We hear from Professor Tara Rampal, Consultant Anaesthetist, and Managing Director and Founder of QuestPrehab, a virtual prehabilitation service that prepares patients, mentally and physically, for major surgery or cancer treatment. Rampal tells us their journey in being a HealthTech founder working with the NHS, and how the space can better open itself to entrepreneurs.
I’m proud to be part of the NHS
The NHS is one of the largest and most respected institutions in the world – I’m proud to be one of its 1.6m employees – with the annual budget for NHS England alone coming in at £153bn. Despite what you might read, it’s one of the world’s top-performing and 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’.
Why I became an entrepreneur
As a consultant anaesthetist, I have a unique insight into what determines a person’s outcome after an operation. Having seen patients often not being able to tolerate the most curative treatment – combined with my late mother’s 10-year battle against cancer – 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 thought long and hard about setting up a start-up. 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.
Both the COVID-19 pandemic and the unprecedented NHS waiting lists proved to be the catalyst. I took the decision of working part time and focussing my free time to develop the framework of a digital Prehab service.
I had already developed a successful face-to-face prehab unit but wanted to design a digital service to make it more efficient and accessible to the public.
At QuestPrehab we’ve developed a multidimensional telehealth intervention. Our technology enabled method and platform addresses the challenges normally associated with delivering prehab services to patients.
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
Despite having a foot in each camp, I’ve faced numerous unexpected hurdles in dealing with the NHS and growing my business. I summarise the salient points from my experience below.
- Funding
Although the NHS is the country’s dominant provider of healthcare, it’s a fragmented organisation. The reality is it’s not a sector that’s high on the radar of investors and venture capitalists – it’s a very challenging concept to sell to investors as they are fearful and hesitant about the long sale cycles to multiple entities and return on investment. As a result, start-ups struggle with seed level funding to scale up their ideas.
2. The challenge of ‘death by pilot’
The issue of ‘death by pilot’ within the NHS arises from its fragmented nature – and in particular clinical practitioners (who utilise systems but lack purchasing authority) and decision-makers (people with purchasing authority). Often, they unknowingly adopt adversarial positions when it comes to innovation.
Often 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, leaving entrepreneurs to realise belatedly that these costly pilots have pushed them toward financial instability.
3. Hesitancy and a complex process for approval
Clinicians by nature, for good reason, are usually risk averse. There is hesitancy in being the first to try a new product. In fact, 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 the large care organisation can prove to be a formidable challenge for smaller organisations.
4. 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 regularly receive a shock when they present their models to those with purchasing power and find they have no funds to allocate.
Uncertainties around longer-term funding also makes it hard for the healthcare SMEs to attract and retain staff that require a level of assurance around their income.
5. ‘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.
6. 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 would lead promotion of innovation through cross sector participation.