Transforming healthcare for a better world

Around the time I was exiting my role at Straight plc, mid 2014, I was approached by Becky Malby, director of the Centre for Innovation in Health Management (CIHM) at the University of Leeds to see if I was interested to take part in a programme. This was called the Leadership Indaba and it would consist of four sessions spread through the following year.

According to Wikipedia, an indaba is an important conference held by the principal men on the Zulo or Zhosa peoples of South Africa. Our indaba aimed to bring together experienced leaders into a thinking space, to do good work and at the same time make an academic contribution. The ultimate goal being to support large scale change that would leave the world a better place.

CIHM seeks to reduce the focus on “reductionist asset stripping approaches to management” within the NHS and social care, instead finding solutions with the people that deliver and use its services.

The programme consisted of discussions where we would share our knowledge and try to come up with ideas to improve matters. At some of the meetings there were speakers who would set the scene for the discussions to follow. Of the nine participants, eight were from the health sector in various different capacities. Then there was me, an entrepreneur with no formal training of any kind but with many years of experience in running a dynamic and rapidly expanding commercial organisation beset with numerous challenges. 

Initially, I was not sure why I was there. But gradually I began to see the value of my involvement. In many ways I was from a different world to the rest and my perspective could therefore be fresh and challenging. 

My observations over the several sessions was that the health sector delivers some excellent outcomes but is beset with big problems which the current system seems unable or unwilling to deal with. I met fundamentally good people doing great jobs in their own spaces but I got the impression that they were all up against something bigger and somehow alien to their way of thinking or working that did not help them in their daily activities. 

All of our discussions were confidential and am not at liberty to share specifics. However, much of the conversation was around the perceived difficulty in repairing a system universally considered to be broken and both the terminology used and the apparent sense of powerlessness that senior leaders feel they possess would probably not be accepted in the private sector. 

 

My observations lead me to some conclusions. These are the views of an outsider but they reflect what I learned in the short few hours I spent on this project.

 

Firstly, managers need to get real. This is difficult because the NHS is not just a heath system but a political system too. I think this is fundamentally wrong and dangerous for patients who end up being the pawns in the actives of politicians. Having a clear remit of what needs to be achieved over a long term would be helpful. Ministers do not add value in this respect in my view. Where there is a bullying culture (and I believe that this comes from the very top) is needs to be dealt with. 

Next, the sector needs to understand why it exists and what are its desired outcomes. Too much focus is on attempting to deliver a cure, not enough focus is on prevention - which intuitively sounds like it would save a lot of money in the long run. Using big data, entrepreneurial management and incentives along with radical, qualitative-based procurement of goods and services will help to deliver a better service at a lower cost.

As an example, in Leeds, Age Concern is delivering an exercise programme to reduce the risk of elderly people falling and needing hip replacements. Using data they know how many people in their target group are admitted to hospital each year and they know that they will save the NHS money through this programme. This is not the job of the charity sector, unless the public purse is directly funding it. The NHS itself should be seeking to deliver such interventions, saving money in the process. But could such an intervention cause a problem? Idle surgeons, empty wards … you see why this may not be quite so simple.

Thirdly, I have understood that the most senior managers interfere with the work of their subordinates in such a manner that it impacts on their ability to do their jobs properly. Some of those managers who are succeeding are playing a game where they focus on what they need to do for their line managers and take little notice of the rest. Some of these areas are thriving. Senior managers and Board members should allow the professionals in their teams to work towards agreed outcomes in their own way as would be the case in any well-managed company. I am talking about effective delegation, not abdication of responsibility. The wider NHS could do well to learn from the places where a bit of rule bending is achieving great results. 

The patient must come first always and without exception. We have all seen what can happen with micro management and a focus on the wrong goals as was the case in Mid Staffordshire. The life of a patient must be the most important factor in any health professional’s thinking and if rules need to be broken to save a life they should be. I would go further and say there is actually an obligation to break the rules if a life can be saved. 

Finally, we should remember that the patient is a human being with the potential to transform his or herself given the right direction and teaching. I was told of people living in desperate communities with few facilities, no jobs and little contact with nearby population centres. This is sad and no doubt difficult for those afflicted. However, we must remember that these people are not destitute, nor are they hungry, they have the blessing of time to pursue whatever they want, something that many might be grateful for a little more of. In many cases they have a choice whether to be healthy or not. Somehow providing the key to self fulfilment would be the best investment that could be made in such people rather than waiting for them to become ill through poor diet, drink and smoking and then treating them for the resulting diseases. 

I remain an outsider to this sector but I have learned a great deal about its workings and its challenges. I see a problem at the top and a confused agenda as to what exactly should be delivered. This is not easy to solve but not impossible, Hopefully, those who can push an agenda of change forward will take note of what all of us on this programme have learned and have published in order to allow us to deliver our goal of leaving the word a better place.

So, what do you do then?

People seem to be obsessed with what you do ... with what I do. Within seconds of meeting someone, within moments of starting a conversation, the subject always comes up, "so, what do you do then?"

Up to 12 months ago the answer was easy. I was the founder and chief executive of the UK's leading supplier of waste and recycling containers. Credibility was added to this as most of the people I was speaking to had something I had made in their homes and expectantly rushed back to see if my name was on the lid of their food waste caddy, which of course it almost always was.

But last year I sold the business. The deal was concluded on the same day as my summer holiday started. I felt very optimistic about the future, I was about to receive a not inconsiderable sum of money, the world was my oyster a they say. But I had a niggling anxiety. What would I say if people asked what I did for a living? After some discussion with my wife, it was decided that I would explain that I had built up a business and that I had recently exited. This did the trick, but as time has passed by my present has increasingly come to be defined by my past.

You see, to explain the above is easy, it takes a few seconds and it gives the other party something to latch on to. Whatever emotions this might invoke: admiration; jealousy; curiosity - at least the same effect is achieved as saying, "I'm a doctor," as an example.

Now, one year post sale I feel I should be looking forward and not putting myself in a pigeon hole defined by what I used to be.

But how to explain simply what I am doing these days is another story. Quite a story, in fact. I sit on five boards at the moment: one NGO; one social enterprise; one art gallery and two charities. One of the charities is my own trust and that is engaging in some interesting projects of which quite a lot can be said on its own. As well as this I am involved with a myriad of other businesses ranging from providing a listening ear and some helpful advice to taking a stake through investment to assisting with a formal fundraise. And on top of all that I am becoming a street photographer of some repute. (Check out Instagram @straightpix to see some of my work). On top of all of this I’m writing a bit, doing quite a bit of public speaking and working on some TV projects too.

So how do you sum that up in a soundbite? Not easy, and I think as people tend towards more plural careers, this is a problem that will not just be mine. How do you sum up a lot of things succinctly? Or maybe in time, people may have more sense than to ask. After all, asking someone what they do is a pretty boring thing to do. It is loaded with baggage, implying that you want to know how much money a person makes, whether they are above or below you in the perceived pecking order or whether they are fulfilling any useful purpose with their lives. 

For the moment, I tend to gear the reply to the person concerned by making a decision about which element of my work might interest them most. I also tend to add an element of tongue in cheek humour to break the ice and to solicit further conversation during which time I can explain precisely what it is that I do. So I may be an “entrepreneur in recovery” or a “reckless investor” or a “maverick photographer” or best of all a “creative genius” if I think I can get away with it!

It is not easy for someone in my position to explain what I do without a few minutes to spare. It is probably worth bearing in mind that there is much more you can find out about a person in terms of who they are rather than what they are and this makes for a much more meaningful conversation. 

Tesco: What goes round comes round.

So Tesco has announced losses of more than £6 billion following on from finding an accounting black hole of £263 million whilst facing an investigation from the Groceries Code Adjudicator that could land some bosses in jail. Never mind falling sales, deserting customers and a plummeting share price.

I used to sell water butts to Tesco Direct. Mini ones that could easily be sold by mail order. We also ran a few-store based promotions. Tesco were not our largest customer for these lines, not by a long shot, but they behaved like they owned us.

Tesco would not pay our bills on time and actually did not even pay them when overdue. We would be paid outrageously late and if we threatened not to deliver until we were paid we were threatened with being delisted.

This, however, was the thin end of the wedge. Tesco Direct would buy some of our goods, use our photography and branding in their catalogue and on their web site and then buy some or all of the goods they sold from someone else. As we prided ourselves on the quality of our products this was a bitter pill to swallow. 

They would sell at a price point way below everyone else even if this failed to generate major volumes. It just trashed the market for everyone. This was done without discussion. There never really was any real relationship between the parties. Looking at what they were selling a delivered product for, I could not believe they were actually making any money. It seemed they were just sucking sales away from other retailers for no real benefit. 

We were not a big account for Tesco but we are now beginning to hear how they may have behaved with their larger suppliers. Some of the falling outs are very public and some brave suppliers are now speaking out. I have seen suppliers delisted with Tesco who then fill the gaps with an own-brand offering rather than pay a fair price for goods they may have sold for years. Again this activity is well documented. 

I have long argued that the only way for businesses to be successful over the long term is by operating in a transparent, moral and ethical manner. My own experience and much of what is coming out in the press now would suggest that Tesco has behaved otherwise for a long time.

It should be no surprise that this business is in big trouble. There may be much debate about what Tesco should or should not do next. In my view what it needs is a great big dose of honesty and until that comes we should expect more of the same.

Uber alles

Earlier this week I spent a day at Leeds University working on a leadership project with a group of health professionals. They had no parking spaces available so I thought I would get a taxi there and back. 

I'm not the biggest fan of the private hire companies in Leeds. Of course it is not possible to generalise, but the cars tend not to be great, there is little room in the back, the drivers are sometimes not the friendliest and sometimes you worry about how they are driving. Being used to London cabs they really don't cut the mustard.

So. when I heard that Uber, the disruptive challenger to the traditional taxi business, had just set up in Leeds so I thought I would give them a try. Impressed by the images of smart black sedans I have seen plastered over the Internet I thought this would be just the way to arrive in style.

I downloaded the Uber app onto my iPhone and filled in my details. It took a couple of minutes, no more. 

The app locates you (in fact it found the house next-door) and then tells you what cars are available nearby. For around 20 minutes from 9am onwards there were no cars available and I thought I would have to call for a mini cab. However, trying one more time a car was indeed available and was shown to be 10 minutes away. I watched on the app as the car got closer, seeing its position at every stage. I also knew that my driver was called Parvez, what the registration of the car was and that somewhat disappointingly he was driving a Mazda 3. 

Nonetheless, the car was clean if not a bit small to be sat in the back of. Pervez asked me where I was going. I thought this was strange as presumably he already knew. Anyway, I told him and we then discussed the best way to get there. Again, I thought the elaborate Uber software would have told him this. No matter.

The Mazda 3 looked like any private hire car except it said Uber on the side. The main difference was that there was no meter and no radio, instead just an iPhone on the dashboard which appeared to look after everything. 

My driver was very chatty and answered all of my questions great detail. In Leeds there are 150 drivers working for Uber. This pales into insignificance compared to London where he claimed there are now 9,000. Many thousands moved from one private hire company. He says drivers are paid £10 per hour if they don't have work and this makes a huge difference to them. He also talked of London drivers being offer £1000 to go back to their original employer. 

Their deal is they give 20% over to Uber and they are paid weekly, but they have to take more then £10 in an hour to be liable for the commission. This differs from the usual model of paying a fixed rent to the operator and getting cash directly from customers on an ongoing basis. 

True to their word I got in, I got out, no cash changed hands and my Paypal account was charged for the journey. I got an e-mail showing me a map of my journey, confirming the cost in terms of distance and time and giving me the opportunity to rate the driver. Apparently the drivers also have the opportunity to rate passengers. David Mellor watch out! 

I was struck by the amazing simplicity of using this system and whilst it looked and felt like a regular minicab the fact I didn't have to ring anyone was great - too used to be lied to or being told there are no cars for an hour - the fact it was cashless was also great and there was no need to ask for a receipt as one came by e-mail. I think the price was very comparable to what I would have paid anywhere else. 

My journey back was equally simple. The car was only two minutes away when I requested it this time but the GPS was not 100% accurate and he went to the wrong place. I could see the car on my screen not moving for several minutes. Eventually he texted me and we found each other. This time I got Ansaar in his little Seat. Ansaar was a seasoned taxi driver of a number of years who had signed up with Uber three hours before the launch. He had both front seats pushed right back so he could recline in comfort whilst his passengers were squashed in the back listening to his hard-core hip hop. The car was spotlessly clean but just too small.

Again the process was simple and flawless. Interesting the fare back cost about 10% more than the fare going. Possibly traffic was heavier. 

I can see now how this business is going to completely overturn the taxi industry and that it will have ripples way beyond this too. Today, whilst writing, there have been no cars available each time I have looked. But as and where there are more cars, it means that you really could manage without a car if you wanted to, door to door effortlessly. And I think there are other possibilities like integrating with online shopping so you could click to collect our goods, but Uber would collect them and they could be with you within an hour or so. Presumably this is why the business is worth $18 billion. 

But, in Leeds we have only got Uber X, basically small cars so the service is cheap. This is not really what I want but probably serves the student areas well where I understand they are very busy. I'm told 100 drivers have moved over from just one local company to Uber in this part of the City. I would like the black sedans - hopefully in the near future. 

There are big issues around taxi drivers and the minimum wage, which they don't always get. Paying £10 per hour for downtime is a great thing but the drivers remain self employed and I can't see this being sustainable beyond the launch phase where Uber clearly is throwing money at the service. There has been no visible advertising - one driver said he had been very busy, the other had been doing nothing all day. 

It is clearly early days but I think this changes things for the better. Parvez told me that all the drivers would have to have Mercedes and BMWs within one year and this could be a welcome improvement. But just for the sheer simplicity of getting a cab from A to B I will certainly be using Uber again.

Finally I can offer each of my readers a gift. If I recommend the service to a friend they will get £10 off their first journey. So those of you who want £10 for now't (as we say in Yorkshire), download the app and use this promo code: jonathans1577 

Bon voyage!

A tale of two Eds.

Photograph: Jonathan Straight

Recently I attended the Inclusive Prosperity Conference at the Science Museum in London. The invite came from The Labour Party and the conference was presented by Policy Network, a think tank with an obvious lean to the left.


I'm not a Labour supporter - at the moment I don't think I'm actually a supporter of anyone - but I was interested in the parts of the conference about fairness in business. One thing I passionately believe in is that business should be a force for good in society and I was keen to hear what was being proposed.

The venue was a interesting choice. I must have walked two miles to the pre-conference refreshments. Water was strangely kept hidden under the table - God only knows what else was secreted under there - and we ate and drank in almost complete darkness. Soon we were ushered in. It struck me that no one had asked who I was or even if I was registered to attend. No one checked that I had left my weapons at home. Very trusting the opposition party!


In we went. And there he was. Ed Balls. I like Ed Balls although his politics scare me a little ... well a lot actually. Ed is the only Leeds MP who replies to invitations, generally to decline, but at least he replies. Whenever I see Ed Balls I still hear Eamon Holmes' voice saying those classic words once uttered on Sky News, "Ed Balls, a man who sometimes talks what his name says."


Ed made no grand entrance, he just appeared and introduced Lord David Sainsbury. Sainsbury stood looking down and read from a script. Industry knows nothing about the Labour Party, he claimed. Possibly true, but then perhaps the Labour Party known nothing about industry either. There was a lot of rambling about the lack of infrastructure and a need to move to the supply of higher value goods (but one has to assume that these goods will not find their way into his supermarkets). He said that entrepreneurs should be "applauded and richly rewarded." We should be considered heroes, not like the "exploiting investors" who were "rigging the market". Wow.  


Having set the tone, Ed returned to introduce the first of several panels to present that day. Maggie Philbin, yes her off the Multi Coloured Swap Shop, her who used to be married to Cheggers and now telling us that eleven million people can't send an email. Probably around the same number who can't read. Balls stood to the side looking on, his left hand deep in his pocket. Yes, you know what I was thinking...


We then had Lord Adonis tell us that the Science Museum had been built in 1857 with the profits from the Great Exhibition, "so we can do it!" he quipped. But that was more than 150 years ago and certainly wasn't under a Labour government, now was it?


The debate continued. We need more maths and science teachers, enterprise and employment directors in schools, more apprenticeships, more universities, more innovation centres. And all of this would be achieved by a "strong collaborative effort".  Quite a shopping list, but what exactly is the "collaborative" bit all about? Who is going to pay for all of this? Well, you and me of course. By "collaborating".


Balls then introduced what he called the "Highlight of the Day" and we hadn't even had lunch yet. It was Labour leader Ed Milliband. He did make an entrance, at least from the front row where he was sitting. Bless him, he looked so young, so earnest, a bit like he was making his Barmitzvah speech. He had been to an air conditioning factory in Leeds which had burned down, the irony completely lost on him. He could have done us all a favour perhaps and brought some air conditioning back with him - it was a hot day. 

So, here it came. There was a crisis of trust, there was a cost of living crisis, there were deep challenges, the financial crisis had exposed problems and the solutions were not going to come from the recovery alone. No, we had to create highly skilled, high paying jobs. We had to reform government and the market. We had to win the "race to the top". 

Still with me? Here is some more detail. 

The 50% who currently do not go into higher education will have that education. Everyone will study English and Maths to age 18 and employers will decide how the money (what money?) is spent.

Budgets will be decentralized with £30 billion moved to the regions. (Hang on that is less than 5% of spending ...)

Short termism will be outlawed with the abolition of quarterly reporting and a change (unspecified) to the rules on takeovers. A Labour Government would be pro-competition, would stay in the EU and would be pro immigration - but not where this would lead to a race to the bottom for wages. (No need, they did that last time).

He spoke with confidence and conviction. He walked the walk, he talked the talk. But he never said how he would pay for any of this, yet alone all of it. This was playing on my mind thoughout.

He then took questions confidently and adeptly from the audience but studiously ignored me despite the fact I was sitting directly in front of him. Probably he could smell an infiltrator and left well alone. He claimed that he wanted questions from business owners and entrepreneurs but what he got was questions from people running charities; pressure groups; advisory groups; representative organisations of one kind or another - all trying to push their unique outlook on the world onto the aspiring Prime Minister.

Surprisingly, no one asked how this was going to be paid for. Or maybe this was not so surprising as perhaps it did not need to be discussed. I was in the company of the political left, money no object, especially when it is someone else's money. Just a knowing wink and a tap in the side of the nose. Nothing further needed to be said.

They almost pulled it off, they almost had us all fooled. Then up stepped Lord Liddle, the Chair of Policy Network. (You know what side of the political divide you are on when people start using pieces of furniture for their title). He patiently informed us that if what we were looking for as business  leaders was government off our back and lower taxes then we would not be very interested in what Mr Milliband had to say. 

So there it was, the cat out of the bag. The clear implication being that voting for Mr M will mean government all over our backs and higher taxes all round. 

Same old, same old.

Who's a glasshole?

A few weeks ago I had the pleasure of receiving an invitation from His Royal Highness Prince Andrew to attend an event at St Jame's Palace where a number of start-ups would be presenting their stories. Probably short of a bob or too, he used his Mother’s franking machine. Nice to have a Buck House postmark though. 

The venue was typically lavish and did not disappoint - they even had red carpet in the toilets. The great and the good were all there and the event was very busy and well attended.

In strolled Eze Vidra, Head of Google Entrepreneurs. He was wearing a strange pair of glasses. I generally notice glasses as they are one of my passions - and these were pretty unusual. As he got closer I could tell that they were in fact a pair (if indeed that is the right word) of the new Google Glass. Eze was busy and we did not get the chance to speak but I noticed that a few other people were also wearing these strange frames.

Later that evening I found myself face to face with a group of gentlemen from a start up, I think it was called OK Yah, but they didn't have cards. Apparently they develop apps for the Google Glass and one of them was wearing some himself. 

I have to say that it was a most unusual feeling being confronted by these all-seeing spectacles, I felt slightly violated. "Do I need to tell you who I am," I said, "Or do you already know?" 

"They are switched off."came the reply.

"Would I be able to tell of they were switched on?" I asked. He pressed a button on the side of the glasses resulting in a ghostly blue flicker.  I don't know what he saw but he switched them off again pretty quickly.

I mentioned this new accessory to another Google person I bumped into. I wondered if they were planning some sort of retro fit as I would struggle with just one frame given my obsessive spectacle habit. It seems they might be. "Eze doesn't like wearing them," she said. "He's worried they make him look like a glasshole!” 

I’m taking bets on how long it is before this ends up in the Oxford Dictionary.

Munich

OMG, is it really 10 months since my last post? Lots of things are happening with the impending sale of Straight plc and so I am going to make a real effort to write a bit more often. Here are some slightly tongue in cheek thoughts about my recent visit to Germany.

Arriving in Munich a few days ago for the IFAT environmental exhibition I was initially very impressed. Less than 5 minutes after the wheels of the plane hit the tarmac, I was in a cab on my way to the exhibition centre. Try that at Leeds Bradford - impossible! About half an hour later it was obvious why the Bavarians are so keen to have your company in such a hurry. It means they can begin to take your money that little bit sooner.

My taxi ride cost 74 Euros. I reminded the driver that the fare was supposed to be 59 Euros as advised on the IFAT website. "Ach!" he said. "You should have told me when you got in. In any case then I would have to take you the longer way round and that would have taken an hour". (Actually the website says it is 35 minutes but I was not in the mood for an argument).

Having been relieved of another 4 Euros to deposit my coat and bag I went round the exhibition, trying to avoid tripping over the overflowing bins full of rubbish.

Thirsty work and at 3.50 Euro for a bottle of water, expensive work too. It was especially impressive to find a vegetarian falafel sandwich for sale. I recall one earlier year the salad without tuna cost more that the salad with it but this was a refreshing find at just 5.50. Unfortunately, they forgot to cook the falafel but then they never really understood vegetarians in wurst country.

My hotel room in town at 425 Euros looked expensive. This did not include breakfast which I opted out of at a further 39 Euros. On checking in I was led to my room by the young lady at the desk. She then asked if I would like her to tell me about the room. I replied that as she had taken the trouble to come up five stories with me then perhaps she should. "So, here is the bed, here is the wardrobe..." she chirped. German humour I suppose.

After a brief rest I flicked through the booklet on the desk only to find that I had a choice of no less than three types of bedding, a comforter, a sleeping plank (whatever that is), a wake up light, a living colour ambience light (again, whatever that is) or one of six different pillows. As I read further my 425 Euro rate was looking more and more bargainsome. An air purifier, a salt water spray for allergies, various paraphernalia for young children including baby phone and rattle, bath toys and a cuddly toy called "Maxl" then onto the dog pillow, dog bowl and some glowshine spray. I think this last item was for a dog but not 100% sure.

Also on the list was aftershave. What a great idea as having travelled with only hand luggage I didn't take any with me. I called housekeeping but somehow got the concierge. He was completely floored by my request and had to call me back several minutes later once he had composed himself. Advising me that they didn't have any he offered to go out and buy a bottle of the brand of my choice. Given I was leaving the room to go out a few minutes later I declined his kind offer.

Returning after around three hours I found a bottle of aftershave balm on my dressing table. It had been made especially for the hotel. I imagine they must have crates of it stashed somewhere. I tried a little. It was vile. It was fahrschtunken. Maybe the concierge was trying to do me a favour.

Most amazing thing of all - they didn't try to charge me for it!