29 Jan 2015

HRH Princess Haya Gives Keynote Address at Leaders in Healthcare in Dubai

Your Excellencies,

Distinguished Guests,

Ladies and Gentlemen,


The topic that I have been asked to talk about today is ageing, which in so many ways is difficult. I hope that you are still sitting comfortably because when I read through my speech one last time, it occurred to me how long it was. One sure outcome I am guaranteed to come away with is that you all may feel that you have aged significantly in the time I have taken from you.

Like Arab Health, I have just celebrated my 40th birthday. Unlike Arab Health, surprisingly, it was a far less painful procedure than I had expected it to be. I did a lot of research before – I have been asking the greatest people I know, and I am blessed to know a few, two of my favourite questions. One, if you have lost a respected elder early in life, what would you be most proud of showing them if they came back today? And two, as you progress in life, what is the truest lesson, one that maybe stems from regret that you have learned? I will leave you to think about those two things as I address our topic.

The UAE has come far in its delivery of healthcare to our rapidly growing population, with changing demographics, and a host of new illnesses resulting from our changing lifestyle habits. Yet despite all our efforts, recent publications suggest that we may be stemming the tide, that there remains much more to do. 26% of deaths in the UAE are due to heart attacks, and diabetes is now haunting 12% of our children. These are sobering statistics.

Across the Emirates, particularly Dubai, we are entrusted with delivering the best healthcare possible to our people, in close collaboration with you, our talented healthcare professionals, in keeping our nation healthy and disease free. Together as partners, we strive to deliver patient centred care; care that ensures that institutional resources and personnel are organised around the patient rather than around specialised departments.

Many would argue that understanding the patient as a person in his or her own right, not merely as a body with an illness, is paramount. For success, we must ensure that we share power and responsibility with the patient, that we build therapeutic alliances where the patient sees the doctor as a well-informed carer not merely as a skilled technician and the government as a partner in prevention not just a provider of state of the art facilities in time of illness. It is our collective responsibility to ensure health care resources are used appropriately in the most cost-effective way, without waste.

Healthcare is often discussed as a result of patient complaints, be it inadequate treatment, poor facilities or simply how the system is not working. It is easy to forget the successes, and more importantly, our responsibility to take care of ourselves and our failure to maintain a healthy lifestyle when illness strikes.

So, how do we provide patient-centred, outcome-driven, efficient healthcare that is sustainable and affordable? How do we future proof it? These are important questions that have taxed the most informed and influential minds for decades. It would be naive to assume that the answers can be easily found, but as we are often reminded by His Highness Sheikh Mohammed Bin Rashid Al Maktoum, success doesn’t often come easily, and certainly requires more than just luck. It requires a good strategy with clear objectives, the right financial and human resources, careful planning, focus and dedication, but most of all, it requires desire and determination.

For failing to take on this challenge would mean accepting defeat, something we are not used to, something simply unacceptable. Today, I stand before you hoping to start an important debate about how to take on this challenge rather than provide you with conclusions.

There is growing evidence that the current global health systems will be unsustainable if unchanged over the next 20 years. Almost universally, healthcare is threatened by a confluence of increasing demand, rising costs, uneven quality, and most importantly, misaligned incentives. If ignored, healthcare systems will be overwhelmed, leaving financial devastation for individual countries and escalating health problems for the individuals who live in them.

Healthcare is changing, and the most ominous of these changes is the impact of ageing. It is a truism that we are all getting older. Today, approximately 12% of the world population is over 60 years or older. That is roughly 800 million people, a number forecast to become 1.4 billion by 2030, and although it is difficult to be exact, it is likely that 25% of the world’s population will be over the age of 60 by 2050. That is over 2 billion people.

Although ageing affects all countries, it appears that the rate of ageing disproportionately affects low-income countries than high-income countries, with most of the world’s population over 80 living in Asia and Latin America in a few decades. Furthermore, as the numbers of elderly people grow, the ratio of those employed to older people will fall thus adding more financial burden on those working to support their elderly. It may be that countries already face this demographic challenge now but soon, others will begin to feel the change. Unfortunately, no country is immune.

Of course, an ageing population is great, as living longer is a sign of progress, and something we should be proud of. However, with ageing comes declining health that stretches healthcare resources. This added pressure handled inappropriately, will lead to a crisis in the provision of healthcare. Our healthcare systems need to be designed in such a way so as to be flexible, to foresee a change in disease patterns and cope with varying demand, but most of all, to be able to continuously innovate in order to avert this crisis.

In order to make our health care systems sustainable and future proof, we must understand the challenge an ageing population presents to our healthcare and welfare systems. We must have a clear vision of what these systems would look like not only in the immediate future but also in the next three to four decades. We must take a holistic view of the needs of older people, which cannot be done without their direct involvement in the design and delivery of services that meets their needs. Perhaps the most fitting description of patient-centred care is “seeing the world through the patient’s eye”. Only then would we be sure that we have designed a system that can truly satisfy their healthcare needs.

Once we have decided on a mechanism to deal with our ageing population, we must measure this against credible benchmarks for performance, sustainability and affordability. Only then can we target innovations where they will make the most difference, and identify and apply best practice in health services and performance management of our health and welfare systems for the benefit of all.

We must not be afraid to look outward, and seek the assistance of our neighbours and even those further afield. We must abandon the notion that healthcare should be local, and the days of operating in silos must end. Globalisation coupled with open-mindedness has led to the emergence of innovative business models that have far-reaching benefits and have forced many of us to think differently, sometimes, in a way we are not used to. This way of thinking does not necessarily mean that we have abandoned our morals or beliefs.

So what are the building blocks for a sustainable health and welfare system? First and perhaps most importantly, we have to find common ground, and a vision and strategy that balances public versus private interests in building infrastructure. This must be built and operated in line with patients’ needs and not solely for financial gain. Coupled closely with that, we must realign our incentives to ensure fair access, accountability and better outcomes. This can be achieved by setting rigid but fair quality and safety standards, with enhanced transparency, thus encouraging standardisation and building consumer confidence and trust. Resources, government and private, must be strategically deployed to satisfy demand, and encourage those who exhibit that they are maintaining high quality, safety and best patient outcomes.

The Centre for Healthcare Quality, under Dubai Healthcare Regulations, has created a framework which provides a greater opportunity for clinicians to practice yet at the same time ensures greater protection for our patients. These regulations are continuously updated in line with international standards. The Centre is also improving access to its users with progressive automation thereby enabling a faster approval for new facilities. We aim to offer protection for the clinicians so that they can create a comfortable environment for practice without losing sight of the most relevant objective - patient safety and good outcomes. The Centre will also have a greater workload with Phase 2 developing, offering facilities focusing on treatment, and rehabilitation. The aim would be prevention, but when that fails, rapid access to appropriate acute care is followed by rehabilitation and reablement, integration into society and returning to work. Those elderly patients would be offered a place of comfort where they would feel valued and cared for.

There is no denying the role technology plays in the delivery of healthcare. A strong digital backbone would allow better use of technology, easily integrated into networks to improve diagnosis and treatment. It would also allow an easy exchange of clinical and educational materials, thus enhancing knowledge transfer within countries, and certainly, across countries.

We are working to do our part to strengthen IT systems essential to developing our healthcare infrastructure. The Al Maktoum Medical Library provides access to countless publications and case studies to keep our teams current on the latest technology and practices. This can all happen from the tip of a finger within the comfort of the library itself, or thanks to today's technology, from the convenience of the user's office, car or a seat on board an aeroplane. The library will also become a hub where students, teachers, doctors, and nurses meet to exchange and shape ideas. Ankabut, the UAE's Advanced National Research & Education Network, a savvy system connecting students and professionals across the globe for academic and research efforts, will soon become part of the services offered.

We live in a world where the word ‘screens’ has taken on an entirely new meaning and purpose. While the trend in healthcare for more than a decade has been to encourage physicians and nurses to take on electronic medical records, the responsibility of connecting with the patient outside of 'screen' time still remains.  In our region, it also, often times, includes connecting with the family as it is the unit that looks after our loved ones when they are growing older.  Therefore, as much as technological advances are an integral part of developing our system, we must not forget empathy and its impact on a patient and their family.

Research is moving fast behind the scenes. The Harvard Medical School Global Health Centre – Dubai, which was announced last week, has now joined our local peers such as the Al Jalila Foundation for Medical Education and Research, National Research Foundation and the Sheikh Hamdan Bin Rashid Al Maktoum Award for Medical Sciences.  We are now in a position to significantly increase the number of peer-reviewed publications, reflecting statistics and data on diseases relevant to our population, including our elderly. We must create our own well of data to fetch from and forge ahead.

One important and crucial factor in our ability to deliver care is human resources. Nations are struggling to train, recruit and retain sufficient doctors and nurses. Many have started to adapt delivery roles and structures to compensate for this shortage. This has the advantage of saving cost and maintains patient dignity and independence without being too far from medical help. Furthermore, monitoring of chronic diseases will allow the development of substantial data banks that can be interrogated and analysed for recurring patterns, increasing the ability to predict when to intervene prior to the development of full-blown illness.

In order to help fuel the facilities that the elderly require, we must continue to groom new generations that will own their place somewhere in the healthcare spectrum.  As part of Phase 2, a high school will be built with a special concentration on health sciences. Additionally, the new Mohammed Bin Rashid University Hospital is well on course to open its doors in the fall of 2016.

All of this good work will take us far, but only so far. To go further, we need to create a climate of change. This will allow us to embrace innovation, technology, and push us to continuously examine our processes, ensuring greater efficiency, cost-effectiveness, and most importantly, a better patient outcome.

I hope I have given you a framework for your debates – but before I end, I want to share with you the answers to the questions I began with.

All the good and respected world leaders have answered in the same vein. And Sheikh Mohammed encapsulated it best for me; he said that if His Highness Sheikh Rashid or Sheikh Zayed came back today, he would not show them the tall buildings and the cutting edge modern glow around this city. He would show them the real achievements, those that have prolonged and touched other human beings for the better.

And when I asked world leaders, who are elders, what their real-life lesson had been, one that maybe stems from regret, they told me the same things, in different ways. Most of them said ‘when you are younger, at times your dreams overshadow the realities of what you can achieve, and ambition can eclipse the outcome or result.’

Only by being truly honest with yourself about the realities of the world we live in can you build dreams and make them happen. With this in mind, I wish you all the very best of luck for 2015 and beyond, and encourage each and every one of you to take ownership of your health, make yourself accountable, and expect doctors, nurses and governments to live up to their capabilities, and their promises, so that we are in a better place to care for our elders and the generations to follow.

Thank you.