Navigating the NHS as a digital start-up

We speak to finalists from the Greater Manchester Future of Health accelerator to find out how digital start-ups can overcome the challenges small companies face in bringing their technologies into the NHS.

Right now the NHS is embracing digital to an extent no one could have foreseen a year ago – but that doesn’t mean it’s a smooth journey for digital health start-ups looking to gain traction in the health service.

“COVID has forced the NHS to change, but so far most of the implemented digital innovations have been low-hanging fruit such as video consultations,” says Rory Cameron, CEO and co-founder at diabetes risk management app Gendius. “Adoption of new tech is still a real challenge.”

The digital startups navigating the complex NHS ecosystemHe says that part of the problem is that standards of care are rapidly changing, and it is therefore difficult for companies to prove their concept.

“The NHS is certainly open to the idea of greater digital adoption – but CCGs often get caught up with various issues that stop them moving forward with new technology.

“Often you’ll need to do a pilot to demonstrate the platform works, where the product is provided for free, but at the same time CCGs will be asking how much you want to charge once the pilot is over. You can’t justify a cost until you have supporting evidence, and you can’t get that evidence until you do a pilot, so you get caught in a vicious circle where nothing can get approved.

“It would be better if CCGs accepted that sometimes they need to take the risk on a pilot, as long as their hearts are in the right place and the patients are able to make an informed decision about whether they want to take part.”

Many Trust and CCGs, as well as pharma companies working in the UK, are aware of these problems. and several digital accelerators have been set up around the UK to help start-ups get their innovations into the health service.

One such initiative is the Greater Manchester Future of Health Challenge – which Gendius was a finalist for.

The accelerator programme was launched last year, with 15 start-ups chosen, and was run by UP Ventures and delivered in partnership with Novartis, Push Doctor, Google, The Landing, MediaCityUK, Salford Royal NHS Foundation Trust, Salford Digital, Apadmi and Health Innovation Manchester – who had support and funding from the UK Office of Life Science and the European Regional Development Fund.

patient using tablet deviceThe programme provided multi-faceted support to help finalists launch their technologies into an NHS setting, ranging from mentoring, investment, networking, office space and access to a range of commercial and healthcare masterclasses.

“The programme was a fantastic example of how we can tackle the healthcare challenges of the 21st century by working together towards a collective mission and embracing innovations in data and digital,” says Rosalind Way, head of strategic partnerships at Novartis.

“We all have a shared interest in ensuring our NHS can continue to provide sustainable healthcare, and partnerships like the Future of Health Challenge create new possibilities to improve the health of people in the UK, provide better experiences for patients and find smart ways of working together to build a health and care system fit for the future.”

Richard Deed, associate commercial director at Health Innovation Manchester, says there were two key criteria the programme was looking for in start-ups who applied.

The first was whether the innovation actually addressed a problem for the Greater Manchester health system.

“You can have a great piece of tech, but if it doesn’t actually address what the system really needs, it’s not going to get any traction,” he says. “Going to a cash-strapped NHS with a product in an area that no one is paying for at the moment is never going to work.”

The second factor was the company itself.

patient using tablet device“We were looking for a mix of a good idea and good people. It doesn’t matter how small the company is, we wanted people who were going to go the extra mile, to take on board what the system is saying and be flexible enough to respond to that.

“The success of an innovation is probably 40% to do with the idea and technology and 60% to do with the people.”

As partners of the programme, Novartis were also involved in the selection process.

“Many pharma companies like Novartis are looking to go beyond providing solutions as pills or devices, and are now also asking where they can intervene and assist with delivering and improving pathways of care,” says Deed.

“Novartis were looking for innovations that could help achieve that – either by coming into an existing pathway of care or disrupting them and offering another way of delivering that care.”

Once the finalists were selected, Health Innovation Manchester’s role was to help them understand the landscape of the NHS.

“A lot of innovators think the NHS is one organisation,” says Deed, “but actually it’s multifaceted. Hospitals and clinical commissioning groups are all working in slightly different ways. We needed to explain that there’s no one front door to go to, no one person that can actually answer all of your problems.”

Return on investment

It was also important to teach the companies how to demonstrate return on investment and show how their innovation will be addressing pain points in the system.

“Even if you’ve got a great innovation, if you can’t demonstrate a return on investment nobody is going to pay for it,” says Deed.

Lara Mott, CEO and co-founder of finalist ImproveWell – which helps hospitals gather feedback for improving their ways of working – says that her company took this advice and built an ‘impact calculator’ on their website, based on their own evidence and academic research.

“People can enter the size of their workforce onto the calculator and see what our tool can do for their organisation,” she says. “It’s been a great conversation starter.”

Mott says the programme was also helpful for honing the company’s approach to customer experience.

“It was great to have lessons on how to do a great job in your customers’ eyes – looking at the basics from the private sector and how you can bring those principles into your own company.”

ImproveWell was co-founded by Mott and her childhood friend Dr Na’eem Ahmed. Dr Ahmed’s original concept was a junior doctor feedback app – the idea being that those on the frontline are best placed to identify areas for improvement.

“It’s now developed into an app for everybody regardless of role or background to get involved in improving their workplace, staff experience, and ultimately the quality of patient care,” says Mott.

Users can set up a working group, and contribute feedback to an ideas hub. The app has a poll survey function, as well as a ‘sentiment tracker’ which helps people understand what contributes to a good day at work.

“Users might want to ask employees if they’ve had a good day, and they can share the reasons behind their answer,” says Mott.

“With the combination of those three feedback systems, different colleagues can get involved in sharing real-time feedback to address known challenges, and also uncover issues that haven’t previously been identified.”

ImproveWell found itself in the right place at the right time when the COVID-19 pandemic hit – with the tool ready to use, they were able to mobilise in just a couple of days to help the emergency Nightingale hospitals in London and Cardiff.

Mott says that real-time feedback and rapid learning were particularly helpful for these new, temporary hospitals.

“They were really focused on listening to staff, understanding what had gone well that day and where it could be improved, and then making those changes the following day.”

Data and diabetes

Meanwhile, for Gendius a key benefit of the programme was the help in gathering data to create the algorithms for their diabetes management app.

“Through the work on the programme, we managed to get Oldham CCG involved,” Cameron says, “and Dr Angela Paisley at Salford Royal NHS Foundation Trust has taken the clinical lead on our AI development project, which is fantastic.

health app device“The programme also gave us some great advice on how to pitch well – for example we were taught in that session that what you really need to articulate isn’t what you already have but what your aspirations are.”

Cameron and co-founder Chris Genders had worked in pharma for some time before founding Gendius. When Genders was diagnosed with diabetes at age 50, he assumed, having worked in healthcare, that he would find it straightforward to deal with.

However, he found it very difficult, and five years after his diagnosis he developed a foot ulcer that took 12 weeks to heal.

Based on that experience, Genders and Cameron developed a tool that would make it easier for diabetes patients to understand what they need to do to avoid complications.

“If you google ‘diabetes’ now, you get millions of results, and while on one hand it’s great to have lots of information to hand it can also be overwhelming,” says Cameron.

“We could see we needed to do something to help empower and educate people with diabetes, and an app seemed like the natural solution.”

The app takes a user’s clinical history and uses algorithms to predict their risk of complications. It then gives them clinically validated hints and tips each day around the areas where they’re at highest risk of complications, with the aim to prevent those complications from happening.

The app is also connected to over 150 different WiFi and Bluetooth and app-enabled devices, such blood pressure cuffs, WiFi scales, and blood glucose meters.

patient at home diabetesGendius is also aiming to integrate with electronic medical records.

“We want it to be as easy as possible for users to pull data in,” Cameron says.

WIth the COVID-19 pandemic in full swing, Gendius has been looking into whether they can leverage their platform to stratify groups by risk – as diabetes patients are thought to be particularly vulnerable to the disease.

“The app could show diabetes patients exactly how much risk COVID poses to them, allowing them to plan their lives accordingly.”

The future of health

Despite accelerators like the Future of Health programme and partnerships between the NHS and pharma helping many start-ups, Deed, Mott and Cameron all acknowledge that there is still a long way to go to make it easy for health innovations as a whole to make an impact on the health service.

“The NHS has done a good job with digital during COVID-19, considering the circumstances,” says Deed. “It’s been great to see resource and support flowing into that area, for example with national initiatives around remote consultation. I think we will see more of that in the future.

“But that’s not to say that the NHS is wonderfully digital now. There’s also a much bigger undercurrent relating to existing digital architecture, particularly the use of data and digital health records. Using electronic health records much more effectively and efficiently will lead to better healthcare for all, but the health service is not quite there yet.”

Mott adds that other challenges for small businesses remain.

“We’ve been very lucky with the strong NHS partnerships we’ve had – and word of mouth can’t be underestimated. We focussed on doing a really good job for one customer, so that they would hopefully talk positively about us to other systems.

“I really believe that the NHS wants to adopt digital technologies, but if I put myself in their shoes, I can see that there’s a lot to choose from.”

Mott says that to show the NHS that your innovation is the right choice, you need an evidence base, and you need to make sure that taking on the product is as low a risk as possible for the buyer.

“You need to make sure you’re up to the standards of a digital supplier to the NHS, your cybersecurity needs to be good, your data policies need to be good, you need to be obviously solving a problem, and you need to communicate that well,” she adds.

“If you execute all of those hurdles and build a track record of delivery and credibility, it’s much easier. It’s a challenging market, but I think it’s a very receptive place if you are actually doing a good job at addressing an unmet need.”

About the author


George Underwood is a senior member of the pharmaphorum editorial team, having previously worked at PharmaTimes and prior to this at Pharmafocus. He is a trained journalist, with a degree from Bournemouth University and current specialisms that include R&D, digital and M&A.

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