Tech: The Missing Generation

I’ve recently been spending a fair bit of time in hospital. Not, thankfully, for myself but with my mother who fell and broke her arm a few weeks back which has resulted in lots of visits to our local Accident & Emergency (A&E)  department as well as a short stay in hospital whilst they pinned her arm back in place.

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An elderly gentleman walks past an NHS hospital sign in London. Photograph: Cate Gillon/Getty Images

Anyone who knows anything about the UK also knows how much we value our National Health Service (NHS). So much so that when it was our turn to run the Olympic Games back in 2012 Danny Boyle’s magnificent opening ceremony dedicated a whole segment to this wonderful institution featuring doctors, nurses and patients dancing around beds to music from Mike Oldfield’s Tubular Bells.

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Olympic Opening Ceremony NHS Segment – Picture Courtesy the International Business Times

The NHS was created out of the ideal that good healthcare should be available to all, regardless of wealth. When it was launched by the then minister of health, Aneurin Bevan, on July 5 1948, it was based on three core principles:

  • that it meet the needs of everyone
  • that it be free at the point of delivery
  • that it be based on clinical need, not ability to pay

These three principles have guided the development of the NHS over more than 60 years, remain at its core and are embodied in its constitution.

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NHS Constitution Logo

All of this, of course, costs:

  • NHS net expenditure (resource plus capital, minus depreciation) has increased from £64.173 billion in 2003/04 to £113.300bn in 2014/15. Planned expenditure for 2015/16 is £116.574bn.
  • Health expenditure (medical services, health research, central and other health services) per capita in England has risen from £1,841 in 2009/10 to £1,994 in 2013/14.
  • The NHS net deficit for the 2014/15 financial year was £471 million (£372m underspend by commissioners and a £843m deficit for trusts and foundation trusts).
  • Current expenditure per capita for the UK was $3,235 in 2013. This can be compared to $8,713 in the USA, $5,131 in the Netherlands, $4,819 in Germany, $4,553 in Denmark, $4,351 in Canada, $4,124 in France and $3,077 in Italy.

The NHS also happens to be the largest employer in the UK. In 2014 the NHS employed 150,273 doctors, 377,191 qualified nursing staff, 155,960 qualified scientific, therapeutic and technical staff and 37,078 managers.

So does it work?

From my recent experience I can honestly say yes. Whilst it may not be the most efficient service in the world the doctors and nurses managed to fix my mothers arm and hopefully set her on the road to recovery. There have been, and I’m sure there will be more, setbacks but given her age (she is 90) they have done an amazing job.

Whilst sitting in those A&E departments whiling away the hours (I did say they could be more efficient) I had plenty of time to observe and think. By its very nature the health service is hugely people intensive. Whilst there is an amazing array of machines beeping and chirping away most activities require people and people cost money.

The UK’s health service, like that of nearly all Western countries, is under a huge amount of pressure:

  • The UK population is projected to increase from an estimated 63.7 million in mid-2012 to 67.13 million by 2020 and 71.04 million by 2030.
  • The UK population is expected to continue ageing, with the average age rising from 39.7 in 2012 to 42.8 by 2037.
  • The number of people aged 65 and over is projected to increase from 10.84m in 2012 to 17.79m by 2037. The number of over-85s is estimated to more than double from 1.44 million in 2012 to 3.64 million by 2037.
  • The number of people of State Pension Age (SPA) in the UK exceeded the number of children for the first time in 2007 and by 2012 the disparity had reached 0.5 million (though this is projected to reverse by).
  • There are an estimated 3.2 million people with diabetes in the UK (2013). This is predicted to reach 4 million by 2025.
  • In England the proportion of men classified as obese increased from 13.2 per cent in 1993 to 26.0 per cent in 2013 (peak of 26.2 in 2010), and from 16.4 per cent to 23.8 per cent for women over the same timescale (peak of 26.1 in 2010).

The doctors and nurses that looked after my mum so well are going to be coming under a increasing pressures as this ageing and less healthy population begins to suck ever more resources out of an already stretched system. So why, given the passion everyone has about the NHS, isn’t there more of a focus on getting technology to ease the burden of these overworked healthcare providers?

Part of the problem of course is that historically the tech industry hasn’t exactly covered itself with glory when it comes to delivering technology to the healthcare sector (I’m thinking the NHS National Programme for IT and the US HealthCare.gov system as being two high profile examples). Whilst some of this may be due to the blunders of government much of it is down to a combination of factors caused by both the providers and consumers of healthcare IT mis-communication and not understanding the real requirements that such complex systems tend to have.

In her essay How to build the Next Unicorn in Healthcare the entrepreneur Yasi Baiani   sets out six tactical tips for how to build a unicorn* digital startup. In summary these are:

  1. Understand the current system.
  2. Know your customers.
  3. Have product hooks.
  4. Have a clear monetization strategy and understand your customers’ willingness-to-pay.
  5. Know the rules and regulations.
  6. Figure out what your unfair competitive advantage is.

Of course, these are strategies that actually apply to any industry when trying to bring about innovation and disruption – they are not unique to healthcare. I would say that when it comes to the healthcare industry the reason why there has been no Uber is because the tech industry is ignoring the generation that is in most need of benefiting from technology, namely the post 65 age group. This is the age group that struggle most with technology either because they are more likely to be digitally disadvantaged or because they simply find it too difficult to get to grips with it.

As the former Yahoo chief technology officer Ashfaq Munshi, who has become interested in ageing tech says:

“Venture capitalists are too busy investing in Uber and things that get virality. The reality is that selling to older people is harder, and if venture capitalists detect resistance, they don’t invest.”

Matters are not helped by the fact that most tech entrepreneurs are between the ages of 20 and 35 and have different interests in life than the problems faced by the aged. As this article by Kevin Maney in the Independent points out:

“Entrepreneurs are told that the best way to start a company is to solve a problem they understand. It makes sense that those problems range from how to get booze delivered 24/7 to how to build a cloud-based enterprise human resources system – the tangible problems in the life and work of a 25- or 30-year-old.”

If it really is the case that entrepreneurs only look at problems they understand or are on their immediate event horizon then clearly we need more entrepreneurs of my age group (let’s just say 45+). We are the people either with elderly parents, like my mum, who are facing the very real problems of old age and poor health and who themselves will very soon be facing the same issues.

A recent Institute of Business Value report from IBM makes the following observation:

“For healthcare in particular, the timing for a game changer couldn’t be better. The industry is coping with upheaval triggered by varied economic, societal and industry influences. Empowered consumers living in an increasingly digital world are demanding more from an industry that is facing growing regulation, soaring costs and a shortage of skilled resources.”

Rather than fearing the new generation of cognitive systems we need to be embracing them and ruthlessly exploiting them to provide solutions that will ease all of our journeys into an ever increasing old age.

At  SXSW, which is running this week in Austin, Texas IBM is providing an exclusive look at its cognitive technology called Watson and showcasing a number of inspiring as well as entertaining applications of this technology. In particular on Tuesday 15th March there is a session called Ageing Populations & The Internet of Caring Things  where you can take a look at accessible technology and how it will create a positive impact on an aging person’s quality of life.

Also at SXSW this year President Obama gave a keynote interview where he called for action in the tech world, especially for applications to improve government IT. The President urged the tech industry to solve some of the nation’s biggest problems by working in conjunction with the government. “It’s not enough to focus on the cool, next big thing,” Obama said, “It’s harnessing the cool, next big thing to help people in this country.”

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President Barack Obama speaks during the 2016 SXSW Festival at Long Center in Austin, Texas, March 11, 2016. PHOTO: NEILSON BARNARD/GETTY IMAGES FOR SXSW

It is my hope that with the vision that people such as Obama have given the experience of getting old will be radically different 10 or 20 years from now and that cognitive and IoT technology will make all of out lives not only longer but more more pleasant.

* Unicorns are referred to companies whose valuation has exceeded $1 billion dollars.

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This is for Everyone

Twenty years ago today on 30th April 1993 CERN published a brief statement that made World Wide Web technology available on a royalty free basis and changed the world forever. Here’s the innocuous piece of paper that shows this and that truly allowed Tim Berners-Lee, at the fantastic London 2012 Olympics opening ceremony to claim “this is for everyone”. Over the past twenty years the web has become imbedded in all of our lives in ways which most of us could never have dreamed of and has probably given many of us in the software industry quite a secure (and for some, lucrative) living during that time.How fitting then that yesterday, almost 20 years to the day since CERN’s historic announcement, IBM announced a new appliance called IBM MessageSight designed to help organizations manage and communicate with the billions of mobile devices and sensors found in systems such as automobiles, traffic management systems, smart buildings and household appliances, the so called Internet of Things.

I’ve no idea what this announcement means in terms of capabilities, other than what is available in the press release, however it is comforting to note that foundational to IBM MessageSight is its support of MQTT, which was recently proposed to become an OASIS standard, providing a lightweight messaging transport for communication in machine to machine (M2M) and mobile environments. Today more than ever enterprises and governments are demanding compliance with open standards rather than proprietary ones so it is good to see that platforms such as MessageSight will be adhering to such standards.