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The NHS needs to constantly adapt and change to meet the ever-growing needs of the population. To that extent, we have with us Professor Tony Young, the youngest ever Director of Innovation at Anglia Ruskin University and also leader of the NHS Director for Clinical Innovation. Oh, he’s also a Urology surgeon as well. A truly inspiring individual and a man who is driving the NHS to take up new innovations, he shares his journey and vision for the next generation.
Thanks very much for taking the time to speak to us today! What originally motivated your interest in innovation?
It depends what you mean by innovation. So I define innovation as invention, adoption, and diffusion; it’s a three part process because some people think innovation is invention but it’s not. It’s the definition of new ideas so really try and start down at that end of it. When I was about six i invented a humane mouse trap so I could catch the mice that were in the garage instead of kill them and then release them into the fields because that’s what you do. As a medical student I came up with the idea for an artificial urinary stent because my grandmother had had dementia and was incontinent. At that stage I didn’t understand anything about urology and put a blood pressure cuff around the urethra thinking I had a really good idea not realizing people had invented that sort of thing. I patented it and if you believe it there was an element of my design that someone hadn’t thought of before and it ultimately got incorporated into a design that’s implanted into people today. So I learned you can invent things and do things differently but learned that if you want to make a big change you can’t shy away from the commercial world of big business. In fact if it’s unsustainable without that business model then it’s no good. In fact one of the pre-determinants of public health is how well off people are. Because that’s how can they know to make the right decisions and right choices, so generational health and wealth can be things that can go together. I was passionate about creating a business that brought those together.
So the entrepreneurial mindset, is that something you’ve had from a young age?
Some people say you’re born an entrepreneur and some people say you can be taught but I think, according to evidence, that because your risk tolerance is set in utero, your testosterone levels and risk taking bits of your brain. So I think some people are very risk-friendly and there is developmental evidence to suggest that this is why some people take more risks than others. So if some people are more apt to be risk takers and some are not, then you learn entrepreneurial skills you can succeed. So to answer your question I think you are born a risk taker, and can learn to be an entrepreneur.
What was your journey to innovation?
I came up with loads of ideas that I keep track of in a book I always have on me. I have loads of these books with dozens of ideas in them and it’s about working through. At one stage I had 20 different ideas I was working through at one time. The hard reality is though that you have to work through the basics of the business plan, what is the problem you’re trying to solve, who is prepared to help you, how much are they paying for it, how are you going to enter the market, who is going to go first, how will you prepare you minimum product, where will you take the money, can you get the orders and sell it. All these things you have to work through. Eventually I got through the age of 30, became a PhD and started my first formal company then, which was a company for medical device development and innovation. The first product was a device was for advancing endoscopes around the colon, the second device was an endoscope sheath for cystoscopes, and that was the product I had to remortgage my house for £150,000. That was a real commitment, as I didn’t have the money, and needed to put it into the business. You can’t give up at that point, that shows the risk taking you have to be okay with. You cannot not have a roof over your family’s heads.
Since then I’ve worked with four startups all with private sector funds and some went well some were disasters! I think failure is when you don’t learn from a negative result so it’s fine to have a negative result, you have to have them. You have to have a safe place, especially in health care, in order to learn from these results. We don’t talk about them but we really learn from them and it’s unfortunate. We should learn when things go wrong and talk about it as well so then we can improve upon it. After those businesses I finished my training at Guys, I had a PHD in Neurology Physics from UCL and I thought I would end up in a big teaching center, but the one I want to for an interview said we really like you as a clinician, but you’ll need to leave the companies behind and I thought – ‘I cannot do that, I’ll lose my house, my wife’. The next job that came up with Southend, which I didn’t expect to work for, said please come work with us and show us how you do innovation and enterprise, so I went there was a consultant 10 years ago. 2 years ago I met the Vice-Chancellor at Anglia Ruskin University, who got my vision as someone who wanted to, through innovation and enterprise, help make healthcare better for everyone on the planet.
Was that a chance meeting?
No, he knew I was doing innovation at Southend hospital and wanted to leave and he wanted to start a fund to help staff invest in their ideas. He asked me immediately to dinner to discuss it. I was expecting a 1 on 1 meeting, but there were 12 professors sitting around the table grilling me! I was shocked about what was happening and was upset because at the place we ate dinner you weren’t allowed to bring bags in and I had brought all my inventions with me to show him what I had been working on and implemented and I was proud of.
Afterwards I couldn’t figure out why I had been invited but on the train on the way home i was on the tube with one of the Pro-Vice Chancellors and asked him if I could show him my inventions in my bag. Everyone on the tube carriage was looking in horror at these medical devices I was showing! Turns out I had done OK at the dinner, but they weren’t convinced and it wasn’t until I started becoming enthusiastic on the tube ride back with the Vice Chancellor showing him what I had done that they reached out and realized I was what they were looking for. I ended up being the youngest surgeon being appointed to the Chair, and it was that fateful train journey that convinced them. I’ve been at AU for nearly 8 years now, and helped them deliver their innovation and enterprise program to help them raise half a billion pounds to build out science parks and tech campus. About 12,500 new jobs will be created from this and turn over £1.3bn.
Is that from the companies that are starting up within the new science park?
Some of them are starting up within the university but many are just technology companies looking for a home. We’ve got our best startup called FutureNova and they design something called a flip–pad which is a resterializable case for your iPad so you can bring it into an operating theatre. They now have 3 factories building these and sell them worldwide. We wanted to make this place the go-to place for innovation and lower the barriers to make things happen.
About four years ago I was approached to be the Clinical Director for the Health Services of England so there wasn’t a job interview or anything they asked me to come and do that for the nation so I’ve been working with them for more than 3 years now. I was asked to drag the Department of Health into the direction of the future because they wanted to be more proactive in testing and trialing ideas and bringing new ideas and action. The priorities of this department were to look at the inequality gaps, help grow the size of the UK life sciences economy, be an advisor to the Department of Health with companies and foreign governments. The last thing he told me was I want you to make England the hub for medical innovation and power – oh and by the way we have no money to fund this, off you go! It sounds impossible doesn’t it? But I don’t mind.
Since then I’ve pitched a number of ideas to the executives and they’ve supported them and one of them is the clinical entrepreneur program which has become the world’s largest entrepreneur program for clinicians. In year one we had 104 clinicians and junior doctors, but now it’s all clinical professionals can apply. In year two we have 230 now, and year three looking to double again. We provide them with commercial coach and mentor, a range of networking and educational events that they can attending, connect them into sources of funding, we also help with a number of internships all in an attempt to make this a workforce development program that teaches the commercial skills, knowledge, and experience to help them take their idea forward as a company. Ultimately they want to become entrepreneurs and improve the health sciences community.
So this is also a sort-of accelerated incubator?
It’s a wholly consistent idea that supports both new businesses and very far along businesses. One of our companies has gone public already, I believe they raised $20m recently and have around 100 employees. But you also don’t have to have a great idea or a startup to come on the program, you can just want to learn the skills. In year one we have 104 people and 50 startups and over £50m in funding raised by them during that first year. This created about 360 new jobs, over 5.6m patients and professionals impacted by the innovations that came out of these startups. An example of one which was amazing was called GeekyMedics, Lewis Potter founded it, and now gets over 200,000 you tube views a month. If you count his figures on all the social media it was several million, which was almost unbelievable. At one point he was the most downloaded medical educational program on the planet and he started all this as a medical student.
Year two we more than doubled the number of participants and opened it up to everyone and it keeps growing from strength to strength. It’s really interesting to watch and see these bright young people grow. You may come onto the program thinking you’re going to make the next best this or that but find out that it’s already been tried and by coming onto the program you can accelerate your business plan by just learning from others what has and hasn’t worked. You end up learning from the other people in the program and end up even possibly partnering with them. It happens frequently the program where two startups with partner or combine forces.
Do you think you could ever open up the medical entrepreneur program to medical students as well?
It is open to medical students now! We have a few in now and then the next round is opening in January. Anyone can apply from medical student to retired clinical staff you just have to have an active link or relationship with the NHS. We will soon open it up to patients as well at some point as long as they are linked with the NHS. There has to be a benefit to the population so no private businesses are allowed to come onboard.
So a slightly controversial topic is the funding of the NHS. Some people see it as a benefit that means only the best innovations get through, therefore the most viable, but it also means that the NHS is slightly risk averse – what is your take on the balance there? Is the way the NHS is funded conducive to innovation?
The currently funding model in the NHS is a commissioning based system which distributes the funding centrally from the Parliament. Parliament each year authorizes a budget for the NHS which then goes to the department of health which gives a majority of the funding to NHS. The chief of the NHS is given a fixed amount and then he has to provide healthcare for the national of England from the amount he was given which is around £120bn. There are a few things that he commissions nationally himself, but the majority of the money is given out to clinical commissioning groups who then commission local services through a tariff based regime for secondary care.
It used to be population-based, where you said how many people you had, what their needs were, and then you got money based on that. So what we’ve done within the system is build in a number of things now that are meant to help innovation, one of which is the innovation technology program, which looks at innovative ideas that the NHS thinks are good and they are then evaluated and it’s decided if they should be available to everyone across the country. We have found a number of ways to help that work one of which is purchasing devices to put in the procurement catalog so that people can buy it at a reduced price since you are buying as part of a bulk order instead of just ones or twos.
Another way is paying for things directly, so the my COPD app which is on the National innovation tariff will pay up to 20% of your population with severe COPD. So you are able to test something at scale to see if it will really work and if we think it will then roll it out to the whole population. But it’s not just money, it’s how you train the staff in using the innovations. The Walter Report said it’s not just about buying new loads of IT it’s taking it out of the box, turning it on, and teaching people how to use it. Innovation is a complex thing in that it’s not just about creating the thing it’s about teaching people how to use it. For this reason funding on it’s own isn’t the key answer to innovations.
I would reverse the questions around, not are the procurement models right in the NHS, because they can always be changed and adapted but I think you should ask how can I best get my idea taken up with the NHS in the first place. And I’d say first make sure you’ve identified a real pain point, something that is really keeping people awake at night. Then people are prepared to find a resource to solve that problem. I call it getting on board trains that are leaving the station. By that I mean areas in the public sector that have been identified as key issues and we need to address that have been given budget and funding resources to make that happen. So if you get on board that train and help them solve the problem you’re much more likely to get your idea to happen than if you going in the opposite direction where there is no funding or national imperative you’re going to really struggle. You need to align yourself with what is going on what and what they key priorities are. Often you can make innovation work in sync with key priorities that the NHS needs to deliver on. If you can do that, and it’s not easy, here or in any country, but very often you can get your idea to have some traction if you follow those steps.
What do you think will be the biggest thing to hit the NHS in the next 5 years, AI … blockchain…?
Technologically speaking there are a whole range of areas and I have just written an editorial for the new statesman, who is putting out a healthcare and technology supplement in the next few weeks I summarize really nicely the key areas since I don’t think there is going to be just one area, there are a number of areas that show real promise. I think AI, including algorithms and machine learning, deep learning. There is a lot of hype in that area but there does seem to be some real promise and lots of advances have been made in the last few years, particularly around natural language processing. This affects beyond translation and goes into radiology reporting. There are notable public announcements about ‘we’ve got the AI doctor and what have you’ and I think we’re still some way from it. I don’t see it as replacing clinical staff, I see it as freeing them up from routine administrative tasks that they do which would allow them more time to spend with patients.
Data analytics and big data lakes are another area where we can improve – how do we use all the data we have to improve care. Genomics is another area, i think 100,000 projects are underway and we’re starting to see real benefits from that. I think this country has the best chance on the planet of delivering personalized medicine for our patients. We have a pooled risk model in the NHS so we don’t have the same issues of worrying about insurance premiums going up based on what is found in your genes. Personalized medicine and genetics will have a big role to play in the future. Robotics will also have a big role to play as well, partly through AI but there are a lot of advances going on in that area such as Pepper the Robot that goes around your apartment and if it hasn’t seen you in a few minutes it can knock on the door and ask you if everything is alright and you can let it know if you need help or not. There will be a number of ways these robots will be helping they of course help us now in surgery. Companies like Johnson & Johnson are investing in these robots to assist in surgery so I think that will be a big area for the future. Patients will continue to see more and more technology around them and it’s not just the fitness trackers where they can see their stats it will be in home diagnostics, or wearable sensors, platforms or apps for specific conditions, clip on devices for your smartphones that can do a whole range of different things, there is the Google contact lenses that detects your glucose, or drones that respond to medical emergencies in remote areas.
There’s definitely a lot to look forward to in the future! Thank you so much for your time.
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