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.

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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.

Why buzzwords lead to bad decisions

Last week I had two separate and unrelated conversations with experienced business people who used buzzwords to express their desired strategy, without having thought through the “how and why”. They didn’t even support their statements with any comment about how they were obviously plagiarising current populist business thinking. They spoke with genuine seriousness about their strategic intent.

This was a case of buzzword bingo in action!

I was shocked.

The first said that they wanted to explore how blockchain could be applied to a commercial proposition that they were developing. They wanted some help in defining how this might be done. This was a classic case of supplier led thinking or technology for technology’s sake.

The second was talking about changes in the healthcare industry and the person concerned said that they needed some AI (artificial intelligence) in a separate proposition. In fact they said that they needed a “Babylon” for their business, in reference to Babylon Health.

In neither case did either of them express any relationship between the identified customer or market need and the use of the respective buzzword to deliver that need.

The problem is that businesses and business leaders often want quick summary words to shortcut how they communicate their strategic intent. Perhaps it just reinforces the need for companies to spend longer working out what they stand for and why they offer something better. The sad truth is that most companies don’t know the answers to these difficult questions. No surprise then that they leap on other people’s coat tails. This wouldn’t matter if it didn’t so often lead to people desperately looking for the latest shiny thing and wasting time and money in this pursuit. So let’s try to kill the use of buzzwords unless they are carefully and precisely used.

10 principles for a 21st Century UK government

It’s no surprise that the 2017 UK General Election is dominated by Brexit and the associated debate. But the danger is that too much of the rhetoric is based on 20th Century thinking; on a country with an established place in the world and the recent history that defined it. Intolerance in all forms is increasing within society, and this also acts as a catalyst to use existing or outdated modes of thinking. It is exactly at a time like this when political leaders need to consider the future more holistically and cast aside some of their old fashioned assumptions about how the country should be governed. Accordingly now is a good time to lay down some core principles for a new government, for a government that is resetting the agenda for the 21st Century and not living by 20th Century rules.

My top 10 principles for future UK governments are as follows:

  1. Free trade. Now that the UK’s relationship with Europe is changing, it must look to establish comprehensive free trade principles across all parts of the world. The UK cannot afford to be half in and half out of Europe; to be neither fish nor fowl. If it is leaving then it needs to set out a new trade philosophy for the world and stick to it. Whatever the result, the UK should be fighting for minimal trade barriers and pushing to reduce the subsidies that artificially inflate prices for consumers.
  2. Freedom of civil rights. It is easy to forget that over the last few centuries many people gave up their lives to win civil liberties for future generations. This was hard fought. We must remain vigilant at keeping these. Although terrorist threats are real and frightening, we should not sacrifice these freedoms in the face of terrorist threats. After all we have faced worse before, without giving in. This means that we should not give away online civil liberties too easily just because we can.
  3. Technology leadership. Technology is at the heart of every aspect of society. We now need to be the masters of own technology destiny. We need to invest in every aspect of technology across industries and in educating all our citizens. We should aim to be at the forefront of technology innovation and see it as a source of future wealth and prosperity rather than as a threat.
  4. Personal responsibility. There is a growing tension between those people who believe that the state should guarantee ever more benefits to its people, without expecting them to take on more personal responsibility, and those who think that society cannot extend its arms ever further. We need to enable and expect people to take on more individual responsibility and be happy to support the minority that cannot, but that minority cannot become the majority. We need to push personal responsibility onto people, as part of our evolving society.
  5. Reinvention. We should be prepared to challenge existing assumptions around every aspect of government. The pace of change continues to increase and societies cannot survive unless they evolve with that change. We must be prepared to reinvent aspects of society and government more frequently. This includes challenging assumptions around healthcare, education, finance, housing and defence. For example  why should the richest members of society have endless access to free healthcare, when the system is struggling to provide free care for the poorest?
  6. Cradle to grave entrepreneurship. We need to help people at every age to work and be self-employed, and not be dependent on an ever smaller group of large employers and the state. This should not be just focused on teaching the youth to code. It is important to help people create new enterprises though into old age – in other words cradle to grave entrepreneurship.
  7. Lifetime education. The most enlightened and richest employers are encouraging their employees to live in an endless cycle of re-education. Given the pace of change, we need to ensure that all society can live in this way. We need to ensure that there is educational capacity to do this across people’s entire lives.
  8. Financial planning. We need to think much more creatively about how we can afford all the aspects of our society. This includes thinking about how we pay for education for children and care for the elderly. We need to facilitate different ways for people’s work to pay for the choices that they want in their life, whether homes, or pensions or care.
  9. Global integration. Whether everyone likes it or not, our world is getting ever more interconnected. We need to debate and define a system that will work for the next 100 years and not just for today. We need to ensure that we engage with other countries and with the most skilled workers that we need, whilst being able to protect our own citizens. At the moment every government of the last 10 years has failed to debate, define or implement anything sustainable. The people do not believe anything that any government tells them about migration.
  10. Sovereign Fund. We need to build our own sovereign fund to enable the country to take a more long-term strategic view on investments.

These principles need to be woven into any future government’s plans. It is likely that this 2017 Election will be unusually short of policy commitments outside of Brexit, but we cannot allow our governments to just focus on the here and now, and not to take key strategic decisions for our future.

Why entrepreneurs should stop underestimating the importance of “people” in their startup

Most research on why startups fail highlights a variety of reasons other than people ones.

CB insights did some research on start-up post mortems which was summarised in this Fortune article. It suggested that the 2 biggest issues were “insufficient market need” and “cash problems”. The team came 3rd.

A different study by Quartz media found that “people” was only just in the top 10 reasons why startups fail!! Here is their list:

  1. the business model wasn’t viable
  2. ran out of cash
  3. not enough traction
  4. lacked financing
  5. technical / product issues
  6. no market need
  7. outcompeted
  8. customer development issues
  9. lack of focus
  10. disharmony on team / investors

I could share with you numerous other articles where the team / leadership and people issues were consistently not at the top of the list. And yet the No 1 determinant of success in start-ups is people. It’s what VC’s say and experienced entrepreneurs know, but it is consistently underestimated by everyone including VC’s. People and people problems kill more businesses than poor products or business models.

Here are 10 reasons why people matter more than anything else in a startup

  1. If the founding team don’t have a shared vision you won’t end up with a good product. You will have a lack of focus and that will slow down or break your business.
  2. If the founders and employees don’t share values, you won’t be fighting for the same things. If everyone is fighting for different things, you will be going too slowly to survive.
  3. If you don’t agree on who the boss is, then you won’t agree on what to do. Either someone has to leave or someone has to accept that they aren’t the leader.
  4. If you don’t ruthlessly get rid of mediocre people and people who don’t share the vision and values, your team will fall apart and your culture will wither and die.
  5. If you don’t deal with people issues, then they fester and cause conflict and that wastes time.
  6. If you don’t put much time into hiring and nurturing people, then they won’t nurture your company.
  7. If you don’t learn to delegate effectively then you won’t and can’t scale.
  8. If the founding team don’t prepare for conflict between each other, than they will run into a wall later, as it always happens.
  9. If the company doesn’t have clear and open communication channels, then it will struggle to scale.
  10. If the company can’t survive without a founder, then the people issues never got solved!

If you don’t care about the people, your startup won’t last

The NHS needs to make choices

Too many people expect too much from the NHS. It is absurd to believe that the NHS can fund every new thing that is thrown at it. The government keeps adding more to the requirements, including 7 day a week access to everything, investing as much in mental health as is in physical health and funding every new treatment innovation.

But why?

The NHS is like every other business or organisation. Ultimately it does not have resources to deliver everything. It has to make choices about what it does do and doesn’t do. Just because it is a public sector, doesn’t exempt us from this basic business tenet. There is no inalienable human right to every aspect of wellness.

It is time for all political parties to have a realistic conversation about what percentage of GDP goes against the NHS and what that can and cannot deliver.

Why don’t Corporates value entrepreneurs?

Corporates talk about wanting to be innovative, agile and entrepreneurial. They use the latest start-up jargon. They run incubators, accelerators and competitions for entrepreneurs, but in the end they don’t value entrepreneurs. They want their reflected glory. but hate the idea of employing them.

Why is that?

Corporate leaders always claim that entrepreneurs don’t fit in. They don’t want a boss. They don’t want to worth within the constraints of a big company. It all moves too slowly for them. They will get frustrated.

But is their argument based on fact or just their own assumptions?

After all in today’s world, many entrepreneurs are highly flexible and adept at working with different types of people. And entrepreneurs always have a boss. This could be an investor, the bank, the Chairman or even their critical customers.

Earlier in 2016 I was at an London Business School event, where the Chairman of Diageo, Franz Hamer, was being interviewed. He said that Corporates needed to become more entrepreneurial, but when i asked him, why then, Corporates didn’t hire entrepreneurs, he was unable to give a convincing answer. He said that they don’t fit in. They want to be elsewhere. But he also admitted that they didn’t actually hire entrepreneurs, so it was an unsubstantiated assumption.

If Corporates really want to innovate, they need to use the classic innovation technique of breaking assumptions. They need to challenge themselves to think differently about who they hire and how to create an environment where entrepreneurs are welcome.

Why?

There are 3 reasons why the Corporate could benefit from a change of heart:

  1. Organic growth is often the best way to drive long-term shareholder value. Corporates know this and run innovation pipelines to deliver these. But they use the same employees to do this. Even the supposed “Intrapreneurs” are generally standard Corporate employees. They often lack the brutal and necessary pragmatism, energy and lateral thinking of the entrepreneur. If Corporates want better percentages for their innovation, they have to change the people they use to drive their growth.
  2. Start-ups within Corporates and small and medium sized acquisitions by Corporates tend not to add the value that they were supposed to or merely allow the value to dissipate externally. Unless Corporates are prepared to parallel track younger businesses with entrepreneurs, over a longer period of time, they will miss out on this classic route to value creation.
  3. Corporates spend a fortune on hiring expensive external consultants to solve problems that entrepreneurs could solve for them at a fraction of the cost.

Corporates need to re-examine their outdated assumptions about entrepreneurs.

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.