Healthcare World Magazine | Issue Eleven by TheTradeAgency

L E A D I N G T H E D E BAT E I N I N T E R NAT I O NA L H E A LT H CA R E & L I F E S C I E N C E S

Issue Eleven | October 2023

NEOM

Reimagining the future of health Dr Mahmoud Alyamany reveals how NEOM’s vision will transform the way we view our health

GLOBAL HEALTH RIYADH | MENTAL HEALTH – COMING OUT OF THE SHADOWS | HLTH - TRANSFORMING THE NEXT DECADE OF HEALTH | DATA

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EDITOR’S WELCOME

Welcome to Healthcare World

s we head to Global Health in Riyadh this month, we have been privileged to hear about healthcare in NEOM. Saudi Arabia’s newest region has a vision for health, not just healthcare, according to Dr Mahmoud Alyamany who is the Sector Head Health & Wellbeing. He spoke to MD Steve Gardner and I about the plans to help NEOM’s inhabitants actively manage all aspects of health in their daily lives by incorporating it into the identity of the new region. He talked of the need to understand what impacts our health, and how we can reduce the incidence of disease by focussing on wellness rather than illness. It’s a theme we have heard recently as healthcare systems across the globe are gradually introducing similar ideas. NEOM’s plans would show how it can be done in a new system from scratch which will be fascinating to see when it comes to fruition. In other parts of KSA, there is a focus on mental health as demand grows for more provision. So how do we provide for all this with the demands on health systems worldwide? Knight Frank’s healthcare team looks at the business case for new mental health facilities in the Kingdom and across the wider region. And 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

Sarah Cartledge Editorial Director

the patient, allowing them the privacy to interact with mental health services in a safe and medical environment. He discusses this issue on page 64. Consultant psychiatrist and Managing Director of Commercial Enterprise for SLaM (South London & Maudsley Hospital) Dr Sean Cross 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 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. To coincide with Global Health in Riyadh, there are features from highly respected companies in our Saudi Arabia centre section, including lawyers Al Tamimi, revenue cycle management experts ACCUMED and PowerHealth, property giants Colliers, and international asset management consultants Currie & Brown. 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

The Healthcare World team Emma Sheldon MBE CEO

Steve Gardner Managing DIrector

Andrew Goldsmith Finance Director

Sarah Cartledge Editorial Director

Ritu Chopra Operations Director

Joe Everley Art Director

Alison Carmichael Operations Executive & Website Manager

Fabian Sutch Marketing & Editorial Executive

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CONTENTS

Contents 8 14

News

The latest from the healthcare sector

Healthcare World Magazine | Issue Eleven

A focus on elderly care in KSA requires substantial investment and offers significant opportunities, says Mansoor Ahmed, Executive Director Middle East and Africa, Colliers

Andrew Castle, Healthcare Director for Currie & Brown in Saudi Arabia, discusses the current healthcare landscape in KSA

Meet the CEO

Mikael Rosén of Skane Care tells HW Editor Sarah Cartledge that sharing knowledge is the key to modern healthcare systems

Harnessing new technologies

Bevan Brittan’s Letitia Winterflood-Blood on harnessing new technologies to improve diagnostics and benefit the global healthcare ecosystem

Deep Dive Data

Jennifer Nobbs, Head of International Advisory, at Beamtree explains how data stored and often used within the electronic patient medical record can be used to fullest potential

Julie Coope of Berkeley Research Group examines benchmarking in healthcare to improve quality of care

Healthcare World Series

38 43 46

Saudi Arabia Health Systems

Mohammed Aldar, Managing Director of ACCUMED, explains why Revenue Cycle Management is crucial for healthcare providers

Finding the right people

TalentFind Solutions CEO Mandy Rowbottom on her mission to improve healthcare recruitment

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

The Introduction to International Programme

Orchestrating healthcare regulation

The importance of diversity in clinical trials

Christina Sochacki and Abdulmohsen Al Saleh outline the importance of privatisation in Saudi Arabia

Bevan Brittan and Healthcare World’s comprehensive solution to provide healthcare businesses with the expertise to enter new markets with confidence

Lina Behrens, Head of Content for HLTH Europe, on the importance of standard data regulation in mainland Europe

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46 52

Fascinating Brazil

Jyoti Mehan of Healthcare First talks about her factfinding visit to Brazil earlier this year

From our Africa correspondent Dr Mwenya Kasonde highlights five business opportunities that will transform African healthcare

Dr Suhel Ahmed outlines how the Healthya solution enables patients to self-manage their health metrics

Focus on Mental Health

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

Archie Read, Senior Operations Controller at ADHD360, explains the importance of diagnosis for anyone suffering with ADHD

Dr Patrick Wynn of Health Care First explains how GPs can work with AI to improve mental health provision

Mental health regulation around the world: Is it time for a shake up? ask Gerard Hanratty and Carly Caton, Partners at Browne Jacobson

Saudi Arabia is addressing the challenges of mental health provision to reduce social stigma, says Ian Chambers CEO of Linea

The Knight Frank healthcare team examines the business case for facilities in the Middle East

Game-changing data NECS, part of the NHS, provides high quality health and care system support to global organisations, says MD Stephen Childs

Patients know best The patient has a vital role to play in future population health management, says Sally Rennison Chief Commercial Officer at Patients Know Best

Empowering patients to better understand their health

Waiting for the future Hospital design will focus on the digital twin supported by the metaverse, says Phi Kim Ho, Arcadis Director and Senior Practice Lead, Vancouver, Canada

NEOM Dr Mahmoud Alyamany tells Steve Gardner and Sarah Cartledge how NEOM’s futuristic vision will change healthcare delivery

Reconfiguring healthcare Mott MacDonald’s Brian Niven on transforming the way services deliver outcomes

Innovative approaches Patrick Power, MD PowerHealth, on delivering the highest quality medical care at the lowest cost

Delivering at-scale recruitment through innovative digital solutions Matching locum clinicians to their ideal roles enables rapid engagement, says APPlocum founder Dr Suhel Ahmed

Opinionated Healthcare World MD Steve Gardner explains why population health isn’t working

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Even healthcare organisations require a health check.

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NEWS Breakthrough agreement set to deliver cancer vaccine trials The UK Government has signed an agreement with BioNTech to provide ground-breaking cancer treatments by 2030

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

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 offered 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.

YouTube rolls out verification process for medical professionals in the UK

Now, YouTube has added a verification feature, similar to the process used for very large channels and official organisations, to licensed medical professionals after 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.

“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.

he UK has moved a step closer to revolutionary new cancer treatments, according to a .gov report. After 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.

UK-based medical content creators will now have to verify their credentials

n an effort 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.

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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 effects 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. Califf, 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 efforts to expand opioid disposal options to attempt to reduce opportunities for nonmedical use, accidental exposure, and overdose.

“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.”

Life-saving Naloxone is now available over the counter in US stores In a move to counteract the opioid crisis in the USA, the antiopioid treatment is now being rolled out across the nation

he 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 effects of opioid overdose and is the standard treatment for such overdoses globally.

Scientists grow synthetic embryos in major breakthrough The research has created the most advanced model of the human embryo so far

cientists 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 efforts 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.

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What matters to you, matters to us

Vincent Buscemi

Partner and Head of Independent Health vincent.buscemi@bevanbrittan.com

Letitia Winterflood-Blood

Senior Associate letitia.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.

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CEO INTERVIEW Mikael Rosén

Mikael Rosén

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Collaborating for success the Swedish way

Mikael Rosén, CEO of Skane Care, tells HW Editor Sarah Cartledge that sharing knowledge is the key to modern healthcare systems

he Swedish have a reputation for efficiency 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.” Learning from the Swedish system 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

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CEO INTERVIEW Mikael Rosén

works for their needs. That can be with 10 per cent Swedish solutions or 100 per cent Swedish solutions.” Skane Care offers 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

“We are exporting learnings from a healthcare model that has evolved over 70+ years” 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 different 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.”

Net Zero healthcare solutions 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.” 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 often 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.” Contact Information Contact Information https://skanecare.com

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Better diagnostics, better prevention, better outcomes Bevan Brittan’s Letitia Winterflood-Blood speaks to Healthcare World about harnessing new technologies to improve diagnostics and benefit the global healthcare ecosystem

iagnostics 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 effective 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 often 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. Getting the basics right 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

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LEGAL Bevan Brittan

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, understaffing 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. Enabling AI to deliver 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 different 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 staff 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 differently across different 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 difficult one to navigate for development, particularly for operators looking at rolling out their offering 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 often the data on that local population has to inform the diagnostic tool to be applied to them.

Letitia Winterflood-Blood Partner Bevan Brittan

“Preventative interventions only work if underlying data, patient understanding, and delivery methods of care are rock solid” 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. Contact Information

www.bevanbrittan.com

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DATA

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DEEP DIVE Beamtree

The hidden secret deep within the electronic medical record 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

oor use of electronic medical record systems (EMRs) could result in potentially lifethreatening implications if the system itself isn’t up to scratch. EMRs can offer huge benefits to patient safety and

workforce efficiency if used well – so why are hospitals taking so long to implement them effectively? 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 19

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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 often that EMRs are not used to their full potential, or worse used as a digital way of continuing to do analogue tasks. Often 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 often 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 efficiency 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. The missing link 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 often 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 efficiency further down the line, data can effectively 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? Promoting use of EMRs across the healthcare sector 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

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DEEP DIVE Beamtree

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 Ainsoff

Jennifer Nobbs Head of International Advisory Beamtree

“Once the data is being actively used for multiple purposes, it can improve each step of the process and feed back in its turn”

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 off 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/ Contact Information

www.beamtree.com.au

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How benchmarking in healthcare can improve performance Julie Coope of Berkeley Research Group examines benchmarking in healthcare to improve quality of care

ealthcare 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 difficult 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 efficiency, 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 often, there are multiple

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DEEP DIVE BRG

Julie Coope Senior Managing Consultant Berkeley Research Group

“Out of quality comes efficiency, because where there is quality performance, you can see a real cost benefit”

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. A balancing act Many metrics not only provide you with other factors of care to examine but are often directly linked to one another. Healthcare executives are often interested in length of hospital stay, but this metric will be affected

by a variety of factors. A best practice is to evaluate this metric alongside readmission rates because often 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 often 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 difficult 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 sufficiently 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. Global benchmarking and payor models Across the globe, the main incentive for healthcare institutions is to treat patients quickly and efficiently, 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 difficulty because the granular data that’s available at patient pathway level in different regions is often 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 different 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 effective 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. Contact Information

jcoope@thinkbrg.com www.thinkbrg.com

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healthcare world series

CLINICAL TRIALS

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healthcare world series

The importance of diversity in clinical trials The Middle East could be an ideal place to run clinical trials, finds our expert panel

ur wellbeing is a combination of mental and physical health that affects 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 different 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 efficacy 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 different 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, 25

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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. Regional points 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

Raesa Afzal Senior Counsel Al Tamimi & Co

“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”

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. Facilitating UAE clinical trials 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 ineffective 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. Data and clinical trials With the collation of data and new integrated health records in the UAE, there will be more valuable data for researchers in the

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HW SERIES Clinical Trials

region. For Raesa, the issue is not just about monetisation of data but about population health management. “It will be more cost effective 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

Mike Failly Founder & Managing Director Zanteris

“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”

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.”

Find out more healthcare world series

www.healthcareworld.com/ healthcare-world-series/

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HEALTH SYSTEMS ACCUMED

Saudi arabia

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Revolutionising RCM: The Power of Technology Mohammed Aldar, Managing Director of ACCUMED Saudi, explains why Revenue Cycle Management is crucial for healthcare providers

CM 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 offers 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 suffered 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 affects 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 offer a clear and complete view

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HEALTH SYSTEMS ACCUMED

the constantly changing healthcare landscape which leads to financial losses.

RCM enables healthcare organisations to improve continuously and maintain their reputation through:

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.

Robotic process automation (RPA) 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.

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 staff 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. of the revenue cycle, which makes it difficult to identify and address problems. • Inflexibility - Traditional RCM processes are not well-designed to accommodate

Mohammed Aldar Managing Director ACCUMED Saudi

“Proper RCM in place ensures that healthcare organisations maintain a revenue that keeps them financially healthy”

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.

Artificial intelligence (AI) Used to improve RCM processes accuracy. AI can be used to identify claims errors prior to submission. Machine learning 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. Big data analytics Used to analyse large datasets of RCM data to identify trends and patterns. This information is used to improve the efficiency and effectiveness 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.

Contact Information

www.accumed.sa

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A comprehensive action plan for the elderly in Saudi Arabia A focus on elderly care in KSA requires substantial investment and offers significant opportunities, says Mansoor Ahmed, Executive Director, Middle East & Africa (MEA) Colliers

ith 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 shift 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 after 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.

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HEALTH SYSTEMS Colliers

Mansoor Ahmed Executive Director, Middle East & Africa (MEA) Colliers

“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”

The development of this sector can act as a change catalyst to the healthcare sector from elderly to acute care. Through a gradual shifting 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. The demand drivers 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 suffers 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 PPP Initiative 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 33

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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 efficiency in home care vary across regions with limited services provided. Due to a lack of efficient 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

Mansoor Ahmed Executive Director, Middle East & Africa (MEA) Colliers

“Patients who could be better served in LTC and rehab facilities occupy an estimated 20- 30 per cent of public hospital beds in KSA”

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.

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HEALTH SYSTEMS Colliers

The Challenge The greatest challenge lies in the shortage of manpower as the number of physicians and specialised nurses and allied healthcare personnel for rehabilitation is insufficient. 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

Overview of KSA LTC Rehabilitation and Home Care Sector_Aug23_v10.pdf

08/09/2023

13:53

mansoor.ahmed@colliers.com +971 50 66 88 239 / +971 55 899 609

Percentage of population above 60 years by 2035

Total Existing & Projected Population 2035

2022

≈32.2m

≈40.0m

≈45.9m

2022*

2030**

2035**

KSA ≈ 4.7%

OECD ≈ 24.0%

2030

KSA ≈ 10.4%

OECD ≈ 26.8%

2035

KSA ≈ 15.1%

OECD ≈ 28.2%

*KSA Census 2022 - issued in May 2023 ** based on CAGR (2010 - 2020) of 2.78%

Government’s Vision 2030 and NTP

Demand for LTC & Rehab Beds 2035, based on “Age Adjusted” Population

LTC Beds Rehab Beds

Type of Assets

2022

2030

2035

Demand based on total KSA population

≈ 15,300

≈ 19,200

≈ 22,600

Demand based on KSA Nationals

≈ 8,900

≈ 11,000

≈ 12,700

Demand based on total KSA population

≈ 9,500

≈ 16,600

≈ 20,600

Demand based on KSA Nationals

≈ 5,500

≈ 9,500

≈ 11,600

focuses on healthcare development, though Ministry of Health (MoH), Private Sector Participation (PSP), using PPP Model

Colliers has used “age-adjusted population rates” for projecting future demand rather than applying crude OECD ratios over 60 years of age. “Age-adjusted population rates” provides more accurate demand instead of

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Changes in the healthcare sector in Saudi Arabia Andrew Castle, Healthcare Director for Currie & Brown in Saudi Arabia, discusses the current healthcare landscape in KSA

s 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. What are you seeing in the healthcare sector currently in KSA? 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 shift. 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 effort presenting significant opportunity for the creation of a world-class healthcare service.

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HEALTH SYSTEMS Currie & Brown

As with all transformations, delivering significant change brings challenges. These include providing sufficiently qualified and experienced staff, 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.

Andrew Castle Healthcare Director Currie & Brown

“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”

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 staff 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. What attracted you to the KSA Health Sector Lead role at Currie & Brown? The offer 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 offer 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 different 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. What does success look like for you? 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. Contact Information

andrew.castle@curriebrown.com www.curriebrown.com

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Healthcare in KSA: Progress, challenges, and opportunities Christina Sochacki and Abdulmohsen Al Saleh at Al Tamimi & Company outline the importance of privatisation in Saudi Arabia’s health sector transformation

ne 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, effective 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.

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LEGAL Al Tamimi & Co

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 effectiveness 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 efficiently 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.

Recent Progress Highlights 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 efficiency, and create greater transparency within the system. 1. HHC 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. 2. New Model of Care The new Model of Care shifts 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. 3. Health Sector Transformation Program The Unified Health Law project emphasises the importance of quality and efficiency in healthcare, encourages the adoption of international best practices, and promotes development, research, and innovation. It also focuses on ensuring sustainability, continuous improvement, effective governance, and enhancing the efficiency 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.

4. Saudi National Institute of Health Research 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. Opportunities 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 efficiency, improve the quality of healthcare and patient safety, and provide valuable data for evaluating performance, automating the healthcare system. 1. Privatisation 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. 39

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Saudi’s Privatization Program was launched in 2018. At its launch, the Privatization Supervisory Committee identified nine different 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. 2. Rehabilitation 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 traffic accident rate. There is an increasing shift 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. 3. Long Term Care 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.

Christina Sochacki Senior Counsel, Head of Healthcare & Life Sciences, KSA Al Tamimi & Co

“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 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. 4. Mental Health & Drug Addiction 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

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LEGAL 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. 5. Primary Care Centres 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 shift 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. Investment Key Considerations 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. Contact Information

www.tamimi.com

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14/09/2023 11:25

RECRUITMENT TalentFind Solutions

Finding the right people TalentFind Solutions CEO Mandy Rowbottom talks to Fabian Sutch-Daggett about her mission to improve healthcare

uccessful recruitment can be remarkably difficult in the healthcare sector. Ensuring staff 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 often do not incorporate – such as strict regulations surrounding certification as well as large amounts of staff 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 difficulties faced by organisations looking for the best of the best. Refining the search Expert recruitment specialists Mandy Rowbottom and Adrian Wilkinson recognised the issues first hand. After starting a company in 2012 that specialised in recruiting Western 43

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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 staff 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. Getting ready for market 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 soft 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

Mandy Rowbottom CEO TalentFind Solutions

“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”

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.

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 differences 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.

Contact Information

AI to the rescue TalentFind World uses Cognitive AI, allowing it to have a deep and unique understanding of the global medical training and licensing requirements,

www.talentfindsolutions.com

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A patient-centred approach to healthcare infrastructure 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 everyone the community, medical staff, but most importantly the patient.

“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

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.

www.curriebrown.com

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MEET THE EXPERT

Maintaining the highest trust in doctors Dr Andrew Hoyle, Assistant Director Decisions and Case Examiners, explains how the UK’s General Medical Council regulates fitness to practise among doctors

he 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 difficult 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.”

Dr Andrew Hoyle •

•

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.

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MEET THE EXPERT Dr Andrew Hoyle

Delivering patient safety 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 different 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 off 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 insufficient 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 often 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.

Examiners to apply the Realistic Prospect Test: “We try very hard to Are the allegations serious enough to require be a compassionate action on registration, is it more likely than not the allegations will be proved, and is there regulator and that current impairment?” means being fair to both Case Examiners do not hear oral evidence and clinical concerns are always addressed patients and doctors” by asking for an independent medical expert Balancing compassion and fairness 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 officers 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 officer 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 officers 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 often the single biggest delay in a case, but once all is in order the case is presented to the Case

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.” Sharing expertise

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 offering guidance and sharing our experience, helping them to fast track their policies and processes and swiftly implement a regulatory model to suit their needs.” Contact Information helen.featherstone@gmcsi.co.uk

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Introducing the ITI Programme 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

ntering 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.

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HEALTHCARE WORLD ITI

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 After 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 effective 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:

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. • Step Two: Initial Advisory Review 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 different markets across the globe. Steve Gardner, Healthcare World MD, our International Healthcare expert,

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: Contact Information

steve@healthcareworld.com +44 7985 462886

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Oboes and silos: Orchestrating healthcare data in Europe Lina Behrens, Head of Content for HLTH Europe, tells Healthcare World about the importance of standard data regulation across mainland Europe

rillions 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 difficulties from a data standpoint. “In Germany, our healthcare system is often 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.” A complex dance 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

Lina Behrens Head of Content HLTH Europe

“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”

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

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HEALTH DATA HLTH

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 efficiency but also opening new frontiers for data-driven insights. It will be a huge jump forward.”

European Health Data Space 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. “Nevertheless, it’s crucial to acknowledge the significant differences in healthcare data management that currently exist among

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 effectively, 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.” Contact Information

europe.hlth.com

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Recognising similarities – opportunities in the healthcare market in Brazil Jyoti Mehan of Health Care First tells Healthcare World about her factfinding visit to Brazil earlier this year

roviding quality healthcare for a nation as enormous as Brazil is fraught with difficulties. Home to a population of more than 214m, spread over the fifth 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 often 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 different 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 often overlooked as an overseas market. The dynamically diverse cultures, languages, populations, economies and demands of the region can put businesses off. 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.

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CONSULTANCY Health Care First

Opportunities in Brazil 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 staff retention. We are all aware of the global workforce crisis, and shortages of staff across the world. With the UK and Brazilian healthcare systems so alike in setup, sharing staff, 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. Overcoming the challenge of scale Obviously, there is a glaring difference 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 difficult. The right digital tools can

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” 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 offer. So, I urge you, if you’re looking to expand internationally, take a look at Brazil – you might be surprised what you find. Contact Information

jyoti.mehan1@nhs.net www.healthcarefirst.co.uk

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Five business opportunities that will transform African healthcare

effectively 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 Mwenya Kasonde highlights five business opportunities that will transform African healthcare

ccording 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

Dr Mwenya Kasonde Dr. Mwenya Kasonde is a global health consultant and advisor on issues relating to gender equality, social impact, sustainable development, global health, public health policy, healthcare investment promotion, and market access.

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AFRICA Mwenya Kasonde

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 efficacious therapeutics, vaccines and other health technologies by hastening regulatory approvals, countering falsified and substandard medicines, and centralising pharmacovigilance efforts. 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.

that are often dominated by multilateral organisations. But with access to resources, intellectual capital, technology and efficient 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. Changing the future of African healthcare 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. 1. Pharmaceuticals and diagnostics 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

2. Digital health 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. 3. Human resources for health 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. 55

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5. Health information systems 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. Conclusion

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. Thereafter, 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. 4. Healthcare financing 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.

Tony Elumelu Nigerian entrepreneur and investor

“There is a better way to invest in africa for a sustainable future that creates value for all”

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.

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 different ways. Contact Information www.mwenyakasonde.com

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FOCUS ON MENTAL HEALTH

mental health

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Recognising the importance of mental health in healthcare provision 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

t’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 different 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.

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FOCUS ON MENTAL HEALTH SLaM

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 offering 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 offer a full suite of services as an NHS consortium internationally. Mental health provision as a service For Sean, the terminology is important, especially that of mental health care which incorporates better services and better staff 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 offer 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 difficult 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

Dr Sean Cross Managing Director of Commercial Enterprise South London and Maudsley NHS

“If you’re going to design healthcare, education systems and healthcare systems for all the ages, you need to integrate mental health within it”

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 different from many physical health conditions.” Developing mental health offers 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 difference 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 offered 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 offer 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 Contact Information

maudsleylearning@slam.nhs.uk

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Changing ADHD one person at a time Archie Read, Senior Operations Controller at ADHD360, explains to HW the importance of diagnosis for anyone suffering with ADHD

ttention-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 sufferers, but they have resolved some of the issues by turning to organisations such as ADHD360 who can provide a faster route to diagnosis. The experience of ADHD For Archie, his diagnosis was key to enabling him to live his best life, as he puts it. Currently studying Business at

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FOCUS ON MENTAL HEALTH ADHD360

stepfather Phil Anderton, founder and MD of ADHD360, would often 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 often be perceived as a naughty schoolboy concept, but my symptoms were different,” 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

“Now that I understand my ADHD I can manage it and I am a much happier person” Understanding ADHD

Sheffield Hallam University, he is also ADHD360s Senior Operations Controller. But as a child, it was difficult 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 sufferers 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

“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 61

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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 often 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 often 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 different 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 effects,” he explains. “One of the side effects 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 effects 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.” Working with ADHD360 Along with other employees, Archie’s experience is directly relevant to ADHD sufferers 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 lift 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 difference to my life that I want everyone with ADHD to have the same opportunity to live their best lives as I do.” Contact Information

www.adhd-360.com

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11:25 14/09/2023 11:21

Dr Patrick Wynn

It’s all in the mind How GPs can work with AI to improve mental health provision

ental 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 difficult - 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 money even 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 often 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 efficient. 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 effective 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 often 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 effectively, 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. Contact Information

www.healthcarefirst.co.uk

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14/09/2023 10:34 11:25 17/04/2023

Legal frameworks for mental health Mental health regulation around the world: is it time for a shake up? ask Gerard Hanratty and Carly Caton, Partners at Browne Jacobson

he 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 suffering 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 often 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

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FOCUS ON MENTAL HEALTH Browne Jacobson

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. Points to consider 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 Draft Mental Health Bill to improve patient choice plus a statutory duty to offer 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.

Carly Caton Partner Browne Jacobson

“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”

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 sufficient 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 difficult. So what is the answer? The sorts of things that we see that have success are really putting time and effort 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. Contact Information

carly.caton@brownejacobson.com gerard.hanratty@brownejacobson.com

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Providing help to see the light Saudi Arabia is addressing the challenges of mental health provision to reduce social stigma, says Ian Chambers CEO of Linea

n 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. The Mental Health Landscape in Saudi Arabia 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 often overlooked or neglected. The stigma surrounding mental health can hinder individuals from seeking help and perpetuate misconceptions about mental well-being. Government Initiatives and Policy Changes 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

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FOCUS ON MENTAL HEALTH Linea

online presence to share personal stories, raise awareness, and provide information regarding available resources. These efforts 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. Challenges and Future Outlook

mental health clinics and centres have been established across the country, offering accessible and confidential services to those in need. Additionally, the government has made efforts 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. Changing Discourse and Public Awareness 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

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

Ian Chambers CEO Linea

“The emergence of social media platforms has played a crucial role in reshaping the discourse surrounding mental health in Saudi Arabia”

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 efforts with national initiatives, we can help create sustainable change. Capacity Building: Building a strong mental health infrastructure requires skilled professionals. Linea offers 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 effectively. Partnerships and Collaboration: Effective 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. Conclusion Saudi Arabia’s journey towards improved mental health provision is marked by significant strides and collaborative efforts. 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. Contact Information

info@linea.net www.linea.net

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Providing quality mental health in the Middle East The Knight Frank Healthcare Team examines the business case for mental health facilities in the region

he COVID-19 pandemic has had far-reaching consequences that have permeated all areas of life. A less visible, but perhaps more significant impact, has been on our mental health. Extended periods of isolation or self-isolation, stemming from repeated lockdowns, combined with the closure of travel routes, have had a negative impact on society.

Yet in many ways, the pandemic has shone a light on an often taboo area of healthcare. As a result, the world has found itself inadequately prepared to cater to those mentally impacted by the virus. Knight Frank’s global teams have collaborated to explore this issue, specifically looking at the need to deliver more mental health facilities across the UAE and Saudi Arabia.

Other factors are also affecting the rise in mental health issues in the region. Population growth and demographic shifts reveal a much younger current demographic profile (20-39 years), while the number of people who will be over 60 by 2030 is also on the rise. The younger population are exposed to tremendous societal changes, hence they are at a higher risk of developing mental health conditions, while the elderly are at a risk of non-communicable diseases and co-morbidities. Since there is a link between risk factors causing non communicable diseases and mental health disorders, the elderly may have a higher requirement for mental health related care. Inpatient facilities do not have the capacity to cope with the potential growth in mental health treatment. In

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FOCUS ON MENTAL HEALTH Knight Frank

Shubhra Singhal Consultant Knight Frank Middle East

“The insurance coverage for mental health conditions has witnessed an increase during recent time, which will enable ease of access for patients in the region”

the UAE there are approximately 72 private outpatient facilities, but only one dedicated public inpatient facility. In contrast, Saudi Arabia has around 99 psychiatric clinics, with 21 inpatient facilities in the public sector. Nevertheless, Knight Frank’s research shows this number is severely under-resourced and will need to grow exponentially in the future. Increasing access to mental health provision Saudi Arabia established The Taif Mental Hospital, the largest specialised hospital for mental care in Taif in 1952. The National Mental Health Policy was introduced in 2006 and the provision of effective care for

KSA Strategic Objectives • Focus on preventive health to reduce burden of NCD’s, as well as mental health illnesses • Effective treatment for people with mental health disorders • Facilitate access to psychiatric consultations and upgrades to current infrastructure and capacity UAE Strategic Objectives • Enhancing the promotion and improving awareness of mental health • Developing, strengthening and expanding comprehensive, integrated and responsive mental health services • Strengthening multi-sector collaboration to implement mental health promotion policy • Promoting the prevention of mental disorders • Strengthening capacities, improving information systems and conducting mental health research

people with mental health illnesses is a stated strategic objective of Vision 2030. The UAE introduced mental health services in 1980 and today mental health is a key performance indicator in the UAE National Agenda. By 2030, the Dubai Health Authority (DHA) and Department of Health - Abu Dhabi (DOH) estimate a national shortfall of 177 acute inpatient beds and 639 acute overnight beds for mental health. In KSA, an additional 915 beds will be required. As a result, significant investment is required to cope with the anticipated demand. Lack of current provision has seen a rise in outbound medical tourism to countries such as Thailand, Switzerland and the USA that have more established mental health facilities. “The number of people struggling with mental health conditions in the region has increased exponentially in the last decade, with the rates of mental illness and disorders similar to those found in other parts of the world,” says stakeholder and clinical psychologist Dr Saliha Alfridi, MD of The Lighthouse Arabia Center for Wellbeing. “However, there are some specific challenges related to mental health in the region, such as a lack of awareness and understanding of mental health issues, as well as cultural and social stigmas that can make it difficult for people to seek treatment.” Knight Frank has found that 60 per cent of patients in the UAE and 80 per cent of patients in KSA suffering from poor mental health do not seek assistance or treatment due to historic and long-standing taboos around the subject. Within the DHA, there is a strong realisation that mental health should not be viewed differently from any other health condition. For Dr Marwan Al Mullah, CEO Health Regulation Sector, improving access for treatment of mental health is a priority and can be expedited by introducing it 71

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Initiatives and Accessibility Saudi Arabia Telehealth: • Four psychosocial support platforms were established to provide free mental health virtual consultations. Awareness Campaign: • Awareness campaigns were launched through live radio broadcasts, press releases and videos to address the mental health and wellbeing of people across the Kingdom. Payment mechanism for mental health facilities: • Outpatient facility and inpatient facility: Public facilities are only accessible to Saudi nationals and are free of charge. Expats have limited access, i.e., only in an emergency. • There are limited beds for psychiatry in the private sector – certainly not enough to cover the current expat population. • Some insurance companies provide coverage of up to SAR 15,000 for psychiatry, even in the most basic packages. UAE Telehealth: • Inclusion of teleconsultation services within all insurance covers, including basicpackages, led to increased virtual consultations services, including addressing mental health challenges. Awareness Campaign: • The National Programme for Happiness and Wellbeing launched a national campaign for mental health support to help residents overcome psychological impacts resulting from COVID-19 which included virtual sessions and hotline numbers. Payment mechanism for mental health facilities: • Outpatient facility – There are few outpatient clinics that accept insurance, while most operate on a cash-only basis. • Inpatient facility- There is only one dedicated public inpatient facility which provides free access to nationals. Expatriates can utilise insurance coverage, if they have psychiatry benefits or may opt to pay in cash.

at the primary health level and supported by a strong referral system. “At present, mental health conditions are predominantly being catered for at public health facilities whilst private sector participation has been fairly limited,” he says. “To make mental health more accessible, we plan to qualify and train family physicians to diagnose, care and refer patients up the healthcare chain as required. We will also introduce rehabilitation and social reintegration programs for all ages and will facilitate private sector participation (foreign or local) for the provision of quality mental health care in the country.” For Knight Frank partner Julian Evans, services can capture different types of registration for either government or privately funded markets. “It is often a hybrid of social care and educational expertise that is required to operate very complex businesses,” he says. “Medical tourism and international operators that

have the expertise and bandwidth are increasingly looking to enter new markets and jurisdictions. Current challenges Although mental health is gradually becoming accessible within the UAE and Saudi Arabia, comprehensive insurance to cover treatments is only available to a premium paying segment of the population. The inpatient facilities provide free access only for nationals and expats can only utilise insurance coverage if they have psychiatry benefits included. Some outpatient facilities are unable to empanel themselves with insurance due to the high recruitment and operating costs. As a result, many are unable to match the pricing set by the insurance regulators which ultimately pushes the cost burden on to patients. Regulations surrounding the licensing of psychiatrists and psychologists is challenging,

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FOCUS ON MENTAL HEALTH Knight Frank

resulting in facilities unable to hire adequate talent leading to long waiting lists. Unsurprisingly, this creates a high burnout rate in existing psychiatrists. In addition, due to the decentralised nature of the regulatory authorities and regular updates of mental health laws and regulations, particularly in the UAE, there is often ambiguity around

Dr Gireesh Kumar Associate Partner Knight Frank Middle East

“The rising volume of mental health conditions in the region creates additional demand for private sector inpatient and outpatient mental health facilities”

the attitude, need and desire to establish additional mental health facilities. Inadequate infrastructure Traditionally, the facilities in the region are predominantly operated by the public sector. Furthermore, poor medical infrastructure in these facilities deters cash patients. Additionally, access to mental health services is extremely limited due to a shortage of mental health professionals and resources resulting in patients having to wait months before they receive treatment, while many others are not able to afford care due to its high cost. “Despite these challenges, I feel hopeful because of the increased efforts in the recent years to improve mental health services and awareness in the region,” says DHA’s Dr Marwan Al Mullah. “Over the years, Dubai has become a medical tourism destination and is attracting

patients from Middle East, Asia and Africa. From a private sector perspective, this presents a strong business case as their target market is beyond the population of Dubai and mental health related services are fairly limited in these regions.” Clearly, significant investment is needed to meet growing demand and for the Middle East to be on a par with international benchmarks. The establishment of dedicated mental health facilities would reduce the need for patients to seek treatment abroad and would bring in highly skilled psychiatrists and psychologists to the region. Contact Information

www.knightfrank.ae

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Game-changing data NECS, part of the NHS, provides high quality health and care system support to global organisations, MD Stephen Childs tells Healthcare World

he 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

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HEALTH DATA NECS

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 75

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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

Stephen Childs Managing Director NECS

“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” 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. Contact Information

www.necsu.nhs.uk

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POPULATION HEALTH Healthya

Empowering patients to better understand their health Dr Suhel Ahmed outlines how the ‘healthya’ solution enables the delivery of a true, data-driven Population Health Strategy

he COVID-19 pandemic has intensified the challenges faced by General Practice in delivering effective chronic disease management. This has stretched primary healthcare services as they deal with issues such as diabetes, hypertension, cardiovascular disease (CVD), and kidney disease, leading to acute hospital admissions and premature deaths. As a Clinical Lead with extensive experience in healthcare innovation in the UK, Dr Suhel Ahmed has spent much of his working life delivering innovative NHS-approved technology solutions to assist healthcare professionals. One of them, ‘healthya,’ is a groundbreaking solution that empowers patients, fosters early diagnosis, and alleviates the strain on traditional GPs. The ‘healthya’ solution addresses the critical challenges of chronic disease management, offering Telehealth, Patient Monitoring, NHS Spine Integration, and advanced Single Patient Records. “The solution provides patients with the tools to self-manage and understand their health metrics, receive automated care and wellness advice, and an ability to access early diagnosis and screening, either inperson or virtually,” Suhel says.

Capturing data in an accessible manner Accessible ‘healthya’ kiosks are strategically located in public spaces, such as pharmacies, retail areas, and workplaces. “These kiosks serve as gateways for patients to access digital health checks, empowering them with vital health data,” he continues. “The app provides them with user-friendly visuals and personalised goal-setting features, delivering automated wellness nudges through push notifications, emails, and SMS. This data, coupled with sophisticated in-app structured health related questionnaires, can then give them a true data-driven proactive, preventative pathway of care.” All collected data feeds into a sophisticated dashboard that not only assists individual users but also enables healthcare organizations and system-level stakeholders to derive population health trends. This in turn facilitates the delivery of targeted interventions at the right time, ultimately improving healthcare outcomes. As an NHS-approved solution, ‘healthya’ boasts a network of key partners, including multiple innovation agencies and universities, The Obesity Insitute, AstraZeneca, PharmSmart, Fusion Health, and MicroLink PC. More than 100

pharmacies in the UK have integrated ‘healthya’ kiosks over the last quarter alone, addressing the decline in footfall and opening opportunities for revenue generation through clinical service delivery, and sales of products through vouchers and discounts. “Our commitment to interoperability and integration extends to wearables and health systems, fostering an ecosystem that empowers users with their health data and enables healthcare organisations to implement data-driven population health strategies” Explains Suhel. By delivering a digital patient triage for earlier diagnosis, ‘healthya’ empowers patients to self-manage their health, provides data-driven insights for optimised resource allocation, and fosters collaborative engagement with pharmacies, retail, employers and CVS’s. As an approved supplier to the NHS, Healthya partners include AstraZeneca, the British Red Cross, PharmSmart and the Priory among others. For retail partners, having a kiosk in a site with high footfall enables them to issue vouchers to redeem against vitamins and health foods, discounts to health or gym facilities or other reductions on shopping. “By capturing data from healthy people, we are able to glean a snapshot of the population,” says Suhel. “Our key strength is interoperability and we have a roadmap to integrating with information from wearables and also from health systems, working with data sets from local stakeholders. The aim is to empower stakeholders with their own data to enable better pathways.” Healthya delivers • Digital patient triage, quickly and efficiently assessing healthcare needs, resulting in earlier diagnosis and management • Patient empowerment - better options and wider access to points of self-care and selfreporting • Data driven insights to enable better resource allocation to those who need it most, first. • Collaborative working with the wider Health Economy – pharmacies, retail and CVS’s Contact Information

dr.ahmed@addvantage-technologies.co.uk www.healthya.co.uk

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The role of the patient in population health management The patient has a vital role to play in future population health management, says Sally Rennison, Chief Commercial Officer at Patients Know Best

oday, 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 difficult 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. Patient engagement and trust Health records are naturally sensitive material. Patients have a right to know who has access to them, as often 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

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POPULATION HEALTH Patients Know Best

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”

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 off 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. Sickness to wellness 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

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. Contact Information

www.patientsknowbest.com

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Waiting for the future to arrive 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

he ever-evolving nature of healthcare makes it extremely difficult 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, Vancouver Canada,

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 after 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

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INFRASTRUCTURE Arcadis Group

Phi Kim Ho Arcadis Director and Senior Practice Lead, Vancouver Canada Arcadis Group

“To create a fully functional service we have to break down the problems of interoperability between the cities and the health authorities” 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 affect bed occupancy and can slow down discharge and admission,” he says. Bringing hospitals up to date

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

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 effectively 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 81

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influence and input and see if there is a technology solution or innovation that we can apply to streamline things.” Business drivers 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 different market or resource pool that wasn’t previously available.” There are also issues around segregation of responsibilities, particularly in the healthcare sector.

Phi Kim Ho Arcadis Director and Senior Practice Lead, Vancouver Canada Arcadis Group

“We’re treating the patient experience like a customer experience”

Different departments require different 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.”

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INFRASTRUCTURE Arcadis Group

The future of hospitals 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 different 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 sufficiently 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 effectively while preparing for the metaverse to arrive. Contact Information

www.arcadis.com

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NEOM – Reimagining the future of health

Line will also deliver cutting edge healthcare efficiently to its citizens by focussing on wellness alongside illness.

In an exclusive interview, Dr Mahmoud Alyamany, Sector Head Health & Wellbeing, tells Healthcare World MD Steve Gardner and Editorial Director Sarah Cartledge how NEOM’s vision will change the way healthcare is viewed

NEOM’s vision encompasses all aspects of health, from nutrition to exercise to self-monitoring. It places great emphasis on education, helping individuals to help themselves. “Our aim is to enable people live longer. By integrating health into our daily lives, we can achieve our goal. Then we can look at preventing the conditions that lead to diseases, rather than fixing diseases when it’s too late,” Dr Alyamany says. “This approach will allow us to design healthcare for individuals rather than having a system that is population-based.” The UAE already has a genomic programme to identify diseases specific to its population, and this type of programme is becoming part of the strategy of healthcare systems globally. In a new region such as NEOM, it has the potential to be incorporated with other information to create the digital twin of each citizen and even overlay AI to see which diseases they may suffer from in the future.

audi Arabia’s healthcare transformation plans are underpinned by the need to deliver modern, efficient medical provision for more than 37m people. The Kingdom is also reimagining healthcare in its new region NEOM in the north-west province that borders the Red Sea on its western side. NEOM currently consists of four main regions: Oxagon, a half-floating industrial city and complete industrial ecosystem that enhances the sustainability of NEOM, the mountainous region of Trojena where the 2029 Asian Winter Games will be held, Sindalah, a golf island resort and an exclusive and glamorous destination in the Red Sea for the world’s yachting

community, and most significantly The Line, an 170km linear city stretching from west to east across the region. The overarching vision is for sustainable liveability in NEOM’s 26,500 square miles, powered by wind, solar and hydrogen. Its 9 million inhabitants will live in just 5 per cent of the land mass, leaving the remaining 95 per cent to be rewilded and reinhabited by former species, flora and fauna. For Dr Mahmoud Alyamany, Sector Head Health & Wellbeing, NEOM is building a relationship with nature that will teach the world how to eliminate the use of carbon. Designed to reach all essential amenities within five-minute walking distances, The

Preventing illness

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HEALTH SYSTEMS NEOM

Dr Mahmoud Alyamany Sector Head Health, Wellbeing & Biotech NEOM

“Our aim is to enable people live longer. By integrating health into our daily lives, we can achieve our goal”

The digital twin will make it much easier to treat symptoms - remedies and procedures can be run through the digital twin to see if they will be successful, rather than burdening the patient. With such ideas as part of the new global thinking for health and healthcare, Dr Alyamany’s vision is to design means and methods to prevent diseases occurring. As data becomes more and more part of the global healthcare methodology, innovation will rely on quality data. Since the emergence of COVID-19, patients are more accustomed to sharing their data with medical practitioners and, as they do so, the future of medicine will become more effective. Dr Alyamany is confident that people will indeed share once they realise the huge benefits the data will bring them, particularly around real time assessments and updates. He suggests that, for someone who is at risk of burnout, the system might even prompt a holiday in the mountains or by the beach. For those who choose to opt out or for those whom the prevention treatment has failed, the healthcare system will step in once they become sick.

Delivering health and care As a new region, it’s difficult to predict population but the total number is expected to reach 9m eventually. Each primary care clinic will refer to one urgent or advanced healthcare clinic and a community hospital. “Further to this, we are enhancing primary care physicians in specific specialties, which is another unique approach,” Dr Alyamany says. “The emphasis with primary care is on the holistic treatment of the patient, referring back to the family physician once secondary or acute care has

taken place. This management is particularly important in referrals, where a patient who is seen for one issue may end up being treated for several conditions without being reviewed as a whole.” Artificial Intelligence can also be used to develop prevention of conditions for the family physician. Cardiac problems particularly can be highlighted and suggestions to prevent the emergence of heart disease made in a timely manner. Each individual would be able to put in their preferences for food and exercise, and their condition would be monitored to keep them as healthy as possible for as long as possible. “Instead of waiting for the disease to occur, we would be able to prevent it from occurring,” Dr Alyamany says. In a similar manner, mental health provision would be delivered via primary care specialists or mental health specialists that do not sit under hospital auspices. These physicians would be able to treat or refer their patients without the label of psychiatrist, bringing mental health into the mainstream and encompassing mental health as part of overall health. The patient would be able to choose whether to be treated online or in person, and even choose a location such as a park or a café. As the population grows, so the number of hospitals will increase. There will also be specialist hospitals in areas including oncology, cardiology, advanced neural procedures, diabetes and metabolic disorders, musculoskeletal including degenerative and congenital diseases, and advancements in preventative medicine. Contact Information

www.neom.com

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Delivering health and wellbeing Reconfiguring healthcare will transform the way services deliver outcomes, says Brian Niven, Technical Principal, Health at Mott MacDonald

henever he is asked about reconfiguring healthcare, Brian Niven finds it difficult to give a simple answer. Unsurprisingly, as healthcare is far from straightforward. But in his experience, he is convinced that rethinking and reorganising the delivery of services differently is key to more successful outcomes. Alongside this, he has come to understand that healthcare cannot exist in isolation from the rest of civil or social infrastructure. In today’s world everything is interlinked, and healthcare is no exception. “Over time I’ve been involved in supporting a number of major large scale acute service reconfiguration programmes largely as a consequence of changes and challenges in the medical workforce. These have logically led to the need for greater centralisation of more specialist services. I have undertaken them from a healthcare planning perspective, but also from an impact assessment perspective – assessing how reconfiguration proposals for the centralisation of services affect different population cohorts of society in terms of access and outcomes to services” he says. As global engineering, development and management consultants, Mott MacDonald’s reach is vast. Its teams bring together wide expertise to create a vision for the future, and healthcare is no exception. Brian and his colleagues examine workforce, models of care, service pathways and systems to create new and innovative ways of tackling seemingly insurmountable problems. And healthcare appears to be one huge mountain to climb. Across the globe, within many well-established and developed healthcare systems, challenges such as outdated and no longer fit-for-purpose facilities, declining workforce, recruitment

challenges and lack of embedding technology are just some of the issues. In particular, the rapid advancements in technology are difficult for many developed and entrenched healthcare systems to adapt to quickly. Unsurprisingly, Brian and

many others are looking in admiration at the opportunities that Saudi Arabia’s Vision 2030 presents. Aiming to take the learnings from other systems and rethinking approaches to healthcare, Vision 2030 aims to drive innovation in healthcare delivery. Redesigning the future

Brian Niven Technical Principal, Health Mott MacDonald

“We are likely to see a greater distinction in service delivery between ambulatory/planned care and emergency care”

It’s obvious that hospitals will have to adapt to advancements in medicine, emerging evidence of improved clinical outcomes, and the use of technologies, and Brian is an advocate for change. In his opinion, acute care will continue to respond to these advances and our knowledge will also evolve. “Take, for example, the way in which medical training is provided. What was once considered general surgery will no longer exist in the future as more sub-specialisation

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CONSULTANCY MOTT MACDONALD

continues to evolve in areas including breast surgery, colon surgery, and vascular surgery,” he says. “This, in turn, presents its own challenges. Improvements in outcomes with a more sub-specialised workforce will only be achieved if the delivery of these services to patients reaches critical mass. For highly specialised facilities to work, you need to ensure that the right patients, and the right amount of these patients, are treated by the facility. This necessitates the consolidation and centralisation of these types of facilities into fewer, but larger centres of excellence, enabling specialists to use their skillset to the fullest potential, and patients to receive the highest level of care. However, through digital advancements, better health promotion and changes in the way in which we provide ambulatory care, more can be done locally.”

This development begins to question the model of a district general hospital that is the backbone of many developed healthcare systems. These facilities have traditionally provided the full range of emergency, acute and ambulatory care services. “However, if we have a greater consolidation of centres of excellence, and the ability to provide more ambulatory care services differently and more locally for patients, then what is the role of the district general hospital?” he asks. “Should we be aiming for a new model of frontline emergency and acute care centres? If so, we are likely to see a greater distinction in service delivery between ambulatory/ planned care and emergency care.” In his opinion, while there will be a natural evolution in the provision of acute care services in the future, reconfiguration should be considered from a wider planning

perspective. “We need to focus not so much on healthcare reconfiguration but on wider systems reconfiguration that has population health and wellbeing at its centre. Healthcare reconfiguration should then be the response.” However, he does acknowledge the challenges in this. “With so much investment tied up in different parts of the healthcare sector, it’s been difficult to make muchneeded changes elsewhere,” he observes. “Despite this, we cannot continue to think and plan in the way that we have done in the past; typically, with a focus on acute care and designing and implementing service improvement around hospital care settings. We need to think about health and care as part of a much wider system and take full advantage of promoting health and wellbeing if we are to ensure 87

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sustainability of healthcare services for a growing and ageing population. We need to promote the conversation around truesystems-led approaches that go far beyond traditional health and care. “Within our Water and Environment Division at Mott MacDonald, I have started to be part of some interesting discussions. There, they are working with clients on a systems approach, which focuses on the inter-relationships and inter-dependencies between water utility companies, environmental agencies, agriculture and farming, and food production and its supply chain. Throw health and wellbeing into that mix and you begin to have some interesting discussions about how to identify the impact that service developments and changes in one sector may have on another, whether that is a positive or negative impact. Ultimately, the aim is to develop a roadmap and practical steps to deliver the best outcomes across all these sectors in future.” “It is well documented that the social determinants of health for 80 per cent of a person’s health and only 20 per cent relates to access to health care. But when considering the health and care needs of a population, as professionals we tend to focus on the 20 per cent rather than engaging with the other 80 per cent. We need to be having more conversations across a wider array of sectors so we can better understand the broader impact of developments in other sectors on the health and wellbeing of the population. Through discussion and negotiations, we can begin to influence and shape wider decision making to achieve the best outcomes across all sectors.” However, he feels the conversation is too often big for people to quite get their heads around, particularly given the operational pressures and challenges that many of our health and care services are under. “That’s the difficulty,” he says. While accepting that our health and care system is under strain, as a sector we need to better promote the longer-term health and wellbeing vision. We need to understand the impact that other sectors may have and help them plan for the future. If we have these key conversations and engagements now, even on a small scale, then we are beginning to put things into motion and it’s a win-win across sectors. It may not get us quite where we need to be, but we will be on the path to making wider system changes which, over the course of a generation, will have a far greater impact on the population and its health.”

Pandemic lessons Mott MacDonald was involved heavily in pandemic activities, delivering the Nightingale hospitals in the UK in record time. They also had the opportunity to evaluate the public health functions of local authorities through the pandemic and to assess the impact their additional investments decisions had on local populations. “It was really encouraging to hear local stories,” Brian says. “There was an overwhelmingly positive response

around the integration with other sectors and, in particular, with the third sector. This investment supported them to pull together their resources and work differently, work differently with a positive reponse to the lives and wellbeing of the local populations that they served. The biggest fear was losing that legacy when the funding ended.” For Brian, this united sense of purpose is the way forward. “We need to focus on health and wellbeing and have a defined statement about our goal. Making that change into

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CONSULTANCY MOTT MACDONALD

Brian Niven Technical Principal, Health Mott MacDonald

“We need to promote the conversation around truesystems-led approaches that go far beyond traditional health and care”

the systems level will only happen through better integration and collaboration across organisations and agencies. The voluntary sector organisations have a huge role to play in our systems thinking approach to health and wellbeing.” So is the answer preventative medicine? He thinks it is. “We talk about it, but it never really materialises in terms of a big push. There has to be an acceptance that you’re not going to get an outcome overnight. This is a generational thing. We need to plan more

strategically over the longer term supported through investment decisions across the whole social infrastructure system that has a focus on improved health and wellbeing for all.” Contact Information

www.mottmac.com brian.niven@mottmac.com

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Resolving the issues facing health and care globally Delivering the highest quality medical care at the lowest operational costs requires innovative approaches, Patrick Power, MD PowerHealth tells Healthcare World

s the global healthcare sector moves towards value-based healthcare, it’s becoming harder to predict future needs, particularly financially. Many, if not most, healthcare systems are insurance-based models, often requiring complex budgeting, analytics and benchmarking. A successful strategy that balances patient safety with patient costing is the way forward, but it can often be fraught with unseen complications. Australian group PowerHealth has been tackling such issues for more than 27 years under the auspices of MD Patrick Power. They specialise in activity-based costing, hospital

billing, healthcare budgeting, analytics and benchmarking, revenue cycle management and AR-DRG classification solutions. “At PowerHealth, we are known for our deep expertise in healthcare costing and funding, niche areas that are enormously complex that have enabled us to apply our innovative approach to problem solving and helping our clients prepare and cater for their future needs in the health industry,” Patrick says. “We are leaders in our field and are at the forefront of medical software technology. From this foundation, and with the understanding,

experience and knowledge of our team, we safely predict future needs and position our technology to deliver further innovation.” PowerHealth’s technology has been adopted by healthcare organisations globally in Australia, New Zealand, United States, Canada, United Kingdom, Ireland, Hong Kong, Asia and the Middle East. It is also part of Telstra, a $22 billion global telecoms company that enables them to add solutions in acute care, aged care, primary care, virtual care and pharmacy to their core offerings of patient level costing and revenue cycle management. The company has also recently implemented its RCM project in Bahrain. “Similar to our KSA national rollout and our Quebec provincial deployment, we established and trained a local team from scratch and delivered a successful RCM project on time and on budget. I met with our Bahrain client this week and they are super happy with the

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HEALTH SYSTEMS PowerHealth

Patrick Power Managing Director PowerHealth

“We have three goals in Australian healthcare - equity, efficiency and quality”

delivery. We’ve also had the Hong Kong hospital authority as an RCM client for a dozen years or so at least, and they just renewed their contract with us for another five years. That says a lot. We focus on fixing issues as they arise, rather than placing blame, and that’s why we’re so successful. “I believe business models have to be all encompassing and every project starts with being on site. We focus on successful and rapid deployments that are on budget and on time. We discourage staff from using the dreaded words ‘project delay’ and instead teach them to use their extensive experience to look for solutions that are outside the box to ensure timely delivery of every project, as stakeholders lose confidence in projects that are incessantly delayed.” Ambitious goals PowerHealth are now bringing their expertise to 291 hospitals in Saudi Arabia.

“I like to go to places that are different and challenging, where I can add value,” says Patrick who sees many similarities between Australia and Saudi Arabia. “Australia is a large landmass with a few big cities where everybody lives, but healthcare services have to be delivered across large rural and remote areas as well. So Saudi resembles Australia in this sense. We have three goals in Australian healthcare - equity, efficiency and quality. The right care at the right time, in the right place by the right person for everyone. Australia has a lot to offer the Kingdom, especially as we are undertaking a lot of virtual care in Australia. “KSA is behind Australia on costing and payment information. Australia adopted Casemix in 1994 but KSA have ambitious goals, especially around capitation where providers are paid a set amount per enrolled patients. It’s a difficult model to implement anywhere in the world and it requires a lot of robust data to understand how to successfully achieve this, so the various current initiatives need to be better

coordinated internally and aligned to make it happen, as 2030 is rapidly approaching. “For national programmes, it’s important in my view to drive everything centrally. I’ve never understood in the UK for example, why procurement is left to the Trusts to figure out on their own. To add the most value in KSA, I would suggest that at least half the budget in any procurement should go for the 5-10 year ongoings, that is staff for data entry, audit and vendor support, as well as ongoing enhancements to ensure the application’s usefulness is improving every year. But that isn’t possible without budget and long term vision. I have seen organisation’s procure sophisticated software without the resources to input the data needed to get the value out of it, so this should be a focus.” Recently PowerHealth created a joint venture with Telstra, an Australian telco with a small presence in the UK. “We’re a medium-sized company and, as the complexities associated with infrastructure, hosting and cybersecurity become ever more complex, having a large telco as a partner who can take care of those areas is definitely a path to future success,” Patrick says. “They have some fabulous products their EMR was rated second in APAC in the KLAS survey. More than 43,000 patients have been supported through their virtual care software which is equivalent to eliminating a 600 bed hospital in terms of volume. We can bring that critical experience to our customers in the GCC and the rest of the world. Being able to offer more value to existing customers is critical for us.” Contact Information

www.powerhealthsolutions.com

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Healthcare World is the world’s leading magazine for the business of healthcare, but we’re also far more than that. 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.

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RECRUITMENT AppLocum

insights and tech-enabled operational efficiencies in how healthcare organisations can manage their clinical workforce. This comprehensive solution includes:

Delivering at-scale recruitment through innovative digital solutions Digital Workforce Management should do more than ‘just’ enhance operational and cost efficiency, says AppLocum founder Dr Suhel Ahmed

espite the fact that healthcare innovation is advancing rapidly, workforce issues continue to create problems. In addition, particularly for the UK, attractive overseas salaries and working conditions are seeing many young professionals leave once they have trained. In primary care, many GPs are not returning to the surgery after working from home during COVID as they are reluctant to change a convenient working arrangement. It’s not a new theme for healthcare entrepreneur and practising GP Dr Suhel Ahmed who founded ADDVantage Technologies, a healthcare software development and consultancy firm with a track record of delivering innovative, NHSapproved technology solutions. “I implicitly understand the need of fellow clinicians, and AppLocum was born out of the need to offer the clinical workforce more than just a job-board,” explains Suhel. For him, the post-pandemic management of the clinical workforce needs to be drastically different, and Digital Workforce Management must extend its scope beyond mere operational and cost efficiency enhancement. “Workforce management to be done at-scale should include vital technological features that cater to pastoral

support, education and e-learning, peer-topeer support, and clinician engagement,” he says. “Beyond enhancing efficiency, the focus should be on prioritising the well-being and professional development of our workforce, cultivating a supportive environment that fosters continuous learning, collaboration, and overall clinician satisfaction.” To achieve this, a collaborative, ongoing co-development approach involving all stakeholders is essential. Such an approach not only optimises operations and costs across an organisation but also significantly enhances the ability to recruit, engage, and retain the best clinical workforce. Driving productivity and efficiency AppLocum’s tech-enabled digital workforce management solution was collaboratively developed in partnership with key stakeholders across various healthcare providers while simultaneously providing a traditional managed service agency solution to them. Some more notable clients include Nuffield, BMI, BUPA, the NHS, and large super-providers across the UK. AppLocum’s digital offering is a revolutionary cloud-based clinical staffing management solution, driving data-driven

• Central Operations CRM: A powerful Customer Relationship Management (CRM) system that provides complete control, visibility, and data-driven insights into staffing status and requirements across multi-site organizations. This CRM has many tech-enabled robotic process automation (RPA) features through which repetitive manual tasks are eliminated. • Clinician App: A sophisticated application that enables digital management of compliance and credentialing (Digital Passporting), roster control solution, clock-in/ clock-out functionality, timesheet, and invoice management, e-learning, better engagement, asynchronous messaging, and peer-to-peer support. • Site-Based Web Portals: Easily accessible individual site-level web portals that offer control to site and clinic managers, allowing them to oversee and manage safe staffing levels. Having seen rapid growth of his innovation in the UK, Suhel has identified AppLocum’s digital compliance and credentialling functionality of clinical workers as a way delivering at-scale staffing into rapidly scaling healthcare economies such as Saudi Arabia. An additional 175,000 doctors, nurses and other healthcare workers will be needed in the Kingdom by 2030 to tackle shortages and meet the healthcare requirements of its growing population. “We have the technology, the know-how, and strong links across the UK, Africa and India to meet this need,” says Suhel. “Our approach is rooted in collaborative, strategic partnerships. We closely engage with our clients to customise and bring to life solutions and services that precisely align with their distinctive strategic requirements, aspirations, and roadmaps. We are excited to bring our services and solutions to the Kingdom and the region as a whole.” Contact Information

suhel@applocum.com www.applocum.com

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Opinionated

Steve Gardner Managing Director

Why Population Health isn’t working

ealthcare 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 effectively 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

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. Sourcing the data – or not 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. Often, there is a motivation to try to use the current data and start modelling based on that information this has significant limits. Until that data is of sufficient 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.

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 often there is no real reason for them to share data with a third-party in the first place. Effectively, there has to be the right incentive for the public to share their health data. Health data is very different to the information which is often 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. Different health Trusts, hospitals, and primary care providers use a vast array of different 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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