For your eyes only

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Visionaries: Chris Canning (left) and Sir Thomas Boyd-Carpenter (right) have big plans for the Gulf.

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The news that the world famous UK-based Moorfields Eye Hospital will soon be opening a private branch in Dubai’s Healthcare City (DHCC) was met with great excitement earlier this month. However, not everyone burst into song. Moorfields has come under fire in recent weeks after it was revealed that the hospital had borrowed money from the UK’s National Health Service (NHS) Foundation Trust in order to fund the opening of a private branch in Dubai, that would then serve as a money-generating scheme to fund its British operations.

The hospital’s actions are earnestly defended by Sir Thomas Boyd-Carpenter, chairman of Moorfields Eye Hospital NHS Foundation Trust, who tells Arabian Business: “The profits that are made here from Moorfields Dubai, which we hope will be vast, will actually be fed back to the benefit of the NHS.

“Furthermore, the Dubai branch will provide exactly the same standard of clinical healthcare as its UK headquarters, so you won’t be able to tell one from the other,” he continues, before joking: “Although it will have rather more marble than you’d find back in Moorfields London.”

It is no secret that the NHS is mired in debt. A recent estimate claimed NHS hospitals were struggling with a budget deficit totalling US$1.065bn, and this is where the NHS Foundation Trust plays a crucial role. If a hospital is granted Foundation Trust status, it can borrow money from the Trust ‘to improve patient services’, but perhaps more significantly, it can decide how best to spend that money. Moorfields was granted Foundation Trust status two years ago but its decision to use the finances to set up a private branch of the renowned NHS eye hospital as a money-making scheme has been heavily criticised by many experts in the UK who believe the money should be instantly re-invested into the NHS. “As you know there’s been quite a lot of hostility to the whole idea of Foundation Trusts being set up. A certain number of backbench members of the Labour Party don’t like the idea,” admits Boyd-Carpenter.

One Labour MP in particular who doesn’t like the idea is Jon Trickett, who openly complained: “If there are assets through which hospitals can release money into the NHS, that money should be used to treat the British people. It’s perverted logic to do what they [Moorfields] are doing and an outrage that this is being allowed to happen.”

“You know all this hostility arises from a misunderstanding,” counters Boyd-Carpenter calmly. “We have borrowed money from the Foundation Trust in order to fund Moorfields Dubai which is a private scheme in order to make money for the NHS. Because it’s private, we’re effectively ringfencing the scheme, which means it’s insulated in case anything goes wrong, so it’s a win-win for these guys’ constituents.”

Chris Canning, the recently appointed CEO of Moorfields Dubai, also has no problem in admitting that the main motivation behind the scheme is to simply “make money”.

“That money [from Dubai] will go straight back to Moorfields in London. What I found remarkable was the implication that you should go into a business venture wanting to make a loss. You go in wanting to make a profit.”

How much ‘profit’ Moorfields aims to make, however, is unclear. Despite carrying out more than 23,000 operations a year, it has been claimed that London’s top NHS eye hospital is currently paying off its debts at an annual rate of US$584,000. Meanwhile a recent article in the UK’s Daily Mail newspaper suggested that Moorfields' total debts stood at US$25.3m, and that the hospital had loaned US$11.7m from the Foundation Trust in order to fund the Moorfields Dubai scheme. “Actually nothing in that article was correct!” adds Boyd-Carpenter. Canning then playfully interjects with: “Well, it did say world-famous". “Yes, and it also said ‘cash-strapped’!” exclaims Boyd-Carpenter, his irritation showing for the first time. The chairman’s mood shifts a gear and it is clear he means business: “Like any company we’ve got a certain amount of capital borrowings in the market which in our case are effectively from the ‘NHS bank’ or Foundation Trust to call it by its proper name. I’m not allowed to give you the actual amount because it’s in confidence, but it’s certainly nothing like US$11.7m. We also invest it in re-developing our own properties — we refurbish some of our rather elderly parts of the building and so on. Anyway, we borrow it at an interest rate and we’re expecting to make a small profit on our relationship with our NHS commissioners, out of which we pay the interest. So it’s effectively treating us like any shareholder in any organisation.”

“Except that there are no shareholders,” Canning is quick to add. “No one is getting richer, because as I said, any profit that we make goes straight back into supporting the NHS in London and to say that’s a bad thing, well I think it’s a bit rich,” he concludes, without seeming to notice his play on words.

“The fact is that we are completely fixated on our clinical standards, on the good name of Moorfields and on delivering a good service to the people in Dubai and the surrounding region,” says Canning in a somewhat final tone.

At this point Boyd-Carpenter helps his CEO change the subject: “We first had the idea around two to three years ago when we said ‘you know we are an international organisation — people come to us from all around the world — both patients and staff.’ So we thought ‘well why don’t we start trying to deliver to a lot of our overseas patients?’ Dubai is a natural place to come to because a fair proportion of our patient base comes from the Middle East region, it’s centrally based, it’s got all the commercial and financial infrastructure that you’d need and good quality controls.”

“Yes, I think the quality standards here in DHCC are top of the range,” echoes Canning. “They’ve been very careful about evaluating all the staff we wish to employ and they have enforced some pretty robust clinical and corporate governance standards which are imperative for us because the preservation of Moorfields's brand image is vital to us — it’s our great asset.”

In order to further ensure seamless integration with its London headquarters, telemedicine video-conferencing links for referral to consultants back in the UK have been installed.

“This means we will be working to exactly the same standards and Moorfields Dubai patients will be receiving our world-class diagnosis and treatment,” says Boyd-Carpenter resolutely. “You see we have an incredible concentration of consultants at Moorfields London who cover all 13 sub-specialities. It is no longer possible for an individual consultant ophthalmologist to know, understand and practice all 13 sub-specialities, and considering the eyeball is only about an inch long, to have 13 subspecialities is quite an achievement."

Canning adds that the hospital will “never" have 13 experts on site in Dubai, but what it can offer is a variety of “different ways of handling different problems". “Primary care and a certain amount of common subspecialist care, in fact a lot of the common subspecialist care, will be done here in Dubai. However, for the very difficult, obscure type of problems, we have the capacity to link with London through the telemedicine links. A patient will then know that no matter what problem they have with their eyes, Moorfields Dubai can always help, but maybe not always on site.

“The consultant here might not be able to treat your condition but they can refer you back to a consultant in the UK." The telemedicine links are also useful to determine whether there is any point in travelling for treatment, says Canning. “For example, a consultant might say ‘you’ve got a 70% chance that this can be treated, it’s worth going’. And this highly expert filter whereby you can talk over a difficult case with another consultant is invaluable."

“But it’s also actually knowing the individuals and having had personal contact with them,” adds Canning.

“You feel like you’re in a community with them.” In fact four staff currently employed by Moorfields in London are moving to Moorfields Dubai. The branch will has been equipped with the latest ophthalmic technology and will comprise a total of 32 staff, including three consultant surgeons who will be supplemented by visiting consultants.

The scale of Moorfields Dubai, however, will be considerably smaller than its counterpart in the UK, which is spread out across 11 different locations in London, has 285,000 outpatient appointments annually, in addition to carrying out over 23,000 ophthalmic operations. “This is going to be a lot smaller,” smiles Canning, “The plan is to do 1000 operations and see 6000 outpatients in the first year, eventually ramping up to about four times that to 4000 operations and 24,000 to 25,000 outpatient visits a year. We think that should suffice in terms of the market that we’ve got and the targets, but I’d love to expand if we need to.”

So is it planning to open any other branches overseas, or in the UAE where the private health sector is currently booming?

“The first question is whether there is more that can be developed with Dubai as a hub — just as in the UK, we have an image of a mothership and ten satellites around it — that’s the sort of model that might be relevant in the Gulf,” says Boyd-Carpenter, before continuing: “We certainly wish to run peripheral clinics and right now we’re looking very actively at setting up a satellite clinic in one of the adjacent emirates. If you need follow-up appointments, do you really want elderly patients endlessly having to travel? But we’ll always do the operations back here because to maintain the standards in surgery, you need top-of-the-range equipment, you need a concentration of surgical equipment and nursing staff, and you can really only achieve that in one place.” Undoubtedly, Moorfields Dubai will be filling the vacuum of much-needed ophthalmic and surgery facilities in Dubai, the UAE and the broader Middle East.

As Canning explains: “In a normal ophthalmic practice, we mostly deal with the very young and the very old. The very young suffer mostly from squints and congenital problems — children have a lot of eye trouble — and the elderly suffer from cataracts, macular degeneration and a variety of degenerative conditions in the eyes. That’s the same mixture that you’d find anywhere in the world, but the proportions are very skewed here because it’s a very young population. However, peculiar to this region is a prevalence of diabetic eye disease and genetic eye problems so we are geared up to those.”

Canning also points out that there is a high demand in the region for laser eye surgery for the correction of long and short-sightedness as well as oculoplastic surgery. “This type of surgery involves things like correcting watery eyes, droopy eyelids, ingrowing eyelids, malposition of the eyelids and a variety of congenital malformations around the eyes which can be corrected surgically." Oculoplastics, however, says Canning, has now transformed into Oculo-facial surgery which is more like cosmetic surgery — removing wrinkles and bags from underneath the eyes. “This tends to then mix very much into changing the shape of the face as a whole with brow lifts, face lifts, botox and so on. And as you know plastic surgery is very big out here. So we’re going to react to the market according to what’s here and what people want.”

In addition to its own commercial venture, Moorfields Dubai will support postgraduate teaching by working closely with the Harvard Medical School Dubai Centre (HMSDC). “Harvard has been a big draw for us because it is committed to teaching and research and so are we,” adds the chief executive.

Indeed, while Moorfields UK is famous for treating the entire range of eye diseases, it is also one of the leading centres for ophthalmic teaching and research, for which it partners with the Institute of Ophthalmology in London. “We’re currently in talks with HMSDC about all the ophthalmic components of their development. We’re planning to go hand in hand with them.

“You know, there is a certain amount of inertia and treacle in the National Health Service — it’s a very established and large organisation and things don’t happen very fast,” reflects Canning. “Whereas here you have the opportunity of carrying through your own beliefs and ideas really rapidly. The speed with which things happen in Dubai, but also the way things happen, it’s just like nothing I’ve experienced before — it’s quite unlike anywhere else in the world.

“Dubai is a very invigorating place to be and the fact that we can run a branch of Moorfields here without having to make compromises, makes it a terribly exciting venture.”

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Posted by Michael Mathur, USA on Tuesday 20 February 2007 at 00:42 UAE time


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