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UK Tech Investment – 14th Sept 2020

Reading the recent stories about the UK government wanting to invest to create UK tech champions reminds me of a conversation with a BT (British Telecom) executive some years back.

This person had been with BT for many years and seen how they had not been able to capitalise on early innovation in packet-switched networking, but rather saw US companies make all the running and take over the market.

His analysis was that US technology leadership had come on the back of significant defense contracts that poured funds into US companies for commercial research and development.

There was also some UK defence spending going into UK companies but the amounts for a company like BT were a pale shadow of those being bestowed on US companies.

This perspective rang true for me as I saw how freely government money might be spent on defense procurement during a spell on the Public Accounts Committee.

A report would be presented from the National Audit Office telling us that, unfortunately, some defense equipment that had been expected to cost £100 million had racked up bills of £500 million and counting.

The response was often a faux slap on the wrists after assurances that some unknown factors made the overspend unforeseeable (like so many others before it) but that this really was necessary for the ‘defence of the Realm’.

An upside of allowing for this wasteful spending was that the recipient companies were effectively able to cross-subsidise their non-defence product development on the back of their military work.

Of course, accountants would draw up the right paperwork to show that projects were being kept separate and government money only spent on government work etc but the reality is that receiving great wodges of public funds will benefit all the operations of a company.

Without going into the rights and wrongs of government doing this at all, I wanted to look at where the UK government might throw their (our) money around in a similar way (outside of the evergreen defence world).

A Healthcare Bet

The strongest candidate that comes to mind is healthcare technology, specifically patient records systems and innovations that work on large patient datasets like AI-driven diagnostics.

The structure we currently have for healthcare technology in the UK would support government investment to boost private companies, per the defense spending model.

  • We have a publicly-funded healthcare system so government can legitimately spend large amounts of public money on technology to support it.
  • We have created a market of largely private sector suppliers (for better or worse) who could take said public money to develop their products for the NHS, and then attempt to sell them globally.
  • We have a large set of patient data that is all nominally within a single framework and usable (within relevant policies) for national solutions.

Find My Appointment

A small incident from my own use of healthcare tech illustrates the nature of this structure and the scope for improvement.

I knew I had an NHS appointment last week and thought I would check the details in the systems that the NHS has made available to me.

I have five apps now from the NHS on my phone.

Fig 1 – many NHS apps

The newest, and the one with the nicest interface, is the ‘NHS App‘.

Sadly, this seems to have no appointment information in it, or anything useful like medical records.

There appear to be hooks for me to see more data in the NHS App but for some reason they are not enabled.

The one thing it does do is allow me to order repeat prescriptions.

The second app is one called ‘Dr IQ‘ which my GP practice asked me to install.

This also did not have my appointment information or medical records or other useful information.

The only thing this app seems to do is to allow me to ask for remote consultations with a GP.

The third app is called ‘TPP SystmOnline‘ (clearly from an age before catchy branding was thought necessary).

This has an area for managing appointments with a GP in it but did not have the appointment I was looking for.

It has the same repeat prescription information that is in the NHS App.

It offers links to medical records and test results but these are dead – I am told my practice is not ‘configured to allow access’ to my records online.

The fourth app is called ‘PatientsKnowBest’ and is by far the most useful.

It is actually not an ‘app’ at all but a good old-fashioned website with a nice mobile format for me to access on my phone.

This has all sorts of useful information about the appointments I have with local hospitals and any test results, and it is updated very promptly whenever I have new hospital tests done.

But it again did not have the appointment I was looking for as this appointment was from another bit of the NHS that is not linked into this system.

The fifth app is called MJOG and I am still not entirely sure what it does.

It says it is for integrated messaging but everyone seems to message me directly using their own apps.

There was a brief flurry of messages back in May when I was asked to install it but silence since then, so maybe everyone has lost interest or moved on?

So, my access to primary care data (from my GP) is extremely limited and confusing with 4 apps in play and none of them offering useful patient health record data.

The main benefit to me from this investment in multiple suppliers is that I can click a button and order the same medicines that I need every month (and which could anyway be dispensed automatically).

I am in a much better place with secondary care data (from the local hospitals) but only if I am being treated within the same trust and not some part of the NHS that uses a different system.

It is always risky to generalise from the particular, but I believe my experience is not dissimilar to that of most people who use the NHS.

And the purpose of this story is not to say NHS tech is terrible but to illustrate the fact that there is a lot of it with much scope for development!

A Boost Not A Moonshot

If I were in the business of placing bets on where the UK could create truly global tech champions, then investing in these patient health record systems seems like a good place to start.

It pains me to think that a lot of this money might be wasted in the end as systems duplicate each other or fail.

But investment in this area is likely to produce some immediate benefits for NHS patients in the UK (as long as there is more standardisation and rationalisation of the products on offer).

And the products being developed (at least the successful ones) will have significant commercial value as people demand more from health information systems around the world.

If the patient health record systems can be improved then this creates the foundation for other healthcare solutions.

Records can be enhanced with lifestyle and monitoring data from the plethora of hardware and software suppliers in the market.

And comprehensive, well-structured, large scale record sets can underpin (with the appropriate transparency and consent) for a host of novel applications, such as those using AI.

Other Bets

Some other areas where the UK has a strong home market are less amenable to the ‘public investment bung’ model but worth considering for any tech industrial strategy.

Public Transport 

This is a mixed picture but we have made significant progress recently in offering simple interfaces to horribly complex back end service provision and accounting structures.

I still cringe when I see visitors to the UK trying to navigate the ultra-confusing train ticket machines in stations, but London cross-mode ticketing works really well and e-ticketing has now landed for rail.
Estate Agents

The UK has a very liquid and information-rich domestic property market that has spawned a host of highly functional and popular apps that compare well with those available in other markets. 

This is of course very much a private commercial sphere, though it makes use of a lot of public data especially from the Land Registry.
Retail Banking

There continue to be issues for the 'unbanked' in accessing services that have to be addressed, but for the 'well-banked' (folks who have good credit records and established accounts) there are great UK tech-enabled offers.

Accounts can be set up quickly and are highly functional, powered by information sharing that is required in regulation.

Again, this is a thought exercise in ‘where might the UK win in tech’ rather than an examination of the pros and cons of an interventionist strategy.

UK companies may get ahead anyway and happily market their solutions around the world without any significant government play.

We are also likely to see interest from other businesses in buying any UK companies that are successful and this may come from outside the UK.

This is playing out today with the discussion about a Japanese company selling a UK tech champion, ARM, to a US company, prompting us to ask whether the facts of UK ownership and a UK HQ matter or if it is enough to have the jobs in the UK?

Questions to explore further another day.

(PS I found the details of my medical appointment in the end on a paper letter which seems to be the preferred communications method of that bit of the NHS.)

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