A short road trip this week has reminded me of the potential that lies in the NHS budget. We need to stop thinking of this as a losing battle. The people and cash we invest in the NHS could be a key catalyst for future innovation.
The view from the road
I am writing this in Chesterfield. I arrived by train at 8.00pm on a damp Sunday evening in February. A 10 minute walk to the hotel seemed to fit with my expectations. It is a picture postcard of the left behind northern town. I pass an estate agents that has no properties for sale in the window. Only rentals.
There are motorways, a couple of modern retail sheds and the inevitable multi screen cinema complex. All plastered over the cracks left by decay. Take the wrong turn and boarded, abandoned early 20th century buildings lie grim and empty. Above one of the few lights an upstairs window has a Saltire draped across it.
Opposite one of the superstores is a newish police compound. A patrol car stopped for two minutes at the high narrow metal gate. Cautious of admitting even such an obvious one of its own. At length it swings open with a gothic menace of creaking and clanging.
The gate is the only gap in a high wall topped with sharp and well polished spikes. In one corner a flag pole pokes above the razor wire. From it flies an incongruous rainbow flag, symbol of gay pride.
At the top of a small hill in the middle of all this is the famous Church of St Mary’s and All Saints - surely a name that hedges it bets - with its famous crooked spire. A plaque in the churchyard marks the battle of Chesterfield in 1266. Part of the endless friction between barons and nobles in England during the Middle Ages.
The area around has the remains of the old medieval market town, awarded its charter by King John in 1204. Wood timbered houses and twisty cobbled streets. One with the magnificent name Knifesmithgate. In another jarring image, the town square contains a victorian market hall and a thronging assortment of stalls. All in the shadow of a giant, miserable Ferris wheel.
The town’s information centre tells me that George Stephenson moved there in 1838. He discovered deposits of coal and ironstone nearby when tunnelling for a railway. I guess he triggered the industrial boom in the town.
Tomorrow I will be visiting the local hospital on business. I anticipate I might see the real front line of the NHS winter crisis in a place like this.
Quietly getting by
Chesterfield Royal is busy but with no sense of urgency. This is typical of the hospital environment. People work at a steady, constant, unrelenting pace. Punctuated by rushing only when there is a genuine life or death crisis.
Its a low, red brick complex on top of Hady Hill at the edge of the town. The inside is functional and feels cleaner and fresher than many I have visited. I saw a woman in an auxiliary uniform going round repairing tears in the red vinyl seats with matching red tape.
My meeting is professional, positive and forward looking. In ePrescribing at least this hospital has been an early adopter. Ten years on they are still striving for improvement.
The more upbeat image is reinforced during the day. The walk to the hospital was tree lined and the view from the entrance is of fields and river valleys. Chesterfield is near the edge of the Peak District National Park. An hour running along the Rother and the Chesterfield Canal is a delight. Every step takes me deeper into rural England. A couple of miles from the town centre I am already in the Bluebank Pools nature reserve.
Solutions are not hard to see
What can we make of all this? Can we rescue centuries of history and tradition? Recovered from the coal fired boom and lingering bust of the past two centuries. Yes.
Places like Chesterfield are the real untapped potential for technology. And the NHS could be one of the keys to unlocking it.
We spend enormous amounts of money in the NHS and we do it with pride. We also tend to see this as desperate struggle to keep our heads above water. Grandiose schemes of reform make things worse rather than better. Spending comes with a cold, target driven culture that beating up management and staff.
The Chairman's View
This road trip has convinced me more than ever that we need a different approach. We should view NHS spending as an investment catalyst. Open the doors to new ideas and new technologies. And its not just the money. Anything new would be supported by some of the smartest and most dedicated people.
More money would be good but we can also do so much more with what we have. Think of NHS procurement as akin to defence procurement in California in the 1950’s. This was the trigger for today’s Silicon Valley. We can make health the fuel for our own tech boom. Powered by the NHS, the benefits would reach every corner of the country.
I am expecting there will be announcement later this week of £100 million of NHS spend on old technology. Something that could be done better for a tenth of the money. There is a different way.
I have never been to Davos. The closest I got was running into our senior partner in the queue for coffee at London City Airport at 5.45am one morning. He was on his way to the Swiss junket looking as miserable as everyone else at that hour.
Nonetheless I do have a Davos story. 6 or 7 years ago, I helped organise a discussion between one of the world’s largest mobile operators and the retail division of a global bank. My firm advised both companies and we wanted to explore ideas on how they might co-operate in mobile banking.
The upshot was a small dinner in a room in the bank’s London offices. I brought along a regional sales director from the mobile operator. The global head of retail from the bank attended along with 3 or 4 hangers on.
Everyone there was a committed leader, smart and engaged. We threw around a lot of ideas and it is fair to say the senior guy from the bank was blown away with the outcome. This nearly didn’t happen. Andy - the mobile guy - started talking about their coolest new ideas. The bank did not respond well to this kind of cutting edge stuff. But Andy was a good listener and dialled it back to more routine solutions. Some of these were already being used by the bank’s competitors and that really got the conversation flying.
As a firm we did a little work developing ideas for this potential partnership but nothing ever went anywhere. There were two reasons. First the bank had a rigid and structured procurement process backed up by a strong and influential procurement division. This meant that technology suppliers were not allowed to talk to bank executives. They could only respond to requests for proposal generated by a business need.
This sounds logical but the practical impact is not so good. The most senior person Andy was allowed to talk to after that dinner was four levels down the organisation chart from the regional head of procurement. A role that was another 5 levels below the senior individual who had attended the dinner. No amount of friendly chat could change this.
The enthusiasm for the whole concept finally died at Davos. Andy had reported back after the dinner. So his Group CEO was briefed on the opportunities generated. The bank guy on the other hand had kept it to the people in the room. He did not want anyone in the organisation getting excited until the time was right.
The two Group CEOs met at Davos (as these people do). The MNO guy mentioned this and his bank counterpart knew nothing. This was exactly the kind of uncontrolled situation the bank guy was trying to avoid. Disaster.
Stop trying to sell software the way your Dad did
If you are still here, you are no doubt wondering what this story from my previous corporate life has to do with the world of early stage B2B SaaS. Its simple. The individual concerned was not a bad person and the bank is not a bad business. Yet a great opportunity was killed before it had a chance to breathe.
The opportunity was mashed by two things that are common in the corporate world. Both have been created in response to an endless stream of enterprise sales people. Sent to corporations by big traditional software companies.
The Chairman's View
In B2B SaaS you are asking your customers to take on real business change - a major risk. Plus at early stage they are also taking a smaller risk on the credibility of your business. Driving that proposition straight into the jaws of the procurement/ don’t tell my boss monster is a fool’s errand.
B2B SaaS can and will change the world. Realising this potential means changing the biggest and best companies. Unless you offer something different they will never notice you are there.
Your product and its benefits already meet this test. Why try to push them through the same tired sales channel? With the same commission led suit and tie sales people? Its time to differentiate enterprise sales as well as enterprise SaaS:
Kenny Fraser is the Director of Sunstone Communication and a personal investor in startups.