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Healthy Conversations brings together leaders and innovators in health care to talk about the biggest issues facing patients and providers today. Every month, we explore new topics to help uncover the clinical insights and emerging technologies transforming health care in real time.
Dr. Tony Young: The greatest medical innovation of all time are the people who work in our health services, because they help put everything into action.
Dr. Daniel Kraf...: Hi, I'm Dr. Daniel Kraft, and welcome to Healthy Conversations. Today, our guest is Dr. Tony Young. He's a urologist, surgeon, National Clinical Director for innovation for the National Health Service England, and founder of the NHS Clinical Entrepreneurs Program. We've been, uh, friends and colleagues for over a decade. And maybe we just start by, you know, asking, how did the concept of the Clinician Entrepreneurs Program come along, and what's sort of your one-to-one description of- of what it is.
Dr. Tony Young: Although I am a surgeon and I have a PhD, and I realized that I wanted to have a bigger impact on the patients than just those who were in front of me, I really had a bee in my bonnet about starting a business. So, eventually I ended up founding four companies, raising about five million pounds for them. But this was 20 years ago. And at the time, I had to fight the National Health Service my whole way to be both a clinician staying in his post as a surgeon and an entrepreneur. In America, uh, people who want to be a clinicianal entrepreneur, you fete them as heroes. You're doing something great in the healthcare and life science industry too to change patient care, but we kind of took the opposite view here. It was really tough.
And then 10 years ago now, Bruce Keogh, who was the National Medical Director for England at the time, he said, "Tony, when I come and take on this new role, the National Clinical Director for Innovation," so a clinician who led a whole nation's healthcare innovations trying to grow the life science economy in the UK become the Senior Clinical Advisor across UK government, arm's length bodies, public and private sectors and foreign governments that come and see us, and then get involved in lots of policy around how do we make our nation a real go-to place for healthcare innovation? And a couple of junior doctors, Sean Neim and Andre Chow from Touch Surgery came to see me at NHS England, and they said, "We've just raised our pre-seed road for our startup, Touch Surgery, this amazing digital education platform for surgeons. And we've been told we can either be entrepreneurs or we can be surgical trainees. We can't be both. So we've quit our jobs in the National Health Service."
And I said, "What? We can't. We'd be losing some of our brightest talent just because the system is so unflexible." So I took them to see Sir Bruce, and he was horrified and just said, "These are some of our most talented and bright, technically minded people, we need to retain them in the health service. Tony, will you go and sort something out?" So although I have no money or no formal power, which is often the way with the National Health Service, I had lots of ability to go and talk to a whole range of different people and try and win their hearts and minds. And eventually proposed that we should launch a workforce development program, but instead of focusing on the startup, we would focus on the employee, the individual, and say to them, "Can we teach you that commercial skill, knowledge, and experience to help you transform healthcare."
You know, we're the fifth largest employer on the planet, 1.4 million employees. And I just thought, if I could combine some of what you were doing in the United States with the challenge I've been given at NHS England, then why can't we create the world's largest entrepreneurial workforce development training program for clinicians who want to be entrepreneurs, learning from other systems, cross-fertilization of ideas?
Dr. Daniel Kraf...: Both of us in our clinical training were outliers. Back 20-plus years ago, I also started this online medical bookstore 'cause books were too expensive and the first internet sales were coming. And at the time, I was looked at like I had crossed eyes. "What? You're doing residency and you're doing a startup?" That was in the late '90s and it wasn't a thing. Particularly as early-on clinicians, we see the challenges and the pain points and things that should be made different. How have you seen things shift and how do you blend those mindsets?
Dr. Tony Young: Well, I think there was an inequality in the system in the United Kingdom. We always supported people who wanted to be a clinician and an academic, a clinician and a leader, but if you wanted to be a clinician and an entrepreneur, we quite frankly did the reverse of support you. And in England, we have a great history of invention, more Nobel Prizes per head of the population than any other nation, but our ability to translate them into world leading businesses isn't as good as done by our competitors abroad. So for example, people listening in America will think that Thomas Edison invented the light bulb. It was actually Joseph Swan, the professor from the Royal Institution. But what Edison did so cleverly was actually he commercialized it. Joseph Swan won the court case in London against Edison and then took it, I believe, to New York, at which point Edison did what all great Americans do, which is he bought The Swan Company, and it became the Edi-Swan Company.
It's not just about coming up with that great idea, it's about building into a business and taking it forward. You know, a startup is just, um, an experiment for saying, "Have I got an idea that works and can I scale it?" And a clinical trial is an experiment for saying, "Have I got an idea that works, and can I scale it?" And we weren't running those experiments in the NHS. The electronic patient records were coming to the fore and how did we make use of that data that was in them? Actually, when I made that case that we're going to miss a trick here, we're not gonna be making the latest greatest things available to our patients in the National Health Service in England, so patient care will improve in other parts of the world. And our patients won't getting that benefit first, they'll have to wait.
And so I managed to win the argument and win hearts and minds. We're just entering year seven of the program now, and it's grown year on year. The greatest medical innovation of all time are the people who work in our health services because they help put everything into action. When you back your most valuable asset, which is what we did, the result you can get are quite incredible. You know, we turned the brain drain in the health service into a brain gain. And I think, I want to say it's around 350 clinicians who quit the National Health Service, came back to work in it as a result of the entrepreneur programs. So people could be a clinician, whether you're a doctor, a nurse, a pharmacist, a clinical scientist, allied health practitioner, a dentist or even in support and managerial staff. They can't find anything that has grown to the scale the National Health Service's entrepreneur program has grown or produced the number of startups or impacted the patients we have.
Dr. Daniel Kraf...: Really, I mean, you have this incredible NHS platform, one of the largest employers in the world, data and systems, I know it's not perfect, but it gives a opportunity and a platform for clinicians and entrepreneurs to really integrate into the workflow and the incentive structure, which is obviously a bit different than in the US than in other places. Maybe help highlight some of the differences between the UK and the US and some of the similarities in the nut of how do you find a clinical challenge, an unmet need and solve for it and then get it implemented and scaled?
Dr. Tony Young: It's a very different system we have, you know, universal healthcare here free at the point of access. It means people are much more free to be open and share and- and the system is less siloed. It has its challenges and I think each system around the world does and its differences. But the benefit, I think, of the National Health Service, even though it is formed of many, literally thousands of different organizations, they're all part of the same whole contributing to the shared aim of betterment of healthcare for our nation. And therefore, clinicians and other people who work in the health service, when they see a problem often want to try and solve it. But they didn't have the commercial skills, knowledge, and experience. You could go to the United States and join Y-Combinator.
You know, if you're a doctor or a nurse, you're working on the wards, you're busy. To taking three months off to go abroad, it didn't really work. So I think of the secrets we uncovered was what I would call a distributed accelerator. The program runs for typically a whole year, but people tend to stay with us once they're with us, and we have nine day and a half sessions across that year. And it's much easier to take an evening off and the following day from work and come along and learn about, oh your lean business canvas or raising funding or legal and regulatory or branding and marketing or how to sell into the NHS and the rest of the world than it is to take a three month block out of work.
You know, I'm a big fan of the work Paul Yock did at Stanford in his bio design program, and I recalled saying to him, "I've just got this idea about building this big entrepreneurial program in the National Health Service, but it's gonna have hundreds and thousands of people on it." And I think Paul looked at me and said, "How are you going to maintain the quality? We have a dozen people that go through the Stanford bio design program each year." And I said, "Well, in the same way that nature does, because nature runs, you know, millions and billions of experiments, you know, in evolution and- and seeing how genes are going to, uh, mix and match and what mutation is gonna actually make the breakthrough that gives you something completely new." And I said, "If I was only running a dozen or 20 experiments a year, I would never find out, but if I run thousands and tens of thousands of experiments, then maybe we will find the one that actually works, and we can support that and then really take it to the level."
And it's kind of what's happened. So, I've taken some very great bits of the American system, such a huge healthcare market. So very often what we do in England is we test and we trial. We've got some really great universities and academic centers. We've got some great early stage grant support funding, and then we always encourage our entrepreneurs, if you want to scale, we will work with you tirelessly in the NHS, but actually you should also have a footprint in a health economy like the United States because it's such a big, uh, market. $4 trillion now perhaps of size. And I'd say about half of them, they've gained their first really big customers and partners and investors in the United States.
I don't call our entrepreneurs stunning mutations, but they are, some of the things they're doing, sort of copied nature. So I think there's a lovely relationship there between the two countries.
Dr. Daniel Kraf...: Well, you kind of foster mutations, but also encourage them to evolve and become new beings. You mentioned the Stanford bio design program. I was lucky to be part of its very first year, but I was a Bone Marrow Transplant Fellow in 2001, and what was the new concept then now, you know, amplified by your sort of mindset, is the idea that a clinician, who often sees a pain point in the clinic, in the operating room, can have an idea, and not just have the idea, but understand the lessons in building a company, the intellectual property, the regulatory systems. Not reinventing the wheel, and learning from others underneath you. And now you have a sort of an engine now of, as you are approaching hundreds of clinician entrepreneurs to kind of hone that wheel.
Maybe share a couple, uh, favorite examples. I know one plastic surgeon, Dr. Nadine Hachach-Haram, has started a very interesting platform called Proximie. Maybe that will be a good small case study.
Dr. Tony Young: We've appointed now over 1000 clinical entrepreneurs in the NHS. Between them, in the first six years, they've founded over 350 startups. They've raised over 500 million pounds between them, and impacted over 100 million patients and professionals that we can count. And you gave one great example of, uh, Nadine, who's a plastic surgical consultant. I think she joined year two of the program. And she had this wonderful idea about, I liken it most closely to the Holodeck on Star Trek that would pop up, and everyone said, "It- it's crazy." But what she was doing was taking green technology and taking a surgical expert into any operating theater around the world so they could appear on the screen, whether it was their hands scrubbed into an operation, training surgeons on how a particular technique would work without having to fly the surgeon halfway across the world to undertake that procedure.
The United Kingdom Armed Forces used Proximie in Afghanistan and Camp Bastion to take trauma experts from the National Health Service into that frontline battlefield operating theater. I think something we're gonna see other companies increasingly focusing on, and where Proximie are focusing now is digitizing their activity in the operating room, some every day thing that costs a large amount in healthcare. We had a look at this in NHS England, and it was around 20% of healthcare cost actually flows through the operating theater. It's a very analog place, isn't it, how people move around the instrumentation that's used, the steps in the operating procedure. But with the Proximie platform, you could actually recognize and see what was going on in the operation, what packs were being opened, how many people were in the theater.
And then you could start to see, well what were the outcomes of that operation and that operating team, and how long did they take? And if you can digitize it, you can measure it. And where there's unwarranted variation, then we can maybe bring in some training or support or look how we can change that around, so we can actually get the best results from surgery for everyone. So this wonderful plastic surgeon with an idea of kind of a hologram doctor that could assist anywhere, I think is building one of the leading platforms anywhere on the planet in digitizing the operating room, meaning that everyone can get the very best high quality standardized care when they go and have their operation. And that makes me just go, "Ah, that's- that's a" ...
But having said that, now you ask me to pick my favorite child. Do you know, I've got over 1000? They're our, what I call our drone boys, Christopher Law and Hamett Gilani, who were two medical students. They came to see me. They'd just won a- a European Space Agency prize. They said, "We're just drone crazy. We really want to see if we can get drones taken up in healthcare. There's such great potential. Can you help us?" The Karolinska Institute had published its work on, um, looking at using, uh, drones to transport defibrillators in- in remote parts of Sweden and showing that that could get there quicker, but no one was yet using it at scale.
I introduced them to Alex Trewby, who'd sold his company Divide to Google about six or seven years earlier, and was looking for his next step. And so a senior tech person who'd been used to that world combined with these guys, and I think they've just raised five million now towards their goal, which is autonomous drone logistics across the National Health Service, so drones operating in a national air grid that are delivering surgical supplies, transporting organs, taking pathology specimens to and from places. I'm pretty sure they've already done the first prescription drug delivery via drone in remote parts of the United Kingdom. And now they've just announced a partnership with Zipline. I mean, they've raised hundreds of millions for the work they're doing on delivering blood samples in Africa to transfusion and other things.
So, they're green drones. They're battery operated. They don't contribute to the environmental issues that we have. Could we have ground beacons and UK satellites controlling these drones, moving around this air grid? I think we could. And it could be these two medical students that came on the clinical entrepreneur program are two of the ones that crack it. But pick a subject in healthcare, and I can pick a startup for you. We've got so many. They're amazing.
Dr. Daniel Kraf...: I love that example. It's, you know, look up in the sky, the future is coming faster y- than you think, and often it's sometimes the younger folks, like the medical students who see the potential of what we've often called, you know, exponential technologies. We'll continue our fascinating conversation with Dr. Tony Young in the next episode of Healthy Conversations. Hope you give it a listen.
This transcript was exported on Feb 21, 2023 - view latest version here.
HC_Tony_Young_Part_1_HI_REZ (Completed 02/20/23)
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