The challenges of being a medical entrepreneur dealing with the NHS

I’m proud to be one the NHS’s 1.6m employees – and despite what you might read, it’s one of the world’s top-performing and the most affordable healthcare systems.

However, as a founder of a telehealth SME, I’ve come to the view that it needs to be more ‘entrepreneur friendly’.

As a consultant anaesthetist, I have a unique insight into what determines a person’s outcome after an operation. I became interested in prehabilitation (prehab) as a way of getting people as mentally and physically fit as possible in advance of an operation and / or treatment.

Put simply, prehab allows patients to use the time between their diagnosis and treatment to improve their health – and in doing so, they experience quicker recovery times and fewer complications.

I’ve always been passionate about the potential of using digital tools in changing the healthcare landscape and I wanted to do something that addressed some of the most common challenges in modern healthcare.

At QuestPrehab we’ve developed a multidimensional telehealth platform which offers cancer patients support and guidance in four key areas - physical fitness, mindfulness, nutrition and lifestyle support. Our method is scalable and cost efficient. To date we’ve worked with over a thousand oncology patients, successfully helping them prepare for their surgery or treatment for a fraction of the cost of the traditional models.

The challenges I’ve faced

I’ve faced numerous hurdles in dealing with the NHS and growing my business including:

(1) Funding

The NHS is a fragmented organisation and not high on the radar of investors and venture capitalists who are fearful and hesitant about the long sale cycles to multiple entities and return on investment. Hence, it may be challenging to receive VC funding for an enterprise that has NHS as a target client.

(2) The challenge of ‘death by pilot’

Often front-line clinicians such as doctors, allied health professionals and nurses recognise the advantages of specific products and services and express a strong interest in their implementation. However, lacking purchasing authority, they resort to requesting pilot programs.

In response, start-ups agree to these pilot initiatives and provide funding with the expectation of potential commercialisation following a successful pilot – unfortunately, this commercialisation rarely materialises.

(3) Hesitancy and a complex process for approval

Clinicians by nature, for good reason, are usually risk averse.

Hesitancy and multi-layered approval processes are prevalent issues within healthcare, primarily driven by complexities and a fear of failure. This lack of coordination often results in significant delays, confusion and inconsistent decision-making. There’s often no clarity for clinicians in terms of intellectual property, data management and licencing.

Consequently, from an external perspective, engaging with and collaborating effectively with a large care organisation can be a formidable challenge for smaller organisations

(5) The distance between policy and coal face implementation… and the distance between commissioners and service providers

The Department of Health and the NHS announce policies but often fail to fund them adequately. Start-ups that deliver / frame projects in accordance with these decisions may regularly be disappointed when they present their models to those with purchasing power and find they have no funds to allocate.

(6) ‘Homegrown’ vs off the shelf solutions

The ‘Not Invented Here’ syndrome when employees or teams resist external solutions in favour of developing their own is prevalent in the healthcare sector – it leads to inefficiencies, slower innovation, missed opportunities and a closed culture. There’s often an unspoken fear about implementing or integrating solutions developed by outsiders, even if they’re more cost effective, flexible and impactful.

(7) Proof of a RoI

As prehab works on the principles of preventive health, it’s challenging to put a price on complications that didn’t happen. Health care is used to fund for interventions, for treatments to address things ‘that happen’ - it’s a paradigm shift to focus on value measures that prevent ‘things that didn’t happen’.

To address these issues, the NHS needs to promote a collaborative culture, emphasising results over the source of solutions, recognise external expertise, evaluate costs and benefits, and have leadership support for open-mindedness. I hope the developing landscape of Integrated Care Boards will lead to promotion of innovation through cross sector participation.