government of the Northwest Territories (GNWT), but controlled and operated by the Northwest Territories Health and Social Services Authority (NTHSSA).
What is the ongoing role of Boreal Health Partnership after the construction is completed?
Boreal Health Partnership will undertake the prescribed services under the Project Agreement over a period of 30 years, including performing maintenance on the new hospital and ensuring it meets the required standard throughout, as well as undertaking certain other services including housekeeping, laundry and linen, managing the help desk, parking management, pest control, security and surveillance and catering.
Any replacement required of building fabric or equipment (e.g., roof or boiler) is included in the contract. The facility will be periodically inspected by the Government of the Northwest Territories to ensure that the facility remains in the required condition and maintenance obligations are being met. Boreal Health Partnership will be subject to deductions from payments should any such obligations not be met.
At the end of the 30-year term, Boreal Health Partnership will leave the people of the Northwest Territories with a hospital that is guaranteed to be in a prescribed condition, with key components of the facility having defined remaining useful lives.
Will jobs be created as a result of this project?
The project is expected to create significant construction-related employment opportunities for the local community as well as stimulate economic development. Additionally, new technologies will enhance and properly support staff to provide patient care. Additional positions may be required to support the new and enhanced level of technology within the new Stanton Territorial Hospital.
How do I find out about employment opportunities related to the Stanton Territorial Hospital Renewal Project and Boreal Health Partnership?
Please visit the websites of our construction and maintenance partners for information on employment opportunities.
Bird Construction: www.bird.ca/careers
Clark Builders: www.clarkbuilders.com/career-opportunities
GNWT & NTHSSA Careers: https://www.gov.nt.ca/careers/en/search/job
How many people currently work at Stanton?
As of July 31 2018, there were 557 employees.
Will any jobs be lost as a result of the Stanton Renewal Project?
The nature of some jobs will change as a result of the project, so current positions can’t be simply compared to positions once the project is completed. Many of the processes now used to deliver clinical and non-clinical services will change after First Patient Day. New technologies will enhance and properly support staff to provide patient care; therefore, additional positions may be required to support the new and enhanced level of technology within the new Stanton Territorial Hospital.
Public-Private Partnerships (P3)
Will the P3 offer economic benefits for Northern workers/companies?
Yes. One of the proposal evaluation considerations was the use of Northern goods and services. The Project Agreement will require the proponent to report on their use of Northern goods and services.
How will we be assured that we won’t get the lowest cost solution with high maintenance and energy costs?
• The specifications for the project were developed to have the same or higher standards as the GNWT requires for the design, construction, and energy performance for all new building projects managed by the GNWT.
• All buildings designed to the GNWT’s Good Building Practice for Northern Facilities over the past several years have consistently exceeded national guidelines for energy performance.
• The successful proponent was selected on the basis of a balanced evaluation framework that considered both the technical quality of the proposed solution, as well as cost implications over not only construction but the full term of the Project Agreement including all maintenance and energy costs.
How will the GNWT ensure that the services are delivered as promised under the P3 agreement?
• Upon substantial completion of construction, the government will pay monthly, performance-based payments to the private partner over the term of the agreement.
• Detailed performance standards will be included in the contract with an agreed mechanism for measuring this performance. With P3 agreements, the owner has an ability to make deductions from the monthly payments if performance standards are not met.
• Transferring most construction-related cost and schedule risks and entering into maintenance arrangements with the winning project team will ultimately benefit the public by ensuring the new hospital is built on time, on budget, and well maintained over the 30-year period.
What do you mean by hard facilities maintenance (FM) services?
Hard facilities maintenance relates to the maintenance of the facility and its equipment that helps the physical building to operate, such as elevators, HVAC systems, and other functions related to the building’s structure.
The P3 model effectively provides the public sector with a 30-year warranty with respect to the condition of the hospital, and the Project Agreement provides significant financial incentive to the private partner to have control over maintenance so that it will be
turned back to the owner at the end of the 30 year agreement in a condition that meets contractual obligations.
Is there a focus on lower quality of equipment under a P3 model?
No, the Canadian experience provides evidence that P3s provide improved maintenance of the facility and the building equipment (elevators. HVAC etc). A P3 contractually binds a private sector provider to maintain the building, its systems, and equipment to an acceptable standard.
If these requirements are not met monies will be held back or penalties assessed to pay for the necessary improvements.
Therefore, it is in the private partner’s interest to ensure the facility and building equipment installed is of high quality and that it is maintained to defined standards.
Government remains responsible for selection and maintenance of diagnostic and clinical care equipment.
What if the private partner gets into financial difficulties?
As part of the competitive selection process, all proponents and their major sub- contractors were subjected to detailed review of their underlying financial capacity to undertake their obligations under the Project Agreement, including their ability to fund and complete construction as well as maintain the hospital over 30 years.
The competitive selection process also required that proponents include as part of their proposals significant performance security arrangements to be implemented, including liquid security available immediately through parent company guarantees covering a substantial proportion of the value of the hospital, or multiples of the annual maintenance contract value, which can be drawn upon should the private partner’s costs be higher than expected.
There are therefore significant protections in place to protect the financial position of the private proponent and ensure its ability to undertake its obligations over the full term of the Project Agreement.
Isn’t it true that the quality of services suffer because private profits take precedence?
In a P3, services are delivered on a pay-for-performance basis, meaning the private partner is potentially subject to deductions from payments if they do not perform according to the specified standards in the contract.
The incentive is there to deliver high-quality services to the public sector owner; and the onus is on the public sector owner to ensure it is getting what it has contracted for through regular monitoring, above and beyond the self-reporting of the private partner.
The public sector has legislative and policy control over the services
Why consider private financing when governments can borrow money at a cheaper rate than private companies?
To achieve best value for taxpayers, many partnership projects include both government funding and private financing.
Private financing in P3 projects helps to facilitate risk transfer, since the repayment of this private financing is subject to meeting the performance standards defined in the Project Agreement
Typically, a P3 involves a mix of public and private financing, striking a balance between having enough public financing to minimise financing costs such as interest, whilst ensuring there is sufficient private financing to strongly align the incentives of the private sector proponent with those of the government.
Repayment of private sector financing is dependent on the proponent meeting its obligations including completing construction on time, addressing any defects should they arise, maintaining the hospital to the required standard and handing it back in an acceptable condition.
Private financiers play an important oversight role in ensuring the private proponent meets its obligations and does not put its capital at risk.
The additional cost of private finance is more than offset by the relative savings generated over the term of the Project Agreement that result from strong motivation to meet defined obligations, when compared to traditional procurement.
How does the taxpayer know P3s are delivered in a fair and competitive manner?
The GNWT hired an external Fairness Adviser to monitor the competitive selection process from RFQ through financial close and issue a report at the end of the process.
RFP Solutions, the Fairness Adviser, was provided access to all documents and information in the competitive selection process and was informed by the public sector owner of related documents and activities.
The Fairness Report can be read at www.stantonrenewal.ca
How was the decision made to use a P3 model?
An in-depth business case analysis looked at a variety of models and demonstrated that a P3 procurement model would provide significantly better value-for-money compared to a traditional procurement and delivery process. A Project Report summarizing the value for money analysis will be published.
This outcome was driven by the private sector’s ability to more effectively and efficiently mitigate key construction and maintenance risks transferred under the P3 model which would otherwise be retained by the public sector under a traditional delivery model, resulting in a lower overall cost over a 30 year time horizon.
Canadian P3s have provided a high degree of cost and time certainty with significant savings and they offer considerably more transparency than conventional public infrastructure projects.
Will the P3 result in some services at Stanton being privatized?
No. P3s do not involve privatization of essential services (such as clinical care services) or the sale of public assets. Private sector partners may deliver non-clinical services (Catering, Laundry, Building Maintenance, Security, Custodial Services, for example) however they must meet performance-based standards that are detailed in the contractual agreement.
The GNWT is able to exercise control over performance through deductions (financial penalties) and hold-backs if the private partner does not meet its obligations under the agreement.
The responsibility for, and delivery of, health care services will remain with Stanton, and the type of clinical and medical services will not change as a result of the agreement.
Other services that are currently provided by private contractors and managed by Stanton Territorial Health Authority will remain as private contracts but will be managed by the P3 provider – dietary, laundry, housekeeping, security, grounds maintenance, snow removal, electrical service needs, garbage removal.
How is a P3 different from privatization?
A P3 is a long-term partnership, and requires significant involvement of both the public and the private sector partners. In a public-private partnership, the government retains ownership of the project, the land/asset, and responsibility to deliver the programs and services.
In the case of a hospital P3 all clinical services continue to be provided by physicians and hospital staff under the public health care system. All facilities are run according to the principles of the Canada Health Act.
“Privatization” is the transfer of ownership and control of a business or service from a government to a privately owned entity. This is not happening in the case of the Stanton Renewal Project.
Why was Stanton considered for a P3?
The GNWT’s Public-Private Partnership Policy allows the GNWT to enter into partnership agreements with the private sector to procure services and public infrastructure when:
o The total projected threshold for procuring those services, including capital, operating, and service costs over the life of the agreement exceeds $50 million;
o There is appropriate risk sharing between the GNWT and the private sector partners;
o The agreement extends beyond the initial capital construction of the project;
o The arrangement results in a clear net benefit, as opposed to being merely neutral in comparison with standard procurement processes.
What are the advantages of using a P3 to build the new Stanton Territorial Hospital?
REDUCTION OF PROJECT RISK
• a fixed construction price is guaranteed
• the hospital delivery (completion) date is guaranteed
• risks are transferred to the contractor after tender (examples include inflation in construction costs, and weather-related delays)
VALUE TO TAXPAYERS
Through the P3 approach the new hospital will provide Northwest Territories taxpayers a savings of at least 20 per cent compared to the cost of doing the same work using a traditional delivery method.
HOSPITAL IS COMPLETED FASTER
The new hospital will open in Yellowknife up to two years sooner than if the traditional method was used.
THIRTY YEAR MAINTENANCE WARRENTY
One key benefit of the P3 is the 30-year maintenance warranty, which ensures the people of the Northwest Territories will have a hospital that will be maintained to a predetermined, acceptable standard over the 30-year contractual term following construction.
Why are P3s used?
Governments around the globe have acknowledged the significant infrastructure gap, the costs associated with addressing that gap, and the need for finding more efficient and cost-effective approaches to providing services and infrastructure.
P3s are often considered when projects are of a significant cost, scope, scale, risk, profile and complexity, whereby delivery through a long-term pay-for-performance contract may be best-suited.
One of the major benefits of P3s is that the private partner assumes the upfront costs and risks of the project, while ownership remains with the public partner. P3s can leverage the accountability and policy capacity of the public sector with the innovation, risk mitigation expertise and project management strengths of the private sector.
P3 transactions are strictly governed by the following five principles set out in the government’s Public-Private Partnership Policy for planning, financing, and procuring public infrastructure:
o Public interest is paramount;
o Value for money must be demonstrable;
o Appropriate public control and ownership must be preserved;
o Accountability must be maintained; and
o All processes must be fair, transparent and efficient.
What is a P3?
A public-private partnership (P3) is a long-term performance-based contract between government and a private partner to deliver infrastructure. In the case of the Stanton Renewal Project the term of the Project Agreement will be for the 3-year construction term plus a 30 year maintenance period.
What is the cost for the new hospital?
The total capitalized cost will be $350 million. After the hospital goes into service in 2018, the GNWT will pay Boreal Health Partnership $18 million per year over the 30 year term, indexed to inflation, a proportion of which will be used to repay capital costs and the remainder of which will be used to fund maintenance costs.
If the project is over budget or late, who will be responsible?
We are confident that Boreal Health Partnership has the experience and ability to deliver on this project consistent with the requirements and the provisions outlined in the project agreement. Under the P3 contract, Boreal guarantees the building will be completed for a fixed price and on a fixed timeline, and is responsible for absorbing any cost or time overruns. There are provisions in the contract to address issues with the schedule and quality of the work and which protect the GNWT and the public interest.
Planning and Design
What will the inside of the new hospital look like?
Kasian Architects developed the design for the interior of the new hospital with input from a panel of regional NWT representatives. Engagement sessions took place in December 2016 and June 2017 to ensure that the designs accurately reflected the cultural needs of our population.
The panel’s recommendations were incorporated into colour schemes, wayfinding tools, focal images and featured artwork throughout the hospital. Each floor represents a distinct northern landscape with a corresponding animal in order to assist with patient navigation:
- Level 0: Barrenlands and the Caribou
- Level 1: Aurora Borealis and the Polar Bear
- Level 2: Rivers/Forest and the Moose
- Level 3: Lakes and the Arctic Char
- Level 4: Mountains and the Mountain Goat
- Level 5: Arctic and the Seal
Click here to see a visual representation of each floor.
Is the organic material (dirt, moss, trees) being removed from the site being recycled?
Yes, anything that can be used for landscaping for the new hospital is being stock piled. Items that can’t be used are being recycled wherever possible. For example, the trees removed from the site have been turned into mulch or been donated as firewood.
Was the Frame Lake Trail considered in the planning stage when selecting the location?
Yes. The Trail must be maintained during construction activities. A portion of the trail will be relocated during construction activities that meets the approval of the City of Yellowknife. Building location and Frame Lake Trail considerations were finalized as part of the procurement process. As part of the procurement process, each proponent team was required to demonstrate how the Frame Lake Trail would be affected during construction and how it would be incorporated into the final design. Feedback related to building location, Frame Lake Trail and retention of natural landscape was provided to each Proponent as part of the collaborative meetings.
Was consideration made to protect trees on the site?
Yes, removal of trees on site is limited to the building footprint, new parking areas and road widening area. Substantial new landscaping is also included in the new development and the Capital Area Development Scheme and City of Yellowknife By-Law was adhered to. Trees removed were either chipped into mulch or donated as firewood.
Who has been involved in planning?
Since standards and best practices have changed considerably since Stanton was built, the newest CSA Standards for Canadian health care facilities and hospital planning experts have guided the planning process. Within each clinical area, Stanton nurses, physicians, allied health professionals, and others have had input into the planning process.
The Schematic Design process included interaction with 33 user groups and over 100 participants from the Health system.
How are staff and health professionals being consulted on the design of the new hospital?
The Stanton Renewal Team has hosted a number of forums for staff and health professionals to provide feedback on design elements:
- January 11, 2016: An open house was hosted for all hospital and Health and Social Services staff.
- April 26, 2016: An open house was hosted for physicians to garner feedback.
- March 31, 2017: Mock-up rooms were set up in the new hospital to get staff feedback.
- September 30, 2017: Nurse Care Station mock-ups were set up in the Centre Square Mall for staff to check out the systems furniture.
Was the public consulted about the final placement?
The site has been approved through the City of Yellowknife’s General Plan and Zoning Bylaws. The building location was determined through an exhaustive review focused on mitigating changes to the natural landscape. This evaluation considered how to limit the removal of existing trees, removal of natural rock, and impact to the existing access routes on the site. Frame Lake Trail was also thoughtfully considered during this evaluation. Boreal Health Partnership analysed the site to determine the best location. Due to the confidential nature of the procurement process, details of the building location and Frame Lake Trail could not be shared with the general public until after a contract was awarded.
When did work start?
Work on the project began in October 2015. Blasting activities started in November 2015.
When will the new hospital be completed?
The Stanton Territorial Hospital is scheduled to be substantially complete by November 30, 2018. First Patient Day is May 26, 2019.
What is the plan for parking at the new hospital?
The new parking lot will offer a total of 375 stalls, doubling the 185 stalls that were previously available at Stanton:
- 226 powered stalls for physicians and staff;
- 59 stalls for clinic patients;
- 42 stalls for patient visitors;
- 20 stalls for the Emergency Department;
- 28 powered stalls for staff for Support Services;
- 38 stalls for disabled persons.
Patients and visitors will not be required to pay for parking. Stanton's Finance Department will continue to control powered parking stalls for staff as they do now, for which a monthly fee is charged.
The number of designated on-call parking spots will remain the same from the old hospital to the new. Appropriate signage will indicate which spots are reserved for this purpose. The Facilities Management provider, Dexterra, will monitor these stalls and tow vehicles without proper identification.
The parking stalls are compliant with the City of Yellowknife Zoning By-law #4404.
Will there be a helipad at the new hospital?
No, there will not be a helipad at the new hospital. The GNWT reviewed the use of the current helipad during the programming stage and determined that one would not be required in the new hospital. This decision was based on the fact that the current hospital’s helipad has not been used in years, since most air ambulances are fixed-wing aircrafts that must land at the airport.
Will northern foods be offered at the new hospital?
With the new hospital being built in a P3 model, Stanton and the GNWT have a unique opportunity to collaborate with their P3 partner to develop a northern and traditional foods menu. Dexterra, the facilities management P3 partner, has already engaged in a dialogue with Stanton leadership (including Stanton’s Indigenous Wellness Program and the Stanton Renewal Project Team) to explore what the northern and traditional foods menu can look like in the new hospital.
The menu planning discussions have included how foods are harvested and prepared. The goal is to have a northern and traditional menu as part of the mainstream menu, rather than being an exception. Northern and traditional foods would also be a part of the menu for all meals served, not just lunches or dinners. Sample menus and preparation techniques have been provided to Dexterra by the Stanton Indigenous Wellness Program.
Will there be Wi-Fi in the new hospital?
Yes, Wi-Fi will be publicly available at the new hospital.
What will happen to the existing hospital?
The existing Stanton Hospital, currently referred to as "Legacy Stanton," will have its cladding and hazardous materials removed by the Boreal Health Partnership. The GNWT will maintain ownership of the building, which will be leased to Ventura Stanton Inc. for development into rental space.
The vision for the building is for it to exist as part of a “Campus of Care.” To date, the GNWT has committed to housing 72 long-term care beds, 18 extended care beds, outpatient rehabilitation services and the Frame Lake Clinic into the renovated Legacy building.
The GNWT will benefit from the agreement with Ventura Stanton Inc. through profit share of leased space and potential for reduced rent if the GNWT should require space in the old facility. This arrangement also ensures the GNWT reduces risk with Stanton Ventura Inc. responsible for marketing, operating, and maintaining the facility for the next 30 years.
More information on the Legacy Stanton project can be found here.
What is being done to promote recycling in the new hospital?
Project Co. is responsible to follow policies and procedures outlined by the Authority for recycling. Their approach to recycling will be identified in their Annual Service Plan. The Authority is responsible to audit and monitor their approach for compliance throughout the 30 years.
The Project Agreement clearly states that Project Co. must follow the following:
3.12 Waste Management & recycling
(f) segregate waste streams including Recyclable Waste (at source where practical to do
so) and place in the appropriate containers at the soiled utility rooms, soiled holding
rooms and exterior waste collection areas designated by the Authority, including:
(1) compostable, recyclable and confidential waste paper;
(3) laser cartridges;
(4) glass and glass containers;
(5) metal food containers, and metal scrap containers;
(6) rigid plastics (1-7);
(7) soft plastics (such as film);
(10) beverage containers;
(11) food waste;
(13) compostable materials;
(14) construction waste;
(15) electronic waste;
(17) general solid waste;
(20) confidential media (bradma plates, ID cards, CDs, DVDs and other similar
Will there be an MRI machine in the new hospital?
Although no MRI machine has been purchased, the building's infrastructure was designed to accommodate future MRI equipment.
How does the scale of this $350 million, five-year construction project rank in NWT history?
The Stanton Territorial Hospital Renewal project will be the largest project ever undertaken by the Government of the NWT.
Will the new hospital be private and will patients have to pay for services?
No. The land, the hospital and everything in it will still be owned by the GNWT, and GNWT will remain responsible for delivery of health care within the new hospital. Healthcare, including most hospital clinical care, is publically funded in Canada through provincial/territorial medical services insurance plans and the new hospital will not impact patient payments for clinical services.
Will the new hospital have extended care beds?
Only temporarily. The Extended Care Unit (ECU) will be located on Level 5 of the new hospital while the existing building is renovated to accommodate:
- Level One:
Outpatient Rehabilitation Services
Frame Lake Community Health Clinic
- Levels Two and Three:
Extended Care Unit (18 beds)
Long Term Care (72 beds)
What changes are included in the project?
- 100 single in-patient rooms, many of which are equipped with patient lifts;
- A significant expansion of the Emergency Department, Day Procedures, Medical Daycare, Ambulatory Care Center and Intensive Care Unit;
- Operating rooms that are double the size and equipped with surgical booms;
- Impressive labour and delivery rooms complete with birthing tubs and views of Frame Lake;
- A secure outdoor space for mental health patients;
- A larger and better-equipped medical laboratory and pharmacy;
- A designated multi-denominational Sacred Space for prayer or spiritual ceremonies, including smudging;
- An expanded cafeteria featuring northern artwork and a living wall;
- Therapeutic gardens complete with a ceremonial fire pit, playground and northern flora and fauna;
- Dedicated elevators for patients and staff separate from the public, to protect patient privacy;
- More space for support services, such as Medical Device Reprocessing and Materials Management;
- System upgrades including a pneumatic tube system, patient lifts, surgical booms, nurse call, integrated beside terminals and public wi-fi;
- 375 parking stalls for staff and public.
How big will the hospital be when construction is finished?
The square footage of the new hospital will be double the existing "Legacy" building; new Stanton is 27,500 m2 while Legacy Stanton is 13,300 m2.
Will safety and security be improved at the new hospital?
The design will strategically incorporate best practice and industry standards to provide a safer environment for both staff and patients. The new hospital has three separate security offices: one in the main lobby, one in the Emergency Department and one on Level 3 - Psychiatry. The building is completely secure with swipe cards used to access staff-only areas.
Additionally, emergency posts have been installed throughout the new parking lot for patients, visitors or staff who need assistance getting to and from the new building.
Will there be an Aboriginal Wellness Centre?
The Department and STHA have planned for the continued delivery of existing Aboriginal wellness programs within the hospital as part of the technical and program renewal of Stanton.
However, some aspects of Aboriginal wellness cannot be accommodated within the walls of an acute care hospital due to building code and safety requirements. We are committed to exploring the need for a stand-alone wellness centre, outside the walls of the acute care hospital that could accommodate traditional activities, and act as a gathering place for patients, family and friends.
The Department has worked with a consultant to complete a report on the need for Aboriginal wellness programming at Stanton, including the potential for a stand-alone Wellness Centre. The findings of the report are now under consideration.
Will I still have to go south for some medical services?
Yes. The type of services provided at Stanton is not changing as part of the renewal; however, there is a process in place to regularly review the number of patients who need particular medical services and the cost/benefit of providing those services at Stanton. So, while the current project will provide space for future use, additional types of services are outside the scope of the Stanton Renewal Project.