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Back on the Fuelband after a terrible experiment with the Jawbone Up.

I’d used a Fuelband for almost a year before deciding it was limited and wanting more. The Up seemed perfect for a geek, a lovely iOS app and an open API that meant it even had an IFTTT channel. Sadly it was let down by flaws in the product and bad support. It never fully worked, and in the eight weeks I waited for a replacement (which was always promised in a ‘few days’) its remaining functionality gave up and died. A very common story on their support forum.

I found myself longing for a return to the Fuelband. Compared to the Up the data created is limited, the measurement proprietary, and the functionality poor.

But it works. Clever target setting changes my behaviour and makes me more active, perhaps because there is limited functionality that concentrates on activity.

And it’s cooler than the Jawbone too.

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Wandsworth council chamber, Mayor's chair and crest
I need a new generic image for the Town Hall

Last night was the first meeting of the ‘wider’ Health and Wellbeing Board for Wandsworth. And a bit of a milestone in the progress towards implementation of the government’s health service reforms. In fact yesterday was something of a health reform day for me, with a meeting in the afternoon between south-west London NHS sector, councils and primary care trusts in the afternoon.

I remain convinced that the Health and Social Care Bill present a magnificent opportunity, perhaps a once in a generation opportunity, to improve health care, and most importantly, the health of Wandsworth.

The move to GP commissioning has attracted the lion’s share of comment – and criticism – but to me this is a perfectly rational move, the GP is the one who knows most about the patient in front of them. And in practice the patient will see no difference – and nor will they care – if a GP refers them on, they get referred on. The commissioning process is neither here nor there to a patient concerned about getting better.

However, the most exciting changes are the move of public health to the council alongside the structural reforms that will help develop a much closer working relationship at all levels of health and social care provision.

The Director of Public Health gave a presentation on the health needs of the borough. What struck me most was how clearly the picture emerged that most health problems are not related to healthcare, but instead to lifestyle choices.

So on each indicator Wandsworth was scoring poorly it wasn’t down (in the most direct sense) to a council, GP or hospital letting people down, but their ‘decisions’ to smoke, drink too much, eat unhealthily or engage in risky behaviour.

This is the sort of area in which I feel my paternalistic and libertarian Conservatism traits clash. Part of me doesn’t mind if people smoke or drink, that’s their choice and – generally – it’s their health they are affecting. Indeed, morally it’s very hard for me to criticise anyone for bad lifestyle choices, in my past I smoked and drank far too much. And while I’ve avoided drugs, I can’t claim to have ever been troubled too much by healthy eating. If there is anything that puts me on the side of the angels it’s my attempt to undo some of the damage with slow trots around Battersea Park.

In the world of Nudge however, there probably needn’t be that conflict between libertarianism and authoritarianism. People are still able to make their own decisions, even if we think they might be the wrong ones. But we should make it easier to make the right ones and pushing them towards those choices where appropriate.

But even there, while I would argue the council is probably in a better position than the NHS to help people make those changes we still aren’t the best people. Those present from the voluntary sector were concerned that they were still not part of the process. Personally, I can see how we will be using them far more than we ever have, working at ground level to help bring about those small improvements that make a dramatic difference over months and years.

But, where we are, it’s hard to reassure them. We’re in the middle of reform and moving towards closer working between two very different cultures. We have the broad vision for where we want to be, but we don’t have lots of the detail filled in. I have my views, but it might not be the same as everyone else around the table (indeed, I might not even be there when the powers are formally transferred from the PCT to the council and GP consortia!)

It’s an exciting time. But however far advanced we think we are – and Wandsworth is further along the process than many, if not most, places – there is still a long way to go.

Where do you think we should be? Do you know any areas we make it ‘hard’ for people to do the right thing?

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Years ago, as a new councillor, one of the old salts told me that he now couldn’t go anywhere in the country without seeing a housing estate and looking for indications of how many of the houses or flats had been bought or how the estate was managed.

I’ve found myself doing the same looking at public sector organisations. So today, at St Thomas’ hospital I was taken with the robot dispenser in the hospital pharmacy which you can see going through the motions in the YouTube video above. Apparently it works by placing drugs where they fit, so they are stored in the most space efficient way, then remembering the location. It will then retrieve drugs within 10 seconds of them being requested. It is quite mesmerizing to watch and MiniMe and I enjoyed seeing boxes with names I couldn’t pronounce being moved around (as well as nicotine patches, they had lots of those).

However, given that the advertised wait time for dispensing prescriptions was 15-20 minutes I couldn’t help feeling that the space saved and time saved by having a robot, rather than a human, go to a shelf and get some tablets hasn’t really made that much difference to the patient experience – who still have to sit in a waiting area and have fairly minimal human contact with the pharmacist through a small, bank-style, dispensing window.

Guy’s and St Thomas’ is a good NHS Trust, so I don’t mean any criticism, but my equivalent of asking myself about the housing mix is to look and wonder whether the design took more account of measurable outputs, like how long it take to retrieve a drug, than the important outcomes, like informed and happy patients. Too often the public sector concentrates too much on what it can measure (and is new shiny), rather than on what’s important.

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I’ve followed, from a distance, the Society of Local Authority Chief Executives (SOLACE) conference today. Far from having sessions on fat cat salaries this morning seems to have been devoted to dismissing Nudge to move onto a new fad involving social connections.

Nudge was on one of those fads taken up a few years ago on, effectively, changing people’s behaviour with intelligent design. Classic examples include painting a fly on a urinal (which reduced the cleaning needed because men’s aim improved) or creating the illusion of uneven road surfaces (which reduce traffic speed). There are plenty of examples on their blog. The fundamental principle was ‘choice architecture’ – designing the choices people make so it’s easier for them to make the right choice.

Push the button: For some reason everyone approached this as a pump, and assumed it was broken when it didn't work that way.

A few weeks ago we took MiniMe to the Science Museum (mainly because I wanted to see the Apollo 10 command module) where there’s a small area for younger children in the basement. A large part is water play, and one bit has air jets under various obstacles so you can see how air moves through water. The problem is that every single person who tried to activate them attempted to pump the button, very few actually experimented to discover they were buttons and you had to keep them depressed to make them work.

A silly example, perhaps, but an interesting one. The area, designed for 3-6 year olds, although I’m sure MiniMe wasn’t the only one under that limit (he’s not quite two), yet everyone, young and old, repeated that mistake. There was clearly something about the design that encouraged people to pump, but not to push. And the consequence was that no-one used that bit of equipment.

The idea that the concepts behind Nudge should be forgotten, as if it was a pair of 70s flares and a horrible mistake, is a nonsense – if the principles were valid a few years ago they remain valid now. I’m not sure why the change in belief, there is always the pressure to appear modern, but perhaps there is also the difficulty in truly adopting something like Nudge in government.

For a start are political difficulties. For example, I have long liked the idea of rewards for people getting back into, and holding down, work. The argument against is that work is its own reward and people should not need added incentive. However, the reality is that for many the idea of sacrificing 35 hours or more a week of ‘free’ time for a small increase in income is not that enticing. But adding an incentive (which need not be that much, vouchers for McDonald’s or stores) reinforces the positive aspects of working by directly linking work with positive outcomes. I would argue it far outweighs the long, and even short, term costs of unemployment.

There are also administrative and cost difficulties. If you take Wandsworth’s street parties, they were incredibly expensive – largely a result of the work that was necessary on the council’s part (since deemed unnecessary by the government). Moving to a cheap fixed fee helps encourage the behaviour we want, the sense of neighbourhood and belonging, but left us with the same work to be done and the added complication of co-ordinating across a number of events, rather than just one. However, in tough times it might seem hard to justify added costs to the council against intangible benefits to the community.

And finally there are the cultural difficulties. As I touched on yesterday it seems that we live in a culture that is defined by the negative– what you can’t do – rather than the positive – what you can do. It is so much easier and much more comfortable to think and act as enforcers in a black and white world than as the encouragers with ever lighter shades of grey.

Which all set me wondering about Wandsworth. The council is, in the neutral sense of the word, a huge bureaucracy – an effect of thirteen years of government target culture and the Daily Mail mentality that creates a risk-adverse approach to public money. Has this led to us developing barriers that discourage people from acting positively? Do you have any examples? I’d love to hear them.

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Warning signEven though this is Battersea, not Broughton, I hesitate to post this sign I came across while canvassing at the weekend.

On the basis it’s visible from the street and the photo doesn’t actually identify the location (OK, it’s in Wandsworth, but which of the 280,000 residents actually put it up?) I’m going to publish and be damned.

It’s certainly a lot stronger than most of the ‘No junk mail’ stickers and I quite like it.  It is specific and provides a clear indication of what will happen if you choose to ignore the request.

All too rarely are people actually made to consider the consequences of their actions, but this forces the deliverer to directly link their actions with potential negative reviews, costs to their company and complaints.

I’d love to know how effective the sign is, or whether I’m the only one who read it and thought it all through!

If you can’t quite read the picture the notice warns:

Please don’t leave us junk mail. If you do I will write poor reviews abour your companies, return the junk to your company in unstamped envelopes and report to whoever I can.  I will do this.

Thank you I’m sure we’ll get on fine

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I’m working out of London for a couple of days, and although I’d posted I wouldn’t be blogging, I couldn’t resist a rant about hotels.

I’m not sure what it is, but it has always seemed that hotels make judgements about me.

The first is that I want a single bed to sleep in, and one spare. In a way it’s been helpful. I could spend the time before meeting colleagues for dinner last night carefully mulling over my choice of bed. And tonight I might sleep in a different bed, just to mix things up.

But that’s probably just one step shy of a rock and roll style room trashing though, so I might reconsider.

The second is that I obviously want to pay well over the odds for communication with the outside world. At the moment I can pay 55p a minute to make a local call, 75p a minute to call home and £17 a day for internet access.

£17 a day?! That’s more than most people pay in a month, if they don’t get free broadband. But I’m wise to their games, so I’m just using my phone to tap out a long rant.

The third and final annoyance is their total and utter conviction that I’m determined to bankrupt them through my compulsive theft of hangers.

I have never stolen anything, let alone a hanger, in my life – the worst I have ever done was, aged 7, receiving some Dennis the Menace stickers that I think may have been stolen. They adorned my lunch-box and gave me daily bouts of guilt that forced me to give up packed lunches at school.

But somehow hoteliers have me down as some sort of clothes storage kleptomaniac, as if I’d steal the wardrobe if it weren’t fitted, and console myself with petty hanger theft. You can get 3 for a £1 on St John’s Road so why would I pay £70 a night to steal £2.67 worth of hangers?

I know I’m not alone in this. I Tweeted last night and received a fabulous response from @agentoffortune expressing his relief that he was not the only one seen by hotels as “a bourgeois yet gullible net freak with a penchant for celibacy and hanger theft”.

But I’m determined to be positive, so I shall finish by mentioning somewhere that I think got it right.

Towards the end of 2006 I stayed in a fabulous hotel in Folkestone when there for a friend’s wedding. It was set-up by a couple of guys who simply felt they could do better. And they did. Internet was free, you just connected to their wifi network (they’d lend you a cable if you needed). They didn’t have mini-bars, but there was beer and wine in the lounge, as well as home-made cake and you were invited to help yourself. And every wardrobe had proper hangers.

And bizarrely, I didn’t steal a single hanger, and didn’t abuse the free booze although I probably did have too much cake. Basically, their guests were treated as responsible adults and, unsurprisingly, behaved as responsible adults. It was a fantastic hotel, and if you ever need to stay in Folkestone (or want to see how a hotel can be well run) I would recommend the Hotel Relish.

I wish I could disclose I’d been paid for that, but sadly I feel compelled to praise them, two years later, simply because it was the last place that didn’t assume I was a petty thief.

And this is going to prolong my rant because it fits in with something I’ve been increasingly thinking recently; that we are all human. Nothing very profound in that, you might say, but it seems that a lot of problems in this world are caused by people who either expect something different of others, or try and portray a different image of themselves.

I’m frustrated because a hotel chain’s assumption I’m a potential hanger thief has left me having to deal with fiddly hangers.

Is Sir Fred Goodwin a greedy banker because of his personality, or because we’ve created a society in which bankers are expected to be like that?

And is Gordon Brown floundering because he’s useless, or because we have created a system where politicians have to appear all-knowing and infalliable and he can’t keep that appearance up?

It seems the public expect politicians to be muppets, and politicians portray themselves as super-human – when it would be much better and healthier for everyone if we recognised that (Kermit and Clark Kent aside) that we are human beings and sit somewhere in the middle of that spectrum.

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