Health Policy January 10, 2019
Sir Robert Naylor assesses the infrastructure of global healthcare systems

By David Duffy - World Healthcare Journal

It takes an impressive record to command as influential a voice in healthcare as Sir Robert Naylor. In 16 years as Chief Executive of University College Hospitals London (UCLH), Sir Robert oversaw the construction of one of the most impressive medical centres in Europe. This is just one of the reasons why the UK Government will have had little hesitation when they asked Sir Robert to be national adviser on NHS Property and Estates.

In addition to creating a truly globally competitive organisation in UCLH, Sir Robert is a Board Director for the Cleveland Clinic in Abu Dhabi and has years of experience in advising healthcare systems across the world. So it is fair to say that Sir Robert Naylor has a unique perspective on the requirements for global healthcare in the 21st Century.


Understanding global issues in healthcare 

Many of the challenges posed to the NHS by changing demographics are visible across the globe. "Demographics, demand and technology mean that we are running out of people to treat patients," he says. "Half a century ago you used to live until your 60s and you would be considered very old; now you reach 70 or 80 and you find yourself still working."

This paints a pretty gloomy picture, but with only 1.7 children being born in the UK per woman and an increasingly ageing population, few could argue with Sir Robert when he asserts that "we are a society in decline." However, this is certainly not a problem exclusive to the UK. “This is a huge, worldwide crisis, which governments need to recognise and address,” he says.

However, the UK does have a world-renowned educational infrastructure which allows for the training of highly skilled clinical staff. “Americans like to boast that they are the biggest and best, but proportionally they are not as good as we are in the UK, both in academia and in biomedical research,” he says. This problem is exacerbated in some parts of the world, such as the Middle East, which has seen rapid development fuelled by oil revenues but has not matched this with social change and educational investment for healthcare professionals.


The Middle East needs an educational infrastructure

Citizens of Kuwait receive lavish benefits such as interest-free housing and free healthcare – thanks to one of the world’s largest oil reserves. Sir Robert firmly believes that the increasing use of electric cars and renewable energy will reduce the need for oil, and if he is right, then countries like Kuwait will face economic challenges and an unprecedented workforce crisis. “99 per cent of doctors are imported but it is not sustainable, so there is a need to escalate medical educational infrastructure both here and in the wider Gulf States,” says Sir Robert who has worked extensively in the UAE to discuss and develop solutions.

He recognises the radical efforts of Prince Mohammad Bin Salman Al Saud to transform Saudi Arabia’s economy. “In the UAE they call it Emiratisation,” says Sir Robert, “a strategy to get citizens into work and further education to sustain a society in a world where oil revenues are in decline. ”


Answer lies in technological innovation

Sir Robert recognises that the Middle East will struggle to develop healthcare systems equivalent to that of the UK, particularly in primary care. “My advice is that they need to turn increasingly to technology to fill the gap in infrastructure. ”

What technology can offer these nations, he argues, is an entirely new interface through which patients can access primary care in addition to opportunities that allow for the early detection of disease. "Increasingly we will have devices planted inside us which will tell us when we are going to be sick and allow for early intervention, but crucially it will also act as the triage between the individual and the health system."


Opportunity for the NHS to export

Sir Robert knows that there is huge opportunity for the NHS to export its expertise and it is something he considered extensively whilst at UCLH. "The NHS is not a group of commercial organisations," says Sir Robert. "Up until the establishment of Foundation Trusts, if a hospital chose to export services, its budget would effectively be cut by the profit made so there was no incentive."

According to Sir Robert, this is also a question of having a commercially orientated mind-set. "The focus has been increasingly about the quality of care that is provided rather than its financial viability, but fiscal restraints are in no way exclusive to the UK. Across the globe, government funding of healthcare simply does not meet public aspirations."

In America, the culture of philanthropy is entirely different from the UK. As a board member for Cleveland Clinic Abu Dhabi, part of the number one hospital for cardiac care in the world, Sir Robert knows that "Cleveland Clinic has financial muscle because of philanthropy and the American system allows hospitals to make profits." This financial standing allows American hospitals and health organisations to export services.

We will soon see evidence of this in the UK, with Cleveland Clinic’s 200 bed London branch set to open in 2021. "The London clinic will change the whole market environment in London and will dwarf the existing private hospitals that aren’t able to provide the complimentary services to conduct complex work," Sir Robert believes. "Whether the London Clinic will make any money or not is a different matter, and that’s not their prime objective. Their strategy is to create an international footprint to influence the development of improved healthcare worldwide."


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