By Jake Arnold-Forster, SME advisor and chair of the expert panel
No one likes the meal time cold call on the otherwise redundant land line. Most people try and fast forward the ads on recorded TV. But most of the time we tolerate being sold something and actually welcome it when we want to buy. How would we get through life without all those people trying to get us to buy a better smart phone or a cheaper taxi ride?
So why do all the SMEs I work with get told whenever they prepare for a meeting with NHS executive and non-executive directors to avoid a sales pitch’?
I think a big reason NHS boards do not like buying is because it is never very clear who it is that can do the buying. And if anyone senior is bold enough to take a decision then they risk being accused of wasting public money (often by their own colleagues). Wasting time does not carry any penalty. Unsurprisingly then, the decision to buy is usually delegated to middle managers or procurement teams even less able to make a decision than their boards.
Yet no self-respecting sales person can blame the customer. And surprisingly – given what I have said already and despite an era of cutbacks – the conditions have never been better to buy health technology from SMEs. The companies I will describe can turn some of the NHS’s most wistful and wishful phrases – like ‘putting patients at the centre of healthcare’ – into reality.
So this blog is directed at anyone who feels they might be able to persuade the board of a hospital – or other provider of other NHS services – to invest in health ICT.
- People want to feel more in control of their health
Most people exercise control over their lives digitally. Whether it is phoning your friends, shopping online or gathering information – we now make more things happen in our lives than ever before because of digital technologies.
By contrast most health systems rely on taking scientific readings from you and not telling you what might be wrong until a nerve-wracking, hard-to-organise, five-times-a-year meeting with your GP. In that meeting you will probably be asked about any symptoms and sign of ill-health you may have detected since the last meeting. Unless you have written them down you are unlikely to give an accurate or useable account of those symptoms. And it is symptoms – not those scientific readings that – according to Calum MacRae chief of cardiovascular medicine at Brigham and Women – are the evidence doctors use for three quarters of all diagnoses.
That is why uMotif[i] is enabling people with cardiovascular disease to simply upload their own assessments of breathlessness, ankle swelling and other symptoms (as well, if they like, of any blood pressure and other biometric readings) to help keep Professor McCrae’s teams informed and themselves reassured.
And umotif is not alone, other SMEs like Patients Know Best and in the US, Patients Like Me, are all helping people to determine both what clinical outcomes and symptoms are important and gaining control over that information.
The benefits of self-measurement and self-management apply to most disease groups (uMotif now covers 14 different diseases) but not all people, of course. Not everyone wants to record their health or manage and add to their health records. But it does not take many people regularly measuring their symptoms and health-related activities to massively improve the quality and quantity of health data, correlations and insights for people and doctors. It also allows people to exercise more control over their disease.
SMEs can make the intention to move from ‘what’s the matter to what matters to you’ become true.
- People want a better experience of care services
I have often been told that you cannot compare the NHS with banking, travel, retail, utilities, education or any other health system in the world. Who could it possibly learn from, if that were true?
It is true that the most active users of NHS services do not seem to want it to change. Huge improvements in clinical care and memories of paying for doctors to visit have created a large, vociferous and tetchy Pro-NHS ‘party’ that no other political party has challenged. However, increasingly, younger people are putting very different demands on a service designed around single organ diseases and death by 66 for men and 71 for women.
My mother does not mind queuing to see a doctor, or waiting on the phone to book an appointment, or receiving letters informing of her next appointment, or not being told what tests mean, or bad hospital food. My daughter, to put it mildly, does.
DrDoctor[ii] makes it easy for people to book and re-book hospital appointments on their smartphone or computer. This saves hospitals money by reducing do-not-attend rates and allows booking clerks to focus on serial non-attenders. More simply and importantly, I believe, it gives people more control over the way they keep themselves well.
- People should not have to pay for wasteful care
There are some very good reasons to support the tax-based financing of the NHS and even better ones to support spending more on care services. However, that is a different argument from the one that says we have no clue about the value of care services in the UK (or any other country for that matter). Michael Porter’s simple calculation that clinical outcomes divided by money equals value has not seriously been challenged. Until we really start capturing, measuring and comparing outcomes that matter to people then we don’t really know whether we have a better or worse system than any other country.
What repeated studies have shown is that 30-40 per cent of health systems waste money on too much care (such as pointless operations) or too little care (not enough effective public health) or make avoidable mistakes (like prescribing the wrong drugs).
Many health technology SMEs – like PaceNet[iii] – have been at the forefront of using digital data to alert providers to costly or risky variations in treatments. VitalPAC[iv] allows hospitals to take reliable biometric data that in turn create predictive algorithms to prevent sudden deterioration of conditions. Deontics[v] (another company for which I have worked) helps doctors adhere to complex and often-changing diagnostic protocols to cut errors.
Beautiful Information[vi] (a new SME of which I am a non-executive director) has designed dashboards and processes to allow all board members and the whole health system to understand the flow of people in and out of hospital.
The challenge that Beautiful Information is setting the NHS is made all the more powerful because it comes from within the NHS.
Other service industries have been required through competition and regulation to cut waste. Mainly they have done this by retraining or replacing back office staff – middle managers, booking-, filing- and administration-clerks – with technology that requires consumers to book, file and administer their own transactions.
By contrast the governments have tended to recruit more NHS staff to help match uncapped demand.
The 2013 census recorded 20 different employee categories in England and Wales. Health and social care was by far the single biggest group at 12.5 per cent of the total workforce.
The efficiency gains that are being required can only be achieved through encouraging people to care for themselves more effectively, radically reducing the number of administrative staff in the NHS and investing in the health technologies that will attack the over-use, under-use, or misuse of medicine.
- The NHS is learning how to buy and SMEs are learning how to sell
The NHS is starting to change the way it invests in digital technology. Not before time. It has created bad spending habits based on central investment funds that inhibit autonomous local decision-making and over-complicated programmes that often become technologically redundant by the time they are implemented (badly).
There has been a big shift in commissioning of care services towards capitated contracts which reward outcomes rather than activity that was pioneered by Cobic[vii]. This has helped equally pioneering NHS organisations – like BI and Yeovil NHS Foundation Trust[viii] – to formulate some of the arguments in favour of SMEs that I have borrowed for this blog.
Yeovil is the first hospital to openly celebrate its relationships with SMEs (ref press releases) and Beautiful Information is the first NHS joint venture to declare its support for SMEs. SMEs are also learning how to sell more effectively. In particular, most now understand that they need to demonstrate at least the prospect of better value (either through better outcomes or cash savings) to NHS providers. The difficulty of proving a prospective benefit (that is the evidence has not been created yet) is often now being overcome by constructing longer partnership contracts that reward the SME and the provider on the delivery of pre-agreed benefits.
In addition, many SMEs are beginning to understand that the best way (and usually the only way) to get bought is to win the support of the senior management team. Again, Yeovil is one of the few NHS trusts to actively engage non-executive directors in understanding and meeting their SME partners.
- SMEs are often less risky than big companies
The fifth and final reason to choose health tech SMEs in 2016 is that the benefits of adaptability and speed of execution over scale of operation is beginning to be understood within the NHS.
More and more boards are learning – some times the hard way – that buying from some big, US-based technology suppliers has its drawbacks. More importantly, a sole focus on introducing electronic health records is not enough. Electronic Health Records (EHRs) do not easily connect with primary, community or social care systems and nor do they provide a direct, useable interface with a largely mobile patient population.
SMEs, by contrast, provide faster, cheaper and more specific answers to specific problems. They also tend to know how to work with each other better than big companies and that is why – helped by ZPB Associates[ix] – SMEs have clubbed together to create their own voice*. And, as SMEs have developed commercially and attracted more funding, the risks of bankruptcy that so worry procurement staff are receding. Indeed the danger of bigger companies being technologically ‘leapfrogged’ by smaller ones has shifted the balance of risk in favour of SMEs.
So, there, you have five good reasons to buy from a health tech SME in 2016. Make it your board’s first New Year resolution.