Our RCM services & solutions revolve around building up financial stability within the healthcare sector aligning with the Kingdom’s Vision 2030.
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Maximizing Revenue Streams
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Facilitating Payment Cycles
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Improving Patient Experience
At all levels of society there is a demand for mental health provision. From the FTSE 100 executive who has enormous responsibility to the international student who may be far from home, there is an increased need to support people in today’s world. Everybody’s needs are di erent and there are varying levels of help, from the counsellor through to the psychologist to the psychiatrist.
So how we do we provide for all this with the demands on health systems worldwide. Fortunately, there are plenty of digital solutions in the marketplace. Some, such as ADHD360 on page 62, are approved by the NHS and alleviate the burden on the health system. Yes, they are private suppliers but for those with the means to seek instant solutions, they deliver quickly and successfully.
The next option is bringing it under the umbrella of primary care. Dr Patrick Wynn of Health Care First, Healthcare World’s GP columnist, is particularly keen on this method if it can be managed correctly. His overriding concern is for the patient and allowing them the privacy to interact with mental health services in a safe and medical environment. He discusses this issue on page 64.
Dr Sean Cross, consultant psychiatrist and Managing Director of Commercial Enterprise for SLaM (South London & Maudsley Hospital) examines the larger picture. With one of the biggest mental health research units globally and the largest training programme for psychiatry doctors in Europe, Dr Cross considers on page 58 how to incorporate mental health into both health systems and education systems so it covers all aspects of healthcare from birth.
Lawyers Browne Jacobson ask on page 66 whether it’s time to review international legislation around the subject. Lastly, Ian Chambers of Linea on page 68 examines Saudi Arabia’s initiatives to increase
Sarah Cartledge Editorial Director
mental health provision while seeking to reduce the stigma around the issue.
It’s fair to say that COVID-19 shone a spotlight on mental health as we all struggled with isolation and the experience of a pandemic. It’s also making us focus on the issue of population health which is the ultimate goal in global healthcare. Many of our experts examine how we can achieve success, including Healthcare World MD Steve Gardner in his Opinionated column on page 82, and NECS MD Stephen Childs who looks at the issues surrounding data on page 72. Sally Rennison of Patients Know Best stresses that once patients understand the importance of sharing their data, it should be mandated by governments to enable organisations to work together for the greater good, rather than hoarding their vital data in individual silos for their own use.
Finally, we’re o to Riyadh for Global Health and Las Vegas for HLTH. Both these international events are key for healthcare experts to meet and learn about the latest innovations and systems in our sector. To coincide with Riyadh, there are features from highly respected companies in our Saudi Arabia centre section, including lawyers Al Tamimi, revenue cycle management experts ACCUMED, property giants Colliers, and international asset management consultants Currie & Brown.
We also learn about Swedish healthcare, as well as opportunities in Brazil and Africa. We hear about TalentFind World, the first global healthcare recruitment platform, as well as regulation from GMCSI. Our Deep Dive section looks at data with Beamtree and BRG, and finally our Healthcare World Series looks at the importance of diversity in clinical trials.
We have redesigned our sections to make it easier for you to navigate your way through this fascinating edition. Do let me know your thoughts –sarah@healthcareworld.com
30 Mohammed Aldar, Managing Director of ACCUMED, explains why Revenue Cycle Management is crucial for healthcare providers
32 A focus on elderly care in KSA requires substantial investment and o ers significant opportunities, says Mansoor Ahmed, Executive Director Middle East and Africa, Colliers
36 Andrew Castle, Healthcare Director for Currie & Brown in Saudi Arabia, discusses the current healthcare landscape in KSA
38 Christina Sochacki and Abdulmohsen Al Saleh, Al Tamimi & Company, outline the importance of privatisation in Saudi Arabia’s health sector transformation
43 TalentFind Solutions CEO Mandy Rowbottom talks to Fabian Sutch-Daggett about her mission to improve healthcare recruitment
46 Meet The Expert
Andrew Hoyle, Assistant Director Decisions and Case Examiners, explains how the UK’s General Medical Council regulates fitness to practise among doctors
48 The Introduction to International Programme
Created by Bevan Brittan and Healthcare World, ITI is a comprehensive solution to provide healthcare businesses with the expertise to enter new markets with confidence
50 Lina Behrens, Head of Content for HLTH Europe, on the importance of standard data regulation across mainland Europe
52 Jyoti Mehan of Healthcare First talks about her factfinding visit to Brazil earlier this year
54 From our Africa correspondent Dr Mwenya Kasonde highlights five business opportunities that will transform African healthcare
57 Focus on Mental Health
58 Consultant psychiatrist Dr Sean Cross tells HW Editor Sarah Cartledge how South London and Maudsley Hospital can help implement mental health into healthcare services across the globe
61 Archie Read, Senior Operations Controller at ADHD360, explains the importance of diagnosis for anyone su ering with ADHD
64 Dr Patrick Wynn of Health Care First explains how GPs can work with AI to improve mental health provision
66 Mental health regulation around the world: Is it time for a shake up? ask Gerard Hanratty and Carly Caton, Partners at Browne Jacobson
68 Saudi Arabia is addressing the challenges of mental health provision to reduce social stigma, says Ian Chambers CEO of Linea
72 NECS, part of the NHS, provides high quality health and care system support to global organisations, says MD Stephen Childs
76 The patient has a vital role to play in future population health management, says Sally Rennison Chief Commercial O icer at Patients Know Best
78 The future of hospital design will focus on the patient digital twin with services designed and supported by the metaverse, says Phi Kim Ho, Arcadis Associate Director and Practice Lead Vancouver, BC
82 Opinionated
Healthcare World MD Steve Gardner explains why Population Health isn’t working
The UK Government has signed an agreement with BioNTech to provide ground-breaking cancer treatments by 2030
The UK has moved a step closer to revolutionary new cancer treatments, according to a .gov report.
A er prior conversations were held at the beginning of the year, the new longterm partnership between the government and BioNTech seeks to provide up to 10,000 patients with “precision cancer immunotherapies” by 2030.
BioNTech, who previously developed one of the chief COVID-19 vaccines in collaboration with Pfizer, are looking to ensure that more patients can benefit from targeted, personalised cancer treatments.
In an e ort to crack down on medical misinformation on the platform, YouTube has now announced new measures to verify medical professionals so that viewers do not watch incorrect or potentially dangerous medical content.
In 2021, UK-based users provided more than 2bn views to medical content on the platform, ranging from clips on health conditions to medical education for students.
These precision immunotherapies help treat patients through stimulating the immune system to recognise and eliminate cancer cells. While this will not work as part of every cancer treatment, the government hopes that it will provide thousands of patients with better care.
“This landmark new agreement takes us one step closer to delivering life-saving new cancer treatments for patients right across the country,” says Rishi Sunak, Prime Minister of the United Kingdom.
“Personalised cancer vaccines have the potential to completely revolutionise the way we treat this cruel disease and it is hugely welcome that, thanks to today’s
Now, YouTube has added a verification feature, similar to the process used for very large channels and o icial organisations, to licensed medical professionals a er undergoing a detailed verification check on their credentials and channel content.
Dr Vishaal Virani, Head of UK Health for YouTube, welcomed the move to verify healthcare content on the platform.
announcement, clinical trials will be rolled out widely.”
In addition, a new Cancer Vaccine Launch Pad (CVLP), led by NHS England in partnership with Genomics England, aims to rapidly identify patients who would be suitable for the trials. A database of suitable NHS patients will be curated by the organisation, with patients o ered the choice to participate in the trials.
“This further demonstrates that the UK is an attractive location for innovative companies to invest and pioneer cutting edge treatments for our patients and underlines this government’s commitment to research and development,” Rishi Sunak says.
“Whether we like it or not, whether we want it or not, whether the health industry is pushing for it or not, people are accessing health information online,” Dr Virani told the BBC.
“We need to do as good a job as possible to bring rigour to the content that they are subsequently consuming when they start their care journey online,” he added.
The video-hosting giant began accepting verification applications from medical professionals with a right to practise in June. Now, these content creators are starting to see the authenticity certification appear on their channels.
Women’s Health practitioner Dr Simi Adedeji has received her verification from YouTube, but stressed that the content published on the platform was for educational purposes, and should not be substituted for real medical advice.
“It’s about giving medical information so that the audience feels empowered, and can then go to see their doctor,” says Dr Adedeji.
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The FDA has approved the overthe-counter sale of two life-saving products, according to an fda.gov report. These treatments are now available to buy in stores across the USA. The active ingredient in both products, Narcan and RiVive, contain naloxone hydrochloride, a medication which rapidly reverses the e ects of opioid overdose and is the standard treatment for such overdoses globally.
The action to allow the purchase of this medication over the counter without the need for a prescription or being provided in an emergency medical setting will undoubtedly save lives.
Drug overdose persists as a major public health issue in the US. In the 12 month period ending in February 2023, more than 105,000 fatal overdoses were reported, largely driven by synthetic opioids such as illicit fentanyl.
“We know naloxone is a powerful tool to help quickly reverse the e ects of opioids during an overdose. Ensuring naloxone is widely available, especially as an approved OTC product, makes a critical tool available to help protect public health,” says FDA Commissioner Robert M. Cali , M.D.
“The agency has long prioritised access to naloxone products, and we welcome manufacturers of other naloxone products to discuss potential nonprescription development programs with the FDA.”
The FDA has recently taken a series of steps to help facilitate access to opioid overdose reversal products and to decrease unnecessary exposure to opioids and prevent new cases of addiction. The agency approved the first non-prescription naloxone spray in March of this year, and the second in July. Over the last year, the agency has made new e orts to expand opioid disposal options to attempt to reduce opportunities for nonmedical use, accidental exposure, and overdose.
Scientists have now developed a synthetic human embryo model using stem cells, without the need for sperm or eggs.
This breakthrough is more advanced than previous e orts to create human embryos and could provide valuable insights into issues such as birth defects and miscarriages.
The aim of the research is to ethically study the very earliest stages of pregnancy, without the need for using actual human embryos. The embryo itself is not able to develop into a real foetus, as it is not possible to insert the embryo into the womb lining.
“This really is a textbook image of a human day-14 embryo,” Professor Jacob Hanna, who led the research at the Weismann Institute, told the BBC.
“It closely mimics the development of a real human embryo, particularly the emergence of its exquisitely fine architecture.”
This type of research is at the bleeding edge of scientific advancement and a large number of countries have no regulations or laws surrounding the creation of synthetic embryos, which raises a number of ethical questions.
Earlier this year, as reported by CNN, a team of researchers at the Żernicka-
Goetz lab also created a synthetic human embryo structure, indicating that there is a big push within the scientific community towards understanding the human embryo at its earliest stages. Professor Magdalena Żernicka-Goetz, who led the UK-US research, described the body of work at a meeting of the International Society for Stem Cell Research in June.
“I wish to stress that they are not human embryos,” Zernicka-Goetz told CNN.
“They are embryo models, but they are very exciting because they are looking very similar to human embryos and the very important path towards discovery of why so many pregnancies fail.”
In a move to counteract the opioid crisis in the USA, the antiopioid treatment is now being rolled out across the nation
The research has created the most advanced model of the human embryo so far
Scientists grow synthetic embryos in major breakthrough
Vincent Buscemi Partner and Head of Independent Health
vincent.buscemi@bevanbrittan.com
Letitia Winterflood-Blood Senior Associateletitia.winterflood-blood@bevanbrittan.com
Jodie Sinclair Senior Partner Employment, Immigration and Pensions
jodie.sinclair@bevanbrittan.com
Bevan Brittan is the market-leader in the provision of legal, governance and regulatory advisory services to businesses delivering and providing healthcare services within the UK and internationally. Our award-winning healthcare teams provide organisations with outstanding corporate, commercial, clinical negligence, litigation, regulatory, property and employment legal advice.
With years of experience and global exposure, Bevan Brittan’s healthcare teams have the expertise to support client’s endeavours anywhere in the world. Our reputation as a leading healthcare firm has taken us across the globe, working with a wide range of clients (from NHS bodies to independent health and social care providers, operators and developers as well as funders and investors) on a multitude of commercial health projects. Our in-depth practical and commercial knowledge of the challenges and opportunities of expanding overseas are second-to-none and a true benefit to our clients in the increasingly global healthcare market.
Mikael Rosén, CEO of Skane Care, tells HW Editor Sarah Cartledge that sharing knowledge is the key to modern healthcare systems
The Swedish have a reputation for e iciency with elegance. This is all the more true within their healthcare system, particularly given the geographical settings and increasingly diverse communities within the country. Like the NHS in the UK, the public healthcare system has undergone an evolution in terms of provision, and much of this learning is hugely valuable as healthcare moves into the digital age.
Skane is a region in the south bordering Denmark. It’s a beautiful province, known for its stunning scenery and high quality of life. Skane Care is part of the public healthcare sector in Sweden and, more specifically, owned by the regional council of Skane. Its mission is to export knowledge from the public healthcare sector to countries outside Sweden and outside the EU.
For CEO Mikael Rosén, the Skane Care model is unique in Sweden and quite
possibly beyond. “We are a company or a designated body with the responsibility of healthcare export, although we are a regional organisation,” he says. “We are not trying to sell the Swedish form of healthcare; rather we are exporting learnings from a healthcare model that has evolved over 70+ years.”
Mikael is clear that Skane Care aims to work with other territories to understand their needs and then draw on Swedish experience to provide answers, or as he says, primarily learnings from a number of successes, but even more from failures on the Swedish side. “Then, together with the client, we help them to create the health care system that
works for their needs. That can be with 10 per cent Swedish solutions or 100 per cent Swedish solutions.”
Skane Care o ers healthcare consulting, specialist training programmes, and customised training. To date, Skane Care has worked in the Middle East on several projects including collaborating with the Saudi Arabia government to upgrade healthcare systems and creating a stroke path for Ajman in the UAE. In Abu Dhabi they worked with Fatima College to deliver diploma trainings in diabetes care for registered nurses.
Sweden has been running training programmes since the 1980s, inviting clinicians to visit the country for study programmes. “When it comes to continuous training, the Swedish healthcare model is very strong,” he says. “Nurses and the doctors and several other clinical groups receive their foundational training from the university with an academic degree, but most of the individual development is done on the job. That type of training for medical teams or specialists and groups of people is something that we are very proud to package and deliver. It could be for a team that is performing in stroke care or for an ICU, for example.
to advanced healthcare at all. It’s a good opportunity for Sweden to show how you can get a lot of health for many people for a comparatively low sum of money.”
He admits that accessibility can be a problem for citizens, especially those who live in northern areas such as Lapland or extremely rural areas. “However, we are confident that we are on the right track. We have initiatives and collaboration schemes that aim to streamline healthcare and clinical best practice, such as the
The Swedish have always delivered innovation in design and living, so it’s no surprise that Mikael is confident that Skane Care can share a lot of ideas when it comes to designing sustainable health care models and delivery programmes. “We can also bring in the specialists that are experts in designing sustainable hospital buildings alongside architects and engineers,” he says.
“It’s complicated but companies are collaborating to provide holistic solutions, and this helps our customers and clients who are in a slightly better position, because to them it’s usually a question of starting from scratch with a building project.”
So what is it about the Swedish system that spells success? “Sweden has a welltested model in primary healthcare,” says Mikael. “It is the driving force behind all other healthcare provision, so it’s the first entry point for the patient in the Swedish model and also the last resort. The patient can make loops and excursions into other parts of the system, but they will eventually end up again in the primary healthcare system.
“This set up and layer of healthcare is underdeveloped in many countries, even those that do aspire to have a comprehensive health care model. Exploring and working with the primary healthcare sector gives the tools and the means to start prevention programmes and even enabling people not to progress
quality registries, over 100 di erent quality registries, that are purely designed to document, track and evaluate KPIs within a special set.”
In the Skane region, the University Hospital caters for the region’s 1.4m population through its centres in Malmo and Lund. “Sweden and the U.K. have made similar mistakes in creating a very diverse floor of systems and solutions without specifically clear rules and regulations for the past 20 or 30 years,” Mikael acknowledges. “Now we are all trying to impose consensus and a national plan across these millions of systems and solutions. So we would really urge partners on a ministerial level to start with a clear plan and watch for any deviations to avoid these serious complications.”
In essence, Skane Care is a gateway to the knowledge residing in the Swedish healthcare system. “There is always a little bit of gap analysis to be done,” admits Mikael. “And we can’t be best at everything. But together we can create an ecosystem that is even more diverse. And I think that’s the way to go when it comes to healthcare and the future of health care, collaboration and export. The ambition is that we can do great things together.
“Clients that reach out are o en surprised at the speed and cost in which we can have a world class expert on site. We pride ourselves in getting things done. Mikael is inviting you to contact Skåne Care and try the Swedish Way.”
“We are exporting learnings from a healthcare model that has evolved over 70+ years”
Bevan Brittan’s Letitia Winterflood-Blood speaks to Healthcare World about harnessing new technologies to improve diagnostics and benefit the global healthcare ecosystem
Diagnostics improvement currently sits at the heart of some of the key health agendas around the world, and for good reason. Prevention, as opposed to cures and treatments, is nearly always a more e ective solution – both in terms of costs for payors and providers, and health outcomes for patients.
Prevention itself falls into a number of categories – for instance, catching a disease early to ensure better treatment, or identifying the correct steps to be taken to avoid the disease developing at all. An o en overlooked aspect of the prevention agenda is the benefits it can bring to improving the diagnosis of symptoms and conditions where a disease has already started to develop. This can help to
mitigate false positive results and lower the occurrence of unnecessary and potentially invasive treatment regimes.
Individual prevention-led solutions have already been dramatically improving outcomes in many sectors of the healthcare industry, such as tools that analyse specific factors to determine the likelihood of pre-term births. By not only providing benefits to clinicians in treating these conditions but also peace of mind to the patients themselves, they allow patients to understand their own conditions and take ownership of their personal health.
‘Wellness’ is yet another topic which is a key aspect of the prevention agenda. Personalised medicine, which is central to improving diagnostics, invariably
falls under the branch of wellness. This itself can be seen as much broader than the traditional health market of disease detection and treatment, providing plenty of opportunities for clinicians, providers and, of course, the patients themselves.
To move towards a proactive, preventionled global healthcare system, we need to get better at prediction. Preventative interventions only work if underlying data, patient understanding, and delivery methods of care are rock solid. Without these factors a preventative approach will not work, and can fail entirely. The basics need to be right in order to implement such a system– for instance, getting patients to attend scans or appointments when necessary. The benefits of this system will only materialise if the data is ready to be collected in the first place, and could be a particular issue in certain population groups – for example, in rural disconnected communities, among minority ethnic groups, or those with sex or gender-based issues.
Until now, the danger of this model completely failing has halted health systems from moving towards a
prevention-led model. Implementing the necessary requisites and diagnostic improvements is a huge task for which health systems neither have the resources, time, or workforce – especially on a system which has little to no room for error.
However, running in tandem to these discussions has been the quiet but monumental rise of artificial intelligence. We are now bearing witness to a watershed moment in this field. AI has been steadily improving over the last decade, but in the last year alone we have seen groundbreaking developments that are starting to revolutionise domestic and corporate environments.
The healthcare sector is no exception to this revolution. With the inadequacies, understa ing and razor-thin budgets of many health systems, AI has been welcomed with open arms and has the potential to remedy many of the current challenges.
Yet AI is only as good as the information it receives. Good diagnostics are essential to gathering useable patient data, which is absolutely vital to building a preventionbased model and promoting personalised
healthcare. With this, of course, come the issues that surround data gathering – for instance, how to collect and curate the data, and understanding its uses and value. In addition, the ever-changing regulatory regime that surrounds personal data is key, and may be a real challenge. Yet in terms of opportunities this is an area ripe for partnering (e.g. where one party has the tech but not the data or the skills to curate and use that data, and vice versa).
AI in diagnostics is no longer on the fringes of development. It is already being used in many di erent health contexts, and the UK government is increasingly trying to bring it into the NHS through directly funding AI research for diagnostic applications to the tune of more than £20m.
But this is not about the “rise of the robots” and there is much work to do around bringing patients’ mindsets along on the journey. AI is a tool to aid clinical decision-making but ultimately it is only a tool. As well as enhancing decision-making capabilities, it frees up time for doctors and other sta so more patients can be seen and more prevention measures can be taken, resulting in fewer people presenting with urgent issues.
On that point – the AI, both in terms of the data being processed by it, and the ‘tool’ to wrap around it – has to have clinicians at the heart of the design. If the results of the AI analysis are not easy to use or do not deliver easy to digest information that gives a clear direction as to the action required, then it won’t provide the benefit necessary to develop a truly functional prevention-led model of care.
There also exists the need to consider the regulatory environment which surrounds AI. Currently, AI is treated widely di erently across di erent jurisdictions. Some already have specific and developed AI related legislation, whereas others rely on a mix of existing rules around medical devices and personal data, which makes the regulatory landscape a di icult one to navigate for development, particularly for operators looking at rolling out their o ering across jurisdictions.
AI and other diagnostic tools will only ever be as good as the data being fed into it. There is very limited ability to pick up an AI tool from one jurisdiction and apply it to another seamlessly – as o en the data on that local population has to inform the diagnostic tool to be applied to them.
For example in the Middle East, AI in diagnostics is being used to help primary care physicians identify patients at high risk of conditions such as heart attacks and direct the doctor to contact a manageable number of them to take preventative steps. In other regions, where location of treatment or capacity issues are present such as the NHS, more sophisticated diagnostic tools allow paramedics to diagnosis certain conditions in situ. As a result, fewer people in the UK present to A&E with falsely suspected heart attacks. The UK government has already invested £123m into 86 AI technologies which are helping patients by supporting stroke diagnosis, screening, cardiovascular monitoring and managing conditions at home.
Conclusion
Good diagnostics are key to valuable patient data that can be utilised in many varied settings. From breast cancer screenings that no longer require ‘four eyes’ to analysing chest X-rays for lung cancer, clinicians and healthcare workers will be able to make faster decisions based on accurate diagnoses. Citizens and patients will be able to evaluate the benefits to their personal health, enabling prevention and wellness as key concepts in today’s healthcare continuum. And once the systems are in place with good data and wrapround tools, there is a real possibility it can help mitigate the workforce crisis and accelerate diagnosis and treatment across all jurisdictions.
“Preventative interventions only work if underlying data, patient understanding, and delivery methods of care are rock solid”
Letitia Winterflood-Blood Partner Bevan Brittan
Jennifer Nobbs, Head of International Advisory at Beamtree, explains how data stored and often used within the electronic medical record can be used to fullest potential
Poor use of electronic medical record systems (EMRs) could result in potentially lifethreatening implications if the system itself isn’t up to scratch. EMRs can o er huge benefits to patient safety and
workforce e iciency if used well – so why are hospitals taking so long to implement them e ectively?
EMRs have in fact been around for a surprisingly long time. The foundations of these systems can be traced back to the
1970s, long before laptops, widespread use of the internet and other technologies we now take for granted. This is not to say that EMRs have been in continual use, however, as it took decades for hospitals and health systems to integrate these new systems into their operations. For years, a risk adverse attitude coupled with the challenge of implementing new systems across services meant people felt it was safer to stick with pen and paper.
It was only during the late 1990s and 2000s that the benefits of an EMR could truly be visualised. Now, EMR systems are commonplace around the world – from the biggest hospitals to the smallest ones. Huge amounts of money have been spent on the creation and implementation of such systems, and the quantity of
data generated and collected by them is undeniably vast in nature.
EMRs were meant to revolutionise healthcare by connecting previously unconnected data. They were also to provide clinicians, analysts, and management with clearer, better, safer, and readily accessible information that can also be taken even further to support longerterm decisions in a health system at large.
Yet, the reality is o en that EMRs are not used to their full potential, or worse used as a digital way of continuing to do analogue tasks. O en in this scenario the EMR makes the task take longer, creating a vicious circle of frustration and then apathy towards a valuable tool in the pursuit of error free healthcare. Additionally, the goodwill of busy clinicians taking time out of patientfacing duties to learn new systems could be returned by using the data they have inputted to support and add value to their work, but all too o en it is not. The EMR itself works, collecting the data and operating as it should; but the data itself? It just sits there, largely unused.
At the same time, the ambition surrounding patient data potential and its integration into health systems to improve outcomes is growing at a rapid pace. Digitisation and data outcomes are held up to be the focus of new and future health systems. There are large-scale projects to build and roll out cutting-edge and enormously powerful EMR systems – with a number of impressive, ambitious projects underway in the Middle East in particular – but they won’t have an impact unless hospitals and operators use them to their fullest capabilities. If their value is properly utilised, these systems could have the ability to revolutionise decision-making all the way from improving patient safety and supporting the e iciency of the individual clinician to large-scale population health management. In a world of increasing workforce challenges and constrained resources, using the information that we have to support better decision-making is critical to sustainability and success.
Data has value when it is accurate and when it is used. The more it is used close to the point of data entry, the more likely it is to be accurate, for example, vital statistics collected from patients. This data is critical to safe patient care and it is used immediately, which means that it goes
through a very practical quality assurance process.
However, EMRs also collect a wealth of data which is o en not immediately relevant at the clinical level or directly useful in a clinical setting. Without quality assurance (practical or otherwise) early on in the process, the data risks being unreliable or untrusted when it is used later; for instance, strategy development for topics such as disease insights, population health modelling, and other longer-term policies and programmes.
The benefit of a fully functioning EMR system relies on creating a virtuous circle of health information: a ‘learning health system’ which puts data to good use to realise its value and support patient care. By using EMR data for clinical decisionmaking at the point of care, and for decision support and improving e iciency further down the line, data can e ectively be used for broader strategies such as benchmarking, pricing, population insights, and more. Once the data is being actively
used for multiple purposes, it can improve each step of the process and feed back in its turn – ultimately improving the EMR and levels of patient care as a whole. But how do we encourage clinicians to interact with these systems?
It is easy to say we should be using and validating the data from EMRs. But people need to see the actual benefit, both in the short term and long term. Clinicians are stretched thin in all manner of ways, and asking someone to recheck the data on a patient they saw a month ago is not a high priority or particularly reliable when they have to focus on the patients they are currently attending.
But what if the data can actively improve patient care in real-time, even faster than conventional methods? Suddenly, there is a reason and a motivation for clinicians to interact with EMR data in a
more meaningful way, as it provides a direct benefit to the quality of care in the immediate setting, while also aiding with planning, strategy and quality of care insights in the long-term. Rather than delivering value to only one group of operators within the hospital, it now provides value to everybody.
One such example of how data can be used meaningfully at all levels of the hospital environment is the Ainso
Deterioration Index, a new tool developed by Beamtree that takes data from the EMR and feeds it back to clinicians in real-time at the point of care to support their own decision-making. It can identify patients at risk of deteriorating – such as those requiring imminent ICU treatment – and reduce adverse events far more accurately and earlier than using conventional methods, and at scale. It does this through examining multiple streams of reliable real-time datasets drawn from the EMR. It supports the clinician in charge of the patient to identify risk, the teams overseeing units across the hospital to manage resources in real time, and the hospital administration to better plan for resource needs in the longer term. Not only can such innovations save lives, but they also serve to demonstrate that the proper collection of EMR data is of direct value to the clinician. The data becomes immediately useful in the short-term and also far more valuable for longer-term modelling because it is accurate, trusted data.
Ultimately, we are now at a point within the healthcare sector where the ability to capture, analyse, and utilise data is becoming easier by the day, and increasingly essential as populations grow and demands change. Yet, as with any large-scale developments over the course of human history, people require convincing before their engagement with these ‘new’ technologies, becomes mainstream and widely accepted. As long as there are innovative solutions which feed o the data, EMR systems will continue to provide growing value to the healthcare industry at large.
https://www.beamtree.com.au/news/ australia-ai-breakthrough-predicts-patientdeterioration/
“Once the data is being actively used for multiple purposes, it can improve each step of the process and feed back in its turn”
Jennifer Nobbs
Head of International Advisory Beamtree
Julie Coope of Berkeley Research Group examines benchmarking in healthcare to improve quality of care
Healthcare executives continue to struggle with what to benchmark to help improve performance and drive value in their organisations. Part of the challenge is the number of metrics that can be benchmarked and knowing where to
focus. When we talk about healthcare benchmarking, we are really focusing on examining performance. Internal performance within institutions, external performance against other institutions, and global performance across the health sector at large are the focal areas for healthcare
benchmarking, and where the best ROI will be made when attempting to improve an organisation.
Yet this is a very large problem to tackle, and it can be very di icult to know where to begin. How exactly can you measure performance, and what data do you need to be looking at?
My background is within nursing, so my focus is very much on improving quality of care – looking to improve issues such as length of stay, readmission, mortality, infection rates and so on. Out of quality comes e iciency, because where there is quality performance, you can see a real cost benefit.
Healthcare organisations are complex and there is rarely a single metric that impacts performance. More o en, there are multiple
metrics that require attention, so taking a structured approach is essential before focussing on actual clinical care. One should begin by evaluating the case mix, processes, and structure within or across an organisation because this will help provide a baseline for your benchmarking analysis. Once you have a single metric to start benchmarking, you can drill down into this data and draw further conclusions from these findings.
Many metrics not only provide you with other factors of care to examine but are o en directly linked to one another. Healthcare executives are o en interested in length of hospital stay, but this metric will be a ected
by a variety of factors. A best practice is to evaluate this metric alongside readmission rates because o en an organisation that is rapidly reducing the length of stays will see a higher rate of readmission, so understanding this relationship is key to analysing the data for better benchmarking. I o en refer to this as a seesaw. Health systems and hospitals have to strike a balance to reduce their readmission rate while at the same time reducing length of stay.
Subsequent readmissions can be di icult to measure depending on how specific you wish to be about the reason for the readmissions. This focus on a metric and its relationship to other drivers should be applied to all aspects of benchmarking. Factors can be connected in ways that are not immediately apparent but viewing the data together can provide valuable, actionable insights. A readmission with a chest infection post hip replacement patient may not look like an immediately obvious connection, but it should be examined to see if there is a specific link to the first admission. For example, was the patient discharge information and education su iciently adequate to prevent this?
In many regions, readmissions are not paid for if they relate directly to the original admission. But how do you measure the reason? It can be somewhat subjective, and it is in that grey area that many health systems and hospitals struggle.
Across the globe, the main incentive for healthcare institutions is to treat patients quickly and e iciently, minimising cost while maximising quality of care. Benchmarking helps health organisations achieve this by identifying areas for improvement and tracking progress as they streamline patient pathways.
In countries such as the UAE, there are now direct incentives for organisations to improve quality. Currently, readmissions are paid for in the UAE but there is a push to move towards a pay-for quality system. There are many quality and performance metrics in the region to measure, and if an organisation does not show quality improvement, then in the future they could potentially lose money, similar to the system in place in many parts of the USA. We are now seeing much more cohesion between finance and quality teams in organisations that will ultimately drive beneficial strategies in any future valuebased payment system.
To achieve success, quality data is vital but many organisations do not have access to it. It is very useful to benchmark against other organisations, or to averages across your region or speciality, but if you are not benchmarking within your own organisation and examining your own data, you can run into issues.
Access to data is a key di iculty because the granular data that’s available at patient pathway level in di erent regions is o en minimal – and to get actual and costed pathway details is nearly impossible.
Yet with granular patient-level data, you can achieve amazing results. A recent project laying out patient pathways looked at di erent data sets and various inputs from a single organisation, such as blood tests and X-ray images. We were then able to triangulate this information with the patient outcome and improve the entire patient pathway. Comparing internally is the best way to engage clinicians initially, by focussing on understanding the variance closer to home before venturing elsewhere to compare.
Ultimately, benchmarking is an underutilised tool in the healthcare industry. Yet it is one that can be remarkably e ective at improving quality of care, reducing costs, creating better outcomes for patients, at the same time providing executives with valuable insights into the operations of their organisation. While starting to benchmark can be a daunting task, the benefits of even a small project can be enormously impactful as you never know where you might find hidden value.
“Out of quality comes efficiency, because where there is quality performance, you can see a real cost benefit”
Julie Coope Senior Managing Consultant Berkeley Research Group
The Middle East could be an ideal place to run clinical trials, finds our expert panel
Our wellbeing is a combination of mental and physical health that a ects our environment, biology, social policies, behaviour, and significantly our own lived experiences. COVID-19 has shown that people can experience the same illness in wildly di erent ways, sometimes to a fatal degree. Factors such as sex, age, race, and ethnicity can largely impact how individuals
respond to specific vaccines or medicines. As such, diversity amongst clinical trial participants is a crucial factor. The more diverse a community of clinical trial participants, the more we can understand about the e icacy and safety of a possible vaccine or medicine for patients right now, and in the years to come.
To account for the various experiences and exposures of di erent communities,
clinical trials need to be suitably inclusive of racial and ethnic minority communities and other groups experiencing personal disparities, which include gender, sexual minority, or socioeconomic status. However, most clinical trials take place in the USA with a narrow base of participants for historical reasons, following the Tuskegee experiment in 1972 which has caused African Americans to boycott them. Currently, there are few interventional clinical trials taking place in the Middle East. Yet, due to its smaller population, varied community, and treatment-naive patients, it is an ideal region for conducting them. For this reason, the Healthcare World Series examined the issue with a panel of experts including Dr Mike Failly of Zanteris,
Dr Hinda Daggag of SEHA, Dr Ibtesam al Bastaki from the Dubai Health Authority, Mansoor Ahmed of Colliers, and Raesa Afzal from regional lawyers Al Tamimi.
Dr Mike Failly began by referring to mistrust due to historical reasons. This scepticism arose as a result of clinical trials in the United States, in particular the long running Tuskegee study of untreated syphilis in the African American male population. Now recognised as unethical - the men were not treated or informed of their condition contributing to a change in federal laws - it has unsurprisingly led to low participation ever since in clinical trials.
The lack of uptake across the board in minority communities he attributes to the absence of community engagement and poor information given to people by the researchers recruiting them. Without understanding how clinical trials can benefit certain communities, participation is low while running costs are high.
Dr Ibtesam Al Bastaki outlined the constituent basis of the Middle East population, which is largely dominated by Saudi Arabia. In the UAE, there is a huge diversity and age range as a result of a mainly expatriate community of workers across the spectrum, from executives to service communities. There is, however, a community resistance to clinical trials across the board and she felt the government should address this with an awareness programme to increase participation.
Despite this, the Emirati Genome Programme has been particularly successful, according to Hinda Daggag. The national project aims to use genomic data to improve the health of the Emirati population and invites all nationals to
contribute a blood sample to this end. As a result, the population has understood the importance of scientific research into diseases and how such research can help identify solutions to mitigate them. She spoke about the meaning of racial and ethnic diversity, and identified the importance of biotech companies targeting the populations of their proposed markets. Currently they focus on the populations they already use, which may not exactly reflect the make-up of other global citizens.
With the UAE aiming to become a life sciences hub, Mansoor Ahmed of Colliers highlighted the issues facing this goal, in particular the lack of R&D facilities as well as teaching hospitals. He felt that education should be the primary focus while building up R&D to allow the pharmaceutical companies to run trials. He acknowledged this aim needs more investment from pharma companies, while the current focus of many hospitals is income-driven rather than education. Yet largest pharma companies already have a presence in the Middle East, according to Mike Failly, who feels there is a big opportunity for targeted drug development. “It’s a gold mine for them as they have patients, diversity, and a huge population which is treatment naive,” he said.
Lawyer Raesa Afzal explained that the emergence of the Dubai Academic Health Corporation (DAHC) aims to focus on the academic, research and training side of healthcare. She stated that many companies have approached the Dubai Health Authority or DHA to undertake clinical trials, and like the other panellists agreed that various measures need to be put into place to enable this to happen.
Hinda Daggag posed the question as to how important genetics is with regard to clinical trials, and emphasised the need to target the correct population in drug therapy. Mike Failly agreed, stating that testing a new drug from Phase 1 to Phase 3b can encompass fewer than 500 people, even less for rare diseases, so there is a need to reconsider sized trials and measures to incorporate diversity in order to ensure that new drugs are not harmful or ine ective while on the market. Hinda agreed, citing the human reference genome that was based on one person of white descent.
Chair Steve Gardner, MD of Healthcare World, queried whether there was no legal incentive for drug companies to diversify
their trials. Raesa agreed, and felt the regulators should step in otherwise nothing will change. She also identified the need for genetic counsellors and measures to address cultural language barriers, pointing out that that the main function of DAHC is to secure research investment.
Steve wondered whether this would deter pharma companies from investing, Raesa thought it might be cheaper instead for them to base themselves in the Middle East. “It’s a Catch 22 situation – you want to incentivise the companies to come here but need to address the ethical questions as it’s a potential safety risk,” she said. Mansoor referenced the new compulsory health insurance in Abu Dhabi and said he thought pharma companies would feel more confident knowing the risk was covered.
With the collation of data and new integrated health records in the UAE, there will be more valuable data for researchers in the
“It’s a Catch 22 situation –you want to incentivise the companies to come here but need to address the ethical questions as it’s a potential safety risk”
Raesa Afzal Senior Counsel
Al Tamimi & Co
region. For Raesa, the issue is not just about monetisation of data but about population health management. “It will be more cost e ective if the population can be screened from birth,” she pointed out. Mansoor felt the population is now more on board as people had to trust the leadership during the COVID pandemic. He went on to point out that the main issue around data is accessibility.
Raesa clarified that although there will be a unified health platform in the Middle East, consent is important and people will be able to opt out. She felt the issue to be around trust and noted that people are reluctant to take part in clinical trials in case their data is used elsewhere.
Hinda posed the question as to how to access more people for clinical trials in that case. For Raesa, the answer lies in community engagement by the government, using social media and highlighting the benefits for voluntary participation, particularly around incentivisation.
Steve closed the session by asking panellists about the importance of
developing a fertile research element for a health system. The consensus was that research is key and should be mandated across health systems and not just academic institutions, and that an education institute with research capability should be key. A governance framework should be instigated and possibly even a percentage of GDP allocated to R&D. The
importance of data was highlighted, with a data hub where data talks to itself and isn’t scattered.
“The UAE has the facilities it needs to sell itself,” said Mike Failly, “but it needs the people’s trust, and it should be regulatory to fulfill international standards to provide quality of outcome.”
Steve brought the proceedings to a close, concluding that it is vital to “create a fertile environment - whether it’s research, with data, with socialisation - and the right regulatory framework to make it easier for research organisations to pace themselves and start to provide that level of diversity in clinical trials that we’re all looking for.”
“The UAE has the facilities it needs to sell itself, but it needs the people’s trust, and it should be regulatory to fulfill international standards to provide quality of outcome”
Mike Failly Founder & Managing Director Zanteris
Mohammed Aldar, Managing Director of ACCUMED Saudi, explains why Revenue Cycle Management is crucial for healthcare providers
RCM monitors and manages the income any healthcare organisation receives from provided care services to patients. This process requires streamlined steps, logistics and manpower to perfect its results. It o ers financial sustainability and elevates the quality of healthcare provided in the society. But what exactly does RCM focus on? In simple words, proper RCM in place
ensures that healthcare organisations maintain a revenue that keeps them financially healthy. For a long time, the healthcare system silently su ered from the incompetence of manual RCM that indirectly led to revenue loss through silent leakage. While RCM encompasses a wide variety of daily logistics, from patient scheduling and insurance verification to claim submission and payment collection,
the chances of minor and major errors are higher with classical RCM methods. However, manual processes and lack of visibility through manual RCM methods lead to a number of disadvantages, including:
• Slow payments - Traditional RCM processes are time consuming and processing claims will eventually take up to several months to be completed which negatively a ects the cash flow.
• High costs - Traditional RCM processes are labour-intensive which becomes a burden for smaller healthcare providers due to the need to invest in manpower and technologies.
• Poor visibility - Traditional RCM does not o er a clear and complete view
of the revenue cycle, which makes it di icult to identify and address problems.
• Inflexibility - Traditional RCM processes are not well-designed to accommodate
the constantly changing healthcare landscape which leads to financial losses.
These four main healthcare RCM bottlenecks, not inclusive of all challenges, have been minimised throughout long years of experience locally and globally by ACCUMED (and in so many cases eliminated) by employing the right expertise, operations, training and consultancy. This success has been achieved with the help of technology that rounds the edges of traditional RCM for elevated healthcare quality in general and, in particular, better financial performance.
Technology for healthcare RCM is a must for:
Streamlining processes and reducing paperwork
Technology assists in automating many of the manual tasks involved in RCM, such as patient registration, insurance verification, billing, and coding. This frees up sta time to focus on other areas, such as patient care, which plays an important role in reducing errors.
Improving accuracy
Technology improves the accuracy of RCM by providing real-time data and insights such as electronic health records (EHRs), which can be used to track patient information and insurance coverage in addition to predictive analytics that are used to identify potential claim denials. We have so far managed a clean claims ratio count of 3.2m since launch.
Optimising cash flow
Technology helps in optimising cash flow by automating the billing and payment processes. This speeds up the time it takes to receive payments which indirectly reduces the risk of bad debt. We have so far achieved an average net collection ratio of 54 per cent.
Providing better patient experiences
Technology provides upgraded patient experiences by making it easier for patients to schedule appointments, pay bills, and track their health records. This improvement increases the credibility of the healthcare organisation, and boosting the overall reputation that any healthcare entity thrives on.
RCM enables healthcare organisations to improve continuously and maintain their reputation through:
Used for tasks’ automation such as claims submission, eligibility verification, and payment posting, saving healthcare organisations significant time and money as well as helping in reducing errors through:
• Automating claims processing such as data entry, verification, and submission which reduces errors and speeds up the claims process.
• Automating denial management through researching the reasons for denials which reduces the number of denials and automatically improves cash flow.
• Automating tracking payments through monitoring payment status to ensure that payments are received in a timely manner.
• Automating reconciling accounts through matching payments to invoices and identifying discrepancies which improves accuracy and prevents fraud.
Used to improve RCM processes accuracy. AI can be used to identify claims errors prior to submission.
Used to develop predictive models that help healthcare organisations in identifying areas for improvement in their RCM performance. Machine learning is used to predict which claims are more likely to be denied.
Used to analyse large datasets of RCM data to identify trends and patterns. This information is used to improve the e iciency and e ectiveness of RCM processes.
As technology continues to evolve, the healthcare industry will witness more innovative solutions that will help healthcare organisations to improve their RCM performance.
“Proper RCM in place ensures that healthcare organisations maintain a revenue that keeps them financially healthy”
Mohammed Aldar Managing Director ACCUMED Saudi
A focus on elderly care in KSA requires substantial investment and offers significant opportunities, says Mansoor Ahmed, Executive Director, Middle East & Africa (MEA) Colliers
With an estimated population of 32.2m, the Kingdom of Saudi Arabia is undergoing fundamental structural changes across all sectors of society. This is particularly true of
healthcare which is evolving on the back of rapid advancements in technology and research and development.
Long term care (LTC), rehabilitation and home care (HC) are among the main focus points of the enhancement and
diversification of healthcare. A key driver is the changing demographic profile through a decreased fertility rate and an increased life expectancy. As a result, the population above 60 years in KSA is expected to increase from 4.5 per cent in 2020 to 10.4 per cent in 2030.
This shi will have a significant impact on disease patterns and the type of healthcare required. As almost 80 per cent of a person’s healthcare requirements happen a er the age of 60, this will increase the demand for LTC, rehab and HC. This is especially true in the case of KSA with its high prevalence of lifestyle related diseases including coronary, diabetes and obesity-related illnesses.
The development of this sector can act as a change catalyst to the healthcare sector from elderly to acute care. Through a gradual shi ing of bed-bound patients to specialised LTC and rehab facilities, ultimately treating them at home, there will be a reduction in the pressure on LTC, acute care and rehabilitation hospitals.
Based on Colliers’ estimates, there will be a demand for 22,600 (19,200 by 2030) LTC beds, and 20,600 (16,600 by 2030) rehabilitative beds by 2035 that will require an additional investment of approximately USD11.6-22.5 billion by 2035.
An important aspect will be improving Home Care service to reduce the pressure on hospitals. The Ministry of Health
(MOH) target is to increase home care coverage annually from 35,000 in 2019 to 145,000 in 2030.
Saudi Arabia is experiencing a steady increase in the number of elderly which calls for a comprehensive action plan to take care of their health, psychological, physical and social needs. By 2030, 42 per cent of the Saudi population is expected to be over the age of 40 and 10.4 per cent over the age of 60. This will further propel the need for healthcare services with a specific focus on rehabilitative services to meet this growing demand.
Like many Gulf states, Saudi Arabia su ers from a high prevalence of chronic, lifestyle and congenital diseases. Of those aged 65 - 69, 85 per cent have some form of chronic illness and 61 per cent of all individuals with chronic illnesses have either diabetes, high blood pressure, or both. But, unlike the UAE and Qatar, where nationals account for 15-20 per cent of the population, in Saudi Arabia nearly 58 per cent of the residents are nationals, which means there is much more demand for long term care services and greater pressure on the health system.
There is a high demand for post-acute and long term care in KSA. Currently the patients requiring the LTPAC care are occupying acute care beds and burdening the healthcare system. KSA has an extremely low rate of 0.08 LTC beds per 1,000 population as compared to 0.53 beds per 1,000 population in OECD countries.
As a result of an ever-improving acute care system, the mortality rate due to birth defects or major injuries has significantly decreased. Consequently, the number of people living with incapacitating medical conditions or disabilities has risen, and therefore require long-term care.
The Ministry of Health (MoH) Private Sector Participation (PSP) initiative aims to increase the share of the private sector in healthcare delivery via Public Private Partnership (PPP) and is focused on enhancing extended care by improving the overall provision and quality of the services.
Due to the shortage of long-term care, rehabilitation and home care services in KSA, patients in need of long-term care utilise acute care facilities which creates a burden on this key area. Based on various reports and discussions with hospital operators, patients who could be
“The population above 60 years in KSA is expected to increase from 4.5 per cent in 2020 to 10.4 per cent in 2030”
Mansoor Ahmed Executive Director, Middle East & Africa (MEA) Colliers
better served in LTC and rehab facilities occupy an estimated 20 - 30 per cent of public hospital beds in KSA.
The cost of patients who need LTC and rehab but are instead treated in general hospitals is significantly higher compared to a long term care facility. This is a crucial issue; all government budgets are under pressure while demand for healthcare continues to rise. Capital and operating costs of setting up LTC and rehab facilities is up to 30 per cent or less when compared to an acute care hospital.
As part of the privatisation process in KSA, the Ministry of Health is seeking to engage operators for LTC and rehab facilities and home care. An important aspect will be improving Home Care (HC) services; presently the capabilities, resources, and e iciency in home care vary across regions with limited services provided. Due to a lack of e icient operational procedures and proper information systems, the utilisation of
home care personnel remains low. An improved home care provision will reduce the pressure on both acute care and LTC and rehabilitation hospitals. The target under the PSP initiative is to increase home care coverage annually from 35,000 in 2019 to 133,000 – 145,000 by 2030.
In 2023, the Ministry of Health Saudi Arabia, in collaboration with the National Center for Privatization & PPP launched the
Expressions of Interest (EOI) for Long Term Care, Medical Rehabilitation and Home Healthcare Projects in the Riyadh and Eastern Regions. These include Long-Term Care (LTC) and Skilled Nursing Home (SNH) projects, a Medical Rehabilitation Hospital, Home Healthcare (HHC): Clinical operation and maintenance of 5,000 active patients (for each region).
These projects will be initially rolled out in the second health cluster (Riyadh) in the central regions, and in the first health cluster (Dammam) in the eastern region. The projects aim to contribute to a key objective of Vision 2030, by increasing private sector participation in the healthcare sector.
The MoH and NCP (National Center for Privatization) announced in May 2023 that a record number of 200 companies submitted 424 expressions of interest in three healthcare Public Private Partnership (PPP) projects in Riyadh and Eastern regions.
“Patients who could be better served in LTC and rehab facilities occupy an estimated 20- 30 per cent of public hospital beds in KSA”
Mansoor Ahmed Executive Director, Middle East & Africa (MEA) Colliers
The greatest challenge lies in the shortage of manpower as the number of physicians and specialised nurses and allied healthcare personnel for rehabilitation is insu icient. With new hospital developments underway, the competition to hire experienced and skilled physicians, nurses and allied workforce is further set to intensify.
Currently, the market is in its nascent stage and many existing LTC, Rehab and HC facilities lack advanced medical capabilities. As the market matures, more centres providing specialised comprehensive rehabilitation such as neurorehabilitation, cardiopulmonary, pediatric and musculoskeletal rehabilitation will come into existence.
Colliers’ Healthcare, Wellness, Life Sciences, PPP and Mergers & Acquisitions (M&A) Advisory & Valuation Services team is actively working with several local, regional and international investors and operators to facilitate entry and/or expansion in KSA’s lucrative LTC, Rehab and HC sector.
Contact Information
Percentage of population above 60 years by 2035
Government’s Vision 2030 and NTP focuses on healthcare development, though Ministry of Health (MoH), Private Sector Participation (PSP), using PPP Model
Andrew Castle, Healthcare Director for Currie & Brown in Saudi Arabia, discusses the current healthcare landscape in KSA
As the Saudi vision for healthcare begins to take concrete shape, it’s an exciting time for healthcare companies. It’s an opportunity to support an overarching vision to create a fully functioning healthcare system created from the ground up, looking to resolve the issues faced by previous systems across the globe and tackling them in a new and innovative manner. This is not to say that all the solutions will be brand new. Saudi Arabia is known for its emphasis on taking
the best, and applying tried and tested concepts within an emphasis on their own particular needs.
As the new healthcare director for Currie & Brown in Saudi Arabia, Andrew Castle joins their growing team to lead them in supporting the delivery of the healthcare agenda as set out in the Kingdom’s Vision 2030. Andrew has experience in the development of clinical strategies and their implementation, and the design and build of clinical facilities. With more than 10 years’ experience
working in the Middle East, he is ideally placed to support the transformation programme with all the opportunities and challenges it brings.
The healthcare sector in KSA is undergoing enormous changes. The transformation of the Ministry of Health’s role from both policy maker and provider to a regulatory and policy role with a clear separation of the provider side is a significant shi . The establishment of recently formed Accountable Care Organisations and the development of new models of care, as well as the focus on healthcare infrastructure development, is a huge e ort presenting significant opportunity for the creation of a world-class healthcare service.
As with all transformations, delivering significant change brings challenges. These include providing su iciently qualified and experienced sta , capacity to deliver specialist work, both clinical and nonclinical, and the need for external support across a range of disciplines.
With new models of care being developed, new providers entering the market, new infrastructure delivery and a recognition that existing estate and infrastructure is not fit for purpose, it is an exciting time for us to be involved.
What are the main challenges that KSA clients are having to overcome?
Many of the healthcare challenges faced in KSA are similar to those seen elsewhere. These include challenging existing ways of working, delivering programmes of work to time and budget, and identifying and putting in place the capacity to deliver large complex programmes of work.
There are some challenges that are specific to KSA. These include the establishment of new Accountable Care Organisations, the implementation of new nationally established models of care such as the Essential and Essential Plus for Primary Care and putting in place the resource to support their implementation. However, in many respects, the problems faced by KSA are similar to other country’s systems where there are changes in demand, demographics, and unmet need.
KSA is at the start of an exciting journey to create a world-class integrated healthcare system across the country. The lack of data specific to KSA needs to be addressed and the alignment of existing services and infrastructure already in place will need to be managed carefully.
None of the challenges are insurmountable and enormous progress has been made across areas including developing new models of care, progressing new infrastructure developments, and healthcare planning for the changing needs of the population. However, it is likely that over time the challenges that KSA faces will evolve. I expect these to include recruiting enough sta to deliver the new ways of working and identifying providers that can support the large and complex programmes of work.
In the medium term, I think the largest challenges the healthcare sector faces will be related to workforce. There may be issues in terms of delivery and capacity in the construction and associated sectors to support the development of new facilities, given the competition in the country from other sectors delivering large critical programmes of work.
The o er to join Currie & Brown as Health Sector Lead in KSA is an amazing opportunity at a pivotal time in the country and region. Currie & Brown are well established as a global firm delivering healthcare-related projects across five continents. They have experienced teams across a range of services and, alongside their Dar Group sister companies, are able to o er complete and complimentary services within the healthcare infrastructure sector.
The opportunity to lead and grow a local team of health specialists and build on existing success to support the delivery of the nationwide transformation in support of Vision 2030 is a unique opportunity.
They have the capacity to support the technical aspects of infrastructure development in a variety of formats, be that PSP or funded through other methods. Currie & Brown understand the approach that both the Ministry of Health and providers are taking regarding the development of new infrastructure and the transformation of clinical services. They have the internal capacity to support healthcare planning, the development of clinical and functional briefs, the production of SOAs and the development of business cases to support future investments.
More broadly, they have the internal expertise to support organisations in the development of clinical operating models, clinical strategies, implementation of new ways of working and the transformation of existing services to address inequities in access and inequalities in outcomes.
What lessons or experiences could KSA share with other systems based on its progress to date, and what can other countries share with KSA given the scale of its vision?
It is fair to say that no other country in recent memory has attempted transformation programmes at scale and as quickly as KSA has, and with that ambition comes challenges.
To date, the programmes of work have been very successful, and the primary reason for this success has been the relentless focus on the desired outcomes. The focus on a limited number of deliverables and ensuring they are completed is a lesson that other systems could learn from.
Equally there are challenges that KSA currently and will prospectively face that other systems have addressed, and there are opportunities to reflect on di erent approaches and to identify the opportunities to learn from elsewhere.
This has been successfully done with the development of new models of care. The KSA healthcare system has looked at international best practice, identified approaches to addressing specific challenges and incorporated them into their new ways of working. It must continue this outward view over the coming years to ensure that the approaches taken to change are current and reflect international best practice.
I think the ultimate success of Vision 2030 and the transformation of the healthcare system will be reflected in reducing barriers to access, improving clinical outcomes, and improving the physical and mental health of the population.
“With new models of care being developed, new providers entering the market, and new infrastructure delivery, it is an exciting time for us to be involved”
Andrew Castle Healthcare Director
Currie & Brown
Christina Sochacki and Abdulmohsen Al Saleh at Al Tamimi & Company outline the importance of privatisation in Saudi Arabia’s health sector transformation
One key pillar of Saudi Vision 2030 is the Health Sector Transformation Program (HSTP).
The HSTP aims to restructure the health sector in Saudi Arabia to be a comprehensive, e ective and integrated health system based on the health of the individual and society, relying on the principle of value-based care.
According to Invest Saudi, Saudi Arabia currently has a population of 35m, nearly 60 per cent of whom are under the age of
35. The healthcare and life sciences sector accounts for 17.7 per cent of the country’s budget expenditure in 2021, making it the third largest recipient of government funding.
As of 2021, there were over 460 hospitals and 2,000 primary healthcare centres across the country, with more than 75,000 hospital beds, equalling 2.3 beds per 1,000 people.
Saudi Arabia’s national healthcare system, where the government is responsible for both the financing of health care and its delivery, is largely
publicly financed. The Saudi Ministry of Health (MOH) is the largest provider of healthcare in the Kingdom. The other governmental healthcare providers (such as the Saudi Arabian National Guard and the Ministry of Defence and Aviation) provide comprehensive health services to their targeted population, usually employees and their dependants, and represent around 20 per cent of health services. The private sector provides the final 20 per cent of healthcare services, but we expect this to increase due to a variety of factors.
Vision 2030 places significant importance on healthcare privatisation to enhance and meet the increasing demands of the population. Privatisation seeks to expand access to healthcare services, expand the provision of e-health services and digital solutions, as well as improving the quality of health services. There are plans to privatise 290 hospitals and 2,300 primary health centres by 2030.
For context, some of the key governmental/semi-governmental entities of the healthcare services sector in KSA are:
1. Ministry of Health (MOH) – provides healthcare, promotes public health and disease prevention, develops laws and legislations concerning both the government and private sectors, regulates the industry, including monitoring the performance of health institutions, supports and conducts research, and operates healthcare academies
2. Saudi Food & Drug Authority (SFDA) – develops and enforces health standards to regulate the food and drug sectors, including the review, registration, classification, pricing, and monitoring of drugs, foods, herbal products, supplements, and medical devices
3. Saudi Commission for Health Specialties (SCFHS) – ensures e ectiveness of health practitioners’ registration and classification, sets controls and standards for the practice of health professions, promotes medical research and education, and supervises and develops professional development programs through coordination and partnerships with local and international institutions
4. Council of Health Insurance (CHI) – oversees the implementation of comprehensive health insurance coverage, while supervising and controlling both insurance companies, and service providers
5. Saudi Health Council (SHC) – liaises between the multiple health sector stakeholders in the Kingdom to: prepare and oversee the healthcare strategy in the Kingdom, issue relevant regulations to ensure that hospitals run by the Ministry of Health and other governmental agencies operate appropriately, and seeks to provide health services e iciently by eliminating duplication and waste, amongst other powers
6. National Unified Procurement Company (NUPCO) - all government health authorities are to purchase medicines and medical supplies exclusively through NUPCO.
Saud Arabia has made significant progress already despite ongoing challenges, such as healthcare workforce shortages and demand outpacing capacity in many areas of the healthcare continuum. Many strategic initiatives are centred on the adoption of digital health solutions, to enhance accessibility, improve e iciency, and create greater transparency within the system.
The establishment of the Health Holding Company (HHC) is part of the sector reforms aimed at decentralising the public sector. KSA has been able to separate the regulator from the operator of the large, mostly publicly-owned, healthcare sector with MOH tasked with setting the regulations and HHC tasked as the operator of public healthcare services in KSA.
The proposed plan is for the HHC to create healthcare clusters across the Kingdom, which are expected amount to approximately 20 - 30 geographically defined, vertically integrated, Accountable Care Organisations, serving around 1-2m people each. These clusters are planned to be established as corporatised public bodies with substantial and defined decision rights. This strategy was drawn widely from the NHS experience in corporatising public healthcare providers.
The new Model of Care shi s the focus of healthcare to proactive, preventative care, emphasising systems integration and wellness, to achieve better health outcomes, improve care quality, and enhanced personal value.
The Unified Health Law project emphasises the importance of quality and e iciency in healthcare, encourages the adoption of international best practices, and promotes development, research, and innovation. It also focuses on ensuring sustainability, continuous improvement, e ective governance, and enhancing the e iciency of the healthcare workforce. By creating a single piece of legislation that covers all aspects of healthcare, it is expected that this will enhance the potential of investments within the healthcare sector in Saudi Arabia.
In August 2023, HSTP announced the establishment of the Saudi National Institute of Health Research (SNIH or Saudi NIH), aimed at supporting research and innovation in the healthcare sector and empowering researchers. The Saudi NIH aims to focus on promoting biomedical research, supervising translational research and clinical trials in KSA.
KSA aims to increase healthcare privatisation to 35 per cent by 2030, aiming for universal health coverage to include not only citizens but also residents and visitors. The government’s goal is to create a unified digital medical records system by 2025 to increase e iciency, improve the quality of healthcare and patient safety, and provide valuable data for evaluating performance, automating the healthcare system.
The 2021 Private Sector Participation Law and its implementing regulations (PSP Law) sets the principles for private sector participation and public-private partnerships (PPP). The PSP Law aims to increase private sector participation in infrastructure projects and in the provision of public services to citizens and residents through PPPs and the privatization of public sector assets. All contractual relationships between the public and private sector that relate to infrastructure or the delivery of public services are covered by the PSP Law, if they meet the following parameters:
1. A term of five years or more
2. The private sector’s obligations include two or more of the following types of work: design, construction, management, operation, maintenance or finance of the assets, whether those assets are government-owned, or owned by the private sector party, or both
3. There is quantitative or qualitative distribution of risks between the parties
4. Payments owed by or to the private sector party are primarily performance-based.
Saudi’s Privatization Program was launched in 2018. At its launch, the Privatization Supervisory Committee identified nine di erent areas that would benefit from privatisation and/ or a public-private-partnership. The areas include the development of health centres, hospital operations, new medical cities, radiology services, rehabilitation and extended care, home care, laboratories, pharmacies, and health care logistics. Thus, by developing the PSP Law and having a clear idea of which healthcare service areas require privatisation, the KSA government has been able to develop a roadmap that allows investors to come in to KSA and benefit from the developments happening as a result of Saudi Vision 2030.
Rehabilitation supports KSA’s new Model of Care, specifically in relation to the Chronic and Planned Care systems. Additional investment is required into rehabilitation facilities due to demographic trends including higher rates of comorbidities and a high road tra ic accident rate. There is an increasing shi towards communitybased multi-disciplinary teams, increased use of technology (such as remote patient monitoring and telemedicine) and demand for rehabilitation beds growing rapidly, with additional requirements of 6,500+ beds by 2030.
KSA is seeking to attract investment into delivery of inpatient services (e.g., post-acute rehab) and outpatient services (physiotherapy, speech/ language therapy), as well as specialised services such as neuro-muscular rehab. The Kingdom welcomes investors for the design, construction / replacement, equipment, operation and maintenance of rehabilitation hospitals in KSA.
Scalability opportunities for rehabilitation hospitals include increased footprint or development of additional facilities to fulfil demand gaps. There are also options to expand into synergistic opportunity areas such as home care and long-term care facilities.
Long term care continues to be a key component of the new Model of Care, which requires availability and integration of a full continuum of care, including post-acute services. KSA seeks healthcare service provision of a variety
of services for an extended period that includes medical, rehabilitative, restorative, palliative, respite care and assistance with activities of daily living to individuals who have a chronic or subacute illness or disability.
There is a potential to scale long term care further through establishing additional hospitals across clusters and to expand into synergistic opportunities areas, such as rehabilitation and home care.
The demand for mental health beds is growing substantively, with additional requirements of 5,000 + beds by 2030. KSA has a national mental health strategy with key themes including access to care and services quality and is seeking investors to design, construct, operate and maintain mental health and drug addiction facilities. Activities upon start of operations include patient sourcing, delivery of inpatient services (e.g., psychiatric treatment) and outpatient services (e.g., cognitive behavioural therapies).
There would also be opportunities to scale mental health hospitals further through an increased footprint (physical expansion of facility to include additional
“Privatisation seeks to expand access to healthcare services, expand the provision of e-health services and digital solutions, as well as improving the quality of health services”
Christina Sochacki Senior Counsel, Head of Healthcare & Life Sciences, KSA Al Tamimi & Co
capacity) or development of additional facilities to fulfil demand gaps. Further, there is a potential to increase hospital service portfolios to advanced therapies such as hypnotherapy, transcranial magnetic stimulation and more.
Primary care is a key prioritisation of the new Model of Care. Driven by an ageing population, rising chronic conditions related to lifestyle and population genetics, demand for primary healthcare centres is expected to increase, requiring 3,500+ additional clinics in KSA by 2030. HSTP’s focus is on integrated care delivery, proposed establishment of Accountable Care Organisations resulting in a shi from hospital to communitybased care and prevention – including delivery of essential and essential plus services through primary healthcare centres (such as health coaching and pre-operative care). KSA is seeking investment to enhance existing primary healthcare centres through physical
building refurbishments, service overhaul, improved demand and capacity planning, workforce enhancement (including employee proposition and recruitment processes) and delivery of clinical services.
There is potential to scale primary healthcare centres further through increased footprint or development of additional PHCs to fulfil demand gaps – there is an expected shortfall of 4,000 clinics by 2030. There is also potential to expand into synergistic opportunity areas such as diabetes clinics or men’s and women’s health centres.
The healthcare sector in Saudi Arabia faces several key challenges that include the need for more robust healthcare infrastructure and investment in all levels of care. Rural and remote areas amount to approximately 15 per cent of the total population and given Saudi Arabia’s diverse geographic areas, it is
imperative for a potential investor to identify the targeted population and area as they will need to meet the particular demands associated with them.
All entities in KSA are required to abide by the Saudization rule to train and educate Saudi nationals to fill the shortage of skilled healthcare professionals in KSA. The Tamheer programme aids entities by allowing graduates to obtain on the job training programmes in both governmental agencies and private sector companies.
It is essential to have the right partners that understand the regulatory and cultural landscape of doing business in the region. This includes having the expertise in terms of incorporation requirements, employment requirements and licensing procedures.
TalentFind Solutions CEO Mandy Rowbottom talks to Fabian Sutch-Daggett about her mission to improve healthcare
Successful recruitment can be remarkably di icult in the healthcare sector. Ensuring sta have the skillset and certifications necessary can be a minefield, especially without a deep pre-existing knowledge of the sector. With the WHO predicting a shortage of 18m healthcare workers by 2030, attracting candidates when there is
such high competition for talent can be a tall order.
Traditional recruiting tools have their place, of course. Yet the healthcare industry has unique demands and needs which these tools o en do not incorporate – such as strict regulations surrounding certification as well as large amounts of sta travelling abroad for work.
Furthermore, the cost of recruiting in healthcare can be monumental and extremely prohibitive, especially for large-scale providers. Last year, the NHS spent £4.9 billion on recruitment and agency fees, highlighting the di iculties faced by organisations looking for the best of the best.
Expert recruitment specialists Mandy Rowbottom and Adrian Wilkinson recognised the issues first hand. A er starting a company in 2012 that specialised in recruiting Western
trained clinicians to the Middle East, despite her initial success, Mandy found covering more regions extremely problematical. Her business partner Adrian, a technology specialist with more than 30 years experience in sophisticated IT, came up with a solution for a careers platform that was immediately successful: TalentFind World.
“My clients in UAE hospitals were always delighted when they saw me using TalentFind to search for their requirements. In fact, the hospital would be very pleased with the sta they had recruited, but even more happy with the system,” Mandy says.
This success motivated Mandy and Adrian to develop the TalentFind platform into a scalable product - the world’s first intelligent healthcare careers and networking platform, powered by TalentFind Cortex AI. Now trusted by the Department of Health in Abu Dhabi, TalentFind powers the Kawader platform which was originally implemented to manage and create resource during the COVID-19 pandemic. TalentFind has now enabled Kawader to attract a talent database of more than 12,000 healthcare professionals, enabling local facilities to easily recruit from local and international talent. This is a valuable tool in the GCC where increase in recruitment spend is predicted to increase by 240 per cent ($60 Bn) within two decades to meet demand.
From initially creating a tool to streamline their day-to-day business needs, Mandy and Adrian found their solution had revolutionised the recruitment process in healthcare – and operators were keen to get a version of this tool for themselves. However, scaling it up into a launchable product was a complex task. Once it was robust enough for the commercial market, they were able to execute a so launch in 2020. “We were keen to get it up and running as soon as possible as there isn’t another product in market dedicated to healthcare recruitment at all,” says Mandy.
Its success lies partly in its knowledge base - it acts as a repository for the enormous amount of information that
recruiters have to hold. It is also able to match the job requisites with individual candidates, ensuring they are eligible to obtain a licence to practise. Verification processes and qualification checks can cause an enormous backlog for all parties involved – operators, candidates and recruiters alike – with the average time for a recruitment agency to be paid taking around 15 months in international recruitment.
“Placing a candidate in a job takes a very long time as a result,” says Mandy. “Even in the NHS, just moving from one hospital Trust to another requires all pre-employment checks to be revalidated which can cause large delays.”
With TalentFind World, these issues can be mitigated or even removed entirely. Firstly, the Regional Eligibility Check built in to TalentFind World can instantly check the eligibility of licenses between countries, allowing candidates and employers to instantly know if they can move to that position seamlessly, improving the times to hire and thereby lessening costs.
Furthermore, the Smart Credentialling built into TalentFind World can intelligently manage the verification and visa requirements, if they are needed – allowing candidates to know exactly what they need to do to move forwards.
But exactly how is this accomplished? Keeping up with the fast-moving rules and regulations is almost impossible for a human to do - the answer lies in Artificial Intelligence.
TalentFind World uses Cognitive AI, allowing it to have a deep and unique understanding of the global medical training and licensing requirements,
reducing dependency on third-party verification tools, and ultimately reducing the time to hire. But even this was not enough for complex healthcare recruitment requirements as it didn’t take into account regional di erences in qualifications and training.
“I was very frustrated with the fact that there are many nurses who don’t quite meet the criteria outside of their own country. This curtails movements of nurses and can discourage nurses to come into the profession,” says Mandy.
Now, through TalentFind World, prospective candidates can receive learning and training on a wide variety of employability factors such as competency training up to the required HCP level, language skills, revision aids, and even an AI tutoring bot. Furthermore, organisations can sponsor individuals through TalentFind World, providing them with the opportunity to gain the correct accreditations and enter the workforce directly with that organisation.
“When an individual wants to work for an organisation, we provide them with an analysis that tells them the regions where they are eligible to work, and other areas where they will need to upskill,” says Mandy.
“On the hospital side, we have systems to recruit directly from training schools and universities, as well as initiatives and campaigns. The recruiter can choose to engage with a specific candidate at an early stage and sponsor them through their training. If they do get sponsored, they become hidden in the talent pool so that organisation can then recruit them when ready.”
Until now TalentFind’s focus has been the UK and the UAE, but with their new improved AI capability the company is now expanding to create the world’s largest unified healthcare community – the world’s first intelligent healthcare network. One Place. One Platform. One Healthcare World.
“Even in the NHS, just moving from one hospital Trust to another requires all pre-employment checks to be revalidated which can cause large delays”
Mandy Rowbottom CEO TalentFind Solutions
The best healthcare systems work as an effective, integrated ecosystem by putting the patient first in all decisions.
Whether that‘s planning infrastructure, integrating systems and processes, or securing finance for new facilities, using the right experts and understanding patient needs will help to deliver a world-class healthcare system.
At Currie & Brown we have the knowledge, experience and data to not only identify the plan, but help it become a sustainable reality for everyonethe community, medical staff, but most importantly the patient.
Currie & Brown is a world-leading provider of cost management, project management and advisory services, covering the public and private sectors. We add value that makes building a better future possible.
We help clients navigate volatility and unpredictability, providing the certainty that enables better, more sustainable built environments for all. We support clients at every stage, from concept, design and construction, to the assessment of best-value options for ongoing use, maintenance, operation and eventually deconstruction.
Offices in 69 locations across the Americas, Asia Pacific, Europe, India and the Middle East.
“A focus on the patient will enable the delivery of world-class integrated and sustainable healthcare systems and infrastructure.”
Helen Pickering
Global Head of Healthcare helen.pickering@curriebrown.com
Dr Andrew Hoyle, Assistant Director Decisions and Case Examiners, explains how the UK’s General Medical Council regulates fitness to practise among doctors
The recent trial of paediatric nurse
Lucy Letby in the UK has shone an unwelcome spotlight on individual caregivers. Letby was convicted of killing newborns under her care in a neonatal ward, showing how di icult it can sometimes be to oversee such a large organisation as the NHS.
Yet there are robust measures in place to protect the public at large, thanks to organisations such as the General Medical Council which works with doctors, patients and other stakeholders to support good, safe patient care across the UK by setting the standards of patient care and professional behaviours doctors need to meet. The GMC is a world-leading professional healthcare regulator that currently has around 375,000 doctors on the register. The register exists to give confidence that doctors practising medicine in the UK have the right knowledge, skills, qualifications and experience needed to meet the standards that patients expect.
Their document Good Medical Practice outlines the expected professional conduct of a doctor, saying that every doctor should:
•Make the care of their patient their first concern
•Be competent and keep their professional knowledge and skills up to date
•Take prompt action if they think patient safety is being compromised
•Establish and maintain good partnerships with patients and colleagues
•Maintain trust in themselves and the profession by being open, honest and acting with integrity.
Doctor and lawyer Andrew Hoyle, GMC Assistant Director Decisions, oversees the GMC’s final decision in determining whether doctors have met the standard set out in Good Medical Practice. “We only progress concerns where there are serious or persistent departures from Good Medical Practice,” he tells Healthcare World.
“At the moment we have around 375,000 doctors on the register and each year we receive about 9000 complaints about doctors. Ultimately, of those 9000 complaints, about 260-80 go forward to the Medical Practitioners Tribunal Service each year, resulting in only about 160 doctors each year having any restrictions placed on their registration.”
• Andrew is a doctor, registered with the GMC with a licence to practise, and he is also a practising barrister. He joined the GMC in May 2022, having previously been head of medico-legal services for part of the UK government. He is an expert in medical law and he has considerable experience advising healthcare professionals involved in clinical negligence claims, inquests and regulatory matters.
• Prior to his full-time appointment at the GMC, Andrew sat as a MPTS tribunal member and a PLAB examiner.
• Andrew’s team of Case Examiners are the lay and medical statutory decision makers who determine, at the final stage of the GMC’s investigation into concerns about a doctor’s fitness to practise, whether a case closes or goes forward to the independent Medical Practitioners Tribunal Service.
As this is an issue facing all countries worldwide, GMCSI, the international arm of the General Medical Council, delivers services across the UK and the rest of the world to improve patient safety. From medical training in the UK, to the review of overseas regulatory frameworks, it provides unparalleled knowledge and expertise.
UK law says that doctors must conduct themselves at a higher standard than the public, as maintaining patient confidence in doctors is more important than the interests of any individual registrants. So the GMC is fundamentally a patient safety organisation, according to Andrew.
“The Medical Act 1983 defines the GMC’s legal duty to maintain the health, safety and wellbeing of the public, public confidence in the profession and proper professional standards,” he says. “As an organisation the GMC does that by di erent mechanisms, starting with Good Medical Practice. We maintain these standards through a process called revalidation where we seek assurance that doctors continue to meet the standards we set, and every five years must be signed o as fit to practise. The part that we play in fitness to practise is to investigate and take action where there are concerns that patient safety or the public’s confidence may be at risk.”
Where there is an alleged failure to adhere to the GMC code of medical conduct, the GMC must consider every concern it is made aware of. These concerns may include misconduct, poor performance, a criminal conviction or caution, physical or mental ill-health that may impact the ability to safely practise medicine, a determination by another regulatory body or insu icient knowledge of English.
The organisation tries to conclude its investigations as soon as possible, and all of them within 12 months of receiving the concern if possible. Doctors are only referred to a Medical Practitioners Tribunal for serious or persistent departures from GMP and where they are currently impaired. Misconduct such as persistent dishonesty or having received a criminal conviction o en lie at the top end of the spectrum of gravity and frequently result in restrictions on a doctor’s practice, but in the last ten years fewer than ten doctors have been stopped from working for purely clinical concerns.
Working conditions for most doctors are stressful, compounded by problems with technology and lack of workforce. As such, there is a recognition that doctors can make an occasional mistake due to tiredness or extreme circumstances. “We try very hard to be a compassionate regulator and that means being fair to both patients and doctors. For the doctors, it’s about us having empathy and understanding how incredibly stressful the process is that they’re going through,” Andrew says. “One of the ways that we can be compassionate is to try and remove some of the fear that exists around regulation. Most doctors will go through their careers and never have anything to do with us apart from being on the register and being revalidated.”
Complaints can arise from patients and members of the public, as well as from doctors about themselves or others. In addition, responsible o icers and employers, police and third parties can also register complaints. “We treat all complaints the same,” Andrew says. It is simply a matter of fact that if a complaint comes from a responsible o icer or an employer, those complaints are more likely to progress because the employers will have done their own investigations. We have an Outreach team that collaborates closely with doctors, responsible o icers and employers to address concerns about doctors and support management to resolve concerns locally, where possible, before they come to us.
“We start by triaging all concerns to consider the remit and quality of evidence, and close around 82 per cent of cases at this stage. The cases that progress are the ones that pose a current and ongoing risk to public protection. A provisional enquiry, where we obtain limited further evidence, allows us to close about another 400 cases at this point, but if there are still concerns then the GMC proceeds to a full investigation with witness statements and more detailed evidence. Obtaining third party evidence is o en the single biggest delay in a case, but once all is in order the case is presented to the Case
Examiners to apply the Realistic Prospect Test: Are the allegations serious enough to require action on registration, is it more likely than not the allegations will be proved, and is there current impairment?”
Case Examiners do not hear oral evidence and clinical concerns are always addressed by asking for an independent medical expert opinion. If the RPT is not met, the case is closed, potentially with advice or a warning. If it is met, undertakings can be agreed between the GMC and the doctor, such as only to work while being supervised. Ultimately, the case may be referred to the Medical Practitioners Tribunal Service or MPTS which operates independently to the GMC. MPTS tribunals comprise a medical practitioner, a lay person and a chair. The tribunals make independent decisions about whether doctors are fit to practise in the UK.
“Regulatory law requires testing the evidence and cases are always dynamic – the evidence heard at each stage changes it,” says Andrew. “We are careful not to fill in any gaps in the evidence, so we only consider the evidence in front of us. We work very hard to mitigate the risks of bias at every stage of our processes.”
Through GMCSI Andrew Hoyle and his team can share their learnings around fitness to practise from both the legal and clinical perspective. However, Andrew is conscious that each territory has its own legal statutes and always works within the rules and guidelines of that context. The work can involve merely reviewing practices and policies, which can be carried out remotely, or training tribunal members or case examiners in country.
Their work includes a full strategic review of another regulator for a country which included fitness to practise. “Most countries that approach the GMC have newer regulatory models which are establishing themselves. Some countries don’t even have existing health regulators. And in fact, some countries don’t even have existing health councils. We can add a lot of value to these countries by o ering guidance and sharing our experience, helping them to fast track their policies and processes and swi ly implement a regulatory model to suit their needs.”
“We try very hard to be a compassionate regulator and that means being fair to both patients and doctors”
The Introduction to International Programme, created by Bevan Brittan and Healthcare World, is a comprehensive solution to provide healthcare businesses with the expertise to enter new markets with confidence
Entering a new market can be a daunting process for growing businesses, and many questions and worries arise when deciding what to do. Is my business ready to expand into new markets? What markets should my business be looking at? What infrastructure do I need to expand? How can I find organisations to partner with in-market?
Am I ready to deal with new regulatory requirements? These concerns can slow down the growth process enormously and deter great businesses from expanding out of their home market.
Recognising this as an issue faced by many in the rapidly growing healthcare sector, Healthcare World have partnered with Bevan Brittan to develop a new
product, the Introduction to International Programme. Aimed at providing businesses looking for assistance in starting their international growth journey, ITI delivers the tools, expertise, and advice necessary to enter new markets with confidence.
So, how does it work?
The Introduction to International Programme Outline
• Step One: Self-analysis Questionnaire
The ITI programme begins with a comprehensive questionnaire to complete, which allows Healthcare World and Bevan Brittan to understand your product, where you are on your international growth journey, the assistance you need, and your initial thoughts on internationalisation.
All the information provided in this questionnaire is protected under an NDA, so you can rest assured that any confidential information you provide will be secure.
Following this, we will arrange an Initial Advisory Review to take a deep dive into your responses to the questionnaire.
The people leading this review will be:
Emma Sheldon MBE, Healthcare World CEO, our International Business expert, who has taken companies into more than 20 di erent markets across the globe.
who has decades of experience in the international healthcare sector, and frequently speaks at the leading healthcare conferences and events about the most pressing issues in world healthcare.
You’ll come away from this meeting with key recommendations on the opportunities that exist for your product and in which market(s).
• Step Three: Legal & Regulatory Support Review
A er your strategic review with Emma and Steve, you will have the opportunity to engage with Healthcare World’s legal partners Bevan Brittan to explore the key areas of risk and the most e ective approach to understanding these and addressing or mitigating them. For example:
• Common areas of legal and regulatory risk
• Business set-up requirements
• Market entry preparation from a legal perspective
• Possible barriers to entry
Leading this review will be:
Letitia Winterflood-Blood, Partner, Bevan Brittan
Letitia is a specialist in commercial ventures within the healthcare sector, with a particular focus on providing contract and commercial advice on partnering projects. In her career, she has advised on services delivery and partnering across the market involving both public sector organisations (including the NHS central government bodies) as well as independent bodies in relation to UK based and international ventures. Letitia is regularly recognised for her expertise and is ranked in Chambers and Partners.
Vincent Buscemi, Partner and Head of Independent Health and Care, Bevan Brittan
Vincent is a highly experienced health, social care and senior living lawyer, specialising in commercial, corporate and regulatory law, recommended by Legal 500 and ranked in Chambers and Partners.
Vincent has extensive experience of advising operators, investors, funders, developers and providers in healthcare,
social care, and the senior living sectors on a diverse range of commercial, corporate and regulatory transactional matters, including market entry and the import and export of goods and services into new and emerging markets.
• Step Four: Intelligence Report
Following your reviews with both Bevan Brittan and Healthcare World, we will provide you with a detailed, in-depth intelligence report into your primary chosen target market, which will encompass information such as:
•Health System overview (Structure, Operations, Scale, Opportunities)
•Key payors, providers, regulators, and government organisations
•Expected healthcare developments over a 24-month forecast
•Potential partners in market
•Key information and guidance on the legal and commercial challenges of doing business internationally and how to approach them.
• Step Five: Summary Report and Workshop
Following the outcomes of the Strategic Reviews and Intelligence Report, we will provide you with a Summary Report comprised of our key findings, opportunities, and recommendations for entering your primary chosen target market. We will walk you through this report and our findings in our Summary Workshop, during which time we’ll provide you with the outcomes of the programme and the next steps for you to take.
By this point, you’ll have a conclusive report with all your questions at Part One answered, and a concrete strategy to move forward with.
If the Introduction to International Programme sounds like something you would be interested in, please get in touch with Healthcare World’s Managing Director, Steve Gardner directly:
Lina Behrens, Head of Content for HLTH Europe, tells Healthcare World about the importance of standard data regulation across mainland Europe
Trillions of rows, across billions of patients, housed in millions of silos globally; healthcare data is an unfathomably huge universe. And while over the last two decades, we have made incredible advances in how this data is stored, used, shared, and learnt from, we still have a very long way to go before healthcare data’s true potential is fully realised.
Berlin-based, Lina frequently encounters inquiries about digital initiatives within the German healthcare landscape. Germany employs a dual healthcare system, wherein individuals can choose to be covered either by one of approximately 100 statutory health insurances (SHIs) or one of 45 private health insurances (PHIs). Comprehensive PHI coverage is accessible only to individuals surpassing a specific income threshold or those who are self-employed.
This insurance-based system, known as the Bismarck model, distinguishes itself significantly from the Beveridge system, the tax-based model which operates under a single national payor, and used by the UK, Italy, Spain, Denmark, Sweden, Norway, New Zealand and others.
Of course, having a large number of payors (and providers) involved can provide di iculties from a data standpoint.
“In Germany, our healthcare system is o en praised for its comprehensive coverage and accessibility, but it’s not without its challenges. Managing data within a multi-payor and multi-provider landscape, each with their own data silos, can be like conducting a symphony with many instruments, each playing its own tune.
“When everyone plays without listening to others, it doesn’t work, but when orchestrated well, it can produce beautiful healthcare outcomes. We certainly have a long way to go to listen to a concert that is fully in tune, but at least the first rehearsals are underway,” says Behrens.
While the data setup in the UK system may have its imperfections, the single-payor model significantly streamlines the data collection process compared to gathering data from nearly 150 distinct payors.
“In addition, the decision-making system in our healthcare landscape can be quite intricate. We have a wonderful long German word, ‘Selbstverwaltung,’ which roughly translates to self-management.
“This term encapsulates the idea that various stakeholders within the healthcare system actively participate in the decisionmaking process. Clearly, when engaging with payors, providers, doctors, and government representatives, distinct incentives come into play.”
To stay with our music references: the decision-making process resembles a complex dance, choreographed to harmonise the diverse interests of these stakeholders, with each dancer deciding what steps to take within certain realms. Compared to countries such as the UK and France, which historically have more centralised decision-making processes, this
decentralisation might seem odd to people from other countries.
“We have strict regulations governing the collection of individualised health data by insurances about their own patients, as well as guidelines for sharing this sensitive healthcare information with other organisations. For 13 consecutive years, IBM’s annual data loss report has consistently ranked the healthcare sector as the costliest industry for data breaches, and rightfully so. The data we handle is among the most sensitive in existence, demanding every necessary protection,” explains Behrens. “However, there are instances where these stringent safeguards are used as a convenient excuse to resist innovation.”
Fortunately, the German government is actively taking steps towards a more digitally advanced healthcare system. One significant milestone took place in August 2023 when the proposed Digital Health Act and the Health Data Utilisation Act were approved by the cabinet.
The core objective of the Digital Health Act is to ensure that all statutory health insurance holders have electronic patient
“Managing data within a multi-payor and multiprovider landscape, each with their own data silos, can be like conducting a symphony with many instruments, each playing its own tune”
Lina Behrens Head of Content HLTH Europe
records, including a digital medication process which enables healthcare professionals across organisations to access prescription information.
Concurrently, the Health Data Utilisation Act maintains its commitment to optimising health data usage, as its name implies. Additionally, the Act opens up exciting avenues for medical research by incorporating genomic medicine data, as well as information sourced from electronic patient records and billing data from statutory health insurance providers. This multifaceted approach exemplifies Germany’s commitment to advancing healthcare through digital innovation.
“Germany’s transition towards opt-out electronic patient records signifies an important step towards using data across silos, or to stay with our previous image, it allows a few more instruments to play in tune with our symphony. By seamlessly integrating patient information into digital records, we are not only enhancing healthcare e iciency but also opening new frontiers for data-driven insights. It will be a huge jump forward.”
The development of the European Health Data Space (EHDS), the details of which are still being finalised, holds the promise of facilitating data exchange across Europe, potentially revolutionising the way healthcare data moves across borders in the future.
Behrens aptly highlights this potential by saying, “The European Health Data Space will hopefully take us several steps forward to share data across European countries. Currently, it’s hard to share and access data across organisations even within an individual country, let alone thinking about sharing on an international scale. It’s like orchestrating a complex symphony rather than a short melody.”
The EHDS appears poised to usher in a new era of collaboration, transcending geographical boundaries and ensuring individuals have seamless access to their health data, regardless of their location.
European countries”, says Behrens. “Some nations such as France are already actively centralising healthcare information with Mon Espace Santé to enhance accessibility.”
While many nations are still grappling with the intricacies of utilising their healthcare data e ectively, progress is undeniable. As these nations refine their data practices, the meaningful sharing and utilisation of health data will inevitably lead to improved healthcare provision across Europe and beyond.
As Behrens notes, “The success of the European Health Data Space hinges on finding that delicate balance between data accessibility and privacy protection. If we can strike that chord right, the future could be extraordinarily promising.”
“Nevertheless, it’s crucial to acknowledge the significant di erences in healthcare data management that currently exist among europe.hlth.com
Providing quality healthcare for a nation as enormous as Brazil is fraught with di iculties. Home to a population of more than 214m, spread over the fi h largest nation on earth, the healthcare system in Brazil faces the unique challenge of providing healthcare for an enormous number of people across truly vast, and o en inhospitable terrain. In addition, rising industrialisation in hand with urbanisation is generating a growing demand for healthcare provision.
As of 2022, Brazil is by far the largest healthcare economy in South America, operating more than 6,600 di erent hospitals, and encompassing more than half a million physicians – but this is still not enough to provide access to care for all. To rectify this, the government has launched multiple new initiatives to develop its workforce.
One such project is the Mais Medicos (More Doctors) programme, recently sanctioned by President Lula, which looks to increase the number of clinicians working
in primary care by more than 15,000, providing access to the service for millions of Brazilians.
South America at large is o en overlooked as an overseas market. The dynamically diverse cultures, languages, populations, economies and demands of the region can put businesses o . In addition, the distances to travel there in the first place, such as from Europe or the Middle East, make it a challenge for SMEs who may not have a large budget or capacity when embarking on an international venture.
Yet Brazil is determined to improve all aspects of their healthcare system – not only primary care, but community engagement and health education. President Lula, during his speech bringing Mais Medicos into law, announced that he himself did not know what a doctor was until he was 10 years old - highlighting the lack of healthcare literacy amongst the Brazilian population, and demonstrating the need for investment and national improvement.
On my trip I found there has been an enormous push for healthcare development in Brazil. Much of it links to the work that is currently taking place in the UK through the NHS – for instance the neighbourhood model of commissioning primary care and integrating local communities into the healthcare delivery structure.
Another revelation was just how similar the NHS and the Brazilian healthcare systems truly are. There is huge admiration for the NHS in the country, and this really shows in the way they are developing their infrastructure. Some of the institutions I had the privilege of visiting could have been directly implanted from the UK as the Brazilian healthcare system looks to the NHS as a role-model provider.
As such, there are fantastic opportunities for UK-based providers, or
organisations with experience in the UK, to enter the Brazilian healthcare system. If there is desire and requirement in the UK, it’s very likely that the same demand or solution will be desired in Brazil. In terms of healthcare provision, the population is roughly 25 per cent private covered, 75 per cent public, remarkably similar to the UK, and therefore it encounters many of the same issues that we do, meaning that demand for our solutions is equally high.
One potential opportunity lies within recruitment and sta retention. We are all aware of the global workforce crisis, and shortages of sta across the world. With the UK and Brazilian healthcare systems so alike in setup, sharing sta , skillsets, and education becomes much easier – whether this is done formally or informally, through large-scale national programmes or collaborations between individual organisations.
Another key opportunity for UK organisations exists within research and development. While it is true that the Brazilian healthcare system at large may still be developing, some of the innovations and trials which are occurring in the country are at the bleeding-edge of clinical research, matching, if not surpassing, the level within the UK. Some of the larger organisations in particular, such as the Albert Einstein Israelite Hospital in São Paulo, see innovation as a key focal area both for improving their own healthcare delivery and also opening the doors wide open for international collaboration.
Obviously, there is a glaring di erence between the UK and Brazil in terms of scale. Geographically, the UK is only 244,820 km2 whereas Brazil covers 8,514,215 km2. These distances create a substantial challenge which requires solutions which the UK NHS simply doesn’t need to consider.
Thankfully, digital health and digital innovation can enable patients to receive care across enormous distances as we have seen in many nations in Africa, where terrain and size make healthcare provision incredibly di icult. The right digital tools can
ensure that healthcare provision is excellent, no matter the distance to a healthcare hub or hospital.
In this regard, there is a laser-like focus for digital solutions within Brazil and, with the UK’s rapidly growing digital health environment, the opportunity for UK digital health organisations looking to expand into a new market is absolutely ripe for the taking.
An emphasis on collaboration and knowledge-sharing is common in Brazilian organisations as opposed to direct deals and purchases of solutions and products. One such example is the Partnership for Productive Development (PPD) - a programme between national public pharmaceutical companies and private technology holders, either national or international, aiming at knowledge sharing, capacity building and technology transfer for local production of strategic drugs, reducing costs to the public health care system.
This route could be more enticing to smaller scale operations who are not looking to provide a fully-fledged product, but rather to develop their business with an international partner.
Overall, I was amazed at what I found in Brazil, and very excited at the opportunities it has to o er. So, I urge you, if you’re looking to expand internationally, take a look at Brazil –you might be surprised what you find.
Jyoti Mehan CEO Health Care First
“Some of the innovations and trials which are occurring in the country are at the bleeding-edge of clinical research”
Dr Mwenya Kasonde highlights five business opportunities that will transform African healthcare
According to the World Bank, Africa now has the fastestgrowing middle class in the world. The pool of Nigerian millionaires grew by 44 per cent in the past decade and this growing middle and upper class is not afraid to pay for things that matter, including healthcare.
2023 marks halfway to the Sustainable Development Goals (SDGs) adopted by the United Nations in 2015 as a universal call to action to end poverty, protect the planet and ensure that by 2030 all people enjoy peace and prosperity. However, domestic pressures and decreasing aid budgets are forcing governments to increase opportunities for enterprise to access new markets and
e ectively contribute to direct investment in emerging regions. The health economy specifically is playing an increasingly important role in inclusive economic growth and therefore sustainable development. It can be hard for the private sector to play an equal role in healthcare markets
Dr
that are o en dominated by multilateral organisations. But with access to resources, intellectual capital, technology and e icient management practices, business adds value across the continuum of health care, and this is especially noticeable where government infrastructure or services are inexistent or weak.
Several areas of health systems strengthening need to be addressed across the continent. These are five business opportunities that will significantly impact African healthcare in the next decade.
In 2014, total pharmaceutical revenues worldwide had exceeded one trillion U.S.
dollars for the first time. According to Forbes magazine, pharmaceuticals and biotechnology are two of the world’s most profitable industries, ahead of IT services and banking.
However, Africa accounts for only 3 per cent of global pharmaceutical manufacturing, and about 70 – 80 per cent of medicines in Sub-Saharan Africa are imported.
The continent is home to around 375 drug manufacturers, mostly in North Africa, and those in sub-Saharan Africa are clustered in nine of 46 countries. In comparison, India has approximately 10,500 drug companies and China has 5,000 for 1.4 billion population each .
With the World Health Organization (WHO) considering that 90 per cent of African countries have minimal to no medical regulatory capacity, the Africa
Medicines Agency (AMA) has recently been launched, a specialised agency of the African Union similar to the European Medicines Agency. The aim of the Agency is to increase timely access to quality, safe and e icacious therapeutics, vaccines and other health technologies by hastening regulatory approvals, countering falsified and substandard medicines, and centralising pharmacovigilance e orts.
With support from the AMA, Africa is warming up to the idea of taking full ownership of the production and distribution chain for pharmaceuticals and diagnostic equipment, opening significant opportunities for investment and return.
Africa has the youngest population in the world, with 70 per cent of sub-Saharan Africans under the age of 30 . This youthful populace needs to be considered when designing the continent’s healthcare systems and presents an opportunity to provide healthcare in a unique way. It is also a digitally literate population, thus providing important opportunities for innovation when designing healthcare solutions, supported by the fact that Africa is the second largest mobile phone market in the world.
With 41 out 54 African countries having a national digital health strategy in place, the private sector is going to drive the digitisation agenda that many governments have embarked on, and the demographics are in a place to embrace this. In many countries, eHealth is now an integral part of delivering improvements in health.
Key areas of focus include telemedicine, teleradiology (the most widespread globally), remote patient monitoring and others.
WHO estimates a projected shortfall of 10m health workers by 2030, mostly in low- and lower-middle income countries . Africa has 25 per cent of the world’s disease burden but only 3 per cent of the healthcare workforce. As such, public and private investment in training of healthcare workers should remain a priority for any stakeholders in the healthcare industry.
The emergence of private medical schools in the continent is noticeable, but there is need for more training institutions to fill the shortage of human resources.
Botswana for example, a country geographically smaller than Texas, has 34 physicians for every 100,000 people and only 21 per cent of these physicians are citizens of Botswana .
Botswana opened its first medical school in 2009 and the first class of 36 doctors graduated in 2014. Therea er, approximately 50 doctors will graduate annually. This is a significant achievement, but not significant enough to close the shortage of health workers.
Businesses willing to fill the gap of undergraduate and specialist training of healthcare workers across the necessary cadres will therefore be key to the development of systems.
Many African governments are under investing in health. In 2021 , African governments made a pledge to allocate a minimum of 15 per cent of their annual budgets to the health sector, a vow referred to as the Abuja Declaration. As of 2023, only two countries (Rwanda and South Africa) have reached the 15 per cent target and seven countries have in fact reduced their health budgets as a proportion of their national budgets.
With only four African countries having health insurance coverage above 20 per cent (Rwanda, Ghana, Gabon, and Burundi) , the important question for adequate provision of healthcare remains; who is going to pay?
The health insurance schemes that do exist tend to cater for the formally employed, and in Africa, 85.8 per cent of employment is informal .
Innovative healthcare financing solutions, including microfinancing for community and primary health insurance schemes, will remain crucial to providing universal health coverage and leaving no one behind.
The UN SDG Progress Report shows that there are only 6 of the 17 SDGs for which more than 2/3 of countries have data to report.
Businesses willing to invest in health data will play a key role in developing solutions for data collection, storage, analysis and use, while maintaining interoperability and advising on modalities for rationalisation of tools.
Timely and accurate data is necessary for evidence generation, to guide policy direction and for successful health programme implementation. A recent investment case on data (beyond health) suggests that for every US dollar invested in data, a country gains about $32 in return, which is on par with the value gained from investing a similar amount in vaccines.
There is a continued need for investment in data and the tools that support data systems, including human resources and infrastructure.
Health pandemics, climate change, a shortage of human resources for health and the digital divide are all problems that require capable government and symbiotic collaborations between public and private sectors.
For sustainable business to valuably contribute to the SDGs at the country level, it must be aligned to national and subnational priorities for the specific country in question.
It’s important to encourage a bottom-up approach where business addresses and aligns with country priorities and plans.
Public private partnerships cannot succeed unless grounded in the realities of the local context to address development issues at the grass root. In this context, country ownership is seen as a process that is government-led and centred around national priorities.
Millions of new jobs that can be created in health and social care will meet a growing demand, respond to demographic changes and assist to deliver universal health coverage. No country can develop without a healthy citizenry and investment in health, in developing markets, will yield massive returns in many di erent ways.
“There is a better way to invest in africa for a sustainable future that creates value for all”
Tony Elumelu Nigerian entrepreneur and investor
Dr Sean Cross, Managing Director of Commercial Enterprise for SLaM, tells HW Editor Sarah Cartledge how South London and Maudsley Hospital can help implement mental health into healthcare services across the globe
It’s no secret that physical health and mental wellbeing are closely intertwined, as seen by the rise in reported mental health conditions following serious injury or as a result of a chronic illness. The impacts of mental health on recovery rates and long-term conditions are equally as important. Despite the enormous stigma that still exists in many areas, people are now talking about mental health in a way that was very di erent 20 years ago.
Dr Sean Cross is a consultant psychiatrist working at the South London
and Maudsley (SLaM) and King’s College Hospitals within South London who believes that mental ill health can be tackled successfully. He focuses on selfharm and suicide prevention, trauma and the complex interplay between mental and physical wellbeing. He trained at the Universities of Edinburgh, Cambridge and London, with a Doctorate in Social and Cultural Psychiatry from the Institute of Psychiatry, Psychology and Neuroscience at King’s College, London.
So perhaps it’s no surprise that Sean has been tasked with taking SLaM’s subject
Consultant psychiatrist Dr Sean Cross has several roles within the NHS
• He is Managing Director of Commercial Enterprise for SLaM, including Maudsley Learning and the national award-winning BMJ Education Team of the Year 2018, Maudsley Simulation.
• He works clinically at King’s College Hospital London in the mental health liaison team.
• He is also Clinical Director for the Mind Body programme. He is also Clinical Director for the Mind and Body programme in King’s Health Partners, the aim of which is to enhance integration across mental and physical healthcare.
• He is also a Visiting Lecturer at the Institute of Psychiatry, Psychology and Neuroscience, at King’s College London.
matter expertise out of South London and into new markets. “Within mental healthcare and the mental health world SLaM is very well known for both research and service development. It has a global reach in a way that many other hospitals don’t - our prescribing guidelines, for example, are used in many countries around the world and we have the largest training programme for psychiatry doctors in Europe,” he says. “We also have one of the largest mental health research units globally.”
His remit covers commercial enterprise endeavours, including learning, consulting, private care, international and property businesses. “In many ways, it’s translating our expertise into services and products for the rest of the world. Over the last couple of years, we have developed and run a joint venture o ering mental health care, both inpatient and outpatient, to the UAE and a platform for potential growth going forward. Currently the organisation has a series of services in the UAE where they manage a hospital in Dubai and will continue to develop services in Dubai, Abu Dhabi and the Northern Emirates.
SLaM is one of the six partners that make up The Kings International Consortium, led by King’s College Hospital. Along with Guys & St Thomas’, Cambridge University Hospitals, Moorfields and The Christie, they o er a full suite of services as an NHS consortium internationally.
For Sean, the terminology is important, especially that of mental health care which incorporates better services and better sta training. “It’s more than designing a hospital and running services – it’s about inculcating a culture of openness,” he says, dividing it into separate areas:
1. Literacy around mental health
2. Bringing mental health into physical healthcare pathways
3. Integrating mental health into new health systems
4. Talking about our collective experiences/how we structure our society
Although there is more recognition generally around mental health, the key is to incorporate it into both health systems and education systems, so it covers all aspects of healthcare from birth. The
question for Sean lies in the system itself. “We’re all celebrating the fact that people are living longer, yet with longevity come comorbidities – COPD, diabetes, heart failure – and alongside these illnesses sit depression and anxiety. So how do you run your primary care services to o er the best health provision? How do you run your hospitals and integrate mental health? How do you start thinking about mental health in schools? And then how do you share this knowledge through a commercial model?”
Psychiatrists like Sean tend to see patients when they have reached a crisis point. But his aim is to prevent this crisis point by treating mental health from the start, particularly through primary care services. “Two thirds of us who have pretty good mental health still may struggle at times because stress may be situational,” he says. “Even someone with robust mental health may well go through periods of being very stressed or strained”
“Many people struggle -probably through circumstances, economic, monetary, familial or relational - so if there is literacy around mental health, people will understand there are things they can do to help themselves. But it’s also good to recognise that there can be genetics and environmental factors, or early life experiences, that make it more di icult for others to work on it and can predispose to development of mental illness.”
“When someone goes through a period of depression, if you give them the best evidence-based treatment, you can get them out of it. Hopefully they’ll learn from their experience and maybe not have that depressive episode again. Someone with schizophrenia may grapple with that schizophrenia for their whole life, but many of their symptoms might be controlled so they have far fewer hospital admissions or
less damage associated with these ongoing flares so they have more ability to spend time with their family and work. There is no reason why mental health conditions should be thought of as di erent from many physical health conditions.”
South London and Maudsley NHS Foundation Trust is a large and complex multi-site provider of the widest range of NHS mental health services in the UK. Serving a population of 1.3m people with more than 260 services, SLaM aims to make a di erence to real people’s lives and develop systems of support to safeguard and nurture the mental health of those in need.
The range of services o ered from inpatient wards, outpatient, community, and addictions services in central, south London cover a diverse and demanding spectrum. As well as serving the communities of south London, SLaM provides more than 20 specialist services for children and adults across the UK including perinatal services, eating disorders, psychosis and autism and are leaders in enhancing better integrated care with local acute and primary care partners.
“As psychiatrists in a general health setting, here at SLaM we o er forensic psychiatry and specialisms for integrated care,” he says. “By developing specialist services for particular regions, backed by high-quality evidence-based pathways, we can help get patients in front of the right people so they can begin to recover.”
He feels it’s important to develop specialisms for older adults and children. As he says; “If you’re going to design healthcare, education systems and healthcare systems for all the ages, you need to integrate mental health within it.”
Dr Cross will be discussing his four key areas for mental health provision in the next issues of Healthcare World, available in print at Arab Health in January and online at www.healthcareworld.com
“If you’re going to design healthcare, education systems and healthcare systems for all the ages, you need to integrate mental health within it”
Dr Sean Cross Managing Director of Commercial Enterprise South London and Maudsley NHS
Archie Read, Senior Operations Controller at ADHD360, explains to HW the importance of diagnosis for anyone suffering with ADHD
Attention-Deficit
Hyperactivity Disorder is a neurodevelopmental disorder that presents during childhood but also commonly lasts through to adulthood. Today there is much more awareness about ADHD, but many people find it hard to pin down. It’s more than hyperactivity in children or forgetfulness in adults – there are a whole range of
symptoms which can be more pronounced in one person than another.
The problem is that an ADHD diagnosis can’t be achieved through a physical test such as blood test. Instead, diagnosis must be done through a specialist examination and evaluation by an ADHD clinician. These tests are comprehensive and cover the full spectrum of activity, and for adults a thorough review of their childhood is also
vital. Only then can a pattern emerge that can be identified and diagnosed or ruled out.
For parents, there can be the fear that their children may not be able to function in society or hold down a steady job. This is where diagnosis and then treatment is vital. In the UK the NHS is currently struggling to assess the long waiting list of potential su erers, but they have resolved some of the issues by turning to organisations such as ADHD360 who can provide a faster route to diagnosis.
For Archie, his diagnosis was key to enabling him to live his best life, as he puts it. Currently studying Business at
She ield Hallam University, he is also ADHD360s Senior Operations Controller. But as a child, it was di icult for either him or his parents to see beyond the immediate problems of surviving the education system.
In the UK teenagers are examined at 15 or 16 via GCSE’s which are a broad test of their knowledge. They then narrow their subject choices to prepare for university via A levels. “Procrastination is a major issue for ADHD su erers and I would be paralysed by it when I tried to study for my GCSE’s,” recalls Archie. “I would go up to my room and just stare at the pages in the book, unable to move forward. I would then tell my parents my revision had been successful, but inside I was terrified of failure.”
Fortunately, Archie’s natural intelligence enabled him to pass his exams. “I have so little self-confidence and self-belief that I could actually achieve and do well, so I didn’t even want to consider the idea of university at one stage. I didn’t even want to do A-levels. I just wanted to get out of education because I knew it was an environment that I didn’t necessarily thrive in.”
However, he took the plunge and opted for subjects he enjoyed – psychology, geography and business. “I understood that I needed to get through the education milestones to reach the next phase and get where I want to be in terms of a working life,” he says.
But it was really his self-diagnosis that helped him resolve his situation. His
stepfather Phil Anderton, founder and MD of ADHD360, would o en discuss ADHD at home with his family. Archie began to help with the administration of new clients and found himself relating to their issues and symptoms. “ADHD can o en be perceived as a naughty schoolboy concept, but my symptoms were di erent,” he says. “I didn’t want to get into trouble so I would spend all day at school masking my symptoms and be utterly exhausted when I got home. It was then that I would have behaviour explosions because I was in a safe environment. It wasn’t until I heard other people describing similar emotions that I realised I might be neurodiverse and decided to be diagnosed.”
Like many of the company’s employees, he can speak from experience when helping patients deal with their symptoms and diagnosis. This can be reassuring for those approaching the company looking for answers as Archie did.
Archie Read Senior Operations Controller ADHD360“I always stress that the best way to help yourself and manage your symptoms is to understand your ADHD,” he says. “For me, knowing there was an issue was a light bulb moment, but that’s just the starting point. Once I began treatment with medication, the symptoms reduced and then I began to manage them. Now that I understand my ADHD I can manage it and I am a much happier person.”
He recognises that, for example, the written word is not his best medium for learning but he is able to absorb information and synthesise it mentally. “I loved Lego as a child and was always good at it,” he recalls. “I’m also one of those people who can put together IKEA furniture from the diagrams. Now I understand that I require instant gratification when I complete a task, so I have to manage the fact that other people may not have the time to appreciate my work when I am
“Now that I understand my ADHD I can manage it and I am a much happier person”
looking for validation. So it’s not that the ADHD disappears, rather that I know how to live with it and work round it.”
Much of the improvement is down to the correct medication and dosage. Initially when patients approach ADHD360 they may not be keen on taking drugs to manage their condition, and Archie’s experience is o en used to show how it can be accomplished. The stimulation medication improves concentration and reduces the fatigue linked with ADHD, while non stimulants do not increase the dopamine in the brain.
“People ask whether they get the results they need through talking therapy, but science and experience say you can’t,” he says. “It’s o en a fear of not being in control, but actually you can control your medicine so you reap the benefits of it. It can take time to get the dosages right, but once you know how you interact with the medication you can manage every hour of the day to your best advantage.”
Medication dosages control the amount of stimulation the brain requires at di erent stages. Archie can decide whether he needs immediate release to achieve a task,
or whether he needs a lower dose to enable him to sleep at night without his brain going into overdrive. “It’s a question of trial and error, but once you have it right then it’s a huge relief,” he says.
“There’s a constant balance between performance against side e ects,” he explains. “One of the side e ects of being slightly overstimulated for me is I have nervous habits such as twiddling with my hair or touching my face. When I’m driving, those aren’t necessarily side e ects that I want to have, so sometimes if I am going on a long drive, I won’t take the 20mg dose but I will take 10 mgs to stop the ticks. I’m able to tailor the dosage to what I’m doing and the activities that I need to perform during the day. And so again, I control what my medicines allow me to do, rather than the medicine dictating to me.”
Along with other employees, Archie’s experience is directly relevant to ADHD su erers who approach the company for help. As MD Phil Anderton explains, the organisation works with each individual
to tailor a programme to manage their symptoms and help them with their lives. For Archie, the medicine acts as a confidence li and validates him for the first time since childhood.
“At ADHD360 we do the same for 1200 people every month,” he says. “Whatever those tangible outcomes are - whether it’s a six year old staying in school, whether it’s someone saving their marriage or job or achieving more – they are hugely important to each individual and to us as an organisation.
“I would never have believed I could go to university, live on my own in a flat and work for an organisation all at the same time. It’s made such a di erence to my life that I want everyone with ADHD to have the same opportunity to live their best lives as I do.”
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Mental health provision is a topic at the heart of the healthcare agenda. Awareness and demand for mental health services is rising, and the stigma attached to mental health has not yet gone away.
Amidst rising demand, the ability to provide care is becoming increasingly di icult - the global workforce crisis continues to be harrowing reading. The pandemic demonstrated the glaring flaws of the health systems of the world – there simply aren’t enough clinicians.
Training clinicians requires a vast amount of moneyeven higher for mental health specialists, not to mention the time it takes for them to be fully trained. We are forced to face the problem with the resources we have right now.
In the UK system, the GP (General Practitioner) serves as the navigational beacon for all healthcare needs. If a patient has a general worry about their health, the first person to call is the GP. If the patient has a minor ailment, the GP can usually treat this straight away. For more complex diagnoses however, the patient is referred to a specialist.
But this care navigation system isn’t really fit for mental health provision. Patients can o en be nonspecific when reporting a mental health problem, which can see them having to wait weeks for an appointment when they may need immediate access to care. A delay between initial contact between the patient and primary care provider is critical when dealing with mental health conditions.
However, if we were to send patients directly to the most appropriate mental health providers the entire process becomes far more e icient. Patients would receive care much faster, and the stress on the workforce would be greatly reduced. Additionally, if the mental health specialist was based in the GP surgery on certain days of the week, the patient would have access to their mental health care close to home and without the stigma of attending a dedicated mental health service.
Of course, mental health services can be accessed through hospitals, but perhaps this may not be the best setting for those who are struggling. AI-based digital solutions have already proven to be remarkably e ective at triaging conditions through analysing responses to clinician-designed questionnaires. A digital mental health triaging system could enable primary care providers to route patients to the right provider immediately without the need to see the GP.
Of course, this comes with issues. Patients o en prefer the human touch – and while app or AI based solutions may come naturally to the younger generation, it’s much harder to get older generations to interact with them, and change their habits.
To use AI-based solutions e ectively, they must be integrated and branded in accordance with the primary care provider. People trust brands for a reason – they feel familiar and comfortable with them – and there are few bigger brands than the NHS. If a patient downloads a mental health app, their likelihood to interact with it is minimal if they do not trust it. However, if that very same app is approved by a leading primary care provider and can route patients directly to mental healthcare provision without the need for a face-to-face triage with a GP, it would undoubtedly be a successful tool.
A primary care delivery system such as this would be far easier to integrate into evolving health systems, such as many of the systems in the Middle East. Rather than having to tear down the present system and rebuild it from the ground up, this can be the standard way to access mental health care from the start – ensuring quality mental health provision for all.
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helen.featherstone@gmcsi.co.uk
Mental health regulation around the world: is it time for a shake up? ask Gerard Hanratty and Carly Caton, Partners at Browne Jacobson
The statistics are stark. We have a global mental health crisis on our hands. But can adapting and changing mental health laws and regulation really help with this?
The World Health Organisation says that: “Depression is one of the leading causes of disability. Suicide is the fourth leading cause of death among 15–29 year olds and people with severe mental health conditions die prematurely – as much as two decades early.”
In the UK it is estimated that more than 60 per cent of children and young people who have a diagnosable mental health condition are not currently receiving NHS care, while rates of probable mental health disorders in 6 to 16-year-olds has risen from 11.6 per cent in 2017 to 17.4 per cent in 2021.
As the world is advancing, particularly in relation to technological advances and the increased usage of social media and other tech platforms, alongside the COVID
pandemic we have seen a greater number of people su ering from worsening mental health. Countries are reconsidering how to provide better support to their population with mental health issues and starting to understand that the need for mental health provision is greater than ever before.
But despite progress in some countries, people with mental health conditions o en still experience human rights violations, discrimination and stigma. Legal frameworks should be able to seek to redress this, but do they? Have we created an approach which has developed with needs of citizens in the 21st century or is legislation still stuck in the 20th century?
Generally, mental health laws are seen as fairly narrow and draconian and it would seem that a move to more flexible, all-inclusive legislation that considers developing mental
health conditions, a need for patient choice, how best to deliver population-based mental health prevention and care for long term mental health needs, would work much better. Such radical realignment to move to prevention and earlier treatment in the right clinical setting does, however, require laws with greater flexibility to enable access to treatment. It also necessitates an understanding that mental health is as important as physical health, meaning a move towards greater equity of funding that enables an approach which allows citizens to access the right mental health care in the right place.
In the UK, the Mental Health Act 1983 has been criticised as being overly restrictive
with inadequate scope for patient choice and autonomy. The proposed reforms of the government’s Dra Mental Health Bill to improve patient choice plus a statutory duty to o er patients advance choice documents the recommendations by a joint parliamentary committee. Certain conditions have also been removed as grounds for detention under the Act. The intention is to try and create a legal framework which is flexible enough to adapt to patient need as that develops, including seeking to keep people in the right place so they can recover as quickly as possible, as opposed to detaining them and potentially not really addressing the trigger for any crisis.
Taking all of the above into account, what should those legislating elsewhere in the world think about when considering their mental health laws? Equally, how do they place patients at the heart of the legislation, given that 80 per cent of WHO Member States reported having a stand-alone or integrated law for mental health but only 38 per cent reported their laws were fully compliant with human rights instruments and only 28 per cent reported having fully compliant laws that were in the process of implementation. That raises the question of why are they not compliant?
It would seem that the limited implementation of mental health plans, policies and legislation is, in part, due to a lack of resources – both human and financial - with most countries spending less than 20 per cent of their mental health budget on community mental health services. The WHO Mental Health Atlas 2020 shows that only half of countries with a mental health policy or plan also have the estimated financial resources they need to implement it, with only around a third of countries having actually allocated financial and human resources to implement their mental health policy or plan. The gap between estimating resources and allocating them is particularly stark among low-income countries.
Alongside writing and implementing mental health laws and policies themselves sits regulation of the issues causing an increase in poor mental health themselves. How do we regulate social media platforms, cyber bullying and the like? How do we protect our children and teenagers from being exposed to damaging content and behaviour in the first place? How do you make children understand that it is damaging and motivate them to take control of their own mental health wellbeing more?
So, it seems that while mental health regulation can support treating the increasing number of mental health issues, it cannot solve them. Many countries around the world are at an early stage in developing their laws and policies, but may not have su icient resource to implement a legal framework that is flexible enough to address the ever changing pressures in the 21st century. It is clear that, as the nature of mental health issues changes, writing laws that cover all eventualities (and anything we do write is likely to be outdated again in a decade (or less)) is increasingly di icult.
So what is the answer? The sorts of things that we see that have success are really putting time and e ort in to working with children and young people to help them understand what can cause poor mental health and the things they can do to seek to redress this. The health sector joining up with schools and education settings, for example. Using students and volunteers to facilitate engagements with others and making it less formal and less of a barrier to people seeking help and support. If we can get it right during these formative years, we may see a generation with less emerging mental health issues meaning that the extreme shortage of mental health professionals can better manage the people they are seeing and caring for. As for developing new legal frameworks then it is essential they are flexible enough to enable treatment options to change and develop to address the mental health problems which people face. That they seek to be patient focussed and not draconian in purpose. And so, as with many other areas, whilst the law can be a useful support and facilitator, it cannot be the answer in itself.
“The WHO Mental Health Atlas 2020 shows that only half of countries with a mental health policy or plan also have the estimated financial resources they need to implement it”
Carly Caton Partner Browne Jacobson
Saudi Arabia is addressing the challenges of mental health provision to reduce social stigma, says Ian Chambers CEO of Linea
In recent years, mental health has emerged as a critical issue worldwide. Exacerbated by the pandemic, there is increased focus in the virtues of societies supporting the well-being of their citizens. Saudi Arabia, a country known for its rich cultural heritage and economic progress, has also recognised the significance of mental health, and has taken steps to address the challenges it presents. As healthcare organisations and governments address these challenges
specialist support increasingly plays a pivotal role in developing and implementing mental health initiatives, creating a bridge between awareness and actionable solutions.
Saudi Arabia, like many other nations, is grappling with the multifaceted challenges of mental health issues.
Societal expectations, rapid modernisation, economic pressures, and cultural stigmas have combined to create an environment where mental health concerns are o en overlooked or neglected. The stigma surrounding mental health can hinder individuals from seeking help and perpetuate misconceptions about mental well-being.
Over the past decade, Saudi Arabia has taken significant steps to address mental health issues and reduce the associated stigma. The government’s Vision 2030 initiative, which aims to transform the country’s social and economic landscape, includes provisions for mental health support and awareness campaigns. Several
mental health clinics and centres have been established across the country, o ering accessible and confidential services to those in need.
Additionally, the government has made e orts to incorporate mental health education within schools and universities. By fostering an understanding of mental health from an early age, Saudi Arabia hopes to create a generation that is more open to discussing and addressing mental wellbeing.
The emergence of social media platforms has played a crucial role in reshaping the discourse surrounding mental health in Saudi Arabia. Individuals, including public figures and influencers, are using their
online presence to share personal stories, raise awareness, and provide information regarding available resources. These e orts have contributed to gradually dismantling the culture of silence and stigmatisation.
Moreover, mental health organisations and support groups have gained momentum in Saudi Arabia, creating safe spaces for individuals to share their experiences, seek advice, and access professional guidance. These platforms are instrumental in fostering a sense of community and normalising conversations about mental well-being.
Despite the progress made, challenges persist in the journey towards destigmatising mental health both in Saudi Arabia and across the globe. Overcoming deeply ingrained cultural beliefs, inadequate mental health infrastructure in certain regions and a shortage of trained professionals are just a few of the hurdles that need to be addressed.
To achieve a comprehensive transformation, Saudi Arabia must continue to invest in mental health infrastructure, education, and awareness campaigns. Collaborations between the government, healthcare institutions and nongovernmental organisations are essential for creating an environment where individuals feel safe seeking help without fear of judgment.
In our experience the following are key contributors in supporting Mental Health improvement:
Awareness Campaigns: We can leverage our communication skills and resources to conduct impactful awareness campaigns. These campaigns are designed to educate the public, break down stigmas, and encourage open conversations about
mental health. We can help create a culture of understanding and acceptance.
Policy and Strategy Development:
Collaborating with mental health experts, we have the capability to assist in the development of comprehensive policies and strategies. These strategies aim to integrate mental health considerations into various sectors, including education, healthcare, and the workplace. By aligning e orts with national initiatives, we can help create sustainable change.
Capacity Building: Building a strong mental health infrastructure requires skilled professionals. Linea o ers training programmes and workshops to enhance the capabilities of healthcare providers, educators, and other relevant stakeholders. This knowledge transfer empowers individuals to identify, address, and support those struggling with mental health issues.
Data-Driven Insights: Our experts are adept at analysing data and deriving insights. Applying this skill to mental health, they help gather and analyse data related to the prevalence of mental health issues, treatment outcomes, and societal perceptions. These insights inform evidence-based decisionmaking and ensure that resources are allocated e ectively.
Partnerships and Collaboration: E ective solutions for mental health require collaboration between government bodies, non-profit organisations, healthcare institutions, and the private sector. We serve as facilitators, fostering partnerships that amplify the impact of mental health initiatives.
Saudi Arabia’s journey towards improved mental health provision is marked by significant strides and collaborative e orts. Through our global expertise in awareness campaigns, policy development, capacity and capability building, data-driven insights, and partnerships, in mental health best practice, Linea is ideally placed to support Saudi Arabia to provision leading Mental Health services, which provide ease of accessibility and break down the stigma barriers.
“The emergence of social media platforms has played a crucial role in reshaping the discourse surrounding mental health in Saudi Arabia”
Ian Chambers CEO Linea
NECS, part of the NHS, provides high quality health and care system support to global organisations, MD Stephen Childs tells Healthcare World
The UK’s NHS is a highly complex and diverse organisation. Parts of it, such as the North of England Care Support System or NECS, provide highly skilled services in the background to support crucial functions to secure its digital future. It serves 550 UK customers and provides data management services for 40 per cent of NHS Integrated Care Systems in England, with an annual turnover of in excess of £100m.
With nearly 2,000 experts, many of whom have significant NHS experience, NECS has the specialist knowledge and skills to help global organisations achieve their health and care goals. It combines healthcare transformation consultancy, population health management, data management and digital services to help international health and care organisations improve care outcomes and experiences, manage cost efficiency and reduce health inequalities. Internationally, NECS provides digital services to various health networks in Australia, achieving its first export success through sales of the Capacity Tracker into the country.
Stephen Childs has been the MD of NECS since its inception in 2013, coming from a background over various Executive Director positions in the NHS.
Stephen, please give us the background to NECS.
NECS came about as a consequence of the change to health and care policy back in 2013, under the-then Secretary of State for Health, Andrew Lansley, whose vision was to create truly clinically-led health commissioning organisations. Initially there were 19 such groups but, with exposure to a commercial marketplace, only four have survived.
A unique feature of NECS and the other CSU’s was the freedom to trade and define future customers, along with services and products in response to customer need. A fast-growing sector of the market are the NHS providers whose needs are quite diverse.
But these new organisations were no longer constrained to serving solely health customers. NECS clients include care systems, the Department of Work and Pensions and are in discussion about medical services to part of the Ministry of Defence, as well as a range of private companies.
How does the digital and data work that NECS undertakes for health systems benefit overseas providers?
Our international offer is around data, digital and improvement services. Around 5 years ago NECS began its journey as an exporter and we have had initial successes. Clearly COVID had an impact, but we’ve maintained our customers in Australia and we’ve had recent success with Republic of Ireland. As our reputation builds and people have become familiar with the capabilities of NECS, we find ourselves being approached by potential partners who are looking for not just the NHS brand to help them with their own credibility abroad, but also the synergy between our expertise and what that partner can deliver and provide.
Our experience has been born out of many years in the field of data gathering, data processing, turning data into information. We have colleagues that have worked in the primary care and acute care commissioning space for more than 20 years. That journey is important, particularly for potential international customers trying to work out how to move from dispersed and inconsistent data sets to information that can be used to inform operations and planning.
In England, NECS is responsible for more than 40 per cent geographically of the country in terms of processing the data that comes in from primary care, from the hospital sector, from mental health and from community services. We turn that data into information that will provide insight and the intelligence to manage operations and plan for future services.
We support our key providers with their minimum data sets and how that
information is gathered and turned around into information that can be used to assess performance. It’s not been an easy journey because the quality of that data, even today, is quite variable. But helping hospitals with operational planning and delivery is become one of the most important, valuable services we provide.
The level of sophistication we have now reached is where we’re supporting NHS England in developing applications that sit on their NHS Foundry Platform to build
on the benefits from the integration of dispersed datasets which will be a game changer. Our involvement is not only helping with the supply of data to inform that database, but also developing the applications that are going to sit on that database and really reap the benefits of the integration of dispersed datasets. The best example I can give is OPTICA Acute, a digital application that sits on their database and is used in 16 acute Trusts that
combines health and social care data in real time to help multidisciplinary teams expedite discharge in a faster, safer way. Discharge is so important to the NHS because it’s a root cause of the problems we’re having with elective care backlog, because if we can’t move patients out of the hospital setting when they’re fit to be discharged, then it makes it harder for us to admit patients and to ensure patients are getting the best experience of, and outcomes from, NHS care.
How do you manage to collect 40 per cent of the UK’s NHS healthcare data into one place in a single translatable format?
It’s taken a long time to get to the point where we spend far less time disputing the quality of the data to understanding what we need to do in response to what the data is telling us. However, I don’t think we’ll ever be at a point where we’ve finished refining the mechanisms
by which we combine these data sets. We’re much better at doing it with acute pharmacy information and primary care information. But there’s still a challenge to bring community data sets and mental health datasets together, and then combining those healthcare datasets with social care and datasets from other services.
We have been responsible for the two years for the development of a data platform called Axym, a repository for local datasets. Axym is a good example of how we’re able to combine not just different sets of healthcare data with social care data, but with education data from the police in what’s being referred to now as a secure data environment (SDE). An interesting aspiration is to have these secure data environments serving populations of around 5m people across England and NECS has been selected as the provider of that secure data environment for the North, East and Yorkshire. It’s groundbreaking because, for the purposes of research, it gives us a safe environment that protects patient
identity and is part of the NHS Research SDE Network covering the whole of England and enabling data to be linked for research on an unprecedented scale. Crucially, data in the SDE is totally anonymised and allows us to begin to fully analyse what’s going on in a large population, reflecting the extraordinary
diversity that we enjoy in this country and the longevity of data that we’ve been collecting, particularly in the NHS, for many years.
There is so much that we can learn and use to inform our planning, so we’re very proud to be in that space. It has been a complicated journey to get where we are, and there’s so much excitement and hope for the future because we understand that the data we hold in the NHS is probably the richest data set in the world.
We know it’s a long journey for those countries that are seeking to set off down this path. We’re confident that the learning that we’ve gathered over 20 plus years means that we can help them reach or get close to where we are today in a much shorter space of time.
“We’re supporting NHS England in developing applications that sit on their NHS Foundry Platform to build on the benefits from the integration of dispersed datasets which will be a game changer”
Stephen Childs Managing Director NECS
We organise virtual events that bring the world of healthcare to your office or take you from your office to healthcare events all around the world.
We organise our own major events like Vision Health 2023 with the Saudi Government and we create networking events in the fringes of major global healthcare gatherings like Arab Health, HIMSS and Africa Health.
Above all we help our customers and friends enter new territories, supporting them with everything from content and marketing through to market scoping, product development and cultural fit.
Healthcare World is the world’s leading magazine for the business of healthcare, but we’re also far more than that.
The patient has a vital role to play in future population health management, says Sally Rennison, Chief Commercial Officer at Patients Know Best
Today, the data which is made available through digital solutions is undeniably vast. However, finding this data, connecting it, and using it to its fullest potential is a problem yet to be solved. Population health modelling is one of these issues – we understand the value which a population health led system can provide, but to create one is an incredibly di icult task.
The issue is not that the data does not exist – rather that the data is inaccessible. Siloed away and hidden behind a myriad of doors and protections, a large proportion of population health models are built on what the creators have ready access to, and only display a glimmer of their true capability.
Yet, if access to a wider range of patient data is enabled, these systems could become groundbreaking tools, with the
benefit recognisable by both the hospital porter and the C-suite executive – not to mention the patient themselves.
But the question is, how do we go about unlocking the wealth of data which is already out there? There are two key issues here – patient engagement and government regulation.
Health records are naturally sensitive material. Patients have a right to know who has access to them, as o en a picture of one’s health can provide a startling amount of information on the individual themselves – their lifestyle, their work, their family and even their own psyche.
Therefore, it is entirely understandable as to why patients are hesitant in allowing their personal health records to be utilised for any purpose other than their own direct care. Ultimately, the crux of this issue is
trust. Can the patient trust that their data will be used correctly and treated with the same level of respect that they are?
The lack of transparency can be a barrier – patients are not going to sign o sharing their patient record if they do not know the information that is on it. Many patients have never seen their own medical records. Patient records are largely a clinical tool, which are only ever observed and used by clinicians who are treating the patient – which can result in inaccuracies in the records themselves.
Ergo, to improve both the data on the medical record, and raise the level of patient trust, the solution is to make the patient record accessible to the patient. By understanding the type of data on the patient record, and having the opportunity to fix incorrect information, the patient will naturally be more comfortable and ready to share
their data. The patient understands what is being provided and can be certain that it is accurate, and as a result will be motivated to share this information as it will directly improve their quality of care.
Another issue is that patient records do not even come close to portraying the full picture of the patient as mainly patients go to the doctor when they have an illness which requires treatment. Thus the patient record is more of a ‘sickness’ report, recording symptoms and treatment, and nothing more. In this scenario, patient records only provide information on how sick the population is, not how healthy it is.
Of course, this is an enormous waste of the wealth of data which is now available. Phones, smart watches and fitness gadgets track a vast amount of
Sally Rennison Chief Commercial Officer Patients Know Best“If we are to link wellness data and illness data, the motivation must come from a governmental organisation that sits above provider-based care”
data – heart rate, daily steps, sleep quality, and many more. Yet, in a clinical setting, this data is largely unused, as there is no way to import it onto the patient record, and no motivation to do so for the provider or insurer. Being able to utilise this data – which is readily available – in a patient record system would improve the ability to build quality population health models.
But of course, the moment this information is linked to a healthcare provider, the conversation becomes about illness, not wellness. Therefore, if we are to link wellness data and illness data, the motivation must come from a governmental organisation that sits above provider-based care. Otherwise, population health data will continue to be largely focused on the sickest portion of the population, which is not useful when attempting to build a model surrounding an entire population.
Ultimately, the lack of incentive for providers, insurers, and even patients themselves to improve and connect their patient record systems necessitates government and regulatory intervention to stimulate progress. If motivated by a government mandate, and rolled out at scale, then the benefit of a truly connected patient health record system could be realised and applied to population health modelling. Further still, if multiple governments were to enact such a system, then perhaps we wouldn’t be looking simply at national population health models – but a global one.
The future of hospital design will focus on the patient digital twin with services designed and supported by the metaverse, says Phi Kim Ho, Arcadis Director and Senior Practice Lead, Vancouver Canada
The ever-evolving nature of healthcare makes it extremely di icult to design buildings that can predict the future. We’re in a phase similar to the evolution of air travel – how do we know what clients or patients will need in the next half century?
But for Phi Kim Ho, Arcadis Director and Senior Practice Lead, VancouverCanada,
this futuristic calculation is precisely what drives his work.
With a background in electronics engineering and computer science working in a traditional electric engineering firm designing systems for buildings, he fought to have technology consulting and engineering to become separate from electrical engineering. “Back then 23 years
ago, when you built a hospital, the electrical engineer designed all the technology in the building, including supporting healthcare systems. I thought that was just insane but technology consulting did not exist at the time,” he recalls.
The intervening years have delivered healthcare innovation that was just in its infancy. Nowadays, the importance of data driven healthcare is a given. With a focus on the operation of a clinical service – which a er all is what a hospital should provide – Phi began to convince clients to consider technology planning at the same time as master planning, so the technology could invoke innovation to feed into the master plan.
As a Director, Phi’s role is to lead the practice in the emerging technology
consulting and digital transformation, developing innovative strategies to which our technology engineering team can deliver. Technology and digital strategies involve assessing current state, market scans, analysis and trending to the targeted future-state digital transformation.
He has delivered technology strategies and digital enablement on several large scale integrated technology projects as the principal strategist, including a $1.9 billion digital-first hospital in Vancouver, a $207 million digitally-enabled courthouse facility in Red Deer, and a 2.2m SF intelligent research and engineering facility for Ford in Detroit USA.
His specialities include Technology Enablement through Digital
Transformation, Digitalization, audio visual (AV/Collaboration), Telecommunication, Security, Information Technology (ICT), Wireless Networking, Integrated Automation (MSI) and Building IoT, Smart Buildings, Smart District, Smart Cities.
Data lies at the heart of Phi’s work, but data itself is not the answer. As Phi says, where does the data come from? Are clinicians expected to become data entry people? “The more you want to be data driven, the more data you need. You have to acquire and ingest that data somehow,” he says.
Over time he began designing systems within healthcare and moved into Agile operations to understand the big gap between informatics and infrastructure. “They should be procured together and
have the patient experience at the centre. Then we can work out how to provide the data automatically that can be analysed later without relying on clinicians to carry out this task.”
This approach to hospital infrastructure can be applied during the design process to new buildings, but retrofitting hospitals to collect data is virtually impossible. “It comes down to everyday issues such as the location of IV pumps – are they in the same room as the patient? Are they even in use, or where are they? These types of issues a ect bed occupancy and can slow down discharge and admission,” he says.
He works out of Vancouver in Canada, where most existing hospitals no longer meet the population demand and are now due for replacement. “That’s why you’re seeing a big uptick in the hospital design and construction activity right now,” he says. “However, to create a fully functional service we have to break down the problems of interoperability between the cities and the health authorities. And we’re not going to get that big data because each organisation has their own silos of data in varying extents.”
The system is a single payor system but publicly led. Such payor systems mean no billable code for innovation so e ectively it is stifled. The UK single payor system means mandated data sharing is possible, but until the issue is resolved there is no financial incentive to build the modern data driven hospital.
The answer for Phi again is the technology masterplan that operates in harmony with the masterplan at the design stage. “We can see where the pain points are, we try to identify moments of
“To create a fully functional service we have to break down the problems of interoperability between the cities and the health authorities”
Phi Kim Ho Arcadis Director and Senior Practice Lead, Vancouver Canada Arcadis Group
influence and input and see if there is a technology solution or innovation that we can apply to streamline things.”
One of the unforeseen results of the pandemic has been the shortage of talent, partly due to individuals reassessing their lifestyle and exiting the workforce. For healthcare workers, much of this was down to exhaustion as the world battled with a novel virus. This, coupled with the extensive everyday use of technology for meetings, removed the need for people to gather together in the workplace.
“Now there is a war on talent,” he says. “People are used to speaking to tablets, so we can incorporate them in a ward or reception area. That way we are aligning innovation with business drivers. It’s
even possible for nurses to answer ward calls remotely and direct them to the right person – we could use retired nurses who still want to work occasionally. Technology is now enabling us to tap into a di erent market or resource pool that wasn’t previously available.” There are also issues around segregation of responsibilities, particularly in the healthcare sector.
Di erent departments require di erent skills, and in a hospital they all should work in harmony. If no one is available to strip a bed and disinfect it, a new patient cannot be admitted to the ward. In the absence of robots moving laundry back and forth, there has to be an expectation of not having full bed capacity or delayed capacity.
“We don’t want to replace human care with technology,” he says. The patient experience is still first and centre; for this reason hospitals are now looking at the hospitality sector for inspiration. “We’re treating the patient experience like a customer experience. We can also attract good doctors with better facilities or experiences, such as reducing waiting times and automating lower value repetitive tasks.”
“We’re treating the patient experience like a customer experience”
Phi Kim Ho Arcadis Director and Senior Practice Lead, Vancouver Canada Arcadis Group
With the advent of personalised treatments and personalised health, it’s a serious possibility that the role of the big hospital is now obsolete. “Evidence has shown that people heal faster at home as opposed to inside a hospital with inpatient care, so as telehealth improves people won’t want or need to come to hospital,” he says. “Smaller, more agile hospitals may replace mega hospitals, but more severe illnesses will come into the hospitals themselves. Currently, it makes no sense if you are sick to go to a building where there are hundreds of other sick people if you can receive equivalent care at home. We will end up with smaller acute hospitals.”
He is also confident about the development of the digital patient twin, collating a patient’s existing health condition and comparing it digitally with population
health studies to create a holistic, individual and comprehensive preventive or treatment regime. Such results would inform hospitals if there would be a demand for particular care or treatments. “So do we design hospitals like airports, changing departments to anticipate di erent needs as the data dictates?” he asks. “Equally the metaverse will support healthcare with digital doctors and diagnoses.”
So where does this leave big hospital operators right now? He acknowledges that it is easier to update technology in new build hospitals as compared to retrofitting an existing facility, but the emphasis has to lie in a regional provider rather than individual facilities. He acknowledges that sometimes it is quicker and cheaper to knock down an old building rather than repurpose it, but the emphasis has to lie in structuring the technology and not just building big, shiny and new.
But who will be incentivised to build these institutions? It’s highly likely it will be the technology companies, as they will see a return on investment. “It will take 15 years before the metaverse will be at a point when people can start using it,” Phi says. For this to happen, the hospitals or healthcare practices must be su iciently digitally networked with structured data and the ability for medical professionals to access the information in the digital twin and use it in everyday clinical settings.
In the meantime, hospitals will have to work out how to maximise technology to serve their patients e ectively while preparing for the metaverse to arrive.
Of course, most healthcare data comes from traditional health system sources – patient records, hospital information systems and so on. By nature, this data is tainted: this is information entirely focused on sick people, not healthy people. Yet, to move towards a preventative model, you need to be considering sick people and healthy people together – indeed, the whole resident population.
But how do we collect data from healthy people (or as we call them, people not yet ill)? Many are reticent to share any personal data – not only are there fears surrounding what exactly it will be used for, but o en there is no real reason for them to share data with a third-party in the first place. E ectively, there has to be the right incentive for the public to share their health data.
Healthcare leaders globally are obsessed with the idea of population health management. In short, the idea of bringing together large quantities of patient data and using it to spot health needs and design services for them at a group or individual level.
It is a fantastic idea in theory. In practice, however, there are many challenges and barriers to such a system delivering real world impact. Firstly, the level of data maturity globally simply isn’t where it needs to be. To spot trends and understand population healthcare needs e ectively requires data. Lots and lots of data. Doing this for individuals needs all of this data at a very granular level.
There have been cases in health systems where the population health data has been crunched, the perceived problem identified, health policies modified to address it, but in the end it hasn’t worked. Academic research shows that 4 out 5 of logical, clinically sensible, population health interventions just don’t deliver the expected benefit. It may be the reason is simply because of the lack of quantity and
Steve Gardner Managing Director
quality in the data from the very beginning, but in reality we don’t really know why.
So, the one way to try and use population health management approaches properly is if you have access to historical health data which stretches out over a period of years, not months. But many health systems simply do not have access to such massive amounts of reliable patient data.
This feeds into another prevalent issue – running before you can walk. Many health systems, particularly in the Middle East, have huge ambition surrounding population health. O en, there is a motivation to try to use the current data and start modelling based on that informationthis has significant limits.
Until that data is of su icient volume, granularity and quality, and there is a system capable of providing accurate predicted outcomes and a library of proven interventions, it can be a complete waste of time. It can even be potentially dangerous if the resource is already stretched thin and this distracts from more fundamental work.
Health data is very di erent to the information which is o en collected on individuals online – usually for the purposes of targeting a consumer about a specific product. Yet collecting large scale, anonymised (though preferably pseudonymised) health data has the ability to provide real benefit to individuals, society at large, and perhaps even the whole of humanity.
The role of the provider in this entire saga is considerably confusing. The UK is lucky to have a single payor system, theoretically placing all its health data under one roof. But that is far from reality. Di erent health Trusts, hospitals, and primary care providers use a vast array of di erent IT systems, which makes fitting together all the pieces of data a real nightmare.
Insurance-based health systems have this problem as well – with the added issues of insurer competition, a reluctance to share data outside their organisation, and ultimately zero incentive to do so in the first place. Even still, what could possibly motivate an insurer to share sensitive company information with a direct competitor?
It is the classic problem of short-term pain for long-term gain. It may take years of collaboration, cooperation, and the slow and steady building of high-quality, large datasets for a true population health model to be put into place – and it’s very unlikely that we could see any large scale benefit any time soon.
One day though, it could change healthcare as we know it.
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