In March 2022, Musical Health Technologies (where I am founder and CEO) was invited by the Yorkshire and Humber Academic Health Science Network (YHAHSN) to attend the first Propel@YH US Bootcamp. The YHAHSN is part of the research arm of the National Health Service (NHS) in the United Kingdom.
For one week in the city of Leeds in the county of Yorkshire, five American companies got a crash course in getting our solutions adopted by (meaning sold into) the NHS, which accounts for 85% of healthcare services in England, Scotland, Wales, and Ireland. The YHAHSN has been holding a similar nine-month bootcamp for UK companies and has successfully compressed the insights, information, and introductions into five days. SingFit and four other American companies were chosen for this curated bootcamp in part because our missions are aligned with the existing priorities of the NHS.
From the nine-month bootcamp the YHAHSN holds for UK companies to the five-day bootcamp they put on for us Yanks (they never called us that), I’ve condensed this information to five (more or less) bullets on what a startup will want to explore should they consider expanding to the UK.
1. Understand the NHS Has Articulated National Priorities
In the US, it is often difficult to discern the top priority for a buyer in terms of conditions treated, payment models, or desired outcomes. This is not so in the UK because the NHS priorities and operational guidance are listed here. If your solution fits (or can fit) into one or more of these priorities, it has a better chance of gaining more traction at a somewhat faster rate because these initiatives receive extra funding. The current solutions offered through our SingFit digital health platform fit into several categories—including F. Improve Mental Health Services, G. Population Health/Preventive, and H. Exploiting Digital Technologies—so we will continue to focus on these categories for our UK launch.
2. Get Your Healthcare Math Right for the UK
I’ve run this equation past several of the NHS partners at the bootcamp who have signed off on the general high-level math, and it goes like this: Does your solution provide better or equal care to more people at a lower cost than the current standard of care? That, my fellow tech companies, is the healthcare math the NHS in the UK will want you to prove in order to adopt your solutions. While this may seem logical, it is not typically the entire equation in the US. The majority of buyers of innovation will also require an additional measure that shows how your solution will make them money since healthcare is a for-profit business on this side of the pond. And while it is true that cost savings can influence purchasing decisions in the US, the savings tends to need to be greater and more emphasis gets put on switching costs.
Don’t get me wrong, getting the various NHS stakeholders to actually sign a purchase order isn't necessarily that straightforward because regardless of stateside or other international success, NHS buyers will want to see the solution work within the UK.
3. Do a UK Based Pilot Study
Here comes the trickiest part. No matter where your solution is already rolled out, NHS buyers will almost certainly want to see it in action and tracked in a UK setting with metrics that match up with healthcare goals by condition and the “side benefits” (see below). Depending on the nature of intervention (i.e., Is it invasive? Does your intervention make a diagnosis? Is it recommending specific care options, or does it digitize therapy that is already widely accepted as safe?) you will need different types of studies. That said, even for solutions like SingFit, where the general premise is already accepted in NHS literature, a feasibility pilot showing that your intervention can be implemented successfully into an NHS workflow is still key. We are incredibly fortunate that SingFit and how it fits within the social prescribing system of the UK—which is now, as we found out in Leeds, going to be more closely integrated with the healthcare system, aka hot goss—was chosen as the subject of a PhD study at Glasgow Caledonian University in Scotland just over two years ago. We are very excited to announce that the results of that study are expected to be released in January 2023. That said, the more studies the better (hint, hint, potential UK-based pilot partners looking to improve the health and wellbeing of people through expertly prescribed therapeutic music).
Two recommendations for UK based pilot studies are below.
Recommendation 1: Check out the NHS’s NICE database and other resources to see if any clinical or cost-effectiveness data exists on similar types of interventions that you can use to bolster your own claims, especially UK-based data. For example, the Commission on Dementia and Music and the Utley Foundation funded a study, which found that therapeutic music is the best intervention for someone with dementia, especially in light of the dearth of pharmaceuticals to prevent, cure or treat the disease. At the same time, the study “Effectiveness and Cost-Effectiveness of Community Singing” showed clear clinical benefits to singing, which continued on average up to three months after people stopped singing! If the studies are pre-backed by the NHS or help set priorities for other governmental sectors, these can substitute (in some case) for a study of your intervention in particular when looking to prove out efficacy and or cost savings and help you skip steps here and there.
Recommendation 2: If you are looking for a pilot partner or really any information on launching in the UK, get your innovation in front of the folks at the YHAHSN or an Academic Health Science Network from another region, as they can help guide you to the most appropriate pilot partners. And, yes, depending on whether your intervention fits in with the NHS or regional priorities (see below) they provide this service for free. That said, they only have so much bandwidth, and this is one of the places where if you can articulate how your solution fits into the 2023 or 2024 priorities, you will stand out.
4. Forget the Single Bottom Line and Articulate How You Meet Multiple Metrics
During our time in Leeds, the five startups were HIGHLY cautioned against ever telling someone from the NHS that you are going to MAKE them money. They won't believe you, and they don’t want to focus on how you can generate cash for the system. Socialized (aka Universal) healthcare systems in general, and the NHS in particular, are focusing on results rather than revenue as their key performance indicator for the healthcare sector. In addition, your innovation will be judged against other key indicators when deciding on where to allocate funding. In other words, three points to Hufflepuff if your solution is:
Accessible: While Digital Health is all well and good, the NHS is aware that not everyone is kitted out with the latest in tech, so they want to make sure digital health is accessible to those who might be a little later on the technology adoption curve. When potential research partners and buyers understood that our new SingFit TV™ solution could be distributed through video streaming, downloaded through any internet-connected device, or even broadcast via TV or radio, this had extra appeal in some sectors even as compared to our reasonably accessible tablet and phone-based solutions.
Sustainable: In the UK, the NHS takes into consideration whether your solution can help lessen healthcare’s impact on the environment. SingFit’s ability, for example, to allow a speech therapy patient to take part in therapeutic activities in between office visits in order to achieve the same or better results with fewer fill-ups at the petrol station is an example of sustainability math buyers will be looking at when comparing your solution against the current standard of care.
Available for Home Use: Like most nations with aging populations, UK governments are aware that most people want to age in place. In many cases it can also be much less expensive to keep people in their own homes, so points if your innovation can work outside typical healthcare settings. Extra points if your innovation can improve the health and lives of unpaid caregivers who experience immense amounts of stress, as our SingFit STUDIO Caregiver™ and SingFit TV™ solutions are designed to do.
In Other Regions: One difference between the UK and US healthcare systems is that, for the most part (and recent UK legislation will work to codify this further), it is a cooperative not a competitive (i.e. capitalistic) system. Because of this, it was often repeated that if your solution works in one region of the UK, it is likely to be picked up in another because if national metrics are being met, many regions are going to want in. Contrast this with the US where if your solution is adopted by one healthcare system, another might not want it because no “differentiator” will give it an edge over the competitor.
For Other Conditions: While Musical Health Technologies has focused on cognitive impairments and mental health for older adults, the applications for our SingFit platform are vast. Our roadmap includes a pregnancy-to-hospice solution and this replicability has appeal to the NHS. Their stance is why reinvent the wheel if it can work for multiple purposes?
5. Pass Through DTAC
This phase is a must-have if you want buyers within the NHS to be able to procure your product on pretty much any scale but definitely on a large scale. While this is a regulatory process, do not let visions of the FDA (with the associated expense, long evaluation times and red t) dance in your head. The Digital Technology Assessment Criteria (DTAC) process is primarily looking at three things:
Is your innovation capable of harming a patient in any way?
Is your user data secure?
Is your technology stable?
If you can pass through DTAC, your innovation can be purchased by NHS funds. Keep in mind, as we were constantly reminded that week in Leeds, that purchasers will want to see outcomes from a pilot study (see point 3) before you are likely to get ink on a contract. That said, even if your pilot is a grand slam, you still won’t be able to get ink on a contract without passing through DTAC and in some cases won’t be able to do a pilot without DTAC.
If DTAC is on your horizon as a healthcare tech company, ORCHA, one of the curated partners of the Bootcamp has a team of clinical and digital health experts that can help you get through DTAC (depending on the complexity of your innovation) in three to six months for around $4,000. Bonus prize, before you even get to DTAC, ORCHA, for free, will assess the likelihood of your technology passing DTAC assessment in its current form. If you score below a 65 in its initial assessment (which takes under a month and looks primarily at the same three criteria as DTAC listed above) ORCHA will provide you with free guidance (yes, free) on what you need to improve your score before starting the official DTAC process.
Of course, this is not the whole story on what it takes to launch a digital healthcare solution in the UK, nor does it fully answer the questions of why, if, or when SingFit might be launching in the UK.
In my next post, “On the Road Back to Leeds with The Spirit of Cricket and Origami Butterflies,” I will answer those questions and more.
Among other things, I will delve deeper into the organizations that hosted the Bootcamp (YHAHSN, Leeds City Council, and Leeds Teaching Hospital Trust), the four other chosen startups (Behavidence, LabReady, Luminare, and Televeda), the curated partners (Barclays Eagle Labs, Hill Dickinson, Nexus, ORCHA, and YHEC) and why I think the UK is a great market for American startups itching to create positive, transformational change in the way healthcare is delivered to people worldwide.
In the meantime, you can follow me on Instagram or Twitter to read some of the posts that led up to and happened during Bootcamp, as well as keep up on my next adventures back to Leeds and London, where I am excited to be attending Leeds Digital Festival events later this month, including the MedTech Showcase (9/19), Nexus Connect (9/20), and Leeds City Council Hack for Good (9/23). SingFit has some musical fun up our sleeves for the Nexus Connect event. More details will be posted on my social media profiles. Hope to see you at #LeedsDigi22!
Founder & CEO of Musical Health Technologies