The launch of Saudi Arabia’s 2030 Vision marked the beginning of one of the biggest transformation projects the Kingdom has ever seen diversifying the economy and developing public services.
As this huge period of transformation takes place, I sat down with primary care specialist, Sally Adams. Sally is a subject-matter expert for healthcare transformation at Health Holding Company Saudi Arabia and is responsible for the transformation and delivery of healthcare across southern KSA. She works extensively with clinical, managerial and finance colleagues to support the delivery of Models of Care transformation.
What are some of the critical challenges facing the health sector in the Kingdom of Saudi Arabia?
As part of Vision 2030 for KSA, priority is being given to the Transformation of the Health Care Sector with a desire to build and create a world class health service. Success here will depend on overcoming some of the critical challenges facing the sector. These are multi-faceted, but will be familiar to people who remember what the NHS was like in the UK of the 1970’s. Consider a health service that does not have a clear ‘core offer’ for services- either primary care or secondary. So, one of the main challenges is the variability of services and a lack of standardisation of pathways of care such as stroke, diabetes, hypertension etc. This is made more difficult by the lack of an integrated IT system and a reliance on a paper-based system. Other challenges are familiar ones, such as a shortage of qualified Doctors, Nurses and AHP’s and a lack of clear clinical governance.
These issues coupled with an absence of a payer/regulator-based system means that the scale of the ambition is remarkable, and the Ministry of Health is working to deliver a hugely ambitious challenge; to make the KSA health system one of the best in the world.
Saudi Arabia embarked on transforming its primary health care system in 2016 to meet international standards proposed in the Saudi Vision 2030. From your perspective how have they progressed so far? What does the current infrastructure look like?
Saudi Arabia has made some real changes so far to its primary care offer, particularly where ‘Clusters’ exist and there is greater local autonomy for change. Whilst there is still considerable variation amongst Primary Health Centres (PHC’s), the rollout of the Enhanced Primary Care strategy (EPC) has enabled changes such as team-based care, disease registers, health coaches, improved IT systems and universal screening to be implemented. Interestingly, PHC’s in Saudi routinely include dentistry as well as scanning and care for low-risk pregnancy so there are many things that we can learn from our KSA colleagues too.
What are the key challenges within primary care in Saudi?
Whilst there are many challenges within primary care here in Saudi, one of the big challenges that Saudi is working to solve is the lack of an integrated IT system that links primary care to secondary care. This means that there is still a reliance on paper-based systems in some places and the linkage with secondary care for shared patient records and discharge planning needs strengthening. However, Saudi has a national strategy to resolve this and pilots are already in place across the Kingdom.
Another familiar issue is a shortage of qualified staff; Doctors, Nurses and AHP’s. Similar to the UK, it isn’t always easy to retain staff and there are lots of opportunities here for Clinical staff to undertake other roles which takes them away from the front line. Overseas nurses eg from the Philippines, have been a real help to support the workforce but there is now a national movement to encourage more Saudi personnel into these roles.
What are the biggest risks to successful implementation?
The time factor is one of the biggest risks for successful implementation. The 2030 vision is very ambitious and Saudi is highly committed to health care delivery. However, capacity and capability is an issue in some instances. Countries such as the UK have taken decades to get to their current position, learning important lessons along the way. Areas such as financial regulation and control, costing and coding etc. take time to get right and to put rigorous processes in to place. Corporatisation is another area that will take time as Clusters move through the journey to become Accountable Care Organisations.
What do you think are the key lessons that could be learned from primary care in the NHS?
We don’t always realise what a great primary care service we have in the UK until we compare and contrast with other countries. Key lessons from primary care in the UK are having a 'core offer’ so that similar services are available wherever you live. This includes the use of a support system such as NHS 111 and clear signposting to the right place to get care at the right time, eg. urgent care centres.
Additionally, patient engagement and involvement are routinely in place in primary care in the UK and this would be of benefit as a discipline here in Saudi. Clearly, having a fully integrated IT system is of huge benefit when delivering high quality patient care.
A further area where lessons can be learned from the UK is in developing extended roles for clinical staff. For example, nurse and pharmacist prescribers, specialist nurses and nurse consultants aren’t as well developed here in Saudi where there is a more traditional model in place for the roles of doctors, nurses and AHPs.
Can you highlight a key success in primary care you have seen since your time in KSA?
One of the things that I have found incredible is the speed by which the practical infrastructure can be changed here in Saudi. Things that would take us many months to complete in the UK are done here in a matter of weeks. For example, whole primary care centres have been restructured and rebuilt in just a few weeks to enable team-based care to be implemented, including integration of both males and female areas moving away from the previous segregated model.
Additionally, the development of care pathways has been highly successful in reducing variation and inequity. The dedication of clinicians to design and adopt care pathways such as diabetes and stroke is laudable together with their willingness to adopt new ways of working to enhance patient care. Working in new ways, undertaking additional duties and responsibilities hasn’t been the barrier that we may have seen in other countries.
Charlotte Harrison is the Principal Consultant for our professional services division. At NSCG, we can help with your leadership and agile workforce management challenges. To find out more, please get in touch.