Retirement is an out of date concept

Retirement or not

It may be heresy to say this, but retirement is an out of date concept, born of an earlier age.

For many people the onset of internet based technology and more recently discussions about AI are making them scared and more inclined to want to keep the world of work in a similar pattern to the past. This includes a view that the retirement age shouldn’t go up but in fact should go down, so that people have more time “post work”. But perhaps the reverse is true? Perhaps we need to refashion what work means and the idea that it starts and stops in the way it might once have in the 20th Century? Now is the time to recognise that work is changing and we should proactively use this as an opportunity to re-imagine work.

Work is good for us. It gives us purpose and can be stimulating in a range of different ways. Purpose is so critical to living healthier and happier lives.

Technology overthrows past behaviours, activities and perceptions, but it also enables new ways of interacting with others and with the wider world that our predecessors could never have imagined. It makes it easier for people to monetise some of their skills and capabilities in other ways, including online. We can make technology work for the wider society.

If we re-imagine retirement then what are some guiding principles?

  • Work is a positive force for good. People should continue to work for as long as they can, but in very different ways and in order to be healthy and motivated and not just to make money.
  • The government should look at how it makes “education for life” a real option for everyone. In other words how government enables people to retrain in different ways to enable them to follow different types of work at different times in their lives
  • People are living much longer lives. The state shouldn’t be expected to pay pensions for 30 years for people if they don’t make any other form of contribution back to society.
  • However, the state should proactively look at how it facilitates older people finding new types of work and giving back to society for a wage.
  • Ageism is rife in society. It needs to be opposed as vigorously as any other form of prejudice.

We should use the COVID crisis to re-imagine our Society for the better and not feel the need to re-entrench past views and a mythical view of better times.

A lot of work will need to be done to create the right environment for this to happen, but we should start sooner rather than later, if we want to ensure that the UK continues to be productive and mould breaking.

Do politicians need to go to business school?

Channel 4’s breakdown of the careers of MP’s in June 2017 showed that 19% were career politicians, 14% were from business, 11% were lawyers, 8% finance and accounting and the rest were a very mixed set of occupations.

In fact more than a quarter of the candidates chosen by Britain’s political parties to fight in the 2010 general election had no experience of any career other than politics. And this was true in the 2015 general election when one in four (26 per cent) of new candidates contesting were political professionals source UCL and PCUK.

Going back to 1979, Nuffield election studies show no less than one in ten MPs from the three main parties have been barristers or solicitors. More recently research compiled by BPP University Law School has revealed that 119 of the 650 MPs in 2015 either studied or practised law before standing for election.

But it is clear that this isn’t what the electorate want.

A YouGov report in 2014 showed that voters would prefer if these trends were reversed. 57% wanted more factory workers elected to Parliament; 61% wanted more doctors (who made up only 1.4% of main-party MPs as of 2010) and 57% wanted more scientists.

Unsurprisingly, there is always a huge clamour for MP’s to come from less privileged backgrounds and indeed represent a wider societal view. However, there is way too little attention given to the need to have more people from business in Parliament.

A huge proportion of the issues that MP’s need to understand, debate and vote on relate to how organisations need to be run, how to improve efficiencies, leverage new ideas and technologies and motivate people. These issues are the bread and butter of business people.

So whilst the public may want more doctors and factory workers, actually we do need more business people before anything else, if we are going to solve the most pressing issues in our society.

Perhaps it’s time to train our MP’s to be better equipped to do their job. At least some of this training needs to be at a Business School or equivalent. Until then we shouldn’t be surprised if so many offices of state are poorly managed, and if too often politicians promise the earth and are unable to deliver it.

What is a human right and what is a societal benefit?

Human rights

There used to be a time when people were absolutely clear about what their human rights should be. It was about freedom of speech, a right to a fair trial, the right to vote, freedom from discrimination, freedom of religion, freedom of thought and freedom from enslavement. These are critical political rights that most right minded people believe in. It’s strange then, when so many people across the world are still fighting for these basic freedoms, that some developed countries are debating whether “paid leave for a bereaved parent” should be a human right.

We must differentiate between human rights that are fundamental to a fair existence and those that are really at the gift of a democratic society. People have fought and died for centuries for basic human rights. It dishonors their memories to claim that some freedoms or benefits enabled by the state should be classified in the same way. So whilst I feel tremendous sympathy for a parent who has lost a child or indeed a child who has lost a parent, i am not convinced that the state or an employer should be picking up the bill to give them paid leave. Either way this is a decision for the government of the day and not one for Parliament or the Judiciary to contemplate in the context of human rights.

Obviously the field of human rights grows ever more complicated and indeed larger, as people clamour for more rights. Sometimes this is reflective of the age, for example when the US set up their constitution and enabled people to bear arms. Equally we are now entering a time when sexual orientation, gender identity and the right to your own home are being talked about as Human rights.

It is interesting to see that people are increasingly relaxed about how others behave. This is a good thing. It is reflective of a more tolerant world. Long may this be the case, whether in terms of sexual orientation or anything else. However, we should be wary of passing endless new matters into legislation as Human Rights until we have genuinely built a Society that globally protects the basics. Until then we should treat many new issues and concepts as benefits but not as rights.

Certainly there must be more public debate on these issues. It is important to bring everybody together on these matters.

It’s time I had a say in my medical treatment

Personalized-Medicine-genomics-1200x480

People have been talking about personalised medicine for ages. It’s all the rage in the NHS now with The 100,000 Genomes Project. This project is committed to sequencing 100,000 whole human genomes, from 70,000 patients, by the end of 2017 to help bring in better treatments.

This is because medical professionals are using genetic sequencing to enable them to separate people with similar symptoms into far narrower groups and target medicines at them. For example last year, researchers from the Wellcome Trust Sanger Institute determined that the most common and dangerous form of Leukaemia is actually eleven distinct diseases that respond differently to treatment. Now that the cost of analysing an individual’s DNA is significantly less expensive, it will become possible to link a person’s genes with specific medicines and even diets.

This is great news, in a world where, by way of example, less than 4% of cancer patients actually participate in a clinical trial. In other words fewer than one in twenty five patients contribute to developing the new knowledge about a condition that informs new treatment plans.

So the flaw in the personalised medicine plan is that the only person that the Government and the medical profession are not consulting is me – the patient!

Why not?

I am a patient living with a long-term condition, ulcerative colitis / crohns. I have had this for 30 years. I know a lot about my condition but I am never consulted on my treatment. I have had several different drugs over the years, from azathioprine – which gave me pancreatitis; asacol – which knocked out all my white blood cells, and salazopyrin, which never fully controlled my condition. Over the time my condition has gone up and down.

Now for many sensible reasons, drug dosage is very carefully controlled in any healthcare system and the drug companies are equally tightly regulated. But in a world of ever increasing healthcare problems and healthcare costs, it is time to relook at this approach.

I am on a biologic, vedolizumab, and it is working. I love it. However, it is working too well. I am classified to be in remission and so the NHS now wants to take it off me. If they do, then inevitably my condition will worsen. The NHS attitude is so binary. I am well or I am ill. I take the infusion or I don’t. Why can’t I have a smaller dose? It would cost less and it might work just as well. The answer is that the clinical trials have only led to approval for the drug based on a standard dose. This is therefore what NICE guidelines accept. But why shouldn’t I be allowed a say in this? It’s my body and I have been living with the condition, longer than any doctor treating me. In many ways I am an expert patient with living experience of the condition.

We need to change the approach. It’s time for the individualisation of drug dosage based on personal response patterns to drugs and not on old fashioned and out of date clinical trial methodologies. We need to bring in individual DNA based personalised medicine, and we need to drive active patient collaboration and participation in drug and treatment decisions. We can’t just leave this to the supposed professionals. We need to do 3 things:

  1. Enable patients to have a say in their treatment and in the drug choices and doses
  2. Enable different types of observational research study based on different levels of patient participation over different times.
  3. Establish formal expert patient councils to advise the NHS based on patients living with conditions or disease for long periods of time.

It’s time to get truly personal.

Should we tag all prescription drugs and pills now?

The scale of increase in medication usage across the world is frightening.

There are numerous disturbing facts that accompany this spread:

  1. The NHS drug bill rose by 8 per cent to £16.8 billion in 2016, up from £13 billion in 2011. 4 treatments now cost more than £1 billion per annum. Source Dec 2016 Times
  2. Half of women and 43% of men in England are now regularly taking prescription drugs. Source NHS 2014
  3. It is estimated that £300 million of NHS prescribed medicines are wasted each year
  4. Diabetes accounts for over 10% of the annual drug bill
  5. One in five do not take all their medicine according to a survey of 2,048 people carried out for an Omnicell report by ComRes in 2016
  6. The U.S. is 4.6% of the world’s population, yet consumes 80% of opioid painkillers
  7. Global spending on medicines is forecast to reach $1.4 trillion by 2020, an increase of between 29 percent and 32 percent from 2015, according to IMS Health

The increase itself is fairly well understood by people. The less well known problem is that the misuse of antibiotics can enable bacteria to develop resistance to them. A lot of antibiotic-resistant strains are popping out. If antibiotics stop working, we have no other defence against bacterial infections. When you take antibiotics, you are putting a tremendous selective pressure on the bacterial population. Randomly, a few bacteria of the billions you have, will be slightly more resistant to the antibiotic than others. This means they are more likely to survive your antibiotic doses, and in turn they could evolve in more and more resistant strains, until the antibiotic has no effect on them anymore.

The trick is poisoning these bacteria with the antibiotic faster and stronger than their efficiency of evolving resistance and replicating. That is, if a bacteria narrowly escapes death by antibiotic, and you give it a break so it has time to replicate, you end up having a growing infection with a quite resistant strain of bacteria. If you instead take your pill at the right time, you give it another chemical punch that will hopefully kill it before it managed to replicate significantly.

So given these facts, why are we not finding other ways to reduce the problems. One of these could be by throwing more energy at tagging prescription medicines to enable:

  1. better understanding of whether patients are following the courses and therefore protecting our long-term antibiotic resistance?
  2. healthcare providers to ensure that patients don’t waste or sell their drugs?
  3. more patients to take the drugs that reduce further healthcare costs?

As long ago as 2004 the FDA backed RFID tagging of prescription medicine to track drug products through the supply chain. Now there has been considerable progress made around drug packaging protection with RFID tags aimed at reducing counterfeiting and wastage. In 2015 The University of Vermont Medical Center in Burlington, Vt., announced that five million medications had been tracked using radio frequency identification technology. This allows a hospital to track reliably from ordering through dispensing through administration at the bedside, and so enhance patient safety.

This has been followed more recently with approval in the UK and US for prescription pills that contain RFID chips – in other words ingestible RFID microchip medicine. This came out of Proteus Digital Health’s Ingestion Event Marker (IEM). This can be embedded in a pill, and ingested to monitor the patient and their bodily health. The device will collect measurements such as heart rate, body position and activity. The IEM sends a signal to your smartphone; which then transmits the data to the doctor.

helius-300x136

It is still very early days for this technology, but given the scale of the problems outlined above, we need to adopt this quickly. First and foremost this should be about tracking drug usage. Once this is done then we can begin to explore the sunny uplands of prevention and bodily health checks.

3 great innovations for ageing

I came across these 3 innovations in the “ageing” space and wanted to share them

1. Bedal

We have all been in this situation before, when you have some sort of drip attached to your arm or wherever and you just can’t wash etc. Well obviously this problem is more acute for old people. So Bedal enables patients with IV therapy to wash autonomously. Its neat.

2. Sit and shower

Again this is a problem that we can all recognise. But it is less well known that 80% of falls for Seniors occur in the bathroom. Well this is a full on mobile seated shower that can fit into any bathroom without needing any complicated modifications.

3. Moff

Moff is a wearable IOT (Internet of things) 3D motion technology that allows you to monitor real time movements and is designed to change the way people rehabilitate.

No-one has answered the question – what can the NHS afford?

The NHS can’t cope is now an everyday cliché. You hear it everywhere.

  • Long-term conditions are becoming an ever bigger drain on budgets. Over 15m people have one or more long-term conditions. Over 1/3rd of the European population of the age of 15 have one chronic condition source WHO
  • We all want more care across more conditions
  • Mental health is now recognised as being as important as physical health. And the costs of mental health problems to the economy in England have recently been estimated at £105 billion, and treatment costs are expected to double in the next 20 years. source Gov.uk
  • The cost of the NHS is 7.4% of GDP, but the government is looking to reduce this to just 6.9% by 2020, as part of reducing the deficit.

Why do I care?

Well the answer is that I am one of those 15 m people who are a drain on the system. I have had a chronic condition, ulcerative colitis, for over 30 years. More recently I got Guillian Barre syndrome, a rare and serious condition of the peripheral nervous system. In both cases I have benefitted from improvements in medical treatment and research, which are expensive. I recognise that when one condition gets treated another condition in another part of the system is at risk. I am equally upset to hear how some patients with cancer are not getting all the drugs that they need. I would hate to be at the mercy of the system like that. It begs the question – what should I get versus the next person? This in turn begs the question are all conditions equal or are some more important than others? This is a debate that is again frequently heard in the media – should the NHS be funding x or y treatments? Of course there are a number of media favourites including obesity, cosmetic surgery and IVF. My answer is that all conditions must be treated equally. It is impossible for the government to play Russian roulette with people’s lives in the same way as the government should not be making choices as to which companies to support and which to let fail.

If that is my answer, then the next question must be about how we make the NHS deliver this. I am unusually in agreement with some of what Polly Toynbee says in her article for the Guardian. I think we need to decide how much we shall pay to have the NHS that we want. I think it is acceptable to maintain the level of spend in the NHS, as it is the number one issue for the British people. If that means that other government issues get de-prioritised, then so be it. This is how budgeting works in every organisation. But I would introduce a long-term plan to bring more permanent staff into the NHS (full time and part time workers) and reduce the dependence on locums and extraordinary consultancy that is the bane of the public sector. I also think that we have to make other compromises.

I agree with the public and the Kings Fund that the NHS cannot afford a 7 day service. After all if we had a £2.45bn deficit in 15-16, why should we believe that we can suddenly afford to deliver 7 days a week without any new money. A survey by the BMA showed that seven in ten patients (69%) believe the NHS cannot currently afford to deliver seven-day services.

I also think that it is acceptable to increase the number of areas where people do pay for services. After all prescription charges are a form of payment and they are an acceptable compromise. I would happily accept that some additional services should incur small charges, especially for people in higher tax brackets. But we need to watch out for the law of unintended consequences, so Australia introduced charging for GP visits and saw a stampede to A&E services.

The country needs to have a more open debate about this topic. We need to make positive decisions to get what we want. If health is the biggest issue for the electorate than we need to sacrifice other things to deliver it and we need to work out a concrete long-term plan for it. We need to be in agreement about what the NHS can afford and how, for the next 50 years and not the next 5.

Challenger banks – overhyped and under-delivering

challenger-banks

Challenger Banks receive a ton of positive publicity. It would appear as if they are re-inventing the banking sector. But is it justified?

The reality seems very different. They offer relatively little that is new and nothing so far that is game changing.

As Tandem founder Ricky Knox said: “A really cool mobile app is great, but it’s not what is going to drive mass customer uptake.” He promises that they are looking for a new business model which brings new economics to the market in a way that the customer can really perceive.

Well if that is true then we haven’t seen it yet from MetroTandem, Monzo, Atom, Starling, Aldemore or B

To be fair to him, Tandem hasn’t launched his products yet, so maybe he will surprise us. And his criticism of the existing retail banking business model is fair – its more punishment and inertia than anything else.

What we have seen from all of the Challengers is slick marketing, crowdfunding and nice clean user interfaces.

But many of the core banks have fairly reasonable banking apps so that’s not enough.

The problem seems to be threefold:

  1. In spite of the apparent customer focus, too many of these challenger banks have got overexcited about their technology and apps. The fact that Atom bank is excited about using the Unity gaming platform as their underlying software is not helping deliver a better product. There is much talk about hyper personalisation and predictive analytics, but it might be better to show it rather than tell it!
  2. Secondly, although Millenials may apparently like it, who cares about receiving your own logo, and being able to name your bank whatever you want to, as Atom bank does. This feels like a different set of personalised gimmicks to entice me in rather than anything fundamental.
  3. Thirdly in many cases they are just fiddling with the current account and how you can spend and record your money on an everyday basis.

We need a more fundamental look at how banking should be delivered and not just like a fitness app

Still there are 2 reasons to like Challengers even now:

  1. They consistently offer better saving rates than the more established banks. In a world of low inflation, this is helpful. How long they can maintain this across a wider set of products is yet to be seen.
  2. They are definitely trying to provide better access to their customers. Metro Bank’s accessibility is way better than the other established banks

So let’s enjoy the benefits but tone down the hype until they can really demonstrate it!

#EUReferendum – a plague on both your houses!

Remain or Leave

Remain or Leave

 

Where’s the vision? The EU Referendum has had none.

It’s a pity that Shakespeare isn’t here today to rebuke both sides of the EU Referendum debate.

Firstly neither the Remain campaign nor the Leave campaign have actually painted a picture of:

  • What they want our country to look like in 10-15 years’ time
  • How we shall prosper, what jobs we shall have and what areas of specialism we should develop in a future world
  • How big or small our society should be

Secondly this hasn’t been a debate. This has been a lecture by so called experts, telling us what we should believe and how we should behave.

They are not listening to our genuine concerns or aspirations.

So many claims from both sides are patently untrue – we won’t lose 3m jobs if we leave but nor will we gain £350m per week if we leave. As many sensible experts say “no one actually knows”.

If we wanted a debate the experts and celebrities should have listened more and responded better.

Thirdly this referendum isn’t just about the economy and migration. It’s about the type of society we want. It should be about how the EU could work better, about what really works and what doesn’t, and about how we change it for the better.

It should be a proper discussion about how its customers (us), want it to be run and how to improve what it does.

This is the debate we should have had – a real vision of a better future.

So given the “debate” has told you nothing of any value, you better make your own mind up based on your vision of the right future.

Why are entrepreneurs failing to disrupt the Professional Services industries?

There is continuous disruption in almost every industry today. So it’s amazing that the professions (lawyers, accountants, auditors, architects etc.) have escaped so unscathed.

Ok so every week we hear about attempts to disrupt one or other professional service. And yes the names on the top of the doors have changed around a bit, yes it’s much more competitive, and yes there have been some tweaks to the operating model, but relatively speaking they march on relentlessly, without any worries. Certainly for most customers, whether consumers, small businesses or Corporates, little has improved.

So what has changed?
The legal industry has seen some important changes, even if most of the effects haven’t been felt widely. These include the following:

1.      The legal industry has deregulated. By 2014, 3 years after this event, there were over 300 applications for Alternative Business structures to run legal services, Including Saga, DLG and PWC.

2.      There are new companies trying out different business models like Riverview Law, which offers a fixed-rate contract, rather than billing by the hour. Riverview Law charges clients an annual fee for all their legal needs up to the point of litigation.

3.      Technology is being used to reduce costs whether this be legal templates like Rocket lawyer, Epoq, or simply-docs or paid Q&A like Just Answer or online compliance checking like Cerico set up by Pinsent Masons. But legal comparison services remain in their infancy and the consumer has yet to engage fully

4.      Private equity has moved in to try to aggregate high street firms into consumer brands like Quality Solicitors.

The truth is that in spite of all of this activity, for most individuals or businesses outside of Legal Aid, access to legal services remains remarkably expensive. Even fairly average solicitors demand a minimum day rate of £1600. It is far easier to get a high quality engineer for less money than a relatively junior solicitor. Frankly it’s a scandal that entrepreneurs haven’t had a greater impact on the professional services. And I can say this as an entrepreneur who raised external investment to disrupt the legal industry, but hasn’t cracked it yet.

Why is this?

Well the main topics of discussion in the legal industry are whether the Partnership structure should survive and whether law firm profitability should be calculated before partner costs as they are currently or whether they should be treated as a cost of sales as in a traditional P&L. This was a core part of the discussion at the Business Leadership Summit organised by The Lawyer in London in September 2015. This is as good as it gets!

The conversation isn’t about what the customer wants and why trust in the profession is in rapid decline. The Legal Services Consumer Panel and YouGov found that only 42% of consumers trust lawyers to tell the truth in 2014, down from 47% in 2011. The decline is mirrored in other professions, the research acknowledges. Lawyers remain more trusted than accountants, bankers and estate agents, but less trusted than teachers and doctors. This is an industry unlike many others, that continues to get away with ignoring the voice of the customer.

In Management consulting, some things have changed in a similar way. There is pressure to reduce costs, there is much more competition and some of the names on the doors are different, but the core principles wouldn’t look out of place in 1980.  So what has changed?

1.      The classic strategy consulting giants have all moved downstream into more executional or implementation work. For example in 2007 Mckinsey launched Mckinsey solutions. This was based on software and technology-based analytics and tools rather than the traditional human capital business model.

2.      As Clayton Christiansen stated in Harvard Business Review in 2013; “the share of work that is classic strategy is now about 20%—down from 60% to 70% some 30 years ago.”

3.      There are more agile competitors like Eden McCallum and Business Talent Group

But in some ways there has been more consolidation and less choice amongst the big consulting groups. The old “Big 8” has been reduced to the Big 4 including PWC, Deloitte, EY and KPMG. This means that an increasing number of companies are having to use these giants for services from audit, assurance, tax, consulting, advisory, actuarial, and corporate finance to legal services.

Fundamentally it remains extremely hard to buy any form of consulting that is based on value generated or results achieved. The industry remains stuck on outdated day rates and continuous selling cycles that actually reduce value for clients.

 

What hasn’t changed?
In spite of all the razzmatazz, the key principles are undisturbed:

  • Most professional services remain as partnerships
  • Most believe that the day rate model should not be changed and have no intention of changing
  • A majority of lawyers and accountants believe that they should charge for every minute from the time they pick up the phone to a customer.
  • There is no sense of customer service.
  • Many of these professional services are so bound up with the establishment that they believe it is their divine right to be paid a high salary. This is particularly true of organisations like the Law Society.

 

Why hasn’t more changed?
Professional services are critical to the success of the UK economy, representing 15% of UK GDP, 14% of employment and 14% of exports source PWC. So it is no surprise and indeed in many ways a good thing, that it is highly respected and that much effort is expended in defending all aspects of the sector. Since 1979 Nuffield election studies show that no less than one in ten MPs from the three main parties have been barristers or solicitors. So although legal services only account for 1.7% of the UK GDP, it has considerable support at the heart of government. This ensures that the industry is well protected.

In the same way that business people used to say “you don’t get fired for choosing IBM”, you now don’t get criticised for selecting Clifford Chance, PWC, Spencer Stuart or McKinsey. And no Non-Executive Director will argue with you on that. This in turn creates a guaranteed market for the traditional professional service firms and little impetus to innovate more than is required.

The Professional services continue to claim that every argument, every problem, is different and requires an unique answer. The reality is that this is no longer true, if it ever was. Technology, outsourcing and business model change can transform the way that challenges are met and answers are given.

 

What should change?
As You Gov polled in 2014, “British people want fewer lawyers and more doctors, scientists and factory workers in Parliament. The professional services are over-represented in all aspects of government. And in spite of the well intentioned deregulation in legal services and other area of professional services, the end customer has not reaped any rewards yet, either in better service or lower costs.

The professional services will only change fundamentally when the following principles are ripped apart:

  • A dependence on hourly and daily rates. This should be replaced by value-based pricing
  • A belief that partnership structures benefit the customer. Firms should become proper corporate structures with standard financial accounting.
  • Traditional Corporate dependence on the big audit firms. This should be opened up to the wider market.
  • An unpreparedness to be judged on results.

The artificially high costs of most professional services keep them out of reach for most SME’s and consumers. This remains an incredible business opportunity for an entrepreneur. In addition very few professional services firms understand the power of the brand to engage the customer and disrupt an industry. It’s only a matter of time before someone builds a professional services brand that rapidly gains trust and takes market share, by improving the service it provides and changing the business model that drives it. Let’s hope that more entrepreneurs take up the challenge