What if Uber did health, housing and social care?

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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.

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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]

 

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