I was recently invited to an investment seminar. An international investment company was presenting a report on the IT opportunities for investing in the NHS – or at least the healthcare market in the UK.

They presented a lot of statistics on how much of GDP went on healthcare and how the market was ripe for innovation. They presented some examples from an American healthcare organisation that had invested in a primary care-driven accountable care organisation.

This, apparently, saved loads of money and delivered better healthcare to subscribers. On the whole, it was a very positive talk. There seem to be a lot of people wanting to invest huge sums of money. Is this privatisation? Or is it using the market to develop? I’m not here to talk politics.

Understanding the NHS

Despite the positive aspects, there were several problems. It became very easy to confuse numbers and markets. At one point, the total NHS budget was talked about as an example of how big the market was; but most of the new products that were discussed were private services operating on the outskirts of health.

It was also clear that people just didn’t understand the NHS. One developer had come up with what looked like a really nice app to inform pregnant women attending a hospital about their labour, the services, their choices.

This was supported with a series of statements, presumably aimed at getting some investment in the company, about how the app could save a fortune in admissions and how it was about to go huge.

Yet there was little explanation as to how the app was going to prevent admissions; and the presenter didn’t seem to get that it perhaps wasn’t in a hospital’s best interests to prevent them anyway.

What the presenter appeared to have missed was that, with a small pivot, he had a product that could save a hospital tens of thousands of pounds on printing leaflets. Spread to multiple departments and hospitals he could have the app that saved the NHS millions of pounds of printing costs.

Scratching itches

This brings me to the ‘scratching an itch’ concept. To my mind, the best ideas come from problems that need a solution – not from solutions looking for a problem.

What are the IT problems that the NHS has that need solving? This is easy – we have been doing IT health checks on 35 practices and I can produce a wish list of IT solutions as long as your arm (I’m sure secondary and community care can say the same).

Once you have your idea, you require two things. One is an environment in which to deliver the idea and second is the money to spend on the time taken to deliver it.

An environment for innovation

Starting with environment – and I’m not picking on EMIS here, it’s just that the company provides the system we use locally – lots of local GPs would love to change the workflow for certain things that they do. Change a button here, a button there; add or remove a message; combine certain actions to speed them up.

If you use Office, then as an organisation you can hire VBA experts who will re-skin it to meet your needs. Can I re-skin Emis to meet my needs? Not that I know. Ok, this is small change but saving GPs time might have huge knock on effects.

Also on the environment front: I met Nuance recently and have been more impressed with its Dragon Medical product than I thought I would be. However, it needs really tight integration into the clinical system to be really worth the investment.

To achieve that kind of integration, Emis would need to start thinking of itself as a platform through which people can input and access data; to be an environment (dare I say it) like Apple. Through the Apple SDK I can produce millions of apps that share a common look and feel (and which deliver 30% share to Apple).

Another company that I met recently was Sunquest, which provides ICE. It has just twigged that the people paying for the system are at the local hospital; while the people getting frustrated with it every day are the GPs.

Now we are federating, we might think of taking our business elsewhere to make our lives easier. Sunquest has a new version of ICE coming out that looks good; but people are going to want to tweak it.

Do companies like this have the time or resources to customise their user interface for every user? No, of course not. But they could create a market in which others could, using their system.

What about the money?

What about the money? Some companies are willing to work for free. Some are willing to do deals on future IP. But there aren’t enough of them to effectively work through enough plan, do, study, act cycles to scratch all our itches.

So I was fascinated to talk to a fund manager at the event mentioned above. He said he had More than £140 million to spend on IT products.

He initially claimed he was aware that most would fail; but said he was prepared to invest as little as £50,000 to pump prime things. He was based in the North West. For a moment, I thought I had the solution. I could give him 20 ideas and 20 clinicians to work with on those ideas.

Reality kicked in. Sorry: has to be a company; has to be trading; has to have a business plan and preferably sales already.  And (here was the real kicker) he wasn’t really interested in selling to the NHS because it was such a slow, difficult to understand beast, and it didn’t always honour contracts.

Let’s Google that!

So how do we get ideas off the ground? I’ve just had an idea for a diabetes app that our nurses think might be a goer. However, we don’t have any money to fund their time or mine or to hire anyone to develop it.

I guess we could take it to a hack event at which clinicians meet with programmers – but how many people know about these, and what happens afterwards?

There are some innovation hubs – but they’ll probably want something more worked up than we have at the moment. I guess we could go to a charity.

I keep thinking about Google, and how it has a 20% rule. Google, reputedly, lets its staff work on their own projects for one day in five. In theory, this can be anything, but it’s usually a new product for service for Google that might fail – or make it millions.

Can you imagine if we let all NHS staff have one day in five to work on projects improving the service?

Connecting with the investors

Alternatively, I keep thinking we need a fund and a team to work stuff up. I’ve spoken to a couple of multimillionaire investor contacts about whether there are legs in a long range investment fund.

It would need to be able to take the seed of an idea, connect the average NHS person who has had this idea with the right developer, or have its own development team. It would need to be prepared to offer backfill and support and a range of key advice along the way.

Connections to the big players would be good. Robust attention to IG and data security would be needed, as it would be easy for small timers to break these.

Perhaps this exists – I just haven’t come across it. It might be nice if the NHS would fund it, but I suspect there is enough return to get private investment. As I learned at the event, there’s plenty of private investment out there; it’s just not going into the NHS.



Neil Paul

Dr Neil Paul is a full time partner at Sandbach GPs; a large (23,000 patient) practice in semi-rural Cheshire. He is also one of the directors of Howbeck Healthcare Ltd, which helps support several GP Federations.

Dr Paul has been involved in primary care IT and health service management for more than ten years in various roles, including PEC member. In his spare time, he writes medical iPhone software and is a keen photographer.