The future of Saudi healthcare
In 2016, Saudi Arabia launched its Saudi Vision 2030 in a bid to diversify its sources of revenue and lessen its reliance on oil. Central to the country’s National Transformation Programme 2020 (NTP) is finding ways to provide an attractive environment for local citizens and foreign investors in order to boost employment opportunities. Additionally, the country will aim to develop strategic partnerships both locally and internationally, embracing new digital tools to further cement its position on the global stage.
The healthcare industry has become a significant area of focus for the Kingdom, with increased spending reflecting its ambition to become a geographical centre of excellence. Additionally, the decision to raise private healthcare expenditure to 35% from 25% of total expenditure by 2020 will create an opportunity for significant change.
“Vision 2030 has laid down a plan of ensuring that more public hospital and public care facilities will become corporatised to a large extent, meaning care will be provided by private institutions,” explains Executive Vice President of Fakeeh Care, Sanjay Shah. “Whether this is hospitals which become privatised or services which are provided by private institutions (or some model similar to what the United Kingdom has), it’s going to be something which the country will find itself developing over time, extracting better patient outcomes and more efficiencies.”
Educated in London and the US, Shah’s background in a number of senior finance, strategic and operational roles led him to join The London Clinic in the United Kingdom. As Chief Financial Officer, he worked to develop and manage The London Clinic’s substantial portfolio of redevelopment and expansion activities, and undertook negotiations with BUPA and AXA PPP, Middle Eastern embassies and other sponsored companies.
Through this role, Shah also worked to deliver the UK’s first state of the art cancer centre as part of the largest single investment deal in the private sector in the United Kingdom for 30 years, costing almost $128mn and opened by Queen Elizabeth II.
Keen to take on a new challenge, Shah joined Fakeeh Care in 2015. Set to enter the Dubai healthcare and medical education market, Fakeeh Care has become a highly regarded pioneering brand providing primary, secondary, urgent and tertiary healthcare provision and services, preventative care, and medical academia and training for local communities in Saudi Arabia.
Operating successfully for four decades and becoming the first private hospital in the western region to become JCIA accredited, Fakeeh Care runs one of the largest hospitals in the Kingdom and is presently building a number of primary care centres around Jeddah and Mecca to deliver a complete integrated and holistic care approach.
“The London Clinic had a special reputation for being a high-end, acute, tertiary care organisation, where we received patients from all over the world. But it was just one line of business. At Fakeeh Care, there are a multitude of related healthcare businesses and that completely fascinated me,” Shah reflects.
“If you take the hub-and-spoke model, we have a number of primary healthcare sites going up in Jeddah and a new outpatient hospital that will be delivered in quarter two. Additionally, we are developing primary care centres in Mecca and a smart hospital in Dubai,” he adds.
“We're very excited with our Dubai project, which will be the smartest hospital in the region and have the ability of not only utilising our software, but also having the whole arena linked in a way that enables better efficiency and many centres of excellence providing superior outcomes for patients. It's a very important project for us.”
Attracting a large number of expatriates, Saudi Arabia has seen an exponential population boom. From 4.1mn citizens in 1960, according to DataBank, the country now houses over 32mn, leading to an increased demand for new public health services.
Although the NTP has responded by investing in healthcare training and development to address this growing need, Fakeeh Care has taken this a step further. Since 2003, the organisation has established a medical college, where it has received its first batch of medical students. It also houses a unique and outstanding residency programme, alongside a number of post-graduate and nursing programmes.
“Fakeeh has always housed a very academic care platform, which is quite unique in this sector,” observes Shah. “Other hospital providers do not have the ability of having their own crop of nursing staff, medical labs and graduates coming through their ranks to provide this care. I would say these are the most important aspects regarding our ability to provide patients the care that they deserve. We take the element of quality and excellence in care as really phenom, so our academic-care model is unique in the Kingdom.”
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Nonetheless, with such an evolving demographic, the rise of lifestyle diseases has skyrocketed, leading to the demand for, and subsequent growth of new health services. “We’ve got a very strong culture of lifestyle diseases. The population is earmarked to rise to approximately 50mn by 2050. 49% of the Kingdom's population is under the age of 29, so we're going to see a very large use of healthcare in the next 30 years or so,” explains Shah, adding that coupled with this there is “a shortage of nurses and physicians, and also a shortage of beds by Organisation for Economic Co-operation and Development (OECD) standards.
“We have 27 physicians and 52 nurses per 10,000 population. In terms of supply there's a limitation. In terms of inpatient beds, they're less than half of what OECD standards are,” he continues. “Smoking, diabetes, obesity and hypertension are therefore some of the biggest challenges we have, where 24% of Saudis are diabetic, a significantly higher figure than the world average of approximately 8%. Saudi is the 20th-largest economy in the world and it has the 19th-most obese population in the world. 28% of Saudi men and 21% of Saudi women are obese. 30% of males are smokers.
“Our outpatient hospital is particularly driven towards providing care for diabetic patients,” he adds. “This means preventative as well as taking care holistically for diabetic patients, which is also quite unique in Jeddah and it’s also not really available in the public sector.”
Quality of life
Its complimentary businesses, including the supply of medical equipment and luxury eyewear, has enabled Fakeeh Care to gain further market share and combine prescription-based eyewear with its luxury sunglasses. The organisation works to provide care to improve the quality of life and services to those outside of a hospital setting.
“We have a wellness angle, related to our fitness facilities. There are gyms for males and females in an iconic headquarters building in Jeddah, which overlooks the shimmering Red Sea,” notes Shah. “We also have an upscale executive clinic to provide high-end bespoke healthcare.”
Nonetheless, with an acute awareness that the global number of citizens over 65 years is set to rise significantly in the next 20 years, the organisation has looked at ways to enhance its home healthcare operations. The market is expected to generate revenue of $392bn by 2021, growing at an annual rate of 9.4% between 2016 and 2021, according to Zion Market Research. “Our ability in the staffing of our nurses is about understanding our patient's needs. Honesty, accountability and integrity of care is paramount for us to be successful,” comments Shah. “Not only do we own and operate a pioneering tertiary care hospital, home healthcare is an expanding part of our portfolio. We expect this to get greater traction in this region.”
Housing an impressive portfolio of services, Fakeeh Care’s operations are firmly underpinned by new digital tools, which have enabled medical staff to deliver care which is not only compassionate and patient centered, but grounded in disruptive technologies.
“I'm a firm believer that you need some disruptors to your model to kickstart some thinking. It’s very easy to become complacent,” explains Shah. “Things are very different now, you can use telemedicine, tele-reporting, tele-diagnostics. We see opportunities in tele-health, tele-radiology and also tele-oncology. I welcome new disruptors if they have something positive to provide to the sector.
“Whilst a number of other industries have embraced the digital age, healthcare seems to be lagging behind across many geographies,” he continues. “The difficulty, I suspect, is that because healthcare provision has tended to be more publicly based, there tends to be a reluctance to engineer acceptance of greater digitalisation and greater technology use.”
However, through the use of decision-making software Yasasii, nurses, doctors and pharmacists at Fakeeh Care are fully supported through driving quality, patient safety and positive patient outcomes, while also building professional skills. “It's a unique software which encompasses elementary decision-making support for physicians to make sure that they don't make an error in their diagnosis, as well as ensuring the correct medication is provided. It's a very powerful tool,” explains Shah. “In the future, we would like to see it connect with external providers. For example, where we see our patient in a primary-care centre making a booking, using the same software, it will enable the patient journey to be much smoother and stress-free. The software offers a unified central record with one dashboard for the physician to make sure that the appropriate level of care is provided for.”
In the long term, where does Shah believe Fakeeh Care is headed in such an evolving space? “Our targets this year include making sure our main IT platform is implemented in all our new sites. We'll commence with our primary-care centres and our outpatient hospitals and then the Dubai facility,” he says. “This is my main focus. We then want to develop this and provide this capability to other hospital groups who want to use it, either for offshoring or to support the development of their own electronic medical record and hospital information systems. With Yasasii, we would then have the ability to provide this superior service throughout the whole Kingdom of Arabia,” he concludes.
Long haul Covid, the brain and digital therapies
It is estimated that around 10% of people who get Covid-19 develop long haul Covid, a debilitating condition that can last many months and cause breathlessness, exhaustion and pain.
Research is underway to find out who is more likely to get it and how to treat it. Here neuroplasticity expert and owner of Harley Street Solutions in London Ashok Gupta tells us how the condition affects the brain.
What is long Covid exactly?
Long Covid is when patients who have experienced Covid-19 go on to have continuing symptoms for weeks and months afterwards. These symptoms can include breathlessness, exhaustion, brain fog, gastric issues, pain, and post-exertional malaise. It is estimated that around 10% of Covid-19 infections may result in developing long haul symptoms, and in the USA, this may be affecting over 3 million people.
How does it affect the brain?
Here at our clinic, we hypothesise that it is due to a malfunction in the unconscious brain, creating a conditioned response that keeps the body in a hyper-aroused state of defensiveness. At the core of this hypothesis is the idea that we are here because our nervous system and immune system have evolved to survive. We are survival machines!
When we encounter something such as Covid-19, the brain perceives it as life threatening, and rightly so. And in the era of the pandemic, with more stress, anxiety and social isolation, our immunity may be compromised, and therefore it may take longer for the immune system to fight off the virus and recover.
If the brain makes the decision that this is potentially life threatening and we get to the stage where we’re overcoming the virus, a legacy is left in the brain; it keeps over-responding to anything that reminds us of the virus. Even if we’ve fought off the virus, the brain will react in a precautionary way to stimuli reminiscent of the virus.
The brain may get stuck in that overprotective response, and keeps stimulating our nervous system and our immune system, just in case the virus may still be present.
What symptoms does this cause?
These signals cause a cascade of symptoms including breathlessness, extreme fatigue, brain fog, loss of taste or smell, headaches, and many others. And these are caused by our own immunes system.
In the case of long-haul Covid, symptoms in the body get detected by a hypersensitive brain which thinks we’re still in danger. The brain then chronically stimulates the immune and nervous systems, and then we have a continuation of a chronic set of symptoms.
This isn’t unique to long-haul Covid. Many patients develop chronic fatigue syndrome, sometimes known as “ME”, for example, after the flu, a stomach bug, or respiratory illness. Covid-19 may be a severe trigger of a form of chronic fatigue syndrome or ME.
How does long-haul Covid affect mental health?
Anxiety is a very common symptom in long haulers. It can be frightening to wonder about what may be happening in your body, and what the prognosis is going to be for one’s long term health. Reaching out for support for mental health is crucial for long-haulers.
How does neuroplasticity treatment work for long-haul COVID patients?
We have been working with patients for two decades with a brain retraining programme using neuroplasticity or “limbic retraining.”
We believe that through neural rewiring, the brain can be “persuaded” that we are no longer in danger and to come back to homeostasis. But to be very clear, we are not saying it is psychological in any way, but we believe there are novel ways of accessing the unconscious brain.
We recently worked successfully with a 56-year-old male with long-haul Covid, who prior to contracting Covid-19 in March of 2020 was running half-marathons and cycling, but afterwards he struggled to get off the sofa for months. Within 3 months he’s now back to 100% and running half marathons again.
At our clinic, we train the patient to be able to recognise those subtle unconscious danger signals on the periphery of consciousness. This, coupled with supportive techniques and the natural hallmarks of good health such as sleep and diet help prepare the patient to respond to perceived threats that might trigger the response.
The natural state of our brain is to default to protection. The brain prioritises survival and passing on our genes to the next generation, over any other impulse. It cares more about that than you feeling healthy and well. Protective responses are evolutionary, and are the right thing for the brain to do – it’s survival.
What digital therapies or apps are proving effective at treating long-haul Covid?
It seems that long haul patients are availing themselves of many online therapies and services, including meditation apps and wellness websites. We have an online neuroplasticity “brain retraining” video course called the “Gupta Program” which hosts 15 interactive videos and many audio exercises. This is proving very popular with long haul patients, and we are currently conducting a trial to test the effectiveness of this therapy.
What is the danger of leaving long-haul Covid untreated?
The longer it goes untreated, we hypothesise that it may become more entrenched in the brain, and become chronic in the longer term. Therefore we advise all patients to get help and advice as soon as possible.