After at least three reports and five years of research the Bermuda Hospitals Board revealed initial plans for a 25-year phased-in process for the King Edward VII Memorial Hospital.

Only the first five years of the plan, which are estimated to cost $315 million have been approved by Government and even those were tempered by CEO David Hill who said construction would not begin for another two years.

The price tag is almost half of the $500 million originally estimated by the Estate Master Plan completed in 2005 by CannonDesign/OBM which suggested a completely new hospital in the near future. After the EMP's suggestion to build a new hospital on the Botanical Gardens was loudly refuted by the public, Johns Hopkins was commissioned by the BHB to review the EMP report and came-up with a phased-in approach that would cost initially about $315 million.

The EMP's suggestion on the new hospital was among other recommendations in the 2005 report that have been analysed and reviewed by Johns Hopkins as part of their mandate and documented in two reports.

Here is a quick look at some of the analysis as it is laid out in the Second Phase of the Johns Hopkins Report that was made public yesterday.

EMP: the existing KEMH facility had limited useful life due to ageing building systems, infrastructure, medical equipment and maintenance and recommended the complete replacement of the hospital.

Johns Hopkins Review: agreed with this analysis for "ideal investment strategies" but also stated that replacing the entire hospital was not "a viable option" nor was it affordable.

They recommended that: "Based on this current understanding, the planning teams developed a strategy for continued reuse of existing facilities for a significant period of time.

"The existing ageing hospital buildings cannot adequately support contemporary hospital high-intensity clinical services, but in the planning team's opinion, can continue to support low-intensity, a more limited range of clinical services, administrative services and support services well into the future as the overall super structure is sound."

While recognising that delaying development could lead to higher costs because of inflation, they also urge BHB to limit their investments in the existing facilities to "aesthetic upgrades".

So the JHI's "Alternative Campus Planning" study attached to the Johns Hopkins Report phase II offers a four phase report to complete the hospital in 25 years.

It starts with building two wings to the current KEMH site, a new Central Utility Plant and renovations to the current building totalling $315 million.

The next phases include relocating the nursing staff residence off-campus, the continuing care unit and the hospice unit.

EMP said: KEMH "exhibits many of the characteristics that would be expected to be found in health facilities that are in excess of 40 years old." And concluded that it was "at the end of its useful life" and maintenance would only be reactive.

Johns Hopkins Report: both the new BHB board and the architects reviewed the conclusion and reviewing the 'backlog maintenance' found that the board could develop and execute a remedial action plan over a period of five to six years that could prolong the 2012 (end) date by 10 to 15 years following a backlog implementation.

Both the Johns Hopkins Reports and the EMP: agree removing Continuing Care patients from KEMH — an acute care centre — was important.

Johns Hopkins Report: "Relocation of the Continuing Care Facilities from the King Edward VII Memorial campus is a critical path item to expedite development of the hospital replacement facility."

But while the first Johns Hopkins Report and the EMP both envisioned three Continuing Care facilities located at MWI, Morgan's Point and Southside St. David's, the second Johns Hopkins Report indicated that removing the third one at MWI would help with the development of both KEMH and MWI.

They state: "Due to phasing concerns for development on the MWI site the phase II Review Team would recommend that containing care replacement facilities not be located on that campus."

EMP: proposed two primary care centres in the East and West Care Campuses

Johns Hopkins Report: criticises the recommendation in the EMP severely, pointing at their severe underestimation of the capital expenses for these campuses.

However, there appears to be no mention of how these primary care centres will be developed.

Government announced this year two urgent care centres at Southside and in Southampton and in the budget this year $2.5 million was allocated for the Southside centre which is still scheduled to be built by April 1, 2009.

The second building will be in next year's budget and yesterday Health Minister Nelson Bascome made it very clear at the press conference that the Urgent Care Centres were completely separate from the Continuing Care Centres.

He said: "Urgent Care Centres are still being developed. In terms of Continuing Care that falls out of just the remit of health.

"The period of this plan will deal with accute care and that may help us come up with a plan how Continuing care can be developed over a period of time."

EMP: looked at an overall reduction in the number of beds as length of stay is reduced and private accommodations allows for increased turnover. Must be implemented in the next five years.

Johns Hopkins Review: said: "The proposed alternate planning concept allows for phased implementation of recommended improvements in bed utilization."

They also proposed a long-range acute care bed capacity of 154 beds excluding nurseries. The first phase of the project with the patient tower will provide at least 90 new private rooms.

That, according to Dr. Donald Thomas, the Chief of Staff will help create private rooms even in the Continuing Care Unit that will not be changed dramatically until the next phase of the report.

Helping with this move to include 100 percent private beds is the move by BHB to billing per complaint (injury, trauma etc.) rather than per diem which it was in the past.

EMP: found a shortfall in space of 131,00 square feet and recommended the development of a medical office building designed to provide physician office space on campus.

Johns Hopkins Review: showed a shortfall of 185,000 square feet to meet contemporary standards and recommended changing the use of this building to an Ambulatory Care Centre housing hospital outpatient services and offices for international specialists.

According to the report, even with this recommendation there is still a short fall of at least 150,000 square feet which is reflected in their phased-in process which has managed to bring the square footage of the hospital from an overall 300,000 to 500,000 square feet.