Professor Tony Young is a NHS Consultant Urological Surgeon turned serial entrepreneur, founding four medtech start-ups. He is Director and Chair of Medical Innovation at the School of Medicine at Anglia Ruskin University, and co-founded the £500m Anglia Ruskin Med-Tech Campus – a series of MedTech and advanced engineering science parks in Essex. In 2014 he was appointed as the first National Clinical Director for Innovation at NHS England, and the following year founded the Clinical Entrepreneur Programme – the world’s largest entrepreneurial training programme for clinicians.
You’ve held various different roles in healthcare. As a clinician wanting to innovate, what are the main obstacles that you’ve overcome?
There are a lot of reasons why people don’t want to adopt innovation and change their behaviour. Getting them onboard to understand how to improve patient care through innovation is fundamental – this is a key challenge from a system point of view. I’ve learned that if you can win hearts and minds of clinicians, patients, providers… every stakeholder in the system then you have the best chance to make innovation happen.
If you can win hearts and minds of clinicians, patients, providers… every stakeholder in the system then you have the best chance to make innovation happen.
In terms of challenges I faced as an entrepreneur, the commercial world is totally different from the NHS and public sector, so understanding commercial behaviour and what’s seen as “right and acceptable” is totally different to what’s “right and acceptable” in public healthcare. This challenged some of the core values I held (and hold), but success comes when you find ways to marry the two together, and win hearts and minds.
The culture of an organisation as a barrier to innovation was also a challenge in Academia. But again, I had to win hearts and minds, and we’ve been successful. For example in Chelmsford, we launched a company called Futurenova, an amazing company with a world-leading sterile case for tablets.
One of the biggest barriers I’ve seen facing companies, is that they may have a great product or service but haven’t tried to understand the clinical-provider problem. You need both – a good product and an understanding of pain points in a clinical-provider environment. To overcome this, you need to think: “What is the problem, and how do I solve it.”
To overcome this, you need to think: “What is the problem, and how do I solve it.”
Now in my role at NHS England, I’m getting to learn about the whole system and how things work. But the same thing cuts through all four parts of my career and all sectors – win hearts and minds. And then you can start to make change happen.
But the same thing cuts through all four parts of my career and all sectors is – win hearts and minds.
What’s the biggest challenge in your career that you’ve faced on a personal level?
I think that my career probably has had four stages: clinical, academic, entrepreneur and now, a national leader.
I made the choice to become a doctor at a young age because it felt like the right thing for me to do. I wanted to use my skills, knowledge and experience to impact lives – I wanted to make a difference to the person in front of me.
As I progressed through medical school, I realised that there was something more that I wanted to do – I wanted to make a difference to millions of people. Clinically, I was impacting the life of one, but I wanted to simultaneously impact the lives of millions.
Clinically, I was impacting the life of one, but I wanted to simultaneously impact the lives of millions.
I felt I was unlikely to do both as a clinician alone, and this was the paradox at the back of my mind as I went through my early training.
And then I started inventing things. I had my first business at the age of 30, and re-mortgaged my house to fund it. This provided me with incredible reward and meaning. I looked up at other clinicians that were doing both, and thought to myself: “I want to do that.”
Along the line, I explored changing lives through impactful research and that drove my PhD in Physiology, but I found that entrepreneurship was the route that I could do it best. So I think, clinically, the biggest challenge was addressing this paradox – how to impact the life of the one and the million.
So I think, clinically, the biggest challenge was addressing this paradox – how to impact the life of the one and the million.
There are some motorways in healthcare careers, and there are tracks in the undergrowth that have hardly been trodden. This was one of them. Very few doctors in the UK were “entrepreneurs-plus-doctors” in the UK at the time.
Is there anything that you would do differently if you were to start your medical Foundation Training now?
No, I wouldn’t change anything. You are who you are and your journey is what it is. I grasped every opportunity that I came across. I also learned to accept, acknowledge and learn from failure at a young age. I wouldn’t change any mistakes I have made (and I have made a lot!) because I wouldn’t be where I am now, if I changed my experience. I am open to embrace the experience that I have been through and learn from it.
When you started the National Clinical Lead role at NHS England, department priorities were to look at the inequality gap – to grow the UK life sciences economy, advise government on healthcare innovation and make England the “go-to” place for medical innovation – with minimal funding. How did you approach a seemingly impossible task?
Winning hearts and minds, and recognising that you can’t do it alone.
What I aim to do with the NHS is to empower the most valuable asset that the NHS has and unlock its potential. This is our workforce. Most other organisations would mine the intellectual capital of their workforce to help them transform. So how can we release the potential of this amazing asset that we have?
By doing these two things you begin creating a movement. The Clinical Entrepreneur Programme is an example of this – the entrepreneurs are agents for change and transformation of healthcare.
What I aim to do with the NHS is to empower the most valuable asset that the NHS has and unlock its potential. This is our workforce.
Why did you set up the Clinical Entrepreneur Programme?
When I started at NHS England five years ago, a number of doctors came to me and told me that they had been advised to leave medicine to “do” their start-ups. They were told that they had to “do” one or the other. They asked me: “You’ve done both and you’re the National Clinical Director for Innovation, how can you help us?”
So I talked to some people and we began to support entrepreneurs in healthcare. The first year was a pilot and there were 118 junior doctors, who raised £56m between them and 50 plus start-ups were born. We recorded all the data and we were given the go-ahead to do Year 2. Year 2 we had 230 doctors, who raised more than £118m and we are now open to all clinicians. There are plans for further expansion outlined in the NHS Long-Term Plan.
A challenge of scaling any business is maintaining quality. How do you ensure the quality of the programme is maintained as you grow it?
Because it’s really light touch. We don’t spoon-feed the entrepreneurs but we do give them: a “badge of permission” to be an entrepreneur in the NHS; a commercial coach; an individually-chosen mentor; a connection to customers; and funding. We arrange networking and educational events across the year. Effectively, we present a smorgasbord – a range of opportunities on the table- and the entrepreneur can pick and choose.
It’s not like medical school where you are told to read notes and so on, this is self-directed learning. We facilitate group learning and ensure resources and facilities are available.
There are only three of us at NHS England plus Polly at Anglia Ruskin, who is amazing. All mentors give their time freely, as do those that come and talk on programme. We manage it very closely and tightly in the centre.
It really works for some people. Others are not comfortable with facilitated self-learning. But that’s a positive outcome, because they can now move forward and have learned about themselves in a safe place.
We are selective on who we pick to be on programme, with a rigorous assessment and interview process. It’s about developing the individual rather than the idea, providing them with the skills, knowledge and experience to evolve.
The recent Topol review recommends that the healthcare workforce requires “expertise and guidance to evaluate new technologies, grounded in real-world evidence.” Technology is fast-moving and randomised control trials (RCTs) – the current gold standard for testing drug products – take time. How should we evidence emerging tech?
Big area. Topol has published a review in Nature, and the summary is true for AI as it is for other tech. We need to introduce things into clinical practice that are safe and clinically effective.
This said, does the RCT serve us as well for AI or digital health as it does for drug discovery? I think not. But it’s still a key component. The future will be to use real world data that we have not seen before or big data analytics. We’re going to have to use new techniques. So yes new technology should go through an absolutely rigorous testing. But is a £2bn RCT appropriate for a lot of technology and other things? Probably not. We have still not solved this issue. But in the UK we are testing, trialing and exploring new methods of evaluation across the system.
But in the UK we are testing, trialing and exploring new methods of evaluation across the system.
Also according to Topol, within the next 20 years, 90% of NHS jobs will require digital skills and patients will need to be informed about health technologies to be involved in their treatment plans. Where is the best source of reliable, evidence-based information on digital health technologies for patients and clinicians?
NHS Choices and NHS 111 have some great algorithms. Cochrane review. NICE evidence. NHS England has commissioned ORCHA and Our Mobile Health to look at health and social care related apps – take a look at their website.
Are there any health start-ups that you’re particularly excited by?
All the ones on Clinical Entrepreneur Programme (!).
And, you clearly have a demanding job, how do you maintain a work-life balance?
By not viewing my work as being life, and not viewing life as being work. I’ve followed my dream to try and improve the healthcare of as many people as I can. As this is my passion I don’t see work as work, but rather a joy. But I do ensure I look after myself physically and emotionally- I exercise, I read, I spend time with my family and children and I take time to get away. I listen to what those around me are saying or observing. And if they say “dial it back”, I do that. No-one has ever told me to “dial it up” though!
Finally, are there any books that have significantly impacted you?
A General Theory of Love – Thomas Lewis. This touches on the psychology of love – not just how we fall in love, but also how we fall in love with products and services. This book challenges the way we think about how we get ideas taken up by customers.
Thinking Fast and Slow – Daniel Kahneman. This is stunning in so many ways about the human condition.
Immunity to Change – Robert Kegan. This taught me so much about Organisational Psychology.
Bad Blood – John Carreyrou. Wow, what a rip-roaring read on how not to do a start-up in healthcare – a breath-taking read.
Living an Examined Life – James Hollis. I have just finished reading this twice!
The books I recommend reflect on a number of things and help to develop an understanding of how to act as a leader, and how others act around you or why. Because in my experience, success in the clinical world, academia, business and leadership is all about winning hearts and minds!