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NHS – The Olympic Legacy

While most of the world was scratching its head about the London Olympics’ opening ceremony, Danny Boyle managed to do something that successive UK Governments have failed to do for over sixty years. The world watched as he promoted the NHS as a Global Brand. For five years we’ve had debates about what the lasting legacy of the London Olympics would be, a lot of which has concentrated on what to do with the buildings. The rest has been about whether it will persuade more people to become more active. Whilst I’m not belittling the positive effects that it may have in reintroducing people to sports and providing renewed support for sporting facilities, I’d like to put forward a much more important legacy – we should follow on from Danny Boyle’s tribute and start making the NHS a Global Health Service.

Readers of this blog will know I’ve been espousing the need to turn the NHS into a Global Brand for many years. But with the Olympic coverage disappearing from the front pages of our papers, that idea seems to be catching on. Recently the Independent ran the headline that the Government was considering a Global NHS. We now have the best opportunity to make that a reality – quite possibly a once in a lifetime chance to transform healthcare in theUK, and improve access to it around the world.

So Jeremy Hunt, here’s a challenge for you. If you want to go down in history, here’s you chance. Take this opportunity to show the world that the UK is great at healthcare as well as sport by making the NHS a truly global brand.

Making the NHS a Global Brand

The current debate about the future of the NHS starts with a correct observation, which is that continuing in its current form is untenable. As the population ages and we get more complex treatment regimes, then, unless we change our approach to healthcare, the numbers don’t add up. But all the Government’s proposed reforms are doing is rearranging the deckchairs on the Titanic. I’d like to suggest something more radical, which is to think about how to make it self-funding, without increasing the strain on the public purse. Not by privatising it, but by extracting value from it and then exporting that value. In other words, let’s see if we can make the NHS a global brand and turn it into something that can generate revenue.

Before you dismiss it, stop and think. We’ve already done it with the BBC, which Superbrands rates as the fifth strongest brand in the UK. The BBC is respected and earns money around the world. Why don’t we think of the NHS in the same way? It doesn’t feature in any list of brands because nobody thinks of it like that. But there are some very good reasons why it should, particularly if we want it to be affordable in the future. The current Government (and every one before it) is missing a trick.

The NHS probably contains more data about treatment and outcomes than any other medical institution in the world. And so it should. For much of its life it’s been one of the world’s largest employers, accumulating detailed information on generations of the UK’s 60 million citizens. That’s an awful lot of “big data”. So here’s the question – “If we could extract and monetise that value, could we make the NHS pay for itself?” We need to extract that value and use it, then export the resulting expertise to make money from the rest of the world.

mHealth Apps need an injection of reality

If you’ve been reading the mHealth blogs and analyst reports over Christmas and the New Year, you’ll have realised that medical apps are being promoted as being the next big thing. You’d be forgiven by thinking that by 2015 we’ll have given up on conventional medicine and the only reason we’ll be going to see our GP is because GPs will replace the Apps Store as the primary source of these apps. So, if you’ve any money left after Christmas the message seems to be to go and invest it in health apps development, as that’s where the cash will be.

Although it feels a little early in the year to be contrarian, I think that the industry is running before it can walk. Do we really think doctors are ready to be start practising the mantra of “first I’ll dispense an iPhone app; if that doesn’t work I’ll give them an Android one; and if they’re still not better I’ll put them on the Symbian app – if that doesn’t cure them, nothing will. They won’t come back after that!”.

I’m not knocking innovation in health apps. As I’ve said before the industry probably needs to think more out of the box than it currently is, but there are already lots around and there will be more to come. Whether they will transform our health is another matter, as is whether anyone will make money out of them. A lot of the current thinking seems to be making unsupportable jumps and simply inflating the mHealth bubble. Let’s look at whether it makes sense…

Mobile Health needs some Medical Pornography

If you’ve been working in Mobile Health or telecare, you’re probably frustrated by the slow progress being made in bringing products to market. Whilst analysts like research2guidance see a rosy future, more down to earth reviews, such as the recent 2020health report “Healthcare without walls: Delivering telehealth at scale”, and Frost & Sullivan’s “E- Healthcare Initiatives in the United Kingdom” continue to point out that very few projects have scaled up past a few tens of users.

Many reasons are put forward for that, ranging from the natural inertia of the medical industry, the barriers imposed by regulators, through to the difficulty in persuading doctors to hand over disease management to their patients.

Technology has been blamed in the past, but that’s no longer a valid reason. Over recent years there have been major advances in sensors, wireless connectivity and processing power. We certainly don’t have solutions to every problem, but there is a wide range of conditions where mHealth could provide significant benefits. So what’s holding it back?

Next week the Mobile Health Industry Review at the King’s Fund in London will be bringing experts and VCs together to talk about business models. I’ll be suggesting that mHealth isn’t the first industry to have suffered from this phenomenon. Even for disruptive technologies, it often needs an unexpected and sometimes even unconnected industry to invent and develop a new application in order to drive things to a point where the disruption can be taken up and embraced by others. One of the classic cases is the Internet. Much of the development of streaming, payment mechanisms and user interface was driven by the porn industry. Once that work was done, it was adopted by others, giving us the e-commerce, video streaming and compelling content that we now expect from every site.

So, if Mobile Health is going to get anywhere it probably needs to follow the same course and forget about conventional medical thinking, (which generally involves a doctor), and embrace some more disruptive models. To put it more bluntly, we need to find out what the equivalent of pornography is for healthcare.

Goodbye Clinical Evidence, Hello Celebrity GPs

Governments like change, so when the UK acquired its recent coalition government, it didn’t take a genius to predict that change was on the way for the National Health Service. The NHS holds a rather special place in the hearts of the UK electorate. Although the UK media loves to hate it, and most people gripe about it, the bulk of the population have a great affection for what it does. Few realise that outside the UK most people involved in the medical industry view it with admiration. Because of its popularity, the incoming government mollified public concern by announcing that they would “ring-fence” spending on the NHS, but then promptly started to change it.

That change was heralded by a consultation on “Liberating the NHS”, which was slipped out before the summer holidays, probably in the hope that few would notice or respond to it before the deadline at the end of September. It signalled a major change in direction, where control would be moved from the current Primary Care Trusts (PCTs) to consortia of General Practitioners (GPs).

That raises some concerns. The first is that we don’t train GPs to be managers. We still train them in much the same way we did a hundred years ago. So the most likely effect is that all of the managers who get made redundant from PCTs will simply go and work for GP consortia. And as there are far more of these, it just results in an even bigger set of people micromanaging.

The more worrying concern is what effect this will have on prescribing practice. The consultation document keeps on trotting out the phrase “clinical evidence”, implying that the NHS and local GP practices base everything they do on good clinical evidence. It’s a nice theory, and it would be nice to think that those developing this policy change believed in and supported it. It should be possible – we have a body called NICE (The National Institute for Clinical Excellence) whose job is to promote it. But as soon as everyone got back from their summer holidays, Andrew Lansley – the new Minister for Health, got out his rusty shears and castrated NICE. It’s difficult to understand why, but the implications for the NHS and GPs are disastrous. It’s goodbye to clinical evidence, and hello to whoever can get the most publicity for their favoured drug of the month.

Medica goes Wireless

Medica claims to be the world’s largest medical show. It’s a very monochrome event – all of the equipment is white and shiny, and most of the exhibitors and visitors are soberly dressed in dark suits, as befits the serious profession of medicine and spending money in Dusseldorf. Looking at the equipment on display and the crowds thronging the show, you certainly wouldn’t get any impression that there’s a recession around, other than slightly more suits than normal and rather fewer bow-ties around the necks of the visiting consultants.

As far as the medical industry is concerned, it’s business as usual, and hopefully more so, as more of us get older and less healthy. But there are some interesting trends. One of which is the increased prevalence of wireless connectivity. In previous years equipment manufacturers were happy for nurses to jot down the readings from their instruments. A few devices had wireless links, but they were the exception. This year, particularly at the consumer end of the market, wireless was becoming the norm, at least at the top end of product ranges.

Almost all of that was Bluetooth. I stopped counting after the first hundred devices, and that was in just two of the twenty halls. ANT was in evidence, helped with a demonstration of a prototype X10 Nano phone from Sony Ericsson, which was using the ANT protocol to connect to a weighing scale, heart rate belt and pedometer. Wi-Fi was there in a few products, but mostly confined to tags for asset management, and I failed to find a single ZigBee medical device. There also seemed to be very little profile for the Continua Alliance in terms of products or signage. Even The Intel stand was conspicuously Continua-free.