Toby Stone @theonlytoby explains accelerators #NHSClinEnt

Toby Stone just explains the what, how and when of accelerators.


In a nutshell they should be a good fit for your business before you join one. You shouldn’t do one if your main need is simply capital. They may take equity or some other parallel. They provide you with mentors who have been through it before. Ideally this mentor and your investors should have specific knowledge but also general knowledge that you don’t have and can benefit from.

An accelerator like an investor is way more than just the money and you should spend time trying to find a good fit. There are some specialised ones.

SeedDB is a great site that lists them all but they are constantly changing. There are some more specialised ones like Healthbox and TechStars

A note on Crowdfunding: Seedrs will manage the crowfuding investors for you, Crowdcube won’t.

One of the best ways to fill your funding round is to use different platforms at different times to lure in different kinds of investors at the right times. For instance Kickstarter is really useful to raise awareness if you have a hardware product. Then when, your round is filling up it gives you momentum and clout when talking to angels, however, this is only one example and every different situation will require a different strategy.

Thanks Toby.


John Spindler @capenterprise on the Lean Startup Method: Part 2 – The Customer. @ #NHSClinEnt

‘Make something people want’ – Paul Graham, Y Combinator

Avoid wasting too much time trying to change the ‘stuck’ middle who don’t want to innovate because they are very good at using the current system. Are your people your assets or your problem?

Before building your business ask: What problem would someone else solve for me?

Another thought: The number of secrets in the world is roughly equivalent to the number of startups we need.

How did the companies that are currently successful scale. When you scale big you win even if your product is inferior. Unless you can bring 10* value you are unlikely to be able to displace an incumbent. (As per Peter Thiel).

Design Thinking: He would thoroughly recommend we all do Stanford’s online course on design thinking (8-10 hours). Emphasise, define, ideate, prototype, test. Do it in groups if you can. Great course

‘Kick Ass’ products have evidence that they solve a customers problem in a big market. Focus on the early adopters. People you can beta test with. Commit 5 people. They need to know they are aren’t buying a perfect solution.

They are trying to find a home made solution. They want you to succeed, they will give you their time and honest feedback and you have a relationship of trust. Your mum is not one of these first customers!

Do you know the demographic? Needs and goals? Problems that need solving, Present behaviours? How do they go about solving those problems? Reference group? The behaviours and the psychology are key.

BJ Fogg. Head of behavioural theory at Stanford. B=mat. B=behaviours, m=motivation, a=pre-acquired ability, t=triggers (we are all contextual. We need external triggers to get us to change our behaviour. Every product is a behaviour change. Activation threshold affected by these three things, the triggers have to be enough to get them over the threshold.


Source: B.Fogg (Stanford) Site as per diagram.

Can you make something better than it already is, make something simpler. In an ideal world how would this problem be solved. Better, Simpler or emerging.

John suggests we build 5 actual profiles of people. The more specific the better. Motivation, Habit , Income, Age, Location, Status, Backstory.

Understand the full use-case lifecycle.

You need a hipster (domain insight), hacker (builder) and hustler (the first two work for him for free!).

Source: Capital Enterprise – John Spindlercap-enterprise-full-case-use-scenario

What do these personas do when ‘triggered?’

Entrepreneurship is a career. Startups are risky experiments. You don’t have to experiment full time. Start today with what you have.

Suggested reading: Moms test by Rob Fitzpatrick, Running Lean by Ash Maurya and Lean Startup by Eric Ries.

#NHSclinent. John Spindler @capenterprise talks about lean startup methodology – Part 1

Brilliant start to the clinical entrepreneur programme. @Tonyyoung and @theonlytoby introduce the programme (below)


Building a culture of entrepreneurial strength should be at the heart of what we are doing.

John Spindler @capenterprise – Lean Startup

Why bother starting a lifestyle business if you are a doctor. You have so much value and you want to share that with the world not just make your life easier. you don’t want a checklist business!

‘Big will not beat small anymore. The fast will beat the slow’ – Rupert Murdoch. Even he is aware of it.

Where can your business be in 12 weeks?

‘There are hidden gun’s in peoples garages which contain bullets with other companies names on them.’

‘Think big, act small, fail fast, learn rapidly’ – Eric Ries


As an investor, John Spindler finds the lack of background research by entrepreneurs to be one of the most commonly encountered frustrating problems.

2 columns:

Fact column- 2-3 facts you KNOW about what you about about do with this business.

Second column- Hypothesis. What things do I need to know to build this thing?

What is your OPPORTUNITY HYPOTHESIS. Build, Measure, Learn. Call it a project rather than a business because it is easier to fail fast. Like the psychology of this.

Experimental stage, metrics, evaluation leads to excellent execution.


Don’t build something nobody wants!

3 types of advice: validated and negative (in 8 weeks you can test it and see if it works. Good or bad it will help)

95% of advice is useless in the next 8 weeks. Shelve it because it’s useless.

Lean is just about organising the chaos, reducing waste and risk, providing more learning and a common language. IF your core assumption is wrong you need to test that FIRST. Then you will save yourself a lot of time.

It’s a common language. There is jargon and as soon as you learn it you can communicate with others – be ‘in the club’ as it were.

If you are going to build do a lot of thinking. Then build the thing that teaches you what you need to learn.

The number one thing an investor will look at is the team. If you can convince a quality person to join you that is a sign of successfulness. If you can recruit a quality army this is your number 1 asset!  What quality of ARMY can you recruit? Investors will care about this more than anything else as it is the biggest determinant of success.

Get OTHERS to validate your product. Your own validation is not that valuable but multiple external validations are.

A good hypothesis is simple & clear, written as a statement, establishes participants (who), variables (what’s involved) and prediction of an outcome (evidence).

The Pepsi Challenge type scenario is NOT the right first validation exercise. You have to assume that the first answer is wrong. Ask 5 why’s eventually & you might get to the nub of it. AVOID CONFIRMATION BIAS like the plague.

Most people are NOT early adopters in ANYTHING. Most people have habits that are very hard to break.

MVP is not a crappy version of the product. It is a prototype. Consierge MVP is legitimate. It can be a simple landing page, it can be a proof of concept, it can be something for people to engage with, it can be a paper prototype, a pitch, fake demo video, or something to help a developer to understand. It is just a way to answer the questions you need to answer.


Consierge means it is not scalable. It’s just there to allow you to learn. If your hypothesis is circular then its not a hypothesis.

Key assumptions: At least several other people are working on the same thing right now. How you think this your business idea will work is probably wrong. Your main job is to learn faster than the competitors. That is why the team is the key. It is the process and the people that win NOT the product itself.

The market is not stable and anyone who doesn’t keep moving forward will fall behind.

Call it a project, give it a name, sell something, convince someone else to join, set a goal that will inspire you, live 6 months in the future, fall in love with the problem and not your solution. Follow Peter Thiel’s philosophy as per ‘Zero to One’ (find it on Amazon its a good book.)

Don’t call it a business because you will overprotect it. Call it a ‘project’. Get people to devote time to your thing.

There are two types of teams. Napoleon team – they will follow your every command. The best teams however are people who are smarter than you and can do things you can’t and you bring them on the journey with you. They don’t want to just be footsoldiers for your army.

Paul Graham- You need three things to be a successful entrepreneur – a great team, proof that customers want it and a willingness to do it with minimal money!

Then questions:

Do you invest in startups who don’t use lean methodology? Yes but its rarer. Sometimes people just get damn lucky and hit a home run of first base but its the exception rather than the rule and it might not be repeatable.

Then he talked about financing and how ‘founders fit’ and how investors look at these things. Do you have someone resourceful, someone who can do x and y. The team you build now might well not be the team that takes it to the next level. Identify the task in hand and see if the team members can get you there.

Funders and investors must fit. An investor should never distort the function of the startup because this is your task. You have the hands on the controls. They are investing in you!

Thanks John.

Why Healthcare is becoming so Unhealthy



I am a medical doctor who has been practicing for 6 years in the British NHS.

The NHS is a great institution. It has brought help to anyone at their point of need for over 68 years. Founded by Aneurin Bevan on 5th July 1948. Built as an instutition by the people, for the people it has certainly been (historically anyway) far from the insurance based systems of the US or the more industrial-type approaches of some other nations towards health. Quite rightly it is something that British people remain proud of.

Acutely Diseased?

However, it was founded at a time when acute illness was more common than chronic disease. It was also founded on a flawed assumption that if you made everyone better then the population as a whole would be healthy. This is unfortunately only true in part; as we are now painfully aware — if you make people better from their acute illness then eventually they live long enough to develop chronic diseases which are not so easily ‘cured’.

You see hospitals are not (and never were) really built for managing chronic diseases. As soon as you take away the specialist hospital input on discharge that person is still left with the problem but has to deal with it largely alone. At this point a hospital building is of limited use.

What, so doctors aren’t special anymore?

Essentially in a word, no. (There you go I have done it). Back when there was no alternative people just accepted it. However, a second key change happened in 1989 which sowed the seed which would eventually change that. When Tim Berners-Lee (disagree with me if you want to) came up with the world wide web the possibilties this would lead to were unknown. Still 27 years on they are largely unrealised, but in 1998 Google made the web searchable (again feel free to disagree); only now are we starting to feel the full effects of this seizmic change.

What this primarily means is that information is now cheap and free (as evidenced by things like books which fortunately for Amazon they foresaw and now sell us everything else instead). It is not just bookshops and libraries who were affected by this seizmic change. Professionals and businesses of all kinds are continuing to see the value of their ‘knowledge’ diminish while their clients knowledge continues to increase and ‘unqualified’ competition stiffen.

The responses to this have been various but in many ways dysfunctional. By focussing even harder on what worked in the past many professionals of all shades have literally driven themselves out of business (look at some taxi firms and Uber for instance).

In Medicine the reaction has been very mixed. Whilst I welcome some recent intiatives to improve patient engagement and make services more patient focussed, these efforts have frequently yielded mediocre results as they are actually glorified customer-focussed data gathering exercises rather than change engines. Such a missed opportunity.

Regulations, Guidelines, Procedures, Repeat

In addition to this in my short 6 years of medicine I have witnessed a stifling increase in regulation to compensate for poor performance. This has largely consisted in the rise of a very rigid system of regulations and checks. This has had the effect of improving the very poor performers at the expense of the best (as in teaching and other public services).

No organisation can really excel if it is constantly trying to meet (sometimes arbitrary) targets. (At this point I must make clear that there are lot of hospitals doing a very good job despite the overwhelming bureaucracy – (I know because I have worked at some of them). However, this doesn’t change the fact that the good is the enemy of the best 1; and you will never get to the best if your efforts are just focussed on meeting targets (WHAT you do?) and improving processes (HOW you do it?). The key is WHY? 2

Why is Why so important?

And this is the problem as I see it: As a country we have lost our healthcare WHY?! The reasons are many but we have become defined by WHAT we do and HOW we do it rather than WHY we do it. If we really cared about WHY we do it then we would do it differently because our still largely acute-illness focussed, pre-internet model of care isn’t working that well anymore for the majority of patients with chronic diseases they have looked up on the internet.

It’s time to stop paying lip service to patient-centered (particularly outpatient) care and start practicing it. You see what we primarily don’t need in my country is a insurance driven model of healthcare, rationing, more doctors (although this would be a nice luxury), more nurses (again would be nice but is not the key) or more fads of management, structure, technology and applications. Instead we need to rediscover our WHY and with it our empathy, compassion, patient-centeredness, team-spiritedness and drive to continually make things better beyond the point where it is about money.

Theirin lies the future of healthcare for anyone who wants to catch the vision. I predict it will be 20 years from now before this really starts to catch on.

If you want to join me in pursuing this? Connect with me on LinkedIn or Follow me on Twitter (I’m a human I prefer connections). If it is not an automessage I will read it. (unless its abusive in which case I won’t.)


1. Jim Collins: Good to Great.

2. Simon Sinek: Start with Why.

Nasal bridles help save lives

This is my poster for the BSG2016. It’s not quit as straightforward as I’m making out but we did find that bridles helped in our elderly cohort.