St John of JerusalemEye Hospital Group

2016

Nicholas Woolf and Tom Ogilvie GrahamChairman & CEO

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Middle East context

POLARISATION (in politics and society)...

ISIS (e.g.”The Islamic State of

Molenbeek?”)

REFUGEE CRISIS

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Palestine: some key facts

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Dire living conditions

• 75% Palestinians in East Jerusalem live below the poverty line• Gaza unemployment rate averages 43%, highest in the world -

60% youth unemployment• Gaza: 1.8 million people “locked in”, 80% rely on international aid• 20% patients (and their companions) from the West Bank were

denied permits to enter Jerusalem• 33% patients (referred on health grounds) from Gaza denied exit in

December 2015, the highest in 7 years

References: The World Bank, Oxfam, Association for Civil Rights in Israel, the World Health Organization and UNRWA.

Socioeconomic Impact of Blindness in the oPt

• The rate of blindness is ten times higher than in the West

• 80% of blindness is preventable

• Social stigmatisation especially for girls

• Impact on GDP –USD 202 billion/ year (vs. treatment would cost USD 28 billion) - WHO study on refractive errors

• Blindness - very high dependency (blind person requires average of 2 carers)

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St John Eye Hospital Group:Providing key basic health

services

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• 128,000 patients (increasing by approx. 5,000 annually) treated in Jerusalem, West Bank and Gaza per year

• Includes:– Over 5,000 major operations– Mobile Outreach: 16,700 patients

checked and health education delivered to their families

– Leading on preventative health and screening programmes

Staff at St John• Employed 235 people

in total, including 148 medical staff

• Trained 5 ophthalmic nurses

• One medical resident entered his final year, two more residents continued on the course and two new residents joined the course

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School of Nursing Graduates, 2015

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Wide reach in Palestine:

•East Jerusalem•Gaza •West Bank

Quality of Care

• SJEHG services offer the highest standards of care, notwithstanding the difficult climate in which we operate

• JCI accreditation is the gold standard in health care and its consultants are the most experienced in the industry

• In 2016 SJEHG had its three yearly review achieving 96% overall

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Strategic Plan 2013-2017

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Patients

Research

Capacity

Partnership

Gaza

FinanceReputation

Growing Reach

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Growing Reach

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Decrease in 2013 due to refurbishment of our theatre in Jerusalem (and increase for 2014 to catch up backlog of patients)

SJEHG 2015

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Unit Patient Numbers (2015)

Running Costs (2015)

Staff Numbers (2015)

Jerusalem Hospital 46,498 (including 3,795 major surgeries)

£6,057,269 170 (including 98 medical staff)

Gaza Hospital 31,419 (including 911 major surgeries)

£522,877 17 (including 14 medical staff)

Hebron Hospital 11,451 (including 338 major surgeries)

£353,397 14 (including 9 medical staff)

Anabta Clinic 22,026 £366,749 17 (including 11 medical staff)

Mobile Outreach Unit 16,760 £336,776 11 (including 8 medical staff)

Total 128,154 £7,375,341* 235

*excludes London office costs

Jerusalem Hospital

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• Covers all ophthalmic specialties and is the base for our doctor and nursing specialist training courses

• In 2015 vital updates to the building’s infrastructure began

• Patient pathways were also introduced to help the visually impaired find their way to their clinics

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Hebron and Anabta Facilities• The new Hebron Hospital opened at the

end of 2015 – purpose-built, located in the city centre and will treat many more patients

• The Anabta Clinic is easily accessible from the bigger towns of Nablus, Tulkarem and Jenin, where many of their residents are refugees from Gaza

• In 2015 these facilities combined treated over 33,000 people

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Gaza Hospital• Main provider of charitable eye care in Gaza

• New hospital to open in May 2016:

– Conflict preparedness: e.g reinforced basement and shatterproof glass to ensure safety of patients and staff

– Double operating capacity

• Only new build by an NGO since last conflict (2014)

OLD CLINIC

NEW HOSPITAL

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Mobile Outreach Programme

• Brings eye care to isolated communities in the West Bank (e.g. Bedouins, small refugee communities…)

• A second outreach team was relaunched in 2015

Drop in numbers due to reduced funding allowing for only one van to be utilised

Diabetic Retinopathy Programme

• Under the programme the unit:– Travels to remote villages to

screen patients– Refers patients for further

treatment in our centres– Educates on ways to prevent

diabetes from developing• Since 2012:

– 21,236 people have benefited from our awareness sessions

– 44,572 have been screened for diabetes

– 13,607 have been diagnosed with diabetic retinopathy and referred to our Hebron Hospital

• We are expanding to refugee camps in northern Jordan, the first time our services have been projected into a neighbouring country

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Jerusalem Old City:Muristan

• A hospital has existed at this site since at least 700 AD and knights from the First Crusade in 1099 formed the Order of St John there in the early 12th century

• Soldier monks looking after recuperating pilgrims and became known as the Knights Hospitaller of the Order of St John

• The building was used by the Eye Hospital as a temporary eye clinic following the 1948 war but has been abandoned since 1961

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Future of Muristan

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• St John wants to preserve the endangered building whilst providing an invaluable walk-in clinic which will provide a primary and emergency eye care clinic, treating an estimated 5,500 patients every year

• A small museum on the history of the Order with a resource/knowledge centre will also be included along with an entire garden area and an outlook with one of the best views of Jerusalem

Partnerships

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• We have developed partnerships that promote peace and result in constructive relationships between Palestinians and Israelis

• Some examples of our partnerships include:

• Tel Aviv University – certifies St John’s Orthoptic Assistants

• Palestinian Red Crescent Society, Al-Quds University medical centres;

• Medical Relief Society – implementation partners for Diabetic Retinopathy Screening Programme in the West Bank

• Help to treat premature babies at the Holy Family and Caritas Baby Hospitals in Bethlehem

Hadassah - St John Partnership

• The Hadassah Medical Center in Jerusalem is one of the largest and most progressive hospitals in the region

• Hadassah was nominated for a Nobel Peace Prize in 2005 for its equal treatment of all patients, an ethos St John shares

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• Since 1998, Prof Jacob Pe’er, head of the ophthalmology department at Hadassah, has worked with St John on complex clinical cases

• The ‘Peres Center for Peace’ funded a Joint Teaching Programme

Joint Teaching Programme• Palestinian ophthalmologists

undertake further training in specialisations at Hadassah that they would not otherwise be able to access

• In 2014, all ophthalmic specialties were covered at St John’s hospital by Palestinian doctors for the first time ever

• Of our 34 doctors, seven have undertaken formal training and qualifications at Hadassah

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Sovereign Military Order of Malta

• St John screens and treats premature babies at the Order of Malta’s Holy Family Hospital in Bethlehem

• The Order of Malta will jointly run our Muristan Clinic

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The Palestinian Authority (PA)• In 2014 St John signed an MOU with the

Palestinian Ministry of Health.• St John:

– Examines and treats diabetic patients in PA run clinics

– Provides free surgical services for many patients who are referred to our services by the PA

– Trains medical personnel in order to increase the efficiency of surgical specialties

– Provides experienced doctors to perform surgeries in PA hospitals

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European Union:‘Partnership for Peace’ Project

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• In 2015, secured funding for a genetic research project with Hadassah from the EU’s Partnership for Peace Programme

• The collaboration will include training: – Geneticist– Epidemiologist– Ocular Ultrasonagraphist

• A dedicated genetic research laboratory will be established in our Jerusalem Hospital

• First major research project undertaken by St John in over 20 years

Finance

Actual 2015 (GBP / ILS = 5.94)Budget 2016 (GBP / ILS =

5.85)

£'000 £'000Patient Related Income 3,776 3,736

Voluntary Income 4,598 5,436Other Income 147 321

Total Incoming Resources 8,521 9,494

Payroll costs 4,987 5,333Medical costs 1,284 1,463Other costs 1,228 1,322Depreciation 700 832

Total Resources Expended 8,199 8,950

Net Income 322 544

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Finance 2015

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Total Incoming Resources: £8,521,000Capital Donations: £564,000

Total Cost Allocations: £8,199,000

Voluntary Income Split

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CAPITAL/OPERATING DONATIONS SPLIT 2015

CAPITAL/OPERATING DONATIONS SPLIT 2016

2015 (£'000) 2016 (£'000)Operating Donations 7,983 8,720Capital Donations 564 774

Balance Sheet - December 31st 2015

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Actual 31st Dec 2015

Budget 31st Dec 2016

£’000 £’000

Fixed Assets 14,469 15,766

Current Assets 5,163 4,019

Current Liabilities -1,462 -1,020

Longterm Liabilities -3,453 -3,504

TOTAL 14,717 15,261

Assets

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Actual Budget 31-Dec-15 31-Dec-16£’000 £’000

Fixed assetsTangible assets at written down value

4,232  5,276

Investments at market value 10,237  10,490

Total 14,469  15,766Current assetsStock 364  400Debtors 1,135  1,650

Sundry debtors & prepayments 595  550

Bank accounts 3,009  1,419

Total 5,103  4,019

Priory Income 2012-2015

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Priory Income 2015

Australia £85,000Canada £50,000England £468,000New Zealand £113,000Scotland £195,000United States £1,318,000Wales £15,000Total £2,244,000

Priory Income: Trend

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GBP / NIS

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USD / NIS

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SJEHG Trustees

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GovernanceSJEHG’s Board meets three times a year, including once in Jerusalem. The Steering Committee meets three times a year, between Board meetings

Committees of the Board:•Finance Committee•Clinical Governance Committee•Steering Committee•Fundraising Committee•Strategy & Planning Committee•Investment Committee•Audit Committee•Honours & Awards Committee

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Competition• SJEHG has increasing competition across the oPt;

• Private practices across the West Bank provide care for patients who live in areas where we do not provide eye care and for those who can afford it. Our doctors themselves also carry out private practice at other clinics

• Government hospitals also provide limited ophthalmic services, mostly cataract surgeries

• In Gaza, we receive corneal graft and retinal surgery referrals from the Palestinian Authority. Cataract patients are referred from them to government hospitals. UNRWA refer many ophthalmic cases to us but not cataract patients, who are now being sent to the Eye Specialty Hospital (run by the Public Aid Society)

Risks

• SJEHG’s risk register analysis is based on UK National Patient Safety approach

• Each committee reviews risk in its own area every meeting

• Board and Steering committee review major risks each meeting. Board signs off annually for the annual accounts

• Only two red risks, after mitigation: political and war, which are beyond our control

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Research: Installing a laboratory to begin researching hereditary eye diseases and publishing research in recognised journalsTraining:Alongside regular training programmes, one doctor will begin Fellowship in Glaucoma to enable our Gaza Hospital to provide treatment for the most complicated cases, one doctor’s Fellowship in herediary eye diseases will continueInfrastructure: •Official openings the new Gaza and Hebron Hospitals and restoration of the ancient site of Muristan•Jerusalem Hospital- update of outdated pipe work and hydrants and a separation of our paediatric and retinal clinical areasInformation: A roll out of the new Hospital Management Information SystemCommunity Healthcare:Expanding our Diabetic Retinopathy Screening Programme to northern JordanMedia: •Releasing ‘Eyes of St John’ on an international stage•Launching a new interactive website & online shop

Plans for 2016

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Radwan (Mobile Outreach Patient) trying glasses on for the first time

Layla (an Anabta cataract patient) and her father had this to say: ‘Thank you so much to all at St John, from Anabta, to London to Jerusalem, from myself, my family and all the city of Jenin - we are so grateful to have your services’ 

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Omar (ruptured retina patient from Gaza). His mother had this to say: “Your doctor was the first person to give us a thread of hope and wanted only the best for us all. He brought us to life again. Thank you to St John, thanks to you all!”

Alice, a nursing school graduate from 2015, who now works in our services:

“The best thing about St John is the teamwork in the hospital. Here it’s like one big family!”

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Eyes of St John