Caribbean Infrastructure, Government & Healthcare Credentials - January 2020 Infrastructure, Government & Healthcare www.kpmg.com/infrastructure
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Caribbean Infrastructure, Government & Healthcare Credentials January 2020 Infrastructure, Government & Healthcare www.kpmg.com/infrastructure
Contents Power and water.....................................................................3 Energy infrastructure............................................................................ 4 Bermuda water and wastewater treatment.......................................... 5 Rio Cobre water treatment plant P3..................................................... 6 Bahamas energy sector reform............................................................ 7 Solid waste management in the Cayman Islands................................ 8 Utility Company procurement function................................................. 9 Health is wealth.................................................................... 11 National Health Fund expansion..........................................................12 Hospital redevelopment Phase 1.........................................................13 Cayman mental health facility............................................................. 16 Bahamas National Health Insurance....................................................17 Trinidad and Tobago hospital redevelopment..................................... 18 Acute care clinical services improvement.......................................... 19 Bermuda Health Council/Ministry of Health....................................... 20 Hospital redevelopment P3, Bermuda............................................... 21 Climate action and infrastructure......................................23 Kingston dock yard project................................................................. 24 Arawak shipping port.......................................................................... 25 Airport financing in Barbados............................................................. 26 L. F. Wade (Bermuda) International Airport redevelopment P3......... 27 Cruise ship ports................................................................................. 29 A better future...................................................................... 31 Economic impact studies.................................................................... 32 35th America’s Cup............................................................................ 33 John Gray High School in the Cayman Islands................................... 34 Social care and assistance programs.................................................. 35 Good governance..................................................................37 Bermuda tax reform............................................................................ 38 Ministry of Tourism intelligent character recognition......................... 39 Securities Commission of The Bahamas supervision platform......... 40 Government reform.............................................................................41 Immigration process improvement..................................................... 43 EU Economic Substance regulations implementation....................... 44 EU Economic Substance compliance platform.................................. 45 National Anti-Money Laundering Policy............................................. 46
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1 Caribbean Infrastructure, Government & Healthcare credentials
Introduction
Around the world, government
and public sector organizations are
facing a multitude of pressures from
fiscal sustainability to deteriorating
infrastructure, impact of climate
change and public pressure
to deliver quality healthcare to
aging populations.
How governments choose to address these challenges
impact every part of a country’s economy. KPMG’s
Global Infrastructure, Government and Healthcare
practices work to deliver meaningful results through a
Cayman Islands
deep understanding of issues, an intimate appreciation
Solid waste management in the Cayman Islands
of how the public sector works, and global and local Cayman mental health facility
insight into the cultural, social and political environment. George Town port
KPMG is a leader in the provision of a broad range of John Gray High School
Infrastructure, Government and Healthcare advisory Modernization of social assistance programs
services with practical, hands-on local experience
to help our clients implement transformational
strategies, economically, efficiently and effectively.
KPMG compiled this selection of regional case studies
to illustrate how island governments are confronting 21st
century challenges with bold and innovative approaches.
Simon Towned
Head of Advisory
KPMG Islands Group
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the independent member firms of the KPMG network are affiliated. All
rights reserved.
Caribbean Infrastructure, Government & Healthcare credentials 2
Bermuda
Water and wastewater treatment
Hospital redevelopment P3, Bermuda
Bahamas L. F. Wade (Bermuda) International Airport redevelopment P3
35th America’s Cup
Energy sector reform Tax reform
National Health Insurance Immigration process improvement
Arawak shipping port EU Economic Substance regulations implementation
Nassau cruise port expansion
Ministry of Tourism intelligent character recognition
Securities Commission supervision platform UK Channel Islands
EU economic substance
compliance platform
Antigua and
Barbuda
British Virgin Islands
Port of St. John’s
Pier and landslide development
Government HR analysis
Jamaica
Rio Cobre water treatment plant P3
Micro-LNG receiving terminal
National Health Fund expansion
Hospital redevelopment Phase 1
Kingston dock yard project St. Lucia
Assessing port development options
Barbados
Barbados oil terminal
Airport financing Barbados
Ports strategy and business planning
Trinidad & Tobago
T&T hospital redevelopment
Ministry of Public Administration change management
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3 Caribbean Infrastructure, Government & Healthcare credentials
Power
and water
Our day to day lives would be
impossible without water and energy.
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International provides no client services and is a Swiss entity with which
the independent member firms of the KPMG network are affiliated. All
rights reserved.
Caribbean Infrastructure, Government & Healthcare credentials 4
Energy
infrastructure
A selection of credentials:
Barbados oil terminal – valuation and strategic
sale advice
• Barbados National Oil Company considered fully divesting
its shares in the Barbados National Terminal Company
Limited, (“the Terminal Company”) in line with the Barbados
Government’s fiscal prudence plan. KPMG in Barbados was
engaged to advise on this strategic transaction.
• KPMG in Barbados assisted with preparation of a
comprehensive valuation of the Terminal Company and
managed the sales process, including: preparing a teaser
document, information memorandum for interested parties,
setting up and managing the data room, and facilitating the
buyer due diligence process. At the end of the sale process,
KPMG in Barbados presented the Terminal Company’s Board
with final offers, a comparative analysis and helped negotiate
the Sale and Purchase Agreement.
Jamaica Micro-LNG receiving terminal –
business valuation
• Located at Berth #1, in the Port of Jamaica, Montego
Freeport, the project consisted of the installation of a
purpose-built Micro-LNG Receiving Terminal to receive, store,
and regasify LNG.
• KPMG in Jamaica performed a valuation of certain tangible
assets required to assist the client in securing of financing
from National Commercial Bank Jamaica Limited. The
tangible assets identified for valuation included land;
buildings; the receiving terminal; the regasification facility;
and natural gas pipeline.
• The valuation report was completed within client timelines
and assisted the client in securing financing from National
Commercial Bank Jamaica Limited. The facility has been
commissioned and is currently delivering fuel to the Bogue
power plant.
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no client services and is a Swiss entity with which the independent member firms of the
KPMG network are affiliated. All rights reserved.
5 Caribbean Infrastructure, Government & Healthcare credentials
Bermuda water
and wastewater
treatment
Financial feasibility study
Context KPMG’s role Outcome
The Government of Bermuda completed • Indicative consumer rates were
Advised on the financial
the development of a strategy for developed using traditional and
feasibility of the proposed
Sustainable Water and Wastewater P3 financing approaches.
plan to integrate the
Servicing for St. George’s Parish. The activities of supplying water, • The public engagement
strategy document examined the wastewater collection process assisted in assessing
treatment and distribution of potable and treatment in St. consumers’ views on the
water, the collection and treatment of George’s Parish. indicative rate structure
wastewater and the practical reuse of the which will inform a future
treated wastewater. Assessed the financial business case.
implications of using • The plan was made available
The Bermuda Ministry of Public Works traditional or P3 financing. for the pubic to view in
engaged a consulting engineering firm December 2017.
to evaluate the present state of water Developed an indicative • KPMG in Bermuda suggested
infrastructure and propose an integrated rate structure to illustrate a number of options which
resource plan for a water and wastewater the estimated costs to could be explored to
servicing for St. George’s Parish as a consumers of the strategy. reduce consumer fees and
pilot. This pilot is intended to be used as attract financing.
a roadmap to implement a similar plan
for Bermuda.
Key Contacts
Steve Woodward
Managing Director
Lori Rockhead
Director
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Caribbean Infrastructure, Government & Healthcare credentials 6
Rio Cobre water
treatment plant P3
Financial advisory
Context KPMG’s Role Outcome
Water supply to the major population KPMG in Jamaica assisted NWC KPMG’s in Jamaica’s work was
centers of the Kingston Metropolitan management with obtaining approval completed within client timelines
Area (“KMA”) has not met demand from the necessary government bodies and assisted with obtaining
due to insufficient production and to proceed with the project as well as approval from PIMSEC to proceed
systemic losses. assisting NWC in its negotiations with the with negotiations with the Project
Project Consortium, including: Consortium. KPMG in Jamaica
• reviewing the Project Consortium’s also assisted NWC in negotiating
Notwithstanding National Water
pricing model for accuracy and the terms of the water purchase
Commission’s (“NWC”) replacement
consistency with the Water Purchase agreement with the Project
of major water treatment plants and
Agreement (“WPA”); Consortium.
various other works across Jamaica, it is
estimated that the KMA has a shortfall of • reviewing WPA and providing
up to 50 MIGD (Million Imperial Gallons assistance with the definitions
per Day), with greater shortages during and sources of data used in the
the dry season. agreement; Key Contact
• providing tax advice related to Raymond Campbell
the WPA; Partner
These shortfalls are primarily the result
of 53% of the water produced being lost • performing a high level affordability
before it reaches the customer. analysis of the project based on the
NWC’s methodology for developing
a Public Sector Comparator and a
NWC determined that to increase
Shadow Bid Model; and
supply in KMA over the medium to long
term, the following initiatives would • assisting with the preparation
be implemented: of a business case submitted to
Development Bank of Jamaica and
• re-activation of disused wells;
Public Investment Management
• various non-revenue water reduction Secretariat (“PIMSEC”) for approval.
projects; and
• the procurement of the Rio Cobre,
15 MIGD capacity, water treatment
plant at Content, St. Catherine at an
estimated cost of US$60 million.
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7 Caribbean Infrastructure, Government & Healthcare credentials
Bahamas energy
sector reform
Financial advisory and regulatory services
Context Outcome
Until a few years ago, electricity supply As part of the restructuring of
across The Bahamas was provided by the the energy sector, the Bahamian
Bahamas Electricity Company (“BEC”), Government passed new
except in Grand Bahama and a few other electricity legislation, appointed
isolated locations. Over the years, BEC an independent regulator for the
became inefficient and heavily burdened sector, and established a new
with debt, resulting in a high of electricity electricity utility for The Bahamas,
to the consumer. which continues to be owned
100% by the Government. A new
financing structure is being
BEC is also completely reliant on fossil
implemented in 2020.
fuel generation with no renewable
energy production in the energy mix.
The Government of the Commonwealth of A business plan was developed for
The Bahamas embarked on a restructuring the new utility, Bahamas Power
of the energy sector with the goal of and Light Company Ltd. (“BPL”),
dramatically reducing the cost of energy to which called for a complete
the consumer while developing a reliable, restructuring of the energy mix and
cost effective, secure and environmentally operations of the former BEC, and
responsible energy sector. includes a significant renewable
energy component across the
KPMG’s role many islands in which the utility
operates. BPL has responsibility for
KPMG in The Bahamas acted as advisor
the provision of electrical supply
to the Bahamian Government in the initial
to 25 island locations across The
stage of the reform process and provided
Bahamas, providing power to
the following services:
over 100,000 customers. This
• regulatory advice with respect to restructuring is ongoing, and BPL is
new legislation; in the process of replacing its base
• advice on restructuring and related load plant with more efficient, multi-
matters; and fuel engines.
• various financial modelling and other
advisory services. Key Contacts
Simon Townend
Partner
Shana Lee
Managing Director
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(“KPMG International”). KPMG
International provides no client services
and is a Swiss entity with which the
independent member firms of the
KPMG network are affiliated. All rights
reserved.Caribbean Infrastructure, Government & Healthcare credentials 8
Solid waste
management in the
Cayman Islands
Financial advisory and procurement assistance
Context • Reduce
The Cayman Islands primarily uses a landfill • Reuse
disposal system on each of its three islands • Recycle
with the Department of Environmental • Recover
Health (“DEH”) being responsible for the
• Dispose
collection of residential and commercial
solid waste along with private haulers.
KPMG’s role
KPMG in the Cayman Islands was
However, there are no franchise collection
appointed as the financial advisor on
contracts or service agreements in place
the engagement supporting a team led
between DEH and the haulers. DEH’s
by AMEC Foster Wheeler as the lead
solid waste revenue is largely generated
consultant. KPMG in the Cayman Islands
from fees on vehicle disposals and
assisted with:
removals, incinerations and container
rentals as well as an annual allocation • Identifying funding and financing
from the Cayman Islands Government’s options for the integrated solid waste
(“CIG”) budget. There is limited revenue management strategy report.
from recycling (most recently scrap mental • Preparing the financial case portion
sales) and no tipping fees are charged for of the outline business case
landfill disposal. issued in accordance with the UK
Treasury’s Greenbook and Five Case
Model format.
In addition to environmental concern,
Grand Cayman’s landfill is expected to • Preparing and evaluating the financial
reach maximum capacity in approximately sections of the tender process.
six years and Cayman Brac’s landfill is The tender was executed through
already at capacity. a competitive dialogue process for
a Design-Build-Finance-Operate-
Maintain contract.
Key Contacts The Challenge
Kris Beighton The CIG has undertaken to develop and
Partner implement a cost-neutral, environmentally Outcome
Ashita Shenoy responsible, 50-year integrated solid The Preferred Bidder was
Director waste management strategy based on the announced in 2017 and the facility is
preferred hierarchy of: scheduled to be completed in 2021.
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Utility Company
procurement function
Procurement policies and procedures, spend
analysis, and fuel procurement services
Context Outcome
The Utility Company (“the Company”), Additionally, the KPMG member firm 1. The engagement team
sought an assessment of its procurement provided project management and leading completed the PMA and
processes to determine if its processes practice procurement advice for tendering provided a report to the
were consistent with leading practice. a multi-year fuel supply contract. Company on the, then, current
The objective of the assessment was to state of their procurement
identify if there were gaps which may KPMG’s role processes. This report also
result in achieving suboptimal value from included discussion on leading
its procurement function. The engagement team conducted a best practices regarding key
Procurement Maturity Assessment procurement function areas
(“PMA”) using methodology which and identified gaps between
In 2017, a KPMG member firm a was provides a consistent framework based current and leading practice.
engaged to: on maturity levels for the power and utility The engagement team
Report on the state of the industry. provided recommendations
procurement processes and to close these gaps and
share initial findings from an Areas of focus included: enhance the Company’s
online survey, interviews and procurement function.
1. Strategy: direction setting,
data analysis. governance and meeting 2. As a result of the updated fuel
regulatory requirements supplier procurement process
Discuss leading practices the Company was able to
2. Organization: organization structure
for key procurement function receive new and innovative fuel
and people
focus areas. supply options, more closely
3. Enablers: data and technology aligned with their objectives.
Discuss fit-for purpose enablement of key processes; The Company secured
initiatives based on leading 4. Processes: the existence and improved margins on fuel
practices and identify the efficiency of support processes supply with resulting savings
most practical action items for being passed through to the
the Company. power consumers in the form
The engagement team also reviewed
of lower fuel costs.
the Request for Proposals process for
heavy and light fuel supply, assisting with 3. The engagement team assisted
the question and answers process and with developing the policy and
analyzing received bids. procedures for the Company’s
procurement function which
address control weaknesses.
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services and is a Swiss entity with which the independent member firms of the KPMG network are
affiliated. All rights reserved.Caribbean Infrastructure, Government & Healthcare credentials 10 2020 KPMG International Cooperative (“KPMG International”). KPMG International provides no client services and is a Swiss entity with which the independent member firms of the KPMG network are affiliated. All rights reserved.
11 Caribbean Infrastructure, Government & Healthcare credentials
Health is
wealth
Dr. Mark Britnell’s speech at the
Caribbean Infrastructure Forum in
2018 elegantly underscored that
a healthy population translates to
greater economic prosperity.
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International provides no client services and is a Swiss entity with which
the independent member firms of the KPMG network are affiliated. All
rights reserved.Caribbean Infrastructure, Government & Healthcare credentials 12
National Health
Fund expansion
Advisory services
Context KPMG’s Role Outcome
The National Health Fund (“NHF”) KPMG in Jamaica provided consulting KPMG in Jamaica developed an
in Jamaica was established by the services regarding the sustainability of the integrated financial model which
NHF Act, effective 1 April 2003, with NHF based on an expanded mandate. included a range of sensitivities and
a mandate to reduce the burden of scenario options. The final model
healthcare in Jamaica. It achieves this included pricing impacts for the
The sustainability study took into account:
objective by providing health related approximately 1,400 drugs on the
funding and information, and selected The current coverage of chronic Vital, Essential and Necessary list,
healthcare benefits, thereby resulting conditions, supporting drugs, profit and loss impacts for changes
in an improvement in the overall health the current level of subsidies and in the three primary revenue
of the Jamaican population. The NHF usage patterns. sources, the subsidies provided to
is organized around five core functions; individuals with covered illnesses,
individual benefits, institutional benefits, operating costs and changes in
pharmaceutical division, Drug Serv The adequacy of funding and pharmacy services.
division and health promotion. existing reserves to meet NHF’s
obligations in various scenarios
The model and summary
The NHF provides a subsidy for all persons report was accepted by all key
residing in Jamaica, regardless of age, The financial impact of the stakeholders and was referenced
gender and income, to assist them with Pharmacy Services expansion in the 2017/2018 Sectoral Debate
their purchase of prescribed drugs, tests project on the sustainability of in Parliament.
and supplies used in the management and the NHF, with the addition of
treatment of 15 specific chronic illnesses. 20 public hospitals and eight
NHF procures, warehouses and distributes comprehensive health centers.
pharmaceuticals and medical supplies to Key Contact
21 public hospitals and 360 government Raymond Campbell
health centres. Additionally, the Drug Serv The financial impact of the
Partner
division provides retail pharmacy services Public Private Partnership on the
to public and private sector clientele sustainability of the NHF, with the
across 16 pharmacies. inclusion of 165 pharmacies in
the program.
The Challenge
The NHF was mandated to increase the The sustainability of the current
number of hospitals, health centers and sources of funding.
pharmacies that they manage as well
as distribution of drugs to public sector
patients through private pharmacies in a
new Public Private Partnership model.
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Hospital
redevelopment Phase 1
Financial advisory and procurement services
Context Outcome
University Hospital of the West UHWI and the Government of Jamaica KPMG in Jamaica developed an
Indies (“UHWI”) primarily consists of have agreed that new contemporary integrated financial model which
older buildings, some of which were hospital facilities are needed to respond included a range of sensitivities
constructed over 50 years ago and suffer to the modern healthcare needs of and scenario options, and also
from significant deficiencies. This has led Jamaicans and the wider region. prepared a business case which
to many and varied electrical, cooling and was used to obtain the UHWI’s
structural maintenance issues. Ongoing KPMG’s Role Board approval of the project.
repairs have had minimal impact on the KPMG in Jamaica worked with
adequacy of the buildings and building KPMG in Jamaica was engaged by UHWI the UHWI team in understanding
systems, and the frequency and cost to develop a business case in order to the procurement options, followed
of repairs is increasing as many of the confirm the viability of Phase 1 of the by UHWI team’s selection of a
buildings and building systems have redevelopment project and to develop preferred procurement strategy
passed their useful life. an analysis and comparison of potential and the development of a high level
procurement strategies. procurement plan.
The demand for surgeries exceeds the The business case assessed the viability
capacity of the existing facilities resulting KPMG in Jamaica also assisted the
of Phase 1 of the redevelopment
in long wait times and underutilized UHWI team in its discussions with
project, through:
staff. Additionally, UHWI operations are the Jamaican Minister of Health
fragmented and the current layout does • financial analysis of preliminary cash and Wellness on the economic and
not lend itself to seamless, efficient, flow estimates; financial viability of the project.
synergetic relationships between • qualitative assessment;
departments such as, for example, • market and investor sounding; and
Accident and Emergency, Radiology and
• development of procurement strategy
Critical Care. Key Contact
options and process framework.
Raymond Campbell
Further, the demand for healthcare Partner
services is increasing due to demographic
changes and population growth.
Additionally, growth in the medical faculty
student population has increased the need
for additional infrastructure to provide
clinical training for the students.
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firms of the KPMG network are affiliated. All rights reserved.Caribbean Infrastructure, Government & Healthcare credentials 14 2020 KPMG International Cooperative (“KPMG International”). KPMG International provides no client services and is a Swiss entity with which the independent member firms of the KPMG network are affiliated. All rights reserved.
15 Caribbean Infrastructure, Government & Healthcare credentials
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Cayman mental
health facility
Financial advisory
Context The Challenge Outcome
Historically, the Cayman Islands did not In July 2015, the CIG issued a Request The OBC was approved by
have a long-term residential mental health for Proposal (“RFP”) for financial and the CIG Cabinet in May 2016.
facility, mental health policy or a mental technical consultancy services to prepare The procurement process was
health plan. In February 2015, the Cayman an Outline Business Case (“OBC”) for completed in 2018 and construction
Islands Government (“CIG”) approved the the proposed LTRMHF developments in began in October 2019.
policy guidance for the development of the Cayman Islands. This engagement
the Long Term Residential Mental Health involved the consideration of the five
Facility (“LTRMHF”) with the project options put forward in the Strategic
intention to support the CIG’s Strategic Outline Case and the preparation of an Key Contacts
Aim and Policy Objective of “a fit and integrated OBC to determine the best Kris Beighton
healthy population”. option for the Cayman Islands community. Partner
Ashita Shenoy
Through the preparation of a Strategic
KPMG’s role
Director
Outline Case, the CIG identified the KPMG in the Cayman Islands was
following five options: engaged as Prime and Financial
Consultant to the CIG, with services
Option 1: provided including:
Status Quo • coordinating a multidisciplinary
engagement team including external
partners serving as the Mental
Option 2: Health Facility and Construction Cost
Enhanced Status Quo
Consultants;
• interviewing and holding consultation
Option 3: meetings with the various
Building a LTRMHF stakeholder groups;
for the local population • providing health sector expertise with
contribution from KPMG’s network of
member firms;
Option 4:
• performing valuation and financial
Building a LTRMHF for the
analysis on the five options presented
local and overseas population
in accordance with the HM Treasury
Green Book guidance;
Option 5: • managing the compilation and
Cayman Islands Government timely completion of the overall
to tender for local service deliverable; and
• presenting the OBC findings to the
CIG Cabinet.
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Bahamas National
Health Insurance
Implementation and ongoing expansion of
National Health Insurance in The Bahamas
Context Outcome
The Government of The Commonwealth • Supporting Board training The Bahamas has successfully
of The Bahamas (“the Bahamian and a comprehensive Board created and implemented NHI, a
Government”) sought to implement orientation program. key component of UHC.
a Universal Health Coverage (“UHC”) • Providing project management
program, a component of the Sustainable support for the creation of NHI. NHI now has close to 70,000
Development Goals initiated by the
• Supporting the procurement Bahamians enrolled, 4,000 of whom
United Nations and the World Health
process for an integrated electronic are under the age of 5, and 9,250
Organization. Accordingly, the Bahamian
health records system and claims senior citizens over the age of 65.
Government developed a National
administration system. 55 provider facilities and close to
Health Insurance (“NHI”) program as the
• Supporting development of a policy 100 primary care physicians are
financing mechanism to provide UHC in
framework, inclusive of jurisdictional registered across 14 islands of
The Bahamas. NHI Bahamas launched in
benchmarking, and drafting of new The Bahamas.
April 2017.
NHI legislation.
KPMG’s role The NHI program continues to
More recently, KPMG in The Bahamas evolve as fiscal and capacity
KPMG in The Bahamas has acted as
has been engaged by NHIA to assist with challenges are addressed and
advisor to the Bahamian Government in
the following: is currently in the feasibility and
the initial design and continues to advise
• Supporting implementation of the assessment stage for the next
on the implementation of NHI Bahamas,
electronic health records and claims phase of NHI which intends to
through a multi-phase engagement.
administration systems. add more services and introduce a
Standard Health Benefit amongst
Areas of consultancy include: • Review of network and technology
other initiatives.
infrastructure and establishment of
• Conducting an evidence-based
cyber security controls and safeguards.
investigation of service delivery
costs and developing risk-adjusted • Advising and supporting the NHIA
capitation rates to provide a on development of a business case Key Contacts
reimbursement model for providers and financial analysis for proposed
expansions of NHI services and Simon Townend
(doctors, laboratory, etc.). Partner
reforms, including a current state
• Facilitating the NHIA organizational Shana Lee
analysis, future state analysis, and
design and advising on the Managing Director
financial projections.
development of the NHI
• Supporting the revision of NHI Nico Maritz
Target Operating Model and IT
legislation to reflect proposed reforms. Director
System Blueprint.
Shripal Doshi
Project Manager
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Trinidad and Tobago
hospital redevelopment
Individual master plans for three
public hospitals in Trinidad & Tobago
Context KPMG’s role
The Ministry of Health of Trinidad and The engagement team comprising • performing sensitivity analysis
Tobago commissioned Master Plan resources from KPMG’s Global Healthcare over key financial model inputs and
Studies of the Country’s three largest practice and KPMG in Trinidad and assumptions; and
acute care hospitals: Port of Spain Tobago, was retained as the financial • providing net present value and
General Hospital, Eric Williams Medical consultant within a project consortium led cash flow comparisons between
Sciences Complex and San Fernando by B+H Architects. various options.
General Hospital.
KPMG in Trinidad and Tobago, in
The master plans included development of: consultation with other team members, Outcome
was responsible for developing the overall The master plans have been
new service delivery model(s) vision of care for each of the hospitals
to align care delivery and built completed, the engagement team
and the business case for the proposed provided two separate deliverables:
infrastructure; redevelopment options. the Future Visioning Report and the
Business Case Report.
business case analysis of the The scope of work included:
feasibility of the proposed • facilitating workshops with key
implementation strategy; stakeholders to create a compelling
vision for hospital care that would
help drive the planning and design of Key Contact
short and long-term each of the three hospitals; Dushyant Sookram
architectural and site plan
• research into leading practices, Partner
development strategies;
trends, demographics, and services
delivered today and in future
enhanced use of clinical and clinical scenarios;
back-office technology; and • projecting healthcare service
unitization and hospital capacity over
a twenty-five year planning horizon;
incorporation of research and
• facilitating workshops to educate key
medical education.
stakeholders regarding traditional
and alternative (P3) infrastructure
delivery models;
• developing financial models to
perform options analysis between
various hospital delivery options;
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Acute care clinical
services improvement
Operational excellence in clinical services
Background Identified clinical process Operational cost efficiencies
The client’s (“the Hospital”) ability to improvements The engagement team provided
deliver on its mandate of providing high To overcome the challenges, the proposals to minimize spend on non-
quality care has been challenged by rising engagement team proposed optimizing value added items such as back-office
costs and a rapidly ageing population. services in the following areas: support services.
Facing a forecast deficit of US$40 million, • Maximizing patient flow and reduction
the Hospital developed the Clinical of variation in how care is delivered.
Services Programme (“CSP”) together Outcome
• Opportunities for de-escalating care.
with its Financial Recovery Plan to achieve • The multi-jurisdictional team
significant savings over a period of • Optimizing length of stay in
have worked very closely with
four years. the hospital.
the clinical teams to identify
• Identifications and securing of process improvements and
KPMG’s role elective patient pathway. savings without an adverse
• Improving operating theater impact on the quality of care.
The engagement team identified
scheduling and performance. • As a result of the engagement,
three key challenges that needed to
be overcome to ensure successful • Optimizing staff scheduling. the average length of inpatient
implementation of the CSP: • Using appropriate medication and stay has been reduced.
1. Improving the quality of care without clinical devices including moving to • Wait time for CAT scans and
increasing cost at the time when generic drugs where appropriate. ultrasounds has decreased
the Hospital was facing budget while utilization of diagnostic
constraints. imaging increased.
Governance
2. System inertia and the need to The engagement team also
secure staff buy-in into the proposed reviewed policies and provided
change and the need to manage staff recommendations on:
engagement on an ongoing basis.
• Financial and corporate governance
3. Ageing population and higher necessary to deliver required savings
care costs associated with island with no (or minimal) impact on
jurisdictions and limited access to service provision.
specialized care.
• Financial and operational controls with
the view of improving performance
management and accountability for
enhanced service delivery.
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Bermuda Health Council/
Ministry of Health
Healthcare reform communications strategy
Context Outcome and phase 2
Bermuda Health Council’s (“BHeC”) BHeC and the Bermuda Ministry of Health launched its health finance reform in line
strategy envisaged a reform of Bermuda’s with the communications plan in 2019. Additionally, KPMG in Bermuda is engaged
healthcare system to achieve greater to assist with the process of reviewing and redrafting the 2020-25 Bermuda Health
sustainability, accessibility, affordability Strategy, in partnership with the Ministry of Health and Bermuda Hospitals Board.
and improved health outcomes.
To implement that strategy BheC was This work is currently underway and will comprise:
looking for assistance with communicating
the significant changes in financing of Analyzing background data and engaging stakeholders to develop a
healthcare in Bermuda. comprehensive view of the Bermuda health system as it is now and its
underlying issues.
The planned communication on financing
reform was intended to be transparent Conduct a system leaders’ survey to identify key issues and develop a
and meaningful to start the process of vision of the desired, future state of the health system.
educating the public and stakeholders
about the importance of the reform, the
need for it and anticipated benefits. Produce materials informed by the above analysis and facilitate a
Leadership Workshop designed to develop a consensus view of the
KPMG’s role current system’s challenges and the path towards the future vision.
KPMG in Bermuda helped to craft a
comprehensive communications plan Supporting the Steering Committee, comprised of senior system
introducing the financing reforms. leaders and decision-makers, in formulating the national health strategy
to achieve the objectives of greater access, affordability and improving
The plan included: health outcomes
• High level announcement of the
Bermuda Government’s plans to
embark on significant structural
challenges to the healthcare system. Key Contacts
• A plan for immediate steps before Steve Woodward
and after the announcement. Managing Director
• Drafting key messages and Lori Rockhead
Frequently Asked Questions on why Director
structural changes are important and
their impact on the general public.
• Different types of communication
methods to be used.
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2020 KPMG International Cooperative (“KPMG International”). KPMG International provides no clientand
client services services and is
is a Swiss a Swiss
entity withentity
whichwith
the which the independent
independent member
member firms firms
of the of the KPMG
KPMG
network are affiliated. All rights reserved. network are affiliated. All rights reserved.21 Caribbean Infrastructure, Government & Healthcare credentials
Hospital redevelopment
Outcome
The ACW opened for operation
in September 2014. The new
hospital wing includes 90 single
P3, Bermuda
en suite private patient beds, new
emergency and diagnostic imaging
departments, out-patient services
for dialysis and oncology and a
new utility hub to support the
hospital campus.
King Edward VII Memorial Hospital Acute Care
Wing business strategy, financial advisory and In 2015, KPMG in Bermuda
advised BHB in relation to the
procurement assistance Paget Health Services’ plans to
refinance senior debt. The Project
Agreement ensured that BHB
would share in the benefits, if
the Private Partner refinanced.
As a result, BHB benefited from
Context • assisting with the identification a reduction in its annual service
and selection of legal and payment of over US$500,000
Based on a third party assessment that technical advisors; annually for the remaining 29 years
Bermuda’s only acute care hospital needed
• establishing the development budget, of the Agreement.
approximately 50% more capacity to sustain
the delivery of high quality health care and schedules, communications, records
expand the range of treatment services management, risk management and
provided locally (thus reducing the need for mitigation, and project agreement International
patients to travel overseas), the Bermuda with the private partner. This recognition
Hospitals Board (“BHB”) sponsored work included: and awards
the King Edward VII Memorial Hospital • marketing of the PPP opportunity;
(“KEMH”) Redevelopment PPP to build the • development of the business, Best Accommodation Project,
Acute Care Wing (“ACW”) extension. regulatory and procurement model; Partnerships Awards 2012
• drafting of regulation, contractual (July 2012)
The five year project to develop the terms and procurement
Press release by World Finance
business case, procure a private sector documentation; and
(January 2013)
partner, design and build the ACW • support through the Request for
(“the Project”) was started in late 2008. Qualifications and Request for
BHB selected a design, build, finance Proposal stages including the
and maintain delivery model to fit its evaluation of qualifications.
requirements. Paget Health Services was
• KPMG in Bermuda provided input on
selected in December 2010 as the private
the development and amendment of
partner and ground breaking started in
legislation critical to supporting the
January 2011.
Project; and
• KPMG in Bermuda was retained as
KPMG’s role
the Fairness Monitor to advise on
KPMG in Bermuda acted as business and fairness of the procurement process
financial advisor including assisting with: and to report on compliance with King Edward Hospital, Bermuda
• developing the business strategy and fairness principles established at
business case; the outset of the Project to ensure
Key Contacts
• establishing the governance the Project met leading international
procurement practice. Steve Woodward
structure to help ensure oversight of
Managing Director
the Project;
Lori Rockhead
• developing BHB’s project
Director
management team structure;
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services and is a Swiss entity with which the independent member firms of the KPMG network are
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23 Caribbean Infrastructure, Government & Healthcare credentials
Climate
action and
infrastructure
Without a doubt, the increasing
severity and frequency of climate
related catastrophes have taken their
toll on the islands region.
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International provides no client services and is a Swiss entity with which
the independent member firms of the KPMG network are affiliated. All
rights reserved.Caribbean Infrastructure, Government & Healthcare credentials 24
Kingston dock
yard project
Development of a business plan
Context KPMG’s Role
Ship owners whose vessels call on KPMG in Jamaica assisted GSRJ with
Jamaica or traverse the region require dry the preparation of the business and
dock facilities for routine and emergency financing plan which included an executive
maintenance and repair work to keep summary; description of the business;
vessels operable. Additionally, all vessels projected financial information; marketing
must also undergo special surveys, based strategy; operations; management and
on the vessel class, every five years or organization of the business and the
less. The selection of a ship repair facility opportunities for providers of debt capital
is highly dependent on the extent and type for the complete project.
of servicing to be done to a vessel, the
proximity of the repair facility to vessels
The scope of work included the
in need of repair or maintenance, and the
development of an integrated financial
preference of the vessel owners.
model including projected income
statements, ratio analyses, projected cash
The time lost from the ship’s regular work flows; and projected balance sheets.
schedule and the related loss of earnings
are also factors in determining where to
undertake vessel repair and maintenance. Outcome
KPMG in Jamaica developed the
The Challenge
business and financing plan and
German Ship Repair Jamaica Limited the related integrated financial
(“GSRJ”) currently provides mobile ship model which included a range of
repair services also known as wet works sensitivities and scenario options.
or wet repair services. The provision of The expansion project has been
dry dock services would be a natural approved by the stakeholders
expansion of their existing ship repair and and is in final stages of pre-
maintenance services. In order to secure implementation activities.
stakeholder support GSRJ needed to
develop a business plan for the expansion
of their business to provide dry dock
services in Jamaica. Key Contact
Raymond Campbell
Partner
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network are affiliated. All rights reserved.25 Caribbean Infrastructure, Government & Healthcare credentials
Arawak shipping port
Capital raising and other advisory services
Context KPMG’s role Outcome
Several years ago, the Government of KPMG in The Bahamas continues to act as Arawak Port, an International Ship
The Commonwealth of The Bahamas financial advisor to APD, a role held since and Port Facility Security (“ISPS”)
(“the Bahamian Government”) decided 2008, and has provided a wide range of compliant facility comprising
to relocate container, bulk and break- services including assistance with: Nassau Container Port (on Arawak
bulk shippers that operated along the Cay) and Gladstone Freight
waterfront in the downtown capital of structuring, negotiating and Terminal (inland terminal), achieved
Nassau to a less congested site further securing US$90 million of substantial completion in May 2012.
west on the island of New Providence. capital in equity, bridge loan
financing, senior bank debt
and preference shares; This followed closure of APD’s
A coalition of shipping interests formed IPO in January 2011, which was
APD Limited (“APD”) to submit a design, the most highly oversubscribed
build, finance and maintain proposal completing a B$10 million public offering in the history of
for a new port (“Arawak Port”). In May initial public offering (“IPO”); The Bahamas. APD’s preference
2010, APD reached a Memorandum share offering in 2013 was also
of Understanding with the Bahamian oversubscribed, at an interest rate
Government for the project to move developing a financial margin that was comparable to
ahead under a 45-year land lease and plan inclusive of a 30-year sovereign domestic offerings.
concession agreement. integrated financial model;
For two consecutive years,
As tourism is The Bahamas’ primary preparing an economic Florida Shipowners Group rated
industry, a significant benefit of Arawak impact study; Arawak Port as the Caribbean’s
Port is that it facilitated the Nassau most productive port, beating out
Downtown Revitalization plan which aims 24 regional rivals. APD has over
to increase tourism in the downtown advising the commercial 100 employees and processes
core. In addition, the revitalization plans terms of key operator more than 70,000 TEUs on an
include converting downtown Nassau to a license agreements; annual basis.
“living city” by bringing a new residential
component to the area.
benchmarking equipment
lease agreements and port
Key Contacts
tariffs; and
Simon Townend
Partner
performing an annual review Shana Lee
of its tariff structure and Managing Director
dividend strategy.
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firms of the KPMG network are affiliated. All rights reserved.Caribbean Infrastructure, Government & Healthcare credentials 26
Airport financing
in Barbados
Capital raising, due diligence
and valuation services
Context Outcome
The Grantley Adams International Airport • The business plan assisted
(“GAIA”) is Barbados’ only airport and the GAIA with its efforts to
aviation hub of the Eastern Caribbean, expand and formed the basis
handling daily flights to and from the other for its corporatization and
Caribbean islands connecting to major privatization objective.
cities in the US, Canada, UK and Europe. • The operational and financial
GAIA is wholly owned by the Government due diligence subsequently
of Barbados and handles in excess of two resulted in the strengthening of
million commercial passengers annually. GAIA’s operations.
• The valuation report was
KPMG’s role prepared, and its conclusion
KPMG in Barbados and the Eastern formed a part of the basis used
Caribbean acted as a financial advisor to to determine the strategic
GAIA, providing a wide range of services, direction of the airport.
including assistance with the following:
developing a business plan;
Key Contacts
providing operational and Lisa Taylor
financial due diligence; and Partner
Christopher Brome
Partner
preparing a comprehensive
valuation report.
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network are affiliated. All rights reserved.27 Caribbean Infrastructure, Government & Healthcare credentials
L. F. Wade (Bermuda)
International Airport
redevelopment P3
Project management and commercial
advisory services
Context KPMG’s role
In 2014, the Government of Bermuda KPMG in Bermuda provided project • Advising on commercial and business
(“the Bermudian Government”) entered management, commercial advice, terms including appropriate risk
into discussions with Aecon Concessions negotiation support, and accounting transfer, scope and specification of
(“Aecon”) and the Canadian Commercial advisory assistance to the Bermudian the redevelopment, performance
Corporation (“CCC”) in relation to using Government including: standards and enforcement
a P3 delivery model to build, finance, • Developing the Cabinet level mechanisms, allocation and
and maintain a new airport terminal and governance structure to ensure mitigation of environmental risks, land
operate the Bermuda airport under the appropriate executive oversight and and lease issues, needs and rights of
terms of a concession agreement. project enablement. Government agencies, establishment
of the Bermuda Airport Authority, and
• Project managing the Bermudian
stakeholder consultations.
The Bermudian Government selected Government and tri-party working
groups, developing the work plan and • Supporting the Bermudian
the Government-to-Government (“G2G”)
tracking results. Government in negotiations with the
procurement model which involved
Concessionaire on deal terms, and
negotiating the Project Agreement with • Advising on increasing Bermudian
with ensuring the UK Government’s
Aecon and CCC. labor participation, including the
conditions for Entrustment were met.
internship program for construction
professionals, and proposing a plan • Advising the Bermudian Government
Following the execution of the Airport on the accounting treatment for
for advanced training of Bermudian
Development Agreement in 2015, the concession.
trade workers which will contribute to
the Bermudian Government required
long-term sustainable employment. • Delivering the P3 workshop to
assistance with project management and
the civil service executive and
commercial advice to fulfil its obligations
department heads to increase
and achieve financial close.
institutional knowledge of alternative
finance for capital development.
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