Introductions Simon Williams Director DIT British Embassy Kuwait Mari Wallace Gulf Strategy Programme Manager Healthcare UK 2
3 UK Connections 3
4 Era of Change 4
5 Economic and Social Overview • Dominated by Oil • GDP $43,000 • Population Kuwait 3.97millon 70% foreigners • 42% Kuwaitis under 15 • 90% men 50 % women in public sector • 30% diabetic • Health/Education/utilities free/ subsidised 5
6 Healthcare Environment • MoH acts as owner, operator, regulator & financer of most of services rendered. Budget forecast 17-18 is approx. KD2.800 billion (£4.9 billion). • System divided into 6 “health regions” • Each with general hospital, 49 Health Centres • 6 major hospitals providing secondary care: • Growing number of private hospitals. • Plans to extend 8 MoH hospitals • Build 4 new hospitals – MPW • 3 Hospitals for “Expats” 6
7 Healthcare Background • A number of Ministries provide health services. • The next five years will witness growth in the healthcare sector, reflecting heavy investment in the country’s healthcare infrastructure. • Government wishes to introduce insurance based health care for expatriates using their own hospitals/clinics as they are deemed to be “blocking” services to Kuwaiti’s and costing the country too much. • Obesity is public enemy number 1 in Kuwait. • Medical tourism. 7
8 Healthcare Projects 1. There are currently 20 large-scale mega healthcare projects in the pipeline for Kuwait, worth 3.5 billion KD (£9.2 billion) with an approximate 11,200 additional hospital beds. 2. Ministry of Health – is adding approximately 4,600 beds, 150 operating rooms and 500 outpatient clinics across 8 different hospital projects (four general and four specialized) have been planned by the MoH at with an estimated total budget of approximately 1.25bn KD (£3.3 billion). 3. Amiri Diwan – New Al Jahra Hospital (1,117 beds) 4. Ministry of Public Works – two new hospitals approximately 1,500 beds one specialized in Maternity and the other specialized in Paediatrics, in addition to Jaber Al Sabah Hospital (1,200 beds) 5. Kuwait Health Assurance Company (KHAC) A Public Private Partnership (PPP) between the Ministry of Finance. Ministry of Health, the Kuwait investment Authority and the private sector to build 3x250 beds hospitals, 10 clinics and one day surgery centre. 6. Kuwait University – New Kuwait Academic Medical Centre (600 Beds) 8
9 Why Jaber Al-Ahmad Al-Jaber Al-Sabah Hospital? • 99% built • DIT know the key stakeholder TICG. • TICG going on a beauty parade – UK USA Asia • High risk but somebody will end up operating the hospital. 9
Jaber Al-Ahmad Al-Jaber Al-Sabah 10 Hospital Project The Ministry of Public Works (MoPW) is scheduled to complete the Kuwait’s largest single hospital building to date – the 1,168 bed Jaber Hospital by the end of 2017. www.jaberalahmadhospital.com 10
Jaber Al-Ahmad Al-Jaber Al-Sabah 11 Hospital Project • The Kuwaiti Cabinet decided to establish a joint stock company that will manage Jaber Hospital. • Ministry of Commerce and Industry approved the establishment of a private company called “ Enaya Kuwaiti Company for hospital Management” • The new company will take responsibility for managing the hospital totally as a private hospital and will have no intervention from the government with the exception of having to comply with the regulation (doctors, nurses ...etc.) laid down by the government. • TICG will appoint board members. 11
Jaber Al-Ahmad Al-Jaber Al-Sabah 12 Hospital Project Current strategy, its level of development and operational timelines. • The hospital will serve all potential markets: government financed patients (many of whom are funded for healthcare abroad), private patients (currently, the private sector provides 10 – 20% of healthcare), insured ex-pats and incoming medical tourism e.g. from GCC countries. • It needs to open as soon as possible and the plan for how is to be opened needs to be agreed. A dental clinic is already operating in a separate building on the site • It is isochronally in the centre of Kuwait for its trauma centre role (and has three helipads and 50 ambulance bays), but it is not clear how it fits with the rest of the government hospital system (let alone primary care). 12
Jaber Al-Ahmad Al-Jaber Al-Sabah 13 Hospital Project Current strategy, its level of development and operational timelines 2. • When fully open, it will need approx. 2,200 doctors and 9000 nurses. (It is estimated that the hospital will eventually employ around 20,000 people in total). • There is space in a 1 km long mall within the hospital for retail outlets. • The next stage is the feasibility study from a specialist health planner. 13
Jaber Al-Ahmad Al-Jaber Al-Sabah 14 Hospital Project How does the strategy translate into the UK system? • Key difference is requirement for investment but Kuwaiti investors e.g. Agility, Zain, National Bank of Kuwait, Kuwait Finance House and Kuwaiti Businessmen. • Also needs a prime integrator, who will also be a Board member and part owner of the company running the hospital. • The clinical provider(s) will be either subcontracted by the prime or be part of a consortium led by the prime. 14
Jaber Al-Ahmad Al-Jaber Al-Sabah 15 Hospital Project What do they need? • A serious player to be the prime operator who can develop a business model and supply chain to distribute the risk and benefits and commission and operate the building • Expert health planners to do the feasibility study. 15
Jaber Al-Ahmad Al-Jaber Al-Sabah 16 Hospital Project Feasibility • Market/catchment/health needs: specialty mix and patient flows • Activity projections (based on existing hospital data and models) • Fit within the health system • Building: review of departments in the design; anything missing?; what adjacencies; any rearrangement or expansion needed? • Workforce strategy: staffing, training and accommodation requirements • Estates development and management • Facilities development and management; mix of long term partners and local contracts • Equipment: Asset requirements and management. Who will do and pay for the final fit out? • Information system strategy and requirements • Communication, marketing and health promotion • Commissioning costs, phasing and timetable, revenue projections and costs 16 estimates; profit levels.
Jaber Al-Ahmad Al-Jaber Al-Sabah 17 Hospital Project The planner will need to: • Agree overall purpose for the hospital: i.e. increase capacity for Kuwaitis, treat patients funded to go overseas at home, model a Centre of Excellence, meet the needs of insured foreign workers, establish it as part of a health system, a centre for income generation from medical tourism • Vision: a modern efficient hospital for all funded patients? • Mission: respond effectively to illness and injury? • Clarify the risks the operator is expected to manage: financial, clinical, reputational; efficiency; productivity, profit? 17
18 Opportunities for UK Companies Overseas Demand • Training and Education. The Kuwaiti health service does not have the capacity to service the number of new beds being created in the country. Partnerships to train future Kuwaiti doctors and nurses both overseas and in the country must be developed. • Digital Healthcare. Kuwait’s electronic patient record system and hospital management systems are dated. TPP has recently demonstrated their system using live data and hope to win a contract. Opportunities exist for developing nationwide and hospital-wide projects. • Primary Care. The Kuwaiti Primary Care system is being enlarged to align with the growth in beds. There are opportunities to transfer UK knowledge, experience and training in Primary Care. • Hospital Infrastructure and Management. Although the fix-priced nature of construction contracts in Kuwait makes it difficult for UK companies to compete in that phase, the Kuwaiti Government has requested UK proposals for running two hospitals on a G-G basis. • Health Systems Development. The Government realises that their current system of management will not adequately control the enlarged health service and have requested UK help in its restructuring and refocusing. Some 4,000 Kuwaiti’s seek medical treatment each year in the UK. 18
19 Challenges • Lack of transparency in decision making and changes in the Ministry of Health hierarchy. • Lack of UK business confidence in Kuwait’s ability to move forward with major projects • Kuwait’s long -term healthcare plans lack detail. (The tender and procurement process can be lengthy). • Language issues for broad scale implementations (sufficient local or English speaking resources), price. • Procurement processes are complex and not well defined which significantly hampers all decision making. 19
20 Thank you Please feel free to send your queries and feedback: Simon Williams (DIT) British Embassy, Kuwait Email: Simon.Williams@fco.gov.uk 00965 97202355 20
21 Q & A session 21
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