Why is it so costly? A hospital projects quick comparison of construction costs between Sweden, Denmark and Germany

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1 Why is it so costly? A hospital projects quick comparison of construction costs between Sweden, Denmark and Germany Christer Hallgren Regionfastigheter Project Manager NSM Carola Joelsson Regionfastigheter Head of Construction Projects Division 01 June 2017, Seminar on Construction Costs of Chalmers University of Technology, Centre for Healthcare Architecture

2 Introducing our project NSM - Nya Sjukhusområdet Malmö (New Hospital Campus Malmö)

3 Malmö Hospital Campus 2016

4 Our vision in 2013

5 Malmö Hospital Campus in

6 Malmö Hospital Campus in 2024 EVACUATION New buildings sqm + large number of rebuilding / refurbishment projects due to evacuations 6

7 Malmö Hospital Campus in 2024 HOSPITAL BUILDINGS Somatic care sqm Two joined buildings, 9 to 10 floors and two basement levels 7

8 Malmö Hospital Campus in 2024 SERVICE BUILDING Supplies logistics, etc Clinical Laboratoy New morgue sqm in 3/4 floor and one basement level 8

9 Malmö Hospital Campus in 2024 TECHNICAL INFRASTRUCTURE 9

10 COST ESTIMATE 12.3 billion SEK Indexed to 2023/24 including risk budget

11 What to do when your politicians question your cost estimates? or specifically, answer the question: Why can we not build as cheap as OUH in Odense?

12 Our approach We tried to answer by looking at it on three different levels I. General differences in costs between countries? II. General differences in hospital planning and design between countries? III. Specific differences between our hospital project (NSM) and the referenced project in Denmark?

13 I. Construction Cost in general Statistics from Eurostat (EU)

14 Construction Index

15 Residential Buildings Index (bostäder)

16 Non-residential Building Index (övriga byggnader)

17 Civil Engineering Works Index (anläggningar)

18 Conclusions from the statistics Notably higher costs in Sweden Less differences in Civil Engineering Highest differences in Non-Residential Building (including hospitals) Sweden >40% more expensive than Germany Sweden almost 20% more expensive than Denmark

19 Personal reflections. CIVIL ENGINEERING European Building Codes Basic structural design Reflects levels of costs for labour and material Better competition (or increased in Sweden) RESIDENTIAL BUILDING Climate zones Standard of living Residential market forces Authority requirements NON-RESIDENTIAL BUILDING Client requirements and ambitions Weak competition?

20 DN artikel 14 feb EU:s högsta byggkostnader finns i Sverige us-hogsta-byggkostnaderfinns-i-sverige/

21 Ur artikeln: De höga byggpriserna beror på olika faktorer. Högre materialkostnader än i andra länder är en orsak. En annan, enligt flera, är att det råder för dålig konkurrens på byggmarknaden. Få utländska företag är med och bygger och de fyra jättarna slukar många av byggprojekten -Vi har ganska hårda regler och normer i Sverige vad gäller saker som energieffektivitet och miljö. Dessutom är förutsättningarna för att bygga olika i olika delar av landet. Det gör det dyrare och svårt att nå effektivitetsvinster - Johan Hammarlund, analytiker på Boverket ARBETSMATERIAL

22 Ur artikeln: Björn Wellhagen, näringspolitisk chef på Sveriges Byggindustrier, tycker inte det är särskilt konstigt att byggpriser är högre i Sverige än resten av EU. Sverige är dyrt generellt sett. Vi har högre kostnader än EUsnittet på livsmedel, transport med mer. Det är naturligt att det är dyrt att bygga här och kanske ska vara så. Han konstaterar att Sverige har relativt höga löner och ställer höga miljökrav. Dessutom bidrar att priset på mark har ökat kraftigt. Att konkurrensen är dålig, håller inte Björn Wellhagen med om. Då är det ett större problem att branschen lider av kompetensbrist, anser han. Det är brist på yrkesarbetare, tjänstemän, lantmätare, arkitekter, tekniska konsulter. ARBETSMATERIAL

23 II. General differences in hosptial design in Sweden, Denmark and Germany Based on experiences from architect firm CF Möller

24 Report by CF Möller (architects) Short report on: Major differences btw Danish and German hospital design Appendix from Bauministerkonferenz on facilities for surgery

25 Single rooms Larger rooms Daylight req. etc Healing architecture Less compact buildings

26 Comparison with OUH - Odense University Hospital in Denmark

27 OUH - Odens Universitet Hospital

28

29 OUH - Odense Universitet Hospital We identified Background and the process of the projects so far Prerequisities and conditions for the specific project The Danish state program for transforming hospital and their financing Some key differences i planning and design Budget and priorities for the project

30 Budget OUH Investment in buildings and medical equipment Fixed budget: +index currency 1.30 Total built area: Key ratio OUH 7.15 billions DKK (2009 price level) 8.62 billions DKK (2016 price level) billions SEK (2016 price level) sqm SEK per sqm

31 Budget NSM Investment in new Hospital buildings (only) Budget: 6.02 billions SEK (2016 price level) (risk budget excluded) Total built area: Key ratio NSM sqm SEK per sqm

32 Comparison OUH & NSM Odense OUH Malmö NSM What our politicians saw and heard was 7.15 billions 12.3 billions for sqm for sqm Turned out to be 11.2 billions SEK 6.02 billions SEK SEK per sqm add 20% assuming Sweden is that more expensive SEK per sqm SEK per sqm and suddenly we are all in the same ball park!

33 Learnings Key ratios are great, we all need and want them But must always be seen in their context!