The mood here in the U.K. is not exactly festive in the run-up to Christmas. Not only are there train strikes to cope with in the closing days of December, but key healthcare workers in the shape of nurses, midwives and paramedics have also been taking unprecedented industrial action. Then there are the ongoing problems. Accident and Emergency units are overstretched to breaking point and it’s not that easy to see a GP.
And yet polling suggests that a majority of Britons – and I’m one of them – hold the free-at-the-point-of-delivery National Health Service close to their hearts. Created in the wake of the second world war, it is generally seen as a massively good deed in the wicked world.
And the sheer size and range of the NHS – it is the U.K.’s largest public sector employer – means that just about every health-tech startup operates in its shadow to a greater or lesser extent. And this throws up both challenges and opportunities.
On the opportunity side of the equation, the NHS is potentially a lucrative customer. Equally, there’s a big market comprised of individuals who are keen to access health services provided by private sector providers. The challenge in that second category is to provide something that customers are prepared to pay for, given that so much is free at the point of delivery through the NHS. So you probably need to offer something that the state health service doesn’t already provide or else find a way of adding value. For instance, you could offer services that allow customers to avoid the NHS waiting lists.
Within the System
So how can a health startup position itself to operate within the U.K. health system? In the run-up to the Christmas holiday, I spoke to Hamish Grierson, CEO and co-founder of Thriva. Founded in 2018, the company markets blood test diagnostic services direct to the public but also through partners, including the NHS. I was keen to get his take on how private-sector startups can interface with the state system.
As Grierson explains, the company’s mission is to enable people to take control of their health by providing easy access to blood tests. The goal is to help customers identify or manage conditions and secure better health outcomes in the longer term.
“The name of the company indicates our ambition,” he says. “We want to help people to thrive in good health.”
So what does that actually mean? Well, Thriva provides kits. Tests can be carried out at home and once the blood has been collected and sent away, the results come back within 48 hours with a GP assessment. The idea is that customers also control their own data and can also manage their health over time by taking account of the blood test results.
To date, the company has carried out about two million tests. So who is buying the service? “We have two buckets of customers,” he says. “First there are people who want to proactively manage their own health. The second bucket is made up of organizations, such as the NHS”
So just how easy (or difficult) is it for a private sector startup to build relations with a National Health Service which is actually quite fragmented? At one level, it is a national service that is controlled not only by the British government in Westminster but also to a degree by the devolved administrations (Northern Ireland, Scotland and Wales). There is further fragmentation with a network of trusts managing hospitals and specialist services in their areas. Then there are GPs surgeries, which are essentially private businesses paid for by government money.
An easy market to break into? “It is easy to start pilots,” says Grierson. “There are always pioneering people within trusts. But it is harder to scale.”
The challenge then is to build on pilot partnerships or supply deals with trusts to create a much bigger business.
Grierson says the NHS will buy services from young companies when it makes sense to do so. “If you can demonstrate that you are offering something that people will engage with and enjoy, then you have an opportunity to add value.”
For instance, a partnership with the Royal Brompton Hospital sees Thriva providing home testing kits to patients with Cystic Fibrosis. “The Royal Brompton approached and asked us if we could supply kits for these patients. We were able to show that people liked home testing and we could add value to the NHS.”
Grierson cites the example of immune system-compromised patients for whom hanging around in a clinic is not a good idea. Home testing is much safer.
So the next step is scaling. The company – which recorded revenues of £16 million in 2020 – has just raised £13 million in VC funding from a group of backers including Target Global. The next stage is to become a one-stop shop for blood diagnostics. That will mean more partnerships, particularly with pharmacies.
As a direct to the public offer, Thriva is perhaps benefitting from a greater awareness of the preventative healthcare as managed by individuals rather than the health system. Equally, there are opportunities for healthcare providers within the NHS system. In the latter case, the key for startups is to find a way to help health system managers solve the problems they face and open a conversation.