What if Uber did health, housing and social care?


If you’ve been to a conference in the past 12 months – you’ll almost certainly have seen the slide above, or a version of it.

Mentioning “disruptive innovation” adds a sprinkle of sophistication to otherwise ordinary presentations. It’s a sit up and take notice slide that says: ‘Better listen, or you could be history.”

However – it doesn’t always hit its intended target. A significant portion of the audience at a couple of events I’ve been to recently have looked at each other as if to say ‘that couldn’t happen to us’.

The reason for this seems to be the comfort blanket that can come with extended working in the public and social sectors.

The thinking can go like this.

  • We are different.
  • We deal with people who are highly complex with multiple needs and vulnerabilities.
  • No tech outfit could hope to understand the extent of the personalisation involved in our services.

It’s optimistic thinking – probably the same that was held by some taxi firms pre-Uber and hotels before Airbnb.

It’s going to take radical change a lot closer to home before many managers recognise how profoundly the rules of business have changed in the digital age.

Arguably though , it’s already happening. I’ve made a slide of my own that might be more relevant to the public sector.

Screen Shot 2016-02-18 at 13.31.22

Far from fantasy – we are at the beginning of the end of one size fits all health, housing and social care monopolies.

Some examples:

Mercy is a hospital with no beds, no waiting rooms and no patients.There are nurses but they work virtually, providing care across 33 hospitals. The strategy is quickly expanding beyond hospitals and into the home. By keeping tabs on patients at home, Mercy can help keep people with chronic conditions out of the hospital.

Buurtzorg is a care system without managers, even though it has 9000 employees. To kill bureaucracy and overheads there are no call centres. Nurses take the calls. In self-managing teams of ten they plan patient visits and decide how long they spend there, depending on their judgement of the need.

Honor is home care without direct employees. Like Uber , the care professionals here are self employed and use an app that helps them find and keep track of job offers. Applicants undergo background checks and in-person interviews to screen them, with only 5% allowed onto the platform so far.  More flexible than traditional care – it allows people to book packages in just one hour increments, and aims to foster long-lasting relationships between caregiver and the customer.

What these systems and technologies do is to enable existing infrastructure to be used more efficiently. They are harnessing the power of the connected citizen rather than the analogue organisation. As Alastair Parvin has written – we are no longer stuck with the choice between the public sector and the private sector. The citizen sector now needs to be recognised as a viable, industrial force.

Is it impossible to imagine a local authority as just a digital platform with its services all outsourced?

Paul Blantern, Chief Exec of Northamptonshire County Council is almost there. The Council employed 12,000 people when he took over. Today they employ 6,000 and his vision is to reduce that to just 150. He was asked in this programme “Is there anything you wouldn’t outsource?”. His response – “No – it’s all about the outcome to the end user.” Essentially the ‘Council’ could reduce to zero as long as people feel the services are still good. [UPDATE MARCH 2018: This approach was ultimately disastrous]

Is it impossible to imagine other organisations , housing associations for example, being managed entirely differently? Rather than multiple companies we may see a singular platform where users themselves directly procure the services they need from the cloud. The next generation of housing manager could be an algorithm rather than a person.

It’s not just housing. Any sector that has multiple players performing similar services is ripe for disruption.

There’s no question about whether the Uber , AirBnb, Facebook and Alibaba of the public sector will emerge.

It’s simply a matter of when.


[Credit to  Mike Clark and Shirley Ayres for inspiration on the slide! Thanks both]



36 thoughts on “What if Uber did health, housing and social care?

  1. I’m not sure on the relevance of Uber. Uber’s business model adjust price as a function of supply and demand, resulting in “surge pricing”. What you’re proposing would (I hope) be a different business model. So not Uber.

    1. Thanks Mark the Uber title is a bit of click bait as they certainly arouse passions! The main point is to consider what our organisations would look like in an era of platforms. And like anything – there will be good and bad platforms..

  2. Challenging as always Paul. One of your tests at Bromford is what the users of the service think. You do not mention it here. It would be good to know what the people in Northamptonshire think Anout the new way of delivering vital services.

    1. It’s the ultimate question Tom. From listening to Paul Blantern he seems to get that and apparently customer satisfaction has increased if anything. I guess outsourcing can be done brilliantly and well as the awful examples we hear.

      Thanks for commenting

  3. A big part of tech-driven disruption is that someone develops a mechanism which shifts the power relationship from producers to consumers and allows the consumer to make the decisions about what to buy and how to buy it. For people in social housing to claim that this could not happen to them is to ignore the reality of what has happened in most of the rest of society; to think that someone is not working on an alternative already (in fact thousands probably are, although only one may succeed), and to think that social housing tenants are not capable of making their own decisions.

    There are some very rude awakenings in the offing.

    1. I agree John. Social housing probably feels safer than most because of the nature of tenancy agreement – which locks down most of the service offer to just two parties. Such a ‘contract’ doesn’t exist with , say , the NHS. However as you say – an alternative will be in the offing. Just a matter of time

  4. Fascinating post, Paul. Time and again it seems that disruption comes from the outside, with the incumbents failing to recognise the threat to their business model until it’s too late.

  5. Great post!
    It’s interesting that the common reaction from people (who want to bury their heads from the potential in your hypothesis) is “but what do the people think about this?”, and yet not a question that is routinely asked of the people regarding current service provision… *strokes chin, pondering…*

  6. I’ve been thinking about this, while walking the dog this morning. Maybe the disrupted social housing model is already here, and it is AirBnB. I’d be very surprised if there isn’t at least one example of someone sub-letting part or whole of a rented social home via AirBnB without the knowledge of their landlord. People get obsessed with the idea that AirBnB is about people renting out their spare bedrooms. There are lots of examples of people using it to rent out entire properties (or even lots of properties). I myself have stayed in several AirBnB places where everyone else in the building is also renting via AirBnB.

    It is obvious this Government hates the current social housing model and is intent on unpicking it. At the moment, not much is being put back in place to meet the needs of those who can’t afford to buy. It is possible to foresee a scenario whereby Housing Benefit is converted into a Personal Housing Allowance and people are encouraged to use it to rent from individual landlords via an AirBnB-type mechanism. I am not saying this is desirable, but it is certainly a possible policy direction.

    1. Agree John and without saying it’s desirable it’s a logical extension of policy unless someone creates a viable alternative. I know of three people in social housing who are letting rooms out I presume without knowledge of landlord (not Bromford I hasten to add).

      But your point is bang on – maybe the disruptors are already here.

  7. The problem with turning every service user into a ‘consumer’ (regardless of the tech available to some of those consumers and *particularly* in services that are critical to personal well-being) is that of unequal purchasing power, where those with the resources will be seen as the only profitable market, and therefore services for those at the bottom of the income distribution stagnate and fail. Free market models only work if we accept a huge amount of failure – and in terms of social care & housing this failure means the destruction of peoples lives.

    1. Thanks for the comment Ben I’m certainly not proposing that any of these models is the right one.

      I think we’ve already got lots of evidence about how the current delivery of health care and housing leaves something to be desired.

      Anecdotal I know but I’m touch with people who are currently very dissatisfied with the paternalism and lack of choice offered by their housing association. Despite the cheerleading for the NHS the last six people I know who used the service had immensely frustrating experiences. I know people in their 70s who don’t want what the current care system has to offer.

      I’m not suggesting consumerisation of these services is the answer , but I do know all three would benefit from less talking and more listening – and treating the end user as , well , a customer.

  8. This is so timely for me, Paul. Thanks for writing this and introducing the idea that public services will not be immune to disruptive alternative services for citizens- it boggles my mind no one is really talking about this. Something that isn’t mentioned here that I feel is really important to talk about is whether or not public service staff, especially at the top tiers, are knowledgeable enough about tech and trends to have a sensible conversation about how to either work with disruption or to make counter offers to citizens. Do we have intelligent commissioners and tech/digitally literate leaders to move elegantly in a tsunami of disruption?

    1. In part, at least, this exposes a wider issue about how public services work with “digital,” viewing it as somehow separate to core service delivery. The consequences are:

      The people with the business know-how aren’t re-engineering the business to take advantage of new technologies — to often they’re just automating a thirty-year old business as usual.

      The people with the technical know-how are building technical solutions, not business solutions.

      This disjunct in roles and perspectives leads to translation difficulties in communication and control issues as each side seeks to protect their perceived territory.

      Agile working is like turning the Queen Mary in a paddling pool.

      For all the use of the ord customer the customer is still treated like a user.

      1. Thanks Steven – “too often they’re just automating a thirty-year old business as usual”.

        I think this is a very good point and echoes that made by Leah. Perhaps we have a deficit of leadership in the digital age capable of taking advantage of the many opportunities for doing business differently – and creating new value.

    2. That’s a fascinating comment Leah and worthy of a lot of follow up discussion.

      “Do we have intelligent commissioners and tech/digitally literate leaders to move elegantly in a tsunami of disruption?”

      I think you’ve gone to the heart of the matter. What is a modern leadership development programme that supports this?

      1. I’m thinking about a development programme as I type! I’ve actually hooked up with a local consultancy to offer up Action Learning to senior people in the commercial and government sectors. I would like to replicate the action learning programme SCVO is offering to senior leaders in Scottish charities (more here: http://www.scvo.org.uk/blog/rare-opportunity-to-digitally-transform-your-charity/) I am giving a talk Thursday to 200-odd senior folk from commercial and government called Digital Transformation and I’d like to suggest Action Learning as a way to improve tech and digital literacy. You might be glad to know I am also going to highlight Bromford’s Innovation Lab as a good way forward too.

  9. The interesting point comes when your AI virtual assistant connects with platforms seamlessly thus potentially excluding businesses and organisations that are not ‘platform-ready’.

    In the U.S., Amazon Echo costs $179 and will connect to a wide range of home sensor systems and other platforms such as Uber & Spotify (see video at http://bit.ly/1S9tkkH).

    In the future, if your housing, health or care providers are not identified as a ‘trusted’ and ‘connected’ platform, your virtual assistant powered by Amazon, Google, Apple Siri (or whoever) could simply identify other sources for a faulty boiler, mental health advice, online symptom checker, personal care visit or a response to a fall at home.

    All of these service providers could also utilise AI as their first point of connection to triage, prioritise and then link to experts as necessary who can advise, ask for more information, call at your home and provide a solution in the same way as Uber, Honor, an online doctor or a car breakdown service currently respond.

    So, a housing association could for instance be automatically signing off a maintenance bill for a home boiler, but the actual work was handled by a trusted person via the householder’s virtual assistant using a recognised platform.

    Of crucial importance will be who you trust with your personal data and IOT sensor information – the more data/knowledge your provider platform has about you, the better the response could be.

    If your health, housing and social care provider has poor information about you they will need to request further details and go through more processes to understand your request or ‘diagnose’ a problem (eg the current situation with the 111 service which does not yet connect to your medical records/personal history).

    In the U.S., employers have extensive knowledge of employee personal data linked to their health providers.

    Initially simple solutions will be also handled by the provider’s virtual assistants.

    in time, as platforms learn more about individuals, communities and populations, even more will be handled by AI supported by large knowledge databases.

    It will not be possible for individuals to hold all of the expertise and knowledge needed – that would include doctors, lawyers and many professional groups.

    GP and health information systems already have flags on their computer systems to point out risks, medication interactions etc.

    Thinking about the Echo/Uber example (above) where the driver will be there in minutes – consumer expectations will expect faster response times from health, housing and care providers that can only be organised by technology that knows where everyone is and their current schedule/workload.

    There are, of course, some very tricky issues with health, housing and social care eg data sharing across existing platforms is practically non-existent.

    How many times do you hear the stories of repeated information requests?

    That means opportunities for those organisations who can aggregate and analyse individually consented data to provide better personalised solutions.

    Think for a moment about the World’s biggest ‘health/fitness’ organisation that holds 160 million user records with 150,000 app downloads a day that is gathering data in close to real time and not episodically as in health, housing and social care?

    …Its not a health organisation (or even a tech organisation), but a manufacturer of sportswear – UA – http://bit.ly/1VyTOKt

    There will be some issues to resolve – reliability, cyber security, ethical issues.

    In the same way that we can Google our health symptoms and our GP can use intelligent IT systems, consider what happens when the individual’s AI virtual assistant powered by Google disagrees with the GP’s virtual assistant powered by IBM Watson for a health diagnosis?

    We can no longer assume that the current providers will exist with the same offerings into the future in services as well as products.

    Being a social or statutory provider is no longer a guarantee of future funding and sustainability.

    Organisations should be thinking seriously about how they can organise their future skills and expertise around whole system, shared platform solutions to provide personalised, responsive solutions that have identifiable outcomes.

    Partnering/merging with similar organisations may find some back office efficiencies and provide some short term sustainability but will not lead to the necessary transformation necessary to survive in the 21st Century.

    1. Just a brilliant authoritative response Mike that takes debate to whole other level. I’ll be sharing and feature this as part of a future post (with your permission)

  10. Leah, Paul – this goes back to the issue of senior managers (I hesitate to call them leaders) who still get their secretaries to print their emails off and then go home a read books or watch TV, never experimenting with new technologies. Even where they use tech, they rarely venture beyond the world of MS Office and Outlook, thus seeing technology about replicated processes that used to be carried out on paper.

  11. Really interesting article and responses. Still makes me think that we have to redefine ‘public’ services in the context of the decline of the state in the UK. The real disruption will come politically, not bureaucratically.

    Why can’t we see that the dismantling of local democratic decision-making in preference to hegemonic behemoths simply serves to disenfranchise and disempower the individual. By reducing the consumer to an individual we create a generation of vulnerable ‘service users’ rather than proactive protagonists.

    As long as the UK citizen is willing to sit back and take it, capitalism, in all its manifestations and perversions is going to dish it out. The real revolution from disruption can only come when the public sector reflects a political power shift towards the empowered and collectivised citizen and away from the bureaucrat. That’s why co-operatives are the future, citizen owned and controlled public funded services with democratic decision-making over resource allocation. As long as the engagement is direct and not channelled through representation and intermediaries.

    It’s either that or some kind of privatisation of public services with asset stripping and offshoring of profits for some kind of tax avoidance scheme.

    Or is that some kind of dystopian nightmare worthy of a trilogy film franchise?

  12. I don’t think this is very far away. In fact, at LGiU, we’re working on a disruptive (but constructive!) technology for home care. Disruptive in that it will hopefully upend the current way of commissioning home care based on time and task. Constructive in that it builds networks of people around the individual who relies on care. More on that: http://www.lgiu.org.uk/project/cocare-supporting-outcomes-based-commissioning/

    We’re also working on a way to transform elections information. Councils still have to provide the service (and should! Let’s not outsource key democratic roles!) This year, it relies on crowdsourcing the data. (So please help!) Next year and beyond it’s an easy way of councils reporting elections returns as open data.
    More on that: http://www.lgiu.org.uk/project/out-for-the-count/

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