HALIFAX—The findings of a newly released report raising concerns about the province’s proposed P3 funding model for the QEII Hospital Redevelopment project is being described by one advocate as “incredibly worrisome.”

The 54-page report was authored by Larissa Atkison, a research associate with the Canadian Centre for Policy Alternatives (CCPA) Nova Scotia and a Dalhousie University adjunct professor.

Titled ‘Shrouded in Secrecy: The Queen Elizabeth II Hospital Redevelopment and the Privatization of Nova Scotia’s Health Care Infrastructure,’ it was co-published by the CCPA and the Nova Scotia Health Coalition.

“In this climate of flailing P3 (public-private partnership) models locally and globally, the Nova Scotia government’s announcement last October to go forward with P3 builds for this crucial hospital infrastructure update seemed irresponsible, yet the premier insisted that this P3 would benefit from the lessons learned in the past and be different from the (province’s past P3) school failures,” Atkison said at a press conference in Halifax.

“And yet the justifications that followed to defend this decision immediately suggested that very little had in fact been learned or changed.”

The ‘Shrouded in Secrecy’ report was released just one day shy of the one-year anniversary of Premier Stephen McNeil’s Oct. 4, 2018 announcement that construction to expand the Halifax Infirmary site and develop the community outpatient centre in Bayers Lake will come through a P3.

As part of that long-awaited and massive QEII Health Sciences Centre redevelopment project, cancer-care services will be moved from the Dickson Building at the Victoria General Hospital (VG) to the Halifax Infirmary. The Infirmary will also have an expanded in-patient care centre, and a new community outpatient centre is being built in Bayers Lake.

The total cost of the QEII Redevelopment is $2 billion, which includes P3 costs.

The newly released report documents and critiques the government’s plans for the project, expressing concerns about “secrecy and lack of transparency” around the P3 decision.

“This report identifies a troubling amount of secrecy and obfuscation surrounding the P3 decision,” Atkison told reporters.

She cites the government’s refusal to release the “controversial and confidential” value for money (VFM) report showing the P3 model would provide financial and service level benefits. That information will only be released after the contract with the successful bidder has been signed.

In addition, Atkison said she’s concerned the province hasn’t yet made tender documents released in July available to the public.

“Without access to these documents, it’s really impossible to discern basic information about the project’s scope such as which maintenance services will be privatized as a result of this contract,” she said.

Atkison said the province’s refusal to immediately release tender documents to the public “deliberately compromises” public understanding of, and debate around, the P3 decision.

“Evidence from auditor general reports…from other similar P3 hospital projects in other provinces make it extremely likely that in this province, Nova Scotians will pay more to get less for this hospital if the government decides to go forward with its P3 plans,” she said.

Atkison said her report estimates that on financing costs alone, private financing of the project will cost more than double that of public borrowing. She said the $151 million earmarked for preliminary transaction costs to oversee the QEII’s P3 contract could fund 116,154 overnight stays in hospital beds, 25,267 average hospital stays and a one-year salary for 582 full-time family doctors.

“Or it could fund, wipe out, the more than $85 million funding gap required for urgent province infrastructure requirements,” she added.

Among its key recommendations, the report says the province of Nova Scotia should reverse its decision to pursue a P3 build, revise the bidding process and limit it to a design-build. It recommends financing the redevelopment project through the normal process of debt servicing.

If it does move forward with a P3 model, Atkison states in the report that “it must comply” with the Public Procurement Act and be open, consistent and transparent.

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Chris Parsons, provincial co-ordinator of the Nova Scotia Health Coalition, said when he first read the report, it was the “scope of the secrecy” that surprised him most. During Thursday’s press conference, he described the scenario as “incredibly worrisome.”

“I thought that Nova Scotia was sort of just as secretive as everyone else and I think it’s actually pretty surprising that they’ve somehow managed to be even more secretive about this,” Parsons later said in an interview.

What Parsons believes Nova Scotians should take away from the report is that money “misspent” on building infrastructure will not go to frontline health care services.

“If we want to be able to pay for things like getting more doctors and nurse practitioners in communities, if we want more long-term care beds, we need to be careful to make sure that we’re not borrowing money at over double the rate that we could,” Parsons said.

In an emailed statement, Department of Transportation and Infrastructure Renewal spokesperson Marla MacInnis said taking the P3 route provides the province with more certainty around project costs and timelines, saves money and will make sure the buildings are maintained “in a high-quality state” for the next 30 years.

MacInnis said the request for proposals tender process must be confidential as it includes project design, contract specifications and other pieces of information that can’t be shared until contracts with a partner are signed and in place.

“We want to make sure Nova Scotians are getting the best value for their investment – that means securing a partner with a competitive bid,” MacInnis said.

“As we’ve said all along, when procurement is complete, we will release the information for Nova Scotians to see. We want to get the best deal for Nova Scotians. Releasing those documents could jeopardize that and we aren’t prepared to take that risk.”

In her report, Atkison points to other provinces, including B.C., which publicly release such documents before deciding on a successful bidder. She said they also do it prior to signing any project agreement “without any impact on the competitive bidding process.”

“I would like the average person in Nova Scotia to have access to all relevant information and to realize that when they’re told that these P3 decisions or a decision to privatize health care infrastructure is in their best interest, that it might not be,” Atkison said in an interview.

“A decision to privatize health care infrastructure often ends up privileging corporate interests over Nova Scotian residents and it will cost more over the long haul and there’s no reason why we can’t fund a fantastic QEII Redevelopment process through normal debt servicing.”

The NDP Caucus introduced a bill on Thursday that would require the provincial government to release financial details of P3 projects before contracts are signed, noting that similar legislation exists in Manitoba. The party said its P3 Transparency Act would give the public an opportunity to evaluate “whether or not these projects are good value for money.”

Yvette d’Entremont is a Halifax-based reporter focusing on health. Follow her on Twitter: @ydentremont

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