WORLD S BIGGEST PPP HOSPITALS: MADE IN TURKEY. Omer Unlu. Arcihtect / General Coordinator, PMP. 4 th Annual Investing in Turkey Forum

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1 WORLD S BIGGEST PPP HOSPITALS: MADE IN TURKEY Omer Unlu Arcihtect / General Coordinator, PMP 4 th Annual Investing in Turkey Forum 15 April 2016, London

2 Introduction

3 NKYExperience onppphealthcare Investments Bed Adana I.H.C. (Owner s Representative) Bed Ankara Bilkent I.H.C. (Design & Planning) Bed Ankara Etlik I.H.C. (Owner s Representative) Bed Istanbul Ikitelli I.H.C. (Owner s Representative) BedKayseri I.H.C. (Owner s Representative) Bed Mersin I.H.C. (Design & Planning) BedGaziantep I.H.C. (Design & Planning) Total bedsdesigned. Total bedsbeing monitored.

4 Biggest? Mersin IHC m2 total construction area / Photo Taken: March 2016

5 Biggest? Gaziantep IHC m2 total construction area / Photo Taken: February 2015

6 Biggest? Gaziantep IHC m2 total construction area / Rendering: March 2016

7 Biggest? Istanbul Ikitelli IHC m2 total construction area / Rendering: February 2016

8 Biggest? Etlik IHC m2 total construction area / Photo Taken: March 2016

9 Biggest? Bilkent IHC m2 total construction area / Photo Taken: January 2016

10 PPP and Healthcare

11 PPP Model Strengths and Opportunities Single source DBFO Offsets between capital and operating costs Private sector financing, risk & expertise Cost and schedule certainity PPP Model Weaknesses and Threats Potentially divergent objectives of public & private sectors Value for money High bidding costs

12 Application of PPP to Healthcare Facilities Integrate service professionals Advancement and flexibility of technology New models of care Recognition of patient first Evolving development strategies In Turkey: clinical care undertaken by MoH, all other services are operated by the contractor, DBFO includes revenue generators on-site

13 PPP Healthcare Investments in Turkey

14 2007 Conceptual Framework Ideas for a new health city by NKY

15 2008 Legislation Health facilities considered necessary to be built by the Supreme Planning Council, may be built on the lands owned by the tenant or by the Treasury, through renting it out for a period which shall not exceed forty-nine years and for a certain price; it shall be rented out to natural or private judicial entities that will be selected through a tender pursuant to the preproject to be delivered by the Ministry of Health and basic standards to be set.

16 2009 Campus Concept Designs Conceptual sketches by NBBJ-NKY

17 2009 Campus Concept Designs Conceptual sketches by NBBJ-NKY

18 2009 Campus Concept Designs Conceptual sketches by NBBJ-NKY

19 2009 Campus Concept Designs Conceptual sketches by NBBJ-NKY

20 2009 Campus Concept Designs Conceptual sketches by NBBJ-NKY

21 2009 Campus Concept Designs Conceptual sketches by NBBJ-NKY

22 2010 The Client Turkish Ministry of Health Department of Public Private Partnership is established

23 January 2011: Tender announcement for Bed Kayseri Health Campus 2011 First Tender

24 Tender Process Client Preparation Feasibility study and basic standards document prepared by MoH Launch bidding First Stage New design proposal and bids collected Short list announced Competitive dialogue Second Stage Final tender document prepared by MoH Select preferred bidder Contract Formation of SPV and contract negotiations Contract signed

25 Tender Process Client Preparation Hand-over of property by MoH Initial Studies Preliminary designs submitted by the contractor Approval of designs by the consultant and the client Building permits Investment Period Right for construction, hand-over of site Start of investment period Operation Period End of investment period

26 Tender and Investment Periods What is given to bidders? First Stage Tender Documents (Original Bid) Tender Specifications: includes RfP, terms and conditions, expectations from bidders, evaluation criteria, etc. Draft Contract and Appendices: includes financial obligations, service conditions, payment mechanisms, insurance and liability, etc. Functional Program: includes list of departments andspaces, construction areas Concept Design Documents: includes basic drawings, technical specifications, room data sheets, etc. Feasibility Study: includes feasibility of the MoH, preliminary site surveys, etc.

27 Tender and Investment Periods What is given to bidders? Second Stage Tender Documents (Final Bid) Final Design Documents: includes site plan, schematic sections, revised functional program, etc. Technical Specifications: includes medical equipment and furnishing lists, repair/maintenance conditions, Service Formats: includes quantitative information for hard and soft services

28 What is listed as fixed investment? Construction Medical equipment and furnishing (clinical, used by MoH) What is listed as operational investment? Services and procurement Medical equipment and furnishings (non-clinical, operated by the Contractor)

29 Health Campuses and Current Status Payment Type Operating Nature No Service Name Format of Submission Non-Quantitive Hard Soft 1 Estate Services S1 2 Lifecycle Replacement S2 3 Utilities S3 4 Furniture & Furnishing S4 5 Landscape & Garden S5 6 Pest Control S6 7 Car Parking S7 8 Materials Management S8 9 Cleaning S9 Hospital Information Management 10 System (including S10 HW & SW) 11 Security S11 12 Patient Escort, Reception and Portering S12 Quantitive 13 Day Nursery S13 14 Other Clinical Support Services S14 Soft 15 Linen & Laundry S15 16 Catering S16 17 Laboratories S17 Non-Clinical 18 Imaging S18 19 Sterilization S19 20 Rehabilitation S20 Hard 21 Waste Management S21

30 Health Campuses and Current Status Goal of MoH: reaching quality beds by the end of 2018 This means 30 beds / people (UK has currently 29) 4 beds by university hospitals 6 beds by private hospitals 20 beds by public hospitals; which 40% is from PPP Budget A total PPP investment of estimated 14,0 billion

31 Health Campuses and Current Status Beds Client Prep Tender Stage Awarded Contract Signed Investment Period Adana IHC Ankara Bilkent IHC Ankara Etlik IHC Antalya IHC Bursa IHC Denizli IHC Diyarbakir IHC Elazig IHC Eskisehir IHC Gaziantep IHC Isparta IHC 755 Istanbul Ikitelli IHC Izmir IHC Kayseri IHC Kocaeli IHC Konya IHC 840 Kutahya IHC 600 Manisa IHC 558 Mersin IHC Rehabilitation & Psychiatric Hospitals Samsun IHC 900 Tekirag IHC 480 Trabzon IHC 400 Urfa IHC Yozgat IHC 475

32 Case Study: Etlik Integrated Health Campus

33 Ankara Etlik Integrated Health Campus

34 Ankara Etlik Integrated Health Campus Main Hospital with 6 specialty towers (General, oncology, pediatrics, women s, neurology, cardiovascular) + Physical therapy & rehabilitation hospital High security forensic psychiatric hospital Clinical hotel

35 Ankara Etlik Integrated Health Campus car capacity parking garages 4 helipads

36 Ankara Etlik Integrated Health Campus 736 exam rooms 116 operating rooms 272 A&E beds 560 critical care beds

37 Ankara Etlik Integrated Health Campus Longest distance between blocks: 900 meters

38 Thank You