The Future of Business

In 2000 I was playing a major role within NHS Direct as the founder MD of the Plain Software Company. We started as a research project and grew to a team of over 30 people.  Our software was used to take millions of clinical calls and covered around 25% of the English & Welsh population as part of the Department of Health NHS Direct pilot projects. It was a fascinating period – introducing a whole new service into a sometimes reluctant NHS.

I moved on in 2001 but recently have been very involved in a group which is pioneering a new field of what we are calling Collapsonomics.  And my thoughts have returned to NHS Direct.

Collapsonomics comes out of thinking as deeply as we can about the possible paths, scenarios and consequences of the current “recession”.  As we dug into these possibilities, it became clear that the level of thinking (at least in the public domain) from Business, Government and the media comes nowhere near even edging up to the very serious situations that could lie ahead of us.

A particular influence has been the work of Dmitry Orlov   He talks about 5 stages of Collapse – the first being Financial Collapse which basically involves the value of currency getting lower and lower – inflation in other words.  Another major trend that is really biting now is the reduction of Government income and the increase in Government spending.  (I’m still looking for UK figures?) In the USA, income is down 14%.  Spending is up 33% (halfway through the year) due to the bank bail-outs.  In other words, there could be an across-the-board 14% reduction in NHS spending. Plus possibly some more if the bank bail-outs  need extra for an unexpected emergency.

In other words, the NHS (and other Departments) could be faced with a need to reduce budgets by 14% next year plus a much greater reduction if we do move towards Financial Collapse.

So what has that to do with NHS Direct? Well, what is the least expensive NHS patient / health professional contact?  By phone with a nurse.   Moreover, NHS Direct is easily extensible – nurse prescribing is already in the version for face-to-face clinics.  A similar system is already aimed at Pharmacists.  Treatments for some common long-term conditions like diabetes can also be monitored and helped from NHS Direct. You also have the proven long-term NHS Direct database which helps to ensure excellent quality control and also helps the NHS to roll out changes to Healthcare nation-wide as changes are needed.

The difficult thing about the Collapsonomic way of thinking is that it gives reasons why there could be serious situations ahead of us.  But with very little idea of timescale and severity – indeed they both depend on our actions in this country – and world-wide.  The best way forward, we believe, is by using scenarios – and then seeing what we could do now that would help to prevent the worst consequences of different levels of future unpleasantnesses!

So for the NHS, NHS Direct is effective, inexpensive and easy to change.  I therefore strongly recommend that consideration be given to thinking through its role in an NHS that has far less money than currently – and to making the changes to both its software and structure to be ready for the worst.