In conversation with… Hassan Chaudhury, Digital Health Specialist at DIT
Formerly an entrepreneur focusing on turning health and care data into actionable insight, Hassan Chaudhury now works as a digital health specialist and consultant for the UK’s Department for International Trade, and independently. In this interview, Hassan gives us insight into what companies looking to take their digital health product overseas should consider, what selling his own business felt like, and how a career full of “accidents” led him to becoming one of the UK’s foremost experts on digital health exports.
Hassan was interviewed in March 2022 by our Head of Communications, Rose de Mendonça.
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Tell me about your role
“I have many hats, but the one that people focus most on is probably the one for the Department for International Trade (DIT), where I advise colleagues in British embassies and consulates in 96 countries. My goal at the DIT is twofold. 1) How can I understand what the UK does well in digital health? So, I travel all over the country. I work with the Office of Life Science, Innovate UK, the AHSN network, the National Association of Primary Care etc. Then 2) I package it all into a value proposition.
“When I have the value proposition, I go around the world and say this is what the UK can do for you if you were to come into the country for digital health. That is known as “investment” - anything into the country is investment. We also work with all of the foreign private equity, venture capital, sovereign wealth funds – more than 200 of them - and we work to get their money to invest into the UK.
“I also do ‘trade’ - anything going out - so who should we support for export? What should we export? What skills and capabilities do we have? How valuable are they abroad? This means I try to understand the UK supply chain and meet the innovators.
“In addition to that, I’m lucky to work at Great Ormond Street Hospital and be an assessor for the AI in Health and Care Awards. I also mentor at a few places including the NHS Innovation Accelerator and I do a little of my own consulting with a few start ups and scale ups.”
You are a very busy person! How did you get where you are?
“It's a really odd one; my career is full of accidents. It might sound like I meant to do this, but I really didn’t.”
“I got a politics degree and then I didn't know what to do with my life. I ended up doing some filing at Hackney Social Services on a two-week contract that ended up lasting three years. It expanded so I was helping a Social Worker with their support needs, and when I wasn’t helping them, I would do assessments, bid for funding. In that time, I learnt what it meant to be in health and social care, and about the connection between people's personal and domestic care, carer support, activities of daily living, and why they often weren't connected into healthcare. It changed the way I viewed care, because it wasn't just about numbers on a page or spreadsheet. People are more than that.
“I did a stint in the civil service, then I moved into analytics at the Royal London and Barts, part of a team hired to save the data after a mess-up with the Cerner Millennium rollout in 2008. They trained me in every single pathway. I learned the patient flows and where the funding was going, and that’s how I knew what was going on in the system. So, I got an education twice.
“I became a Senior Commissioning Analyst at a PCT, became an analyst at NHS Commissioning Support for London (CSL) where we worked on commissioning quality, then moved to the London Public Health Observatory where I was lead analyst adding metrics on multiple pathways.
“At that time, we could see Andrew Lansley’s reforms were going to have a huge impact on analytics in the NHS. One of my friends was working in data for NHS London, and another had helped to launch BBC iPlayer. We brought together our skills to form a company called Health iQ, which transformed NHS data into information then into intelligence. We launched in 2011, and pivoted multiple times, going international until we were acquired in 2019 by a firm named Corrona LLC – they changed their name recently. I didn’t stay for the earnout and accepted a three-year non-compete. I felt I needed a break to decompress from startup life, and that’s when I ended up in my current government role.”
I'm really interested to know, how does health tech in the UK compare with other countries?
“It differs in multiple ways. The first is, the NHS is a really, really good lab for throwing people against a problem.”
“We've got - in name at least - the same system across the country, so we can think about common problems. That's why we've got the NHS Innovation Accelerator, the AAC, the AHSN Network, NHS Clinical Entrepreneurs… there's commonality rather than uniformity.
“The difficulty is that innovation typically happens despite the NHS. We have to make it easier for people to innovate.”
“Staff who innovate also have to do their day job. When no one really supports them and what they’re doing on the side, those people leave. Not only do they occasionally leave the profession, they take their invention with them. The whole point of the NHS Clinical Entrepreneurs Programme is to keep these people and keep their technology in the NHS.
“Finland and Israel deserve special mention on innovation. You also have places that are better at extracting innovation and following innovation through to genuine scale. The US is better than us in that regard.”
“We also don't really have a culture in this country of frugal innovation. In some parts of the world, particularly in sub-Saharan Africa, you find people who say, “I'm just going to make it on my own and I don't have much money, but I don't care. I'm going to hack it.” Hacking it works in many places. In the UK, it doesn’t, because we expect regulation, we expect safety, we want you to pass ORCHA and DTAC, we want a health economics case, a health utility case. There are benefits to this: firstly, reputationally, anything that comes from the UK is viewed as good; secondly, things from the UK are actually good because they have to be. The halo effect is additional to the actual benefit.
“However, it does create a challenge; UK products are generally more expensive when going into markets with less robust regulation. Imagine going into SE Asia. Even if, for example, the AHSN Network gives you help in the UK with your health economic case, for you to pass your ISOs, for you to make sure that you're fully regulated, you're going to go up against foreign companies that have none of those things, haven’t had to invest comparable time and resources and you can't compete. Your prices are going to be higher while your international competition is going to be worse. These things limit you, but I guess they limit you in a good way because when you’re walking into pitch and people ask if you’re worth spending more on - the answer is “yes,” and generally so for British healthtech.”
When there’s a company that doesn't have the same regulation, but on the surface is providing the same service, how do British companies compete with that?
“They can compete on two levels; focus on countries who look up to the way we do things in the NHS and also on brand name association.
“On the first, there's lots of Anglophile countries. India is an example where they love the British. Malaysia and Kuwait too. They're places that will buy something because it's British, in part because many people have trained here. British medical education and training is world-class and a big part of our soft power. Unfortunately, there are a few countries in the world where they couldn't care less. You go to the US and say we've done it in the NHS… it doesn't matter to them.
”You need to play your strings on the first level, where you've got an audience that wants you because you've done it in the right places, and then secondarily you've got to have association with the right brand names. Unfortunately, people can still be snobbish in healthcare, and they're interested in who you've done it for. So, if you say you've done it for Moorfields in the UK or you've done it for the Cleveland Clinic in the US, that's seen as amazing. Actually, to me, that doesn't mean quite as much on its own. What matters to me is the evidence generated. What are the stats? How much money was saved or released? How many lives did you save? Did you prevent avoidable harm? That’s the transferable element required to scale.
“The other thing to say is that if you're going to go after the big markets, especially those that don't really care about the NHS, you need to find - whether you beg, steal, or borrow - a reference customer.
“Then you need to make that reference customer so happy that you might even lose money on the deal to succeed. There's no doubt - you can call it “at cost” - but we all know it's going to hurt.”
You said the international value of having that NHS stamp of approval is greater in some countries. Where is it most powerful?
“The Gulf; you're likely to do well in the GCC (Cooperation Council for the Arab States of the Gulf, originally known as the Gulf Cooperation Council) if you have a lot of NHS traction.
“You won't do as well in many parts of Western Europe as you would have before Brexit.
“I think Ireland is one of the first places that you should look immediately if you're a UK healthtech company that's done well.”
“So many companies jump from a tiny bit of progress, for example, in the south of England, to going straight for the US and I often think they aren’t being realistic. The next places to go in Europe would be either the Netherlands and Catalonia then I would probably say Austria.”
Is that because they love the NHS or for other reasons?
“The European countries I mentioned aren’t in love with the NHS. They do like the NHS in Eastern and Southern Europe though.
“They're also not going to say that they couldn't care less about the NHS if that is the case, but you’ll sense it.
“What most regions are doing is trying to adopt innovation on an international level so the innovation angle is how you approach them.
”If you go to Italy, it's all federal. You go to Bulgaria, Greece, Turkey, they're not all the same size. With a major deal in Liverpool, you might make more than a major deal in southeastern Europe. There's always a balance of whether it is worth hitting the market. Of those friendly countries and regions, the Gulf is the biggest price. Saudi is really worth targeting.”
Do you think there's a threshold of traction within the NHS that a startup would need before considering international opportunities?
“When firms go abroad, it's very easy to obscure what they've really done, which is why you've got lots of chancers who've done absolutely nothing in the NHS, pretending that they're really good. You have to compete with that. I respect you guys at Infinity Health; you have got something that you've sweated for and you’ve bled to get.
“The next hard part is getting to the right person and impressing them.
“Credentials wise, you don’t need as many. Someone said to me, I want to get contracts at 20 NHS Trusts before I export, and I thought “you could do it with three good reference sites.””
In your view, what is the optimum strategy for international expansion for companies with solutions that require careful setup and implementation?
“You might not make it in some regions unless you have an accelerator. Infinity doesn't “need” an accelerator; you’re already got really far, but when a British company uses an accelerator in the US, what that means is you've got advocates, a third party endorsement to get past the barriers, because you guys are not “switch on, done.” They will use their social capital to get you into places.
“Two accelerators that you might need for the US are ScaleHealth in California and the TMCx, Texas Medical Campus.
“When you’re going out to the Nordics and Western Europe, the way that you might win is saying we'll set up an office. Health Valley, in the east Netherlands, will get you all the meetings you want in exchange for you setting up an office and employing some people, and you don't have to change your global headquarters.”
Are there examples of companies that have scaled solutions like Infinity through systems integrators or do companies need to directly own the full implementation and support?
“You can go through a system integrator, and I would suggest Softcat. They have a catalogue and they ask the NHS what they need.
“They hire people NHS CIOs respect, so when they have that conversation, they will make sure the right solution gets discussed and implemented.”
Which countries do you think are the best implementing health tech? The worst?
“I will tell you straight off the bat; Israel, Finland and Estonia are probably the best.
“If you take your tech to Israel, they will probably have worked it out and are ready to copy it before you finished your presentation. They are very smart and switched on.”
There are lots of places that face serious challenges, for various reasons that have nothing to do with tech. For example, in Manila I saw an ambulance wasn't being let through because people thought someone had paid money to use it to get through a traffic jam. There's a complete lack of trust in the system, and corruption is endemic. There are some amazing people in the Philippines but how do you get things done with that level of corruption? I saw the same in Dhaka in Bangladesh.
Nigeria - where's all the money gone? If you try and challenge it, you won’t get far.
What in your experience is the biggest barrier that digital health companies face when scaling overseas?
“Everything in business comes down to “jobs to be done”. What's the thing that the person needs at that moment? And why do they think of you? That's going to be very different in Bangkok compared to rural Thailand. It's going to be very different in Sao Paulo to rural Brazil. Most companies assume that the job to be done is the same. The language is the same. The buyer is the same. The funding is the same. In reality, nothing's the same.
“Once you get past that barrier, the second barrier is getting in the right meeting with the right person with the right person vouching for you. In the UK, you might have Tara Donnelly vouching for you. Who do you have when you go to South Africa?”
Are there any kinds of innovation that you feel particularly excited about for the future, or the present, of healthcare?
“I'm excited by the idea that we can bring diagnostics to a patient, not that the patient goes to the diagnostics. There's a whole series of things happening, where for example, based on how you cough, just the audio, we can tell if you've got COVID. Non-invasive. There's Lifelight, an innovation in the Beyond 100 cohort, which can take your vital signs through a smartphone camera. Again non-invasive.
“The most exciting thing is how to create what is known as “joy at work.” It's almost a guarantee that we won't have a sustainable health system in the next five to 10 years, at this level of patient contact and this level of burden without serious effort. People are leaving the profession, and we don't have enough people to train those who want to care. Unless we're able to make it an easier profession to provide care, we're screwed.”
“So, anyone who's able to make work a joy, and remove those pain points, are important. I can see Infinity is aiming at that.
“Also, have you heard of the Quintuple Aim? The Triple Aim, Quadruple Aim. The goals of all healthcare are now: reducing per capita cost of care, improving population health, patient experience. Then a fourth was added: to improve the caregiver experience of care, which is joy at work. The a fifth: to improve health equity. If you're a healthcare provider, and you achieve the quintuple aim, you've won. I think that you are actually helping all five.
