The NHS is like a very dear elderly relative – you don’t choose them, you love them dearly but you are also frustrated by their old fashioned ways and inability to change. It is however really time to have that talk with them because this time something really has to give.
I recently moved back to the UK and despite having experienced excellent healthcare in Switzerland it came at a steep price and sometimes lacked the empathy and compassion that makes me love the NHS (except my Swiss GP who was phenomenal). I have also had the misfortune of experiencing the Spanish (private) healthcare system which not only lacked the compassion and empathy but was downright terrible, unprofessional and borderline dangerous. Having moved back to the UK and the NHS I soon had my first experiences – and run ins – with our venerable old system of healthcare. I have been left in shock at what I have experienced and has led me to say “we need to talk”.
The NHS is our sacred cow that we defend to the hilt and which we love but it has come to a point where the system is so clearly broken that it is time that we moved our sacred cow into newer pastures and gave her a good clean. The problem with sacred cows is that no one wants to touch them and there is the hope that just throwing money at the problems will make them magically disappear. From my experience however there are many small fixes that could be implemented that could start to help resolve some of the issues, and the very least save some much needed cash.
My first experience upon returning home was the lack of digitisation. When I asked my local GP how to get 6 years worth of blood results to them from my Swiss records I was told to print it out and bring it in! I looked at the receptionist aghast and asked if she was joking – she in turn looked at me perplexed, clearly unaware of what a ridiculous thing she had just asked. My response was categorical – if they wanted my blood results they could have them either via email, USB stick or from a location in the cloud. After much consultation I was given an email address to send my data to.
My next experience came a few days later when we had to call am ambulance for my mother in the middle of the night as she could no longer breath. We were told there were no ambulances available but that an emergency medic would call. This took over two hours – by which time my mother might have already died. Fortunately she actually got better and so we followed the medics advice and took her to our local GP first thing … only to be told there were no appointments available and that we would have to take her to A&E ourselves! By this time my mother was feeling perfectly normal again but spent the day on a ward waiting to see a cardiologist (her ECG was slightly off). By end of day still no sign of the cardiologist and not wanted to bed block when she felt fine we asked if we could take her home for the night and come back the next day to see the cardiologist. We were told however that this would mean she would be treated as an outpatient and would have to wait weeks to see a cardiologist. Eventually she spent two nights in hospital, entertaining the ward, feeling totally healthy, and ended up discharging herself on the 3rd day as they still had no idea what was wrong with her.
And here comes my third moment of “WTF” – during her entire stay and during her discharge everything was done on paper! Not a tablet in sight! The nurses station was totally submerged in a mound of paper and even a simple questionnaire was done on paper. Now the NHS has apparently spent millions on upgrading their IT systems … where exactly did that money vanish to?!
So as I look at this sacred cow I realise that it is clearly very sick and needs help. Firstly we should not be having to bed block simply so that someone can see a doctor – the cost of that alone is an astronomical waste of money that could probably fund additional doctors to deal with the increased number of outpatients. Secondly in this day an age there is no excuse for using paper anymore (and let’s not get started on the fact that the NHS still uses fax machines!) – which also costs more. There is more than enough research showing the financial and safety benefits of going digital. There are also now plenty of off-the-shelf products out there that could be used for at least the basics (like that questionnaire). The cost savings of going digital would probably fund the tablets needed (or more doctors and ambulances).
The other thing that annoys me about the use of paper is the amount of waste it generates – both in terms of time (think of that poor sod who has to type up all that paper) but also in terms of environmental impact. Which brings me on to my final “GRRRR” moment with my NHS experience – the excessive waste and use of disposable plastic. Again this would be a quick fix and would surely save the NHS yet more precious pennies. The wards seem to cope fine with re-usable plastic jugs and cups – why not implement this throughout the hospital. And why on earth have we moved to using disposable plastic aprons for the staff serving food? We seemed to cope fine in the recent past with traditional aprons that got cleaned after each use – which have the added benefit that they absorb spills rather than letting the spill drip down off the plastic apron onto the floor.
Despite all these issues, just like that elderly relative, I still love my NHS. Whilst I am in shock at how antiquated it now is and the amount of wastage, the thing that still makes the NHS a world leader is the level of care its staff deliver – regardless of who you are. The dedication and care of its doctors, nurses and support staff is world class and at the end of the day this is one of the most critical parts to healthcare. If only though we could help those amazing people do their job better by supporting them with the use of technology and chipping away at the waste. Our sacred cow deserves more and we should not be afraid to overhaul her to place what she does best at the centre, namely the care of patients – because at that the NHS truly excels, despite all its flaws.
When I started my career in the pharmaceutical industry I was told I would never work in pharma marketing without having been a sales rep. The fact that I hold a Masters in International Marketing, grew up in the industry (I followed in my father’s footsteps) and brought a range of highly pertinent skills was irrelevant – being a sales rep was seen as more critical to being a successful marketeer than having the right qualifications or skills. I have since disproved this “fact” by spending the majority of my career working as a digital marketeer, in some shape or form, for some of the world’s top pharma companies.
During my career I have fortunately seen a shift in thinking away from this mentality but the sad reality it has not completely disappeared, as evidenced in a job application I just saw for a top pharma. There it was again – listed among the basic requirements of the job spec. In this day and age I cannot for the life of me understand why work as a sales rep should still be a pre-requisite for a marketing role. Far more critical should be a good understanding of basic marketing, multichannel engagement and a degree of creative flair or innovative thinking.
Sadly I have experienced, time and time again, the result of having sales people in marketing roles. The lack of understanding of basic marketing by pharma marketeers, including senior people, is shocking. As I try to support brand teams and companies in developing and implementing innovative multichannel strategies I often have to also train them in basic marketing before we can even consider looking at how to navigate the complex multichannel world we now live in. For example trying to explain to teams how to develop plans and strategies tailored to their customer segments I may discover that their idea of segment actually links to HCP group such as GP or Oncologists rather than actual detailed segments linking to behaviours and beliefs.
In order to be a successful marketeer today you need to understand not only basic marketing but you also need to understand the complexities that digital has driven. You need to be creative and innovative to come up with marketing strategies that actually deliver real impact and engage, and not just be able to complete a brand planning template. Our customers now face so much choice and can simply click away from pharmaceutical content and messages. In many countries the role of the rep has diminished drastically and yet we still have many companies placing an inordinate amount of effort on this channel – and this is not helped if marketeers have been hired because of their sales skills rather than marketing expertise. Whilst reps still play an important role for many brands they are now one of many channels and a marketeer needs to understand the reps role within a more complex and interconnected landscape.
We live in a noisy world where the customer has the power and the choice. If companies continue to hire marketeers who tow the old line they will never see the impact they could be achieving. Our industry needs innovators and people who will challenge the status quo. We need people who will above all else always put the customer in the centre and try their utmost to understand what that customer wants and needs, and then deliver the brand messages in such a way that it speaks to those needs and resonates with those customers. The big tech giants are already investing heavily in healthcare and if pharma companies start having to compete head to head with these companies it is pretty clear who the winner will be unless we change our approach and who we hire. Anyone can learn to fill in a brand template but coming up with successful, innovative strategies that speak to today’s customers is a very different skill that takes talent, experience and a different mindset.
Last weekend, after nearly 9 years of living in Switzerland, I finally made it to Zermatt to see the famous Matterhorn. It was of course stunning, but it also got me thinking how life is a bit like a mountain.
At first it seems like this huge insurmountable obstacle, way off in the distance, but then as you get closer it becomes a challenge that you might just manage. As you move forward and start climbing the mountain, it is tough going. There are times when you question what you are doing, when your resolve waivers and the mountain starts to feel insurmountable again.
But then something happens and gives you the push to keep going. This could be something such as the sun shining through the clouds and the sheer beauty of the mountain filling you with inner strength, or perhaps a friend giving you the encouragement you need. Whilst these external elements are critical to getting up that mountain, without that inner strength and determination you probably will fail.
Once you have got to the top of the mountain there is that sense of elation and achievement – you are the top of the world and can look back at your journey with pride. However sometimes the road down off the mountain is much harder – your drive to achieve something is gone (after all you have made it to the top!), and there can follow a low period as you arrive in the valley with no more challenge ahead. This is when you have to start looking for the next mountain to climb and start your next challenge.
Right now I am about to start up my next mountain. After 6 years of living in Switzerland, mostly working as an independent consultant, I am now packing up and getting ready to move and looking for my next challenge. I have no idea right now what that next mountain will look like or how tough a climb it will be, but after climbing many mountains in the past I feel I have enough experience, and a great support network, to be able to make it up that next mountain.
Full disclaimer – I used a train to get to the top … no actual climbing involved!
In June my long-term contract with Boehringer Ingelheim comes to an end so I have started actively looking for a new role. In case you are not aware job hunting really sucks! One of the main reasons for this, IMHO, is the incredibly painful online systems most companies now use.
To give you a more specific example – I have been trying to apply for a digital role with a certain top pharma through their careers portal … for the last hour but to no avail. The first pain point was trying to set up an account. I always try to use my pharmaguapa email for job applications but apparently the system did not like this email and kept telling me an account already existed, but when I tried to reset the password I was told no account existed with that email account afterall. After multiple attempts I gave in and used my private email to create an account.
Next up came what should be straightforward – actually applying to the role. At first glance I was hopeful as the system looks better than some of the others I have used. However looks can be deceiving and now 1 hour later I have still not managed to get the system to upload my CV and let me move onto the next section.
Sadly I have had this experience all too often. With today’s technology and understanding of User Experience filling in an online job application really should be very easy and straightforward, and yet it remains painful.
I will of course persevere – and in doing so I am aware that if I ever need to apply to this company in the future I will no doubt have to go through the same painful experience – starting with issues logging in (I will almost certainly forget that I had to use a different email address than normal).
Of course if you know of any suitable positions (ideally that does not involve a painful online application!) please do let me know – the sooner I find that new opportunity the sooner I can stop putting myself through this painful process! You can find a copy of my CV here.
I am currently at Intelligent Health’s AI conference in Basel so thought I should write a blog post on the topic. I first got really interested in AI at SXSW a few years ago when I saw the applications of AI in chatbots for patient groups with limited access to care, such as refugees. I have since looked deeper at the topic as a result of the Reverse Mentoring project and believe this is a technology that will really bring huge value to our industry.
One thing that strikes me from the presentations I have seen at this conference is the level of partnerships between pharma and tech companies. This is a trend that I hope we will see more of – big cumbersome pharma companies are not the most innovative but by partnering with start-ups there is a great opportunity to bring new, innovative thinking into the organisation. However to get the full value of these partnerships it would be worth sharing that experience and learnings with a broader internal audience. Too often these partnerships remain within a small team and other people not directly connected to the partnership have no idea it is happening or the outcomes. If we want to drive new thinking in the industry then we also need to disseminate outcomes from these partnerships more broadly within companies.
Another factor that is clearly coming across in this conference is how critical access to data is. Whilst I have heard patients mentioned a few times I have not yet seen anything that is looking at empowering patients to share their data (and full disclaimer there are multiple streams so maybe this was covered in a stream I didn’t attend). By combining AI with Blockchain for example we might see some innovative solutions to the patient data access issue. Having more accessible data will benefit everyone – not just the AI technology but also the patients and HCPs themselves. I have heard so many people complain about going to a new doctor and having to essentially start from scratch as they do not have access to their full digital record. Of course at the same time we need security and privacy for these said records.
Leading on from this point (again with same disclaimer!) I am also struck – but not surprised – that with all this talk of patient data there appears to be no actual patients on stage talking about what AI really means to them. Just as I have spoken at conferences about how social media has had a huge impact on my health it would also be great to actually hear from patients who have seen a positive impact from AI.
Today I gave a presentation on Key Online Influencers (KOI) to my reverse mentoring group and one comment I got was “why on earth aren’t we doing this?!”. Great question. While many other industries have embraced the age of the online influencer pharma has not. Now we all know that pharma has been very late to game in terms of social, driven my multiple misconceptions, most of which revolve around a “we can’t do that” attitude or perspective, but we are also an industry used to working with “influencers” so why is the concept of online influencers so difficult?
I am old enough to remember to industry pre-digital, and unlike some other industries, pharma actually embraced the concept of influencers, in the guise of KOLs (Key Opinion Leaders). There are process and job functions dedicated to working with KOLs and yet when it comes to digital many run out of the room screaming (not literally I hasten to add). It seems to be linked to this lingering fear of social media, and the lack of perceived control that this channel has brought. Yet we have the process already in place that just need minor tweaks to cope with the online realm so why are we not doing more with Online Influencers?
I firmly believe the answer to this lies in a lack of understanding and the fears that many senior people still associate with social media. Counter this with the digital natives we now have working in pharma who may not fully understand the reticence to use the channel but are not yet in a position to champion it or to challenge the status quo (unless they are reverse mentors!).
What we need is for our senior leaders to embrace what has become one of the main communication channels of our age. We need those leaders to step up and help us bridge our old KOL process to a modern online friendly process. We need those leaders to question their teams as to “why on earth aren’t we doing this”. The only way they will be able to do that however is through education and actually starting to understand this channel, and understand that it brings us value and is not to be feared but rather embraced.
I am very fortunate that I have been able to build up a reverse mentoring programme for my client and am starting to see some of this change happening. It is immensely rewarding to start seeing senior leaders say things like “why on earth aren’t we doing this” when I talk about online influencers. It is also so rewarding to see the change that this programme is driving. After years of helping drive change in pharma companies this has to be one of the most personally rewarding initiatives I have been involved with. When I set up the programme I would have been happy to see one or two senior leaders using social – but now I a seeing many more signing up, and also embracing other new technologies such as AI and Blockchain. Maybe soon the question will be “why on earth didn’t we do this sooner”…
Back in June I read an article on the BBC about influencers and the potential backlash against them. It is fascinating to see the rise of the influencers on social media and the impact they are now having on people’s lives. It is a sign of our times that some of today’s biggest celebrities online are not movie or pop stars but ordinary people who through a combination of hard work, luck / timing and personal investment have managed to build themselves up as online influencers. Some of these online “stars” can get as much as $20,000 per post and they can have incredible power on people’s behaviours and attitudes.
Sadly not all of this power is well used and we have seen plenty of health scandals and issues that have arisen as a result of influencers sharing false information, such as the vaccine issue or an increase in body dysmorphia as teenagers try to mimic the perfection they see on Instagram.
This issue is then further compounded by an increasing use of cheats and fake accounts to build up the accounts – often to appear to be more influential and therefore generate higher revenue from posts. As the article mentions this is very vexing for the influencers who have actually got to where they are by a great deal of hard work, rather than paying someone or a company to boost their followers for them. I fully understand them – I personally have been working hard to build my own Instagram account, only to then see a friend’s account jump by over 6,000 followers in a matter of days. On closer inspection most of his new followers appear to be fake accounts but this still seems to be working in giving him a leg up in terms of impact and visibility. I myself now am wondering whether I too should consider this route – because frankly I do not have the time to spend in order to get thousands more followers.
Whilst for me this situation is vexing it highlights an important issue – namely that there seems to be little remedy for the rise in fake accounts … and the subsequent influence they help generate. Whilst those teens see perfection what they may not realise is that a great deal of that perfection is in fact fake and bought.
One could argue that one potential remedy is for companies to invest more and put more effort into countering negative influence, e.g. in the domain of vaccines, however this is unlikely to happen in the near future. Particularly in pharma I would question whether many pharma companies have the talent and resources to do this anyway. As an industry we are still woefully behind, and this is not helped by a lack of internal training and understanding on this critical channel, or senior management support, e.g. through extra headcount and resources. I see this lack of resources and expertise through the teams that I support but also by the low number of jobs coming up in pharma social media (heads up I’m looking – email me if you have an opportunity!).
My fear is that by the time we as an industry have caught up to where influencers are today it will be too late for many of our patients. Unless we start to really invest in this mainstream channel, and build up the teams and expertise to do so, we will continue to lose ground to the fake news and false information that is being pushed by online influencers with a very different agenda. And do we not as an industry have a duty of care to our patients to try to ensure they have access to accurate information? I would say we do but I do not see us meeting this duty of care through our continued ignorance when it comes to social media.
I am very open about my disease and the painful journey I have had to go through to get my health back. It is because of what I went through that I am now so passionate about educating anyone who will listen, and it is because of my journey that I am so passionate about social media.
However I also find it so frustrating working in an industry that does not listen to it’s core customers – indeed often does not consider patients as a customer. I work in an industry that emblazons its websites with words around patient centricity but in reality does very little for its patients. I work in an industry that has huge teams dedicated to marketing and communicating to doctors but only has small teams (sometimes a single person) dedicated to patient interactions and communications. How can we as an industry talk about caring for patients when we do not even resource our patient advocacy teams appropriately or hire patients to be part of those teams? I have already written about the fact that to work in patient advocacy for a pharma company you need to have experience in working with governmental agencies but not in social media and not as a patient. Surely patient advocacy teams should include actual patients?!
Whenever I have the opportunity to share my story with pharma teams they are often blown away by my passion and by what I say but sadly I feel like nothing changes. I feel as an autoimmune patient our voices are just not being heard by the very industry that often saves our lives. I am frustrated as an autoimmune patient that our voices are not being heard because many of us do not have a terminal disease like cancer or a visible disability. We are not dying but we are suffering.
Many of us are surviving but not “living” – we battle on in silence, we suffer in silence, and we often carry on being stigamtised because what we have is not understood or visibly obvious. Just because you can’t see our pain does not mean it is not there. Just because we do not have big patient associations behind us does not mean we do not exist. Just because we have a chronic disease that will not kill us does not mean we are okay. We battle on but we want to be heard and there are more and more of us out there.
I am passionate about raising awareness for autoimmune diseases because I am an autoimmune patient. I am passionate because time and time again I meet another patient, or friends and family of an autoimmune patient, and I am struck by the same stories we share and by the fact that often we seem to be ignored. Just because we are not dying (or at least not quickly) or because physically we look healthy does not mean we are not suffering. Just because our conditions are not always fatal does not mean we should not be heard. It is time for our voice to be heard.
It is time for us to stand up and tell the world that it is not okay – we are suffering and we need support. We need support to fund research to find answers. We need support to help make people understand that not all disabilities are visible. We need support because frankly when we have a bad day it is the equivalent of your worst nightmare but we persevere – and often in silence. We are so much stronger than you could imagine but we are also in desperate need of your support.
All we ask is that you hear our voice and support us in our daily struggle – because together we can fight these diseases and together we are strong.
Today in one of my mentoring sessions we were looking at the use of Artificial Intelligence in the pharma industry. This in itself is a fascinating area to look at but equally fascinating was the discussion the topic generated – namely the changing dynamics of the healthcare industry and the pharmaceutical industry’s continued snail pace of change.
As we looked at some of the new players entering the market, such as AI startups like BenevolentAi or the big players like Google and Apple, we discussed how pharma is starting to miss increasingly large value opportunities in healthcare, which tech companies are seizing. Whilst currently much of the pharma industry still remains clearly in the domain of the pharma companies that may change in the future as the industry fails to adapt to changes being driven by technology.
Looking at AI & clinical trials for example – currently clinical trials are very clearly the domain for pharma because of the huge financial investments required but also because of the need for highly skilled and experienced people to work in this area. However as AI makes inroads, for example in molecule identification, what’s not to say that non-pharma companies might look at this area and bring in their technology expertise and just hire / poach the expertise they need to run the trials … or indeed just outsource to the CRO?
This article also gives the nice example that technology will increasingly play an important role in treatment and if tech companies find that the pharma industry is the bottle neck to their products what’s to prevent them just buying their own way in to the industry? Once this happens pharma could potentially face major issues as all of sudden their direct competition no longer comes from another slow, cumbersome pharma company but rather an agile, dynamic and fast moving tech company.
And this leads on to another factor that is also hindering the industry namely how cumbersome and slow the internal systems and structures are. Even when a pharma decides to partner with a start up (which is happening but IMHO not as much as it should be) often the clash between the two cultures proves a major obstacle to the success of the partnership. While a startup will expect to move quickly – and may need to move quickly due to limited funds – they then find themselves with a partner who may expect things to take years (by which time the startup has run out of funds / has lost key people / etc.).
Many people in pharma argue that due to regulations this is a totally different market and it is the regulatory environment that hampers speed I would push back on this. Time and time again regulatory constraints is bandied around as an excuse when it should not be. The length of time it takes for a pharma company to draft and sign off a contract or agreement with a startup for example has very little to do with the regulatory environment but rather with the internal systems and staff.
Another cultural aspect that differs between pharma and tech companies – and again which is only partially linked to the regulatory environment – is the right to fail. Traditionally pharma, like many other industries, will only launch or release something when it is perfect, which contrasts with the tech industry which focuses more on agility and adaption. Many tech companies will launch something as a beta version – so not final – but will then adapt it based on feedback and data. Whilst this approach may not be appropriate for the actual pharma products there are many other parts of the industry that would benefit from this approach.
So will we be losing our jobs to the likes of Google and Apple? Probably not in the near future but if pharma companies continue to only adapt at a snails pace it will become less of a philosophical debate and will move closer to reality. And what is certain is that as pharma tries to deal with increasing costs and prices pressures if they do not start to look at the full value picture of the healthcare industry they will lose out on potential new revenue and value sources – and there are plenty of non-pharma companies lining up to grab this value.