Appendix OS10_Proposition P107_2017 – Future Hospital Approval of Preferred Scheme and Funding STATES OF JERSEY FUTURE HOSPITAL: APPROVAL OF PREFERRED SCHEME AND FUNDING Lodged au Greffe on 31st October 2017 by the Minister for Treasury and Resources STATES GREFFE 2017 P.107 PROPOSITION THE STATES are asked to decide whether they are of opinion to refer to their Act dated 23rd October 2012, which requested the Council of Ministers to bring forward proposals for a new Hospital, and their Act dated 1st December 2016, which approved in principle the site location for the new General Hospital; and – (a) to approve the Preferred Scheme contained within the Future Hospital Outline Business Case with a capital expenditure budget of up to £466 million; (b) to approve, in accordance with the provisions of Article 3(3)(a) of the Public Finances (Jersey) Law 2005 (“the Law”), the establishment of a Special Fund to be known as the “Hospital Construction Fund” and to approve the Fund’s purpose, as set out in Appendix A to the report accompanying this proposition; (c) to authorise, in accordance with Article 21(1) of the Law, the Minister for Treasury and Resources to borrow up to £275 million towards the construction of the Preferred Scheme, and to direct that the amount borrowed be paid into the Strategic Reserve Fund; (d) to agree that the Strategic Reserve Fund policy be amended so as to authorise the transfer from the Strategic Reserve Fund to the Hospital Construction Fund, drawn down as required, the sum representing the balance of up to £466 million after deducting the £23.6 million already allocated in connection with this project in previous Budgets; (e) to agree that the Strategic Reserve Fund policy be further amended so as to authorise – (i) that the costs of borrowing and ongoing finance and administration costs related to the borrowing be borne by the Strategic Reserve Fund; and (ii) the repayment from the Strategic Reserve Fund of the amount borrowed in accordance with paragraph (c) above; and (iii) that on the final account of the Preferred Scheme being presented, any unspent monies shall be returned to the Strategic Reserve Fund. MINISTER FOR TREASURY AND RESOURCES Page - 2 P.107/2017 REPORT Executive Summary Jersey is not alone in the challenges of maintaining the health and wellbeing of an ageing population. However, unlike many jurisdictions, we are facing up to these challenges and putting in place a range of policies to tackle them. A Hospital that is fit for purpose is an essential component of our strategy, and will provide high-quality medical treatment both now and in the future. The current Hospital has developed piecemeal over many decades and its physical condition, as independently assessed, is rapidly becoming inadequate. All credible solutions for a new Hospital require a ‘once in a generation’ investment. This proposition has been lodged by the Minister for Treasury and Resources in order to comply with the rules set out in the Public Finances (Jersey) Law 2005; however, if those rules were not as they are, this proposition would have been in the name of the Council of Ministers, reflecting their support for this proposal and their belief that this is absolutely the right solution to make progress to address the challenges we face. This is a crucial decision for the States Assembly to make. In approving the proposition “Health and Social Services: A New Way Forward” (P.82/2012) as amended (P.82/2012 Amd.) on 23rd October 2012, the States Assembly approved that – “the Council of Ministers … co-ordinate the necessary steps by all relevant Ministers to bring forward for approval proposals for the priorities for investment in Hospital services and detailed plans for a new Hospital (either on a new site or a rebuilt and refurbished Hospital on the current site)”. In approving the proposition “Future Hospital: preferred site” (P.110/2016) on 1st December 2016, the States Assembly approved the preferred site for the Future Hospital, in principle, as being the current Jersey General Hospital site with an extension along the east side of Kensington Place and other nearby sites, including Westaway Court. This Proposition requests approval of the Preferred Scheme that responds to the identified requirements for modern safe, sustainable, and affordable Hospital services as anticipated by “Health and Social Services: A New Way Forward”, and which are in line with the “Acute Service Strategy” approved by the Minister for Health and Social Services in a decision signed on 18th July 2016 (MD-HSS-2016-0035). The Preferred Scheme is a New Build Hospital on a part of the current site, with additional properties on Kensington Place and a New Build support facility at Westaway Court, contained within the Future Hospital Outline Business Case (“OBC”) with a capital expenditure budget of up to £466 million. An indicative capital cost of up to £466 million for the project cost of developing the concept envisaged was proposed in “Future Hospital: preferred site” (P.110/2016). The cost estimate incorporated all works to the main Hospital, together with all related relocation, site acquisition, enabling works and associated fees, but was an indicative estimate, founded on area-based assumptions. Significant further design, as well as planning and procurement activity, was needed before a final cost could be provided. Page - 3 P.107/2017 A significant amount of work has been ongoing to inform the workforce assessments and plans, to develop a concept design, to develop the proposed procurement strategy and outline planning approach, to tender for a supply-chain construction partner, and to commence the planning of relocation works, as well as undertaking extensive stakeholder and clinical engagement throughout. This work has provided more cost certainty on the construction costs, and the detail within the OBC is intended to provide Members with sufficient information in order to make the decision to invest. The OBC provides the case for this investment. It set out the whole life costs associated with the delivery of the Preferred Scheme and associated details in relation to its nature, scale, profile and cost-drivers. The capital cost estimate of £466 million includes works required to repurpose the Granite Block, but not any other legacy buildings. The cost of acquiring property to form the Preferred Site are included, as are the costs to build temporary clinical blocks, and the cost of relocating the corporate functions to free up the space necessary to allow a single phased main construction. The cost estimate will be managed in 2 parts. The optimism bias and contingency (“risk”) will be managed by the Treasury, leaving the delivery team to manage the remaining estimated project costs, including an estimate for inflation. The contingency sums, if and when required, will be accessed through a process of challenge and agreement between the delivery team and Treasury. The workings associated with the cost estimate for this project have been brought together with the assistance of Gleeds Management Services (Hospital project advisers) and EY (Hospital project financial advisers) who have provided advice over the costs and modelling associated with their estimates. As set out in P.110/2016, the Future Hospital provides an opportunity to crystallise the very best of Jersey in a high-quality and enduring safe, sustainable, and affordable Hospital. The core purpose of the Future Hospital will be an environment that provides excellent care for everyone, all of the time, now and for the future. The States Assembly now has the opportunity to put this vision into practice through approving this Proposition. This report summarises the key aspects of the OBC, describing – the context in which the need for the Hospital is defined in the Strategic Case; the method by which the Options were appraised, in accordance with best practice, and the selection of the Preferred Scheme in the Economic Case; the means by which the Preferred Scheme can be procured in the Commercial Case; the long-term financial impacts of the Preferred Scheme in the Finance Case; and the capability and capacity of the client to safely deliver the Preferred Scheme in the Management Case. This will be Jersey’s largest single capital investment in a generation. After considering all the options and consulting with expert advisers, the Minister for Treasury and Resources, with the support of the Council of Ministers, is proposing to raise the funding Page - 4 P.107/2017 required through a blended solution; borrowing, supplemented by existing reserves. That borrowing is proposed to be by means of a public-rated sterling bond. That borrowing would be repaid by future excess returns on the Strategic Reserve Fund. The proceeds of any future sales of property or other strategic assets would be used to further strengthen reserves. It is not planned to raised additional taxation to pay for the new Hospital. The Treasury Advisory Panel (“TAP”) is established by the Minister for Treasury and Resources to advise him, the Assistant Minister and the Treasurer of the States on matters relating to investment decisions, and may also be requested to provide advice on other relevant Treasury matters. The Panel comprises – an Independent Chairman; the Treasurer of the States of Jersey and/or delegated Treasury Director; and up to 3 Non-Executive Members (currently 2). The Panel was requested to recommend a suitable funding methodology for the Future Hospital project requirements, using its relevant expertise, experience and knowledge. On 13th April 2017, the Minister for Treasury and Resources received a formal recommendation from the TAP, further to and consistent with advice from other experts, as follows – 1. A public-rated sterling bond issuance is the optimal debt instrument to finance the construction of a new Hospital rather than using sums from the Strategic Reserve.