Bilaga - Nya Karolinska Solna

3. PPP Opportunity
In addition to being the flagship construction project in terms of size and importance, the New
Karolinska Solna Hospital PPP whilst being designed to meet the Council’s healthcare
requirements would be conscious of investor needs. The PPP project would be structured in a way
that recognises accepted principles and tried and tested project scope. Therefore, the project
scope is likely to closely resemble a typical UK PFI project with greenfield construction and the
typical range of facilities management services. The PPP legal structure would be based on
internationally accepted PPP principles. The commercial and legal structure would allow direct
comparison with other hospital PPP projects in the UK and globally supporting competitive
financing and longer term secondary market liquidity for debt and equity.
New Karolinska Solna Hospital has the potential to be one of the first of a series of PPP projects in
Sweden. A new coalition Swedish government was elected in 2006. The new government has
clearly indicated its interest in trying new forms for procurement, risk sharing and financing of public
investment, in particular for large public infrastructure investment projects. It has commissioned a
study from the road and rail authorities, which identified no absolute legal or other impediments to
PPP in Sweden. The government is considering the use of PPPs as an option to improve economic
efficiency, in particular for train and road projects. In the coming Infrastructure Bill that will be
proposed to the Riksdag (the Swedish parliament) in March, it is likely that the Government will ask
for permission to initiate the procurement using PPP for a few selected road and rail projects. In
other sectors such as defence and municipal investments, PPP is already being implemented as
pilot projects have been announced and are being procured. If positive experiences can be
demonstrated, schools and hospitals may follow suit.
Public expenditure in Sweden accounts for a high share of GDP and the scale of decentralisation
of tasks to Municipalities and County Councils is substantial in international terms. Municipalities
and county councils account for the bulk of welfare services by being responsible for schools,
healthcare and other forms of care, local government expenditure accounts for a higher share of
GDP than in most other countries. On average some 70 per cent of municipal and county council
costs for services are financed by local taxes. Only a small proportion of the revenues, 15 per cent
on average, consists of central government grants. The Stockholm County Council has a stable
AA/A-1+ Standard and Poors credit rating.
The existing hospital facilities will continue in operation until the new facilities are available. Whilst
some buildings on the site will be demolished in preparation for the new hospital it will be to all
intents and purposes, a green field project. The project will not include the demolition works nor
any refurbishment or use of existing facilities. The PPP could also include the construction,
operation and running of the adjacent patient and families hospital, although that is not currently
included in the scope of the estimated costs.
The initial investment will include the financing and construction of the new facilities according to
specifications made by Council. The specification will be output based and conceptual in an effort
to promote innovation from bidders. A design that maximises operational flexibility is a key
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