Exponential Medicine 2016 – Harry Thirkettle #NHSClinEnt


Exponential medicine conference 2016


Edwards – amazing new valve technology




Robotics, 3D printing, Genetics, Precision Medicine, Functional Medicine, AI / Deep learning

They saw all sorts of amazing new projects.


A lot of the advice given by many of the innovators was not to leave clinical practice because then you lose touch with the problems at source.

Mark Hyman, Director of the Cleveland Clinic explained that we need to start looking at the causes of disease and treat those instead. The key is to find the path to wellness. One of the Cents is setting up an institute of functional medicine.

“You better Uber yourself before you get Kodak’d”


Red Ninja, Lee Omar #NHSClinent

Red Ninja: Tech design team consisting of data scientists, developers, hardware guys and designers.


They work with industry to design smart and sleek products.

Smart Transport – NWAS. How can we get people to A&E faster?

Making the traffic lights green. They spent time speaking to the ambulance service and the call centre people. What is it like to drive an ambulance. They filmed the ambulance and tried to understand their problems.


They decided the best way to solve the problem was by changing the lights to green when they needed to.

Little Moments

They designed a camera project to let parents see their premature children from home. (Little moments). This was supported by Alder Hay.


Kitchen Sense

With the Welsh NHS they are working on Kitchen Sense


It analyses patterns of use using wearables to try and help people with neurological recovery.

Light Touch

They worked with Walton hospital to build a fall prevention sensor.


This connects to a traffic light box outside the bathroom.

In Hand


Mindfulness technology to distract teenagers when they are feeling depressed. CAMHS services are now recommending this as an alternative to traditional techniques.

They were paid by google to do some work in India. Project Loon. Solution to try and get internet to remote villages in India. They are creating the apps to improve people’s health in the villages. They are working with a healthcare chain in India to improve things there.


They have grown fast and scaled quickly. 3 years ago it was just Lee. Momentum will get you going. Where they felt they didn’t excel was HR, Finance and systems development. It’s really boring but you have to do it.



The prior failures:

Prior to this he had two other startups. The first one took investment for an app. It failed because they gave away control of the company. They were unable to pay the salaries and the company was shut down. He had to pay them back over a 2 year period and he became poor for 2 years. He had to work, beg and borrow to do it.

Second startup was another app company. Was done with a cofounder from an ad agency background. There was co-founder tension because the vision was not the same. Ended in divorce. It had the glamour but it was soul-less. His background was in human rights. Had to leave it with nothing. This company eventually got sold to another company but it wasn’t right for him. Lesson – pick your cofounders carefully and keep talking to them.

Red Ninja:

Listen, Think, Do. Prototype something and keep iterating.

Use your network of peers, learn, learn, learn. Use the collegiate vanguard you have to build and grow. Most of his employees came from the voluntary sector initially and then as time went on he linked into the startup ecosystem and found good people that way. Meetup / Cofounders lab.

You have to take the jump. People want to work with YOU! It involves a collaborative approach .

Damibu – Dave Burrows’ story #NHSClinent

Social impact tech company based in Liverpool.


The founder started as a programmer. He always knew he wanted to be a programmer. Used to work in gaming after his engineering degree. He used to work for Sony doing games programming (worked on Wipeout), post ps2,3. Small studio in a big company = great fun.

He won programmer of the year and was technical director. 2008-2009 he ended up in the group deciding how the playstation network would work (he was one of 15 doing this).

Then in 2009 two top guys left playstation and he decided to leave. March 2010 he started Damibu. He knew a lot about team management, IP and programming. However, he knew nothing about business, finance so he had to transform himself into a business person.

Handsome Businessman Portrait - IsolatedHalf businessman, half hacker.


We all have a worldview.


Don’t confront that worldview face-on. Don’t underestimate others.


Don’t assume they don’t understand or come in telling them your wrong. Don’t ‘Do Business’ – people by from people not necessarily the best solution.

Do – do procurement and economics. Do Ask questions.


Do network – show your face, do plan – they use tender direct to try and find the right projects (obtain as much information from others as you can. Look at other companies and see how they got there.) Work backwards.


Legal Issues for Startups with Martin Nobel #NHSClinent

Martin Nobel @ShakespeareMartineau

Confidentiality agreement

There are different kinds of legal protection: trade secrets, copyright, trademarks, patents, trade marks.

If you tell someone else about your patentable idea they can steal it. Therefore it is best to drip-feed the information. Non-disclosure agreements should be considered but it depends on the circumstances.


Confidentiality agreements need to be framed. Why are you meeting? How long is it going to last? (NHS and govt bodies don’t like to keep things secret forever because it is too burdensome.)

Is it legally binding? Is it “subject to contract”, is there a termination or exclusivity period? Negotiation – are they just setting the scene or is this a firm agreement.

Head’s of terms documents are equally just provisional documents. Is it just a bluff?


Some things are binding. NDA’s/Confidentiality obligations in UK law is binding. There could be a 6 month exclusivity period. Speed and bargaining position all need to be considered.

NDA, Consultancy, IP licence, manufacturing, agency / distribution, collaboration and IP assignment agreements are all binding. As is Joint venture.


Memorandum of understanding, heads of terms – these are normally interim holding positions and are not formally binding.


If somebody else writes the code they technically own the copyright. The agreement needs to be clear that the contract involves exchange of money or equity for the IP (in the case of IP you are talking about a joint venture).


Joint ventures – for example the Innovation Hub joined up with Nova with a memorandum of understanding – then this was put into the articles of how the company was set up.

What are the exit provisions if the other side doesn’t perform? Not every eventuality can be covered. However, you can cover the broad areas.

Never give away more than you need to. Drip feed the information – particularly if it is out of the country. IP is like a currency that you spend around the world. It might not convert well. You can get european patents.


You want to restrict what other people can do with your IP.

Trademark and copyright are automatic to a degree when you start trading but if a logo for instance is going to be important going forward then you need to try and protect it.


The biggest danger is running too quickly into things without building the framework first.

If you do end up in difficulty then you will need legal support and a strategy to deal with it.

If a computer produces code it is the person who built the computer who owns the code. This is true for images and any individually coding that is done.

Business Planning for Success – Workshop with Paul Gaudin #NHSClinent

Without the right product and heart in the right place you will never become a multimillionaire.


The key is partnership. You need to partner in order to succeed because this will reduce the odds of failure.

You have to sort out the legal infrastructure of your business otherwise you will fail. The IP issues are massive. You will have people issues and management issues as well.

Critical Success Factors:

Start at the end and work backwards. Sense check – the outline business plan or lean canvas. What is the likelihood of success? This is something you just learn over time.

Distribution – what is the best/fastest/most profitable route to market to achieve your plan? How many mouths to feed on the way? – This HAS to be in your model.

Are you a product or a business? (If you are just a one product business then this is highly volatile and risky)

Are you in a position to pull this off. Do you really need a CTO etc? How quickly can you pull it off and are you in the position to pull it off?

This is all about patient care and these things deserve to be in the market.

What do you want to achieve?

Are you in the right place in your life? Training, personal financials, relationships, skills, etc.

Have you got the right team? (This needs to evolve along the way). Shareholder agreements when people fall out are a nightmare. You have to plan it into your business journey. As you change gear your on the cusp and red line the business. Then you solve the problem and hopefully rescue it, however, its much better to plan for this!

What is your business model? How will you generate cash.

Have you got the capital to see it through? Nobody ever has enough capital. Double everything (once the plan has come together).

Where is your market? Setting up offices in major markets – they are different all over the world! Even in China things are changing and starting to get better. There are massive healthcare markets there.

How big is it and what % can you expect to convert? (0.1% or even 0.01% is an amazing start)

The 4 P’s.

Reasons for Failure:

  • Lack of experience, (this is learned)
  • Poor leadership, (you can learn this)
  • Lack of research, (This is critical)
  • Lack of focus, (too many ideas, but lack of focus)
  • Lack of capital, (common)
  • Lack of realism, (get real)
  • Poor team dynamics, (if you don’t address the cracks it will split)
  • Wrong skills, (get the right skills and the right people. Otherwise they will be finite (which is ok as well but it needs to be planned)
  • Lack of distribution, (what channels can you use)
  • Over trading, (don’t overtrade or you run out of working capital, look at the bottom line). CASH IS KING! Planning, planning, planning.
  • Lack of innovation, (others will catch up if you become complacent)
  • No strategy (don’t be afraid to adapt to the market). It is accelerating more and more at a rate of knots. The culture is changing. There used to be only a few entrepreneurs, now there are many and this is changing the culture.

What makes a successful innovation?:

Is it worth doing? Are you providing a service solution or a product. Can I make sufficient margin out of it? Is it valued> If so how much and by whom? Who pays? Follow the wave – be a fast follower. Is there evidence or research? What is the cost and the timescale to market? Have you got enough research and capital? (DOUBLE IT!) Will you gain sufficient distribution before competition overtakes you?

For the first time businesses are having to compromise on how long it takes to get a new idea out because they can’t afford to wait any longer. Don’t wait till its too late! Plan ahead. Evidence and research is becoming less important by necessity. What is the best chance of success to impact problem x (Diabetes for example.) A lot of businesses keep a low profile with secret partnerships, and then come out of nowhere because this is a great way to succeed.

distribution, strategy, margin, time , marketing budget – These are the things people tend to underestimate.

Other tools: OGSM – The 1 page business plan. Objective, Goals, Strategies, Measures.

Business Models

Business Model is quite simply ‘how you plan to make money’.

De-risking your model:

  • Synchronise with your main client of distributor
  • Discounting, freemium, up-sell, cross-sell, etc…
  • Deploy a responsive and multi-channel strategy with different pricing models delivered against a common RRP
  • Develop a loyal test consumer group who can act as your canary in the mine.

4 P’s: Product, Price, Promotion and …

Financial Modelling:

Sales – A

  • D2c
  • Distributor
  • International
  • Licence
  • Franchise

Sales – B

  • Production Cost
  • Sales and Marketing


  • Human resources
    • Directors
    • Management
    • Production
    • Sales
    • Admin
    • Other
  • Material
    • Rent and rates (how can you best find the lowest cost rent and rates and work it down)
    • Light and heat
    • Communications and IT
    • Professional Fees – (Lawyers you have to have them, they win either way) Patents require feeding and growing. They can cost an enormous amount of money. £7million case recently – took many years (extremely frustrating).
    • Marketing and PR
    • Finance Cost

Output – D

Operating profit is C – D

Profit percentages vary per industry. R & D costs and fixed assets are deducted from the profits to generate and end of year profit and contribute to the balance sheet. Massive variations between 100% gross profit and 30% depending on industry. Revenue is vanity. Profit is sanity.

Share capital can inspire confidence.

Liquidity ratios enable you to borrow money (look this up) – Available cash you have got to enable you to cover your debts.

Valuations – what are they valuing you on? Main measures – current and potential.

Investors are interested in shareholder value (this is very different to making money). Distribution channel, number of customers, revenues, profit, product, IP, patents.

EBITDA = net profit + interest + taxes + depreciation + amortisation.
Look at the chief exec. Are they growing the business or consolidating it? Are they a 2 year CEO = probably stay away. 3-5 they might be making long term value for the business. It’s the business cycle that counts.

Case Studies:

New York bagel company. 18 months R&D. $1 million startup costs, $1 million marketing costs. Took a year to get the water content right. Good repeatable revenues, high barrier to entry for competitors because of distribution and brand. Year 1 – 2m bagels – 5 year ROI. 10 years too early – nobody knew what a bagel was. Supermarkets wanted preservatives added. If they had started at the end they might have been able to bake this in from the beginning. They had to be sold as the bread roll with the non-fattening centre because people didn’t get them.

Q Score. Total pivot from bagels. Totally different concept. Single number that gives you a cardiovascular risk. Doing in conjuction with key healthcare people. Now moved into corporate wellness market.

Carebnb and Tutella – 3 hospitals signed up to enable social cohesion back to care. We are heading towards a big change in the proportion of carers to those who need care. Japan will hit 1 to 1 by 2050. The patients now have the data. They are becoming real experts. The money is migrating to the consumer which is a good thing.

Role of the AHSN’s – Academic Health Sciences Network #NHSClinEnt



AHSN network for the North West Coast

2/3rds funded by NHS England. 1/3rd funded by industry. They act as brokers in the system and are not tied to any particular side.

There is a local board made up of 45 people including patient, government, clinical and industry representatives. They will take innovations and try to help scale them within the NHS by building products into pathways. They link to the NIA – National Innovation Accelerator. This can then lead to products going on the NHS tariff’s and ultimately saving lives.

This is a map of what they do:



They have an innovation exchange which includes:


They have scouts who help to champion various innovations:


Then then use bags to carry around innovations to perform market research.


Can UX Improve the NHS? #GiantHealthEvent

Panel chaired by Dr Gyles Morrison of Dr-Hyphen.

UX is shorthand for user experience design. It is a hot topic at the moment, particularly as ‘UX experts’ like Apple move into healthcare.


The premise was put to the group that NHS UX tends to suck. However, it is not just the user interface that needs to change but the problem needs to be looked at holistically from all angles. It’s no good if a piece of software becomes easier to use at the cost of overall utility. There will also be knock on – unexpected effects which UX seeks to solve. For instance the interface might look good and become very usable, but if the system slows down as a result this is an un-acceptable trade off. what-exactly-is-ux-design-01

Some of the panel then made the point that clinicians and frontline staff are not consulted by any of the decision makers. One of the panel members – an orthopaedic surgeon believes we need to fight back against the legacy systems we currently have.

One of the audience then suggested that part of the issue is commissioning. Managers will look for the simplest single solution that ticks the most government boxes and UX doesn’t come into it at all. He gave the example of script switch which almost invisibly switches your script around, saving money and time.


UX crosses the boundaries of lots of different sectors. The orthopaedic surgeon then told a story about consultants in his hospital being told to see patients within 14 hours of their admission. This was agreed with the CCG than the hospital would hit a 90% target of achieving this. This was not discussed with the consultants until after it had been agreed. They then realised they had a major problem – the staff had no buy in and the managers had no mechanism to actually measure their success.

The GP in the audience then argued that the problems we are trying to solve are normally artificial. We should rather be working out which steps add value to patients, clinicians and managers.

One of the other panel members suggested that the key is to solve a single problem rather than try to tackle many problems at once. I then suggested there is a danger here that we end up like the app market where there are multiple individual proprietary platforms all competing together for money. This could lead to an increasingly fragmented health service which may not serve patients well.


All were agreed that empowering patients therefore is important, but how this happens and how we cater for patients’ future needs will be key to whether or not we succeed in creating a better future for all patients or only some.

Partnership for change – What is your purpose? #GiantHealthTech

From the founder of Remington and Mallowstreet – Dawid Ahulu @Dawid1.

These companies are both about saving for retirement. Partnership for change is his latest company and is much more about societal change.

To a worm in a horseradish the world is a horseradish. If you work in finance you know about finance and everything is finance. However, in contrast with everything else this is just a small pale blue dot in a vast universe.


Why do I do what I do? Why did I get up this morning? He read Simon Sineks book: Start with Why and it changed his perspective. If you start with the purpose then it changes the whole gig.

He has been interviewing his parents the last few years to try and understand their why? He asked them what they would want now in life (in their 80’s). They wanted health, happiness and to stay at home.

Virgin Healthcare talk about health as 1) absence of pain, 2) having pleasure, 3) presence of purpose and 4) committed relationships.

Then he talked about: Dementia, Heart Disease, Cancer, Diabetes. The non-communicable diseases. Many organisations are trying to stop these things: technologists, healthcare staff, governments.

Savings technology. Oinky – moves your savings after working out your spending habits. This is another ‘horseradish’. Smart home-tech is another major field in another ‘horseradish’. Social-tech: Stitch for elderly people. Caring-tech: Cardiocity – using a sprayed substance on cars he managed to use it to detect people’s ECG patterns in an extremely cost efficient way!

His vision is for all these silo’s to connect and accomplish things together. That’s what partnership for change is about.

The ambidextrous organisation – one hand should be making the firm efficient at what it already does. The right hand should be innovating and looking for the next danger. This is what the finance industry is now looking at. Allianz and all sorts of massive finance sectors are interested in all this and they want to bring ‘purpose’ to their finance.

There is a why ecosystem and it’s important to work out where you fit into it.

The why revolution will involve integrating all these different aspects. They will all start to talk to one another.

There is also an extinction process going on. If you forget your just a pale blue dot then your in danger.

We are in the age of warp speed obsolescence.

There are ‘influencers’ but they will soon be replaced by millennials. They are connected, open, adaptable. They live in a ‘gig’ economy. People like Zuck and Bezois cross all the horseradish boundaries.

The world is changing. Figure out your why, broaden your horizons and chase your

You have to learn all the languages: finance, health, government, sustainability, civil society. Who are your 100 key influencers you need to meet in the next year? Meet them and build your network!

If you stay in your ‘horseradish’ and you don’t figure out who moved your cheese then you might be a dinosaur. If that is the case you might suffer the same fate.

Find your place.

Panel interview with senior members of some prominent healthcare AI startups #GiantHealthEvent

Data Science representatives from Eagle Genomics, Babylon Health, Touch Surgery, Myrecovery, Creation were interviewed by Cognition X.

All these companies use machine learning in different ways either to analyse the genome, diagnostic/surgical implications or helping patients directly.

All of the panel agree that AI is coming back after going through a ‘nuclear’ winter.


Eagle Genomics feel that by 2025 there will be over 250 million patients with their genomes sequenced. This constitutes several zetabytes of data. This cannot be analysed by humans but only machines. We have a burgeoning data management crisis that can be solved in no other way. We need to turn big data into actionable insights.


Babylon health say they want to make healthcare affordable to all – that is their vision. They believe in augmenting doctors and making them safer. Babylon feel the biggest need is in Africa. That is why they are working in Rwanda because the needs are so great.

They think that in the next 5 years there needs to be some sort of regulatory mechanism to govern the use of AI diagnostics. They want to improve the productivity of doctors not replace them.


Touch surgery feel that humans alone cannot deal with all the data alone. They feel that it is essential to use that data in order to learn how to make their product as good as they can. Currently they are trying to use machine learning to improve the user experience and training. They believe that the technology should also help the surgeon in the same way that power-assisted steering and GPS enhance the driving experience.


Myrecovery are analysing how their users are using the apps as well to try and predict their recovery. A lot of people complained about the US election predictions. Garbage in = garbage out. Longer term they see it as a core asset to the business. They feel that the present situation is unsustainable. We can’t compete with robots any more, we need to work with them in order to get the job done.


Creation feel that it will be essential in the future but at the present are focusing on building data sets and getting them verified by medical professionals. They talked about developing a system that could analyse a photo via a network – like instagram for medical diagnosis. They feel that doctors use social media quite a lot. Sometimes they have found doctors answering individual patients on social media. They feel the barriers are breaking down. They also sited the microbiome. He talked about machine sentiment analysis and how it is currently largely useless. Most ‘AI’ is still heavily dependant on human interaction to make it work but in the future this won’t be the case.

Then Charlie asked the panel what advice they would give to tech startups thinking about working in this field. Their advice was:

  • Get good at selling yourself.
  • You need to be in it for the long haul. (We are in the middle of a revolution).
  • Be prepared to change your business model several times.

Cognition X on the challenges of applying AI in Health #GiantHealthEvent

Healthcare is rapidly becoming the biggest market in AI. The opportunities are enormous.

Prescriptions, Surgery, Diagnostics, Drug discovery and Nursing will all be involved.

The big challenges are: Acquiring enough data, navigating regulation and privacy are the main obstacles slowing down progress here.


Zero knowledge: minimising the number of systems who have a full view of anything.

Cognition X already has 500 AI related products listed. They provide a vertical search engine for AI to find the right machine learning tools.