The Mental Health Crisis Starts in Primary School | with Laura Earnshaw, myHappymind

0:00There's a million between the age of 18 and 25 and what most of them say in the data over 40 % of them is because it's some kind of mental health issue and there's also a million kids who are waiting for mental health services in the UK right now doubled since 2018 2019.

0:12Steve Roest: Wow. So there is something going on. They said that they just needed to develop a stiff upper lip. The child your son. The four year old. Yeah the four year old. Okay. And you know this wasn't in the 1700s. We're teaching three year olds about their brains. Okay. Where they live in their heads. Oh yeah. We're teaching three-year-olds that their brains control everything that they do, including their bodies and how they feel. We're teaching three-year-olds what to do if their brain feels busy. The health system, the local authority system, isn't necessarily set up to think about that holistic picture because they've all got their own metrics and their own targets.

0:44Somebody in my family had been sectioned under the Mental Health Act.

0:48Steve Roest: Hello and welcome to this week's Health Tech Hour with me, Steve Roost. Each week we bring you the best news, views and interviews with the CEOs, founders, clinicians, lawyers, journalists, investors who are changing the face of healthcare in the UK and beyond. As everyone listening knows, I am a CEO and co-founder of a health tech business myself called PocDoc. PocDoc has built the digital infrastructure that's required to scale prevention for cardiovascular disease, metabolic and kidney disease across the world. Our flagship product, the Healthy Heart Check, is now the number one tool being used outside of GP surgery to check your heart health in the UK.

1:25Steve Roest: If you'd like any more information about PocDoc, head to pocdoc.co, that's P-O-C-D-O-C.co, or you can find the test on the shelf at Boots, Well, Pharmacy to You, Superdrug, the list goes on. Thank you to PocDoc for all of the support with the show. Thank you also to everybody listening live on UK Health Radio. We love the live platform. UK Health Radio has a ton of other presenters doing great shows, so please check them out and thank you also if you're listening on demand on the podcast channels or watching us on youtube so as of this show we are now available fully available translated into french german japanese spanish and arabic so bonjour guten tag konichiwa hola and salaamu alaikum to all of our wonderful international listeners we think we are now the most globally accessible health tech podcast and we get downloads in over 50 countries every single month which blows my mind every single time so on to today's show on today's show we've got one of the most inspirational people in the uk health tech scene someone that i look up to as part of an nhs group that i'm part of um and someone that's done really charted a really unique course in her career and then moved across into a well at the time when she started her company my happy mind was was probably considered to be a rather neglected area i suspect of of of the health tech industry so um my happy Mind is a preventative mental health education platform targeted at children and it's available in over 2 ,000 schools across the UK and we have the founder Laura Earnshaw on today's show.

3:01Steve Roest: Laura welcome to the show how are you? So much I'm really good thanks for having me. Great so like you had a fairly non-healthcare route into healthcare. Yeah. Right so what was that like? Yeah it was crazy so I did business at uni and then I joined Accenture on their milk ground consulting scheme mostly because they did a good starting bonus which was good on the student that difference yeah and then I kind of found myself in the human capital consulting space and so I worked across different industries with Accenture and then I went into AstraZeneca so I was kind of in a farmer environment for a while but always in the human resource type space so I used to work in leadership development talent management and ended up being the global head of talent and development for AstraZeneca So working with the CEO there and the top kind of 200 leaders on helping them to become the best leaders they could be.

3:52So I became a kind of an expert in the science of resilience and well-being. And to be honest, my plan was just to keep climbing the greasy ladder of corporate life. But that all changed when, yeah, a couple of life experiences, which we can get into. Sure, go for it. Change the course. So when my firstborn started school at age four, really struggled with that transition into school. okay um so crying at the school gate kind of like holding on to my legs saying i don't want to go in tears at bedtime and i went in to see the school and i was like look what's what's the plan here this doesn't seem to be getting any easier it seems to be getting harder and they said that

4:27Steve Roest: they just needed to develop a stiff upper lip which the child your son the four-year-old yeah the four-year-old um okay and you know this wasn't in the 1700s it wasn't that long ago so particularly unhappy with that response as you can imagine so went home and started to think about how I could support him and realize that actually all of the strategies that I was teaching these senior leaders in AstraZeneca were exactly the same strategies that that they needed so you know learning how to self-regulate learning how to be resilient learning how to build positive relationships like it's it's the same science whether you're an adult or a four-year-old so anyway I didn't actually at that point plan to do much with that other than help him but towards the end of that first year in school they call me back in and they were like what what have you done like we've seen this big transformation actually we've got loads of kids like this we don't we don't know what to do we're not trained in this stuff wow the only time we really get involved is when it's so bad that they get referred into cams i was like cams being the um mental health service yeah so anyway still thought it was bonkers but said okay well here's what i've been doing feel free to use it and then about six months after that i uh received a phone call that i describe as like having a double-decker bus crashing into me at a million miles an hour which was to tell me that somebody in my family had been sectioned under the mental health act oh wow now this was a person who you know great job happily married three kids in private school like from the outside looking in everything looked pretty rosy right um but they had cracked under the mental health pressure they were facing so went to visit them in the secure mental health hospital in london um which is an experience i'll never forget that's sobering yeah for reasons that you can imagine and as I drove back up north where I live from London somewhere on the M25 I just decided that if mental health issues could affect my child who really had grown up in a very privileged happy home and it could affect this person who by society's standards kind of had it all then it could affect anyone so I quit my job at AstraZeneca and told my husband I was going to build a program to help the children to be happy at which point I think he thought I was going a bit mad myself to be honest and um but that that was 10 years ago and yeah the rest is history and like what what what was it that really led you to build it like because you could have that that that self-talk on the m25 on the way back yeah it ended up in a variety of different executions yeah so how did it go from that which was a fairly there's a singular statement yeah i'm gonna build something that helps children yeah with their mental health how did that then get filtered down into what you then launched yeah i guess i mean i'd like to say i was really smart and it was like a you know a process that i went through but i guess i just saw this massive gap in education and you know the stats on kids mental health you know 10 years ago we weren't talking about it as much as obviously we are today but the reality is schools are the absolute perfect place to be teaching kids skills to thrive because you know the kids are there all every day they've got the trust of the family kids are generally there a lot of the time so i just felt like it was this travesty that we were missing this opportunity to teach what are really quite simple skills in schools and i just knew that it wasn't happening so i just thought maybe that's that's the place to start and it wasn't happening it wasn't happening because they hadn't it's just not in the curriculum yeah it's not in the curriculum it's not prioritized and if you look at how schools get measured they get measured on results you know they get measured on sat results in the mainstream system here.

7:54So you know how well children can read, how well they can do maths. No one's looking at measuring a school based on how happy the kids are, what the state of wellbeing is in that school. Yeah. And what gets measured gets done. So I wanted to just do something that made it part of the school day so that emotional literacy becomes as commonplace as numeracy on the curriculum. And that's my mission. It was super interesting.

8:15Steve Roest: On the last show that we had Penny Dash on, she, at the end of the show, was talking about how she's very concerned about the sort of sub 40 year old yeah yeah which right the way down to children coming through the school system a sort of inherent lack of resilience absolutely coping skills yeah absolutely well you've only got to look at the latest stats on NEETs those that in the UK who are not in education employment or training there's a million between the age of 18 and 25 yeah and what most of them say in the data over 40 percent of them is because it's some kind of mental health issue is it yeah absolutely wow and there's also a million kids um who are waiting for mental health services in the uk right now wow a report that just came out in june that's huge that's doubled since 2018 2019 wow so there is something going on much of which tracks back to covid i'm sure yeah in our young people's ability to cope with and be resilient in the face of uncertainty and adversity which is only increasing well and you can't treat your way out of that i don't believe unfortunately as much as i'm not look everyone's in a bad spot but you can't invent more child psychologist places you can't and you don't need to so much of it is preventable well yes this is where you come in so much of it's preventable yeah and it's you know your work's about prevention as well right taking it downstream that's what it's all about it's about acknowledging that there are a proportion of children for whom if they have the right skills and the right strategies early then they will not have the same experience as they as they otherwise would so i think what's really interesting about um my happy mind really impressive is is the so outside in not my sector yeah right so bear that in mind anyone listening before you start shouting at me um is is like it's you you've i'm sure there have been different people at different times in different schools who've tried to do something like this thematically similar not the same execution at all yeah but the fact that you've managed to scale it so effectively to 2000 schools yeah it's really really impressive because I'm sure that you know in what is the the PSHE lesson or whatever it is probably has come up right but actually the fact that you managed to create something scalable is super impressive yeah well thank you um I mean I'm just obsessive about listening to the customer okay and seeing the problem okay um and I've always just been totally focused on what's the impact I want to make and how do I make it easy for schools to deliver it and I think those two things together have made us able to create something that that schools want to use and how much is it technology and how much is it content programmatical content or a bit of both it's a bit of both yes it's delivered via technology which makes it really scalable sure and but it's a content it's a content platform and I think you know there's a couple of reasons teachers haven't historically taught the type of content we teach and a big part of that is around confidence yeah teachers aren't aren't taught this stuff on teacher training in fact I did a lecture at Liverpool I think it was a couple of months ago on their teacher training course and I asked a couple of pupils oh how much have you done around mental health and well-being and they said oh yeah we had an afternoon on it on a three-year degree yeah and you're thinking well hang on a minute yeah what do we expect then so we're putting teachers in classrooms without the knowledge and the skill to teach this stuff so what we do is we put that knowledge and skill in the palm of their hands and how does it actually work at a school and what actually happens so a school gets access to our program so think a website that they get access to yep nice and simple and then they go in and they click on whichever lesson they're up to in the program based on the age of the children.

11:35And then they teach the lesson to the children. So they project it onto the whiteboard at the front of the classroom. And they teach all the contents pre-made. There's quizzes, games, animations, songs, fun characters.

11:46Steve Roest: And what type of ages does it go? We start at age three. Oh, cool. Yeah. What do you teach the three-year-olds? We're teaching three-year-olds about their brains. Okay. Where they live, in their heads. Oh, yeah. We're teaching three-year-olds that their brains control everything that they do, including their bodies and how they feel. we're teaching three-year-olds what to do if their brain feels busy oh okay and then we're teaching them breathing strategies and we're teaching three-year-olds about their character strengths so to feel good about being kind or funny or determined nice so we're shifting the dialogue in schools and in nurseries as well we work in early year settings and schools to being around um definition of self being about competence sorry being about character not competence so our entire education system is about how good you are at something yeah that's definitely true um like but that doesn't build self-esteem so in fact the opposite exactly so the research on self-esteem goes if you feel good about who you are at your core so for your humor your kindness your bravery whatever it might be that's when you feel good about yourself as a human that's what we're teaching in schools yeah i mean some one of my friends described us as all like a kind of what did she say she said something like a bunch of nervous wrecking overachievers you know kind of thing which is like yeah it's when we were at school it was all about marks and grades and things like that i mean to a large extent it still is my son's um doing a levels next year so he's first year just finished his first year one of his friends was over last week just got results and it's still all about what grades did he get did he get into uni i'm gonna have to go through clearing it's like where's the where's the bit about but you're an amazing human and you worked really hard and it's just not it's not built into our education system no so it doesn't get prioritized unless you put it into the system and that's what i'm trying to do do you think it's built into any education system just curious are there anything the scandy countries are much better at this stuff okay um partly because they don't start education until that much later yeah there's like the seven the seven the seven yeah compared to four here and obviously most kids go into some kind of formal setting before that um but no i think it's just it's what gets measured gets done and the government are measuring schools based on attendance and and scores in maths and english and therefore that's what teachers feel pressured to focus on so what was the reaction from teachers because actually let's dial it back a second so you had this idea i had this idea you had this idea yeah and everyone thought i was mad well yeah obviously everyone thought you know that's half the course yeah and then you you were like oh okay well i've been teaching some grown-up four-year-olds some stuff anyway so it might work with like Overpaid.

14:17Steve Roest: Overpaid. Overpaid grown-up four-year-olds in suits and it might actually work with real four-year-olds. Yeah. But how did you start to put the building blocks together? So I found two headteachers where I had a bit of an in. One was at a private school in Manchester where I was on a bursary. And one was a really tough school in inner city, Manchester, where my mum knew the head. Okay. And I went to meet both of the heads and I said, look, if I build this thing, will you test it for me? And if it's any good, you can have it for free forever. they were like yeah sounds great um and then i started taking all the science that i knew from programs i'd done at harvard and insead and all these places i've worked in my corporate life and i was starting to go how do i boil this down into a curriculum for kids and i just sat on my kitchen table and started writing and then i taught myself how to write e-learning first version of the program is really bad nice sometimes i look back and shudder but somebody i can't remember who it is famous person i think it's zuckerberg or someone said if you're not embarrassed of the first version of your product you waited too long to launch it yeah i'm a complete believer in that like when we've you know this is it's not about me but i'll just riff for a second but like but one of the my big things that i say is like there are so many great products out there in medtech they just never leave the lab yes just don't leave the lab well yeah not perfect and the whole scientific ethos is about perfection yes there's always another experiment you can run and there's always another thing you can tweak but at some point you've got to get the dish on the pass and you have to let the customer decide yeah that's the best experiment you have to let the market decide i need the customer yeah and listen anyway carry on so no i totally agree but i love the fact there that you basically because for me that was that what you did there was straight out of like customer discovery 101 yeah which is like look i i think you have an issue do you have an issue what kind of issue do you have like what you know and then i'll come to you with a solution and would you test it for me so i can learn and then i can iterate is like absolutely spot on and i've never stopped doing that sure so i think that's why we've built something that schools love so much because it's been built with them yeah co-designed yeah co-designed and actually i started with the problems i said you know what what do you do now we don't really do it why not don't have time don't feel confident too much else going on in school dealing with behavior problems all the time so but you realize that if you get this stuff right the behavior problems start to decrease and then starting to just build that and have you seen data on that oh my god the data we have is insane really in terms of what our program does on that so really wow absolutely we've just study in Portsmouth, a local authority.

16:43Yeah. They saw... Difficult area. Difficult area, yeah. So they had My Happy Mind in some schools and not in others. And they compared the data on attendance and suspensions over a two-year period. Okay. Attendance in non-My Happy Mind schools over this two-year period... Sorry, severe persistent absence over the two-year period increased by 120%. Wow. In non-My Happy Mind schools. Wow. In my Happy Mind schools, severe persistent absence only increased by 20%. That's amazing. And we see the same thing with suspensions, massively reducing in schools that have the program.

17:19Steve Roest: And roughly, like, other factors are roughly equalized. Other factors are equalized. Yeah, absolutely. Yeah, yeah, yeah. I mean, as much as you ever can, right? Yeah, no, I get it, because it's social. Prevention stuff. And then the other big stat that we see time and time again is around attainment. Okay. Massively improves to the tune of, like, eight times the rate of schools that don't have the program. Wow. you know happy kids learn right if you're if you're happy yeah you've got better self-esteem you're going to work harder and you're going to do better so the data that you're seeing on the ground around actual so i think that's one of the things again like i said i'm not it's not my sector yeah but i can i can hypothesize yeah some of the critics of this type of thing yeah i like oh yeah that's really soft and sure it's like net positive but like show me the data yeah yeah absolutely so what we've tried to do is look at um education data and health data because we sit on this weird boundary because we're an education product that delivers health care outcomes.

18:13Steve Roest: Mental health outcomes. Mental health outcomes. So sometimes when we're looking at commissioning arrangements, local authorities are going, well, isn't this a health thing? And health are going, well, isn't this an education thing? And I'm going, why don't you split the cost? I've got a solution for you. Yeah, I can help you with that. So yeah, and we do, we get commissioned by both. But yeah, we see really strong attainment and attendance correlation, as I've said, But we also see really significant reductions in referrals into services like CAMHS, children, adult mental health services, reduced referrals into even to speech and language therapy services like that.

18:46Because actually, if you give you give teachers and parents and kids the tools to to get stuff early and to catch stuff early, to nip it in the bud, for want of a better phrase, it just doesn't escalate. I mean, it's just prevention 101. Right. But you're right. There is always that kind of, yeah, but how do you prove it? And all we can do is say, well, let's look at these controlled data points that we're not collecting. The NHS is collecting, the local authorities collecting, and let's isolate as many of the other factors as we can. And every time we do it, and we've done 50, 60, 70 of these studies, the outcome is the same.

19:16Steve Roest: That's amazing. And do you feel like the kind of health authorities look at the attendance and the other data points that you mentioned? Or is that more like, like, as in, is there a holistic view of all of this stuff? because it's all interconnected but i could also see some people being like well oh that's not a health thing and yeah so uh i have two decks so and to be fair some some of the health commissioners really get that if you can see an impact on attendance then that's going to also have a health outcome but yeah yeah different audiences have different priorities and sadly again the system the health system the local authority system isn't necessarily set up to think about that holistic picture because they've all got their own metrics and their own targets yeah i mean i could tell you some horror stories about some of the conversations i've had with commissioners who won't commission it right because it might negatively affect the number of kids that they can get through therapy so oh because they get paid per capita yeah oh my goodness yeah what a perverse incentive i know oh my god yeah so you so we so as a as a commissioner i've got to get you know i've got a target of getting a thousand young people through therapy but if i put my happy mind in a thousand people might not need therapy therefore if i commission you i might not hit my target wow did you just say that out loud yeah how did you deal with that when when i actually said did you just say that out there wow and then i said i said well i guess the other way to think about it is that that would be fewer children and young people that need support yeah might be a good thing good yeah they were just a little bit sheepish and embarrassed at that point but also if we're faced with a situation where waiting lists are really long then you might have no issue because there might be still lots of people to yeah yeah yeah that's the that's the law of unintended consequences and yes the wrong incentives yeah i would say absolutely right um so what you know how at what point did you because so you got the first product ready gave it to the private school in manchester and the other school in manchester yeah they got it for free yeah and then how did you transition which i think is a really difficult transition with this stuff which is like generally speaking if you've listened to the customer and you've built against initial customer requirements yeah and the customer likes you yeah they're probably gonna be positive about it yes in some way shape or form yeah you know and but how do you then take that from there into something that you actually sell to somebody yeah who may not like you may not know you yeah you know yeah what was that transition like really scary because you're right i mean i'd given it to them for free yeah i had a loose connection to both of them one was my old school and the other was my mum's mate you know so there was always the risk that they were just telling me what i wanted to hear so i figured out i was gonna have to go and knock on school doors and get myself a meeting and see if someone would pay for it and what did they say when you started to knock on random doors they said it's a massive gap they actually straight out said that straight out the gate oh amazing yeah that's awesome but but it's interesting looking back because my first few schools that were actual real customers rather than pretend customers um i would i would have like actually paid them to use it because that was like you're still in that fearful thing of what if this is what if this is all you know a load of rubbish but but no they they were great and they they still use it today to this day my first customers we lose very few customers yeah and part of the beauty of the product is that because the teachers deliver the content they get that instant feedback from the kids yeah they see it working so they're not removed from the impact it's having they are the impact it's having yeah and that just creates a very different connection point for them as well they almost become the hero well it's also kind of again not my area but it feels like it's helping them solve a problem that up till now they've struggled to solve 100 as a teacher because they might be a science teacher or math teacher but they're still seeing these sort of systemic behavioral issues yeah absolutely and they don't know what to do other than, oh, toughen up or, oh, you know, yeah, I'll listen to you.

23:02Steve Roest: You know, they're just freewheeling it, really. Yeah, absolutely. And, you know, we started in primary schools because I'm really passionate about that early stage prevention space. And the data says that something like 80 % of mental health issues that will manifest in teenage years can be originated back to something that happened in the primary school years. Okay. But most of the investment in children and adults' mental health services is in teenagers and adults. Okay. If I go back, hang on. If the data's telling us that it's starting earlier, yeah that's when we need to be giving them the skills that's like the prevention versus prevention versus exactly versus um treatment um but most primary school teachers i think go into teaching because they really genuinely love kids yeah and they want to help kids thrive yeah and so actually we're giving them something that enables them to do the thing that they probably went into teaching to do yeah um so in that sense it works really well yeah and so at what point did you feel like i'm i've got a business here do you remember that moment or was it kind of just incrementally it just sort of built and built and built i don't know if there was a moment i remember getting to 150 schools and it was still me and my kitchen table oh that's cool and a customer called me and they said oh laura it's a bit of a problem we've gone to log in and we're locked out and it's a subscription-based business so it's an annual fee and i was like oh yeah there must have been a technical glitch i'll talk to my tech team yeah i'll talk to my tech team laura what's going on and um and they just they their subscription had lapsed and i and that's when i was like oh hang on a minute like the wheels are going to start coming off if i'm not if i'm not onto this um and then my husband came into the business which was great because we've got very different skill sets okay and he kind of took on all of the operational side of things and and yeah then like the rest is history with team of 40 odd now so oh that's cool yeah that's great and um where does it go from here do you think i just want to keep keep growing it i mean we're in about nine percent of uk primary schools oh really okay long way to go Oh, you've got loads of growth.

24:53Loads of growth. Oh, that's awesome. Yeah, we've started a secondary school program. Okay. So we're starting to get into older kids. Going international as well. We've just got our first school in the US, which is cool. What's your take on the US? I mean, how long have you got? Yeah. That's a whole other episode. Yeah. I mean, they've got real issues in the US. Right. But there's a different willingness, I think, or lack of willingness from some senior leaders there to address it. So it's going to be a different ball game. Right. actually this this one school's come about very organically um so we've not kind of made a play for the us um but we're doing a lot in international schools in asia in the uae right there's a massive issue out there now okay there's war lots of anxiety yes coming up for kids so yeah yeah we keep growing in the uk the uk is the focus but yeah okay and take it internationally as well

25:42Steve Roest: and what was the sort of what if if there was any what was the kind of challenge or pushback on this I mean, was there anyone saying like, no, this isn't a good idea or like, was it all just sort of, oh my God, we've been waiting for this? I think not many people would argue that it makes sense to be teaching young kids strategies to help them to be happy. So, you know, the kind of the narrative around this business is very relatable, I think, for most people. Most people have got either had their own children or seen a friend struggle or have a friend whose kids struggle. So I don't think there was ever any pushback on the concept.

26:14I think the hardest thing in the early days and to an extent still today is is getting people to fund it so we have two kind of um different go-to-market strategies either schools pay for it themselves yep or the NHS or local authority pay for it but as as you well know it's not there's no such thing as one NHS contract so you know we've got 50 odd of those and sometimes there's still a bit of well you know we've got all this we've got waitlist we need to clear the waitlist how do we how do we this as well so funding can still be a challenge although that's getting easier all the time i mean when i started prevention in mental health with kids wasn't really a thing yeah but now it's it's

26:52Steve Roest: up the priority list well there's no you can't it's it's it's just unavoidable now you can't there's no there's no way to clear the cams waiting list yeah you've got to do something you have you have to yeah you have to look for the upstream or downstream whichever way you want to put it i think that's the same for most kind of health tech most kind of therapeutic areas like prevention exists in so many forms in so many therapeutic areas like like with your organization but it's you know we always as a society react to crisis quicker than we react to preventing that crisis yeah it's harder i mean i don't know it sounds like you've found the same thing but i've definitely found the argument around why we should take cost out of the future yeah by spending today it's getting easier and easier with each passing day yeah definitely i mean i think the system is just so broken and it feels like a perfect storm right now in children's mental health because obviously the NHS is is really challenged um and at the same time we've never seen more children and young people struggling with their mental health and those two things together I think have made people go actually come on we've got to do something differently how do you think this is a slightly off topic I know this isn't your responsibility at all so I'm not making out like it is but what what do you think could be done around the needs the million needs which which is a terrifying yeah like that heart breaks my heart like that number i know you know that that the million 18 to 25 year olds where they should be just at the beginning of like cracking on you know and and sort of the the hopelessness of that situation is is rough but what what do you if 40 of them have have diagnosable mental health issues yeah what do you you know what do we do we're going to find different pathways for those young people into some kind of formal educational training clearly if there's that many who have gone there's nothing for me there's no job for me or there's no educational path i want to pursue then we've got we've got a problem with the with the setup which i think to be fair andy burnham is starting to talk about wanting to look at different pathways hopefully but my nervousness is that we're just going to focus on initiatives for that cohort and obviously that's really important but we've also got to think about initiatives further back because it's just another wave of those those young people coming through if we don't if we don't do that and the data on it is something like 40 percent have got special educational needs okay um wow really yeah of those their needs so then you go well hang on what what are we getting wrong further back in their education that we're not equipping them to feel able to you know put to progress in some way so i think we've got to look at the that million for sure but we've also got to look further back and i think that's what the milburn review is is suggesting okay um but it's whether the funding follows as is always the case with these things we're pretty good in this country at articulating the issue i don't know that we're always as good at yeah i mean i look this i'm not this is not my area so i don't want to sort of start opining but i feel like we we're we're we are good at doing inquiries yeah and we we love a report love a paper we love a paper white or otherwise or other colors all colors are available um sometimes i feel like we don't back ourselves to to really commit to a 10 year or 15 year generational change now yes and push that through in a i know we're not bipartisan but what's the phrase like cross bench type of way to say look like the a million needs has got nothing to do with your position on immigration or exactly it's got nothing to do with any of it yeah let's fix it let's fix it but this is a 10 to 15 year plan to fix it yeah because you can't just invent jobs and you can't just you you know you can't invent uh you can't invent a cultural change around um apprenticeships no you you you know you just can't do that that's there are other countries that have done that really well like germany for example but that started very soon after the the rebuilding of the the entire country yeah in the 50s and 60s and then it got carried forward though so they've been doing it for 40 years you can't just look at them and say oh we should do the german model and like we'll get loads of people to see a result it's a you it's a complete rebuild because at 16 you have to create really, really, really solid pathways that have to be connected into industry.

30:53Steve Roest: And it's really difficult. It's really difficult. It's going to take a long time and a lot of really smart people to think really, really hard about it. And I feel like sometimes we don't give those people enough air cover to go off and fix it without worrying about whether or not they need to make an announcement in the press about some new program that's going to magically fix it. Exactly. That's my take on it. Agree. And the other thing I don't think we do very well whilst we're talking about things we don't do very well is scale things that we know do work right so you and i are in a community of innovation innovators we are shout out to the nia shout out to the nia um who have been through pretty rigorous assessment around you know clinical due diligence financial due diligence all the due diligence and have had the rubber stamp of this is something that the nhs promote and think should be scaled and yet still it can be really hard to do that so i think the other thing as a society that we're not always great at is going there's a problem there are some solutions out there that we know work rather than putting loads more money into research which we are also very good at in this country yep let's put some money into scaling things that have already been proven to work um and that that's a frustration of mine as a as a founder is i've not had a penny of grant money um yeah because you're in that awkward area yeah i think you're in it you're you're in it you're you you you've been that's that's highlights the awkwardness around grant funding which is because you're real world yeah you're live you're doing stuff yeah you need you get grant money to do things yeah but what grant money in this country is often geared around is like researching new things yeah even in areas where we already have the things that work yeah and i mean there's also i had this terrible thing we're a positive we're a positive podcast so we'll get back to it in a second but one of the things that blew my mind um we got called by one of these um grant writing businesses i'm sure i don't know if you get contacted all the time i won't know i won't name them because that's not what we do but they called us and they said that 99 of all winning innovate grants go through their ai platform now so wow 99 of all innovate uk grants that get one are written by this company's ai tool and you're like well what is the point what's the point what's the point yeah you know so i think that there's definitely like a distribution of those things and like and And I don't understand what the fear is about backing real world things with grants.

33:14No, I don't.

33:15Steve Roest: I don't get it. I just don't understand. It's a bit like, I think about it a bit more like an investment question. Yeah. Like if you were an investor, you know, one pro equity, VC, doesn't matter. Yeah. You're basically saying, no, no, no, no. We'd prefer to back stuff that's much higher risk, right, than stuff that's much lower risk. Because we think that's better for what we're trying to achieve. It just feels a bit, I don't know if anyone's done the real thinking of that or whether they just have a bucket of money for high-risk research. It feels like the government playing VC to me. A little bit, but they keep it at arm's length, right?

33:49Steve Roest: Because it's not even like the government has a lot of influence over what Innovate do, I don't think. I mean, I'm up for the research bit, but I think there should be equal part opportunity to scale the things that work. Particularly when they're in those high-priority areas and they've been proven already. Well, I think that's what NHS England was kind of partly supposed to do. Yeah. I think to say, like, take a kind of overall view of things and say, well, hold up a minute. Look, regions can do what they want. Regions are always going to do what they want. It's very hard for us to say regions shouldn't do what they want.

34:18That genie's out the bottle a little bit.

34:21Steve Roest: We can try and bring people around and we can try and do certain things. But broadly speaking, regions are going to do what they're going to do. However, we're also able to take a national view, which is to say we think there are these big priorities. And we're going to back them. yeah and i'm not sure necessarily that happened in the way that they probably thought that was going to happen i mean i think it's interesting isn't like the core 20 plus 5 stuff was really clearly articulated massively clearly articulated but the solutions that are already proven to deliver against those priorities less so i think there's like a fear around endorsing things but anyway no but i but i think this is a good it's a good it's a good thing to talk about because you know ultimately i agree with then i had we had a guy called matt witty on who used to be the director of innovation at nhs england a couple of shows ago we had this exact same conversation which is what is what are people really scared about here by by supporting a company that does a thing a british company well it doesn't like any company in a sense because you know they're like oh we don't like the privatization of the nhs like okay well what do you really mean by that because the nhs uses huge amounts of private companies to do all kinds of different things like the nhs doesn't make its own surgical clubs no exactly right and nhs doesn't make its own toilet rolls you know so what are you what are we really saying here about the concern i feel like there's just a bit more of an honest conversation that needs to happen in that space that hasn't really happened yet yeah look that then leads back around to why things can't be backed yeah necessarily but when they are backed rightly or wrongly like palantir all hell breaks loose yeah you know i don't know if you've got a view on that one yeah i might stay away from the yeah fair enough a lot of people a lot of people want to so um what kind of drives you on a day-to-day basis around this to keep going to keep pushing to keep pushing through all the challenges within the nhs and things like that i just feel that um i don't want any other parent to ever go through what i went through and feel unsupported and feel like there isn't an answer and there isn't an out because there is for so many kids it's you know there are things you can do to help their lives be a lot better um and i feel like you get a bit addicted to breaking breaking some of the stereotypes and breaking some of the boundaries and people saying you won't be able to do that and i'm like okay let's see nice i've always been a bit of a rebel i think yeah i think you've got to be a bit of a rebel to be in this game oh well i mean look i i believe that that people who become entrepreneurs have a particular yeah um character character set you You know, resilience is one key trait.

36:52Steve Roest: And there's kind of like an F you, I'm going to prove you wrong type of thing. You know, if you tell me I can't do something, then I'm pretty much going to drive myself into the ground to prove you wrong. So, yeah, that all makes a lot of sense. If you could wave a magic wand, what would you actually change about the way the NHS does things in your area? I would change two things. I would change the share of funding. So that there was ring fence funding on prevention. In mental health? In mental health. Okay. Because you're still scrapping around the edges to get the funding for prevention in mental health.

37:25Steve Roest: Oh, because it's in the same bucket? It's in the same bucket as reacting. I would do that and then I would measure different things. So right now, as I said before, the system is rewarded or penalised based on how many children get seen. So based on access targets. So how many children are ill and how many ill children do we see from a mental health perspective? Okay. I would start measuring how many children did we prevent or how many preventative interventions is this system running so that we were putting more focus on prevention in what gets measured. What gets measured gets done. What gets measured gets done.

37:58Steve Roest: And how, when you talk about those two things, what's been the reaction? Because I'm assuming that's not the first time you've communicated those two things. No, and you know what's crazy about it is everybody agrees with that. When I talk to commissioners and I say to them, so if we're measuring different things, would you have a problem? No, absolutely not. I think there's so much fear in the NHS particularly over the last few years where there's been so much change, so many reorgs but the people that are still there, I do think there's quite a lot of fear in the system and that cultural fear doesn't drive risk taking behaviour it drives kind of, oh I'm going to keep my head down I'm going to stick to the rules so a lot of our commissioners I feel like are the rebels as well or the ones that are kind of going listen this isn't necessarily going to help me with my targets but it's the right thing to do It will help with other targets It'll help with other targets and it's helping them to see that but yeah I think I think it's I think the NHS is a real kind of watershed moment in terms of its culture because I think people are burnt out I think people are not in a great place and I think trying to give them some sense of hope and empower them to be agents of change is really important and our work helps them to do that because it's so positive I agree right we're going to go for our final commercial break and then we're back again with the last bit of today's show with Laura Earnshaw from My Happy Mind we'll be right back welcome back to the final part of today's show with my guest today laura earnshaw the ceo of my happy mind so let's talk about culture yeah so this thing comes up a lot with you know in our nhs circles yes entrepreneur circles and i i take a more kind of i'm always a glass half full guy yeah you know i'm always i want to kind of always be the good news bearer and because mostly because i don't like feeling like negative and moany the whole time for myself like i don't i just i don't i don't like that but sometimes it's quite difficult to kind of maintain that i feel like you're kind of similar so how do you sort of maintain elements of positivity when i mean even if you look at some of the whatsapp groups that we're on some stuff stuff can get pretty negative on there you know yeah i'm a glass half full person as well i think you have to be otherwise i think you just become miserable yeah um and i feel very grateful that i get to do this work i feel very grateful that i get to have the impact that i have in the system um and i just i just focus on that stuff my i grew up as a so my dad's a vicar okay so i grew up in a very positive giving grateful grateful world and family and i choose i choose gratitude every day and both of my kids you know they've had their own journeys with health stuff um and i just choose i choose to be grateful i think life's too short to be anything else um and you feel like that more of the kind of innovators in the uk at least should maybe be a little bit more positive i mean it's hard to say right because everyone's having a tough time of it everyone's having a tough time of it but i think negativity is never going to help you have a better time of it you got to find the small wins along the way and i think you know interestingly in the science around gratitude which is another one of the things we teach in our program okay great um what we know about gratitude and when we give it or we receive it is that we get these little happy hormone bursts in the brain right we get these dopamine serotonin releases and that doesn't just make you feel good in the moment but it also has been proven in the science to help you become more resilient against adversity down the line so actually being grateful thinking about gratitude is more than just a nice instagram quote it's actually proven in the science to really help us and and that's why i think it's such a powerful force and yeah i mean i get it it is it is hard out there but i don't think if an organization is having a hard time the answer is to blame the customer I think the answer is to have a different conversation with your customer and get to the root of it you're ringing my bell it's one of the things I love to say which I couldn't believe so I my background wasn't in health either and when one of the first things that struck me when I started to look at the space was I was like oh everyone's complaining about their customer publicly that's a thing is that we do that do we do that like everyone's just like slag slagging off the NHS on on LinkedIn about how bad they are and even people who are consultants to the nhs yeah like the nhs yeah and you're like they're your customer what is this what we do yeah and they are and the people in it are not the nhs they are part of a system yeah that is has got a culture for many many reasons and actually what you need to be doing is understanding that and supporting customers to get to their outcomes so yeah yeah i take a different approach i i just could never and would never ever complain publicly no about my customer no and i just still shocks me about how many people still do yeah and about like they complain about some real structural things that that's not really even in anyone's pay grade exactly no one's fault no one's set out to be a difficult organization it's a complex beast yeah and the trick is figuring out how you work with it my favorite one is when you see innovators taking on the nhs for their quote unquote stupidity about daring to have a clinical pathway that includes things so so these innovators that aren't clinicians but they run a business that would change a clinical pathway yeah and they're upset about the way the clinical pathway is right now yeah so they like slag off the nhs for being stupid enough to have that clinical pathway guys come on i mean how do you think that's gonna work yeah you're in the wrong game if you can't figure out a way to make your customer happy even in a complex system like the nhs but you feel like why why would is it something about health that means that people that start businesses in that are more inclined to or is it about because they believe that the nhs is somewhat sort of it's it's it's sort of an amorphous nebulous thing that they can complain about because it's not really the customer you know what yeah i don't know it's interesting isn't it i wonder if there's like a dynamic of if you grew up in health versus if you didn't yeah it's possible so a lot of the people that i know that are entrepreneurs in health are healthcare professionals and have kind of come out of that to build some things maybe that gives them a different perspective maybe it makes them feel they have more of a right to quote unquote slag off the nhs like i i see it as a i mean i never thought you just said to me when i started oh the nhs will commission this i'd never have believed you right i didn't go after the nhs commissioning us they came to me sure and said we're noticing a massive decrease in cams referrals in the schools you're in in our area awesome can we do a pilot that's an awesome story yeah it was cool i was having my daughter's school shoes fitted in clarks when i got the call i was like sure you can that's That was not a path that I, so it's funny when we first joined the NIA program and we were talking about like how many commissions have you got and you know, how fast is your car?

44:23And they were like, oh, how did you get your first commission? And everyone was like, oh my God, it was so hard. It took me years. And I was just sat there going, um, I got a phone call when I was in Clark's trying my daughter's school shoes on with her. So my journey has been quite different. And I, yeah, I don't see merit in.

44:38Steve Roest: I wonder whether that's because you from the beginning were solving a real problem yeah a really real problem yeah yeah you know that that exists and there was no debate about it existing it wasn't sort of like having to try and persuade someone to that that was an issue yeah I think is often and I think you I think sometimes some of the solutions that I see in our space mental health and otherwise are amazing solutions like the technology is amazing the idea is amazing but they're almost too amazing for the customer base and so our product had to actually be quite simple sure for teachers because teachers aren't massively techie always they don't always have that skill set so there's two bits for me there's the the product and then there's the readiness for your customer to accept it and i think sometimes that's the bit that's in the middle so i think sometimes we hear innovators slagging off the nhs it's not because their product isn't right but it's that they've not necessarily done the work to figure out how they make that accepted accepted by the system yeah so i i get into arguments all the time on linkedin when i put stuff out about this about like don't blame the customer and then you know people come back and be like well you know timing it's all about timing and sometimes the timing's just wrong and i'm like well you could say that but actually or you could say well did the customer even have that problem to begin with yeah you know or was your solution a solution to the problem but the solution was over-engineered or under-engineered or too expensive or just the wrong commercial model or you know it still comes back to whether or not you you solve that customer's needs yeah as opposed to saying oh yeah just you know bad timing that's why you've just got to have the customer at the center of everything you do yeah i think so um and there's always going to be bad timing stuff and funding cuts and all that and that happens but yeah i i definitely choose not to not to go down that route yeah i think how do you think we could try and sort of change change the perspective on it because i do i do feel like there's loads and loads businesses in the uk that work really hard and there's just people a little bit down in the mouth at the moment i'd like to know i'd love to know what we could do if you if you have any thoughts just try and change it up a little bit i don't know i think we i think we've got to look at these networks that we that we have like the nio program like other programs that are out there and think about what are they what they're giving to the innovators so sometimes i feel like at those events there's almost a sense of you know people should be coming to us and and helping us to get our innovations out there i feel like we need to flip that script yeah maybe it's about helping people to understand how they become more customer centric or how do they access the customer in a different way how do they have different conversations i think that's the best piece of advice i would ever give somebody trying to start something in any field is go and understand your customer go and understand the problem and don't build anything until you've got that totally clear yeah and i wonder whether for those that are really struggling they need to not go back to basics but go back to the start and revisit their product their organization their business based on what's happening now because there's a lot of innovation that was built a long time ago and maybe the problems moved on maybe because yeah moved on yeah i mean i remember i always tell this story like we did three or four hundred hours worth of of customer research before we started building yeah of of of all different types of customer and stripes and etc and um um you know because we had this conception so when we spoke to all of the we spoke to like mums and dads and friends of mums and dads and all of these different people about how do you like get cholesterol tested and what do you do and how do you think about heart health and and then you know they were like oh yeah it's really annoying i'll go go to the gp and you know it's really frustrating and i'd love to do it at home and we were like oh great that'd be cool because like then if the gp buys our test yeah their patients will be happier yeah right yeah And we were like, oh, that sounds great.

48:16Steve Roest: And that theory lasted about 12 seconds in the first GP conversation when we found out the GPs get pathology lab testing for free from the NHS ICB. Yeah. So they're like, well, why would I? Why would we do that? And you're like, oh, yeah, of course. And then we found that out and then we've worked around it. And then, you know, latterly we've worked out a way to work with GPs, but they weren't our initial customer group and, you know, all the stuff that you do. But there are so many businesses that I come across when I do the Last Friday Club and stuff that are still trying to sell point of care diagnostics to GPs.

48:46Steve Roest: Yeah. I'm like, they get, you're competing against free. You've got no test. And they're like, yeah, yeah, but my thing is like better and it does different things to the lab test and they get the result immediately. And I'm like, they don't care because your test is coming off their bottom line, whereas they get it for free. I mean, it's impossible to compete against free. Yeah. Yeah. Yeah. I don't know. Well, where do you go from there? Yeah. What do you do? Yeah. And what's the response you get out of interest when you say that? Mixed. Yeah. I'd say it's very mixed. i say some people are very the reason a lot of the time why people um come on to those last friday calls yeah it's great that you do that by the way i just want to help yeah you know i want to raise the tide of everyone and i think you know companies like yours where you had a good exit or a partial exit to private equity and yeah like ultimately we're all in this yeah for a journey right and the the more successful everyone in is this space it helps everyone in it yeah right so like this is another thing the pet ain't mine is when people slag off the nhs on linkedin when that's your customer so when what do you think vc investors think when you're slagging off your own customer yeah because the first thing they're going to do is google you and yeah what do you and you're like oh it's a disaster the nhs is this and it's like you know what why would you do that what do you think they're going to think about your business so um so people people join because they want to help yeah i think yeah mostly so they've made that first step which is which is good they sort of said hey i'd like to talk to you about this and i'd say 50 are like oh i hadn't thought about it like that yeah and then the other half are no you're wrong and i'm like all right cool yeah i mean i i have no dog in the fight yeah you you called me kind of thing and yeah i'm here like i gave you my opinion and yeah there you go yeah um so but but the other half is a bit like a light bulb moment yeah when they're like oh so what would you do is the next what would you do i'm like well i don't know this is what i could do yeah so um but i you know i do it because i I really believe a little bit like you.

50:38Steve Roest: I really believe in trying to help and trying to elevate everybody because we're all in this together in the wonderful wide world of health technology. And the more winners there are, the more it helps all of us. Absolutely. Couldn't agree more. Cool. So we always end the show by asking our guests, what kind of self-talk or mottos do you use or have used in difficult situations to get through those difficult situations that you want to pass on to help anyone that might be listening who may also be in a difficult situation? So I have two things that I'd say to that, both of which my kids say are totally cringe.

51:10But I have a 17 and a 13. Yeah. So most of what I say is cringe. Yeah. The first is everything is figureoutable. OK. And I really believe that. Nothing is that. We're not doing rocket science here. Well, we're not doing rocket science. Rocket scientists are, but we're not. So any problem that you're faced with, there will be a way through it. So everything is figureoutable is a big one. and the second one is every action you take either gives you the result that you wanted

51:38Steve Roest: or the lesson that you needed oh that's a good one that's a new one on me that's a good one that's a good one yeah i can't remember where i first heard it it's definitely not mine but i do really think about that all the time and so when things don't go right when i you know the commission doesn't come off or whatever happens i go okay what's the lesson that i needed from this what can i learn from this what can i take from it to build and i think you've just got to have that mindset when you're a founder because it's not all going to be cupcakes and roses not you're going to get punched in the face you're going to get punched in the face exactly so yeah brilliant well laura and shaw thank you for coming on the show thanks for having me it's been great brilliant and thanks to everyone listening we'll be back again next week with another show thanks so much great thank you