Healthcare World Magazine | Issue Twelve 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 Twelve | January 2024

REINVENTING THE FUTURE OF HEALTHCARE

SCREENING FOR POPULATION HEALTH | MEDICAL TOURISM DUBAI | MENTAL HEALTH | SUSTAINABILITY IN HEALTHCARE

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INFO@THINKBRG.COM |

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EDITOR’S WELCOME

WELCOME TO HEALTHCARE WORLD

elcome again to another Arab Health, and another edition of Healthcare World. It’s difficult to believe that we are back in Dubai again, but then so much has happened. Not just in healthcare but across the world. So how can we all maximise our time at Arab Health to ensure that our meetings, conversations, discussions and events create the future of healthcare that we all deserve? Clearly, we need to harness the realities of artificial intelligence or AI, as it’s now a part of our everyday lives. The healthcare sector has already benefitted from the huge leap in digital capability, utilising it everywhere from patient-focussed apps such as Patients Know Best to managing and treating conditions like ADHD 360. Jonas Muff at Vara is incorporating AI into routine breast screenings to detect infinitesimal cell changes before they become cancerous. Read his trajectory in Meet the CEO on pages 11-14 and find out more about population health screening in our Deep Dive on pages 46-51. Linked to this, in Talking Point I examine the issues surrounding women’s health in today’s world and herald a new initiative - Redesigning Healthcare with Women in Mind – at the World Economic Forum in Davos. Oskari Eskola, CEO of patient engagement platform BeeHealthy, tells us how their one stop solution is the perfect front door to digital health services. Dr Umar Naeem Ahmad, CEO of Abtrace, thinks healthcare transformation will depend on better use of clinical data, leading to healthier patients, happier clinicians and reduced health costs. Elsewhere in the magazine you can read how health partnerships are the way forward - Bevan Brittan’s Vincent Buscemi and Jodie Sinclair consider that connecting minds is the key to transformation in healthcare for the future. You’ll be pleased to hear that Healthcare World has a much greater presence at Arab Health this year. You’ll find us in the Smart Hospitals Zone on Monday

SARAH CARTLEDGE EDITORIAL DIRECTOR

29th January where Managing Director Steve Gardner is chairing a panel on Environmental Sustainability in Middle East Healthcare. This is followed by Clinical Benchmarking and Data, and then The Healthcare Data Continuum from Population to Precision chaired by Simon Swift. The final session of the day is The NHS of the Future. On Wednesday we present the Healthcare World Stage, a full day of panellists and speakers who are partners and friends of Healthcare World, and chaired by Steve Gardner and our CEO Emma Sheldon MBE. We kick off with an update of the Dubai Health Authority Investment Guide, spotlighting areas of development in the Dubai Health Economy and the Government of Dubai’s plans to grow the health economy of the Emirate in the coming years. You can also read about the Guide on pages 70-72. The session on the Healthcare Strategy at NEOM features a Q+A with a panel of senior managers from the health and wellness division of the new city in Saudi Arabia, some 9m people alongside industrial leisure and tourism on a unique scale, in a sustainable, eco-friendly eco-system and with a healthcare delivery strategy which will define the next 100 years. How to Effectively Launch Value-Based Healthcare Initiatives in the Middle East, Public Health in the Middle East and Mental Health in the Middle East are the afternoon sessions, rounding up the day’s comprehensive look at current issues in the region’s sector. Last but not least, Steve Gardner asks if sustainability is just part of a bigger healthcare conundrum. For Bjorn Almér of Skane Care Central co-ordination for sustainability in healthcare is not just vital; it saves lives, while Rebecca Stubbs, Principal Net Zero Carbon Consultant Mott MacDonald, tells us about the NHS road to Net Zero. It’s a complicated world out there, but the breadth and depth of experience among the attendees at Arab Health guarantees that solutions will be found to simplify the patient experience to improve outcomes and save lives.

THE HEALTHCARE WORLD TEAM EMMA SHELDON MBE CEO

STEVE GARDNER Managing Director

ANDREW GOLDSMITH Finance Director

SARAH CARTLEDGE Editorial Director

RITU CHOPRA COO

JOE EVERLEY Art Director

ALISON CARMICHAEL Operations Executive

SIMON SWIFT Data Correspondent

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CONTENTS

Healthcare World Magazine | Issue Twelve

News

Meet the CEO – Jonas Muff CEO of Vara

Reimagining the future of healthcare

Dr Mahmoud Alyamany tells Steve Gardner and Sarah Cartledge how NEOM’s futuristic vision will change healthcare delivery Getting the basics right will support the transformation of healthcare, say Dr Hasham Khan, Partner and Dr Urooj Khan, Family Medicine Consultant Linea Healthcare

Spotlight on Dr Ibtesam Al Bastaki - Leading from the front

Maintaining the highest trust in doctors

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

Empowering healthcare leaders with data, context and action

Health systems struggle to understand where to focus when addressing financial and operational challenges, says Julie Coope of BRG

Truly personalised care

Digital solutions with access to medical records can play a vital role in the transition to a sustainable healthcare system, says Patients Know Best’s Chief Commercial Officer Sally Rennison

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

Connecting minds: transforming healthcare for the future

Dr Ibtesam al Bastaki, Director of Healthcare Investment and PPP projects at DHA, speaks to HW Editor Sarah Cartledge about her role and her plans for the future

Fuelling the ambitions of GCC healthcare

The synergy between minds, communities, and evolving technologies plays a pivotal role in shaping the future of health and care, say Vincent Buscemi and Jodie Sinclair, Partners at Bevan Brittan LLP

Deep Dive - Harnessing AI in screening

Incorporating AI into national breast cancer screening programmes will significantly reduce mortality, says Egbert Schillings, Chief Commercial Officer, Vara

Deep Dive - Screening for population health

Early detection is key to optimum health outcomes according to Paul Roberts, Head of Service for the Cervical Screening Administration Service for North of England Care System Support

Designing the digital hospital

Digital healthcare is a catalyst for Human-Centred Design, says Con McGarry, Senior Consultant Digital Healthcare, Arcadis

Building net zero

Travelling for healthcare – Destination Dubai

Healthcare World Editor Sarah Cartledge speaks to Rebecca Stubbs, Principal Net Zero Carbon Consultant Mott MacDonald, about the NHS road to Net Zero

The post-COVID growth in medical tourism in Dubai is thanks to a perfect alignment of factors, says Mansoor Ahmed – Executive Director (Middle East & Africa) at Colliers

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70 74

Meet The Expert – Where the Mind Meets the Brain

Sotiris Posporelis, Consultant Liaison Neuropsychiatrist, King’s College Hospital London, explains to HW Editor Sarah Cartledge the intricate link between the brain and the body

Dubai Investment Guide - Healthcare needs and opportunities in Dubai

Carly Caton and Gerard Hanratty, Partners, Browne Jacobson LLP ask if integrated care systems are the right approach

Morocco’s healthcare industry

Understanding ethics and patient rights in clinical trials is vital for the advancement of treatments, says Mike Failly Managing Director of Zanteris

Health Partnerships - Shaping the future of healthcare through digitising financial system The importance of a healthcare provider having the right financial and funding models in place cannot be underestimated, says Chris Norton Telstra Health’s Hospital Care Executive

Andrea Tithecott and Nesrine Roudane, Partners at Al Tamimi & Company, examine perspectives for healthcare investment in Morocco

Focus on Patient Ethics - Developing the medicines of the future

Health Partnerships - Planning the future of healthcare

Health Partnerships - Sustainability saves lives Central coordination for sustainability in healthcare is not just vital; it’s imperative for our collective future, says Bjorn Almér of Skane Care

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CONTENTS

100

Plugging the leak

104

Finding value in healthcare

ADHD360 - ADHD and emerging medical markets

106

Healthier patients, happier clinicians, and reduced health costs

Claim denials damage goes beyond finances, says Dr Mohammed Abdullah Aldar, Managing Director of ACCUMED Saudi Arabia

The Middle East stands out as a region where thinking has progressed impressively around mental ill-health, says Phil Anderton, MD of ADHD360

Healthcare transformation will depend on better use of clinical data, thinks Umar Naeem Ahmad,CEO Abtrace

healthya - Empowering patients to better understand their health

108

Talking Point

Making healthcare smarter

110

Opinionated

Dr. Suhel Ahmed outlines how the healthya solution enables the delivery of a true, data-driven Population Health Strategy

102

The issue of healthcare resources outstripping demand is a concern worldwide, say Robert McGough and Gemma Badger, Partners Hill Dickinson LLP

Oskari Eskola, CEO of BeeHealthy, shares the transformative impact the new company is having on the international healthcare landscape

Sarah Cartledge, Healthcare World Editorial Director, examines the current discussions around women’s healthcare

Is Sustainability Just Part of a Much Bigger Healthcare Conundrum? asks Steve Gardner Healthcare World Managing Director

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NEWS ARTIFICIAL INTELLIGENCE REVOLUTIONISES ANTIBIOTIC DEVELOPMENT

esearchers at MIT and McMaster University have harnessed the power of artificial intelligence (AI) to accelerate the development of new antibiotics. According to Scientific American, a ground-breaking study published in May employed an AI algorithm to identify an antibiotic effective against Acinetobacter baumannii, a highly resistant bacterium often found in healthcare settings and prevalent among military personnel in the Middle East. Antibiotic resistance or AMR poses a severe global threat, with projections of up to10m annual deaths by 2050. AI, particularly machine learning, dramatically streamlines the antibiotic development process by reducing the number of experiments and associated costs. The

AI algorithm in this study analysed 6,680 compounds in a few hours, a task requiring weeks without AI. The model identified promising candidates, leading to the discovery of a narrow-spectrum antibiotic named abaucin. Abaucin targets A. baumannii by disrupting its protective cell membrane. Tests on mice demonstrated its effectiveness against A. baumannii infections. The antibiotic also exhibited efficacy against drug-resistant strains. Jocelyn Ulrich, from Pharmaceutical Research and Manufacturers of America,

RISING MOSQUITO-BORNE INFECTIONS THREATEN EUROPE

s warmer temperatures envelop Europe, the continent faces an escalating threat from mosquitoborne infections traditionally associated

with tropical climates. The European Centre for Disease Prevention and Control (ECDC) reports a surge in diseases such as chikungunya and dengue, driven

acknowledges the potential of AI in expediting drug development but stresses the need for thorough clinical trials. Aleksandra Mojsilović, IBM Fellow, emphasises AI’s capability to predict properties of molecules, screen toxicity, and design novel molecules. In light of market challenges for antibiotic development, the PASTEUR Act, introduced in Congress, aims to incentivise and invest $6bn in antimicrobial drug development. The FDA is actively exploring the integration of AI and machine learning in the drug development process.

by favourable weather conditions for virus-spreading mosquitoes. The invasive Aedes albopictus and Aedes aegypti mosquitoes, thriving in warmer climates, have expanded their presence to 13 countries and 337 regions, according to the ECDC. Climate-related factors, including heatwaves and flooding, create conducive environments for these species, posing an increased risk of infections. ECDC Director Andrea Ammon emphasises the urgency to control mosquito populations, enhance surveillance, and enforce protective measures to mitigate the potential rise in cases and fatalities. In 2022, Europe witnessed 1,133 cases and 92 deaths from the West Nile virus, with a notable increase in locally acquired cases. The ECDC’s alert underscores the pressing need for proactive measures to combat the expanding threat of mosquitoborne diseases in the changing climate landscape.

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NEWS

MIT RESEARCHER DEVELOPS WEARABLE ULTRASOUND PATCH FOR BREAST CANCER SCREENING

anan Dağdeviren, an assistant professor at MIT’s Media Lab, has successfully developed a wearable, flexible ultrasound patch designed to revolutionise breast cancer screening. Inspired by her aunt’s aggressive breast cancer diagnosis in 2015, Dağdeviren envisioned an electronic bra with an embedded ultrasound that could provide more frequent scans to detect cancer early. After six and a half years of overcoming funding challenges and technical obstacles,

Dağdeviren’s team has created a palm-sized, honeycomb-designed ultrasound patch that fits into a bra cup, held in place by magnets. Unlike mammograms, the wearable patch conforms to the breast’s shape, capturing real-time data that can potentially be sent directly to a smartphone app. The ultrasound patch addresses the imperfections of traditional breast cancer screening methods. Mammograms, involving X-rays, are performed every two to three years and may not be as effective for women with dense breast tissue. In contrast, the ultrasound patch provides daily data points, potentially enabling earlier detection of malignant lumps. The technology has the potential to save 12m lives annually. In a proof-of-concept study published in Science Advances in July 2023 and reported by Wired, Dağdeviren’s team demonstrated the patch’s ability to spot cysts as small as 0.3 centimeters in diameter. Dağdeviren envisions the technology extending beyond

PILL ON A THREAD

ground-breaking UK clinical trial, known as BEST4, aimed at preventing oesophageal cancer through the use of a “capsule sponge,” has commenced at Addenbrooke’s Hospital in Cambridge. The BBC reports that the innovative £6.4m project is a collaborative effort between Cancer Research UK and the National Institute for Health and Care Research.

The trial’s first participant, Tim Cowper, a 49-year-old brewer from Cambridge, heralded the capsule sponge, also known as the “pill-on-a-thread,” as a welcome alternative to the uncomfortable endoscopies he previously underwent due to acid reflux. Mr. Cowper has experienced heartburn nightly since the age of 16. The capsule sponge test focuses on Barrett’s oesophagus, a precursor

breast cancer screening, applying it to monitor other parts of the human body. Dağdeviren plans to start her own company to license the technology to healthcare systems once it receives approval from the US Food and Drug Administration. She proposes to make the technology available to high-risk individuals, those with a family history of breast cancer, underserved populations, and women in less privileged countries without access to screening programmes.

condition to cancer. Patients swallow the capsule containing the sponge, which dissolves in the stomach but expands to the size of a 50p coin. The attached string allows for the careful retrieval of the sponge, collecting cells for laboratory testing. The trial’s initial phase targets individuals diagnosed with Barrett’s oesophagus, evaluating whether the test could replace endoscopies for monitoring the condition. The second stage, set for this summer, aims to recruit 120,000 individuals over 50 receiving long-term treatment for heartburn. Should the trial prove successful, the capsule sponge test could potentially evolve into a national screening programme across the NHS, mirroring the approach of mammograms for breast cancer. Professor Rebecca Fitzgerald, a key researcher at Addenbrooke’s and the University of Cambridge’s Early Cancer Institute, emphasized the potential impact of the device, suggesting it “could halve the number of deaths from oesophageal cancer every year.” 9

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CEO INTERVIEW Jonas Muff

JONAS MUFF

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REVOLUTIONISING BREAST CANCER DETECTION Jonas Muff, CEO of Vara, tells HW Editor Sarah Cartledge about Vara’s strategic approach to global breast cancer screening

n the realm of healthcare, routine screenings are commonplace, from childhood vaccinations to regular checkups. The importance of early detection cannot be overstated, and breast cancer screening, in particular, plays a crucial role in saving lives. In most national screening programmes, mammograms are reviewed by radiologists whose skill at detecting abnormalities cannot be understated. Despite this, in 2020, breast cancer became the most commonly diagnosed cancer in the world with more than 2.26m new cases and 685,000 deaths, according to WHO.

However, thanks to the advance of Artificial Intelligence, breast screening is now taking a step into the future. Jonas Muff is the CEO and founder of Vara, a breast screening platform underpinned by AI, capable of identifying cancers not visible to the human eye. The technology can detect subtle tissue changes, ensuring early detection of cancers when they are easily treatable. Breast cancer is highly influenced by genetic traits. Although there are many other contributing causes, such as alcohol and obesity, the main reason is age. Post-

menopausal women between 50 and 70 see the most incidents which is why population screening is vital to prevent late diagnosis.

Early influences

Growing up in a family of doctors in Switzerland, the impact of healthcare was deeply ingrained in Jonas’s life from an early age. Family gatherings were filled with discussions about the destinies and journeys of patients, instilling a passion for helping people during their darkest moments. But he found his route to ground-breaking innovation through finance, rather than medicine. He studied economics at a leading Swiss business school where he became president of a prestigious student club focussing on entrepreneurship and technology. A Swiss entrepreneur at a conference offered him a job at his venture incubator focussing on AI. There Jonas met

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CEO INTERVIEW Jonas Muff

A key part of Jonas’s role is strategic development, in particular early adopters. “They are the hardest to get and usually require the spirit and energy of the founder,” he considers.

Real-world evidence

Vara’s strategic approach sets it apart in the competitive landscape. Jonas emphasises the company’s commitment to real-world evidence and, recognising the importance of proving clinical and scientific merits, has conducted several peer-reviewed large-scale studies in Germany, most recently, the largest ever

JONAS MUFF CEO Vara

“Our goal is to empower the field so that radiologists can do more”

his co-founder Stefan Bunk, now CTO of Vara, and together they decided to concentrate on breast cancer screening to prevent cancers from being detected too late. “The solution to finding cancers early is to harness large scale nationwide programmes and link them to AI,” Muff says. “Applying AI to significantly help radiologists find many more cancers much earlier and more efficiently is fascinating because it ultimately leads to more cancers being treated with a 97 per cent probability of success.” With immediate access to some of the world’s best technical talent, Jonas and Stefan decided to call their company Vara, which refers to a most cherished granting of a blessing in Sanskrit. “We liked it because that’s ultimately what we want to bring to the world’s population,” says Jonas who oversees commercial development, business strategy, fundraising, and regulatory aspects.

prospective study on AI in breast cancer screening , comprising more than half a million women from the German National Breast Cancer Screening Programme. Once published later this year, the results will serve as a further proof point of the product’s impressive performance in real and very diverse clinical settings. “We’ve always been very focussed on developing large scale evidence, population wide evidence,” he says. “And the only way to do that as a small start-up is real evidence and we’re very proud of being pioneers in that regard. “As breast cancer is very much linked to age, asymptomatic breast cancer screening for women without any symptoms and without any family predisposition is usually only advised after 40 in some countries and in Germany only after 50. But there are differences in populations as well. Young Saudi women, for example, have a high prevalence of breast cancer which as yet is not understood. “For this reason, we need to make sure that we build technology in a way that generalises across populations. And then we need to build the tools and the processes and the evidence generation capabilities that help us monitor what our AI does in clinical routine.”

Software success

The Vara platform takes a comprehensive approach to screening programmes, one that not only embraces AI but also prioritises efficient use of existing resources, and patient navigation. Streamlining the patient journey from awareness to invitation, scan and detection to treatment is essential to ensure timely interventions. Radiologists find their work supported by a unique workflow solution . Unlike conventional AI plug-ins, Vara was designed as a virtual layer tailored to existing workflows, enhancing the capabilities of radiologists rather than replacing them. The modular integration approach allows Vara to adapt to different market dynamics and varying radiologist workloads. “When we launched there was a general feeling that our solution would replace radiologists,” Jonas says. “But the problem we are trying to solve is the shortage of radiologists. Our goal is to empower the field so that radiologists can do more. We need to give them the tools to maximise their precious time rather than build the technology to replace them. Stefan is a clinician radiologist and still works as a clinician so as not to lose touch with his colleagues. And he’s been really the heart and soul of the of the product.” Vara’s software enables radiology clinics and departments to make better use of their existing mammography scanners to provide high-quality and reliable breast cancer screening at much lower costs. An integrated specialised viewer allows a radiologist working with the Vara interface to use the Vara software from any of their workstations. In this way, the AI is designed for the workflow, rather than the other way around. “This factor contributed significantly to the important success in Germany, where more than 100,000 mammograms are undertaken every month. We never try to integrate AI as a plug into encrypted legacy software that is not ready for AI,” says Jonas. The commitment to extensive research and evidence-backed solutions has become crucial in gaining credibility and fostering collaborations with healthcare systems globally. “We always have to be quite modular in the way we integrate into existing workflows,” he continues.

Navigating global partnerships

Jonas is acutely aware that breast cancer detection in emerging economies present different problems. In many countries 13

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organised national screening programmes don’t exist yet, leading Vara to enter into partnerships that include education – promoting the importance of screening to the population. India, for example, offers both a substantial opportunity to reinvent healthcare delivery and a chance to make a significant impact. Vara’s collaborative efforts extend beyond engaging with radiologists as customers, emphasising partnerships with health systems, payors, civil society and various stakeholders to develop screening programmes tailored to each market. “We engage with NGOs, government bodies, private institutions and academic institutions to really move the dial on breast cancer and early detection, which ultimately is a population health interest. In order to move and pull the levers, you have to immerse yourself in the ecosystem holistically,” he says. The company works with the payor systems, both public and private. “We develop a screening programme for those health systems and payors with a

configured booking platform for companies so, for example, employees of a certain age can book screening directly. It’s also our responsibility to help women after they’ve been screened in case they need a biopsy, so our health navigators help them get the subsequent intervention.” After Germany and India, Vara has also made inroads into Mexico and Egypt. For Jonas, Egypt’s strong historical presence in public health initiatives and its potential to act as a gateway to North Africa and the larger Arab-speaking world makes it an important market. “Egypt has almost eradicated Hepatitis C in a national campaign, so they know how to orchestrate on a huge scale,” he says. “This is really important for us as we need to unleash our full potential on existing infrastructure, public health mindsets and behaviours.”

Future successes

In 2022 Vara raised 4.4m USD in its Series A extension funding, and this will enable the company to expand further. “Ultimately, we are a public health company and

breast cancer screening is usually run at a national or state level. The business will grow if we succeed getting into large scale health systems and payor systems that have a population health interest as well.” For Jonas the ultimate vision is to find every breast cancer early. “This is genuinely possible with the technology we have built,” he states. “Obviously, we cannot do this alone as there is a whole breast cancer control ecosystem in existence, but it would bring breast cancer-related deaths to almost zero. It would also minimise chemotherapies and the terrible invasive interventions that are currently utilised. That is why we ventured into this domain particularly and then we will potentially focus on other cancer types.” CONTACT INFORMATION

www.vara.ai

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NEOM – REIMAGINING THE FUTURE OF HEALTH 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

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.

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HEALTH SYSTEMS NEOM

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

Preventing illness NEOM’s vision encompasses all aspects of health, from nutrition to exercise to selfmonitoring. 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. 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. 17

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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”

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.”

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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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FUELLING THE AMBITIONS OF GCC HEALTHCARE Getting the basics right will support the transformation of healthcare, say Dr Hasham Khan, Partner and Dr Urooj Khan, Family Medicine Consultant Linea Healthcare

he healthcare sector in the Gulf Cooperation Council (GCC) countries, comprising diverse nations with varying economic development, faces various challenges, despite substantial investments in recent decades. While advancements in medical technology and facilities have occurred,

issues such as ageing infrastructure, inadequate resources, insufficient funding, workforce challenges, and disparities in healthcare accessibility persist. The COVID-19 pandemic has underscored the importance of capacity building, infrastructure upgrades, and workforce enhancement.

GCC health system transformation

The GCC healthcare sector is undergoing a transformative journey marked by substantial growth in the last five years. The region grapples with providing high-quality, accessible, and affordable healthcare to a growing population with diverse needs. Initiatives include adopting new technologies, transforming health systems to address rising costs, workforce issues, value-based healthcare, and prioritising patient-centricity. The transformation journey involves shifting from hospital-centric to patientcentred care systems, emphasising modernisation and digitalisation. Population Health Management (PHM), utilising patient data, a commitment to personalised

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HEALTH SYSTEMS Linea

Personalised and precision medicine is an emerging practice using an individual’s genetic profile to guide decisions regarding the prevention, diagnoses, and treatment of diseases. This knowledge of the individual’s genotype helps care planners and frontline clinicians provide advanced diagnosis, treatment options and personalised preventive programmes tailored to genetics, while predicting and preventing future genetic diseases and implementing new therapies for rare and chronic diseases.

DR HASHAM KHAN Partner Linea

“The era of Sharing Medicine emphasises empathic care, acknowledging the active role patients play in understanding their conditions”

GCC authorities use genomic data to develop healthcare strategies that address population needs and support preventive medicine advancement. Personalised medicine is advancing through the Human Genome Programmes, which use genomic data to improve population health. Such programmes invite citizens to partake by providing a single blood sample which is profiled to determine the gene sequencing to prevent and treat chronic diseases.

Patient engagement and activation and eventually precision medicine are integral components. The corporatisation of healthcare entities, private sector participation, and the establishment of accountable care organisations aim to improve public sector finances and enhance healthcare. Entities such as Value in Care and Academic Health Councils, along with a national payer and regulator for universal health insurance, play roles in shaping the evolving healthcare landscape. The oncedominant Health Ministries are evolving into regulators. Addressing the connections between climate change and health is a priority, as declared in the UN Climate Change Conference.

Population health management for patient-centred care

PHM improves clinical outcomes through care coordination and patient engagement. Patient-Centred Care or PCC involves collaborative planning with individuals to meet their unique needs, emphasising fairness and avoiding harmful treatment. The emergence of personalised and precision medicine, utilising genomic data, contributes to developing healthcare strategies tailored to the population’s specific needs. PCC involves working together to plan care and support to meet unique needs. The individual is put at the centre, able to choose and control their care provision.

Patient activation reflects a changing doctor-patient relationship. The era of Sharing Medicine emphasises empathic care, acknowledging the active role patients play in understanding their conditions. The future of primary care in the GCC is crucial, necessitating increased investment in infrastructure and workforce development to address access issues and improve overall health outcomes.

Future of primary care in the GCC

Most GCC health systems are dependent on expatriate doctors for medical services. Limited resources and infrastructure have impacted the overall system because of a lack of access, delayed diagnosis, and mismanagement. Thus, in most 23

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countries, satisfaction with primary care services has been low. With poor access to primary care facilities and a lack of gatekeeping, hospital utilisation continues to be very high. A third of emergency room service utilisation could be avoided with better and earlier diagnosis within primary care. Up to two thirds of inpatient admissions are for treatment of chronic conditions rather than surgical procedures, leading to long in-hospital stays, impacting utilisation of resources and health outcomes. A significant proportion of the healthcare expenditure in the region is spent in secondary and tertiary care hospitals, thereby aggravating, and leaving unaddressed issues related to primary care, extended care, home care, and other clinical services. Health systems must commit to increased investment in primary

DR UROOJ KHAN Family Medicine Consultant Linea

“Health systems must commit to increased investment in primary care”

care both in terms of infrastructure development for fit for purpose health centres, and workforce development leading to a responsible, highly skilled, trained, and adaptable workforce capable of patient empathy and understanding future needs.

Determining the future of clinicians in modern and futuristic GCC health systems

The evolution of GCC health systems reflects a shift in power from clinicians to patients. Empathy remains essential as technology, including AI and cognitive computing, influence healthcare delivery. Disruptive technologies such as ChatGPT and other language models are impacting specialties such as pathology and radiology. Despite challenges such as high dependency on imports, climate change impacts, and the potential costs of pandemics, the GCC healthcare sector’s transformation, disruptive technologies, and novel approaches offer glimpses of a future where infectious diseases and lifestyle-related disorders are addressed effectively. Policymakers and healthcare leaders must establish a firm foundation for modernisation to achieve world-class healthcare systems.

How we can help

Business improvement specialists, such as Linea, play a pivotal role in supporting the dynamic and rapidly evolving healthcare sector in the GCC. As the healthcare landscape undergoes transformative changes, we utilise our extensive expertise and specialised knowledge to assist GCC healthcare entities in optimising operational efficiency, implementing innovative technologies, and navigating complex regulatory frameworks. In addition, we provide strategic guidance on adapting to new healthcare models, improving patient outcomes, and enhancing overall organisational resilience. Additionally, we provide insights into data analytics, helping healthcare providers harness the power of information to make informed decisions, optimise resource allocation, and improve patient care. In leveraging our expertise, the healthcare sector in the GCC can navigate the challenges of change effectively, ensuring sustainable growth in an era of transformation. CONTACT INFORMATION

info@linea.net www.linea.net

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19/01/2024 20:27 18:45 17/01/2022

CONNECTING MINDS: TRANSFORMING HEALTHCARE FOR THE FUTURE The synergy between minds, communities, and evolving technologies plays a pivotal role in shaping the future of health and care, say Vincent Buscemi and Jodie Sinclair, Partners at Bevan Brittan LLP

he future of health and care can often appear confusing. The plethora of digital solutions, the issues around integrating technology into existing systems and the global challenges faced by the health and care workforce cannot be underestimated. From a legal standpoint, there are

multiple challenges around regulation and ethics that need to be addressed and overcome, but the promise of better health and care delivery resulting from new solutions provides a compelling driver for success. Healthcare is undergoing a revolutionary transformation as the power

of new technology facilitates multiple solutions to existing challenges. Clinicians who would previously not have engaged with technology are now understanding how it can ease their workload, many creating their own solutions which they bring to market. Collaborative efforts can help to integrate these innovations into frontline care as well as wider support functions, but the complexity of the regulatory and healthcare ecosystems is confusing and requires definite guidelines and leadership, both at a policy and ethical level. At the heart of all this innovation lies patient care. Innovative technologies can create particular solutions for distinct problems, but it’s incumbent upon the sector to bridge the gap between clinical practitioners, the technology and their communities by streamlining workflow and enhancing the patient experience.

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LEGAL Bevan Brittan

Leveraging technology

Connected minds by leveraging technologies such as AI, big data analytics, and telemedicine to enhance diagnostics, personalise treatment plans, and ensure better health outcomes is a top priority for many systems. Much of the resulting success relies on the involvement of the patient. Organisations are refining their offerings as consumers become more demanding in their technology requirements, often expecting healthcare providers to keep pace with e-solutions. While remote patient monitoring is becoming the norm, the connected operational software can be uncommunicative to the point of being ineffective. So seamless integration of advanced technologies is vital to enhance diagnosis and treatment but also to facilitate the connection between health and care providers and patients.

Governments and health departments across the world are battling to integrate the most effective, and cost-effective, solutions. It’s a step-by-step process that focuses on the areas that will deliver most value. In the UK, the government has

VINCENT BUSCEMI Partner Bevan Brittan LLP

“Few healthcare tasks can be completely automated, so the health and care workforce must adapt to new tools, workflows, and interdisciplinary collaboration”

allocated £21m to 64 NHS trusts across England to roll out AI tools to speed up the diagnosis and treatment of lung cancer. These tools will help NHS staff analyse X-rays and CT scans, speeding up diagnosis and cutting waiting times. More than 600,000 chest X-rays are performed each month in England. Similarly, a new Rehab Technologies Network has been instigated to support those who are disabled post-illness or trauma to live independent and fulfilling lives. Targeting musculoskeletal, cardiorespiratory, neurological and mental health conditions, the work will focus on the development of devices, wearables or applications that will improve living conditions and facilitate independent lifestyles. In other territories, telemedicine has emerged as a crucial tool in bridging geographical barriers, enabling 27

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remote consultations, and enhancing accessibility to health and care services. Wearable devices and health monitoring apps further empower individuals to actively participate in their health and care management and engage in wellbeing.

Transforming the workforce

The route to the ultimate goal of interconnectivity and seamless sharing of patient data is still a long way off. While healthcare workers can now provide services remotely and are assisted by AI tools in decision making, there is an underlying fear that AI will lead to a loss of jobs within the sector. The focus, of course, has to be where humans can add value - and healthcare is a people-centred sector. The futuristic view of healthcare sees doctors becoming avatars, treating their patients in a virtual world using digital twin technology, but given the nature of healthcare, the reality is that as technologies evolve and individuals, from the patients, the healthcare workforce, and stakeholders across the whole system, build their knowledge, we are likely to see a hybrid system – a mix of digital and face to face. So what is the role of AI in this more realistic scenario? Ideally AI will free up clinicians to spend more time with their patients, using their empathic and instinctive human skills to diagnose and treat. Technology will provide diagnoses that are faster and more effective, such as in the case of the new breast cancer software that can see abnormalities not visible to the human eye. Such advances will allow clinicians to focus on early treatment with more favourable outcomes. Human skills such as critical thinking, and social and emotional intelligence will be hard to replicate. AI could support empathetic communication but currently lacks the ability to express and reason with emotion. Other skills such as communicating a serious diagnosis or supporting a patient should be undertaken by clinicians for quality and ethical reasons. Finally, few healthcare tasks can be completely automated, so the health and care workforce must adapt to new tools, workflows, and interdisciplinary collaboration. Educational institutions are likely to play an increasing role in training and developing a much more technologicallyable healthcare workforce.

Legal issues and challenges

The ethical use of emerging technologies such as AI and machine learning is a crucial aspect of the healthcare transformation. Establishing guidelines for responsible AI implementation ensures that decisions made by algorithms align with medical ethics and human values. Safeguarding patient rights is vital and the integration of technology should be seen as complementing human care rather than replacing it.

JODIE SINCLAIR

Partner Bevan Brittan LLP

“Establishing guidelines for responsible AI implementation ensures that decisions made by algorithms align with medical ethics and human values”

Regulation and legal frameworks play a crucial role. Huge amounts of patient data are floating around global healthcare systems, with implications around privacy and security. Encryption, robust access controls, and regular security audits are essential to safeguard patient confidentiality and trust in the healthcare system. The ethical implications of AI must also be a critical consideration. Regulations such as the Health Insurance Portability and Accountability Act (HIPAA) in the United States and the General Data Protection Regulation (GDPR) in the UK and Europe set the foundation for protecting patient information. Compliance, therefore, has become a major factor in healthcare administration. The evolving regulatory landscape requires constant monitoring and updates to internal and external policies for healthcare providers. It’s in this complex space that law firms such as Bevan Brittan can advise and guide to avoid unnecessary litigation.

Facing the future

The new technological environment creates as many difficulties as it resolves. For every new successful solution there are new issues to consider, so continuous education and professional development are necessary for all healthcare professionals to help them navigate the ever-changing landscape. The requirement to learn new skills to keep pace with their own job can lead to burnout for staff, so in turn they will require

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LEGAL Bevan Brittan

proper care and support. As the workforce and indeed patient cohort becomes more global, diversity and inclusion are also critical to ensure both staff and patients receive the proper care they deserve. Finally, the success of future healthcare lies in collaboration, not only between healthcare workers and patients but between systems and healthcare providers. In this way, patients can receive comprehensive and coordinated care throughout the patient journey as

they benefit from a holistic and patientcentred approach to care and treatment. As a result, healthcare providers will properly serve their communities through the advancement of technology and the increased provision of human-faced healthcare. Bevan Brittan are the market-leader in the provision of legal, governance and regulatory advisory services to businesses delivering and providing health and care services within the UK and internationally.

If you would like to know more about the work we do or to discuss how we can help your business then please get in touch. CONTACT INFORMATION

jodie.sinclair@bevanbrittan.com vincent.buscemi@bevanbrittan.com www.bevanbrittan.com

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SPOTLIGHT ON

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SPOTLIGHT ON Dr Ibtesam Al Bastaki

growing expat contingent set to take Dubai’s population to 40m by 2030. The key to her work is partnerships. “We need to learn and we need to share our knowledge,” she says. “It’s good to know other people, other nationalities, other cultures – this is how we learn from each other.”

Forging a career

LEADING FROM THE FRONT Dr Ibtesam al Bastaki, Director of Healthcare Investment and PPP projects at DHA, speaks to HW Editor Sarah Cartledge about her role and her plans for the future

peak to anyone in the Middle East healthcare sector, and they all know Dr Ibtesam al Bastaki. Slight yet dynamic, this female powerhouse has blazed a trail through Dubai’s successful healthcare arena, bringing her instincts and intellect to bear on strategy and insight in her field. She has spent the past six to seven years at the Dubai Health Authority (DHA) where she has headed up healthcare investment and PPP projects, identifying key companies and partnerships to create

strong healthcare offerings across the Emirate. She is passionate about her work, constantly striving to find new ways to deliver healthcare that benefits first the patient and then the state. At the heart of her work is her passion for people and the community. Since childhood she has had a clear vocation and she has embraced opportunities both in medicine and then management to advance healthcare in Dubai, not just for the local Emiratis but for the rapidly

Her first exposure to the international medical community began her career in Dublin where she graduated in medicine from the Royal College of Surgeons. She chose to specialise in family medicine to allow her to work with communities, and secured her first role as a family physician register at Al Safa Health Centre in Dubai where she stayed for two years. She went on to qualify in aviation medicine at Monash University in Melbourne, Australia, which led to her next position as Medical Director at Dubai International Airport. “An airport is actually a city,” she says. “As Medical Director I created a successful healthcare system for passengers and for crew, while at the same time studying for a Masters in Healthcare Management. I was spending my time considering how I could improve the healthcare system to make it more cost effective and efficient.” Her success was noticed and she received a call from the Prime Minister’s office, asking her to design a healthcare strategy for the UAE. “My work enabled me to see the challenges facing not just Dubai but also the UAE, and to work out how to fill the gaps and meet the demand for various specialities.” From there she took on the private sector working as a business development director for VPS Healthcare, a private UAE organisation where her role was to ensure a proper holistic expansion of the group in healthcare industries within UAE. “I wanted to sit in the other chair,” she says with a smile. “I wanted to learn about the pains, the difficulties, the gaps, and how even the private sector can face challenges, especially in a new country where a new system is developing and there are new guidelines, standards and different payment mechanisms.” This experience led to another call from the government, this time asking her to build a strategy for healthcare investment and public private partnerships (PPPs). “I was interested in the public private partnership infrastructure projects where you have design, build, finance, facility 31

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management plus and minus operational aids which you then transfer back to the government. “I started to explore various methodologies and PPE from a simple small operation and management project to building a defined project like the Cardiology Centre of Excellence, which is a still an ongoing project. I concluded the project with the management for the final decisions. “When it came to clinical operations, we wanted to create more affiliations with international clinical partners,

bringing a brand to the country. In this way we could encourage health tourism and build up a centre of excellence, not

DR. IBTESAM AL BASTAKI Director Of Investment & Partnership DHA

“It’s good to know other people, other nationalities, other cultures – this is how we learn from each other”

only as a service provider, but also with research and training programmes for postgraduates, and all the other essential elements necessary for any centre of excellence.”

Looking to the future

Much of her work involved exploring healthcare investment, particularly around capacity planning, demand and supply, the gap and the need, along with attracting investors to assist the government in building an infrastructure to meet those demand and the needs of the population.

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SPOTLIGHT ON Dr Ibtesam Al Bastaki

DR. IBTESAM AL BASTAKI Director Of Investment & Partnership DHA

“I really want to give back to the community by working on prevention promotion, identifying how we can use the best technology to ease the healthcare system”

of affordable tests now to screen for family issues, so for less than $1 you can prevent diseases before they become more complex. It would reward the government in the long term. But these policies need education programmes and incentives, such as removing health insurance from those who refuse screening.”

Moving on

Her most recent focus has been around leveraging technology and start-ups to support innovation by embedding it into the investment programme. So far she has been working with four or five companies, mainly medtech, from concept to proof and accreditation to market entry. “I’m in discussions with the government about security processes around software – communication, licencing and telecommunication accreditation,” she says. Her main passion is value-based healthcare, rather than a fee for services.

“When the patient is at the centre then you can focus on prevention,” she says. “We could screen everyone properly and customise services based on their background. This approach applies to the whole world. We really need to move health systems to focus on health promotion and health prevention. If we want to see a good health system – not perfect because there is no perfect system – then we have to have good policies that embrace screening and prevention. “This is where my background as a family physician comes in. There are plenty

So after nearly seven years Dr Ibtesam considers it is time to move on. She’s keen to pull together the different strands of her experience and offer her services more broadly. “I really want to give back to the community by working on prevention promotion, identifying how we can use the best technology to ease the healthcare system by getting a better outcome for the patient first and for the government second,” she says. “Dubai is very unique – it’s a hub with multi nationalities so you are dealing with a multitude of different diseases. If any city wants to explore, expand and attract different nationalities, it needs to have good infrastructure and a system to make it more affordable and accessible to the people, whether it’s a physical or financially. “I want to share my experience with the region by training and educating others how to run projects such as simple JVs, to infrastructure PPPs. I might look at two or three companies where I can give my expertise. I can work, for instance, with one company that is really looking at the project and in parallel I can work with another company to develop a technology or a solution for prevention and promotion to bring a better health outcome for the population. At the end these two issues are very close to my heart and I really want to give back as much as I can.” 33

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MAINTAINING THE HIGHEST TRUST IN DOCTORS 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 its 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

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DEEP DIVE GMSCI

•

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 9,000 complaints about

doctors. Ultimately, of those 9,000 complaints, about 260-80 go forward to the Medical Practitioners Tribunal Service each year, resulting in only about 160 doctors annually having any restrictions placed on their registration.”

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 well-being 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 35

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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 where 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.

Balancing compassion and fairness

Working conditions for most doctors are stressful, compounded by problems with technology and lack of workforce. As such, there is the 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,

ANDREW HOYLE

Assistant Director Decisions & Case Examiners GMCSI

“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”

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 Examiners to apply the Realistic Prospect Test: Are the allegations serious

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DEEP DIVE GMSCI

enough to require action on registration, is it more likely than not the allegations will be proved, and is there current impairment?” Case Examiners do not hear oral evidence and clinical concerns are always addressed by asking for an independent medical expert opinion. If the RPT is not met, the case is closed, potentially with advice or a warning. If it is met, undertakings can be agreed between the GMC and the doctor, such as only to work while being supervised. Ultimately, the case may be referred to the Medical Practitioners Tribunal Service or MPTS which operates independently to the GMC. MPTS tribunals comprise a medical practitioner, a lay person and a chair. The tribunals make independent decisions about whether doctors are fit to practise in the UK. “Regulatory law requires testing the evidence and cases are always dynamic –

the evidence heard at each stage changes it,” says Andrew. “We are careful not to fill in any gaps in the evidence, so we only consider the evidence in front of us. We work very hard to mitigate the risks of bias at every stage of our processes.”

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. 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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EMPOWERING HEALTHCARE LEADERS WITH DATA, CONTEXT AND ACTION Health systems struggle to understand where to focus when addressing financial and operational challenges, says Julie Coope of BRG

ealth system and hospital executives are eager to capitalise on their substantial technology investments and time spent upskilling staff to extract actionable insights from vast data troves. They want to identify performance metrics that will drive better outcomes for patients and improve business processes to reduce burdens on staff and waste. However, health systems and hospitals continue to struggle to understand where to focus when addressing financial and operational challenges.

A combination of expertise and technology is required to break down and break out data to understand what is impacting performance and quality. But what does that mean? The Plan-DoStudy-Act (PDSA) framework outlines key considerations and best practices for organisations undergoing performance improvement initiatives.

PLAN - Data Visibility

Many health organisations have disparate data sources in silos that are either

disconnected or unaccounted for. To implement a performance improvement initiative effectively, it is crucial to bring data sources into a single platform and visualise key data sets and outcomes that align with your business and performance goals.

DO – Contextualise Data

Siloed data, devoid of context, is susceptible to misinterpretation, so consolidating data into a unified, dynamic platform will empower teams by giving them a comprehensive perspective. In the hands of a performance improvement expert who can tap into teams with deep organisational experience, raw data can be transformed into meaningful narratives. This synergistic approach enables teams to rigorously test hypotheses and draw more informed conclusions, unlocking the transformative power of data and giving it a clear and convincing voice.

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CONSULTANCY BRG

STUDY – Data Aggregation and Analysis Visualising the data in this state is essential for the team to transform it into more actionable insights. Without visualisation, data lacks meaning and is more likely to be misinterpreted by clinicians and managers. When guided by a performance improvement expert, a narrative will emerge from the visualised data that contextualises it for key stakeholders, highlighting hidden patterns and performance variations. Data visualisation + Experienced questioning = ↑Quality improvement

ACT – Measurable Improvement Benchmarking

Curated analytics that can be visualised make it easier to test hypotheses and develop measurable performance improvement programs. Bringing an organisation’s clinicians and managers together with performance improvement experts, positions health systems and hospitals to more quickly identify underlying key performance indicators. CONTACT INFORMATION

info@thinkbrg.com www.thinkbrg.com

Taking a health system from siloes to insights

A state-run regional health system in EMEA found itself grappling with a fragmented data landscape. Hospitals within the system employed disparate BI and analytics tools, resulting in siloed data that hindered comprehensive insights into their patient population, treatment practices and documentation. Recognising the need for a centralised approach, the executive team turned to BRG for assistance in establishing a unified data management strategy. Empowered by BRG’s expertise and the Symphony platform, this strategic initiative involved a crossfunctional team of clinicians and managers tasked with collecting and centralising their disparate data sources into a single platform for visualisation and analysis of key performance metrics. The remote nature of the health system’s many sites had made past collaboration and data sharing difficult, but BRG leveraged the power of Symphony to centralise data analytics and develop a comprehensive data narrative to provide the teams with a 360-degree view of the health system’s performance. Initial analysis of the consolidated data revealed a significant variation in average length of stay (LOS) and treatment for tuberculosis (TB) patients at the site level. This discrepancy prompted directed conversations with stakeholders and additional data and clinical investigation to uncover and better understand the underlying root causes of the variation. Deeper analysis of the treatment of patients with TB identified key challenges including: • lack of standardised clinical management • clinical teams’ lack of awareness of appropriate medical management • patient discharge requirements and inconsistent follow-up care The analysis resulted in: • greater than 21-day reduction in average LOS in the health system • readmission rate reduction from 11.5 to 3.3 per cent • 2.5m USD cost reduction from efficiencies gained, including better productivity.

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TRULY PERSONALISED CARE Digital solutions with access to medical records can play a vital role in the transition to a sustainable healthcare system, says Patients Know Best’s Chief Commercial Officer Sally Rennison

or years Patients Know Best’s mission has focused on enabling patients to access their medical records. In many territories, individuals are not able to access their patient records, depriving them of vital information that could help them manage conditions or

recognise symptoms when they appear, thus allowing them to receive quicker diagnoses. After nearly 16 years of campaigning and turning our vision into a reality, we are delighted to see the progress across so many countries. In our first market, the

UK’s NHS App has transformed adoption; today PKB has nearly 3.5m registered patients and every month we release more than 16m test results to individual patients. It’s exciting to see nationally driven momentum elsewhere, particularly in the Gulf countries which have mandated data release for all providers. Yet for PKB, getting patients access to their records has only ever been the first stage of our mission. It serves as a catalyst for something bigger: ensuring patients understand what this information means and how to use this understanding to make

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DEEP DIVE PKB

shared decisions with family members or carers and healthcare professionals. This paves the way for truly personalised care. Shared decision making and enabling self-management have long been recognised as better for patients and instrumental to a sustainable healthcare system. What excites us is that we are entering the ‘next stage’ where digital solutions with access to medical records can play a vital role in this transition. Our platform has tangible examples and demonstrates real impact from customers using more interactive and dynamic

features to educate, engage and collaborate with patients, using both clinical and patient-provided data. Most notably, PKB’s care plans, together with questionnaires and messaging, enable the implementation of an interactive process to enhance the patient experience and improve outcomes.

Digitising care planning

Care planning lies at the heart of healthcare, ensuring every patient has a personalised plan in place outlining their care needs. This system is even more important for those living with a chronic condition, such

as epilepsy or diabetes, where much of a patient’s care, and outcome, is dependent on their actions away from a healthcare setting. Traditionally, this has been a cumbersome, paper-based process for clinicians to log information and communicate care instructions between each other. What’s been lacking is making the patient part of the process so they can gain knowledge, support and advice to manage their plan. If they are lucky, the patient might leave the hospital with a paper copy but 41

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it is immediately out of date as they walk through the door. There has been no way for the patients to access or update their own data as things change. Nor is it easy for the patient to share guidance with the people who pick up their care once they leave.

The care plan can be updated by any party involved in the individual’s care, regardless of location. Each update is recorded with an audit trail, enabling clinicians to review information effectively for safe, timely decision making.

perspective, care teams are no longer tied to clinic appointments or unnecessary phone calls, but have the flexibility to consult remotely and focus in-person care where it is clinically needed.

A dynamic personalised system

Shared decision making

Making a difference in practice

Central to improving care planning is the ability to digitally integrate it with an individual’s personal health record. PKB is structured to utilise real-time data inputs. The platform pulls in ever changing data points about the individual - diagnosis, allergies, symptoms as well as resulting treatment and medications - which are all populated in a digitally dynamic care plan. The body of the care plan can be edited to individualise for the patient. Information and guidance can be given, goals set, symptoms can be tracked and measurements monitored. As a result everyone, including the patient, can see an up-to-date view of the patient’s health status, responsive to their evolving needs.

The organisation maintains control over the care plan set up, deciding how and where patients contribute. The main opportunity for them is the ability for patients to self-enter their data for a clinician to evaluate the best course of action. Several important features enable and maximise this shared care planning. For example, configurable questionnaires can be used at any point for pre or post-operative assessments as well as to gather general patient information. Alongside, the secure messaging capability allows for asynchronous communication between patient and care teams, all logged for future reference. From a healthcare organisation’s

NHS customer Luton CCG (Clinical Commissioning Group) is an inspiring example where PKB has been used to revolutionise care for children with complex epilepsy. With a comprehensive care plan in place, including guidance on pre-emptive measures and a diary to track seizure patterns, parents are supported to co-ordinate care for their children. The valuable data they collect is easily accessible to consultants to make informed decisions. Meanwhile, PKB’s messaging service serves as a lifeline for parents to consult with care teams remotely, including medication reviews. As one parent shares here, this comprehensive, accessible resource

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DEEP DIVE PKB

enables their child to engage in normal activities, like travel or attending school: ‘‘It’s nice to have everything in one place, particularly to have videos which are sent to a safe email so they’re in a different place, but now they’re attached to the actual seizures record in PKB. It’s great for sharing with her school as well. If the care plan changes, I would normally have to wait for it to be written and signed, arrive in the post and then give the school a copy.”

SALLY RENNISON

Chief Commercial Officer Patients Know Best

“Central to improving care planning is the ability to digitally integrate it with an individual’s personal health record”

Implementing new standards

The Heart Failure Team at Chelsea & Westminster NHS Trust is another great example of pioneering use of care plans to self-manage a chronic condition. With the guidance to monitor, assess and act on their changing symptoms, patients use a traffic light system for timely interventions to manage themselves at home. Using the messaging function for medical reviews, it has also been one of a few international heart failure services to implement guidelines from a medical optimisation study for patients suffering from Heart Failure with Reduced Ejection Fraction, a condition which affects millions of people worldwide. Overall, using PKB as part of their Virtual Ward initiative the hospital has recorded an impressive 48 per cent reduction in readmissions.

boundaries further. In the Netherlands, for example, our partner CMyLife has launched an enhanced Decision Aid app for patients dealing with Chronic Lymphocytic Leukaemia. The tool provides information about the treatment options and personalised recommendations. Using PKB’s questionnaires, patients select and provide reasons for their choices. Logged in a care plan, this information is available to clinicians via a dashboard as well as to patients to reference and share with relatives. With so much learning over the last decade, we have proven models and the opportunities are enormous. My question is, who is ready to take the next step in this region? CONTACT INFORMATION

Pushing the boundaries

What excites us is that around the world, organisations are pushing the

enquiries@patientsknowbest.com

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DELIVERING ATSCALE 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, NHS-approved technology solutions. He implicitly understands the needs of fellow clinicians, and AppLocum was born out of the need to offer the clinical workforce more than just a job board. For Suhel, 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-to-peer support, and clinician engagement,” he says. “Beyond enhancing efficiency, the focus should be on prioritising the wellbeing 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.

Harnessing the gig economy

A key advantage of the gig economy in healthcare staffing is its ability to enhance extended hours of service delivery.

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RECRUITMENT AppLocum

ready supply of qualified professionals available when and where they are needed most. The gig economy model allows healthcare providers to seamlessly adapt to peak periods, emergencies, or special projects without the constraints of a fixed, full-time workforce.” Moreover, the gig economy model promotes a more efficient allocation of workforce hours. Healthcare organisations can optimise staffing levels based on realtime demand, ensuring that resources are allocated precisely where they are needed. This not only leads to cost savings but also enables healthcare professionals to better balance work-life commitments. In essence, the gig economy in healthcare staffing introduces a paradigm shift that aligns workforce flexibility with the everevolving needs of the healthcare industry, ultimately fostering a more responsive and patient-centric healthcare system.

DR SUHEL AHMED Founder AppLocum

Traditional healthcare settings often face challenges in maintaining roundthe-clock services due to staffing limitations. The gig economy addresses this constraint by providing a diverse pool of healthcare professionals willing to work during non-traditional hours. Through the gig model, daytime healthcare workers have the option to deliver extra hours for unscheduled care, out-of-hours services, and elective surgery waiting lists. This not only improves the accessibility of healthcare services for patients but also contributes to the efficient utilisation of healthcare facilities, reducing wait times, and enhancing overall patient satisfaction. “The gig economy model in healthcare staffing brings transformative benefits, particularly in workforce optimisation and the extension of service hours. By tapping into a pool of on-demand healthcare professionals, organisations gain flexibility to meet fluctuating demands for services,” Suhel says. “This dynamic approach ensures there is a

“The gig economy model in healthcare staffing brings transformative benefits, particularly in workforce optimisation and the extension of service hours”

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 notable clients include Nuffield, BMI, BUPA, the NHS, and other super-providers across the UK. 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 of 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 knowhow, 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.” AppLocum’s digital offering is a revolutionary cloud-based clinical staffing management solution, driving data-driven insights and tech-enabled operational efficiencies in how healthcare organisations can manage their clinical workforce. This comprehensive solution includes: • 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 organisations. 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 credentialling (Digital Passporting), roster control solution, clock-in/ clock-out functionality, timesheet, and invoice management, e-learning, better engagement, asynchronous messaging, and peerto-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. CONTACT INFORMATION

suhel@applocum.com www.applocum.com

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SCREENING

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DEEP DIVE Vara

HARNESSING AI IN SCREENING Incorporating AI into national breast cancer screening programmes will significantly reduce mortality, says Egbert Schillings, Chief Commercial Officer, Vara

reast cancer screening transcends the boundaries of a mere diagnostic test. The success of screening programmes hinges on a wellrounded strategy that includes awareness, education, efficient processes, and the integration of technological advancements. As the global incidence of breast cancer rises, it’s vital to not only detect cancer early but to ensure that screening becomes an integral part of national cancer control systems.

In the more mature health economies, mammography has been the screening modality since the 1970s. Mammograms have transformed early breast cancer detection and diagnosis by identifying breast cancer before there are signs and symptoms. Mammograms have been shown to reduce the risk of dying of breast cancer and have saved countless lives. In emerging economies, incidence is rising but screening with mammography remains opportunistic, rather than systematic and

new approaches are required to make better use of scarce resources, particularly scanners and radiologists. For Egbert Schillings at Vara, the solution is obvious. “If you have ambitions as a health system and at the same time the disease burden of breast cancer is rising, resources must meet the demand. The demand for radiologists rises six to eight per cent every year, but the actual supply of radiologists rises by two per cent,” he says. “The only way to bridge this massive gap is through technology because there will never be enough radiologists to read all the images.” Breast cancer screening involves a sequence of steps, starting with the vital task of informing and educating the target population. Driven by the goal of identifying unrecognised cancer 47

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or pre-cancer in a healthy population, screening programmes must be more than just a test—they must be designed as a comprehensive pathway. The process begins with raising awareness and educating the eligible population about the importance of screening. Cultural considerations come into play, making it crucial to tailor communication strategies to diverse communities. The next step is inviting the target population to participate but the challenge lies in ensuring active engagement, as mere awareness doesn’t guarantee participation.

Reducing the workload

Vara is an intelligent platform that infuses state-of-the-art artificial intelligence into routine breast screenings. By mitigating much of the human subjectivity associated with reading mammography results—and

reducing the repetitive work for radiologists - it makes breast screenings more effective, personal, and accessible for everyone. “By plugging AI into the screening process, which Vara has done within the German National Cancer Screening programme involving more than 1m women to date and adding 80,000 every month, we can show definitively with evidence that it is superior to two independent radiologists doing a double read,” says Egbert. “The results demonstrate Vara’s ability to detect cancers missed by traditional radiologists without increasing false positives. In fact, higher accuracy goes hand in hand with a reduction of unnecessary recalls, which reduces both costs to the system and anxiety for the women involved.” As a company, Vara has decided to make sure that the entire screening process is undertaken efficiently. “In India and

Egypt, we can show that if you seamlessly integrate the screening programme into an end-to-end cancer care continuum, then suddenly you make a difference at a system level. We undertake awareness raising; we invite people for screening; we have a booking platform; we have patient navigators to make sure that women are supported along the pathway, especially when this involves recalls for further testing and referral to treatment. All this is aligned with the the goals set by the WHO in their Global Breast Cancer Initiative (GBCI)” The World Health Organization’s (WHO) global strategy for breast cancer sets specific targets, including detecting 60 per cent of breast cancers at stages one and two and ensuring access to treatment within 60 days of an abnormal screening result. Vara supports radiologists in identifying abnormalities more reliably

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DEEP DIVE Vara

workload and improving overall productivity. The technology doesn’t just add another layer to the existing process; it streamlines it for maximum effectiveness. Most breast screening programmes cover women from the age of 40-74. The highest screening uptake in the world is in Sweden, Denmark and Finland, where up to 90 per cent of the eligible female population screen regularly. As a result, these countries have seen the greatest drop in cancer mortality and more than 90 per cent of all breast cancers are found at stages one and two, where the five-year survival chance is better than 97 per cent. At stage four, this drops to 26 per cent. Inherited high risk gene mutations can only explain around 15 per cent of breast cancers at a population level,” says Egbert. “Roughly half of all breast cancers occur in women with no specific risk factors other than their sex and age. One of the sad and most striking things is that there’s no effective prevention because modifiable risk factors don’t really come into play as they do with tobacco control and lung cancer. Age at birth of first child, obesity, alcohol consumption and some emerging evidence on environmental toxins have been cited, but none of them are as easily modifiable as smoking cessation and other interventions.”

Overcoming cultural barriers

while minimising false positives. The platform’s workflow tool, coupled with Vara AI, optimises radiologist capacity by up to 73 per cent. This efficiency allows radiologists to focus on cases that require their expertise, reducing unnecessary

EGBERT SCHILLINGS Chief Commercial Officer Vara

“Health systems should really be accountable for the way they engage with the population and the best results can only be achieved via an integrated digital platform”

The WHO’s guidelines emphasise the necessity of assessing a health system’s capacity and infrastructure before introducing cancer screening programmes. Despite the availability of advanced cancer centres in GCC countries, cultural factors play a significant role in deterring individuals from participating in screening programmes. Studies in Saudi Arabia, for instance, highlight the need for awareness and education to dispel myths and encourage participation. “The KSA data shows the rate of detection at elevated stages is still higher than it should be, given the economic development of the country. Therefore, more systematic screening programmes with an integrated and easy process for women will increase uptake substantially. For Vara, the awareness-raising and the invitation process should be culturally appropriate and undertaken in such a way that it becomes something as easy as getting your driver’s licence renewed. All participants are treated with dignity and respect so they will return for the repeat follow-up.”

In his opinion, organising screening for a country such as Saudi Arabia should be relatively straightforward. Populations are subdivided into clusters within which there are between 100,000 to 300,000 women of the appropriate age for screening. The invitation should be as personalised as possible using the modalities that the local population will appreciate, such as WhatsApp or the primary health care practice or even at a mall or a hospital. As a cloud-based system, a medical technician performing a mammogram at a rural site can upload the image and it will be reviewed remotely by teams of radiologists who can do thousands each day. “GCC countries have all the infrastructure required to reach world-leading levels of screening uptake. It is now a matter of organising, delivering, and monitoring the programmes at maximum levels of operational efficiency.” “Health systems should really be accountable for the way they engage with the population and the best results can only be achieved via an integrated digital platform,” Egbert says. “In India, for instance, ten years ago access to treatment wasn’t available, and now it’s thriving, mainly because as one of the largest growing economies in the world, the government recognises that access to quality healthcare is at the heart of any thriving society, so they have decided to heavily invest in healthcare.” And with screening, the future is clear, thanks to machine learning. “Vara is the most relentlessly peer-reviewed AI for breast cancer screening,” claims Egbert. “We can show that we free up 73 per cent of a radiologist’s capacity, allowing them to review up to 30,000 scans per year. Only mammography is shown in randomised controlled trials to reduce mortality, and thanks to cloud-based platforms like Vara, it can easily be delivered in a hub-and-spoke model. This is particularly true in the Middle East where health systems are moving from being intervention-focussed, acutecentric and reactive to being proactive and leveraging modern technology in a way that actually decreases costs and increases access.” CONTACT INFORMATION

www.vara.ai

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SCREENING FOR POPULATION HEALTH Early detection is key to optimum health outcomes according to Paul Roberts, Head of Service for the Cervical Screening Administration Service for North of England Care System Support

s value-based healthcare and population health continue to be the focus for health systems globally, screening is a key part of this function. In the UK, there is a successful series of screening programmes that

include cervical, breast and bowel. Based on age ranges found to be clinically the most common for these cancers, citizens are invited for screening via a national programme. Originally a regional service, cervical screening became a national service in

2015. The process looks for the human papillomavirus (HPV) which can cause abnormal cells on the cervix. If HPV is found, a cytology test checks for any abnormal cells and, if identified, the individual will be referred to colposcopy. If no abnormal cells are found, a follow up screening is arranged for 12 months’ time. This checks to see if the immune system has cleared the virus. Most HPV infections are transient, and slightly abnormal cells often go away on their own when the virus clears. If HPV persists, abnormal cells can, if left untreated, turn into cancer over time.

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DEEP DIVE NECS

per cent, only a small proportion will have cervical cancer. Paul Roberts heads up the Cervical Screening Administration Service for NECS. Part of the NHS, NECS 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.

PAUL ROBERTS

Head of Service for the Cervical Screening Administration Service NECS

“As cervical cancer is due to abnormalities in cell development, it is about educating people at the right age so that screening becomes the norm”

Providing a comprehensive service

The UK process runs from ages 25-65, with participants being invited six months prior to their 25th birthday. The GP is notified that a patient is due to be called and the patient will be invited every three to five years depending on their situation. The HPV vaccination programme started in 2008 but vaccinated individuals should still consider screening as the vaccine does not protect against all sub-types of HPV. NECS sends out around 2.5m invitations and reminders per year, along with 3m results of which around 187,000 are abnormal, less than two per cent of the total invited. And of that two

“We invite participants for screening, including anyone with a cervix,” he says. “It can be easy to miss particular cohorts of people, so we provide a comprehensive information suite aimed at including hard to reach groups of the population. These include people with learning disabilities, ethnic minorities and other groups.” The programme is not mandatory and people can choose not to be screened. In England, participants are contacted by letter, but the team is actively looking at other ways of communicating via more digital forms of communication such as SMS text links, which ultimately could be a more secure way of communicating with people. Paul and his team have a full set of KPIs which they have delivered successfully for the past 12 months and which are discussed every month with NHS England to ensure the programme is providing the best outcomes for participants.

The importance of cervical screening education Education is key to screening success and it is important that any screening programme includes public health expertise to design effective screening messaging. In England, the cervical

screening education campaigns and invitations are designed by Public Health England. Paul notes that in some cultures, there can be taboos around the screening process. “As cervical cancer is due to abnormalities in cell development, it is about educating people at the right age so that screening becomes the norm and any abnormalities can be investigated.”

Delivering screening programmes internationally

For Paul, it’s important that screening is free to encourage a wide uptake. In newer health economies, the education and screening programme could be delivered via the primary care system and family doctors, making it a routine part of family check-ups. Accessibility to appointments can part of the challenge, but for the Middle East which has a doctor-led healthcare system, there are potentially multiple options. Paul highlights software that could enable patients to book their own appointments at a location convenient for them. Complimentary self-sampling is another option. “We supported a self-sample trial in London in 2022 and the results seemed very positive. Comprehensive collateral gave information with supporting videos about how to, and the number of non-samples returned were relatively low.” Paul stresses the importance of digital communication when designing systems: “Innovative screening programmes of the future should embrace digital healthcare such as patient portals or apps. These would deliver appointment messages and follow up schedules, creating a confidential service that caters for all participants who can access the programme at a time convenient to them. “A comprehensive reporting system and fast turnaround times will enable early diagnosis, while hard to reach sectors of the population will be accessed via education and family doctors,” Paul concludes. “In this way, there is a genuine opportunity for cervical cancers to be treated in the early stages and for incidences of the disease to become almost non-existent.” CONTACT INFORMATION

necsu.export@nhs.net www.necsu.nhs.uk

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DESIGNING THE DIGITAL HOSPITAL Digital healthcare is a catalyst for Human-Centred Design, says Con McGarry, Senior Consultant Digital Healthcare, Arcadis

he digital revolution in healthcare is a widely discussed narrative. We are inundated with tales of how digital tools are poised to redefine healthcare dynamics. Yes, we know - the digital wave is here, and it’s a profound evolution that holds the promise to transform healthcare as we know it. But what follows, beyond the need to implement the technology? Advances in, and implementation of digital healthcare is not an endpoint but a launchpad, prompting further evolution in healthcare design. But what will that next layer of evolution look like? Perhaps now is the time to consider the impact that digital healthcare will have on the physical healthcare environment. This is where Human-Centred Design (HCD) enters the dialogue. HCD is an approach that prioritises the human experience within the design process, striving to create environments that are intuitive, accessible, and responsive to human needs. The potential modifications facilitated by digital healthcare tools create a conducive milieu for embedding HCD principles within healthcare spaces. They act as a catalyst, enabling a shift towards a design philosophy that places patients and healthcare staff at the core of architectural and operational design. If digital healthcare and HCD can successfully converge, they become a powerful force capable of reshaping the healthcare landscape, driving a comprehensive evolution in healthcare design that is both technologically robust and focused on enhancing the human experience.

Take telemedicine as a forerunner – it propels a model of care that extends beyond the physical boundaries of healthcare facilities. This decentralisation promotes a continuum of care that demands a rethink of patient areas to accommodate technology-enabled remote monitoring. Virtual care platforms, for instance, require designated areas within healthcare facilities for remote consultations. They also challenge the traditional concept of waiting rooms, urging a re-evaluation of the vast space allocated for waiting areas in healthcare settings. Automation and robotics usher in a new era, where the built environment is significantly impacted. Whether it’s autonomous mobile robots streamlining supply chain logistics or robotic process automation easing administrative tasks, the butterfly effect on spatial design is profound.

The Connected Care Model

The spectrum of digital healthcare influences on the built environment

The healthcare landscape is expansive, and with digital tools making strides, they are introducing innovative elements to this environment. Be it patient-centric wearables or fleets of autonomous mobile robots roaming the floors of healthcare campuses, each technology has the potential to significantly impact the design, utilisation and evolution of healthcare spaces. 52

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ARCHITECTURE Arcadis

The burgeoning array of digital healthcare tools hold the promise to redefine the physical healthcare environment. These tools not only alter spatial needs but also boost operational efficiencies and redefine care delivery methods.

The intersection of digital healthcare and HCD

The essence of HCD resides in crafting environments that prioritise human needs, experiences, and behaviours. In the realm of digital healthcare, this ethos manifests in two distinct ways: 1. HCD by Design – the intentional incorporation of HCD principles during the development of digital healthcare tools. 2. Digitally Derived HCD – The organic manifestation of HCD principles as a byproduct of implementing digital healthcare solutions within the healthcare environment.

Exploring the facet of ‘HCD by Design’ in digital healthcare, the integration of digital wayfinding solutions not only simplifies navigation but also minimises the anxiety associated with traversing complex healthcare facilities. Intelligent building controls and other digital tools that influence the built environment can be leveraged to create spaces that dynamically respond to human needs. For example, heating, ventilation systems and circadian lighting that adapt automatically to occupancy and user preferences enhance the comfort and well-being of occupants, aligning with the aim of creating responsive and user-friendly spaces.

The emergence of HCD through digital deployment Yet, it is the melding of digital tools with architectural design that can truly propel healthcare spaces into a realm of enhanced human-centricity. Deploying digital

technology to tackle specific operational or clinical challenges often yields efficiencies that liberate physical space, time or resources. The flexibility this affords provides fertile ground on which HCD initiatives can flourish. The symbiotic convergence of digital tools and HCD holds the promise of redefining healthcare spaces into bastions of patient centric innovation, where every area is meticulously designed with these principles in mind, courtesy of the digital momentum paving the way. Consider the scenario where a healthcare facility adopts a fully digitised appointment, check-in and virtual waiting room platform. This innovative system streamlines the scheduling process, optimises the utilisation of consultation rooms, significantly enhances patient flow and minimises on-site wait times. Moreover, it introduces a “wait anywhere” approach, where patients are not confined to traditional waiting areas but have the freedom to utilise nearby facilities or 53

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outdoor spaces. They are notified via mobile alerts when it’s their turn to be seen and guided back to the facility in time for their appointment. Triggered by digital innovation, this transformation redefines the conventional need for physical waiting areas, creating a ripple effect on the facility’s spatial design. Guided by the principles of HCD, this newfound spatial freedom presents exciting opportunities. What was once a crowded waiting area can now be repurposed into a range of beneficial spaces - a serene relaxation zone, an educational centre offering health workshops, or simply, additional consultation rooms to expedite patient care. The design of these spaces is driven by the goal of enhancing the patient experience, ensuring accessibility, comfort, and engagement. This narrative exemplifies the evolutionary journey, initiated by the integration of digital healthcare tools that solve immediate operational challenges, leading to a cascade of opportunities for embedding HCD principles within healthcare spaces.

CON MCGARRY

Senior Consultant Digital Healthcare Arcadis

“What is stopping us from fully embracing this transformative confluence of technology and humancentric principles?” In a second scenario, the deployment of digital inventory management systems, centralised supply chain solutions and autonomous mobile robots for transport and logistics could significantly improve space utilisation and reduce the need for satellite storage throughout a healthcare facility. Ward space once reserved for ‘just-in-case’ inventory becomes accessible to re-imagine the layout of the ward. Expanded, single patient rooms that enhance privacy and introduce amenities catering to the needs and comfort of both patients and their loved ones are now within reach. Multi-functional spaces for group therapy, educational sessions, or community support groups transition from wishful thinking to rational reality. Similarly, the integration of telemedicine and virtual care solutions can potentially reduce foot traffic within healthcare facilities.

The Realisation Plan

The reduced number of in-person visits could translate to less demand for parking space, (un) paving the way for repurposed green, outdoor spaces, therapeutic gardens, or exercise areas. Incorporating HCD principles, these outdoor spaces can be transformed into sanctuaries that promote physical activity, relaxation, and mental well-being for both patients and staff.

About Arcadis

Arcadis is the world’s leading company delivering sustainable design, engineering, digital and consultancy solutions for natural and built assets. We are more than 36,000 architects, data analysts, designers, engineers, project planners, water management and sustainability experts, all driven by our passion for improving quality Embarking on a human-centric digital of life. evolution We exist to find solutions to today’s most The narrative presented here is a journey of pressing challenges, from the impact of evolution, beginning with the integration of climate change to increasing urbanisation digital healthcare tools which set the stage by and digital transformation – all with the addressing immediate challenges, and opening goal of improving quality of life for people spaces rich with potential. The next leap in around the world. Evidenced by the work this journey involves harnessing these digital we do for our clients, the opportunities we advancements to embed and embrace HCD create for our people, and in our efforts principles, amplifying the human experience to enhance the communities in which we within healthcare environments. This dual live and work. We bring together worldsynergy transcends mere operational and class resources and the latest innovative clinical efficiencies, heralding a new era of technologies to help define the cities and human-centric healthcare spaces. It poses experiences of tomorrow. a riveting question: what is stopping us from This has been our mission since 1888, fully embracing this transformative confluence when we were founded to transform of technology and human-centric principles? unusable wetlands in the Netherlands into The path forward beckons healthcare prosperous land for people to farm. And it organisations to prioritise the infusion of digital continues today. innovations in their design blueprints. It is a call to action for a collaborative endeavour involving technologists, architects, clinicians, CONTACT INFORMATION and patients. As we champion patient-centred care, efficient space utilisation, and resource optimisation, we edge closer to a healthcare environment that’s not only efficient and www.arcadis.com responsive but also deeply empathetic.

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BUILDING NET ZERO Healthcare World Editor Sarah Cartledge speaks to Rebecca Stubbs, Principal Net Zero Carbon Consultant Mott MacDonald, about the NHS road to Net Zero

n October 2020, the NHS became the first healthcare service in the world to commit to becoming Net Zero Carbon (NZC). This pledge will see Europe’s largest employer reduce their carbon emissions by 2040, proactively improving public health for the future. Rebecca Stubbs is the Principal Net Zero Carbon Consultant for Mott MacDonald and has been involved in the biggest UK hospital restructuring project in this area.

She has advised the UK government on its approach to tackling hospital emissions and has worked very closely with NHS England and the Green NHS team over the past two years, leading the development of the NHS net zero building standard.

How do you describe Net Zero Carbon? NZC is a science-based target driven approach to tackling climate change. This means that we are trying to reduce our

emissions to levels that are aligned with trajectories of 1.5 degrees. Practically speaking, this will require incremental steps, year on year, to reduce about 90 per cent, if not 95 per cent, of emissions before the specific NZC year. The end dates vary depending on scope of emissions. Emissions reductions are not linear. The NHS has 80 per cent reduction targets for 2030, which is approaching very quickly. To achieve NZC, we must offset any residual emissions - that is the key difference between NZC and True Zero carbon. In true zero carbon, there are no residual emissions! The other key difference is that carbon neutral is different from carbon neutral within Net

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INFRASTRUCTURE Mott MacDonald

Zero. The offset is sequestering carbon - actually removing emissions from the atmosphere and not just paying for them to be mitigated or reduced somewhere else. As an analogy, if you imagine a balance scales, on one side are the positive emissions into the atmosphere and on the other side the negative emissions that are removing them via carbon sequestering offsets which we need to balance to zero.

How can healthcare institutions assist in mitigating climate change? The climate emergency is a health emergency. By lowering emissions, the NHS is able to minimise the generally negative health impacts of climate change. The NHS is responsible for 4 per cent

of UK emissions and so it has taken ambitious steps to reduce this including incorporating it into legislation within the Social Care Act 2022. Estates and facilities are typically about 15 per cent of the NHS footprint and are within direct control of the NHS, whereas much of the NHS footprint is supply chain emissions e.g. through produced goods and services - medicines and equipment, and other induced emissions e.g. patient and staff travel. These are less easy to assess and influence. Facilities are largely ‘in-house’, hence the Net Zero Building Standard for NHS facilities, that we supported. NHS ‘facilities’ is a very broad term. It might include GP centres, any kind

of operating theatres, containment labs or inpatient facilities. The degree of variability within the estate is huge, therefore, there are both quantitative and qualitative expectations in the NHS Net Zero Building Standard. We must also be respectful of the variability of specialisms in different spaces and create a bespoke approach to accommodate this diversity. Healthcare facilities and services are also very highly constrained; infection control is pertinent to ensure the highest levels of patient safety are maintained. When trying to decarbonise, this is important because it’s very much safety first, which has produced several barriers for basic changes in improving energy efficiency. As a result, a tension is 57

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created between optimising patient care in the short term that is likely to adversely impact the health of future generations.

Why are healthcare facilities so challenging to decarbonise?

We need to capture all the emissions from the construction and from the materiality of these buildings, which is typically about 50 per cent of the total emissions of a building over its whole life. If a building is in place for 60 to 100 years and it is demolished, it will create more emissions to reduce the operational carbon from the construction of a new one. Materials are energy intensive and carbon intensive at the moment, and will be for the next decade. Construction in the short to medium term is really carbon intensive because we haven’t decarbonised raw materials such as concrete and steel, or machinery used on site or in transportation of goods, thus we haven’t decarbonised construction.

REBECCA STUBBS Principal Net Zero Carbon Consultant Mott MacDonald

“Sometimes there is little to no benefit in refurbishing a building to establish high energy efficiency because it’s not fit for clinical need”

It is important that we refurbish existing buildings where we can, but there are challenges in terms of clinical standards. There are many old buildings where immediate changes can be implemented, such as facade upgrades and general amendments, to increase energy efficiency. But sometimes there is little to no benefit in refurbishing a building to establish high energy efficiency because it’s not fit for clinical need. There are some very old, highly constrained buildings belonging to healthcare providers today which are going to be incredibly expensive and disruptive to refurbish, so it’s about a balanced approach across our estates.

Are the answers to the NZC challenge as simple as reducing their emissions?

No, we also need climate resilient buildings. We have a real challenge in the UK as

everyone is focused on heating in terms of the efficiency of hospitals. The equally important question is, how are we going to cool these buildings down? With temperatures rising above 40 degrees during the summer of 2022, cooling is vital across much longer periods of the year, and there are real problems with patient safety trying to keep hospital facilities at the right temperature, especially for vulnerable patients and staff. A bespoke, strategic approach to each building is the required answer. It can take a huge amount of co-ordination; it is very dependent on those operational constraints of the spaces within the

building and how much decant space there might be to allow for refurbishments. Ensuring resilience of energy systems is also crucial within this design and strategy process.

In addition to buildings, does there need to be a focus on any other areas to achieve NZC within a healthcare system?

Yes, the achievement of NZC within healthcare will be the result of hundreds of projects spanning multiple areas, including procurement, food and nutrition, staff and patient behavioural change, and sustainable models of care, to name a few.

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INFRASTRUCTURE Mott MacDonald

Sustainable models of care is an area of particular interest and focus for us at Mott MacDonald. Historically, healthcare services have been redesigned or transformed to deliver improved patient outcomes, or financial efficiencies, or both. However, through an approach underpinned with NZC and sustainable principles, future models of care can be reconfigured to achieve both these areas as well as reducing their carbon footprints. Examples of this include the adoption of digital solutions to enable the delivery of virtual wards and telemedicine, or undertaking more surgical procedures within appropriate

community settings to release hospital theatre space. Mott MacDonald have been supporting various NHS Trusts with their decarbonisation journeys. The transformation of system-wide clinical pathways is often complex and requires engagement across multiple healthcare professionals, including commissioners, clinicians, finance, clinical governance, estates and facilities, medicines management and most importantly, patients themselves. However, this is a worthwhile undertaking with benefits that could be profound for patients, healthcare professionals and for our planet.

In summary, I strongly suggest that all healthcare operators follow the leadership shown by NHS England and formulate a strategy and roadmap of priorities to give clear direction of travel to suppliers for their required contribution, to align collective efforts and step up to this challenge of a generation. CONTACT INFORMATION

www.mottmac.com

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TRAVELLING FOR HEALTHCARE DESTINATION DUBAI The post-COVID growth in medical tourism in Dubai is thanks to a perfect alignment of factors, says Mansoor Ahmed – Executive Director (Middle East & Africa) at Colliers

ccording to the OECD, Medical Tourism is defined as ‘when consumers elect to travel across international borders with the intention of receiving some form of medical treatment. This treatment may span the full range of medical services, but most commonly includes dental care, cosmetic surgery, elective surgery, and fertility treatment’. Medical tourism is related to the broader notion of health tourism. Many analysts

combine health and medical tourism; however, based on an OECD report, health tourism exists for mind and body wellbeing while medical tourism exists for the enhancement or restoration of an individual‘s health through medical intervention. Despite a buzzword, there is still a lack of hardcore data to determine the actual market size, mainly as the sector is not fully organised and documented. Due to

these anomalies, various research reports and scholarly articles estimate the global medical tourism market size between $75-100 bn with the total number of crossborder patients estimated between 20-25m. Dubai has established its name as a reliable global medical tourism destination and has become one of the top destinations globally. Based on the Medical Tourism Index (MTI), Dubai ranked sixth globally based on three key factors: Destination Environment (seventh out of 46 destinations); Medical Tourism Industry (13th) and Quality of Facilities & Services (fifth) with a total score of 71.85 per cent. In 2022, Dubai received 674,000 medical tourists spending almost AED 1bn. One of the main reasons for Dubai’s quick resurgence in medical tourism is the effectiveness with which UAE and Dubai battled COVID-19, reflecting the strength and resilience of its medical infrastructure. Moreover, an early opening of skies also

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HEALTH SYSTEMS Colliers

flight time from Dubai, while two thirds of the world’s population with approximately 53 per cent of global GDP lives eight hours flight time from Dubai. Dubai International Airport (DXB) expects its annual passenger traffic to reach 93.8m by 2025 and the magic 100m number not long after. In 2023 Dubai airport expects to number more than 86m passengers, close to the busiest year in 2018 when it recorded 89.1m travellers. Dubai Airport is the gleaming aviation hub of the region, operating 84 airlines to and from 188 destinations.

Medical tourism hub

played a vital role to attract medical tourists who would traditionally go to Asia, Europe and the USA. Due to the travel ban in other countries, these medical tourists came to Dubai for the first time and, after experiencing high quality services along

MANSOOR AHMED

Executive Director (Middle East & Africa) Colliers

“One of the main reasons for Dubai’s quick resurgence in medical tourism is the effectiveness with which UAE and Dubai battled COVID-19, reflecting the strength and resilience of its medical infrastructure”

with a great hospitality environment, went on to become regular customers. Dubai also attracted those requiring critical care for issues such as cancer and other life threatening conditions that could not wait for travel restrictions to lift or for waiting lists to ease. In addition, the Emirate is adapting to the new normal by utilising digital technology to expand and improve telemedicine services, creating a more welcoming business environment to drive medical investment and innovation, and taking its advanced healthcare infrastructure to the next level.

Geographical position

One of the key factors enabling Dubai to become a top medical tourism hub is its strategic location and its connectivity with the rest of the world. One third of the world’s population with approximately 11 per cent of global GDP lives four hours’

Dubai is well positioned as a medical tourism hub thanks to exemplary government support, skilled healthcare professionals and state of the art healthcare. Other important stakeholders involved are the government, hospitality sector, tour operators and payors. DXH – a government-led initiative connects healthcare providers to medical tourists and visitors can obtain a medical tourism visa for long-term treatments in Dubai in its world class healthcare facilities that comprise 40,000 healthcare professionals from 110 nationalities. Custom-made comprehensive tourism packages (including costs of treatment, visas, hotel stays and recreational activities for accompanying family members) can be tailor-made in collaboration with hospitals, airlines, hotels, travel agents and health authorities. Dubai Health Experience (DXH) is part of Dubai’s health tourism strategy, aiming to position Dubai as a global destination for health tourism. The DXH portal provides visitors seeking treatment with a single platform for a seamless patient journey in Dubai. To further assist overseas health tourists, the portal provides information on visa requirements, hotel and flight bookings including the list of DXH partners and their services available for international patients. The DXH SMO Program aims to provide the patient with an easy and effective way of getting a better perspective and insight into their medical condition by reviewing medical reports, validating the original diagnosis and discussing the case with the referring doctor, including suggested treatment plans that incorporate the latest or alternate treatment modalities available in Dubai. 61

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In addition, unparalleled infrastructure, economic and political stability, a religiously and culturally tolerant population, and a range of events and activities make the UAE an ideal tourist destination.

Key statistics

Dubai received 674,000 medical tourists spending almost AED 1bn in 2022, an increase of AED 262m from 2021, with more than 60 per cent travelling from Asia and GCC. Up to 39 per cent of the medical tourists who came to Dubai were from Asian countries, 22 per cent from Europe and the Commonwealth of Independent States and 21 per cent from Arab and Gulf Cooperation Council (GCC) countries. The three specialities that saw the highest number of medical tourists were dermatology (31 per cent) dentistry (24 per cent) and gynaecology (18 per cent). Medical tourists from Asia, Europe and Africa, as well as from GCC and Arab countries, also visited Dubai for treatment in the fields of orthopaedics, plastic surgery, ophthalmology, fertility treatments, hospitalisation and recovery.

MANSOOR AHMED

Executive Director (Middle East & Africa) Colliers

“Dubai is well positioned as a medical tourism hub thanks to exemplary government support, skilled healthcare professionals and state of the art healthcare”

Medical tourism benefits

Most of the GCC countries are focussing on making the healthcare industry a key sector for economic diversification by providing incentives to the private sector to establish themselves in the healthcare landscape. The aim is not only to make the region a leading global medical tourism hub but also to reduce outbound medical tourism. Other important factors expected to benefit Dubai in attracting more medical tourism include the rapid increase in healthcare costs in Western countries and the lack or limitation of insurance coverage

for certain procedures, resulting in patients willing to travel to other countries to seek medical treatments. Similarly, long waiting time for life threatening conditions in systems like the UK NHS, such as oncology, can result in irreversible loss. Attributes such as international accreditations, cultural similarity, healthcare infrastructure, government initiatives and destination environment act as major drivers of medical tourism in Dubai. Some of the key attributes include: • International Accreditations: International accreditation helps bring universal standards to clinical process and patient safety, offering improved choice to cross-border patients and building increased trust throughout the global healthcare community. • Accessibility: People who cannot afford the long waiting time in their country prefer to travel abroad where high quality medical services, along with cutting edge technology are available without delayed wait times. • Cultural Similarity: Cultural similarity is one of the major drivers for development of medical tourism including food, ease of practising religious activities and language. For these reasons the UAE is the preferred destination for patients from GCC countries. • Destination Environment: Medical tourists often take advantage of their stay in a foreign country to travel for pleasure by scheduling a vacation before or after

their procedure. This is an inexpensive way to travel especially if their insurance provider is paying for the flight and the cost of staying is low. • Healthcare Infrastructure: Availability of beds and the availability of medical professionals per head of population attract patients who do not wish to wait. The build quality, look and feel of the health facilities are also attractive. • Government Initiatives: Governments have created dedicated platforms to highlight their country’s expertise and advancement in technology specifically in the healthcare sector. The aim of the Dubai government initiative – Dubai Health Experience – DXH is to strengthen health facilities in Dubai and the position of Dubai on the world map of health tourism. CONTACT INFORMATION

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

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Go global with Bevan Brittan We are 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.

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

With years of experience and global exposure, our healthcare teams have the expertise to support clients’ 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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Senior Partner and Head of Employment, Pensions and Immigration jodie.sinclair@bevanbrittan.com

Bevan Brittan LLP |

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Partner and Head of Independent Health & Care Real Estate sarah.skuse@bevanbrittan.com

MEET THE EXPERT

WHERE THE MIND MEETS THE BRAIN Sotiris Posporelis, Consultant Liaison Neuropsychiatrist, King’s College Hospital London, explains to HW Editor Sarah Cartledge the intricate link between the brain and the body

ealthcare today is increasingly recognising the link between mind and body. In this complicated landscape, where the boundaries between disciplines blur, neuropsychiatry emerges as a critical junction. Here neurology, neurosurgery, and various subspecialties intersect with

psychiatry and this dynamic field deals with a range of disorders where brain malfunction is clearly identifiable, ranging from strokes and traumatic brain injuries to neurodegeneration and functional neurological disorders. For Dr Sotiris Posporelis (Pospo), a consultant liaison neuropsychiatrist at King’s

College Hospital and part of the national specialist service at the Maudsley neuropsychiatry outpatient department, “One could argue that everything is neuropsychiatry.” In the early days, the lines between neurology and psychiatry were blurred, and even luminaries like Sigmund Freud began their careers as neurologists. He was, in fact, inspired by another fellow neurologist’s work (JeanMartin Charcot), on what was then called hysteria that he later laid the foundation for psychoanalysis. Today, neuropsychiatry stands at the crossroads of diverse medical disciplines, such as neurology, neurosurgery,

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MEET THE EXPERT Sotiris Posporelis

“Neuropsychiatry is the prototypical subspecialty that shows that there’s no distinction or divide between the mind and body

working closely with electrophysiology, and neuro-radiology, too. In his work at Kings College Hospital, which is a major trauma centre with a capacity of more than 1000 beds, Pospo sees a vast range of patients with really diverse presentations, including those where dysfunction is apparent, but the underlying cause, may remain elusive. It is the close collaboration between different subspecialties that ensures comprehensive and effective treatment for their patients. Another focal point in neuropsychiatry is the recognition and management of functional neurological disorders. “These are conditions arising primarily from a disorder of nervous system functioning, rather than a clearly

identifiable pathophysiological disease as Professor Jon Stone eloquently put it”, Pospo says. “They present with genuine neurological symptoms such as seizures, tremor, paralysis (among others) that can be positively identified as functional. It is a common diagnosis that can have debilitating effects on people’s function and well-being”, yet negative misconceptions and lack of expertise have been hindering people from getting appropriate help.

Technology and psychiatry

Pospo’s passion for his subject is evident when he speaks. “As a medical student I was always attracted to the brain,” he says. “I was split between neurology and

psychiatry until I realised I could study them together in the UK which offers training programmes not often available in the rest of the world. The brain is vast, complex and fascinating but sadly psychiatric patients don’t always receive all the appropriate treatment they need.” With more than 30 professionals in the Kings Liaison psychiatry team, including medics, nurses, and psychologists, and 50 in the Maudsley neuropsychiatry department, these teams are recognised as world leaders in clinical neuropsychiatry. In addition, they foster cutting-edge research through tight clinical and academic links with institutions like the Institute of Psychiatry, Psychology and Neuroscience (IoPPN). Technology plays a pivotal role in advancing neuropsychiatric care. “It can help in multiple ways and multiple levels, such as electronic record systems that facilitate quick access to patient history and investigations, promoting a holistic understanding of a patient’s health journey.” Ever-evolving neuroimaging techniques alongside robust clinical skills can enhance both diagnosis and management, from Epilepsy to Parkinson’s and beyond. Innovative technologies extend to mobile health apps, virtual reality, and artificial intelligence, making personalised medicine a reality, all aiming to enhance the patient experience. Mobile health apps, for instance, may aid in predicting relapses or ensuring adherence with prescribed medication. Virtual reality headsets can be implemented in psychiatry to help people with anxiety disorders and functional neurological disorders, providing innovative therapeutic approaches. “King’s is a centre of excellence for neurosciences, where patients can access innovative technologies, like deep brain stimulation. Essentially this is a neurosurgical operation, whereby implanted electrodes stimulate select 65

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brain regions to alleviate the symptoms of a variety of disorders, including Parkinson’s, where it can make a massive difference in people’s lives,” he says. He also highlights the significance of pharmacogenomics, where understanding how genes affect drug response allows for more personalised and effective medication choices.

Autoimmune disorders

Autoimmune disorders may also affect the brain, and present a challenging aspect of neuropsychiatry. “Autoimmunity can affect various

different organs and neuropsychiatric lupus is a really good example, whereby close collaboration between Rheumatologists and Neuropsychiatrists can greatly benefit patients”, he says. Autoimmune encephalitis, characterised by inflammation of the brain due to autoimmune responses, is another good example of how good clinical skills and appropriate investigations can make a difference, as frequently the correct diagnosis is missed and patients do not receive much-needed treatment. Early recognition, especially in young individuals with a first episode of

psychosis of acute/subacute onset , can make a significant difference. “Encephalitides can be of various causes. Ten years ago, viral causes would have accounted for the majority of these presentations. Fast forward to nowadays and autoimmune aetiologies surpass infective ones,” Pospo says. The improved detection of autoimmune antibodies has played a pivotal role in this shift, enabling targeted diagnostic approaches and more effective treatments. “There is also the association between autoimmune encephalitides and neoplasms, such as ovarian tumours,

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MEET THE EXPERT Sotiris Posporelis

“Integrating mental health into overall health care is essential as is a holistic approach that treats mental health disorders with the same attention as other health conditions” so we would recommend a pelvic ultrasound in young women who present with a first episode of psychosis and suspicion of an autoimmune process, like NMDAR Encephalitis.” Without wanting to oversimplify, Pospo suggests that dying (apoptotic) tumour cells can

trigger an autoimmune response that further down the line can lead to the production of antibodies against NMDA receptors in the brain. This, in turn, results in neuropsychiatric symptoms. The treatment involves immunotherapy (steroids, intravenous immunoglobulin,

plasma exchange, rituximab among others) and close monitoring by Neuropsychiatry that plays a crucial role in supporting patients during the acute phase of the illness, but also aiding in their rehabilitation. Genetics may also be a key consideration in neuropsychiatric disorders, but Pospo is keen to dispel the idea that genetics solely hold the key to everything. “With only a few exceptions, neurosychiatric disorders are not the byproduct of only one thing, but due to the complex interaction of many things, including genes and the environment”. 67

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SOTIRIS POSPORELIS • • • • • • • • •

Consultant Liaison Neuropsychiatrist Hon. Clinical Senior Lecturer in Psychiatry, IoPPN The Maudsley MRCPsych Course Organiser Chair, Liaison Psychiatry Education Committee, Royal College of Psychiatrists Maudsley Research + Development Team Clinical Placement + Module Lead, Clinical Neuropsychiatry MSc, IoPPN Academic Lead, Maudsley Grand Rounds, IoPPN South London and Maudsley NHS Foundation Trust Department of Psychological Medicine King’s College Hospital NHS Foundation Trust

A holistic approach

In his education work, Pospo stresses that link between mind and body to all his trainees. “Neuropsychiatry is the prototypical subspecialty that shows that there’s no distinction or divide between the mind and body,” he says. Rejecting the idea of an organic versus non-organic divide in mental health, he highlights the interconnectedness of the brain and the body. “Our brain helps us make sense of our environment, with functions that span speech, movement, breathing, memory, emotions and so many others. If there is a malfunction, then obviously there will be consequences. This is not to say that our life experiences and environment are irrelevant, the opposite, but ultimately- in ways that we still don’t fully grasp- they all affect the brain and there’s nothing nonorganic about the brain”. Sadly though, this mind-body division at times fuelled stigma attached to mental health. There is systematic underrecognition and treatment of other health comorbidities in individuals with mental health disorders. In a seminal Lancet Psychiatry paper by Claire Henderson, it was shown that people with mental illness and substance misuse disorders receive lower quality treatment for various other

physical illnesses including cardiovascular disease, diabetes, HIV, hepatitis, and cancer than do people without mental illness. This significant health inequality leads to substantial morbidity and premature mortality. “Integrating mental health into overall health care is essential as is a holistic approach that treats mental health disorders with the same attention as other health conditions,” he says. Although a starting point might be upskilling primary care professionals, this can be hampered by underfunding and significant pressures healthcare systems face worldwide. Pospo suggests the integration of mental health professionals into GP practices to support early identification and management of mental health disorders, which is something the Maudsley has been pioneering. “The key lies in integrating care, fostering good communication between clinicians, and leveraging digital health solutions to tackle the existing fragmentation in healthcare.”

Education in mental health

For Pospo, fostering emotional intelligence is paramount. “Kids nowadays are way more in tune with their emotions than previous generations, but we still need to work on challenging the stigma attached to mental health which prevents some people from openly seeking help,” he says. An unexpected beneficial outcome of the COVID-19 pandemic was the

adoption of new technologies and virtual platforms, providing unprecedented access to mental health resources, like BRAINCAST, a video podcast series Pospo created during the pandemic that is freely available on the Maudsley Learning website. Maudsley Learning runs a vast number of both in-person and online mental health training courses for individuals and organisations to help them enhance their knowledge and skills to support others. “COVID broke down the geographical barriers,” Pospo says referring to the Neuropsychiatry course that he used to run face to face but now delivers online. “People signed up from all over the world and it gave them access to information delivered by world experts that they otherwise would not have had. Technology has also begun to break down cultural barriers and allows people from different cultures to work together in real time, enabling them to better understand and deliver their services.” CONTACT INFORMATION

sotiris.posporelis@slam.nhs.uk Twitter @pospo LinkedIn www.linkedin.com/in/posporelis

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SAVE THE DATE • SAVE THE DATE • SAVE THE DATE

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THE DUBAI INVESTMENT GUIDE Healthcare needs and opportunites in Dubai

ubai boasts a robust and progressive healthcare sector, offering a plethora of opportunities. The city has strategically invested in healthcare, fostering a worldclass infrastructure that attracts global professionals and entrepreneurs. The healthcare landscape in Dubai is diverse, encompassing cutting-edge medical facilities, advanced technology, and a range of specialised services. With a commitment to innovation and quality care, the city has

become a hub for medical tourism, drawing patients from around the world seeking top-notch treatments and procedures. Population growth is considered as a major demand driver for the healthcare sector. The population of Dubai reached 3.5m by end of 2022 and is expected to reach 4.1m by 2030 at a CAGR of two per cent in a base case scenario. Dubai’s bed per 1,000 was 1.4 in 2022, which is below the global average of 2.9, hence there is demand for outpatient and inpatient facilities providing

essential and specialised healthcare services. In addition, the population above the age of 60 years is expected to increase threefold by 2030 which will have significant implications on the demand for elderly care services such as homecare services, long term care and rehabilitation facilities. Dubai has been divided into nine geographical sectors. Each sector features meticulously planned residential development with a focus on specific demographic and income profile. These upcoming developments will require specific healthcare facilities based on the profile of the catchment area. Sector three has the highest volume of population, while sector five and nine have witnessed a faster growth in population due to recent master development plans.

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DUBAI INVESTMENT GUIDE Knight Frank

Furthermore, Dubai witnessed a 15 per cent increase in High Net Worth Individuals(HNWIs) between 2021-2022. A recent study conducted by Knight Frank depicts that healthcare facilities were an important consideration for the HNWI in choosing a residential community. This consideration creates a variety of opportunities for outpatient and inpatient facilities within the sectors expected additional supply of residential units.

SHEHZAD JAMAL

Partner - Head of Strategy & Consultancy, Healthcare, Education, MEA Knight Frank Middle East

“There is a pronounced need for innovative healthcare solutions, presenting substantial prospects for existing, emerging and international healthcare service providers”

“The Emirate of Dubai is currently in a period of sustained transformation, as governmental bodies and regulatory authorities endeavour to nurture economic prospects and enhance the wellbeing of both citizens and residents,” says Shehzad Jamal, Partner Head of Strategy & Consultancy, Healthcare, Education, Knight Frank Middle East. “The overarching objective, outlined in the Dubai Economic Agenda (D33), is to elevate Dubai into one of the world’s top four

financial hubs within a decade, attracting foreign direct investments surpassing AED 700bn. Additionally, there exists a comprehensive urban development plan aimed at rendering Dubai a ‘20-minute city’. “Central to our social framework is the role of healthcare in ensuring the realisation of these objectives and the welfare of the populace. Consequently, there is a pronounced need for innovative healthcare solutions, presenting substantial prospects for existing, emerging and international healthcare service providers to broaden their scope of operation within Dubai.”

Healthcare investment focus areas

Long Term Care and Rehabilitation Demand has increased for specialised centres and inpatient facilities for rehabilitation, expanding home health and telehealth services for consultations, in addition to remote monitoring for less complex cases. • Several studies indicate that one in 59 children suffer from autism, one in 12 have disorders related to speech or language. • WHO estimated approximately 16 per cent of the world’s population is living with some form of disability. People with a disability have twice the risk of developing conditions such as depression, asthma, diabetes, stroke, obesity or poor oral health. A certain percentage of this population suffers from severe disability such as quadriplegia or blindness requiring specialised care services such as physiotherapy, speech therapy and so on. • Furthermore, Dubai’s population over the age of 60 is estimated to grow from two to six per cent by 2030, leading to demand for healthcare services in general and geriatric care.

Chronic Disease Management and Tertiary Care

The growing demand for specialised centres to be set up in order to provide specific treatments is clear, in order to meet prevention, diagnosis and treatment needs. • In the UAE, non-communicable diseases account for 76 per cent of deaths; 16 per cent suffer from diabetes, 40 per cent are overweight and cardiovascular diseases are up to three times higher than in some developed countries. • Chronic disease management can benefit from ambulatory care centres and remote monitoring programmes which can help decrease cost and burden on healthcare facilities. 71

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• In UAE, the current density of beds catering to mental health services is observed to be 14 beds per 100,000, which is lower in terms of other developed nations.

DR. IBTESAM AL BASTAKI Director Of Investment & Partnership DHA

“At the heart of our healthcare investment strategy is a commitment to fostering innovation, collaboration, and partnerships”

Urgent Care

Approximately 60 per cent of cases reported in the emergency department in Dubai are non-critical cases. Urgent care clinics with telehealth application collaboration would be able to reduce the pressure on the ERs and decrease the rising costs from utilisation of services in the premium segment.

Wellness and Anti-Ageing

Demand for wellness facilities has increased globally, with a shift towards prioritising holistic health and wellbeing. • In 2022, Dubai received over 674,069 tourists, generating over AED 992m in total healthcare revenue. • In 2022, an international tourist visiting Dubai spent 41 per cent more than the average international tourist, while a domestic tourist spent 175 per cent more here than the average domestic tourist anywhere else.

• Wellness tourism has increased due to factors such as ageing populations, increased disposable income and increased health awareness.

Precision Medicine

Investors are encouraged to focus on the development of novel and groundbreaking personalised medicine solutions towards improving overall health outcomes. • The Middle and East Africa precision medicine market is expected to grow by 11 per cent annually to 2026 to be worth $142 bn globally. • The UAE launched the National Genome Strategy to help guide advanced healthcare research, innovation and future technology use. This is one of the most comprehensive genomic regulatory initiatives in the world.

Mental Health

In Dubai, there is a need for dedicated inpatient and outpatient facilities for mental health to manage the demand. • Neuropsychiatric disorders contribute 20 per cent of the burden of disease in UAE; 75 per cent of these are psychological conditions such as depression and anxiety. • Between 2018 to 2022, the outpatient volumes in Dubai for mental and behavioural health grew at a CAGR of 20 per cent in the private sector and 39 per cent in the public sector.

“At the heart of our healthcare investment strategy is a commitment to fostering innovation, collaboration, and partnerships that will help us achieve our goals. We believe that by working together with leading healthcare providers, researchers and innovators from around the world, we can create a healthcare ecosystem that delivers exceptional patient care, drives medical innovation, and contributes to the overall well-being of our society,” says Dr. Ibtesam Al Bastaki, Director of Investment & Partnership at the DHA. “By focusing on start-up innovation, collaboration and partnership, we can ensure that Dubai continues to be a leading destination for healthcare investment and innovation, and that we provide our citizens and residents with the best possible healthcare services.”

Key success factors

• Basing the healthcare concept on the needs of the immediate catchment population - patients most often visit local healthcare facilities for the majority of their health and care requirements, except for certain services which are limited to specialist healthcare facilities. • Focusing on highlighted services and facilities which present the most opportunity in Dubai - such as mental health care and support, wellness and anti-ageing. • Defining the target segment, while introducing a new brand into Dubai – affordable vs mid-market vs premium offerings. • Utilising the hub and spoke model of healthcare which has been identified as successful for brands seeking to establish a chain of healthcare facilities.

CONTACT INFORMATION

www.dha.gov.ae

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An exciting new concept in neurodiverse assessment and care

ADHD 360 delivering improved patient outcomes

Rapid progress to superior life experiences through a revolutionary care pathway Ubiquitous access through appropriate use of telehealth technology Organisational efficiency reducing the cost of care and improving affordability Clinical development training on the ADHD 360 Academy promoting neurodiverse expertise across the UK health workforce.

ADHD 360, a virtual clinic for the assessment, diagnosis, and treatment of neurodiverse conditions. A disruptive business model, highly focussed and motivated team, plus the drive of a determined leadership have created Europe’s largest provider. Harnessing the best of telemedicine and face to face consultations through a combination of video conferencing, bespoke IT platform, and patient portal. Now assessing an average of 1000+ patients each month. A paradigm improvement in clinician productivity with a bespoke rules-based process and the support of a highly motivated and efficient front office team all trained in the ADHD 360 Academy. A service with quality at its core, rigorously audited by the UK Care Quality Commission, caring for previously under provisioned patients and their families.

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19/01/2024 10:51 18:45 16/01/2024

MOROCCO’S HEALTHCARE INDUSTRY Andrea Tithecott and Nesrine Roudane, Partners at Al Tamimi & Company, examine perspectives for healthcare investment in Morocco

ocated at the crossroads of Africa and Europe, Morocco offers a favourable environment for investment in the healthcare sector. In Morocco, there are three main sectors in the healthcare industry: pharmaceuticals, medical devices, and private medical establishments. The Moroccan healthcare sector is evolving rapidly and offers numerous investment opportunities. Morocco’s private

healthcare sector is booming, with over 360 private clinics and more than 9,661 medical specialists. Morocco is also focusing on improving medical infrastructure by creating new university hospital centres (CHU), emergency units and mobile hospitals. Some of these projects offer a wide range of investment opportunities, including construction, the supply of medical equipment and the provision of medical services, among others.

Morocco offers strategic advantages that make it an attractive destination for investors in the healthcare sector. First and foremost, its geographical position makes it a point of convergence between Africa, Europe, and the Middle East, offering access to international markets. In addition, the country boasts a skilled medical workforce, guaranteeing high-quality services. Labour costs are also competitive with Western countries, offering a significant economic advantage. To ensure the success of their investments in Morocco’s healthcare sector, investors can actively engage in managing the necessary procedures. Indepth knowledge of local regulations and meticulous research are essential.

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LEGAL Al Tamimi & Company

In addition, establishing partnerships with local players can facilitate market integration and ensure a thorough understanding of local needs and opportunities.

NESRINE ROUDANE

Partner, Morocco Office Al Tamimi & Company

“Establishing partnerships with local players can facilitate market integration and ensure a thorough understanding of local needs and opportunities”

The pharmaceutical market

The pharmaceutical market in Morocco is governed by Dahir n°1-06-151 of 30 chaoual 1427 (November 22, 2006), implementing law No. 17-04 on the drug and pharmacy code. This law defines a medicine as any substance or composition with curative or preventive properties against human or animal diseases, as well as any product that can be administered to humans or animals to establish a medical diagnosis or restore, correct, or modify their organic functions. All aspects of medicines and pharmaceutical products are governed by law No. 17-04, including marketing, authorisation, manufacture, import, export, sale and distribution. It also lays down strict rules for the transport,

storage and destruction of medicines unfit for consumption. It is important to point out that all medicines, whether industrially manufactured, imported, or exported, including samples, must obtain authorisation from the authorities before being marketed or distributed, whether wholesale or retail, in return for payment or free of charge. To obtain this, it is essential that the drug complies with current regulatory requirements. Compliance with these requirements is intended to guarantee the safety, quality, and efficacy of medicines, which is crucial to the protection of public health. Regulatory authorities ensure that medicines meet these standards before authorising them to be marketed, distributed, or used. 75

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Another important provision of Law No. 17-04 is the regulation of drug imports. Under this law, all imports of medicines require a health visa issued by the relevant authorities. The main purpose of this visa is to guarantee traceability of imported medicines, particularly regarding their place of manufacture or origin. This measure aims to reinforce the safety and quality of medicines on the Moroccan market. Where there’s import, there’s also export, which is why Law No. 17-04 requires any industrial pharmaceutical establishment exporting a drug to apply to the authorities for a certificate of free sale. This certificate attests that the drug intended for export has been granted a marketing authorisation, thus guaranteeing its compliance with current standards. This strengthens the credibility and traceability of exported medicines. Moroccan legislation on pharmaceuticals attaches great importance to the storage

ANDREA TITHECOTT

Partner, Head of Regulatory Practice, Healthcare & Life Sciences Corporate Commercial Al Tamimi & Company

“Morocco offers a favourable environment for investment in the healthcare industry, with a solid legal framework, strategic advantages, and rapid growth in the sector” and transport of medicines, requiring that these operations be carried out in such a way as to preserve their quality and prevent any deterioration. This requirement aims to maintain the integrity of medicines throughout their supply chain, from manufacture to use, to guarantee their efficacy and safety. These provisions reinforce the safety and quality of medicines on the Moroccan market.

The medical devices market

Dahir n°1-13-90 of 22 chaoual 1434 (August 30, 2013) established law No.84-12 on medical devices in Morocco. This law defines a medical device as any instrument, apparatus, equipment, material, product, or other article intended for use in humans for medical or surgical purposes, including accessories and software involved in its

operation. This medical device cannot achieve its main purpose by using pharmacological, immunological, or metabolic mechanisms, but it can help to accomplish its function. Companies manufacturing, importing, exporting, and distributing medical devices are subject to the Medical Devices Regulation. It defines the requirements for the marketing and use of medical devices, including registration, traceability, and withdrawal of registrations in the event of non-compliance. This legislation has allowed medical devices to be classified according to their uses, including the diagnosis, prevention, control, treatment, or alleviation of disease, as well as the diagnosis, control, treatment, alleviation or compensation of injury or disability. It also includes medical devices used for the study, replacement, or modification of anatomy, as well as those used for the diagnosis, study, replacement, or modification of physiological processes, including those related to procreation. Medical devices are classified according to various criteria, including their duration of use, their nature, their use, and the part of the body to which they are applied. A fundamental condition is that these medical devices must meet essential quality, safety, and performance requirements, guaranteeing a high level of safety. As regards the importation, exportation, and distribution of these medical devices, it is imperative to submit a declaration to the competent administration. This declaration must be accompanied by a complete file containing all relevant documents relating to the device in question. These provisions are designed to guarantee the quality, safety, and efficacy of medical devices on the Moroccan market.

Private medical clinics

Morocco has private medical clinics that are governed by the 2nd Title of Dahir n°1-15-26 of 29 rabii II 1436 (February 19, 2015), promulgating law 131-13 concerning the practice of medicine. Clinics are private health establishments that provide diagnosis and care to the sick, injured, pregnant or parturient women within the framework of hospitalisation for the period necessary for their state of health, in accordance with this law. Furthermore, in accordance with current regulations, clinics can provide rehabilitation services and be part of the emergency medical assistance service (SAMU).

The law defines the operating rules for clinics and the procedures for obtaining authorisations to set up and operate. It also establishes standards for the practice of clinics, guaranteeing high standards of quality and safety in private-sector healthcare. To set up a clinic, prior authorisation must be obtained from the relevant government authority, after consultation with the National Council, even before construction work begins. Once construction work has been completed, the clinic can only begin operating once final authorisation has been obtained from the competent authority. The authorities may ask the clinic’s founders to provide further documents to obtain this authorisation. In addition, the plan to set up the clinic must be implemented within three years of the date of issue of the prior authorisation. Moreover, the clinic must comply with the management rules laid down

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LEGAL Al Tamimi & Company

by law, particularly with regard to audit procedures and the roles of the medical director, the medical committee and the ethics committee.

Why invest in Morocco’s healthcare sector?

Foreign investment in the medical sector depends to a large extent on the way healthcare services are reimbursed, notably through the “Assurance Maladie Obligatoire” (AMO) scheme managed by the “Caisse Nationale de Sécurité Sociale”(CNSS). Initially limited to specific treatments, the AMO care package has been progressively extended to include outpatient care, dental care and facial orthodontics for children, thus covering a complete range of benefits. At the same time, patients can also benefit from reimbursement of certain medical services via private mutual insurance companies, subject to agreements between private clinics and insurers, and have the option

of self-financing medical services without recourse to health insurance or public funds. In the latter case, reimbursement does not depend on a third-party payor, but is made directly by the patient himself, offering flexibility in healthcare financing options. There are numerous investment opportunities for foreign investors in Morocco’s healthcare sector. This includes not only medical tourism, which offers a variety of services such as cosmetic surgery, elective surgery, and fertility treatments, but also dental care and aesthetics in response to a growing demand for quality dental care. Aesthetic dental services such as Hollywood smiles, dental implants, dental veneers, and dental crowns also offer opportunities. In addition, there are significant investment opportunities in the surgical sector. In Morocco, specialisations such as cardiovascular, orthopaedic, ophthalmic, urological, neurosurgical, visceral and

ENT surgery are being developed. In addition, due to growing demand for these procedures, cosmetic surgery of the face, figure and breasts is also available. Bariatric surgery, which includes procedures such as by-pass, sleeve/ gastrectomy, and the use of the Allurion balloon, is a particularly attractive area for investment. Morocco offers a favourable environment for investment in the healthcare industry, with a solid legal framework, strategic advantages, and rapid growth in the sector. Investors can become actively involved in managing procedures to ensure the success of their investments. CONTACT INFORMATION

www.tamimi.com

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FOCUS ON PATIENT ETHICS Zanteris

PATIENT ETHICS

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DEVELOPING THE MEDICINES OF THE FUTURE Understanding ethics and patient rights in clinical trials is vital for the advancement of treatments, says Mike Failly Managing Director of Zanteris

linical trials are at the forefront of medical research and involve human subjects. Such trials are studies that test the safety and effectiveness of medical treatments, and they involve individuals who volunteer to participate. These individuals may be dealing with illness and may be in a vulnerable state. For this reason it is crucial to protect their rights and wellbeing and

carefully consider the trial’s potential risks and benefits. Ethics in clinical trials refer to the moral principles and values that guide the conduct of research involving human subjects. Ethics provide the guidelines to make sure every clinical trial is done in a fair and responsible way, ensuring that research is conducted in a respectful, fair, and transparent manner.

Patient rights ensure individuals are treated fairly and respectfully during their participation in the trial, including the right to make their own decisions about whether or not to participate in the trial. They also have the right to know what the trial involves and to have all the information they need. The history of ethics and patient rights in clinical trials dates back to the mid-20th century. Several unethical experiments, such as the Tuskegee syphilis study and the Nazi experiments, were conducted during this time. These incidents led to the establishment of the Nuremberg Code and the Declaration of Helsinki. The Nuremberg Code was established in 1947 and outlines ten principles that have become the foundation of modern research ethics.

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FOCUS ON PATIENT ETHICS Zanteris

3. Beneficence - the ethical responsibility of researchers to promote participants’ wellbeing and best interests in research studies. The principle of beneficence requires researchers to take steps in ensuring the benefits of a study outweigh its potential risks. For example, researchers may only use placebos in a study if they are confident that the placebo will not cause harm to participants. 4. Non-maleficence - The nonmaleficence principle that requires researchers to ensure their studies do not cause unnecessary harm to their participants. This includes using the most up-to-date scientific knowledge and technology and designing the study in a way that minimizes the potential for harm. Researchers must also be prepared to stop a study if it becomes clear that it is causing harm to participants.

Major ethical considerations in clinical trials are:

Regulatory framework for ethics and patient rights in clinical trials

The regulatory framework for ethics and patient rights in clinical trials is a set of rules and guidelines to ensure that research studies involving people are done in a fair and safe way. By following the regulatory framework’s principles and guidelines, researchers can ensure their studies are ethical and safe. The four fundamental principles of ethics in clinical trials are: 1. Autonomy - the ethical obligation that ensures researchers respect participants’ right to make their own choices. The principle of autonomy requires that researchers obtain informed consent from participants

before they participate in a study. Researchers must provide participants with all the information they need to make an informed decision about whether or not to participate. 2. Justice - the principle of justice that ensures research studies are fair to every participant. Researchers are to choose participants in a way that is not biased or unfair. This could mean using a random selection process or other methods to make sure that the group of people in the study represents the larger population. Researchers must also ensure that the benefits and risks of the study are shared fairly among all the participants.

Informed Consent Process - a process in which participants are given information about what the study involves. This information includes why the study is being done, the risks and benefits, and other vital information. This process gives participants a chance to ask questions and make a decision about whether or not they want to be part of the trial. It’s important that the information is given in a way that respects the rights of each individual and in a way they can understand. Throughout the trial, participants should be kept up to date about any changes that might affect their decision to keep participating. They should also be reminded that they can stop being part of the trial at any time without any negative consequences.

MIKE FAILLY Managing Director Zanteris

“Ethics in clinical trials refer to the moral principles and values that guide the conduct of research involving human subjects”

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Confidentiality and privacy of participants - privacy and confidentiality is a critical ethical consideration as participants may share sensitive information during a trial. Researchers and stakeholders must take steps to ensure that personal information is kept safe and secure. This might include encryption and access controls to ensure access only to those who need to see the information. There should also be policies in place to deal with any situations where confidentiality might be breached.

Minimisation of risk and maximisation of benefits

Clinical trials should be conducted in a way that ensures the safety of participants and the potential for human benefit. For these reasons, the research should be designed carefully and ensure the risks to participants are worth the potential benefits. Identifying the potential risks and reducing their likelihood includes choosing participants who are a good fit for the study, and using small amounts of drugs or treatments. If something does go wrong during the trial, the research team needs to be ready to respond quickly and take appropriate action. The research team should also work with an Ethics Committee (EC) or an Institutional Review Board (IRB). These groups can review the study design and ensure that it’s being done in a safe and fair way for everyone involved.

Monitoring and reporting adverse events

During a clinical trial, the team should keep a close eye on what’s happening and report any unexpected or unwanted medical events that occur. These adverse events may be related to the treatment being studied or not related at all. If an adverse event happens, the research team needs to take action to make sure that the person gets the right medical care. This might mean changing the treatment being studied, providing extra medical care, and stopping the trial if serious. The research team must report any adverse events to the right people, like regulatory authorities and ethics committees as per their local regulations. This helps make sure that the trial is being done in a responsible and ethical way and that everyone involved is kept safe.

Protecting patients’ rights in clinical trials

Clinical trials are essential for developing new medical treatments and making sure they’re safe and effective for patients. Ensuring the people who participate in these trials are treated fairly is as important as the reason for conducting clinical trials. Right to privacy and confidentiality this right is backed by the General Data Protection Regulation (GDPR), a legal

MIKE FAILLY Managing Director Zanteris

“Clinical trials should be conducted in a way that ensures the safety of participants and the potential for human benefit”

framework that imposes obligations on organisations collecting data of individuals residing in the European Union (EU). Failure to adhere to GDPR guidelines results in harsh fines and penalties. Researchers must protect participants’ personal information from unauthorised disclosure, by following strict security protocols. Right to informed consent - researchers must provide participants with information about the study, including the purpose, risks, and benefits of the study. Clinical investigators must allow participants to make an informed decision about whether they want to participate in the study or not. Right to withdraw from the trial Researchers must inform participants of their right to withdraw from the trial at any time without penalty at the start of the study. They must communicate this to the participants in a way they can easily understand.

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FOCUS ON PATIENT ETHICS Zanteris

Right to access trial-related information - researchers and clinical investigators must provide participants with the result of the study and other information in a timely and transparent manner.

in clinical trials can help ensure that the study is designed to meet everyone’s needs. This can make participants feel comfortable sharing their thoughts and ideas and can lead to the development of new treatments and interventions.

Right to compensation for injury or harm - patients have a right to compensation for any injury or harm that may occur due to their participation in the clinical trial. This includes compensation for medical expenses, lost wages, and other damages. Researchers must inform participants where they can receive treatment if they have a research-related injury and should communicate clearly who will pay for research-related treatment. Clinical researchers must ensure they treat research participants with respect, fairness and honesty by protecting their rights. This will help ensure that the research is conducted in an open way and that the participants’ wellbeing is safeguarded. In addition, collaboration

Adherence to ICH-GCP

ICH-GCP stands for the International Council for Harmonization of Technical Requirements for Pharmaceuticals for Human Use (ICH) Guideline for Good Clinical Practice (GCP). Adhering to ICH-GCP guidelines is essential for conducting ethical clinical trials. GCP is a set of international standards that help ensure clinical trials are designed, conducted, and reported in an ethical and scientifically valid way.

Training and education of trial personnel

Before conducting ethical clinical trials, everyone involved in the study must receive adequate training and education. This includes the principal investigators,

study co-ordinators, nurses, and other staff members. They need to understand the ethical principles that guide clinical research and be familiar with the study protocol and procedures. When everyone is aware of the importance of ethics and rights, it ensures that the study is conducted with the participant’s best interests in mind. By incorporating these principles into every aspect of clinical trial conduct, we can ensure that research is conducted safely. Researchers, sponsors, ECs/IRBs, and regulatory bodies all have a role in prioritising ethics and patient rights in clinical trials. In this way, clinical research can continue to improve patient outcomes while upholding ethical standards. CONTACT INFORMATION

www.zanteris.com contact@zanteris.com

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PARTNERSHIPS

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HEALTH PARTNERSHIPS Browne Jacobson

PLANNING THE FUTURE OF HEALTHCARE Carly Caton and Gerard Hanratty, Partners, Browne Jacobson LLP ask if integrated care systems are the right approach

n the UK the requirement for organisations involved in the delivery of care to NHS patients to collaborate between themselves and across the healthcare system has now become law. There is a duty on healthcare organisations and providers within the NHS system to collaborate rather than compete. But what benefits does this collaboration bring and do other health systems around the world put partnership, integration

and collaboration at the core of how they work? How well are we doing globally with providing an integrated healthcare system to our populations and what are the benefits of doing so?

Integrated care systems in England

Integrated care systems (ICSs) are partnerships that bring together NHS organisations, local authorities and other relevant stakeholders to take collective

responsibility for planning health and care services, improving the health of the population and reducing inequalities across geographical areas in England. There are 42 ICSs across England, covering populations of around 500,000 to 3m people each. ICSs are the centrepiece of the reforms introduced through the Health and Care Act 2022 and are part of a fundamental shift in the way the English health and care system is organised. Following several decades during which the emphasis was on organisational autonomy, competition and the separation of commissioners and providers, ICSs depend instead on collaboration and a focus on places and local populations as the driving forces for improvement. There is general consensus among those involved with the health 85

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sector, and more broadly, that this is a “good thing to do” and that, if done well, it will: benefit the patient, improve patient pathways, improve outcomes in population health, reduce inequalities, improve access and enhance productivity and value for money. To support these aims each ICS in England has the purpose of bringing partner organisations together to: • improve outcomes in population health and healthcare • tackle inequalities in outcomes, experience and access

• enhance productivity and value for money • help the NHS support broader social and economic development.

Health systems partnerships around the world

When we look at other countries around the world, we can see quite a difference in approaches to how health systems are organised. There are other adopters of this more joined-up approach, but in certain places the system is still siloed and fragmented.

Well-integrated health systems

In the Kingdom of Saudi Arabia we see a similar approach to the Integrated Care Systems in Health Clusters. These organisations are being established in the regions to facilitate patient access to a more integrated and interconnected network of service providers, subject to one administrative structure overseen by the Ministry of Health. In fact, this transformation is a key element of Saudi Arabia’s “Vision for 2030”. The key reforms are centred around improving access to health services,

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HEALTH PARTNERSHIPS Browne Jacobson

CARLY CATON Partner Browne Jacobson

“Integrated care systems are based on the aspiration to benefit patients by providing coordinated and seamless care across different healthcare providers and settings”

expanding the provision of e-health services and digital solutions, as well as improving the quality of health services. Like many other countries, Saudi Arabia wants to move from a curative system which effectively addresses sick care to a preventative system that addresses health care based on the principle of value-based care, involving privatisation through adopting Public Private Partnerships (PPPs). Specific aims in improving the quality of services and access to them will focus on optimising coverage, including geographically,

through expanding e-health services and digital solutions. Estonia has also been implementing an integrated care system since 2008 to provide seamless and patient-centred care. The system includes electronic health records, e-prescriptions, and a national health information exchange. According to a 2019 report by the European Observatory on Health Systems and Policies, Estonia’s integrated care system has shown promising results in improving patient outcomes and reducing healthcare costs. 87

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In the Netherlands there is also a well-established integrated care system. The Dutch healthcare system is highly decentralised, and the responsibility for healthcare delivery is shared between municipalities, health insurers, and healthcare providers. The system is based on the principle of “managed competition,” which aims to promote quality, efficiency, and innovation in healthcare. The Dutch integrated care system includes various initiatives such as disease management programmes, multidisciplinary care teams, and electronic health records. Denmark, Sweden, and Australia amongst others are also noted for having well integrated healthcare systems.

Less integrated approaches

The United States, Brazil, and India may be said to have less integrated care systems. In the US, healthcare is largely delivered through a more fragmented system of private insurance providers, healthcare facilities, and government programmes. This can lead to challenges in coordinating care across different providers and settings, which can result in inefficiencies and gaps in care. However, the system of integrating a patient’s pathway delivered by some private insurance providers is a positive approach to holistic health provision that may be worth considering. Similarly, in Brazil and India healthcare is delivered through a mix of public and private providers, which can lead to fragmentation and challenges in coordinating care. In these countries, there are also significant disparities in access to healthcare services, which can further exacerbate issues related to integration.

The benefits of an integrated care system

Integrated care systems are based on the aspiration to benefit patients by providing coordinated and seamless care across different healthcare providers and settings. This should lead to improved health outcomes, better patient experience, and reduced healthcare costs. Patients can also benefit from increased access to preventative care, early diagnosis, and timely treatment. In the Netherlands, for example, integrated care systems have been shown to improve patient outcomes for chronic conditions such as diabetes and COPD. In Denmark, integrated care has led to reduced hospital admissions and improved patient satisfaction. In Sweden, integrated care has

been associated with improved quality of care and reduced healthcare costs. This greater integrated care in nations in theory should provide a more joinedup international approach to develop the benefits of shared knowledge, through greater joint research on such as genomics, to support the building of a preventative health culture.

GERARD HANRATTY Partner Browne Jacobson

“Many systems still remain fragmented, focused on episodic acute care and are unsuitable to solve complex health needs through a patient-centred approach” Across OECD countries, ageing populations and an increasing number of people living with chronic diseases has shifted the focus of health and care delivery beyond acute hospitals. Almost two in three people aged over 65 years live with one or more chronic conditions, often requiring multiple interactions with different providers, thus making them more susceptible to poor and fragmented care. Ensuring health systems are people-centred is a goal of most countries. This approach requires integrated systems capable of continuous, co-ordinated, and high-quality healthcare delivery throughout a patient’s lifetime. Despite mostly locallevel promising experiences of integrated care models, many systems still remain fragmented, focused on episodic acute care and are unsuitable to solve complex health needs through a patient-centred approach that blends a preventative approach with curative interventions when needed. In order to measure the success of an integrated system we need to better understand, capture and use the data available to us. Equally, we need to develop the capability to share understanding internationally, so all systems can better develop their health care offer to their citizens.

Success factors for an effective integrated care system

Strong leadership: effective leadership is critical to the success of an integrated healthcare system. Leaders must be able to articulate a clear vision for integration,

build consensus among stakeholders, and provide the resources and support needed to implement integrated care models. They must also be able to build strong and lasting relationships across an integrated care system to ensure trust in the approach. Collaborative partnerships: Successful integration requires collaboration among healthcare providers, community organisations, and other relevant stakeholders (country dependent). Partnerships can help to break down siloes and facilitate communication and coordination across different settings. Information technology: The use of information technology can play a key role in facilitating integration by enabling the sharing of patient data across different providers and settings. Electronic health records, telemedicine, and other digital tools can help to improve communication and coordination among healthcare providers. It is also clear that AI has an important role to play in healthcare delivery in the future. Patient-centred care: Integrated healthcare systems should prioritise patient-centred care, which involves tailoring care to meet the unique needs and preferences of individual patients. This approach can help to improve patient outcomes, experience and satisfaction and ensure nothing is missed, also enabling systems to tackle issues of inequality. Outcome measurement: Effective integrated healthcare systems should have systems in place to measure and evaluate outcomes that can help to identify areas for improvement and ensure that integrated care models are delivering the intended benefits.

The right way?

So, is integrated care the right way forward for health systems? There is developing and supportive evidence to indicate that integrated care systems will support the delivery of improved healthcare services for citizens that make sense for patients and develop preventative rather than curative systems in the future. However, it is clear we need to develop better systems to collect, understand, use and share data to inform how we continue to adapt our healthcare offerings and support the development of successful integrated care systems. CONTACT INFORMATION

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

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SHAPING THE FUTURE OF HEALTHCARE THROUGH DIGITISING FINANCIAL SYSTEMS The importance of a healthcare provider having the right financial and funding models in place cannot be underestimated, says Chris Norton Telstra Health’s Hospital Care Executive

nvesting in innovative digitised financial functions provides valuable insights into billing, costing, budgeting, and other financial components which are typical within any business. But they also create a range of efficiencies so that healthcare professionals can focus on what’s important – caring for patients. This focus is particularly relevant for PowerHealth’s team of health, finance and technology experts, many of whom began their careers in a clinical setting. As a global healthcare and hospital software solutions provider, PowerHealth has supported governments and private hospitals across Europe, Hong Kong,

Canada, Australia, New Zealand, the Gulf Cooperation Council (GCC) and other areas. Its commitment to innovation in clinical settings has been strengthened recently by leveraging the expertise, skills, security and investment opportunities of its joint venture partner Telstra Health, a global digital health technology company with a footprint across the spectrum of health, aged care and social services worldwide. Backed by Telstra, Australia’s largest telecommunications company, Telstra Health has the innovation, technology, cyber security expertise, data governance, national infrastructure and financial sustainability to provide a safe and reliable

ecosystem for clinical providers. As a result, PowerHealth and Telstra Health have been able to provide a more sophisticated and comprehensive offering of digital health solutions, software and platforms across the globe, including in the GCC.

Improving lives through digitallyenabled care across the GCC

“At Telstra Health we’re bringing together our expertise and capability in a connected way to develop interoperable solutions for improving health systems and health outcomes,” says Chris. “Recognising synergies between the digital health goals of the GCC and those of Australia, North America, and the UK - where Telstra Health is already actively engaged we are committed to fostering interoperable solutions which enhance health systems and outcomes on a global scale.” PowerHealth has a strong presence in the GCC with local offices and teams specialising in revenue cycle management and activity-based costing in the Kingdom of Saudi Arabia (KSA) and the Kingdom of Bahrain. In line with KSA’s Vision 2030 Health Sector Transformation Program, PowerHealth’s PowerPerformance Manager (PPM) solution has implemented

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HEALTH PARTNERSHIPS PowerHealth

a standardised costing method in 70 per cent of hospital clusters across the country with the remaining clusters scheduled for completion by August 2024. PPM is a digital system which calculates hospital service delivery costs, integrates private and public funding revenue and provides accurate, frequent reports. Since being awarded the contract from KSA’s Vision Realization Office, the PowerHealth team has trained 155 local cluster staff members on PPM and received a feedback score of 97 per cent on the quality of the training. Furthermore, with the remaining 30 per cent of the hospitals in the country recently being grouped into six clusters, PowerHealth can now roll out PPM across these newly formed hospital clusters. PowerHealth is also a trusted partner of a large independent, not-for-profit hospital in KSA. The teams have worked closely with the hospital’s complex tertiary care facility to advise on implementing a standardised activity-based funding model for accurately classifying hospital clinical activity and allocating funding; this has helped to transform a decade of variable cost centre management practices into a centralised funding model. “We know that having the right model of funding means the right model of care,” says Chris. “We put data to work to deliver best practice outcomes via PPM and now support more than 1,000 hospitals across the world.

CHRIS NORTON

Hospital Care Executive Telstra Health

“We know that having the right model of funding means the right model of care” “We remain committed to delivering a standardised costing solution across 100 per cent of hospitals in KSA. Assisting the healthcare clusters in achieving data normalisation, adopting a Data-Driven Quality Improvement process, and enabling national benchmarking and the identification of national best practices is helping to overcome various costing barriers and complexities across hospitals in KSA.”

Global reach

In addition to its work in KSA, PowerHealth and Telstra Health have implemented its globally-renowned PowerRCM at Bahrain’s largest public healthcare facility. PowerRCM combines PowerHealth’s hospital billing, costing and analytics solutions into an end-to-end managed service which has transformed revenue cycle management systems at the 1,400-bed facility. PowerRCM offers a wide scope of services including patient administration,

billing and collections, clinical coding management, revenue optimisation and payor management. “Through PowerRCM, we’ve seen the value in digitising a provider’s full lifecycle of data collection and revenue management from the moment a patient is registered,” outlines Chris. “As an experienced team working at scale with mature systems, we benefit our customers by optimising revenue, improving cost management and uplifting data quality and reporting.” Taking PowerHealth’s capability and innovation potential further, the company can now leverage Telstra Health’s extensive experience in data and analytics, AI, digital hospital products, virtual care, e-prescriptions via its joint venture pharmacy solutions partner Fred IT Group and whole of population health solutions such as cancer screening. Its UK based business, Telstra Health UK, is a leading provider of data-led population health management and analytics services to the UK’s National Health Service (NHS) hospital trusts. In 2023 alone, Telstra Health UK used specialist data analytics and consulting expertise to deliver more than 500 mortality reports and over 700 customer reports. Furthermore, Telstra Health’s next generation virtual care solution, Virtual Health Platform, is having a significant impact in Australia and internationally. The highly interoperable, FHIR-native solution has been adopted by state-wide health services to offer Hospital in the Home and other remote care programmes. The platform’s features and adaptability make it an attractive asset for addressing the evolving healthcare landscape, offering a seamless, proven and efficient approach to virtual care delivery. Digitisation of a healthcare provider’s systems can deliver greater access to care, improved patient and clinician experiences and accurate real-time data and analytics. Digitising a healthcare provider’s financial systems not only modernises its operations but can enhance its ability to deliver quality care by freeing up resources, ensuring compliance, and improving the overall patient experience. CONTACT INFORMATION

www.powerhealthsolutions.com

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30/01/2024 09:58

SUSTAINABILITY SAVES LIVES Central coordination for sustainability in healthcare is not just vital; it’s imperative for our collective future, says Bjorn Almér of Skane Care

“C

limate change is the number one threat to population health according to the WHO. Healthcare is about long-term quality of life, and this is clearly better on a healthy planet. Strikingly, if healthcare were a country, it would be the fifth largest pollution emitter on the planet, equivalent to two gigatonnes of carbon dioxide. The United Nations’ sustainable goals advocate for an efficient, circular economy and a healthy environment with minimal climate impact. Ten of these goals have been identified by Sweden as co-dependent of our activities in healthcare and are followed up in our reporting. It is safe to say that most of the healthcare industry has not been a leader in sustainability. This must change!

Barriers to progress and the way forward

A key barrier to sustainable healthcare is the lack of senior management focus and coordination. The sheer size of healthcare organisations can be a challenge too. Daring to reward and celebrate heroes of sustainability on every level will be key to continuous improvement. Some major decisions such as electrifying transport, modernising heating/cooling or putting solar panels on the roof can be initiated and executed by senior management. But that only takes us part of the distance. Healthcare staff in general are highly ethically motivated and conscientious. Trusting their will to make healthcare sustainable is the first step for management.

At the very top – on national and political levels – there tends to be other challenges: Sweden, for example, has no central coordination for healthcare sustainability. Yet. Although international accords on emission reduction, for example, might be signed, there is often a lack of attention to follow-through, leading to insufficient trickle-down action in healthcare governance. In fact, healthcare may be one of the few remaining industries where top leadership can omit sustainability in their presentations without being questioned. Yes, there are pressing healthcare demand challenges from the ageing population and, yes, there are staffing and budget constraints. But as the fifth largest emitter on the planet – we are also making people sick. Additionally, it is seen that when budgets are further tightened, even ongoing sustainability projects get side-lined despite their acknowledged importance.

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HEALTH PARTNERSHIPS Skåne Care

country’s emissions by 75 per cent since 2009. Changing to double masks can cut up to 80 per cent of the gases. Relatively manageable investments can have tremendous effect on sustainability.

Start with waste – it is a win-win

While there are sometimes concerns that there could be a trade-off between cost control and sustainability, real life initiatives often identify and reduce wastage, thus saving costs. Take these two recent examples of this from Sweden: 1)One of the highest volumes of sterilised clinical stainless-steel toolkits turned out to have high wastage as packs often were opened just to use one popular tool. When that tool was offered as a single pack, wastage and cost was reduced significantly. 2)The cost of each item was displayed on the shelves in the storage room. Just because there are hundreds of items in each box doesn’t make them “cheap” and staff being made aware of this fact made them more selective, further saving costs. Sweden uses 48 gloves per capita annually, with gloves being the top consumable in healthcare. It may not sound like much, but it includes every citizen, even those that haven’t needed any care for years. So even in a small country like Sweden, we use half a billion gloves each year! On a global scale that is a problem. By simply using gloves as directed — only when there’s a risk of fluid transmission — significant reductions in waste and emissions can be achieved. Some estimates say consumption could or should be cut in half. Imagine what this would mean if enforced on a global scale. Better for the planet while helping our tight budgets. Up to 71 per cent of emissions come from the supply chain. Until recently the

Act now: educate and legislate

BJORN ALMÉR

Chief Business Officer Skane Care

“A key barrier to sustainable healthcare is the lack of senior management focus and coordination”

focus was on the lowest cost, mainly from China manufacturers. If anything good has come out of the COVID pandemic, it’s the realisation that long supply chains are not very reliable nor flexible. With the new emphasis on a robust supply chain there is opportunity to address sustainability issues, not least because production is closer geographically and better regulated.

The dangers of medical gases

Medical gases are potent greenhouse gases. Laughing gas or nitrous oxide is 273 times more potent than carbon dioxide. Desflurane is almost 4,000 times as strong as carbon dioxide, and for this reason is forbidden in many Swedish and all Scottish hospitals. If ever there was a definition for a “low hanging fruit”, banning Desflurane would be a contender, on a par with campaigns about when to use gloves properly. Sweden now has 36 facilities for neutralising medical gases, cutting the

Showing leadership from the very top can make a huge difference. Healthcare staff love sustainability, so engaging them and trusting their commitment to doing good will deliver results. Sweden and the UK are leading by example as their governments have mandated that Net Zero will be reached by 2045. In fact, the UK Health and Care Act 2022 was the first such legislation in healthcare. Rules for procurement need to be revised. Allowing sustainability criteria to override cost at defined parameters is a next step when the easy wins have been exhausted. It requires brave leadership and a long-term perspective. Sweden is also focusing on embedding sustainability in medical education. Universities such as Karolinska Institutet offer courses and programmes dedicated to sustainable healthcare, ensuring that the next generation of healthcare professionals is well-equipped with the knowledge and skills to maintain and promote sustainable practices. This focus on education is creating a ripple effect, inspiring international collaborations and setting global standards in sustainable healthcare education. The purpose of our industry (and the Hippocratic oath) is challenged by our inability to perform the task without causing further harm. The healthcare sector, therefore, is not just a victim of climate change but a contributor to it, emphasising the urgent need for sustainable healthcare practices.” Government-owned Skåne Care offers consultancy to both public and private entities wishing to improve healthcare sustainability. CONTACT INFORMATION

bjorn.almer@skanecare.com www.skanecare.com

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PLUGGING THE LEAK Claim denials damage goes beyond finances, says Dr Mohammed Abdullah Aldar, Managing Director of ACCUMED Saudi Arabia

“Y

ou can see a water puddle but cannot place a finger on the leak? This is exactly how claim denials impact your healthcare business. A hospital can suffer large financial losses as a result of claim denials as it might not be compensated for the services rendered. If claims are denied, as they can be regularly, it could have an adverse effect on revenue, profitability and overall outcome in healthcare services. This well-recognised phenomenon within the healthcare industry is often not addressed, amplifying its adverse effects on healthcare quality. Yet clearly, processes to reduce and resolve claim denials are accessible and worth the investment. These steps to reducing the damages of denied claims revolve around deploying an efficient RCM action plan focusing on the claims’ phase which helps in keeping all factors leading to denials under control. The repercussions of multiple claims denials extend far beyond financial considerations and include important considerations such as:

Reduced quality of care

If healthcare professionals are constantly dealing with denied claims and resolving insurance issues, they may have less time to devote to patient care and may become more focused on the business side of healthcare. If claims are resolved speedily, there will be a better flow of patients through the facility and more time can be spent on delivery quality healthcare to them.

Damaged reputation

Claim denials are capable of damaging a hospital’s reputation in the long run, especially those caused by staff errors. It’s vital to mitigate such issues, as patients may lose trust in the hospital and choose to seek care elsewhere.

Delay & inconvenience (treatment-wise)

When a claim is denied, patients may not receive the necessary medical treatment in a timely manner. Chasing claims can lead staff to cut corners or provide less comprehensive care, eventually negatively impacting the outcome of the treatment. Thus, the potential damage to a hospital’s reputation, especially when attributable to staff errors, underscores the need for proactive management.

Financial losses (plus a hint of incompetency)

Any healthcare provider will suffer noticeable financial losses resulting from claim denials as it will simply not be compensated for the services provided to patients. When claims are denied and require resubmission, a delay in receiving payments will take place, exacerbating cash flow challenges. This, in turn, affects a hospital’s financial obligations, including salaries, medical supplies, and expansion plans. The resultant deterioration in revenue, profitability, and quality of care is inevitable.

process, leveraging intelligent solutions and tools to enhance efficiency, reduce errors, and detect fraud. In this context, ACCUMED Saudi assumes a pivotal role in refining the intricate details of RCM processes, emphasising a seamless claims management approach. A milestone aim for every healthcare provider always revolves around timely and accurate payments to sustain a healthy financial performance. A sustainable financial performance enables providers to augment staff, acquire advanced equipment, and enhance technologies, aligning with the Kingdom’s overarching vision of delivering elevated and accessible healthcare for all citizens. At ACCUMED we take care of complicated insurance and patient billing processes by providing the latest solutions to manage your revenue efficiently and in a timely manner. Addressing RCM challenges requires a combination of technology solutions, process improvements, staff training, and effective collaboration between healthcare providers, payors, and regulatory bodies. We accurately process claims in a timely manner to help you with decreasing the claim rejection on the first submission. This will automatically ensure that rejection rates drop to reach an acceptable range. As a result, we are able to maximise reimbursements on claims, reducing the number of denial and rejection rates, as well as shortening the billing cycle. We support you, as a healthcare facility, in enhancing your financial performance through change management, business process improvement and innovative technology. We are your partner in preventing fraud and abuse within the system and in ensuring that regulatory compliance requirements are met. By outsourcing your RCM to a trusted partner, especially investing in ACCUMED’s latest rule engine tool, you will be allowing your staff to focus on delivering a healthcare quality commensurate with the latest healthcare quality levels locally and internationally, while building the desired legacy for your hospital or clinic.” CONTACT INFORMATION

Solving the problem

Effectively addressing this multifaceted challenge requires a diligent focus on the claims phase within a robust RCM

www.accumed.sa

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Maximize Your Revenue Our RCM services & solutions revolve around building up financial stability within the healthcare sector aligning with the Kingdom’s Vision 2030.

Maximizing Revenue Streams

Facilitating Payment Cycles

Improving Patient Experience

www.accumed.sa

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19/01/2024 18:45

ADHD AND EMERGING MEDICAL MARKETS The Middle East stands out as a region where thinking has progressed impressively around mental ill-health, says Phil Anderton, MD of ADHD360

he pandemic changed the world like no other single occurrence. The legacy of COVID-19 stretches far beyond the international scales of loss or the physical implications of ‘Long Covid’. Across the globe the meteoric rise of ‘remote’ meetings replaced the occasional Skype call with a whole new approach. ‘Let’s meet on Teams’ and ‘Let’s have a Zoom’ established new meanings in our

language, and the increased standards in those capabilities have led to hybrid working, while at the same time providing secure platforms for more sensitive work. As the pandemic started to run rampant, many service providers made plans to cease their provision as the restrictions were too difficult to accommodate. It is easy to forget how segregated we all were, how little physical contact we had with

friends and family, and how draconian our restricted use of outdoor space was. Against that backdrop ADHD 360, Europe’s largest provider of ADHD assessment and treatment, made a conscious decision to continue to provide services as much as possible. ADHD 360 is a UK-based specialist service offering world-class and cutting-edge assessment and treatment of Attention Deficit Hyperactivity Disorder (ADHD) accessed through virtual consultations that offer increased privacy in support of the patient’s personal journey. However, reflecting back on these restrictions, we should remember that we knew virtually nothing about a possible end point, the scale of the impact to society nor the unintended longer term effects on well-being, especially mental ill health across all walks of society.

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MENTAL HEALTH ADHD360

Assessing the impact of the pandemic on mental health

It is prudent to discuss the decision-making that led to the switching with unapparelled agility from face-to-face consultations to a total remote working model, while still complying with the multitude of regulatory requirements that face any healthcare provider. Managing Director, Phil Anderton, recalls the thought process in honest and candid terms. “We sat as a small team and realised that if we stopped and claimed furlough, we would be financially secure. However, we had a large patient base that needed us. This may read and sound as something that is ridiculously righteous but, in our value set, we believed we were a committed a dedicated service and we had a job to do.”

In the event, it wasn’t just the patients that needed the organisation’s help. Mental ill-health became far more prevalent during and after the pandemic. Isolation, loss, fear, all took their toll and these emotions and human responses to them are indelibly now imprinted on modern life. And as mental ill-health increased, the capability to discuss ‘not being all right’ also emerged, becoming ‘OK to not be OK’. Phil became aware of the impact when one of his own team discussed her situation in the immediate post-COVID period. “She was suffering with her mental health, especially her relationship with food, and this was encroaching on her capability to work, and importantly, to enjoy work,” he recalls. “While colleagues were enjoying the communal nature of being able to eat

lunch together again in a COVID ‘bubble,’ she was uncomfortable to such an extent that she didn’t enjoy food and even thinking about eating was making her poorly,” he says. “In a 1-2-1 coaching session she said she felt we needed to create an environment to ‘not be mentally OK’ at work. So we did. And one day she presented me with a small, desktop book called It’s OK to not be OK as a gift of thanks.”

The impact of the pandemic on the mental health of nations

Recognising the impact of mental health in their own environment had offered the team a new perspective. If we convene our thinking to a more strategic, international level, using these learnings as 97

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guidelines, we can perhaps explore the impact of the pandemic on nations, especially those regions where mental illhealth has not been traditionally subject to discussion. The Middle East stands out as a region where thinking has progressed impressively with regard to approaches to mental illhealth. It has challenged its own cultural base from within, making such great progress that it is perhaps outstripping the UK and USA in terms of its contribution to modern change. Having worked in the region pre and now post-pandemic, Phil Anderton and his ADHD team can see tangible differences in thinking. Mental ill-health is now being championed as a change agenda across the GCC, with a recognition of previous struggles, a paucity of services to meet that need and a commitment, led from on high, to meet newly-recognised challenges. This pivot gives service providers more

PHIL ANDERTON

Managing Director ADHD360

“ADHD is commonly a Public Health issue, yet often overlooked strategically as a ‘naughty boys’ issue”

opportunities to be part of something ‘special’, as moves towards a healthier community are now being discussed at every level. The time is right for those with an organisational competence, a niche and a successful model for delivery to gather around the emerging community need in the nations and communities of the Middle East to deliver mental well-being. For Phil Anderton,a Fellow of the Royal Society of Medicine in London, healthcare is about long lasting, sustainable change, whether that is for the individual patient, their families or the ‘system’. “It’s wrong to see ADHD as a simple mental health niche - it cannot and has never stood alone,” he says. “ADHD is a consequence of a genetic issue that affects far more than the standard characteristics of impulsivity, inattention and hyperactivity. In fact, using those three words to describe what is going on here could just disable the changes happening that are very much required across the GCC and beyond. People with suspected ADHD don’t report those three ailments. Rather, they present as suicidal, diabetic, drug users, alcoholics, and people struggling with anxiety and depression. ADHD is commonly a Public Health issue, yet often overlooked strategically as a ‘naughty boys’ issue.” Most adults with ADHD have at least one of these listed social outcomes as a ‘problem’. Society therefore needs a response that is proportionate to the need. Healthcare ‘payors’ are beginning to see

not only the health benefits of treating ADHD, but also the fiscal argument for the preventative agenda in this therapy area. The Middle East especially is on the cusp of groundbreaking change in approaches to psychiatry that will set it further apart from others on the world stage, a leader and a defined international agent for change. In embracing the ADHD case for change, it is Phil’s hope that the GCC and its associated participating nations will quickly become post-pandemic reflectors for opportunity, ensuring widespread enduring change for the next generations. “As we grasp the full economic impact of treating ADHD as a public health issue, not a smaller compartmentalised mental health disorder, we see the business case for change gaining strength and becoming compelling,” he says. “Given that the assessment and treatment are relatively affordable, especially when compared to the rising costs of treating and suffering the alternative outcomes of mental ill-health, there is a tremendous opportunity to bring commercial viability and change into public health across Middle East communities for a sustainable future.” CONTACT INFORMATION

phil@adhd-360.com www.adhd-360.com

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We see what women can’t feel From Germany to the world. A groundbreaking era in early detection of breast cancer is ushered in by Vara. Our AI-powered mammography identifies subtle changes in breast tissue ensuring early detection of deadly breast cancers when they are still curable.

vara.ai

Vara’s CE-certified AI technology can improve the accuracy of routine breast cancer screenings as demonstrated in published evidence in leading scientific journals 1 Leibig C, Brehmer M, Bunk S, et al. Combining the strengths of radiologists and AI for breast cancer screening: a retrospective analysis. Lancet Digital Health. 2022 2 Byng D, Strauch B, Gnas, L, et al. AI-based prevention of interval cancers in a national mammography screening program. European Journal of Radiology. 2022

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19/01/2024 11:53 18:46 12/01/2024

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. Primary healthcare services facilities are stretched 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 NHSapproved 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. As he says: “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 in-person or virtually.”

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. The app provides them with user-friendly visuals and personalised goal-setting features, delivering

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POPULATION HEALTH healthya

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.

DR SUHEL AHMED Founder healthya

“These digital tools play a vital role in reshaping healthcare by leveraging data-driven insights to enhance preventive measures”

All collected data feeds into a sophisticated dashboard that not only assists individual users but also enables healthcare organisations 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. Such digital population health management solutions represent a transformative advancement in healthcare, aiding in the collection and analysis of data to shape strategies for service delivery. These solutions utilise technology to gather a broad spectrum of information, providing healthcare providers with a comprehensive view of the health landscape within a population. For instance, Electronic Health Records (EHRs) serve as a cornerstone, consolidating patient data, medical histories, and treatment plans. This collation allows healthcare organisations to gain a unified perspective on prevalent conditions, risk factors, and usage patterns related to health concerns like obesity and diabetes. Additionally, wearable devices and mobile health apps contribute real-time data to these solutions. These tools empower individuals to actively monitor their health, generating continuous streams of data on vital signs, physical activity, and lifestyle choices. Those that track parameters such as glucose levels, for example, offer insights into the daily health behaviours of a population. “Integrating such data into population health management platforms enables more precise analysis, facilitating tailored interventions based on individual health patterns and preferences,” says Suhel. Moreover, deploying healthcare kiosks in areas of high footfall enhances accessibility, encouraging individuals to actively engage in monitoring their health through user-friendly interfaces and streamlined data collection. The insights derived from these digital solutions empower healthcare organisations to design targeted services. For instance, if data indicates a surge in obesity or diabetes prevalence within a specific age group or geographical area, healthcare providers can craft focused education campaigns, preventive strategies, and personalised care plans. This proactive approach not only addresses immediate health concerns but also fosters long-term health enhancements and cost-effective interventions. “Overall, these digital tools play a vital role in reshaping healthcare by leveraging data-driven insights to enhance

preventive measures, allocate resources effectively, and improve health outcomes, particularly in combating issues like obesity and diabetes across diverse populations,” he says. 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,” Suhel adds.

Empowering patients

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.” CONTACT INFORMATION

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

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MAKING HEALTHCARE SMARTER Oskari Eskola, CEO of BeeHealthy shares the transformative impact the new company is having on the international healthcare landscape

n the dynamic healthcare landscape, BeeHealthy stands as a figurehead of innovation, reshaping the way we perceive and access digital and physical health and care services. Emerging quietly as a potentially global leader in the industry, BeeHealthy is beginning to have a transformative impact on the future of healthcare technology integration. Oskari Eskola, CEO of BeeHealthy, brings a unique perspective shaped by his background in management consulting and private equity. Eskola worked at the fund who owned Mehiläinen, BeeHealthy’s parent company, at a time when the investments in digital patient engagement started. The decision to develop in-house software solutions in 2015, at a time

when there was no ready-made product available, turned out to be a pivotal move that set BeeHealthy on a trajectory of huge success. BeeHealthy is part of the Mehilainen Group, a 114 year old private health group provider in Finland, Estonia, Sweden and Germany. Customers include corporations, insurance providers, private individuals and the public sector. With 820 clinics, more than 33,000 healthcare professionals and 2.1m patients per 5m population per year, it was an unusual move to design an in-house platform that could potentially revolutionise the delivery of healthcare. “I wouldn’t recommend this process to most healthcare companies,” laughs Eskola. “Essentially, the platform is an enterprise

solution for primarily healthcare providers and payers for patient engagement and new digital provision models. We focus on holistic patient engagement with six core modules that have flexible integrations to EMR and other systems.”

Digital consultations and cost efficiency

BeeHealthy provides all the functionality that a healthcare organisation needs in a patient-facing application. Emphasising efficiency of chat-based consultations over traditional phone calls or video calls, BeeHealthy enables patients to send pictures and seamlessly transition to voice, or video, where necessary. As a result, efficiency has dramatically increased and medical professionals are able to carry out a combined 6,000 consultations per day. Until now patients have had to download several applications to fulfil all their healthcare administrative requirements, but now it’s all in one place. BeeHealthy’s impact on patient interaction is multifaceted, introducing online booking, symptom checkers and care

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DIGITAL BeeHealthy

plans that have transformed the healthcare landscape. For some customers, almost half of all appointments are now booked through their website or application, demonstrating substantial cost-cutting potential for healthcare providers. The development of care plans automates and guides patients through extended care pathways, reducing administrative burdens and enhancing patient education about their conditions. Now available as a SAAS product via white-labelling, Eskola explains that “we provide the technology to healthcare providers to then provide the services and applications to their patients. Of course, it also works on a web-based portal, but

OSKARI ESKOLA CEO BeeHealthy

typically end-users favor native mobile applications, and we’ve developed all our functionalities natively on Android and iOS. “The most exciting thing for me is for a patient to see their health data. This isn’t possible in most countries, so the patient is excluded from a key part of their own health. In Finland, access has been customary for the past 10 years, and with BeeHealthy’s Me page patients can see their past and future medical visits, their prescriptions, lab results and referrals. This is something that really drives the adoption of digital healthcare services in general. “Once you have a good online booking function as a private healthcare provider you can really use it to drive revenues. If you’re a public business or you’re running on a capitation-based model, it’s a huge cost cutting opportunity by reducing the number of people in the call centre.”

Commercial growth

Our customers have experienced increased efficiency and cost savings while fostering a superior customer experience and delivering exceptional outcomes without compromising on quality”

The establishment of BeeHealthy as a separate business entity, with a dedicated team focusing on platform development, marked a strategic move gearing the company toward exponential growth BeeHealthy has been very international from the start. With the first client in Greece, the second in Italy, the business has had a strong need to make the platform as configurable as possible to suit different needs in different markets. “It wasn’t easy in the beginning”, says Eskola ,“but now

that we’ve come a long way in product development, further international growth is easier.”

Focus on the Middle East

Globally deployed in 10 countries, BeeHealthy’s modular, white-label software presents unprecedented adaptability to a diverse range of international markets, highlighting its commitment to becoming a cornerstone healthcare solution. The company’s strategic expansion into the Middle East, particularly the Arab Emirates and Saudi Arabia, has broadened its global footprint. Inbound interest surged after collaboration with heathcare partners in the region and BeeHealthy’s participation in events such as Arab Health showcases not only its commitment to global outreach, but also its receptiveness to evolving to meet regional healthcare needs. The core of BeeHealthy’s business model is not just about providing a service; it’s about fundamentally changing the way healthcare is delivered. The platform’s ability to streamline operations, reduce costs, and enhance patient outcomes positions it as a cornerstone in the evolution of modern healthcare delivery systems. CONTACT INFORMATION

www.beehealthy.com

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FINDING VALUE IN HEALTHCARE The issue of healthcare resources outstripping demand is a concern worldwide, say Robert McGough and Gemma Badger, Partners Hill Dickinson LLP

alue-based healthcare has the potential to be a game changer for the future of healthcare. A traditional fee-for-service model, which compensates healthcare providers based on the quantity of services rendered, is proving to be unsustainable in many areas, often leading to escalating costs and variable quality of care. Value-based healthcare, on the other hand, prioritises delivery of high-quality, cost-effective care that focuses on improving patient outcomes and overall well-being. What does this mean, and how are healthcare systems around the world looking to use

value-based principles to solve funding concerns and improve the quality of outcomes achieved for patients?

cost of care. VBH is a patient-centred approach which also aims to maximise the value to society more broadly in terms of healthcare spending. There is a broad spectrum within which value-based approaches can be used, from individual products or services purchased by a single healthcare provider to whole health and social care pathways in which multiple suppliers and providers work together to achieve best value patient outcomes. The complexity involved in

What is value-based healthcare?

Value-based healthcare (VBH) is an outcomes-focussed approach in which both providers and suppliers of healthcare services and products are paid based on outcomes achieved for patients. Providers and suppliers share the financial risk that the outcomes are accomplished. The concept of value is broad, encompassing three key elements – (i) outcomes (ii) other stakeholder benefits and (iii) total

GEMMA BADGER

Partner Hill Dickinson LLP

“A key element in the successful implementation of VBH is adoption of efficient contracting and procurement processes”

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LEGAL Hill Dickinson

ROBERT MCGOUGH Partner Hill Dickinson LLP

“Value-based approaches at scale require partnering between those supplying products and services and the providers delivering these to patients”

Value-based healthcare in the Middle East

procuring and contracting for these types of approaches increases depending on the breadth of the solution being offered.

How are value-based approaches being adopted?

While there are examples of healthcare systems, including those in Middle East, looking to redesign existing systemwide approaches with a focus on value, many current examples of value-based approaches stem from a more localised focus. Some recent examples of valuebased approaches include: • Integrated teams of providers working collaboratively to target improved outcomes for cardiac patients • Wound care products supplied based on an assessment of the total cost of treatment, as opposed to individual units • Value-based approaches to procuring and contracting for services related to chronic and long-term conditions including mental health and diabetes.

With its changing demographic and disease burden shifting to more chronic conditions, the Ministry of Health in Saudi Arabia is closely focussed on integrating a value-based approach into the healthcare system as part of its national Vision 2030 programme. Since the update to the Government Tender and Public Procurement Law of Saudi Arabia, the process for awarding bids is generally two-staged. Bidders must submit an initial commercial proposal detailing the services and outcome that will be provided and then a second separate proposal detailing the cost. The Ministry of Health will first select the proposals with the greatest outcomes, then turning to the financial proposals to select a winner based on the value. Likewise, within the UAE, clear motivators for a shift to value-based approaches include the rapid growth in ageing population, high prevalence of chronic noncommunicable disease, and the influence of increasing patient demand for more personalised care and choice.

Operationalising VBH

Given the shared risk approach, valuebased approaches at scale require partnering between those supplying products and services and the providers delivering these to patients. For pathwaywide approaches, collaboration is needed between providers working with patients at different levels, from primary through to secondary and tertiary care. Social care providers may also be involved, and there should be substantial engagement with individual care givers (the doctors, nurses and other healthcare professionals) to assess value achieved and, most importantly, with the patients themselves

to understand how they interpret the value and assess the outcomes for them. High quality data drives value-based approaches, and therefore extensive good quality data on outcomes is also required to evidence and support the model but this can be challenging to source and share. From a legal perspective, a key element in the successful implementation of VBH is adoption of efficient contracting and procurement processes. Designed effectively, these help to ensure that healthcare providers are incentivised to deliver better care while containing costs, ultimately benefiting both patients and healthcare systems as a whole. Making this work requires engagement between payors and providers/suppliers from an early stage in the procurement process to ensure that all parties have a clear idea of how the relationship between them should work. It is also imperative that the parties start discussing how results can be achieved through an appropriate contracting approach at the outset (or that this is prepared/agreed prior to any procurement).

Moving forwards

It is fair to say that while there are many motivating factors and widespread enthusiasm for adopting value-based approaches to healthcare, the move from theory to practice is difficult to achieve and requires longer term thinking and support from policymakers. In some parts of the world, for example the US and some parts of Europe, the concept has been in place for longer and initiatives well-advanced; in others, more development work is needed. Within healthcare systems there needs to be engagement between providers to consider what they can achieve through working together in this way, and with suppliers to build trust and form relationships which can be used as a strong foundation on which to share the risk of delivering value focused patientcentred outcomes. Data sources need to be investigated and approaches built to monitor progress and support the models adopted within the contracts.

CONTACT INFORMATION

robert.mcgough@hilldickinson.com gemma.badger@hilldickinson.com www.hilldickinson.com

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The importance of clinical data

HEALTHIER PATIENTS, HAPPIER CLINICIANS, AND REDUCED HEALTH COSTS Personalised care at population scale has become possible through integrated data driven software, says Dr Umar Naeem Ahmad, CEO of Abtrace

At university, I briefly trained in Ju-jitsu. The art of defeating a much bigger opponent is finding the pivot point. Once you do, you can use the opponent’s strength to your advantage. In healthcare, this pivot point is electronic health record data. We believe electronic health record data can be used to ‘industrialise’ medicine. Doctors today work as artisans, trained after a decade as an apprentice, acting as the central conductor for most decision loops. Healthcare delivery is the product of a $10 trillion artisanal industry that payors find unsustainably expensive, patients find inconsistent in quality and staff find repetitive and exhausting. Electronic health record data is the raw material that healthcare needs to make decisions, allocate resources and measure outcomes. Doctors will need to move from artisans to data driven actors. For us, health systems can, will and must embrace automation and data-driven care at scale to free up time to focus on the communicating with the patient. This can only be achieved by software, grounded in existing clinical workflow, powered by granular clinical data, and fully integrated into existing electronic health records (EHR).

Primary care first

Primary care can shift to provide proactive, predictive, preventative clinical care. Hospital-based care can be seen as the result of a healthcare system failing to keep the patient healthy. Care has progressed from bricks and mortar to virtual telehealth

here is a global challenge in healthcare and the scale of the problem is clear. By 2050, the population aged over 60 will double to 2.1bn people. More than half of these will have a long-term chronic disease which accounts for 70 per cent of health expenditure. Healthcare budgets continue to rise representing $10 trillion, yet life expectancy gains have not kept pace. This is particularly true for those countries with the highest spending. These trends are shared across the healthcare models – from single payor systems like the NHS to self-pay and hybrid segments in the USA, Middle East in high, medium and low-income economies. We are all patients, friends of patients, relatives of patients. More than a health issue, or an economic issue, this is a longterm trend rightly worrying many people, so how do we reverse course?

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DATA Abtrace

providers, but this is still reactive and does not remove the need and expense of staff. Patient records should be continuous as proactive monitoring will allow predictive earlier detection of disease and avoidance of preventable conditions.

The Abtrace approach

Abtrace has built software that integrates into multiple electronic health record systems and wearable devices to run AI algorithms on clinical data. Covering 3m patients in the NHS, the software identifies patients who need interventions, contacts them for information, arranges consultation with appropriate clinicians, ensures all interventions are done and calculates the efficiency and quality of care in real-time, for every patient, every day.

existing providers the tools to improve care, reducing costs and demonstrating value to payors and providers.

Aligning providers, payors and regulators

Traditionally, startups have focused on the real-world evidence and billing use cases for electronic health records focussed on the pharmaceutical or medical insurance industry. In contrast, Abtrace focusses on delivering value from EHR data in transforming healthcare delivery.

regulation-first approach by building deep integrations before bringing a product to market, supported by extensive internal expertise and user feedback to optimise the initial product. Our focus has been on applications where the triple bottom line can be delivered at scale to allow healthier patients and happier clinicians, all the while reducing health costs. Abtrace has built healthcare system integrations that cover 96 per cent of the UK population, extracting real-time comprehensive, longitudinal patient health records every day, trained on a unique primary care dataset from cradle to grave. This approach allows the delivery of AI models using structured and unstructured data (including clinical Large Language Models), all underpinned by medical device certification with UKCA marked Software as a Medical Device. The experience of delivering value in the NHS for 3m people in the UK has allowed our team of doctors, machine learning specialists and regulatory experts to develop the expertise in overcoming technical challenges and to build a device that meets the regulatory and clinical bar.

Digital health 3.0

1. The first generation of digital health providers focussed on solutions and investments in teleconsultation, the triage and appointment booking space 2. More recent interest has been in technology enabled service providers who focus on specific disease verticals in mental health and diabetes care 3. The third generation of providers is cleaning and automatically processing electronic and patient-generated healthcare data to give

UMAR NAEEM AHMAD CEO Abtrace

“Electronic health record data is the raw material that healthcare needs to make decisions, allocate resources and measure outcomes”

Healthcare is sometimes seen as a commercial zero-sum game - competing insurers optimising value from providers trying to meet the demand of regulators who struggle to get a real time view of on the ground processes and delivery. A single view of the data that encodes payor priorities will give providers a solution that reduces their costs and allows regulators to design and monitor policies and incentives based on real-time insight. Better alignment through technology builds value, regardless of the healthcare model.

Overcoming integration and regulation

Making healthcare providers our target customer requires understanding of, and engagement with, the complexity of health systems. Abtrace has focussed on a

A different healthcare future

Our vision is an automated, self-learning care system where we can provide personalised care, delivered at population scale, where predictive, preventative and proactive approaches keep people healthy and out of hospital to deliver a global impact for patients and healthcare systems. It’s a vision that has been proven in the NHS and our ambition is to scale it globally, to partner and to reach as many people around the world as possible. CONTACT INFORMATION

umar@abtrace.co www.abtrace.co

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Sarah Cartledge, Healthcare World Editorial Director, examines the current discussions around women’s healthcare

ground-breaking initiative was launched at the World Economic Forum in Davos this month. Redesigning Healthcare with Women in Mind addresses critical issues in women’s health, a long time coming in today’s fastmoving healthcare sector. A prestigious roster of signatories, led by international management consultants Kearney, are highlighting the fact that women are not treated as seriously as men in their healthcare concerns. On average, women wait four years longer than men to receive a diagnosis for the same disease, are seven times more likely to have a heart condition misdiagnosed and experience a 44 per cent higher likelihood of dying from secondary complications of type one diabetes when compared to men. The report also notes that women are 52 per cent more likely than men to experience adverse reactions to prescribed medications. So why is this happening? It’s a fact that women go to the doctor more

regularly – they aren’t as shy as men as discussing health problems. But does this make doctors less likely to take their issues seriously? It doesn’t make sense given the amount of changes to a female body during her lifetime – from puberty, childbirth, perimenonpause to post menopause. With more than 50 recognised symptoms of menopause and very little education for women around the subject, it’s hardly surprising that the female population spends a lot of time wondering what is happening to them. Which is why it’s so impressive that the classic image of the Davos Man is prepared to sit up and listen. An open letter signed by more than 40 prominent organisations, including Ferring, UCB, Roche, GE Healthcare, SAP, Salesforce, Tech Mahindra, and Microsoft focusses on fostering gender equity across healthcare systems to tackle historical biases and improve health outcomes for women globally. The report sheds light on the pervasive gender bias within the healthcare

ecosystem. From a mere three percent of digital health funding allocated to women’s health start-ups, to the underrepresentation of women in research and development, the disparities are alarming. For instance, despite women constituting 70 per cent of chronic pain patients, 80 per cent of pain medication has been predominantly tested on men or male mice. Moreover, education and public awareness regarding women’s health are insufficient, with 41 per cent of UK medical schools lacking mandatory menopause education. Throughout the pages of this magazine, we’re examining how women’s needs are now being put at the heart of healthcare systems engineering. In particular, Vara and NECS outline how crucial it is to design healthcare systems which not only consider the needs of women, but also provide wider education programmes and support networks across cultural and geographical divides. And interestingly, many of the new initiatives are coming from younger men. By placing women at the heart of the healthcare system, not only are we creating equitable access, we’re also able to tackle the additional costs incurred by misdiagnosis, complications and drawnout ill-health. The economic impacts are as far reaching as the positive impacts health equality would have on overall population health. The letter outlines six key recommendations for redesigning the healthcare system with women in mind: • Increasing advocacy and awareness around women’s health • Expanding curriculums to cover women’s health topics adequately • Increasing the volume of clinical and policy research trials on women’s health • Building women-centric integrated care pathways • Ensuring gender-specific data sets are collected, regulated, analysed, used, and shared • Boosting funding for academic research, product development, and consumer health solutions focussed on women’s health. Fantastic companies around the world are ushering in a new era of equitable healthcare. We need more collaboration and more initiatives like these in order to cement women as an equal part of the healthcare landscape.

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kit and equipment, and very often a reliance on converting out of date and sometimes crumbling infrastructure to deal with conditions and requirements that were never foreseen by its funders and designers. Add environmental sustainability to this queue of funding requirements and what do you get? Does a hospital founder or designer prioritise human health or planetary health? The answer should be both, but what of the costs?

Turning to technology

So how do we decrease the planetary toll of our healthcare requirements? The simple answer would be that we need less healthcare, fewer hospitals and facilities burning away at our greenhouse gasses and sapping all our energy. Let’s turn, as we always do, to technology for an answer:

OPINIONATED

STEVE GARDNER Managing Director

SUSTAINABILITY? JUST PART OF A MUCH BIGGER HEALTHCARE CONUNDRUM

ny discussion about sustainability and net zero in healthcare has to start with an ironic paradox. Climate change affects health. Pollution affects asthma and respiratory conditions. Planetary health will affect food security and our ability to maintain healthy lifestyles. More and more climate-related emergencies - storms, wildfires, tsunamis - directly increase our global healthcare requirements. It’s an irony and a paradox when you consider that healthcare is one of the largest and most polluting industries in the world. Healthcare as a sector is creating and worsening a problem which directly affects health - that’s far more ironic than 10,000 spoons when all you need is a knife. (Those of a certain age will understand the cultural reference; those who don’t, Google it, you’ll thank me later!). Think about it, a hospital runs 24 hours a day. It’s an ecosystem, a mini city in which people eat, sleep and work. It relies on a huge amount of power for its

infrastructure and a myriad machines); it has its own transport network system with ambulances coming and going, and its own waste disposal system with furnaces burning highly toxic materials and releasing them into the atmosphere. In short, it’s an energy consumption and ecological tyre fire, almost literally. The answer, though, is as complex as healthcare itself. Yes, there is a design element - we could, should and will design greener buildings with better energy consumption and more eco-friendly design, but this takes us straight into a whole raft of complex interdependencies. As anyone who reads these pages regularly knows, the biggest issue in healthcare is always money. A hospital or any healthcare facility is expensive and in a constantly evolving sector. Human health is a moving target with new technology requirements, changing disease profiles, ever-changing social profiles, populations and requirements. This means there is a constant need for new healthcare facilities with the latest

• Harnessing genomics, data, personalised, preventative medicine and changing the healthcare setting from hospital to home • By better understanding our healthcare needs and requirements we can focus our (literal) energy on the people who need it most • Using genomic and healthcare data we need to (finally!) figure out how to do population health properly and predict the healthcare requirements, disease profiles, public health interventions and individual health needs of our customers We need to triage and monitor properly. Reduce the number of people entering healthcare facilities and you reduce the number of required healthcare facilities. What about pre-op rehab done remotely, post op and long term condition management done by mobile application? But it always comes back to money and that’s why we need to work hard to create value based healthcare models. Such models drive efficiency and save money for health systems to reinvest into digital health and data, as well as more energy efficient and economic infrastructure. Hopefully we’re now waking up to the fact that we’re bad actors in this space and have a difficult, complex, interdependent and expensive route in trying to be part of the solution rather than the problem!

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Even healthcare organisations require a health check.

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