Branding: Adam Devey-Smith #NHSClinEnt

How do clients build brands?


The One Off (Top 10 agency). They are idea agitators. Their team is broad with multiple people across disciplines working together. They live by their promises. The biggest one is respect – you have to respect your client and your customers.

How will AI affect consumer behaviour – people are not dumb. They get what is going on and they will vote with their feet. Your brand has to stay ahead. The branding has to fit with the product.

Things they have learned:

  • Manage Risk – evolve and collaborate
  • Listen all the time
  • Don’t hang out with the wrong people
  • Well research your ideas and market
  • Good branding and communications

Don’t assume that you know what the competition are doing.

  • What’s your secret. Your story? Vision, mission, values.
  • What are your promises? (Give them something to believe it).
  • Why should I believe you? (Do something compelling).
  • How do you tell your story?
  • Where should you tell/sell it?

Is it sustainable? It needs to be more than just you and the product. Vision and love – do you fall in love with the idea?

Just GYSD – ‘Get your shiz done’

Q&A, actions, age breakdown. Ask everyone what do you think? Why you? What are your competition doing?

Big Promises: Align the vision/brand promise with the behaviour of the company – have a really strong passion!

Little Promises: ‘By 10:30 AM’ – that’s crap don’t do that.

Brand Matrices – Get these nailed down!

Do the groundwork – why are the customers here! Go back to basics and the history of ‘what the company is about’.


  • Don’t get hung up on your brand logo early on. Do get hung up on the name and vision.
  • Vision and Brand Values
  • Articulate your brand promises and belief points across all media.
  • Your logo does not need to do everything
  • Align your business to your brand – branding is a promise.
  • This will build a brand map.

What is your BHAG – Big Hairy Audacious Goal – Anita Roddick, Body Shop

The tech, fashion and sports industries are the most demanding. They want an idea now – if you can crack those industries you can iterate really quickly and build great stuff.

Spend at least a day doing this – sit down with others and beat around each others’ ideas. It is important – a VC will be looking for a sustainable business.


Make sure your pitch is understandable by investors, customers and colleagues.

You will succeed when you identify a problem that needs solving. Listen to 5 good people and your customers. When you see this as a journey you never give up!

When you get the team and customers behind you… really understanding, believing and loving your brand. (Not just you and not just your product.)


300 people, 4 centres round the world. Collaborations to build great products.

They are excited about what can be done in health.


It’s so important to be authentic. Ctrl group – Wearables, Babylon Health, Echo – hacking the service to get prescriptions delivered locally, Dr Focused – to minimise the amount of note taking in order to focus more on patient care.

‘Move fast and break things’ – but this has to be adapted in health as ‘breaking’ things definitely has limits. Patients, clinicians and designers together can achieve great things.

It’s not easy but by building bridges is key. Collaboration is more than just joint stakeholders – it’s sharing all the problems. Everyone has to care equally about each aspect.



They wanted to help people to cope with their mental health better. Depression may become the number one cause of mental disability by 2030. This is something they are passionate about.

The biggest challenge of any health app is to ‘hide the vegetables in the meal.’ This is what Ustwo did with Moodnotes. They managed to build the products in a very quick timescale.

iWantGreatCare – Neil Bacon shares a few predictions

download-17 iwantgreatcare

He explained that patient ratings are directly related to outcomes, patient satisfaction, absenteeism and cost.

Transparency drives performance. Relative’s ratings of cleanliness in hospital predicts MRSA and C-diff rates.

In 5 years time your professional reputation will be determined by what Google says about you.

Your colleagues will be threatened by your ambitions. He had to sell his house in order to start and then invested all the money he got from in iWantGreatCare. It is going well but taking time to scale. Watch this space.

Proximie – An NHS Clinicial Entrepreneur Startup


Proximie – augmented reality platform that allows surgeons/clinicians to collaborate in a AR platform.

Secure system – cloud based telesurgery. Allows you to work together locally and internationally. Crowdsourcing knowledge. Hardware agnostic. Virtually hands-on. Surgeons can reach the poorest from the richest areas.

AR is growing massively. What do the surgeons actually need? What does a consultant at home actually need?

They have now got some really diverse partnerships and have won some great awards.

She co-founded with a technical person and when they realised they were on to something they brought in a chairman and a director to make the team start to scale. It’s only when you have the idea, traction and team (with the right vision) that you can start to scale the business. They are now 25 strong! Good job!

Founder’s Story – Vivek Muthu – You don’t have to build a tech business!


Didn’t build a tech business! He built a consultancy business. You don’t have to be in tech!

He feels he used to be the least entrepreneurial person that he knew. As far as he was concerned he was just doing the normal job and then he developed an itch – so he joined the BMJ. He was instrumental in developing the clinical evidence series. That’s where he met his business partner and the business started!

It was called Baysian and it helped publishers, commissioners, NICE and others to look at the evidence for various treatments. Then they got into guideline development and gradually became digitalised.

13 years on he sold the business to the Economist group who wanted to develop a health consulting wing. This led to a good relationship with them and he still consults for those who bought his business and has developed a portfolio career.

He was surrounded by good people. He feels that serendipity was helpful. He never knew where he would end up. Find people you trust and value who are more experienced than you – you are exposed and you have to realise who you are in yourself and what you believe in / your values are.

Find people around you who at their core have similar values to you. The idea is only a small part of success, execution and diligence in execution are so important. Keep an eye on your finances, staff, culture, products. It takes absolute commitment. There comes a point where you have to make a decision: It can be destructive so you have to watch your relationships. It also requires resilience. In 2007 his business partner developed breast cancer and had to leave the business.

On the flip-side it is the most liberating thing. Like anything that is hard you come out of it stronger, having survived. They managed to build their business without investors – perhaps it wasn’t as big as it could have been but it didn’t matter to him. He is living proof that consulting is a viable option for clinical entrepreneurs.

Gastrointestinal Disease in Pregnancy


Physiology – ‘A state of Loose tubes and high roids’

The foregut and small bowel speeds up transit of food contents. However, the large bowel slows down and this can lead to constipation, as can pressure of the baby on the rectosigmoid. They have very high levels of circulating steroid hormone.


Increasing the fluid intake will often help. High fibre diet. Stop iron supplements and give reassurance.


Gastro Oesophageal Reflux Disease

Reflux becomes more common. Using salts, alginates, metoclopramide, sucralfate, H2 receptor antagonists and PPI’s can help.


Peptic Ulcer Disease

This is relatively uncommon. Do not give misoprostol (Arthotec has misoprostol in it). Treatment is PPI / endoscopy in the context of bleeding



Do not investigate long-standing IBS, only proctoscopy if needed.


Try to minimise medication use unless absolutely necessary.


Abdominal Pain (unexplained – non-obstetric)

Can be appendicicits, pancreatitis, pyelonephritis, cholecystitis, pneumonia, renal colic, iliac vein thrombosis, Budd-Chiari and almost any cause. If you need to do a test then you should do it. However, at 8-15 weeks of gestation the risk of damaging a childs mental development with radiation is higher (>50mGy’s). This is about equivalent to two pelvic CT scans.

Liver Disease

Acute Liver Failure

Acute viral hepatitis and acute liver failure in pregnancy is still relatively uncommon in pregnant mothers. However, chronic hepatitis (normally hep B and C) need to be managed by specialists. Particularly as there is a risk of vertical transmission.

Acute hepatitis E however, is becoming a lot more common and comes with a 20% risk of acute fulminant liver failure in pregnancy.


In general all pre-existing medication should be continued during pregnancy unless it is explicitly teratogenic as good chronic disease control is the most associated with good outcomes. Teratogenic medications should be changed to non-teratogenic ones in general. Beta-blockers can be used from the second trimester onwards in portal hypertension.

Inflammatory Bowel Disease

This has affects on fertility and pregnancy outcomes plus delivery options.


If you have UC – the disease is likely to reflect the pre-pregnant state (ie. if the UC was well controlled pre-pregnancy then it will tend to remain that way throughout).

Most exacerbations of inactive Crohn’s disease will occur during the first trimester. The vast majority of crohn’s patients will improve when pregnant. Fertility is more likely to be affected in crohn’s as it is strongly associated with prior surgery and the tubes may be involved.

Active disease at the time of conception is associated with an increased risk of miscarriage.


Acute flares should be treated aggressively and quickly. Medical treatment should be continued in general except for: Methotrexate, Thalidomide and 6-Thioguanine (no data) which are contraindicated [this is even the case for the partner]. Infliximab, Adalimumab, certolizumab, cyclosporin, tacrolimus, budesonide, metronidazole and ciprofloxacin are all probably safe in pregnancy. 5-ASA’s, sulfasalazine, azathioprine, corticosteroids and 6-mercaptopurine are all thought to be safe as long as folic acid supplementation is given.

When using biologic therapy there is some evidence that (infliximab/adalimumab) should be stopped after 30 weeks (third trimester) if possible. This is because of concerns Re: inducing immunosuppression in the infant.

Optimising maternal nutrition is also a major priority. Surgery should only be performed if absolutely necessary.

Previous ileostomy, colostomy is not a contraindication to normal full-term vaginal delivery.

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However, c-section is indicated if the patient has severe peri-anal Crohn’s disease and some pouches (must be discussed with surgeons).

Obscure Gastrointestinal (GI) Bleeding

Can be either overt or obscure. Accounts for up to 5% of GI bleeding (the vast majority can be found either on gastroscopy or colonoscopy.


This bleeding jet from a duelafoy is obvious, but sometimes the causes of GI bleeding can be hard to spot at endoscopy.

These are some of the more difficult causes to spot. Once these have been excluded in the foregut and colon one needs to start thinking about the small bowel.

Causes here can include:

  • Heyde’s Syndrome (Aortic Valvular Issues -> damaged vWF and vessel abnormalities)
  • Meckles Diverticulum
  • Small Bowel Angioectasia
  • Pancreatic Bleeding

Investigations might include:

  • CT Enteroclysis
  • Small Bowel Wireless Capsule
  • Red Cell Scan
  • CT Angiography
  • Baloon Enteroscopy
  • Push Enteroscopy

Capsule retention is an issue (but rare). This technology has revolutionised imaging of the small bowel.


Enteroscopy can be done with either a longer scope or a single/double baloon, or spiral enteroscopy. It is hard work and best done under a general anaesthetic as the procedure can take a long time to complete.


CT Enteroclysis


Red cell scan tends to be reserved as a second/third line test as it is not as good as the other tests above.

CT Angiography


If CT angiography fails then virtual capsule endoscopy should be performed within 10 to 14 days.

Following that the recommendation is device assisted enteroscopy. CT enterocylsis would probably be the second line option.

If the capsule is negative in the first instance normally one would try to manage the condition conservatively. If that failed then normally repeating the capsule endoscopy would be the next best option.

Sometimes bleeds cannot be treated endoscopically ie. ++ angioectasia throughout the small bowel. In these cases it is better to think about medical management with tranexamic acid/thalidomide etc.