Silicon Valley comes to Oxford 2013

I've attended Silicon Valley comes to the UK (SVC2UK) at the University of Cambridge for the last 3 years, which led to me quitting my job. The chance to attend, Silicon Valley comes to Oxford (SVCO) came up, and I registered, curious to see how it would compare. I knew the university was old, but I didn't realise exactly how old, until I asked Siri.

As you remember from my post a few weeks ago, my first impressions of SVC2UK in 2013 were not great, as no public wifi in the venue. So, full marks to University of Oxford for having free public wifi available in the venue, from the moment I entered the venue.

Also, I received a survey from SVCO asking for feedback, 2 days after the event. Contrast this with SVC2UK, which sent me a survey by email, 17 days after the event. It does make me wonder.

The day I registered for involved 20:20 sessions featuring leaders from California, along with the Oxford Union debate in the evening. Tracks for the day's sessions were Venture Capital, Tech Entrepreneurship, Technology Executives, Health Care & Tech, and Sales & Marketing in Tech. The primary interest for me was the Health Care sessions.

First up was Dr David Edwards, who talked about redesigning food & how it will impact human health over the next 2 decades. One venture he has founded is Aerolife, which currently makes air based smart nutrition products. He was giving out samples after his talk. I took the breathable energy, excited to try it out. I tried it out today. Loved the energy boost and mode of delivery, but it left a horrible taste in my mouth. I was compelled to then drink a cup of coffee to get rid of the taste!

Next was Gary Lauer, CEO of eHealth who talked about the consumer centric approach in healthcare.

I spend so much time with medical professionals, investors, techies & patients, that hearing Stacey's Chang talk was very refreshing. Director of the IDEO Healthcare Practice, his talk was about 'Returning Humanity to Healthcare'. It wasn't just me who appreciated his unique perspective, you could see by the tweets and reactions of people around the room. One of the best talks I've heard in 2013.

For the last session, I decided to hear Michael Fertik, CEO of Reputation.com, talk about the future of Big Data, Privacy & the Individual. I didn't necessarily learn anything new, but it was the manner in which he explained his thoughts which was well received. Do we want to be a data serf or a data landlord?

Now, we had the chance after each of the 20:20 sessions to ask questions, plenty of time was allotted, and it was fairly informal. All of the speakers were great at taking questions, apart from one, who behaved arrogantly, Michael Fertik. People who had just heard him speak, asked him questions, and he interrupted, in a sarcastic tone, each person who was asking him a question. We had quietly listened to his talk, and yet he couldn't show the same respect when audience asked him questions? Maybe he was trying to be humourous, but he came across as a complete idiot. 

Should we rest our hopes on technology?

In the evening was the Oxford Union debate. So exciting, given that it's been going for 189 years, and is considered the world's most prestigious debating society. 

Panoramic view of Oxford Union's debating chamber

Panoramic view of Oxford Union's debating chamber

Dr Catherine Mohr

Dr Catherine Mohr

The debate was centered around one thing, "This house believes that the technology revolution will solve the global health care crisis". I really enjoyed it, as did the 8 leaders from Silicon Valley who participated. What's fascinating is that Dr Catherine Mohr, Director of Medical Research at Intuitive Surgical was the ONLY woman who was part of the debate, and everyone thought she was brilliant too, judging by the applause. Oh the final result, the opposition won the debate. I was one of those who voted for the opposition. I don't believe technology can solve ALL of the problems in Global Health. Certain problems can only be solved by using the ultimate technology, our brains! I managed to record the opening minutes of the debate being introduced, video is below (and is quite fun to watch).  

The beginning of the debate, opening remarks by Joe Dinucci

Mindset & Culture

I really appreciate events like SVCO & SVC2UK, as I'm sure there is much preparation involved. Both are now firmly on my calendar for 2014. However, these events are just one element of the change that is needed in the UK. Yes, we have brilliant minds in the UK, and yet why is that many of those brilliant minds only flourish once they relocate to Silicon Valley. In my numerous visits to the Valley, I observe how the 'energy', the 'culture', the 'mindset' is so unique and inspires me each time I'm over there. Reading this great article this week on Silicon Valley, two sentences stand out,

  1. Silicon Valley is as much about mindset as it is about the location.

  2. This mindset is something rarely studied as it is woven through the fabric of the Valley and difficult to see.

I don't have the answers about how we cultivate that 'mindset' in this country. If you do, I'd love to know what your thoughts are. 

Perhaps, it's too late for those of us who've been through the established education system here? Maybe it's the 5 year old children of today who we need to influence and inspire, as both their hearts & minds are relatively more open than the MBA graduates of today? Perhaps in 2014, we can have "Silicon Valley comes to your primary school"?

In healthcare, the reality is often far different than events such as SVCO. Starting a business and creating new technology is the easy part, finding people willing to pay for your innovation is much harder, and sometimes impossible. Pascal Lardier, who runs the international conferences for Health 2.0, recently wrote about how the NHS isn't doing as well as it wanted to, when it comes to working with UK health tech startups.

We were told at the start of Sunday by Professor Andrew Hamilton, Vice-Chancellor, University of Oxford that the university wanted to be more like Stanford & Berkeley. That we shouldn't be fooled by the old architecture, we are a very modern university. However, having visited both Stanford & Berkeley, I was struck by how many people in suits were in attendance at the event in Oxford. When I attend events in the Valley, I'm struck by how few people are wearing suits. This is what I mean about 'mindset' and 'culture'. 

What were people saying on Twitter?

Not that much actually. Despite the fact that the printed program had the Twitter handle of each speaker listed (well, actually, out of 51 speakers, 24 had a Twitter handle). Kudos to the organisers, most events I attend do not list this in the program, and you waste time searching to see if the speaker you're hearing is on Twitter. 

Given the multi-billion dollar IPO of Twitter this year, I was surprised by the low number of people at an event with 'Silicon Valley' in the title engaging in the Twitter conversation. Apparently, 600 attendees the day I attended. Being a data person, I turned to Tweet Binder to analyse the hashtag of the event, #SVCO to gather evidence You can see excerpts from the report below. Naturally, if someone tweeted during the event, without the hashtag, it's not included in the report. So, 247 original tweets from 179 contributors. Interesting stuff! 

Twitter hashtag analysis #SVCO

Twitter hashtag analysis #SVCO

So who exactly was tweeting? If you've read my previous posts, you'll know that I'm very active on Twitter. The definition of 'Most Active' in this report is the contributor who sent the highest number of tweets (RTs included). 'Most popular' is simply the number of followers for each contributor, it's the 'highest impact', defined as number of tweets or RTs multiplied by number of followers for that contributor. 

Twitter hashtag analysis #SVCO

Twitter hashtag analysis #SVCO

Conclusion

Overall, an enjoyable, inspiring and educational day, and the organisers must be applauded for running this for the 13th year. I got a dose of Silicon Valley without having to sit on a plane for 11 hours!

In fact, I met people at the event that may be interested in working with me in 2014 in the area of Digital Health. A totally unexpected bonus. It reminds me that despite our fixation with being online in the digital economy, we can learn so much by connecting with people in real life at events such as SVCO.

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Highlights from Health 2.0 Europe

At the start of this week, Health 2.0 Europe began. Previous held in Berlin, the event has now moved to London. Having been to Health 2.0 Europe last year, Health 2.0 Middle East and Health 2.0 Silicon Valley this year, I was pleasantly surprised to see many new faces at the event. I didn't recognise the majority of delegates.

Great to see such enthusiasm, and looks of surprise and amazement on people's faces as they watched demos on the stage. I've seen so much in this space myself through running the Health 2.0 London Chapter, that I didn't see what the fuss was about. I then realised that I'm part of a bubble. Whilst being able to use an app for medication adherence may seem 'normal' to me, for the vast majority of people, it's still something they've never seen before.

I wasn't able to attend every session, so these highlights are from sessions I did attend. Additionally, if you want to get a flavour of Health 2.0 Silicon Valley, you can read my posts about Day 1, Day 2 & Day 3.

Day 1

Back to London, in the first session, Improving and Enriching the Patient-Provider Relationship, 3 out of the 4 demos were from US companies. That led to some in the audience feeling surprised.

However, the reality is that there are far fewer companies in this space in Europe vs the USA, even fewer when you are looking for high quality companies with a high quality product or service to demo on stage. Whilst the conference could have perhaps had only EU companies on stage, the conference would have probably been over by mid-afternoon on Day 1.

As part of the first session, it was encouraging to see a real patient on stage sharing their experience.

Next up from NHS England, were Tim Kelsey and Geraint Lewis giving a double keynote on what's happening with NHS data. Care.data is one of the big initiatives that was mentioned. For a fascinating and thought provoking article on care.data which just was published yesterday, take a look here.

The session on Health 2.0 for the brain was well received. Jon Stamford, himself a Parkinsons' patient said that the best app is the one that people will want to use. So true.

We had a session called NHS Compass with Alex Abbott and Tracey Watson who shared their one year plan to open the NHS up for business. One great question from the audience was whether NHS England would have any influence over the local trusts to buy products & services from SMEs? It didn't sound like they have any influence, and the question was for the most part, avoided. We heard from Tracey that NHS England are likely to set up a 'Centre of Excellence' and new processes and procedures as part of the plan to help entrepreneurs navigate the NHS. Many entrepreneurs in this space have left the NHS to pursue their ideas without getting entangled in bureacracy, processes & procedures. To be fair, the NHS is extremely complex, it employs 1.7 million, and it's going to take time to change such a large organisation. Could you or I do a better job of opening up the NHS to startups? Maybe, maybe not. The task of doing so is immense, so kudos for the NHS for starting to change. 

However, myself and other entrepreneurs aren't interested in hearing about the IT failures of the past, or the internal problems facing the NHS today. They simply want to know exactly which person they need to speak to if they have an app that could help the NHS. They want to know what tech solutions the NHS is willing to pay for. Why doesn't NHS England have one website that lists all the current 'wants', just like GSK Consumer Healthcare does?

Now, when it comes to the catering at Health 2.0 Europe, many delegates told me how they were impressed with the food. However, Inga Deakin's tweet during one coffee break made me smile. Even when I worked at GSK, vending machines were stuffed full of fizzy drinks, chocolate bars and crisps.

One of the most inspiring sessions of the entire conference for me was the 'Empowering patients session'. The audience loved hearing from Maria Gjerpe, a patient from Norway who raised $1.2 million for a clinical trial using crowdfunding. Now that's what you call courageous leadership. We need more people like her within the healthcare system itself. More on here story here.

Day 2

The first session was on Sensors & Tracking: Quantifying the Self & Listening to Your Body. One of the speakers, Adriana Lukas who runs Quantified Self London, pointed out that whilst self-tracking leaders to greater self awareness, most people stop tracking after 3 months. I heard a new term mentioned during this session, Email Apnea. Yes, many of us stop breathing whilst reading an email.

In the session on Health 2.0 Tools for Doctors & Hospitals, we heard from Chris Farmer on how it can be a challenge for doctors in the hospital to share data with each other, i.e. medical photography due to consent models. Chris also told us that sometimes, they have to use 7 or 8 different software applications to view data in a single clinic. When I hear from people like Chris, I realise that we have people on the inside of healthcare systems who are equally as frustrated with the status quo when it comes to not having access to the right technologies.

Many of us have ideas but we often need someone to invest in our idea. Financing Health 2.0: Who's Stepping Up? was a fascinating and candid discussion. It is very challenging here in Europe. Every time a startup in Europe asks me about getting funding, I remind them of something I read in the Startup Genome report published in Nov 2012, "Even developed ecosystems such as New York and London have more than 70 percent less risk capital available than Silicon Valley". When you add the scarcity of risk capital, the fear of failure, and the challenges of doing business with the NHS, I don't find it surprising when I see European entrepreneurs heading to the US in order to follow their dreams. I find it sad, that after quitting my job in 2012, and becoming a consultant in the field of Digital Health, I still don't have any clients in the UK. The only organisations who pay me to work for them are all outside of the UK. As much as I'd like the country of my birth, the UK, to succeed and prosper, I now encourage any startups that ask for my advice, to also consider either Silicon Valley or an Emerging Market. There are even entrepreneurs in the UK who give up on their ideas here, since they aren't likely to make any money from them. 

A great talk from Richard Smith, about the rise of chronic disease in the world, and that a lot of patients don't take their drugs. Many in the area of Digital Health see apps as a possible path towards behaviour change. I remain unconvinced, and this post by Nir Eyal on why behaviour change apps fail to change behaviour is one of my favourite things I've read in 2013.

The final session of the day was Not your mother's Health 2.0, covering the topics that health tech conferences don't actually have on the agenda. I loved all of the demos. Mark Steedman, an expert in End of Life Care, remarked that we don't study how people die. He also told us that most people want to die at home, but actually die in hospital. Mark challenged the entrepreneurs in the audience to develop technology that could help End of Life Care.

Ever wished you could check how much alcohol is in your blood before you drive a car? Dr Gautam Mehta has developed a gadget that plugs into the headphone jack of your phone that will allow you to do that.

So, what was it like?

In conclusion, fascinating to see how much this scene in Europe has progressed in just a few years. It's encouraging for those that want to support European entrepreneurs, and inspiring for those who have ideas but have yet to make the jump into doing their own startup. The Twitter stream was very active at this conference, and I hope that this event has triggered new conversations here in Europe. I was impressed to see how much energy there was during the final coffee break of the conference. One suggestion for next year is to have a patient in each session. I believe having a patient in each session would provided much needed insights into what they actually need (and want to use!).

Lots of energy during the final coffee break on Day 2

Lots of energy during the final coffee break on Day 2

We can come up with so many innovations, but the ultimate question is, "Who is going to pay for it?". Whilst many of my friends have left Europe to either head to California or an Emerging Market, there are rays of hope here. One UK startup, uMotif, was on stage twice at this conference. Once in my pre-conference workshop on Sunday, and again on Monday on the main stage. I remember when I invited them to demo at my Health 2.0 London event on mHealth back in September 2012. It's been amazing to see them go from strength to strength. Just recently, they beat hundreds of other startups to win Cisco's British Innovation Gateway award, with a prize package worth $200,000.

So, it IS possible to succeed without being in Silicon Valley.

Can't wait until Health 2.0 Europe 2014? We have 3 Chapters in the UK. Health 2.0 Manchester & Health 2.0 Birmingham. In terms of the Health 2.0 London Chapter, which I run as a volunteer, we now have 540 members. I've already scheduled 4 events for 2014. A big thanks to the ICTKTN for sponsoring our events. The events are kept small as we've found it works well in 2013. If you are interested in attending, don't be put off by the fact that all of the events are full. Join the waiting list, as many people registered can't attend due to work & family, so people on the waiting list usually get a space. 

  • Jan 22nd - Digital Health: How do we avoid 'Digital Exclusion' in Health & Social Care? 

  • Feb 19th - Digital Health in UK hospitals: Hope or Hype?

  • Mar 18th - The Internet of Things: Could this be the catalyst for innovation in the NHS?

  • Apr 16th - Does giving patients more data actually increase engagement & improve outcomes?

[Disclosure: I have no commercial ties with the companies listed above, apart from Health 2.0, which uses me as a consultant from time to time]

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Ontario: The global hub for 'science driven' wearable tech startups?

Last week I was part of a panel discussion in Toronto, Canada. Hosted by MaRS and Ontario Genomics Institute (OGI), the topic was Big Data and Personalized Medicine. The event was part of the MaRS Global Leadership series. MaRS is a place where science, technology and social entrepreneurs come together and get the help they need, where new conversations take place, and innovation is actively nurtured. OGI is a private, not-for-profit corporation focused on using world-class research to create strategic genomics resources and accelerate Ontario’s development of a globally-competitive life sciences sector.

Rhonda Tannenbaum, VP of Business Development at Ontario Genomics Institute introducing the event

Rhonda Tannenbaum, VP of Business Development at Ontario Genomics Institute introducing the event

The other two panellists had amazing backgrounds. Phyllis Frosst, Senior Policy Fellow at the Personalised Medicine Coalition, and Fiona Stewart, practices at Belfast City Hospital, specialises in Clinical Genetics & also is part of the UK Genetic testing network. I learnt so much from spending time with them (as did the audience).

 

I shared my thoughts on trends in Digital Health and what it means from a data perspective. Such as the forthcoming explosion of data generated by our bodies 24/7 but now being captured by sensors, apps and genetic tests. How will it best be shared? How will it be governed? Do we need to rethink data privacy & security in the 21st century? How can patients be given real-time dynamic consent when it comes to toggling levels of access to their health data? How can these data support personalised medicine or will they just be meaningless datasets in 5 years time? One of the last questions from the audience was whether these trends in technology & data will lead to Canada's population being served in the future by doctors based in other countries. Healthcare without borders may well be one of the options employed in order to cope with rising costs.

Participating in the event reminded of the need for more 'science driven' health tech startups. In the world of health & social care, which is used to evidence based medicine, I believe those startups which are based upon good science, have the greatest chances of long term success & prosperity.

Science driven wearable tech startups

Whilst I was in Toronto, I decided to grab some time with a number of wearable tech startups that are based out there. After meeting them, I was truly impressed by their passion, 'science driven' approach, and their humility. None of the arrogance and false superiority displayed by many startups I've met in other places.

I met with Mike Lovas from PUSH. They are working on the first fitness tracking device that measures strength. When performing your bench press, squats, or deadlift in the gym, the device promises to capture sets, reps, force output, power, and velocity. The goal of PUSH is not to replace the human trainer/coach, but to support the trainer. I started imagining the possibilities of combining PUSH with other wearable tech. For example, what if during your squats, PUSH records your strength, your Lumoback would measure your posture, and smart socks from Sensoria would measure if your feet are moving in the wrong direction. Combine all of the resulting data, and provide real-time feedback via earphones to the person performing the exercise. Not only does this feedback loop optimise your workout, but you could prevent injuries due to poor technique. Wouldn't that be awesome? You can hear more about PUSH in the video.

Mike Lovas, Chief Design Officer, co-founder at PUSH 

Next I met with, Ashley Beattie from Kiwi Wearable Technologies. They are currently working on the kiwi move, which is is an internet-enabled motion sensing device and can be used to track your activity, automate your home and even secure your valuables. We didn't have much time for our meeting, so didn't get a chance to view their device. However, I was enthralled by the conversation with Ashley and the vision for Kiwi. I remember that he told me, "the dominant wearable tech company of the future wll be a platform company, having multiple apps, with one device, creating a 'pivot chart' for your sensor data." Definitely a company to keep an eye on. You can hear more about Kiwi in the video.

Ashley Beattie, co-founder, Kiwi Wearables 

Running around Toronto, I popped into the offices of Interaxon, and caught up with Trevor Coleman. In addition to being the person that persuaded me to start using Twitter back in early 2012, when I met him at Wisdom 2.0 in Silicon Valley, he's working on MUSE, their new brain sensing headband. I admire how they want people to use the technology to actually connect to themselves. Trevor possesses unique insights into the merging of wisdom & technology. I'm excited to see reactions from consumers once the product starts shipping in 2014. Hear more from Trevor in the video.

Trevor Coleman, Chief Product Officer, Interaxon

Finally, I got a chance to meet the super busy Saul Colt, principal at Kinetic Cafe and also the head of the new Fresh Startups program. Saul is a pioneer who is challenging the status quo when it comes to our beliefs regarding accelerating and incubating health tech startups. Their differentiator is their partnership with Freshii, a health food restaurant chain looking to shake up fast food while keeping meals healthy. You must watch the short video of Saul explaining why he started the Fresh Startups program. 

Saul Colt, Founder, Fresh Startups 

I meet a lot of startups, in different parts of the world, but in Toronto, something seemed to make them different. Their commitment to creating 'science driven' wearable technology in the world of fitness & health. I see so many startups in this area developing a product simply because it's cool or sexy, but based on little or no science. What seems to give Toronto's wearable tech startups an edge over other parts of the world can be found by driving 115km away from Toronto, to the University of Waterloo. "Every Canadian in a successful startup seems to be from the University of Waterloo", remarked Mike Lovas.

According to Startup Genome’s Startup Ecosystem Report 2013, three Canadian cities rank among the top 20 most active startup scenes in the world. Toronto, Vancouver & Waterloo. I'm seriously impressed that Waterloo is ranked 16th, just behind Berlin. Why am I impressed? The population of Waterloo is just 124,600! I didn't get a chance to meet Airo Health, and Thalmic Labs, two more wearable tech startups, who are based near Waterloo.

UK Independence Party advert

UK Independence Party advert

From a cultural perspective, whilst the UK Independence Party is trying to change influence policy to limit immigration, Toronto in particular seems to be welcoming immigrants with open arms. Nearly 50% of Toronto's population is foreign born. That's critical when it comes to attracting global talent.

Poster in downtown Toronto welcoming new immigrants

Poster in downtown Toronto welcoming new immigrants

My experiences in Toronto have left me enlightened and inspired. My last thoughts as I headed back to London, were that if current trends continue, the province of Ontario (which includes Toronto and Waterloo) may well become the global hub for 'science driven' wearable tech startups.

[Disclosure: I have no commercial ties with the companies mentioned in this post]

How do we make Aging as sexy as Global Warming?

The title of this blog post is one of the questions that I posed to the panel & the audience at the pre-conference workshop I ran for Health 2.0 in London on Sunday 17th November. [Note: credit to Victor Wang for coming up with the quote on Saturday]

Yesterday, Health 2.0, myself, and the participants of this workshop created history.

A bold claim, but look at the variety of Health IT, mHealth & Digital Health conferences around the world. How many run workshops which discuss old age and dying? Kudos to Matthew Holt and Pascal Lardier for being pioneers in making this happen. What I love about being involved with the Health 2.0 conferences is the genuine desire of the team to challenge the status quo. When the idea for this workshop was first discussed, the immediate response from Health 2.0 was not the all too common, "No, it's going to be too difficult", but "Yes, this is risky and uncharted territory, but let's give it a go". 

Where is everyone else?

The workshop was not perfect. We had no patients in the room, apart from Sarah Reed who delivered wonderful insights on behalf of older patients. We didn't have policy makers, the NHS, investors, the third sector, or designers in the room. We did use various channels to publicise the workshop, and I reached out to a number of entities that would have benefited from attending, but either no response or they were simply too busy. Perhaps they felt talking about old age & dying and how technology can help was a bit too radical for a Sunday afternoon? 

I started the workshop setting the scene in terms of Aging populations and the challenges & opportunities. You can see the slides below. The trends of Aging populations is a gradual one, and perhaps that's why it's often not number 1 priority on the minds of decision makers & politicians, who are often faced with short term pressures. Furthermore, many of us use words such as 'burden, 'cost' and 'problem' when describing citizens aged 65 years and up.

I say, older people must be embraced by society. Let's celebrate their existence. They offer life experience, wisdom & talents that could help so many of us, especially young people. In modern times, many of us, not just older people live lonely and isolated lives. A recent survey of GPs in the UK found that 1 in every 10 patients they see every day are coming to see the doctor because they are lonely. Naturally, that places pressure on already stretched services, but more importantly, what does that say about our society? 

Whilst technology can't necessarily reinvent our social fabric, some of the innovations shown at the workshop could be employed to allow older people to stay connected with others in society. 

A very intense and well received 3.5 hours with patient insights, 13 demos of innovative technologies and a 5 member panel discussion featuring Tobias Stone, Janet Jadavji, Clive Bowman, Bart Collet & Brenda Reginatto.

The demos were split into 3 sections;

Disease prevention & Disease Management

uMotif, Memory Lane Games, Advanced Balance Systems, SmartCitizen

Aging in Place

Fresh Idea Factory, Vivago, Intelesant, Zilta

Tools for Caregivers & Families

GeriJoy, Yecco, SpeakSet, Mindings, Breezie

Sarah Reed sharing insights from a patient's perspective

Sarah Reed sharing insights from a patient's perspective

Key learnings

  1. You can be successful at a global level without being based in Silicon Valley

  2. The importance of 'science driven' health startups

  3. Many startups in this arena are founded by people who have cared for an elderly relative

  4. We can't just treat older people as one big cohort and assume they all have the same needs

  5. Underlying technology doesn't need to be complex to be effective

  6. How can innovators & investors make money after developing these technologies?

  7. Who is actually going to pay for the innovation?

One or more of the startups who demonstrated their products at the workshop may well be a global name in future years. I left the workshop feeling hopeful, inspired and positive. I acknowledge that data & technology alone won't solve every issue faced by older people, health & social care professionals and their families & caregivers but it definitely has a role to play.

What next?

Even if you weren't at the workshop, and won't be attending Health 2.0 Europe, I encourage you, wherever in the world you are based, to discuss and debate, old age and dying. These conversations will be uncomfortable and frightening, and at times rather unpleasant, but we won't be able to move forward unless we act with courage. Each of you can (and hopefully will) play a part in making Aging as sexy as Global Warming.

[Disclosure: I have no commercial ties to any of the companies mentioned above, apart from Health 2.0, which I provide consulting services to from time to time]

The Internet of Things World Forum

I recently attended the inaugural Internet of Things (IoT) World Forum in Barcelona, Spain which was hosted by Cisco.  For those that have not heard of IoT, it could even be bigger than the Internet. Check out this infographic from Cisco. John Chambers, CEO of Cisco reckons IoT as a market could generate $14 trillion in profits over the next decade. Yes, you read correctly, $14 trillion! Mr Chambers certainly seems to be one of the most forward thinking CEOs of a large organisation that I've heard speak in 2013.

Reading through the attendee list, I did not see any pharmaceutical companies, neither anyone from the NHS. Oh wait, during the event, I did bump into someone from Eli Lilly. I have no idea why their were so few healthcare organisations at the event, despite a closing keynote delivered by Jay Walker, chairman and curator of TEDMED (more on that later).

Cisco are so excited at the prospect of IoT as the next big thing, they are setting up a new business unit. After coming back from the event, I learnt that Intel, the chipmaker, is also setting up an IoT business unit.

When I imagine IoT and our health, I'm envisioning sensors embedded in everyday objects that are wirelessly connected to the net. An example might be that my sofa, TV, fitness tracking wristband, and my smartphone are all connected. So, I've been sitting on the sofa watching TV for hours, despite my goal being to walk 1 mile every day. My sofa senses my inactivity, knows it's going to rain in 2 hours, and then switches the TV off and sends me a text message saying, it's time to go for a walk before it starts raining. I didn't see anything like this at the event. To be fair, there was one fascinating session on IoT & healthcare, featuring some pioneering work shown by Bill Kennedy, who has been using in IoT technology in telehealth.

The first video at the bottom of this post is of Steve Lucas from SAP and includes a demo of a smart vending machine that can suggest food options based upon your sleep & physical activity [actual demo starts from 4 mins onwards] 

Internet_of_Things_Infographic.jpg

The second video is of the closing keynote from Jay Walker. I've included a 10 min video from his speech [unfortunately, ran out of space on my iPhone, so didn't record all of it]

Easier said than done

There was a Smart City Walking tour, to showcase what the city of Barcelona is doing to embrace IoT. Initiatives such as parking sensors that let citizens know where an empty parking spot is located, location analytics that allow the city to understand where pedestrians are walking, sensors in waste bins that inform when the bin is full and free public wifi. All to be applauded. However, when flying back to London from Barcelona airport, and looking to get online, I was in a different Barcelona from the glitzy forum. Not a single power socket at the gate (phone was running out of juice), and 15 minutes free wifi (fee required for >15 mins). So much for a smart city!

Even when departing London Gatwick airport for Barcelona, I spent ages wandering around the terminal hunting for a place to plug my laptop in before my flight. I finally found a power socket, in between two chairs. Plugging in my laptop revealed the socket was not functioning.

More recently, attending the Health Tech Summit by Silicon Valley Comes to the UK, held at University of Cambridge. An illustrious panel flown across from the USA to share their vision on the future of healthcare. Exciting stuff! Oh wait, I struggled to live tweet during the event. No public wifi in the venue. On top of that, my mifi device had no signal, and my mobile phone's signal was often too weak for a data connection. These incidents make me feel like I'm living in a real-life Dilbert cartoon!  

As inspired and excited as I am by the vision of a hyper connected & programmable world, the on the ground reality in healthcare is very different. I remember a business trip when I worked at GSK. I took the Eurostar train from London to Brussels one morning to visit the Vaccines division. A taxi had been booked for me at Brussels station. Upon arrival, I found my taxi driver waiting for me, with my name and the GSK logo on a card he was holding up. Actually, there were many drivers around him, all holding up cards for GSK staff. So, same train from England, with employees from different divisions, all heading to the same GSK building in Belgium, each with their own taxi. Hmmm. We frequently can't get people to talk to one another and share information, and yet, we expect those same people will enable  50 billion devices to talk to one another. Technology seems to be progressing at an exponential pace, leaving many leaders and their organisations struggling to keep up.  

I don't see a prosperous future for many organisations in health & social care unless they wake up. I was talking to a friend in the US about IoT and the NHS. He told me "a true IoT means we wouldn't need the NHS at all. It is not about innovating within current structures but innovating and being willing to change the physical geography of healthcare and beyond!!" 

Beyond IoT  

Yes, whilst IoT is yet to hit the radar screens of many organisations, visionaries such as Alice Rathjen are already thinking beyond IoT. Alice is a good friend of mine, and spoke at Silicon Valley comes to the UK a few days ago. Her vision of the future is the Internet of Human Beings. Truly fascinating stuff!  

So what next?

I applaud Cisco for hosting this pioneering event, and it was a privilege to be there and witness what felt like a turning point in history. Naturally, there will be tremendous hype surrounding the potential of IoT, just like the hype we are forced to navigate in 'Big Data' & 'Digital Health' for example. The dreamer in me wants to believe IoT will solve many of the challenges we face in health and social care. However, looking at recently released data about internet usage in Europe. 100 million people in Europe have NEVER used the internet. Take Greece, where 65% of residents have never used the internet.

60 million Americans don't use the internet, according to Pew research. Many of the people who don't use the internet are poor, disabled or elderly. However, the Greek government have promised to roll out free wifi across Greece in 2014. Looking at the bigger picture, social inequalities in health do exist. Amazing developments in technology including IoT seem to have the potential to either widen or reduce those inequalities around the world. I really hope it will be the latter. As Jay Walker said in his closing keynote, "our biggest challenge is lack of imagination".

Can you and your organisation imagine what a hyper connected world would look like?  What will the IoT mean for you? Does the IoT frighten or excite you?

[Disclosure: I have no commercial ties with any of the companies mentioned above] 

Steve Lucas from SAP at Internet of Things World Forum - 31st Oct 2013 

Jay Walker, chairman of TEDMED delivering closing keynote at IoT World Forum - 31 Oct 2013 

Putting patients at the heart of innovation in the NHS – Responsible or reckless?

It was fascinating to be part of the Healthcare Innovation event hosted by Westminster Forum projects last week. After the death of his wife from ovarian cancer, Lord Saatchi felt crushed by the ‘medieval’ treatment that cancer patients must endure. It drove him to launch a Private Member’s Bill in the House of Lords, which seeks to promote medical innovation and reduce doctors’ fear of litigation in the event of something going wrong. Is it right to give doctors license to experiment on their patients with unapproved treatments, even if they have the best of intentions? Is the distinction between responsible innovation and reckless innovation so easily made?

I used to think that having worked in GSK when it had approximately 100,000 employees, I’d experienced the challenges of innovating in a complex and regulated environment. However, the NHS employs more than 1.7 million people, and deals with 1 million patients every 36 hours. According to the NHS website, only the Chinese People’s Liberation Army, the Wal-Mart supermarket chain and the Indian Railways directly employ more people!

The more I learn about the inner workings of the NHS, the more respect I have for the hard working men and women who help deliver care to patients. It can be tempting to poke holes in NHS strategies from an external perspective, but I recognise that NHS leadership has to routinely make very tough decisions, particularly when evaluating the risks and benefits of new products & services. 

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Many of the solutions we all desire for the NHS won’t arise by employing the same thinking we’ve always used. There has been significant change in recent years, and there is much more change still to come, at least from a technology perspective. When I meet innovators in Silicon Valley, they are intent on ‘disrupting healthcare’ and developing ‘algorithms’ and ‘software’ that will in theory, replace much of what a doctor does today in terms of diagnosing diseases. Then there are the multitude of startups around the globe developing mobile health apps, many of which claim to trigger ‘behaviour change’. When the pharmaceutical industry is largely focused on treatment, what will the impact be for them, if the NHS can one day use new technology to operate ‘beyond the pill’?

Indeed, Happtique in New York have been trialling prescribing health apps to patients. The Internet of Things promises us a world of billions of devices connected to the Internet, from our cars to our fridges to our clothing! Yes, the possibility of gathering streams of real-time data from a t-shirt embedded with health sensors. Google just announced the launch of Helpouts, which could one day bring telemedicine to the entire globe.

Given the biggest challenge for the NHS is chronic disease management, these advancements could make remote monitoring of the elderly a reality, except that today, 80% of care homes in the UK don’t offer internet access to their residents. 7 million people in the UK have never used the internet, many of which are poor, disabled or elderly. The Digital Divide could result in multiple tiers of innovation, not accessible to every patient.

For many people in society, these technologies could offer patients the chance to be much more in control of their health, to be more informed and to be more independent. I believe both patients & entrepreneurs will not wait for the establishment to catch up with trends in technology.

To be fair, there is a huge amount of froth and hype in Digital Health, often with limited or no evidence. There are many pioneers, but also many cowboys. The regulatory framework we use for evaluating these Digital Health technologies will have to be different from existing regulatory frameworks. We might not even get things right first time around, as this is a new area for everyone. However, we can’t let fear of failure hold us back. Many people in health & social care, particularly doctors and other leaders, are afraid at the prospect of Digital Health technologies coming into the NHS. It’s only natural to be fearful, if your own future may be at risk.

However, given a choice, I’d rather have medical professionals afraid of new technology rather than patients afraid of not having access to the latest technological innovations. Whilst we may not be able to help the patients of yesterday, such as Lord Saatchi’s late wife, I sincerely believe by continuing the open and mature debate, we could help the patients of tomorrow.

“Courage is not the absence of fear, but rather the judgement that something else is more important than fear.” - Ambrose Redmoon   

8 reasons why FutureMed changed my life

In Feb 2012, I had resigned from my job at GSK but was working my notice period. I was dreaming of a yet to be undiscovered future. I'd spent almost two decades working either in the research or marketing functions of a variety of organisations. Those two functions are the parts of an organisation which are constantly thinking about the future. 

I remember finding the FutureMed (FM) website one day, and I said to myself, "This looks amazing, it would be a dream come true to get admitted". I shared the link with a few colleagues who rolled their eyes, and questioned what I would get from hanging out with some 'space billionaires' in California. In the same month, I was told by someone higher up the food chain at GSK, to remove the word 'Disruptive' from the meeting on 'Disruptive Innovation' that I had scheduled, because the word 'Disruptive' was kinda scary for them. These attitudes, beliefs and cultural norms played a big role in my desire to exit one of the largest pharmaceutical companies in the world, and search for other free thinkers who weren't afraid of exploring new technology. 

Friends of mine in California urged me to apply to FM, saying that my crazy & radical ideas that seemed to terrify everyone in the UK & Europe, would be not only be welcomed, but warmly encouraged at Singularity University (SU). So, I applied, and got admitted. One of only two people from the UK, I might add. I attended the 6 day program in Feb 2013, which cost me $8,500 just for the program. Over the last 8 months, people ask me all the time, was it worth it? What did you get from it? Should I attend the next FM? That's what compelled me to write this blog post, so my experience could reach a wider audience. 

The 8 reasons

 (Not ranked in any particular order)

  • #1 I'm now getting paid work as a Digital Health Futurist - I've always been more interested in the future, rather than the past or present. Since leaving my job, I've worked hard to research the latest technologies, and stay right on the edge. FM took me to a whole new level and gave me the confidence to start my own blog, deliver my first TEDx talk, and give talks and workshops on the future of Digital Health. In fact, some of my clients have told me part of the reason they first contacted me was just because I'd been to FutureMed! 

  • #2 Opened my eyes to new possibilities  - Robotic surgery, 3D bioprinting, Synthetic Biology, Regenerative Medicine, and Neuromedicine & more. I'm not necessarily an expert in these areas after FM, but it's helped me become aware of what these exponential technologies are about, where they are heading and how they may potentially change the world. The program is extremely well curated. It was the passion and energy of each of the speakers who brought these new technologies to life for me. I wish I had teachers like that when I was in school. 

Virtual simulation with Da Vinci robotic surgery system

Virtual simulation with Da Vinci robotic surgery system

  • #3 Hands on experience with the most amazing technologies - I'll never forget how I got to play with the Da Vinci robotic surgery system, make a 3D printed iPhone case, or be in a group picture which was taken by a camera mounted on a UAV flying above our heads. I was fed up of reading about these technologies in blogs & articles, I wanted to see them up close with my own eyes. I don't believe I could have experienced this anywhere apart from SU.  

 

 

 

  • #4 Enlarged my network in Silicon Valley  - You know the saying, it's not what you know, it's WHO you know? Despite all the optimistic press releases about New York, London or Berlin being the next Silicon Valley, there is only ONE Silicon Valley. In my opinion, the Valley will continue to dominate the world in technology, at least for the next decade or two. There is just an incredible energy there. It's the only place I've ever been to where not only are people passionate about 'changing the world', but they are actually doing so too! You come into contact with so many inspiring people during the program, in addition to the awesome faculty.  

  • #5 Fellow students have become friends -  I spent 6 long days with 80 other students from 20+ countries. Some were entrepreneurs and some were employees of large organisations, it was a good mix. Despite having travelled to 44 countries, I met people from countries I've never been to, such as Brazil and Argentina. I was surrounded by people so much smarter than me, and it led to wonderful debates about the future of healthcare. I've kept in regular contact with some of the students, who have now become friends. Before I left FM, we were told that we were now part of the SU 'family', and each of us got our own SU email address! I went back in August 2013 to SU for the Alumni Reunion & the 5th birthday party of SU [I learnt that most students at SU are from the USA, but the second biggest group is from Brazil]

A talk in the main classroom by Vinod Khosla

A talk in the main classroom by Vinod Khosla

  • #6 Rewired my brain - SU has a nickname, 'Sleepless University', and I found that out on Day 1. I remember speaking with the SU ambassador for Saudi Arabia (Yasser Bahjatt) at TEDActive 2012 (which itself is described by attendees as the ultimate brain spa), and he told me that SU was like TEDActive on steroids. Classes at FM started first thing in the morning, and finished in the evening, interspersed with field trips. My mind was stimulated so much, I'd often stay up till 1 or 2am, discussing the day's learnings with other students. I haven't had a learning experience like that anywhere else but it was seriously hard work. Fortunately, SU provided the tastiest and most nourishing selection of food & drinks of ANY event I've attended.  

  • #7 Got a free reality check - Towards the end of the program, an unconference was held one evening. I shared my idea and I didn't get many positive comments. I was immediately asked about the business model and who it would benefit. At the time, it felt like folks there didn't get my idea. However, with the benefit of hindsight, I realise that the hyper-focus of people in Silicon Valley was actually a sorely needed reality check. That's helped me refocus my ideas and dreams during 2013. 

  • #8 It's opening so many doors for me - This week, I will be attending two events which are both invitation only. The first is the very prestigious Westminster Health Forum's seminar on Health Innovation where I am actually speaking, and the second is the inaugural Internet of Things World Forum, where I'm a delegate. I'm convinced that attending FutureMed helped in securing these two opportunities.   

The class of FutureMed Feb 2013 in our scrubs! I'm in the top-right hand corner with sunglasses. 

The class of FutureMed Feb 2013 in our scrubs! I'm in the top-right hand corner with sunglasses. 

A student had printed this out in the Innovation Lab

A student had printed this out in the Innovation Lab

I made it to the end of the program!

I made it to the end of the program!

However, FutureMed is not perfect

I recognise that FM is a relatively new program, but there were elements of FM in 2013, which for me, were not great. The biggest issue was the intensity of the program. There is SO much packed into each day, and so little time during the program to digest all that material. I would have preferred not just more breaks, but longer breaks to allow more time to exchange ideas with other students. Not everyone has the stamina to stay up to the early hours of the morning. I appreciate that the faculty want to help you to get value out of your time there, but there were moments when I just wanted some down-time, where I could go for a walk without having to miss a class. 

You hear the term exponential technologies used a lot at SU. In fact, it's over-used at some points. 

The session on Global Health was on the last day and just 2 hours long. Personally, I'm really interested in how technology can impact 7 billion lives, not just those who are in the richest nations. I hope the organisers make that section of FM much longer in the future. 

SU wants to impact a billion lives. One might argue, why are they based in the USA? Surely, SU could be based in the place where those billion people are, such as rural Africa or rural India?

I've had difficulty explaining to people that despite the name, SU, is not an accredited university. Others point out that SU is sort of a cult, you get brainwashed or that it runs overpriced elitist networking events. One could argue that the people who spend 2 weeks camping outside Apple retail stores to be first in line for a new version of the iPhone are part of a cult. One could also argue that programs such as TED are also overpriced elitist networking events. 

Astronaut space food. In case you're wondering, it looks better than it tastes. 

Astronaut space food. In case you're wondering, it looks better than it tastes. 

Overall, the positives far outweighed the negatives for me, and the experience HAS changed my life, and continues to change my life. The next FM is being held in Nov 2013 . Alas, I won't be able to attend, and I'm curious how the experience will be in San Diego, away from the SU Campus. One of the benefits of attending FM earlier this year was that it was based at SU. Growing up in the 70s with Star Trek, and then following the progress of the Space Shuttle in the 80s, it was a really special treat to be on campus at NASA Ames Research Park. Leaving campus back into the real world, I purchased some Astronaut space food. As amazing as going into space might be for some people, I'd miss the food on Earth.    

Some more pictures I took at FM are in the slideshow below.

[Note: I have no commercial ties with any of the organisations mentioned above]

NHS England Citizens' Assembly - Day 2

Well, I made it back to Day 2 of the Citizens' Assembly development day. To be candid, after writing my post about Day 1, I almost felt like NOT coming back for Day 2. Why? Well, I was presented with no compelling need for a Citizens' Assembly. So, what contribution could I make to a proposed model that I'm not sure is actually needed?  

In the end, I attended Day 2, with my confusion and skepticism in tow. Again, kudos to the facilitators & the other attendees who worked into the night once Day 1 had concluded, to revise the draft paper based upon the sentiments expressed on Day 1. The revised paper can be found here.

Anthony Zacharzewski [facilitator] curating the Open Space lineup

Anthony Zacharzewski [facilitator] curating the Open Space lineup

After the opening remarks, we were told about the 'Open Space' session during the morning. A chance for attendees to lead discussion groups, based upon topics 'pitched' to the room rather spontaneously. Similar to an 'unconference' that are prevalent at technology events. We were invited to pitch the questions that WE felt were important and needed to be discussed further. Questions pitched included culture change, truth to power, inclusive membership, and lowering the bar for evidence. My question was about understanding the gaps in existing patient voice mechanisms. Another attendee, Avril Davies wanted to discuss avoiding duplication with existing services, so both our questions were merged into one discussion group. Each discussion group, had it's own room, and approx 60 minutes to debate, discuss, argue and hopefully move forward with some action points. 

I think here I was describing the scale of the problem! Photo by Ruth Beattie [Yes, that's a genuine Hawaii shirt that I actually purchased in Honolulu]

I think here I was describing the scale of the problem! Photo by Ruth Beattie [Yes, that's a genuine Hawaii shirt that I actually purchased in Honolulu]

In my group, I thought it would be really quick and easy. Let's just map out what existing patient voice mechanisms exist, establish what works, what doesn't work, and determine if there really is a gap that needs a Citizens' Assembly. It wasn't THAT easy! The group discussion was extremely lively, and I was frequently astonished by the collective wisdom and experience shared within the group [Sidenote: How does NHS England harness that combined wisdom and experience at a grassroots level across the nation?]  

I believe the map of existing patient voice mechanisms had already been started during the evening of Day 1 by those awesome facilitators. Our discussion group added a few more to the map on the wall.   

Some of the existing patient voice mechanisms

Some of the existing patient voice mechanisms

More existing patient voice mechanisms

More existing patient voice mechanisms

So what did our group conclude?  

  1. An audit of existing services and systems is required. Just how many ways in which patient voices can be captured currently exist? A SWOT analysis to prevent wasting taxpayer money on new systems. How many patients use each service? How much money does each cost to run? Are they effective? If not, why not? Can they be tweaked in any way to be effective? [Note: Personally I believe NHS England should have these metrics, regardless of the debate about a Citizens' Assembly]

  2. All these current routes may not be delivering a powerful democratic voice.

  3. Existing channels are collecting patient feedback but not necessarily enabling patient participation at a national level.

  4. Patient feedback at the moment may not always get a response from the system.

  5. No one central place in NHS England for feedback/questions from patients. Why can't there simply be one 'customer service' department just like a chain of supermarkets? Patients may be simply be confused about where to currently give feedback, as there are so many different routes.  

  6. Aggregate, Amplify and not Duplicate.

At the end of the discussion, I asked the group, "Should we be talking about a Citizens' Assembly at this point in time?".  Out of 9 people, 2 said 'Yes', 3 said 'Some concerns', and 4 said 'Serious concerns'. [Note: I was in the last group]

Tim Kelsey sat in one some of the discussion groups (not mine though), and after the 'Open Space' sessions were over, he spoke for 15 minutes. Tim told us that some very senior leaders in the UK government were following this event on Twitter. I guess this Citizens' Assembly idea has high visibility then? Tim also said "The Citizens Assembly should not just have impact, but 'authentic' impact", and "It's about having a grown up conversation about this commissioning thing with people who use health & social care". One of his most powerful statements was "one of the key reasons for having a Citizens' Assembly is to hold NHS England to account".

This was MY immediate response on Twitter to Tim's talk.  

After lunch, each of the attendees who had facilitated an 'Open Space' group were invited to share their conclusions. Once again, congrats to the facilitators for politely but firmly making sure each person didn't go past their allocated 5 minutes. Four attendees are shown in the pictures below. [left to right], Fiona Carey - lowering the bar for evidence, John C - truth to power, Carol Munt - Inclusive membership, and Simon Blake - will this lead to better outcomes? 

Simon Burall leading a shared pause to allow us to reflect upon the intense conversation

Simon Burall leading a shared pause to allow us to reflect upon the intense conversation

By the time everyone had shared their conclusions, Simon Burall could see how tired everyone was and ended the meeting ahead of schedule. Again, this is a sign of facilitators who pay attention to the needs of participants. That's rare. Before Simon closed the discussion, he asked us to pause and ask ourselves what we will do on Monday morning as a result of attending these 2 days? After 2 intense days where our minds were busy with questions, thoughts and ideas, this brief moment to reflect was most appreciated. We were given the chance to share with the group what practical action each of us would undertake on Monday morning. Most of the actions revolved around sharing of ideas, and getting others involved in this conversation. I've attended conferences and seminars around the world, and I cannot praise the facilitators enough for their patience, wisdom and guidance these last 2 days. I admired how questions from people watching the webcast and/or following the Twitter stream were captured and relayed to the room throughout the 2 days, which helped me understand what others were thinking despite not being in the same room as us.

Follow up thoughts

Some points which didn't really get discussed much were;

  • Resources. Who is going to pay for all of this? Tim Kelsey himself has a few months ago addressed technology entrepreneurs about the £30 bn shortfall in funding that the NHS is predicted to face by 2020. I did hear of some costs in the room today but they were not confirmed. Even though the proposed Citizens' Assembly may have money allocated towards it, is it the optimal allocation of resources? Would the funds that go towards this idea be better spent on keeping a maternity ward open or hiring extra nurses? I am extremely curious to know just how much is already spent annually on patient voice mechanisms such as Healthwatch, NHS Choices and the myriad of others.

  • Outcomes, Value & Success. Have we really given a chance to some of the most recent patient voice mechanisms in the NHS? Who has the authority to define that one mechanism delivers more value than the other? For example, how do we define the value of a patient experience survey? I recognise there may be many hard working people involved in those different services. Are we disrespecting their contributions by jumping into a Citizens' Assembly without hearing their point of view? How do we define the success of any mechanism that holds NHS England to account? Is it the absence of a major scandal such as Stafford Hospital or Baby P? I'm curious, what evidence suggests that NHS England can't be held to account right now? 

  • Technology. I operate in the world of Digital Health. A world which promises smartphones that know you are sick before you know or sensors that will allow software & algorithms to monitor us remotely without us having to leave our homes, with the smartphone being the healthcare delivery system of the future. A world where doctors' offices & hospitals may reduce in size, because an app on your iPhone knows more about your heart than your cardiologist. Digital Health technology is evolving so rapidly, it's frightening a lot of people, especially those who would prefer the paternalistic model of medicine. With trials of telehealth taking place and the 3millionlives initiative, could the fundamental nature of how we deliver health & social care make a Citizens' Assembly obsolete before it's even been launched?

Now what?

It's human nature to view new ideas through a lens which may be coloured by negative experiences from the past. Many of us despair when we hear of yet another radical idea from government that promises change for the better. I'm not surprised to see some patients on Twitter today expressing sentiments that make them feel like "here we go again, same old story but with different faces, blah blah blah". At the beginning of Day 1, we were told that this is a suggestion, and if at the end of Day 2, the feedback is that we don't need or want a Citizens' Assembly, then that feedback will be delivered to Tim Kelsey and the board of NHS England. However, we were hearing a date today, March 2014, that's a potential launch date for a Citizens' Assembly. To be fair, nothing has been confirmed. It's still very much a suggestion. 

Some people in the audience today felt as if the Citizens' Assembly is a 'pre-ordained deal', and that these 2 days were just a 'box ticking exercise' to make it appear as if stakeholders are involved in the process. I certainly hope not. 

A Citizens' Assembly in one form or another may be what Tim Kelsey and the board of NHS England want. However, despite 2 days of intense discussions, I remain unconvinced that's what the 53 million people served by NHS England actually want (or need).   

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NHS England Citizens' Assembly - Day 1

I've just attended Day 1 of the Citizens Assembly development day organised and facilitated by NHS England with the Democratic Society, Involve, and Public_i. A fascinating and thought provoking day with lots of very interesting people. A big thanks to the facilitators Catherine Howe, Anthony Zacharzewski and Simon Burall for a smoothly run day. I was extremely impressed by how they managed to keep the event running on time, despite the strong opinions voiced from the audience. Many of the conferences that I pay thousands of pounds to attend could learn a thing or two from these individuals. 

What is the proposed model?

A model of a NHS Citizens' Assembly was to be discussed and developed during these two days. What is the purpose of the NHS Citizens' Assembly you may ask?  

From Tim Kelsey's  blog, these are the 3 intended purposes; 

  1. To give citizens and organisations a direct transparent route for their voices to reach the heart of the NHS England decision making process, in a way that cannot be ignored.

  2. To give the NHS England board and others a new source of evidence and opinion on the NHS now and future.

  3. To give the public an open and robust accountability mechanism for the work of NHS England, and opportunities to participate in every aspect of the organisation’s work.

The paper on the Citizens' Assembly can be found here. [Note: This draft outline is intended to give a common starting point for discussion, critique and positive contribution. It is not intended to be the final word on the structure and working of the NHS England Citizen Assembly, and it is not a statement of Government policy]. 

An overview of the model that was discussed today is posted on the Demographic Society's website. [Note: the wikipedia definition of a Citizens' Assembly is here]

This is definitely an admirable vision to have, and makes me proud to be British, as I don't read much about other countries who are pursuing this type of vision.  

From the Demographic Society's blog, "We are seeing the NHS Citizen as being a complete system which is actively listening to citizens via digital and other channels and then curating and developing the evidence around ideas which emerge until they are in a state to be debated at a formal assembly. The model to do this is built in three layers:

A ‘Discovery’ Layer which is doing the active listening and seeking out ideas.  This layer will also join up related ideas and while digital by default will also be responsible for making sure that the whole system is as representative as possible by actively seeking out the views and ideas of groups who are not coming forward on their own.

A ‘Discussion’ layer which will develop the evidence base around ideas and help to create actionable proposals.  When we talk about evidence in this layer we are seeking to combine different forms of evidence from a range of stakeholders

An ‘Assembly’ layer which will physically meet twice a year in order to look at discussion ideas and make recommendations to the NHS England board" 

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Olivia Butterworth (furthest to the right)

Olivia Butterworth (furthest to the right)

Olivia Butterworth made a remark at the beginning of the day that NHS England wants to get a direct connection to those who use services. 

We spent the morning splitting into groups and discussing each of the 'layers', and in the afternoon, drilled down into topics such culture change, agenda setting & governance. The discussions certainly showed the variety and intensity of opinions that people in each group held. The facilitators listened to what was said and plan to use the output of the discussion to update the draft paper. This is definitely not going to be easy. 

Wait a minute - surely there are existing mechanisms?

However, for me personally, a critical step has been overlooked. An audit of all the different ways that currently exist where citizens' voices can be heard. I'm curious to see the evidence used in reaching the decision to propose a Citizens' Assembly? Show me the data! I'm not convinced of the need for a Citizens' Assembly. There seems to be a myriad of routes where a patient could have their voice heard by decision makers in the NHS, which don't appear to be mapped out in one diagram as yet. I did ask in today's meeting if such a map existed, but it doesn't appear to exist. Now, I learnt so much about the NHS today, and just how complex it has become. For example, Healthwatch England, set up 12 months ago, and according to their website;

is the independent consumer champion for health and social care in England. Working with a network of 152 local Healthwatch, we ensure that the voices of consumers and those who use services reach the ears of the decision makers.

We also have Health & Wellbeing boards, and according to Wikipedia;

The aim of health and wellbeing boards is to improve integrated working between local health care, social care, public health and other public service practitioners so that patients and service users experience more joined-up care, particularly in the transition between health and social care. The boards are also responsible for leading locally on reducing health inequalities.

Additionally, I was reading about patient experience and the 2013/14 Outcomes Framework. The Outcomes Framework states;

1.43 A new placeholder indicator 4c has been included, which will be based on the Friends and Family test. The inclusion of this indicator will enable more ‘real-time’ feedback to be reflected in the framework. The Friends and Family test will ask patients whether they would recommend the hospital where they received their treatment and care, to a family member or friend.

1.44 It will be rolled out nationally starting with adult acute inpatient and A&E services in April 2013. The precise details of this indicator will need to be developed as national roll out takes place.

Are you as confused as I am? Wait there is more!  

NHS Specialised Services engages with patients and welcomes their views and experience of the services we commission. This helps us to check the development and improvement of services. Evaluating the patient experience and the quality of care received often helps the NHS to discover better ways of working. 

Someone in today's meeting talked about PEGs that currently capture patient experiences. PEG stands for Patient Experience Group, and this is an example of a PEG. 

I also noticed that Clinical Commissioning Groups also have their own Patient Experience surveys, such as this example by the Oxfordshire CCG. 

What I've described above is not necessarily a comprehensive audit of existing routes where a patient's voice can reach decision makers, it's just what I found in my research this evening. The question that remains unanswered for me is 'Where is the GAP in existing services and mechanisms for capturing feedback from patients?'.  

Risk of missing patient voices

Another problem that I see with the proposed Citizens' Assembly model is the government's digital by default agenda.  

Looking again at the paper, and picking out a few areas of concern for me, within the 'Discovery' layer.

To be actively (and persistently) listening to public conversations (usually on digital channels) that relate to the sphere of influence of NHS England and to ensure that these are visible across the discover space;  

Online/offline bridges, enabling the content and conversations from the Discovery layer to include and be included in offline events, will need to be developed. 

This is a digital by default approach, underpinned by work to ensure that this approach does not exclude those who are not able to participate online.

Being a data person, I did quote several statistics in today's meeting. 7 million people in the UK have NEVER used the internet. Whilst 99% of those aged 16-24 have used the internet, only 31% of those aged 75 years and over have used the internet. Given that the NHS's biggest challenge is chronic disease management, which age group do YOU think is likely to be a bigger user of NHS England's services? 

It's not just me. The National Audit Office has warned the UK government that it's digital by default agenda could exclude more vulnerable members of society who don't access the internet. Their survey found many of those who have never been online are poor, elderly or disabled.  

Another shocking statistic. Only 20% of care homes in the UK offer internet access to their residents. 

According to Twitter UK, there are 15 million 'active' Twitter users in this country. When I quizzed them on how they define active, this was their response. I wonder how many smartphones are logged into Twitter simply because the device was switched on that day. I'm curious if that instance of logging in is counted as 'active'?

The digital divide is not something that can be just dismissed. In the 21st century, it has to be taken seriously. Whose voices are we at risk of ignoring? Can monitoring of digital services really provide the 'truth' about public opinion? Are we at a point with these digital tools where we can find the 'signal' within the 'noise'? Can we really bridge the gap between 'online' and 'offline' without spending lots of money? 

Don't get me wrong, I love technology, and am passionate about how it can serve all of us in healthcare. However, I'm also conscious that new technologies can often appear so 'sexy' that we forget to ask critical questions, such as, 'Where is the evidence that these data are accurate and representative?'.

Do we need to go back a few steps?

I'm struggling to see the justification for the discussion and development for a proposed Citizens' Assembly at this moment in time, when I do not have clarity on what currently exists, and where the GAPS are. A critical step in the process appears to have been omitted, and it's left me extremely confused. When the meeting finished today, it felt to me as if this discussion was too early. An advert I spotted at a US airport captures that feeling. 

I recognise and appreciate that NHS England and others have put a lot of effort into the process so far, including the workshop in July and organising these development days. There were many people in the room today who have much greater experience and wisdom in the area of the NHS, and perhaps they reached a different conclusion to me. I'd love to hear your perspective after you read this post (even if you were not at the meeting or watching the webcast).

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