To answer my (rhetorical) question in this post I think it’s been pretty much confirmed since the election that Dominic Cummings is, in equal measures, the most influential, disruptive, powerful and dangerous man in British politics right now. He has certainly set the cat amongst the pigeons in this blog post where he has effectively by-passed the civil service recruitment process by advertising for people to join his ever growing team of SPAD’s (special advisors). Cummings is looking for data scientists, project managers, policy experts and assorted weirdos to join his team. (Interestingly today we hear that the self-proclaimed psychic Uri Geller has applied for the job believing he qualifies because of the super-talented weirdo aspect of the job spec.)
Cummings is famed for his wide reaching reading tastes and the job spec also cites a number of scientific papers potential applicants “will be considering”. The papers mentioned are broadly in the areas of complex systems and the use of maths and statistics in forecasting which give an inkling into the kind of problems Cummings sees as those that need to be ‘fixed’ in the civil service as well as the government at large (including the assertion that “Brexit requires many large changes in policy and in the structure of decision-making”).
Like many of his posts, this particular one tends to ramble and also be contradictory. In one paragraph he’s saying that you “do not need a PhD” but then in the very next one saying you “must have exceptional academic qualifications from one of the world’s best universities with a PhD or MSc in maths or physics.”
Cummings also returns to one of his favourite topics which is that of the failure of projects – mega projects in particular – and presumably those that governments tend to initiate and not complete on time or to budget (or at all). He’s an admirer of some of the huge project successes of yesteryear such as The Manhattan Project (1940s), ICBMs (1950s) and Apollo (1960s) but reckons that since then the Pentagon has “systematically de-programmed itself from more effective approaches to less effective approaches from the mid-1960s, in the name of ‘efficiency’.” Certainly the UK government is no stranger to some spectacular project failures itself both in the past and present (HS2 and Crossrail being two more contemporary examples of not so much failures but certainly massive cost overruns).
However as John Naughton points out here“these inspirational projects have some interesting things in common: no ‘politics’, no bureaucratic processes and no legal niceties. Which is exactly how Cummings likes things to be.” Let’s face it both Crossrail and HS2 would be a doddle of only you could do away with all those pesky planning proposals and environmental impact assessments you have to do and just move people out of the way quickly – sort of how they do things in China maybe?
Cummings believes that now is the time to bring together the right set of people with a sufficient amount of cognitive diversity and work in Downing Street with him and other SPADs to start to address some of the wicked problems of government. One ‘lucky’ person will be his personal assistant, a role which he says will “involve a mix of very interesting work and lots of uninteresting trivia that makes my life easier which you won’t enjoy.” He goes on to say that in this role you “will not have weekday date nights, you will sacrifice many weekends — frankly it will hard having a boy/girlfriend at all. It will be exhausting but interesting and if you cut it you will be involved in things at the age of ~21 that most people never see.” That’s quite some sales pitch for a job!
What this so called job posting is really about though is another of Cummings abiding obsessions (which he often discusses in his blog) that the government in general, and civil service in particular (which he groups together as “SW1”), is basically not fit for purpose because it is scientifically and technologically illiterate as well as being staffed largely with Oxbridge humanities graduates. The posting is also a thinly veiled attempt at pushing the now somewhat outdated ‘move fast and break things” mantra of Silicon Valley. An approach that does not always play out well in government (Universal Credit anyone). I well remember my time working at the DWP (yes, as a consultant) where one of the civil servants with whom I was working said that the only problem with disruption in government IT was that it was likely to lead to riots on the streets if benefit payments were not paid on time. Sadly, Universal Credit has shown us that it’s not so much street riots that are caused but a demonstrable increase in demand for food banks. On average, 12 months after roll-out, food banks see a 52% increase in demand, compared to 13% in areas with Universal Credit for 3 months or less.
Cummings of course would say that the problem is not so much that disruption per se causes problems but rather the ineffective, stupid and incapable civil servants who plan and deploy such projects are at fault, hence the need for hiring the right ‘assorted weirdos’ who will bring new insights that fusty old civil servants cannot see. Whilst he may well be right that SW1 is lacking in deep technical experts as well as great project managers and ‘unusual’ economists he needs to realise that government transformation cannot succeed unless it is built on a sound strategy and good underlying architecture. Ideas are just thoughts floating in space until they can be transformed into actions that result in change which takes into account that the ‘products’ that governments deal with are people not software and hardware widgets.
This problem is far better articulated by Hannah Fry when she says that although maths has, and will continue to have, the capability to transform the world those who apply equations to human behaviour fall into two groups: “those who think numbers and data ultimately hold the answer to everything, and those who have the humility to realise they don’t.”
“The final thing I’ll say is that government will never run the way Silicon Valley runs because, by definition, democracy is messy. This is a big, diverse country with a lot of interests and a lot of disparate points of view. And part of government’s job, by the way, is dealing with problems that nobody else wants to deal with.
So sometimes I talk to CEOs, they come in and they start telling me about leadership, and here’s how we do things. And I say, well, if all I was doing was making a widget or producing an app, and I didn’t have to worry about whether poor people could afford the widget, or I didn’t have to worry about whether the app had some unintended consequences — setting aside my Syria and Yemen portfolio — then I think those suggestions are terrific. That’s not, by the way, to say that there aren’t huge efficiencies and improvements that have to be made.
But the reason I say this is sometimes we get, I think, in the scientific community, the tech community, the entrepreneurial community, the sense of we just have to blow up the system, or create this parallel society and culture because government is inherently wrecked. No, it’s not inherently wrecked; it’s just government has to care for, for example, veterans who come home. That’s not on your balance sheet, that’s on our collective balance sheet, because we have a sacred duty to take care of those veterans. And that’s hard and it’s messy, and we’re building up legacy systems that we can’t just blow up.”
Now I think that’s a man who shows true humility, something our current leaders (and their SPADs) could do with a little more of I think.
If you want to understand the likely trajectory of the new Conservative government you could do worse than study the blog posts of Dominic Cummings. In case you missed this announcement amongst all the cabinet reshuffling that happened last week, Cummings is to be Boris Johnson’s new “special adviser”.
*For what it’s worth I could equally have used any of the adjectives ‘disruptive’, ‘powerful’ or ‘dangerous’here I think.
Cummings has had three previous significant advisory roles either in UK government or in support of political campaigns:
Campaign director at Business for Sterling (the campaign against the UK joining the Euro) between 1999 and 2002;
Special adviser to Michael Gove at the Deprtment for Education between 2010 and 2014;
Campaign Director Vote Leave between 2015 and 2016.
Much has already been written about Cummings, some of it more speculative and wishful thinking than factual I suspect, that you can find elsewhere (David Cameron was alleged to have called Cummings a “career psychopath“). What is far more interesting to me is what Cummings writes in his sometimes rambling blog posts, and what I focus on here.
In his capacity advising Gove at the DfE Cummings wrote a 240-page essay, Some thoughts on education and political priorities which was about transforming Britain into a “meritocratic technopolis”. Significantly during Gove’s tenure as education minister we saw far more emphasis on maths and grammar being taught from primary age (8-11) and teaching of ‘proper’ computer science in secondary schools (i.e. programming rather than how to use Microsoft Office products). Clearly his thoughts were being acted upon.
Given that his advise has been implemented before it does not seem unreasonable that a study of Cummings blog posts may give us some insight into what ideas we may see enacted by the current government. Here are a few of Cummings most significant thoughts from my reading of his blog. I have only included thoughts on his more recent posts, mainly those from his time in exile between the end of the Vote Leave campaign and now. Many of these build on previous posts anyway but more significantly are most relevant to what we are about to see happen in Johnsons new government. The name of the post is highlighted in italics and also contains a hyperlink to the actual post.
Cummings is very critical of the UK civil service, as well as government ministers, that he maintains do not make decisions based on facts and hard data but more often on intuition, feelings and inevitably their own biases and prejudices. In this post he suggests that ‘systems’ should be implemented to help run government. These would be things like:
Cognitive toolkits and AI that would support rational decision-making and help to decide what is possible as well as what is not (and why).
Prediction tournaments that could easily and cheaply be extended to consider ‘clusters’ of issues around themes like Brexit to improve policy and project management.
Red Teams and pre-mortems to help combat groupthink and “normal cognitive biases” . He advocates that Red Teams should work ‘above’ the Cabinet Office to ensure diversity of opinions, fight groupthink and other standard biases that make sure lessons are learned and government blunders avoided or at least minimised.
Seeing rooms that would replace the antiquated meeting spaces found in much of government (e.g. the Cabinet room) and use state of the art screens, IT and conference facilities to ensure better and more accurate decision making.
Two people mentioned often in this post by Cummings are Bret Victor and Michael Nielsen. Victor is a an interface designer, computer scientist, and electrical engineer who writes and talks on the future of technology. Nielsen is also a writer and computer scientist with an interest in neural networks and deep learning. The way Cummings immerses himself in fields outside of his area of expertise (he studied Ancient & Modern History at Oxford) and makes connections between different disciplines is itself instructive. Often the best ideas come from having such a cross-disciplinary approach to life without confining oneself to your particular comfort zone.
This post, published as a paper in February 2017, looks at what Cummings refers to as ‘mission critical’ political institutions” i.e. government departments with huge budgets, complex programs of work like HS2 (or Brexit) and those dealing with emergency situations such as terrorist incidents and wars. It looks at how disasters can (or could) be avoided by deploying “high performance man-machine teams” where the individuals involved are selected on the basis of their training and education as well “incentives”. The paper considers the development of new ideas about managing complex projects that were used by George Mueller to put men on the moon in 1969.
This quote sums up Cummings concerns with our current political institutions:
The project of rewiring institutions and national priorities is a ‘systems’ problem requiring a systems solution. Could we develop a systems politics that applies the unrecognised simplicities of effective action? The tale of George Mueller will be useful for all those thinking about how to improve government performance dramatically, reliably, and quantifiably.
The paper gives a potted history of systems engineering ideas and practices bringing in everyone from the military strategist John Boyd to the mathematician John von Neumann and along the way. Cummings is also fond of comparing the success of NASA’s mission to put a man on the moon and bring him safely home to the failure of the European Launcher Development Organisation (ELDO) to even launch a rocket. The difference being (according to Cummings) that NASA’s success was due to “a managerial effort, no less prodigious than the technological one”.
Cummings corelessonsforpolitics which he believes “could be applied to re-engineering political institutions such as Downing Street” are many and varied. but here are a few, which even after less than a week of Boris Johnsons government I think we are seeing being enacted. How that is happening are my italics in the below.
Organisation-wide orientation. Everybody in a large organisation must understand as much about the goals and plans as possible. The UK is leaving the EU on 31st October 2019.
There must be an overall approach in which the most important elements fit together, including in policy, management, and communications. Johnson has completely gutted May’s cabinet and everyone new onboard has allegedly been told they must be on message, tow the party line and vote with the government in any upcoming parliamentary votes.
You need a complex mix of centralisation and decentralisation.While overall vision, goals, and strategy usually comes from the top, it is vital that extreme decentralisation dominates operationally so that decisions are fast and unbureaucratic. Interesting that Johnsons first act as prime minister is to visit the regions (not Brussels) promising them various amounts of money presumably to do just this.
People and ideas are more important than technology. Computers and other technologies can help but Colonel Boyd’s dictum holds: people, ideas, technology — in that order. It is too early to see if this approach will be implemented. Certainly government does not have a good track record when it comes to implementing IT systems so it will be interesting to see if the ‘solution’ to the Irish backstop does end up being IT driven.
What this post is about is probably best summed up by Cummings own words near the beginning of the article:
In SW1 (i.e. Whitehall) now, those at the apex of power practically never think in a serious way about the reasons for the endemic dysfunctional decision-making that constitutes most of their daily experience or how to change it. What looks like omnishambles to the public and high performers in technology or business is seen by Insiders, always implicitly and often explicitly, as ‘normal performance’. ‘Crises’ such as the collapse of Carillion or our farcical multi-decade multi-billion ‘aircraft carrier’ project occasionally provoke a few days of headlines but it’s very rare anything important changes in the underlying structures and there is no real reflection on system failure.
Although this post covers some of the same ground as previous ones it shows how Cummings ideas on how to tackle the key problems of government are beginning to coalesce, probably best summed up in the following:
One of the most powerful simplicities in all conflict (almost always unrecognised) is: ‘winning without fighting is the highest form of war’. If we approach the problem of government performance at the right level of generality then we have a chance to solve specific problems ‘without fighting’ — or, rather, without fighting nearly so much and the fighting will be more fruitful.
If you see the major problem of government as solving the wicked problem of Brexit it will be interesting to see how, and if, Cummings manages to tackle this particular issue. After all it has already led to two prime ministers resigning or being pushed out and even Boris Johnsons’ tenure is not guaranteed if he fails to deliver Brexit or calls an election that gains a greatly increased majority that allows him to push his ideas through.
The Digital Activist’s View
Few would argue that a government that based its decisions on data, more scientific methods and industry best practices around project and systems management would not be a good thing. However, using data to understand people and their needs is very different to using data to try and influence what people think, how they vote and the way they go about their daily lives. Something that Vote Leave (and by implication Cummings) have been accused of by proliferating fake new stories during the leave campaign. In short who is going to sit above the teams that position themselves above our decision makers?
One of Cummings pet hates is the whole Whitehall/civil service infrastructure. He sees it as being archaic and not fit for purpose and an organisation whose leaders come from a particular educational background and set of institutions that religiously follow the rules as well as outdated work practices no matter what. To quote Cummings from this paper:
The reason why Gove’s team got much more done than ANY insider thought was possible – including Cameron and the Perm Sec – was because we bent or broke the rules and focused very hard on a) replacing rubbish officials and bringing in people from outside and b) project management.
The danger here is that by bringing in some of the changes Cummings is advocating just risks replacing one set of biases/backgrounds with another. After all the industries that are spawning both the tools and techniques he is advocating (i.e. predominantly US West Coast tech companies) are hardly known for their gender/ethnic diversity or socially inclusive policies. They too tend to follow particular practices, some of which may work when running a startup business but less so when running a country. I remember being told myself when discussing ‘disruption’ with a civil servant in one of the UK’s large departments of state that the problem with disruption in government is that it can lead to rioting in the streets if it goes wrong.
There is also a concern that by focusing on the large, headline grabbing government departments (e.g. Cabinet Office, DWP, MoD etc) you miss some of the good work being done by lesser departments and agencies within them. I’m thinking of Ordnance Survey and HM Land Registry in particular (both currently part of the Department for Business, Energy and Industrial Strategy and which I have direct experience of working with). The Ordnance Survey (which is classified as a ‘public corporation) has successfully mapped the UK for over 100 years and runs a thriving commercial business for its maps and mapping services. Similarly HM Land Registry has kept several trillion pounds worth of the nations land and property assets safe in digital storage for around 50 years and is looking at innovative ways of extending its services using technologies such as blockchain.
Sometimes when one’s entire working life is spent in the bubble that is Westminster it is easy to miss the innovative thinking that is going on outside. Often this is most successful when that thinking is being done by practitioners. For a good example of this see the work being done by the consultant neurologist Dr. Mark Wardle including this paper on using algorithms in healthcare.
If UK government really is as devoid of skills as Cummings is implying there is the danger they will try to ‘import’ skills by employing ever larger armies of consultants. This approach is fraught with danger as there is no guarantee the consultants will be as well read and immersed in the issues as Cummings hopes. The consultants will of course tell a good story but in my experience (i.e. as a consultant, not in government) unless they are well managed their performance is unlikely to be better than the people they are trying to replace. Cummings acknowledges this potential issue when he asks how we “distinguish between fields dominated by real expertise and those dominated by confident ‘experts’ who make bad predictions?“
Finally, do we really want Whitehall to become a department of USA Inc by climbing into bed with a country which, under the presidency of Trump, seems to be leaning ever more rightward? As part of any post-Brexit trade deal it is likely the US will be seeking a greater say in running not just our civil service but health service, schools and universities. All at a time when its tech companies seem to be playing an ever more intrusive part in our daily lives.
So what is the answer to the question that is the title of this post? As someone who trained as a scientist and has worked in software architecture and development all of my life I recognise how some of the practices Cummings advocates could, if implemented properly, lead to change for the better in UK government at this critical time in the nations history. However we need to realise that ultimately by following the ideas of one, or a small group of people, we run the risk of replacing one dogma with another. Dogma always has to be something we are prepared to rip up no matter where or who it comes from. Sometimes we have to depend on what the military strategist John Boyd (one of Cummings influences) calls “intuitive competence” in order to deal with the novelty that permeates human life.
I also think that a government run by technocrats will not necessarily lead to a better world. Something I think even Cummings hints at when he says:
A very interesting comment that I have heard from some of the most important scientists involved in the creation of advanced technologies is that ‘artists see things first’ — that is, artists glimpse possibilities before most technologists and long before most businessmen and politicians.
At the time of writing Boris Johnsons’ government is barely one week old. All we are seeing for now are the headline grabbing statements and sound bites. Behind the scenes though we can be sure that Cummings and his team of advisers are doing much string pulling and arm bending of ministers and civil servants alike. We shall soon see not just what the outcomes of this are, but how long Boris Johnson survives.
Today (12th March, 2018) is the World Wide Web’s 29th birthday. Sir Tim Berners-Lee (the “inventor of the world-wide web”), in an interview with the Financial Times and in this Web Foundation post has used this anniversary to raise awareness of how the web behemoths Facebook, Google and Twitter are “promoting misinformation and ‘questionable’ political advertising while exploiting people’s personal data”. Whilst I admire hugely Tim Berners-Lee’s universe-denting invention it has to be said he himself is not entirely without fault in the wayhe bequeathed us with his invention. In his defence, hindsight is a wonderful thing of course, no one could have possibly predicted at the time just how the web would take off and transform our lives both for better and for worse.
If, as Marc Andreessen famously said in 2011, software is eating the world then many of those powerful tech companies are consuming us (or at least our data and I’m increasingly becoming unsure there is any difference between us and the data we choose to represent ourselves by.
Here are five recent examples of some of the negative ways software is eating up our world.
Over the past 40+ years the computer software industry has undergone some fairly major changes. Individually these were significant (to those of us in the industry at least) but if we look at these changes with the benefit of hindsight we can see how they have combined to bring us to where we are today. A world of cheap, ubiquitous computing that has unleashed seismic shocks of disruption which are overthrowing not just whole industries but our lives and the way our industrialised society functions. Here are some highlights for the 40 years between 1976 and 2016.
I have written before about how I believe that we, as software architects, have a responsibility, not only to explain the benefits (and there are many) of what we do but also to highlight the potential negative impacts of software’s voracious appetite to eat up our world.
This is my 201st post on Software Architecture Zen (2016/17 were barren years in terms of updates). This year I plan to spend more time examining some of the issues raised in this post and look at ways we can become more aware of them and hopefully not become so seduced by those sirenic entrepreneurs.
Ten years ago this week (on 9th January 2007) the late Steve Jobs, then at the hight of his powers at Apple, introduced the iPhone to an unsuspecting world. The history of that little device (which has got both smaller and bigger in the interceding ten years) is writ large over the entire Internet so I’m not going to repeat it here. However it’s worth looking at the above video on YouTube not just to remind yourself what a monumental and historical moment in tech history this was, even though few of us realised it at the time, but also to see a masterpiece in how to launch a new product.
Within two minutes of Jobs walking on stage he has the audience shouting and cheering as if he’s a rock star rather than a CEO. At around 16:25 when he’s unveiled his new baby and shows for the first time how to scroll through a list in a screen (hard to believe that ten years ago know one knew this was possible) they are practically eating out of his hand and he still has over an hour to go!
This iPhone keynote, probably one of the most important in the whole of tech history, is a case study on how to deliver a great presentation. Indeed, Nancy Duart in her book Resonate, has this as one of her case studies for how to “present visual stories that transform audiences”. In the book she analyses the whole event to show how Jobs’ uses all of the classic techniques of storytelling, establish what is and what could be, build suspense, keep your audience engaged, make them marvel and finally show them a new bliss.
The iPhone product launch, though hugely important, is not what this post is about though. Rather, it’s about how ten years later the iPhone has kept pace with innovations in technology to not only remain relevant (and much copied) but also to continue to influence (for better and worse) the way people interact, communicate and indeed live. There are a number of enabling ideas and technologies, both introduced at launch as well as since, that have enabled this to happen. What are they and how can we learn from the example set by Apple and how can we improve on them?
Open systems generally beat closed systems
At its launch Apple had created a small set of native apps the making of which was not available to third-party developers. According to Jobs, it was an issue of security. “You don’t want your phone to be an open platform,” he said. “You don’t want it to not work because one of the apps you loaded that morning screwed it up. Cingular doesn’t want to see their West Coast network go down because of some app. This thing is more like an iPod than it is a computer in that sense.”
Jobs soon went back on that decision which is one of the factors that has led to the overwhelming success of the device. There are now 2.2 million apps available for download in the App Store with over 140 billion downloads made since 2007.
Claiming your system is open does not mean developers will flock to it to extend your system unless it is both easy and potentially profitable to do so. Further, the second of these is unlikely to happen unless the first enabler is put in place.
Today with new systems being built around Cognitive computing, the Internet of Things (IoT) and Blockchain companies both large and small are vying with each other to provide easy to use but secure ecosystems that allow these new technologies to flourish and grow, hopefully to the benefits to business and society as a whole. There will be casualties on the way but this competition, and the recognition that systems need to be built right rather than us just building the right system at the time is what matters.
Open systems must not mean insecure systems
One of the reasons Jobs gave for not initially making the iPhone an open platform was his concerns over security and for hackers to break into those systems wreaking havoc. These concerns have not gone away but have become even more prominent. IoT and artificial intelligence, when embedded in everyday objects like cars and kitchen appliances as well as our logistics and defence systems have the potential to cause there own unique and potentially disastrous type of destruction.
The cost of data breaches alone is estimated at $3.8 to $4 million and that’s without even considering the wider reputational loss companies face. Organisations need to monitor how security threats are evolving year to year and get well-informed insights about the impact they can have on their business and reputation.
In October last year the Whitehouse released a report called Preparing for the Future of Artificial Intelligence. The report looked at the current state of AI, its existing and potential applications, and the questions that progress in AI raise for society and public policy and made a number of recommendations on further actions. These included:
Prioritising open training data and open data standards in AI.
Industry should work with government to keep government updated on the general progress of AI in industry, including the likelihood of milestones being reached
The Federal government should prioritize basic and long-term AI research
As part of the answer to addressing the Whitehouse report this week a group of private investors, including LinkedIn co-founder Reid Hoffman and eBay founder Pierre Omidyar, launched a $27 million research fund, called the Ethics and Governance of Artificial Intelligence Fund. The group’s purpose is to foster the development of artificial intelligence for social good by approaching technological developments with input from a diverse set of viewpoints, such as policymakers, faith leaders, and economists.
I have discussed before about transformative technologies like the world wide web have impacted all of our lives, and not always for the good. I hope that initiatives like that of the US government (which will hopefully continue under the new leadership) will enable a good and rationale public discourse on how we allow these new systems to shape our lives for the next ten years and beyond.
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.
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.
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.
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.
Have a clear monetization strategy and understand your customers’ willingness-to-pay.
Know the rules and regulations.
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.
“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.
“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.”
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.”
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.