PocDoc: A son's quest to tackle heart disease with tech

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0:46So my passion for this business stems from the fact that when I was 14 and my dad is the same age that I am now, he had a huge stroke due to undiagnosed cardiovascular disease. So that was catastrophic for him, catastrophic for our family. and so I've been really really intimately involved in this disease area for a really long time. That's Steve Roost, co-founder and CEO of PocDoc, a medical diagnostic startup which makes a device for people to test themselves at home for conditions like heart disease. I took a trip up to Cambridgeshire to meet him and hear his story. His business is on an industrial estate next to the Fens where scientists are busy at work in a warehouse where thousands of his kits are also stored.

1:30So we're in your kind of huge warehouse here. What happens here? So this is what we call the hub. This is our global HQ and it's a combination of two things. The core of it is the R &D manufacture and assembly of all of our products. So we focus on cardio, metabolic and renal disease. We've developed a set of technologies that are completely novel and unique that we've developed in-house and we have chosen we chose very early in the business to in-house all of our manufacturing which is the complete opposite of what people do in diagnostics normally they outsource and subcontract out normally offshore we onshore absolutely everything but as you can see there's quite a lot going on so for everyone listening we're actually having huge racking put in at the back because we need more capacity you can see the is a combination of the manufacturer of the high-tech R &D-driven element, as well as research and development for our future tests.

2:25And this warehouse piece is where we store all of the tests before them being shipped out to our NHS and health retail customers. So that's where the literal pop-dog boxes are going to be stored on their shelves? This is literally it, yeah. And so in 18 months, we've gone from a capacity of 500 to 500 ,000. So we're putting on our lab coats here. We're still part of the warehouse here, but this looks much more like a kind of science lab. Yeah, so when we were in our old building, which was on Cambridge Science Park, which is where we started life, we quickly outgrew that space. So we're now one of the fastest growing health tech businesses in the UK.

3:02When we moved in here, this was a complete empty shell. We've kitted this out as part science lab, part R &D, and part high-scale, high-growth manufacture. I mean, I see, for example, huge jars of liquid in it, and they seem to be being weighed or something. What kind of stuff happens here? So this is team Healthy Heart Check. So this is where the flagship product, the Healthy Heart Check, is manufactured from scratch. Like I said, we build, we've developed all the IP ourselves. We own it all ourselves and manufacture everything ourselves. There's a number of very highly technical processes that are proprietary to us that take place in this area that end up with one of these silver pouches being produced.

3:39And this itself is the Healthy Heart Check. So after this pouch is produced, it moves across into picking and packing and dispatch, which is currently being completely disrupted by us having put in massive pallet racking that goes up to the ceiling.

3:55I'm Dougal Shaw and this is the Business Leader Podcast, where we look at the stories and strategies behind modern businesses. Today I've travelled up to Cambridgeshire to meet Steve Roost of PockDock. He co-founded the company with his wife in 2019. It makes at-home digital diagnostic kits so people can do health tests for chronic conditions like heart disease. The company can make up to 200 ,000 tests per month. It has 40 employees and multi-million pound revenues. So I was keen to hear from Roost what lessons he has learned growing a startup in the health tech space, working with organizations like the NHS in the process.

4:31After retiring to the quieter offices above the warehouse, we started with a box opening, taking a closer look at one of his home diagnostic kits. this takes me a bit back to the days of covid where it's like you know the medical kits that come in the post yeah what's inside this white box called healthy heart check how does it work so as a bit of background we built the business focused on cardiometabolic and renal diseases so cardiometabolic and renal diseases are the three major cost centers for the nhs and 90 % of them are completely preventable so if we're worried about how to save money and how can we save the NHS, actually investing a huge amount of time in the prevention of cardiovascular disease, type 2 diabetes and chronic kidney disease is a really, really good place to spend time.

5:18The major difference between the diagnostic technology that we've developed in COVID is that COVID was a yes, no, or sometimes I don't know. If you remember, some of those tests just didn't work. That won't really cut it in cardiometabolical renal disease. You need a very accurate test that doesn't just provide a yes no or maybe it provides a fully quantitative response which our test does that was the first challenge the second challenge was that it needs to be multi-marker so it needs to not just do for example covid actually this test does the full six marker lipid panel all in one test then the other challenges that we've had to overcome we've built into the test that you need to be able to take those blood test results combine them with information about that patient, run it through the NHS clinical risk assessment tool, which we're integrated with to actually provide an overall health score, cardiovascular risk score.

6:15And then you need to integrate back up with the healthcare system. So we integrate with the NHS app and we integrate back up with the patient record. So all in all, in 10 minutes, we're able to deliver the equivalent of an NHS health check at home or in the community or in a workplace. And I did a blood tests recently with the NHS. I just went to my GP, then the results were a few days later after going to a lab sent to the NHS app. So what's the benefit of doing it your way? So there are many, and this is why we've scaled so rapidly across the NHS. For many people, going to the GP is not an issue, but for many others it is.

6:50And the three major shifts that the government and the NHS have communicated are analog to digital from hospital to home and communities and from sick care to prevention so our test our healthy heart check really aligns across all of those things for the first time ever we can deliver or the healthcare system can deliver the same experience and without sacrificing any clinical validity or clinical utility or patient experience at home or in the community or in a workplace if you can go into a gp surgery and the gp will see you for a preventative screen then no problem that's absolutely fine actually many GPs now are choosing to use our technology because the results are immediate the patient experience is really good and it means that they don't need to completely rely on what's called the pathology lab network so pathology labs within the NHS are generally only available between 9 and 3 p.m on a work day and so outside of those hours GPs can't access blood testing services in many parts of the United Kingdom so they're actually choosing technology like ours to be able to almost provide wraparound care to be able to provide this sort of health check cardiovascular screen so let's look inside this box show me what is actually in it sure so if i open it up this is our home kit we have another kit where we provide healthcare professionals with them this is really simple so we have a um a simple intro card which is how to get started so you can download the app from the app store or from the play store we have the test itself i like to say it looks a little bit like a covid test on steroids if you like many more colors on it a lot more colors yeah so we use these colored barcodes which obviously you can't see but we use these colored barcodes because we ask the user as part of the um as part of the testing process to take a photo of the test itself and that photo we use our in-house diagnostic AI imaging tools to analyze the color changes and we can work across any phone in any lighting condition and we're able to determine the quantitative result and we use these colors to aid us in that diagnostic process.

8:57But you're actually taking a blood blood from the person as well? So it's a small finger prick of blood so I'll show you the size of the capillary it's a standard lancet that we use or that we provide that people might be familiar with the major difference is between some of the kits that you might have seen you know lab testing at home kits we require about we require 30 microliters of blood and those kits generally require 600 microliters so that's multiple fin pricks put pin pricks rather sometimes people say that their table looks like an abattoir there's been lots of feedback about that negative customer experience that was something that when we started the company we spent a huge amount of time we spent hundreds and hundreds of hours before we started development speaking to clinicians clinical leaders and to patients to understand exactly what our product needed to do in order for it to fit and solve this entire unmet need which actually is I didn't realize at the time how unique that was but a lot of technical technically founded businesses really just focused solely on their technology and they forget a lot about actually solving a whole customer need.

10:07Let's talk about how you got into this. Are you a kind of entrepreneurial doctor? Are you from a medical background or were you just drawn into the medical world? So I feel really passionately about what we do at PocDoc because when I was 14 and my dad was effectively the same age I am now, he had a huge stroke due to undiagnosed cardiovascular disease. In fact, he was at lunch one day in West London and collapsed at the table, smashed through the table. He then spent two or three months in Chelsea and Westminster, who were incredible. He then spent, you know, give or take a year at home bedridden, which was obviously a hugely stressful time for us.

10:43And he survived, thankfully, but with some fairly major health issues as a result. And now today, probably he's cost the healthcare system north of seven figures, all for the sake of a£40 intervention 25 years ago. So on a personal level, I don't want any other family to have to go through what I went through if I can avoid it and then secondly from a professional commercial perspective it just doesn't make any damn sense that we are willing to prioritize seven-figure health bills at the expense of a really early detection program so my my background after that point as I'm not a clinician I'm not a scientist so I met my two co-founders who were scientists one of them is actually my wife and she they were both working on a research project around how you could use mobile phones to do quantitative blood testing.

11:35It was very obvious very early that cardiometabolic and renal diseases were the perfect conditions. I obviously felt very, very passionately about the cardiovascular pathway. So that made it was a perfect fit. They were the science and I came in with the commercial. My commercial background in this space or in sort of VC back tech, if you like, I was one of the very early employees at a business that became hugely successful. So I was one of the early people at Viagogo, which was an online ticket marketplace. It became the third or fourth largest ticket company in the world. By the point I left to focus on PocDoc, I started their commercial group when I was 25, scaled that to being active in over 80 markets worldwide, multi-billion dollar business, unicorn, multi-unicorn, decacorn now actually.

12:23so I have a really strong background in in in entrepreneurialism and actually it's worth mentioning as well my dad from the eponymous story with the restaurant he actually was the first he after he got back into the workforce he became the first CEO of Shazam so his background was all in the 90s around um telco so when we used to call the internet was called telco with the CDs in the machine in the wall garden so he was the CEO of Europe Online and CEO of CompuServe and then stroke happened um so i remember sitting around the kitchen table you know before the dot-com crash about how we're going to buy a caribbean island and then after the dot-com crash being like how are we going to pay the mortgage you know and things like that so i've lived through all of that my dad became the first ceo of shazam i did my work experience in their offices when i was a kid so always been completely comfortable with the the risk reward profile so i i was never looking for a linear career path i was always looking to be able to make extraordinary steps and leaps and I was willing to trade off risk against the possibility of making those huge strides.

13:31We hear a lot of things about Apple Health watches or, you know, Garmin watches providing some early information that might save someone's life. But people say, hang on, that's not medical grade equipment. So how do you fit into all that? It's a really good question. And it's coming up particularly with things like the Oura Ring and other things like that. It's becoming a much more relevant question. For us, the line's really clear we're a very regulated clinically valid medical device that delivers a significant amount of clinical information that can be used in the course of determining someone's treatment definitely determining their risk of having cardiovascular disease and fits into the official NHS and nice published clinical pathways about cardiovascular disease in in the case of a healthy heart check so we're directly and intimately involved in the delivery of that care pathway what you're talking about with things like apple health and aura ring and those other things their information many many many people millions of people find that really really helpful um it isn't necessarily to the same level of clinical utility as something like ours and many other people doing different things in the market you you won't get a gp for example asking to see your sleep records from your aura ring to then determine whether or not you should be prescribed anti-anxiety medication or sleeping medication whereas with our test people are being diagnosed from having done it and people are being put into treatment so we know that of everyone that's done our test 30 percent of everyone that's ever been screened we're talking thousands and thousands of patients every month now are actually at risk of developing cardiovascular disease and of being connected to the right treatment pathway.

15:14And your business actually came about through what's called an NHS incubator. So what does that mean? So we're a huge fan of the NHS and unashamedly so. The NHS gets a lot of stick around its adoption of innovation and a lot of it is unfair. The NHS adopts and scales innovation every day of the week all over the country. So we did a few things. So the first was we spent hundreds of hours, I really mean hundreds of hours before we started development to really understand the clinical pathway that we were operating in front to back from the clinician perspective, from the NHS system perspective, and also from the patient perspective.

15:53So we knew that we wanted to work in cardiovascular disease. We knew roughly what the test would be able to do from a diagnostic perspective, the actual core blood test part of it. but actually everything around it so the patient questionnaire the risk assessment the integration backup with the record really understanding how we would fit into that pathway we'd spent hundreds of hours before we started development um all with nhs clinicians so call that like an unofficial boot camp if you want and that's really stood us in in great stead and if if anyone's listening and they're at the beginning of this pathway i can't emphasize clinician patient review feedback up front is really really valuable the second thing we did was we actually proactively applied for as many nhs incubator programs support programs as we could um and just sought to learn and educate ourselves so myself as a non-clinician i actually left my scientific co-founders to the development of the device as you'd expect while i went out into the market so to speak to educate myself around the system what clinicians would want what they wouldn't want the clinical unmet needs the differences in different areas and actually how the nhs itself operated which is it's a highly highly complex organization in my experience is probably the most complex organization that i've ever had to interact with um and so we the first program we were on was called the digital health london or the first major program where we were on was called the digital health london accelerator and that is sort of the premier nhs incubator for very early stage businesses and then from there on we were involved with a number of other different accelerators and incubators because they also there are national level ones but there's also a number of regional ones so we went to every single region we could find and entered into every single program we could enter into more just so that we what we knew that we needed to become real experts in this space one of the things that because of our focus on cardio metabolic and renal we've avoided one of the I call them like bear traps one of the bear traps that often befalls diagnostics businesses where they go so broad so quick and they start to test for all kinds of different things where there's no narrative whatsoever we've been very very focused so it's actually been very easy for us to operate in that space.

18:05Did you find that they were up for working with entrepreneurs because as we know there's a lot of focus right now trying to get the civil service a bit more entrepreneurial did you find the NHS up for working with entrepreneurs like yourself? So I could talk for hours on this so I'm also I'm lucky enough to be one of the eight businesses that's represented on the eight NHS England SME advisory board so I'm a member of the NHS England advisory board on SMEs and we know from what we're looking at is actually 75 % of all NHS contracts are bid on by SMEs so SMEs are actually the backbone of the NHS and the NHS probably I don't know I don't have the statistic to hand but I suspect of all organizations in the UK the NHS probably spends more with SMEs than any other organization does in the country.

18:49So it's not quite fair to say that the NHS doesn't engage with entrepreneurs. I think where you most often hear that from is from innovators who, albeit have developed an innovative technology, but are struggling to scale it within the NHS, which is not quite the same thing. So in my personal experience, I found the NHS to be actually as open and willing to adopt new technology as any other organization that I've ever worked with. I think the difference is that there's a way and a means to go about engaging with them. And there's more in different gates that you have to get through because they don't operate on economic principles.

19:27It's not a commercially driven organization. It's clinically driven, impact driven, patient driven. You know, they have different gates that you have to get through, which is often, particularly if you're from a technical background, can be quite difficult to kind of parse and understand. but no I found the NHS actually and it's getting ever more so with the new government particularly around the areas that we work in so the kind of CVD prevention type 2 diabetes prevention chronic kidney disease prevention they've never been more open and engaged than I've seen them right now let's talk about the location where we are right now so I arrived at Cambridge station and it was still a good 20 minute ride to get here went past you know the original bit of Cambridge, the centre, which is kind of the Disneyland part of all the old medieval colleges and things.

20:16Then there's on the outskirts, the science park, but you're even beyond that. Why are you based here and how do you find it? So we are really proud to be a Cambridge business, born and bred UK success story. We started here because there is a great pool of talent for research and development in and around our clinical space. When we realised we had a product that was going to be successful. We actually had demand that was far outstripping our ability to supply from our previous location, which was a bit closer to Cambridge. We chose very early on to in-house, so onshore, all manufacturing assembly, and we actually own all of our own IP as well.

20:56That's really unusual in diagnostics. It's a real disappointment to many when they start to look at the UK diagnostics industry to find actually that most of it is actually offshored and imported. from overseas so we've embedded everything here and actually it's led to some really exciting and lovely stories so for example we are partnered with the local nhs group here cambridge and peterborough icb and local staff from the area are making the test kits that are being used in the local area to help prevent people have heart attacks and strokes which is brilliant it's a wonderful narrative and actually owning all of our manufacturing and assembly has allowed us to massively scale our manufacturing operation from 500 a month capacity 18 months ago to over 500 ,000 a month now which is insane without using a single subcontractor so these plastic things here that we looked at the colors on the pog doc where you where you add your test when you do it at home that's all made in the uk all made in the uk and we um we manufacture everything in the uk we assemble everything here and that's not going to change anytime soon the reason why we we wanted to in-house everything is it gives us absolute complete control over our complete supply chain, unit economics, everything.

22:09So as we aim to be a high growth, high margin business, you know, we grew 10x last year, we're growing 10x a year, every year at the moment, which is an incredible growth rate, and just shows the appetite for the technology that we deliver and the impact that we're able to provide to the healthcare system, and into the retailers that we sell through. And as you know, the government's talking about this Oxford Cambridge corridor and it is quite actually difficult from a physical transport point of view to get between the two do you think that would make a difference to have this kind of connectivity between them I take a mixed here's my mixed view on this so anything that talks up the positivity around the UK is brilliant any any initiative any legislation any funding that improves the lot of entrepreneurs and SMEs is brilliant.

22:58So I'm hugely supportive, particularly after the period of, let's say, downbeat language, really, really behind anything that helps UK PLC, particularly the startup sector, entrepreneurs really, really keen on that. The thing I would say is that Silicon Valley and other sort of startup hotspots, if you like, of which there are many, they have a number of things in common so they have a critical mass of founders a critical mass of generally quite high technology output universities a high concentration of very skilled engineering talent software engineering talent and other related talent and they have a really high density of potential early customers for businesses and then the final piece is they have a high density of investors so I question whether Oxford and Cambridge tick all those boxes Cambridge nearly gets there but still you don't have any major customers in this area that for example you can walk into that have a program where they are willing to try businesses from different areas that doesn't exist at all I'm almost certain it doesn't exist in in Oxford I'm not even sure it exists in London but it does exist in Silicon Valley for example you've got a good investor network here is it stellar I'm not sure you know Cambridge is still a really small place and Oxford probably similar so you know I think also I don't quite know and I mean this honestly I don't know quite how the university spin out funds are structured here no and I don't know whether that's restrictive because obviously that capital can only go to businesses that spin out which is an official process so there's all sorts of things like that I would love for that corridor to be grown into something magical I actually lived in that corridor when I was a kid so when I when I saw that announcement I I plotted it and it's like you know we're talking about like you know Leighton Buzzard becoming the new you know downtown Silicon Valley I'm not sure about that bit of it um I the other thing is like I said earlier we've done so much work with with the NHS and and other private sort of pharmacies and other groups north of the midlands from the midlands north there's so much innovation that happens there so much and so what i also don't know is that are we saying the northern powerhouse is no longer a thing um and then my final take on it is that in my experience generally labeling something as the next this i'm not sure ages very well quite quite frankly i think it either is the thing or it isn't the thing but i'm not sure you need to label it so you can see of your own eyes when you come here and as you drive here all the new buildings all the companies that appear to be sprouting up but do you have the actual infrastructure here to make this work for business?

25:50I mean I don't represent the area from a sort of chambers of commerce perspective but it works for us at the moment we're likely to expand this location here there are empty units as you probably saw when you drove in that we can easily expand to the local area is adding population massively so you know there's there's sort of like two or three major startup hubs in this country london's obviously one oxford's another cambridge is another i think that there is more that can be done with the north so actually the vast majority of our work within the healthy heart check work that we're delivering our customers are actually from the midlands up to the north newcastle for example was the newcastle and edinburgh and glasgow were the first areas that worked with us so we've always been really focused in those areas and they've got great innovation here they've got some issues to solve on infrastructure definitely so there's a huge amount of empty units here that could be filled up there's a lot of capacity what Cambridge is extremely good at I'm more familiar with the Cambridge ecosystem than I am with Oxford even though I went to university there but they're very very good at creating small highly technical extremely innovative businesses that are normally founded as part of a spin-out the big challenge is how can you then drive them on to being the unicorns of the future and that is within the science and technology space there has to be a huge people have to really start to think about how the commercial operational angle of these businesses is scaled so just because you're innovative it doesn't give you a free pass to not think about how to run a great business you'll get some runway right you'll get some leeway on it because your technology might be so innovative but at some point you're going to have to figure out if you want to generate a billion dollars in revenue a year which is where you know one of the goals that we have you're going to be selling significant volumes of your kit or your product or your service and so how are you going to manufacture and assemble that if you're a high technology business like us you've got to think ahead about that things those type of things so do you think therefore that universities are obviously very good places to generate new ideas and create startups but is it is at that early stage you need an intervention where you can get people who know about scaling up large companies to start feeding in some ideas quite early on yeah so that's one of the reasons i started this initiative called the last friday club so i felt like there was a large number of people that were coming organically to me for advice about about this exact issue partly in the local area partly beyond the majority of them were i would say in and involved in or founded founders of technical businesses who had issues around this point where they sort of proven something in the laboratory raised a bit of funding and they were like well now what and I realized that there was a huge number of people out there that needed some help so I created this sort of movement I guess if you like called last Friday club where on the last Friday of every month I give up my day just to help people and they can schedule an interview with me if they we do half an hour slots i can i try and help you with your challenge about your business if i can't help then i probably know someone that can more just to try and help the ecosystem with this exact thing because that is a very difficult question there's a very difficult discussion to have with your investors and it's a very different difficult discussion to have with prospective investors you can't go to a prospective investor and say oh i'm really struggling with the concept of how I scale my business that's gonna that's gonna be the worst investment meeting you've ever had you know and so I realized there was this real lack of like open safe space for people to have a discussion around that because also you can't really go to your board necessarily always about those type of things or your existing investors because there's sort of an implication that you might need to know what the answer is already sort of thing so that's why I've done it and it's been really successful like we've had multiple companies raise funding directly from from the conversations we've had and multiple people entering into the next phase of their business with that so I feel really passionately about that even though giving up a whole day of my time isn't you know as busy as I am is a bit of a stretch but I feel really passionately about it we're now in our sort of second season of that on a final note is there any business advice that you would pass on to yourself never mind the Friday club or anything but yourself your younger yourself starting out?

30:02I would like to remind myself that the only way you lose is if you quit. That's the first thing. The second thing I would remind myself is to have as much confidence as you can in your vision and think as big as possible and just keep going.

30:26you've been listening to me Dougal Shaw speaking to Steve Roost CEO of PocDoc for the Business Leader podcast please do rate and subscribe to us wherever you get your podcasts we do two episodes every week

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