When the coronavirus took hold in the UK in mid-March, the team at DrDoctor, a health technology start-up co-founded by Tom Whicher, Perran Pengelly and Rinesh Amin in 2012, decided it would focus all of its energy on helping the National Health Service.
DrDoctor automates appointment bookings, cancellations and referrals for more than 30 NHS hospitals across 20 trusts. Within hours, the team had started building digital tools that would allow hospitals to broadcast in large volumes about changed and cancelled clinics as all non-essential appointments were put on hold. At the same time, they started working on a series of remote consultation tools to allow people to reach their doctors by video or phone.
Three days later, the broadcasting function had been used to reach 150,000 patients. A week later, the remote consultation tools were rolled out to hospitals.
Mr Whicher says after eight years developing the app, he’s never seen the NHS move so quickly. “In this crisis, hospital teams have stepped up in a way that is incredible,” he says. “Hospitals are on the front foot here, they are being really proactive and taking the change management into their own hands. It’s being driven right from the top.”
Medical start-ups say that the coronavirus has been like a phase transition for the NHS, digitally transforming the famously slow-to-innovate service after decades of inertia.
Historically, responsibility for digital, data and tech was split across different parts of the NHS. In 2019, the NHS launched NHSX, a unit intended to bring together all these functions and speed up the pace of change. “Everyone knows how hard it’s been to get the NHS to adopt the best in digital,” Matt Hancock, the Health Secretary, said at the time of the launch. NHSX “will remove red tape and create a culture of innovation.”
On March 23 the UK government advertised a £500,000 fund to find digital ways to support people who need help during the crisis, offering up to £25,000 per company for solutions to providing remote social care, coordinating volunteers and improving mental health support. Matthew Gould, chief executive of NHSX, committed to rolling out solutions “within weeks”. “Tech can play an important role in helping the country deal with the challenges created by coronavirus,” he said.
The NHS is already using an adapted version of GoodSAM. This platform was initially set up to alert medical professionals when someone near them goes into cardiac arrest, so they can administer life-saving treatment while an ambulance is on route. Now 750,000 members of the public have signed up with GoodSAM to volunteer to do simple but vital tasks for the health service.
Many other founders and entrepreneurs are rapidly adapting their platforms to the present crisis. James Flint says Hospify, a GDPR-compliant messaging platform he co-founded to replace WhatsApp messaging among medical professionals, had been going for five years by the time it was admitted to the NHS Apps library at the end of February. A week later, coronavirus hit.
“It poured petrol on the fire,” Mr Flint said. “We are adding thousands of users a day at the moment.” The basic version of Hospify is free for users. Hospify makes money from its premium version, Hospify Hub, that allows administrators to set up authorised chat groups and broadcast messages and surveys to teams.
“We have beaten all our targets for the year in the last week,” Mr Flint says. “We have set up an online call centre in a week. We have doubled our development side. I’m hiring people I’m not even meeting.”
The recent focus on innovation in the NHS has hastened the adoption of start-ups such as Patchwork, an app that allows healthcare workers to access flexible shifts while reducing NHS reliance on agencies to fill vacancies. “Most of us innovators in the NHS have gone through ups and downs,” Anas Nader, Patchwork co-founder, says. “It’s a challenging journey, especially when you are in a market that has established businesses. New players will find it hard to navigate.”
Since coronavirus hit, Patchwork has seen an increase in demand for temporary staff from all its current NHS partners. It has also been approached by other trusts and the company has responded by building digital and regional banks of staff to rapidly fill vacancies at hospitals, providing support services, free of charge.
Paul Miller is managing partner and chief executive of Bethnal Green Ventures, which invests in start-ups that have a social purpose. Mr Miller says the present moment is an opportunity for founders who are focused on solving real problems. “Certainly over the next few years we’re going to see the public sector needing tech in a way it hasn’t really accepted before,” he says. “The corollary of that is that the public sector needs to want to work with start-ups in procurement processes.”
Founders are optimistic that the demand for tech within the NHS during coronavirus heralds the start of a true digital transformation. “We’ve been talking about this for two decades and no one has been able to make a decision about anything,” Mr Flint says. “And in the last two weeks, decisions have been made. Now suddenly, instantly, it’s happening — and it will never go back.”
Investors: a supporting role
Healthcare start-ups may find it harder than usual to raise funds given the downturn in capital markets, according to Nathan Elstub, chief investment officer at Nesta, a foundation that supports innovation. He says most of the investment market is disappearing right now, adding that “a couple of the companies that we have invested in have got revenue challenges”.
The government’s interest-free business interruption loan scheme — intended to support small businesses while trading is uncertain — might be appropriate for some, Mr Elstub says. But it is less suitable for early-stage start-ups. “[Start-ups] need money not because they have delayed income but because a hole has appeared in their books,” he says. “Filling that with debt is a challenge.”
Paul Miller, chief executive of Bethnal Green Ventures, says early-stage investors have a key role to play: “A downturn is a good time to invest in start-ups because you’re working with small companies that can be nimble and are then poised for growth.” Mr Miller knows first hand how an economic downturn can affect a start-up. His own venture, a marketplace for adult education called School of Everything, was unable to raise Series A funding to keep going after the 2008 financial crisis. It eventually folded in 2011.
“People are worried that the angel investment market is going to suddenly stop because individuals are being hammered by the market,” Mr Miller adds. “There are no immediate problems, but the worries are about those pre-seed, angel investments coming through in the next 18 months. It’s a worry [for those start-ups] as they don’t have much in the bank.”
Despite funding challenges, Mr Miller believes start-ups are uniquely positioned to respond to the present crisis as they are often smaller and more agile than legacy businesses. “It’s easier to turn around a start-up than it is to turn around an airline,” he says. “Getting that leadership together, thinking about how you can help in this situation is a very good tactic for survival, rather than battening down the hatches.”