Tony Young

Professor Tony Young and clinical entrepreneurs Dr Mark Martin and Dr Tom Oakley

Accelerating innovation in the NHS

Professor Tony Young, National Clinical Lead for Innovation at NHS England, had recorded a short video for the ViVet Innovation Symposium to describe how innovation and entrepreneurship in healthcare is now being encouraged within the NHS. He explained that, until recently, the NHS had had no system to support staff who had ideas that could benefit patient care and, as a result, many frontline staff had left to develop their ideas outside of the NHS.

The NHS Clinical Entrepreneur Programme was launched three years ago, with the vision of equipping frontline staff with skills, knowledge and experience from the commercial and start-up sector so that they could help address some of the “grand challenges” facing healthcare, either through setting up a business, social enterprise or charitable enterprise, or by being an “intrepreneur” – someone who worked within the NHS to bring their commercial knowledge to influence change.

The programme is now three years old, and has become the World’s largest workforce development programme in healthcare. More than 500 entrepreneurs have enrolled on it, including 360 frontline clinicians. It has given rise to 175 start-up companies, which have raised over £164 million in funding, mainly from the private sector, and impacted 17 million patients and professionals as well as generating over half a billion social media impressions.

He also reported that 106 clinicians who had left the health service have returned to it as a result of the programme. “We have turned a brain drain into a brain gain for the health service,” he said. “But all we’ve done is given people permission to be entrepreneurs within healthcare.”

There have been some “amazing” start-ups emerging from the programme, ranging from back office technologies, through to virtual holographic avatars that can provide medical advice in remote war zones. There is a lot of work going on in the field of artificial intelligence (AI), including the creation of an AI patient that responds to a doctor’s questions.

“Technology has really changed and transformed everything,” he said, “and if we expect our universities, hospitals or the centre of government to come up with the ideas that will change healthcare, I think we’re going to be waiting a long time.”

Including entrepreneurs, start-ups, frontline staff and patients in redesigning the healthcare system will bring new thinking and new actions to healthcare, he said. The NHS Clinical Entrepreneur Programme was willing to share its thinking with the RCVS to see how veterinary medicine might benefit. “We realise we need to bring everyone to the centre of healthcare if we are going to bring all the thinking we need to try and effect change and tackle the grand challenges that we face.”

Two entrepreneurs from the NHS programme then gave presentations on the ideas that they had developed into start-up companies. Dr Mark Martin, a trainee GP and founder of Set Points Health, explained that his innovation is a metabolic urine test that allows individuals to learn how their body responds to diet, exercise and medication. He said that being an NHS Clinical Entrepreneur had given him a “badge of credibility” while he was developing the test – meaning that when he approached people to talk about it, they listened to him.

Initially, he had set out to find data that could be used to design a metabolic disease prevention programme. He had partnered with a company that made what he described as “a bench top MRI scanner, about the size of a microwave” and had discovered that, by running a urine sample in a test tube, it was possible to tell the difference between an individual with diabetes and a healthy individual. This generated data to use in developing a programme to help people in day-to-day clinical practice. He “did a bit of research” and found out that, by looking at very specific amino acids and metabolites in urine, it is possible to detect diabetes many years before sugar levels begin to rise.

He wants to help people to manage their metabolic health and give them a tool that could help them prevent diabetes and other metabolic diseases. This would ease the long-term burden on the NHS. “The major challenge the NHS has today is keeping people who are living longer, healthier for longer,” he said. With medicine “moving closer to the home”, particularly when it comes to dealing with chronic disease, the aim is to empower patients to manage themselves.

To evaluate whether people would engage with his product, he developed a self-test kit and investigated four potential target markets for the test – the NHS, pharma, health insurance companies and the health and wellness industry. From this evaluation, he identified the health and wellness industry as the best entry route to the market. He is now working with health clubs to develop tools that will encourage people who are interested in their own health and wellbeing to use the test to give them an insight into their metabolic health and how their body responds to diet, etc. The ultimate aim is to develop a test that detects metabolic syndrome – a combination of diseases.

The second NHS Clinical Entrepreneur to speak was Dr Tom Oakley, a radiologist by background who is now the CEO of a public limited company that has floated on the London Stock Exchange. He has raised £2 million and employed 12 people to help him develop his product.

He explained that, as a radiologist, his biggest problem with the healthcare system had been that it was not possible to share medical images easily and that communication between clinical colleagues in different locations was difficult. “If you’re having a stroke, even in the centre of London, and you have to go down the road to another hospital for a thrombectomy, it can take up to three hours for us to exchange your images from the hospital you were at to the hospital you’re going to,” he said.

In response, he had created Bleepa, a picture archiving and communication system (PACS) that operated on a mobile phone. “You can access any medical image – MRI, CT, plain film studies, even fluoro – from wherever you are in the world,” he said.

The system also allows clinicians to communicate through instant messaging. This means that a clinician can highlight a feature of interest on a scan, for example, and ask colleagues about it.

His company is now exploring whether patients might be interested in accessing the system, which would allow them to keep copies of their scans. “Quite useful if you’re overseas and suddenly you’re taken ill and your CTs from the UK can be seen by clinicians in the States,” he suggested.

Other potential developments include incorporating AI imaging tools into the platform to help non-specialists interpret an image while waiting for a specialist opinion.

He wondered if there might be potential for the system to be used in the veterinary field, asking if members of the audience would benefit from being able to share images and whether owners might want their pets’ images.

One audience member commented that issues of liability and indemnity might arise if a vet outside the RCVS’s jurisdiction – for example, living overseas – used this type of technology to comment on images from a UK case and a problem arose, and suggested that this was a “live sandbox issue that we should perhaps be thinking about now”. “The tech’s the easy bit, right?” replied Dr Oakley, “It’s all the bits that go around it…”

He reported that his company runs sandboxes for testing and regulating AI and is evaluating some of this work with NICE and the Health Research Authority. “We will build a sandbox of 10,000 CTs and deploy the AI tool into it and we will see what the outcome is compared to radiology reports. So you get some real-world analysis of these types of tools,” he concluded.

Chris Gush

Chris Gush and Lori Teller DVM

RCVS Knowledge – Evidence into practice & Initial findings of the telemedicine study

Chris Gush, Chief Executive Director of RCVS Knowledge, gave a brief introduction to the work of the RCVS’s charitable partner, explaining that it offers a range of services to help advance the quality of veterinary care for the benefit of animals, the public and society. These include an open access journal, Veterinary Evidence, the provision of summaries of impactful research studies, a library service, and quality improvement resources such as templates for guidelines, checklists, e-learning and benchmarking data.

He also noted that RCVS Knowledge is responsible for the RCVS historical archive of veterinary literature, documents and artwork.

Lori teller
Lori Teller

He was followed by Lori Teller of the Texas A&M College of Veterinary Medicine & Biomedical Sciences, who had been commissioned by RCVS Knowledge to carry out a literature review on telemedicine. She explained that her study, which would be submitted for peer review, had been triggered by the RCVS review of telemedicine and under care, and noted that the UK is not the only country struggling with this issue. “This is a global issue, trying to master what to do with telemedicine,” she commented.

For the literature review, she had read nearly 200 articles from veterinary journals, news magazines, conference proceedings and theses, by 100 authors and dating from 1981 to 2019, with the vast majority being published between 2001 and 2019, with 84 of the articles having been published since 2012.

There is, she said, strong evidence to support the continued use of vet-to-vet teleconsulting and also teleconsulting between vets and other experts. She gave some examples of how teleconsulting has been used in these situations. Some of the studies have shown that teleconsulting is beneficial not only in terms of giving clinically useful information, but also in other ways, such as giving reassurance to practitioners, improving veterinary wellbeing, influencing how individuals practise, offering mentoring between vets, and allowing veterinary input in remote areas or for unusual problems.

Turning to the issue of telemedicine direct to the consumer, she noted that this is the area where “everybody has a lot of angst”, and that the evidence base here is not as extensive, but it is developing.

There is some research around the use of telemedicine for follow-up checks after surgery that shows that the dogs of clients who opt for remote checks are less fearful than dogs brought to the veterinary clinic for checks. Telemedicine is also being used for behavioural work direct to consumer, with good results in treating separation anxiety and issues of aggression, she said. She also cited the example of a military working dog that had become ill at a remote army post where there was no veterinarian available. Telemedicine, overseen by a veterinarian with expertise in treating military dogs, had been used to stabilise the dog before it was evacuated to a base where it could be treated before being sent back to the USA.

She went on to discuss the use of wearable technology and mobile health gadgets. There is a fair amount of evidence-based literature in this area, she said, giving various examples, including phone apps and head halters for horses that took continuous EEGs and monitored seizure activity.

Due to there not being a great deal of literature about telemedicine direct to consumer in the veterinary world, she had evaluated some literature on the use of telemedicine in paediatric medicine, as this is related in that the patients cannot speak for themselves. The paediatric journals indicated that telemedicine can be used to enable more informed decision making, that documentation should be the same as a face-to-face visit, and that many negligence cases in the paediatric arena had arisen when a practitioner had prescribed medication across state lines without examining a patient.

“So that is something that we as veterinarians can learn from,” she suggested.

Paediatric studies have also shown that telemedicine is as reliable as hands-on examination in assessing high fevers and respiratory diseases in children. Another study has shown that children are more likely to receive antibiotics for acute respiratory illnesses if they have received a telemedicine consultation than if they have presented to an urgent care centre or to a paediatrician’s office. This, Dr Teller concluded, is another area where veterinarians could be informed by the experience of human medicine.

Symposium stage with speaker and audience

Future of the professions debate

“In order to thrive the veterinary professions must become truly ‘customer-centric’.”

This was the proposition for debate at the ViVet Innovation Symposium. Chaired by Dr George Gunn, Founder and CEO of Stonehaven Consulting, the debate heard two speakers support the proposition and two oppose it. An initial vote indicated that a majority of symposium delegates supported the proposition.

The first speaker was Dr Gudrun Ravetz, a Past-President of the BVA. Arguing in support of the motion, she said that being customer-centric meant better understanding the needs of clients and, in so doing, being better able to treat animals under veterinary care and ensure their welfare. “We should be asking the client…what is your need? Where do you want to go? What I can do for you to help enable you as a customer?” she said. “That is being customer-centric.”

There were a number of ways in which to assess whether the professions were thriving, she suggested. These included whether workplaces and businesses were economically viable and whether members of the veterinary team were professionally and personally viable – that is, they were fulfilled in their roles and worked somewhere with a positive approach.

“My argument is that, if we are customer-centric, if we build that relationship with our customers around their needs, and if we enable them, we have a better relationship with them, we have a better working day, we can get better outcomes for animal welfare, and we can provide economically viable businesses.”

She emphasised the importance of treating clients as individuals and understanding that different clients had different needs. She cited examples of situations – pet vaccinations and diet/nutrition – where she believed that better understanding customer needs would enable better welfare.

But, she said, being customer-centric did not mean “blindly doing anything that the customer wants”, particularly if what the customer wanted was not in the interests of their animal’s welfare. However, unless veterinary professionals attempted to understand the reasoning behind these wants, they would alienate customers to the detriment of animal welfare.

“Ultimately, I would argue that being customer-centric allows a welfare-focused veterinary profession to thrive,” she concluded.

Opposing the motion, Iain Richards, an independent veterinary consultant, considered the potential impact of being highly customer-centric on the lives of veterinary professionals. He began by considering what the “gold standard” of being customer-centric might be, suggesting that it might be the level of service offered by a top hotel, where customers could have whatever they wanted, whenever they wanted it.

“If we take that ‘whenever they want it’ into the veterinary profession, that means the vet being available at all times. With the level of mental [ill] health that we’ve got, is that something that we truly want?” he asked.

He continued: “We’ve heard there’s a recruitment crisis in practice. I’m wondering if that recruitment crisis is perhaps driven by being too customer-centric.”

He was also concerned about the impact on clinical judgement: “To be customer-centric, we focus on the customer’s needs. It’s very difficult not to get drawn into the customer’s desires – and that is hard territory.”

The NHS was, he suggested, a good example of a customer-centric organisation, particularly when it came to patient focus groups. These were “a great idea”, bringing patients together to talk about their experiences and what could improve their experience of the healthcare system. However, members of such focus groups were often “single issue” people, “there to complain about their one thing that affected just them…they don’t look at the whole issue,” he said.

However, his biggest problem with the proposition was the use of the word “customer”. He believed that by becoming too customer-centric, the veterinary professions would turn their work into a commodity and in so doing, would undermine the trust that the public retained in them.

After hearing one speaker for the proposition, and one against, the debate was opened to the floor. There was discussion of what “customer-centric” actually meant; whether there was a difference between being customer-centric and involving clients in joint decision making; and whether being customer-centric extended to all aspects of veterinary practice. There was also discussion of whether becoming more customer-centric would encourage more people to consult vets. Another point raised was that, at times, there would be situations where what the customer wanted would not be in the best interests of their animal or society at large. In response to this, Dr Ravetz acknowledged that there would always be situations where societal good would override the wants of the customer.

Following the discussion, symposium delegates heard from two more speakers, one supporting the proposition, one opposing it.

Speaking in support, Ebony Escalona, the founder of Vets: Stay, Go, Diversify, argued that, if vets were not serving their customers, they were serving others: “By that I mean that, as a horse vet, if I’m really not being customer-centric, they will spend more time with their homeopath, their reiki person and everyone else. If I am not serving them and listening to them, Someone else will be.”

Opposing the proposition, Lynne Hill, a Past-President of the RCVS, said that, while she felt it was impossible to be a vet unless one was customer-centric, as well as considering customers, employers also had to consider the people they employed. She believed that if veterinary professionals did their best for the animal in front of them, their clients would be happy, even if the professional did not do exactly what the client wanted. “It’s very much about the pet first –doing the right thing,” she said. “For me, you look after the pet, you look after the client, and actually that helps your staff and your teams, whether it’s the nurses, the receptionists, or the vets. Because, if you’re all headed to do the right thing for the pet, the right thing for the client, your teams actually are extremely happy in where they work – and if they’re happy in where they work, my goodness, does your business thrive.”

She believed that it was important to always act in the best interests of the animal, and the professions could not move entirely down the route of what clients wanted, they got. Care was needed in how the professions moved forward to ensure the welfare of those who worked within them.

“We’ve got a lot of questions to answer in how we should go forward,’ she said. “We’ve got to remember that, yes, the client is always the client, they’re the ones that pay your wages in the end, but they’re not always right…We can be successful in businesses…by not just listening to the customer, but listening to our staff and listening to the animals that we treat.”

A final vote was taken after the speakers had concluded. While a majority of the delegates remained in support of the proposition, some had changed their opinion, increasing the number opposing it.

Guen Bradbury & Greg Dickens

Guen Bradbury MRCVS & Greg Dickens MRCVS

Precision veterinary medicine: a vision of the future

Guen Bradbury MRCVS and Greg Dickins MRCVS, use roleplay to show examples of what the role of veterinary professionals could look like if we adopt the technology advances and innovations showcased throughout the day.

Inspired by the session of the day, they harness the new ideas and innovations to give examples of what a consultation and farm visit might look like in the future.

Watch a video of this talk

Anthony Roberts

Anthony Roberts

A profession with innovation at its heart

Summarising the ViVet Innovation Symposium, Anthony Roberts, RCVS Director of Leadership and Innovation, focused on three key themes from the day. The first was changing consumer demand. The consumer of old is gone and reiterated Nancy’s message that “loyalty has been replaced with convenience”. This creates a huge challenge because veterinary professionals cannot focus solely on meeting the needs of the customer: instead, they have to deal with the complex tripartite relationship that exists between veterinary professionals, their clients and their animals.

“The vet must always have the animal’s welfare at their heart; that must be what they are focusing on,” he said, “but in order to do that, they must always do it through the client, the animal owner, the keeper.”

But, unless veterinary professionals pay sufficient attention to the needs of clients, owners or keepers, others will come from outside to meet these needs, and clients could be led to products or services that are not necessarily in their animals’ best interests. This is a complex situation, he said, but needs attention now to address the “new normal” that is emerging.

The symposium also examined the changing role of the professional, and how technology – such as low-cost, real-time genomics, or artificial intelligence – is affecting the professions. As technology takes away the need for some expert knowledge, and as it becomes clear that individuals are no longer able to absorb and process all the data that is being produced, there will be a new reliance on technology. It will be incumbent on the professions to think about how they can use technology, in conjunction with the empathy, communication and leadership skills that they have, to create opportunities to improve the quality, efficacy and accessibility of veterinary services. “We should focus on those immense opportunities that exist there and how we can embrace those,” he said.

The final theme was the regulatory challenges created by innovation. “It’s very difficult for a regulator when dealing with something like innovation,” he said. “Innovation is the fundamental mechanism through which products and services improve, but it inherently carries risk because it involves new, novel ways of working that are untried and untested.” It is difficult for regulators to find the right balance in a fast-moving, volatile, unpredictable market, but it is clear that old approaches are no longer working. The best practice currently emerging is around anticipatory regulation and finding a way of allowing innovation to flourish in a safe space so that the opportunities are fostered and the risks minimised.

Thanking the symposium speakers, he said he had been “inspired and astounded” by the quality of the content delivered. He also thanked everyone who had attended for their engagement with the day.