#416 Steve Roest from PocDoc: Is Point-of-Care Testing the Future of Preventative Health?

0:00Welcome to the health tech podcast. Here we talk about everything healthcare and technology. And I'm your host, James Summery. Hey everyone, delighted to be joined this week by the one and only Steve Roest, founder of PocDoc, Health Tech Hour, wearer of glorious blazers in Maltese health tech events. More on that, I'm sure later. key part of Steve's founding story. Yeah, man, delighted to have you on. I can't believe you haven't been on so far. This is like a massive oversight on both of our parts. Yeah. And I'm super honored to be on. I mean, you are the absolute OG in this health tech podcast.

0:44And I know that when we started the health tech hour, you know, I was very much looking up to you and the quality and the content that you had already delivered. Like by the time we started it, you were like on EPP like 200. And I remember looking at that and I was like, that is impossible. like that just that just strikes me as an impossibility so no it's i'm super honored to be here and it's been amazing to sort of watch you and jess and somex and everything you guys have done from the from from the sidelines and and sort of be be cheering you on as best as i can so congrats well thank you mate appreciate you appreciate you but um yeah i mean the the the the ticker of 100 200 300 400 episodes continues to pass me by i continue to not really think about it but when you look when you look backwards and you'll notice this as well right when you look backwards it's like oh yeah i have just recorded every week and they add up oh yeah it adds up and i i said this on a call literally before this podcast because they were asking me about it consistency beats talent any day of the week and it is true and by the way you'll accumulate a bit of talent on the way because you you do well to not become a slightly better interviewer or maybe i have i don't know but like you know i mean that's a great oh that's so good that's excellent i love that one um yeah yeah it does man consistency honestly it's uh it's it's been my it's been my secret weapon just the belligerence and well i don't know about how you feel about it but it's weird i mean you you started you know 200 episodes before i did right and and so um You were way more on the early adoption curve on this content generation than I was by some distance, clearly.

2:31But even one of the things that I've noticed now, even when we just shipped episode 130, 131 or something, even now that puts me and us so much further ahead than anyone that starts now. I don't mean competitively because it's not that type of game but more like just in terms of accumulated wisdom and experience and knowledge and understanding how content can be used to achieve all kinds of different things whether that's in business, outside of business, platform, profile. We've used the platform in a few ways really specifically to highlight some amazing work by our NHS partners and amplify what they've been doing because it's been a pretty rough time over the fence over there you know over the last 12 to 18 months so i don't know what you feel like but it just puts you in a position where you know through consistency like you say and accumulated wisdom you're actually one of the experts in the space about this i mean who else who else yeah i think on a personal level on a personal level yeah because you have a conversation a week with a subject matter expert and you have the chance to ask them in great detail about the science or the tech or the business model or how they manage to do this thing that they do really well and all that knowledge just sort of gets added on and i think when people think about content and they think about starting a podcast think about all this stuff they they naturally will think about what's the roi and you end up trying to quantify that roi in okay can i convert the guests to clients can i sponsor it and this whole sponsorship thing i mean you're like it's just a it's it's a crazy conversation for like niche b2b podcast it's it's incredibly difficult to do and it's not the value doesn't live there because quite rightly like you've said it's it's in all the conversations its network and i actually said this to someone i think it was like last week two weeks ago that um you know i've had i've done i've done what 400 and something episodes like in a really really really practical way bit of value 400 episodes later there are 400 people that are much more likely to like my LinkedIn posts because I've given them an opportunity.

4:39We've had a nice chat, we've connected and da-da-da. And actually then when you start adding that up of all the posts that you then do that are just someone you've had a nice conversation with, it's so interesting seeing that network effect in real life because it starts to compound and it compounds and it compounds and it compounds. And then, yeah, all of a sudden you're getting 10, 20 ,000 LinkedIn impressions for posts that you do. it's crazy how that stuff builds up but like it's i don't understand how more people don't understand it and well it's because you have to i think now i think you have to stand up and look at it because i think the way the world is moving is that most companies if not all companies will see some to a lot of benefit from being their own production companies and i think that just is the way that content has has evolved and marketing has evolved when we i know we're bouncing around a little bit here and i'm happy to talk about content because i look i'm i'm i'm part of the club you know like i i love it i live yeah i believe you are yeah i believe it i i i've seen not just in in pock talk but i've seen before the power of content to deliver on personal professional business life goals is is enormous and it does that because it creates impact and connection and engagement and that is what drives behavior change that is what drives action it doesn't matter what type of action it could be going here going there buying this doing that replying to an email whatever it happens to be but actually that content particularly when you're working in a an industry like like diagnostics like in med tech which is sometimes quite technical boring dry actually though those products not just ours but but but but not just pocdocs but lots of products are used in an incredible way to deliver this incredible outcome but that impact is often just completely lost behind dry, static, you know, academic publications and things like that.

6:33So we, from day one at PocDoc, we're out there with cameras and, you know, people talking to patients, filming patients, like, you know, in a Tesco's car park in Middlesbrough, how was your healthy heart check? And then you get some incredible content. And actually that represents patient engagement, which is a big deal for the NHS, you know? So yeah, I'm a buyer of what you're selling, put it that way. Yeah, the connection thing is interesting. I think in the world of AI, we're going to really require this a lot more. I think there's a reason that TikTok is the most popular B2C channel for people brain rotting because who wants to scroll a platform where they're reading?

7:16Because as AI generates more and more and more of that content, it doesn't feel as authentic. and it's a lot more difficult to build that connection with people and it's what people are after they really want to feel authentic content that is connecting with them and these things always leak into the b2b side eventually and you're right that's what we're starting to see and i think it's just what people are after and well i love it the lot one of the largest creators on linkedin is a guy called chris donnelly who many yeah right he's got 1.5 million people on LinkedIn he's straight out b2b so so so his his content is not b2c it's about how to help b2b leaders generate more revenue from understanding how to leverage social channels more effectively so um and he's the largest LinkedIn creator he's got four million followers on Instagram you know um so I I I completely agree with you that I think that as as AI obviously continues to hyperscale, which is not going to slow down anytime soon, might even accelerate, probably will, right?

8:16Hit the singularity. True authenticity is going to be potentially priceless. Like the really demonstrated true unfiltered or semi-filtered authenticity is going to become much, much rarer as good content generally starts to become commoditized because it's so easy and the barrier to create it is so low. But then people are going to become more discerning. You know, those eyeballs are going to start choosing. And actually, for anyone that understands how that content game works, they're going to be positioned far further ahead. So, yeah. Yeah, it's true. It's true. And it forces people, I think, to have opinions because it's actually opinions that are going to win in that world because that's where the polarization is because content will be, you know, content on topics you've already seen it on linkedin you know there was that brief period where it was like top 10 reasons that your boss sucks or top three reasons that and this listicle there's that stuff still goes really well for some of them but yeah you're right it it took off massively but it's it's very easily to ai generate that stuff yes and on one level of it on the surface level of it i think though where it then becomes a story and and and and based on people's lived experiences they've built an opinion on something it's then interesting because then people absorbing that content are going to try and think about something from that side and another side and they're add their own lived experience and then develop these opinions that's going to become what differentiates us and this is it's the whole thing ai ai allowing us to be more human it gives us permission yeah to actually express ourselves and our emotions because that is the differentiator yes okay we can crunch all the data and i can give you an answer but that's not going to tell me whether to sit on the red side or the blue side when it comes to politics or whatever it is but anyway um we die we digress yeah exactly yeah where where are we what are we talking about listen mate be good to be good to get your story actually because i've never actually heard this from you in any course like i guess the long version of of where it all began for you and and what you're doing now with pock dog it's funny actually i was from i was writing health tech pigeon the other day and um i was writing a story what a story about pock talking a healthy heart checks and i and i wrote um point of care testing company pock dog and then i was like oh my god is that where the name comes like have i just realized like something incredibly obvious of like that is where the name comes it was a it was a i mean i wouldn't say it was a clever a double entendre but it was a double entendre so poc point of care and also pocket pocket doc so it was kind of like a you know it was a you know it was and we just sort of we sort of we sort of it was twice the genius i mean yeah off of a low bar i don't know what the 2x i'm not sure what we're 2xing but so i guess my kind of um my background i you know you can feel free to speed me up but but i guess um i've always been in and around the vc-backed tech space ever since i was a kid in the 90s my old man was one of the leaders kind of entrepreneurs in the online space so back then they were called telcos and used to have to put a cd in the machine to install a version of the internet which was this walled garden and so he ran businesses like compu serve if that rings any bells or europe online he created europe online was one of the founders of europe online and did a whole bunch of things in that space.

11:53Wow. So we would have VCs over for dinner and he would make us do like weird mock pitches and stuff as kids. It was all, it was slightly bizarre. But then we lived through the dot-com crash where we were going to buy an island and then we really weren't going to buy an island. I was going to say the boom and the bust. So lived all the way through that, the ups and the downs. And then when I was 14, he had this enormous stroke due to undiagnosed cardiovascular disease. so it was massively catastrophic for him and for a family it was huge and he was he was in Chelsea and Westminster for like six weeks he couldn't walk for like a year we had to rearrange the whole house so he could be downstairs my mum sort of became his carer my sister and I were sort of left to our own devices and you know bumbled around between friends sofas and things like that for a while and and then so we didn't know if he'd ever get back into the workforce and then weirdly just serendipitously I guess um the only job that he could get when he when he came back was as the first hire um the very first hire at this startup that was about to go out of business and um it was struggling couldn't get product finished couldn't couldn't get any commercials going and um that startup was called Shazam so he was the first ever CEO of Shazam the three MIT founders who they literally just finished their algorithm.

13:19They'd raised a million dollars in series A, which, which a million dollars at series A, even back in back then, it was tiny. And so he took that business from basically about to fail into launch. And so I did a lot of my work experience in Shazam's offices when I was a kid, um, doing various bits and bobs. And so, you know, uh, and, and I guess there's a lot that I took from the Shazam thing, which was, it was a great piece of technology that was waiting for the right platform. So that business really didn't take off until the iPhone came around. And there's a huge amount we can get into in that story about just keeping going until the timing becomes right.

13:53So the actual core algorithm underneath it didn't change at all, not one iota. But the difference of having to type 2580 on your phone and hold it up and get an SMS back and not being able to then purchase the music versus the seamless experience with the iPhone to then be able to download it from the iTunes store is night and day. I mean, that's completely different. So anyway, then I guess that that at a young age sort of, I don't know, I'd had a lot of exposure to ups and downs, I guess. And I'd seen, you know, non traditional businesses and dealt with some non traditional people at quite a young, young age.

14:33um and then when i was uh and so i sort of developed i don't know exactly where it came from and developed quite an independent sort of streak um which is sometimes good and sometimes expressed itself in in different ways that were maybe potentially less good in hindsight but what what happened when i was um 16 i finished my gcse's and i basically took myself off to germany um didn't speak german but i spoke a bit of german but i took myself off to live with a german family for nine weeks or so. And I managed to blag some work experience at British Aerospace working on the Eurofighter project.

15:06And part of that, so I was only 16 and everyone else in this apprenticeship thing was like 20, 21. And so they kind of adopted me and like I would be, I didn't have a security clearance. I was sort of sneaking in through various doors and looking at top secret documents and wild stuff. They had me one day. Good to know that's possible. Yeah, they had me photocopy this whole bunch of top secret documents that were about the missile systems and stuff were like, had like nato top secret and all these documents complete it's just completely completely mad stuff and then as part of that program all of those because at the end of each year they that graduating class goes off um and goes to this sort of island in the north sea where for team building but they also learn how to fly so at 16 i was off there with these guys learning how to fly in german a language i did not speak not only did i not speak i definitely didn't speak it well enough to be doing like flight navigation and all this other stuff so like i remember this one time but they let me have at it anyway which credits them so i learned how to fly a plane so by the end of two and a half weeks i was taking off landing wow our instructor was absolutely terrified because he'd be saying stuff to me and i would just sort of smile inanely and then um so i guess that that sort of um that just created quite a lot of independence of spirit a lot of confidence a self-confidence i mean if anyone listening has ever had to sort of socialize with people and build relationships fast with people that are in older generations quickly at a young age that creates quite a lot of resilience and adaptability and you you have to be very very good at building relationships and understanding the value transactions the value exchanges around group dynamics and and those type of things and so i i kind of had that embedded quite early and that was actually really helpful as i moved through so university must have quite high emotional intelligence anyway you must be starting from a good base there yeah i don't know i guess so i i think i mean i i i think so yeah i'm pretty empathetic when when i when i want to be um and i i mean my background's always been in and around the commercial elements really of businesses that i've worked in um in various different ways and i i don't believe you can be a good commercial leader without having a high emotional intelligence because if you don't have a high emotional intelligence you are not going to understand how your customers think what problems they have and and ultimately be able to engage and build those relationships so that you can generate enough trust so that they'll let you solve their problems um and particularly that that that that index is that requirement index is massively when you're starting a business because you have to persuade investors to give you cash and they're definitely not giving you cash unless you can create some kind of connection and trust and relationship there and even then when you find your first customers your first customers are basically taking a punt on you like a massive punt on you so um yeah so and and particularly in the nhs relationships are everything so that's been something that's sort of stood me in good stead so anyway um you know some other stuff that was sort of instructive i guess is um you know i went to oxford i'm still the only person in college history to have failed my first year and then got a first with distinction so i i was i was a state school kid bittersweet that sort of outcome isn't it i mean look state school kid got there by the by the skin of my teeth and didn't appreciate the huge leap in standards and you know right i'd had this kind of slightly odd upbringing with lots of various stressful moments and and sort of some independence and so when i was given complete independence there was it's there's some you know i didn't i basically just didn't work as hard as i should have done but managed to turn it ran to the end um and then went off and worked in advertising for a bit and then ended up being one of the very early people at uh what would become probably europe's most profitable marketplace business um so i was employee number 12 at an entertainment startup um it's actually gonna ipo next week for 10 billion dollars so i took that business into 80 different markets in five years being the commercial lead.

19:09So I was made commercial director at 25. And that business did when I left$2 billion in gross marketplace volume when I came across the stock. Do you keep any shares? I mean, some. So let's just say I'm looking forward to next week. Let's just say Steve's getting a new car next week. If it happens. So let's just wait and see. But that was one of the ones where I knew I was willing to trade. all of my friends had gone into consulting and banking and these things and I was like no I'm going to go and work at a startup because the the value proposition is is if you're basically willing to trade away pension security you can make huge leap I mean I was a commercial director at 25 that's almost unheard of and I had this unbelievable experience of growing this business globally to 80 markets in five years I mean that that's an incredible experience um high risk really high risk so then and that so then scroll forward to the pock talk piece so um i you know got lucky at at this this previous venture and you know done well and was hugely grateful for it and sort of i guess tapped out a little bit like we'd done really well and and a lot of the stuff had been sort of you know not commoditized but it was very it was we were doing rinse and repeat you know going from 80 markets to 90 markets is sort of rinse and repeating and um i there my family I came across my two co-founders for PocDoc, both of whom are scientists, one of whom is my wife.

20:37And she had had this idea, she's got a long and very successful background in life sciences. And she had had this idea around how could you leverage the massive improvement in phone camera fidelity, smartphone camera fidelity, to actually create a quantitative blood testing product that was basically run off of an app ecosystem. app infrastructure app backend. It would require the development of a physical test, but could you make that physical test so economically scalable and shift the diagnostics into an app cloud sort of stack to massively reduce cost, massively increase speed? And this was about three years after a business called Healthy.io had launched.

21:27Do you know, I was going to mention them. Sounds similar. Yeah, so they'd launched out of Israel, and then they'd launched in the UK. And their technology was and remains to this day, an off the shelf urine strip, commoditized urine strip with a digital layer that can say yes, no, or I don't know, basically, which is in diagnostics is called a semi quantitative system. when they launched that was revolutionary um and massively valuable and you know they've obviously had their own wins and losses and ups and downs as far as the uk and other markets go but they're doing great in the us as i understand it right now um and their uk lead damian is an absolute legend so shout out to damian if you're listening and um but they had two major limitations one was it's urine which is an excretory substance and not everything is in urine so the diagnostic value of urine is very um eclectic finite yeah and finite and it's sort of like you can do some things but you definitely can't do other things and um the diagnostic output of their test was yes no or i don't know which again doesn't actually in that limits the impact that you can have so anyway kieran who's my wife was working on this kind of theoretical research paper around how could you take conceptually the same sort of idea but do it with blood because if you could do it with blood and if you could do it quantitatively and if you could do it to a level that would be clinically acceptable you could really unlock entire disease pathways you could unlock monitoring you could really revolutionize um some of these some of these areas she'd found our other co-founder vlad who is one of the most highly cited authors in the point of care diagnostic space and i was mostly concerned to be honest with you initially about who she was talking to late at night like I was like who's Vlad I was like what is going where why are we doing late night calls with Vlad like what is going on here sounds like he's bigger than me yeah like what what's what up what's going on here just shoot me straight just tear the band-aid off okay and um so that but then I started to listen to them a bit more and um was obviously it just so happens that one of the areas that they were looking at first in this paper was around cardiovascular disease and obviously what What happened with my dad, I felt hugely passionate about and hugely engaged around.

23:44And I sort of, I mean, there was a lot more to it. But in the interest of time, I effectively came down to a discussion of, do you want someone else to take your research paper and start your company? Or should we start the company? That was effectively the decision. And so I said to them, look, I can be the business in the operations. I don't know anything right now about how the clinical stuff works or the medical stuff. I'm a pretty quick learner. I'm pretty adaptable. and we're talking about using this in a highly focused way so we can I was very confident that I could learn enough to be able to talk about it to the extent that I would be required to do so and it was really more of a decision for those two as the individuals that came up with this idea and were working on it were they willing to make that commitment because I'd known from my previous ventures that look if we if we start a company here is what is going to happen okay this is going to be it's an all-in thing it's completely consuming it's going to be terrifying and wonderful and exciting and awful and and the most frustrating thing you've ever done and the most incredible thing you've ever done all within the same eight hour day okay every day so you know there's that we're going to get to a point where we're not going to know if we're going to be able to pay ourselves at the end of the month we're not going to know if we're going to have to fire everyone like it's going to that will all happen and so you kind of got to be up for it or not and if you're not there's no problem and we haven't lost anything and you can have a paper and get cited again and get published again and all good and um in the end they said no let's let credit to them they're like no let's let's go for it so that's kind of how it came together and we then um So we did a very small sort of, you know, mums and dads type of round to build a very, very, very basic iteration to, because there was a huge amount of technical risk with something like this, because no one had ever done this before.

25:37Yeah. So the biggest question that angel investors had for us was, look, this all sounds great on paper. The macro problem's clear. You know, like how can you increase access to these things? Cardiovascular disease, diabetes, chronic kidney disease. Those are the three things that we were focused on. Huge problem access to testing, huge upswing in people's proclivity and interest in self-testing, you know, huge upside if you can prevent. Right. So they weren't worried about the macro. they were very very concerned around the um the technical risk partly not exclusively but certainly partly because around the time that we went out with our angel round was around the times about six to twelve months after the um theranos book had just been published which was like about i mean i was in a pitch event i this is true i was in a pitch event where i was doing a kind of a dragons denny style pitch to a group of angel investors in the north one of them had the book on his lap and i'm like amazing i'm like great this is as well i i mean honestly in that in that least the questions are predictable from that person and it you know and i mean look obviously it's a big deal so people are going to ask about it so that was what we did with the first money and then we used that early concept to be able to say no look this isn't this isn't putting someone on mars yes it is technically exciting and we are pushing the boundaries but this is real you can see it's real and here we go so that's kind of how it how it happened started in Cambridge our first lab was about the size of what if anyone's watching on YouTube I'm in a sort of a home office but this was about the size of our first lab and you know went went went from there love it man so much that I want to ask you and so much that I can talk about here I want to ask you specifically before i go on like the the technology because i think this is really interesting it's a very interesting part of this that you've had to skill up on from not being a cited scientific researcher so you're sort of best placed to talk about this in a way for from a from a level of understanding that all of the audiences that listen to this will kind of understand what What was the unlock here with the technology?

27:58What is the difference here? And what I'm interested in actually is why hadn't this been thought of or done before? Great. All good questions. So I could talk about this for ages, but what you find that there's a few things. So I'll go macro and then I'll go into the micro. So if you assume for a second, just for the sake of the conversation, that any successful med tech business of any scale is required to raise external capital let's just take right so you cannot bootstrap a medical device business and get it to any kind of scale there will be people listening that i'm sure disagree with that and i'm sure there'll be some there'll be exceptions there'll be exceptions but broadly speaking particularly not in this market to get through the regulation yeah to get the level of products that will do the et cetera et cetera yeah so i I mean, our first product, I mean, we were lean, but our first product took three and a half years to get through from start through, right?

28:58So you've got three and a half years of salaries, three and a half years of rent, three and a half years of consumables, regulatory fees, QMS, quality management system fees, and so on and so on and so on. So, I mean, even if you were completely bootstrapping that, that's still seven figures, multi-seven figures in some way, shape or form. So therefore, if you go a next layer deeper, what generally in medical technology, medtech, is able to secure funding, private investment funding? What normally happens? What normally happens is stuff that gets spun out of university is well funded. So the vast majority of medtech businesses are actually spin outs from universities out of research departments.

29:39And so that tends to dictate a lot of the capital flow. So a lot of those research projects are really like super high risk, as in, you know, we've discovered a new molecule or we've discovered a completely new research area because they've been driven by academic research. The definition of academic research is really geared around greenfield. You know, go down a rabbit hole, find me a rabbit hole that no one's looked at before. Now, that is very well funded in the UK and Europe and whether you call it life science or med tech. The issue with those businesses is they're extremely high risk because by definition, they are doing things that are based off of lab research that may never translate into the real world.

30:20Like you might be able to repeat something on the bench, but that doesn't mean that you can actually create it scalably into a successful business. Like a concept car, basically. Exactly. Exactly the same thing. You're not going to get off the conveyor belt in any kind of ROI fashion or even ability to mass produce it. Exactly. So rapid testing. wasn't very interesting for academic researchers conceptually like that was never that's not that exciting as a concept so there was a complete lack of capital being invested in this space period um i think the second thing is that no one had really joined the dots before about about the impact it was more like so the way we were from from day one for us the test itself was the top of the funnel and if you think about prevention like a funnel problem your top needs to be the most efficient most scalable most usable test to deliver the set of biomarkers and results and risk scores that mean you can move that person through the middle stratification um you know triaging and then at the bottom into treatment so actually looking at it that way means that it provided provided us with a lot of context around the fact that the test itself was actually the thing that unlocked the pathway but what most diagnostics businesses do is they stop at the test they don't because they're either constrained by their technology platform or constrained by other different views of the world but they never progress beyond the top of the funnel so that's another kind of aspect to this and if you can't deliver the impact increases as you move through the funnel and therefore revenue opportunity scale market opportunity increases as you move through the funnel if you only ever do the top of the funnel you're really limited or more limited which then has a downstream impact on how exciting you are for investors which means you're limited in how much capital you can raise which therefore limits the scale of your business and the speed you can operate at.

32:20So there's all these kind of interlinking things. And the other piece is that we were at the forefront of this hugely accelerating wave of improvements around smartphone cameras, improvements and ease of access around interoperability with patient records, with EMRs, you know, with risk assessment tools. And actually, we were the first people to bring all this stuff together to connect it in real time with that diagnostic test. But we knew that that test was always part of an overall experience or platform. Whereas almost every other diagnostic business that I've really seen, there are definitely exceptions, but particularly more of the older traditional types, the Abbots and the Roshes and the things like that.

33:01They're very, very constrained by basically a drive to miniaturize lab testing machines, which is where they've made all their revenue historically. So our lab testing machines are great and their lab testing machines are phenomenal so a lot of their innovation capital thought and cash just goes into miniaturizing miniaturizing making smaller making smaller but because of the kind of technology basis of those machines there's just a limit to how small you can make them like the smallest abbott machine is sort of the size of a small photocopier or a large microwave and costs four thousand pounds that doesn't solve the problem and then so then the final piece on the macro or the micro before we started developing anything we'd spent about three or four hundred hours with clinicians patients potential customers just just asking them about this conceptual space and how they solve their problem right now what problems they actually had so that we then could make sure we were building a product that would serve as customer needs because again one of the things that i noticed coming into it which was the benefit of me not being blinkered or biased was um that there were people that were investing years in technology development where there was never going to be a customer like there was never going to be anyone buying that because it didn't solve their problem and they didn't figure that out until they got it into market i was like i don't want to waste i don't want to waste my time my wife's time our time our life developing something unless i was really quite sure i mean you can never be certain right because who knows what can happen but i wanted to be very very clear so a really good example um and feel free to interrupt me if this is boring but we we've we figured out really early that gps wouldn't the initial reaction from investors was like oh my goodness wouldn't gps will love this this will be so much easier that for them than using a laboratory and they can get the results immediately well guess what it turns out that gps in the uk get lab testing for free so so why it what why they're never going to buy it interesting they are never and this is the i see this consistently so one of the things i do i've done for a while now is what i call the last friday club where on the last friday of every month i just give up my day and seen you do just just to it's 30 minutes it's my view on things if i can help you great like i've got no dog in the fight no cash no equity i don't want to be on the board and i have this conversation so many times where people are like i don't understand why gps aren't buying it and i'm like well because they get they get all diagnostic testing for free so latterly with PocTalk actually we figured out we're scaling a model with with primary care networks but that's after being in the market for you know 18 months to two years but that's a really good example of of of sort of why we or the approach that we took um and why other people hadn't necessarily done it before I think all kind of encapsulated um but the big leap for us was one being able to create a physical rapid test which enabled multi-marker high fidelity quantitative signal generation and then combine that with a universal image analysis model so any phone any tablet to generate a clinical equivalent lab equivalent biomarker result that would be accepted by clinical teams clinicians would fall within accepted global standards of accuracy required for the conditions that we're operating in such that it enabled us to unlock that post-test pathway whether that be risk assessment whether that be stratification and we do things now where we're connecting directly into clinicians so you can discuss your results live minutes after doing it so yeah that was that was how we that we came about it so So the physical piece had to be calibrated and developed very, very in tandem with our AI image analysis pipeline, which works very, very well.

36:59So it was kind of, I think it was a combination of really deeply understanding the problems we were trying to solve and how we needed to solve them so that we built to spec, built to customer spec, if you like, early. and then taking a pragmatic view of bringing elements together into something that was much more valuable than the sum of its parts. That's incredible, man. Which markers? So our healthy heart check is the equivalent of the NHS health check. So it's the full lipid panel. Full lipid panel. We're the only company to API directly up into QRISC3 in the UK. We're actually the number one generator of QRIS3 scores in the UK now outside of GP surgery.

37:43We do it all live. So you get your full lipid panel, all your other biomarkers and self-entered data and things like that. We do an automatic NHS number lookup. We track location so we can do a postcode and map across onto deprivation indices, NHS heart age, tenure, risk of having a heart attack, your relative risk to peer group. You can enter blood pressure. We provide a risk score on that. And then our diabetes health check that we launched last week is a type 2 diabetes prevention geared around an HbA1c test. So yeah. And then the next one is a kidney called the kidney health check. So that will take us a couple of years to get out, but that's chronic kidney disease prevention, creatinine and an egfr digital egfr so the way the thing that we really focus on is that that test or those tests that that that sort of top of funnel intervention whether it's called the healthy heart check or the diabetes health check or the kidney health check that itself is the we we're very focused on those being the number one method of gathering the relevant biomarkers to then deliver the clinical prevention pathway whatever that clinical prevention pathway happens to be in whatever market we happen to be operating in the uk the us germany you know we're here to make that pathway a hundred times more cost effective and a hundred times faster to prevent more people suffering from whatever the thing is that we're trying to prevent yeah i want to go into that a bit more detail about the actual you know the patient journey through the uk and like how you've actually managed to set that up and i think a way of me asking this actually is one thing that you mentioned previously was the was this the the problem that innovating in healthcare has which when i first got into health tech was very seemed very clear which was that there were so many people so passionate with their viewpoint from their career and the way they've seen a problem that there were so many partial solutions to full problems and that there was very rarely and where it did exist it really worked like echo that got bought by mckesson and that kind of stuff that like and you know in the really early days and stephen that we worked with at digital health at london like the whole pharmacy stuff of like actually zooming out and going how does this whole thing actually work at an infrastructure level very rarely that was thought about in the early days and and there's so much legacy to that now is where i'm going with this that that thinking that you had i think is actually relatively unique because perhaps you're coming from outside of health care and going i need to actually just understand this to begin with because i think there's perhaps a bias of people from you know if you've seen the world from clinical medicine and god knows i was guilty of this i thought i had all the answers and and how how much of a genius was i because i've seen that this thing could work and then all of a sudden you learn one thing about how money moves in a hospital and one of my consultants actually said to me once one of my neonatal consultants just said to me once i can't empty this department anymore if i discharge people any quicker if this if your thing your idea actually gets rid of people any quicker i look like a mug because i've just had this whole unit paid for it's already half empty if i discharge people any quicker i'm not going to get paid so like the and you learn these incentives and you're like okay no i actually know nothing i i know nothing about how to innovate in health care but to actually solve the problem you need that level of understanding and and and it's so interesting how you approached it man as i've built various businesses and done various different things and you know seeing things go well and see things completely go terribly badly um what one of the things that's really consistent is that if you ever if generally there's a correlation between thinking you know what the answer is and it not going very well versus actually listening to customers or people and trying to learn and and actually really humbly learn and and and listen and then try and understand because like for example in our business we always had a concept around what the technology could do right we knew what we knew we weren't making mri scanners we were doing what what we were doing but what we were interested in is understanding is what that overlapped with an actual requirement a customer requirement you know right so a really obvious place that we started to cut our teeth was in um community pharmacy so the kind of use case was there that was coalesced which is pharmacies want to do more services it's a super space constrained trained place they have very very low budgets on a unit basis so they're highly disinclined to purchase pieces of equipment right because they're run like individual business individual businesses um but they're also highly clinically trained so that they can cope with the content and are comfortable with the content because we're delivering a clinical product that that delivers clinical outcomes so um and that went really really well so it was more around how do you the thing that I have seen how working in health tech now quite consistently um is that the the badge of being innovative doesn't come in the same envelope as a successful business okay it it doesn't and you can be innovative and not have a business that that is I've seen that be really possible and it's really sad and really tragic um and sometimes you just you don't have a business and there's nothing you can do about it.

43:23But a lot of the time there is. And you're not, or those founders or those teams, for whatever reason, aren't open or can't or don't have the skillset to approach the market in such a way, approach their customers in such a way to find out where that overlap is, to just get going. You know, to the point I made before, trying to sell diagnostic devices into GPs is virtually impossible. It doesn't matter what diagnostic device it is. It really doesn't. Because you're selling against free. so but there will be somewhere somewhere that benefits probably from speed increasing speed of diagnosis reducing cost of diagnosis do you know how i know that because abbott's a pretty big business so's rosh you know these these are these are big big players so someone's doing it somewhere um but it's about that kind of um i don't know humility and again massive generalization i think i i can understand why if you are a clinical expert in a particular space it's much harder than someone like myself coming in being like okay cool i'm i have to learn i had no option i had to listen there's no point me going around telling people about you know that's really interesting and you know what they should or shouldn't be doing around the health check that was totally pointless but what became really really clear is once you ask people questions and then And this is also one of my sort of, I guess, themes that I try and help with is that it's okay to talk about sales.

44:50It's okay to talk about revenue in healthcare. That's okay. And part, like if you're selling into a healthcare system, that's a B2B sales, it's an enterprise sales approach. And a big part of that is really, really understanding your customers' requirements. and a big part of that is being humble enough to actually ask and then actually listen and learn and not tell them that they're wrong and they should be doing it the way that you're telling them to do it that is very rarely successful you might get lucky because it might turn out that your thing is just the greatest thing and the tech the product might carry the day a lot of the time it doesn't particularly when you're selling against an incumbent right because in the nhs there's always an incumbent i think pretty much is accepted there's always something that they're doing instead of using your thing so I don't know that's sort of how I feel about that um it's really interesting man it's really interesting and I think with that first principle thinking and the listening and the figuring out and the zooming out and solving the whole problem it's got you obviously to where you are with PocDoc now which is starting to scale and the whole community pharmacy thing and where you're slotting into the health care system I think is interesting because i'm from again my my viewpoint of the world very much from clinical medicine where if you're unwell you go to the gp the gp will refer you into a hospital you get something sorted you'll become an inpatient then an outpatient and you will be continued to seen until you're discharged and that being the structure any sort of prevention you know from when i think back 20 years to when i started medical school uh it was not a conversation that was your own problem that was your own personal problem there were no outside rogue ways of doing things there were no it was not complicated it was not complex perhaps your gp ran a really interesting clinic with a pharmacist or something along those lines but that'd be really out there if they did that so like but now the world's obviously very different and in part because of things like you're doing and so my question i guess is twofold firstly exactly where does pop doc fit in the uk health system let's start there and where do you think we are in terms of i guess going from that world that i described where it was very formulaic and the one path to whatever version of the future that we have what what what is that version of the future that we're going towards and is that a state paid for prevention where does that become where does yeah i think that's a super interesting debate to have particularly around you know because it it sort of segues into this um you know the glp1 debate the weight loss drug debate around like you know are we are we really saying that we're signing up for a somewhat dystopian future where we've abdicated all personal responsibility of being healthy in favor of just medicating ourselves to be thin even though there's like muscle wastage and all these other different things so I'm up for I'm up for that I'll answer the first bit first though so where we through our extensive and humble understanding of of the needs of the various system elements that we were we're working with we very quickly established that within each nhs region whether you define that as a an integrated care board as an integrated care partnership however you divvy up the landscape there was a number of different things that were either happening but weren't as efficient happening but not hitting the numbers that they wanted to hit happening um or not happening because they felt like there wasn't a technology solution.

48:40So in and around cardiovascular disease prevention, so things like community screening programs, things like screening, targeting populations that were considered to be underserved, that have worse access to healthcare, delivery of the NHS health check itself, addressing health inequalities where cardiovascular disease contributes 30 % based on depending which data source 20 to 30 percent of health inequality relates to cardiovascular disease and then even higher deaths from cardiovascular disease are rising every single year so clearly the prevention battle isn't working or what was being done with it despite all the money being invested and we realized as well that when we were hit what we were hearing were very clear problems that our technology could solve it wasn't that no one knew what to test for or that a new biomarker needed to be invented or a new pathway needed to be.

49:39They had a pathway. There's always been a national CVD prevention pathway that obviously people disagree with it and it should include this and it should include that. But for the most part, there's pretty widespread acceptance that it's correct. It's not something that's particularly changed very often. So it was really more around how we could help the system outside of a GP surgery, which was another critical insight which is the gps are doing what they're doing and they're they they they are running it to the very best they can do it and if you're in a gp surgery you will be taken through the pathology lab gp led screening process and that's fine and that's great but that can't serve and doesn't serve everybody and the systems were looking at ways to plug that gap and not being very well serviced by the existing major diagnostics players and so we created a solution that solved really what what the systems what the nhs was looking for was how can we in a community pharmacy get as close as possible to the experience that the system gets when someone goes to a gp surgery so what does that mean well it's the same biomarkers to approximately the same um or an acceptable clinical equivalence it includes a key risk risk assessment the results go back into the record there's signposting in connection on with other forms of treatment the individual becomes known the individual understands what their risks are and so that's what we that's what our platform does in effect and it includes the biomarker piece and really that that takes 10 minutes and actually the equivalent the equivalent that we have used in our nhs um health economics the nhs actually co-authored our health economic study with us is that what we do in 10 minutes um takes two and a half appointments on average at a gp surgery because of the way that that system works yeah so you go in and you have your blood you have your phlebotomy then you get called back in for the remainder of the check and to discuss your blood test results and then if there's a follow-up that's a third appointment so actually we've managed to condense that but like i said if if the gp is able to see you and that gp system works they're great that's there's no problem there whatsoever i think that's also another insight where is really trying to understand where your undeniable value adds to the system so some gps are some of our biggest supporters because they don't want people out there sick or potentially sick either they're keeping the queues free but neither do they want but they definitely don't want health tech businesses coming up in their business and even tangentially suggesting that they could they don't that's they got it they're good they're incredible professionals they got enough to deal with but but but definitely they're up for supporting community work for um you know for doing home screening workplace screening because they can't really facilitate that you know they it's very difficult for a gp to get involved above and beyond the incredible work and resources required to run a surgery from eight to eight every single day like they got plenty on their plate um but the system itself needed to make investments and needed to scale up prevention efforts in communities workplaces and homes even before the government came up with communities workplaces and homes as they shift so um that's where we've really been scaling really effectively um and and the other thing that we we did you know we did this from the beginning but but it but it certainly helped is that we've been very focused on those three pathways cardio metabolic renal thank you we we know everything there is to know we're very interested in learning everything there is to know about everything in those pathways and right now anything outside of that we can that can be for another day it creates a lot of focus who pays for it so it depends but i mean right now most of the revenue comes from the icb pot but whether that gets filtered through various different layers so for example you've got local pharmacy committees you've got community pharmacy programs you've got health inequality teams you've got you know you've got various different entities in that space um we've also been working really successfully with a number of primary care networks where they're shipping our test out i mean this is incredible actually so on average which a primary care network might have between one to two thousand health checks per year, based on our research, that it could deliver and get paid for, but for resource reasons might not be able to do that.

54:14Or more often, people are invited, but they don't show. Right. So if you get paid 25 to 40 pounds for a health check, that's actually material revenue that you're leaving on the table. So we've been working with PCNs where they'll actually ask them, do you want to come in or would you prefer to do the poc.healthyheart.com so within 24 hours we started by working with some pcn's around their non-responder lists so effectively the worst interesting so like people that never responded so don't give us the good people give us the people that have never responded and we'll see you're not gonna they're not they literally we're working with people that hadn't responded to multiple invites over five years 80 of those people ordered a test in 24 hours off of one sms through acuax so that so that so that shows that shows us which which we always suspected which is there are definitely people that are not interested in engaging about their health undeniably true it is not anywhere close to as big as people make out it's actually about the right intervention at the right time in the right way and if you can get if you can get that that i think it's very lazy to say like oh well you know you can't ever do this or that'll never work and actually it's really more around the intervention and 80 percent off of a single text message in 24 hours is mad it is um and to understand this just one stage further i'm interested in the value propositions all the way through this so for the individual i get it they get a test they get their own personal health sorted fine i get i get that what about the what So are we talking about like the ICB paying because ultimately they're going to have a more healthy population, which is going to be less of a financial burden down the line?

56:00Is there any low hanging for it? There isn't a short term win for them there, I'm interested. And then I suppose for the pharmacy, where's the win for them? There's wins across the board, right? I think that's another thing which I realized early on is being able to map those incentives to your point earlier about the neonatal unit sort of example that you gave. you it's why i'm asking the question to be honest because like this this is the learning for people for the for everyone listening right now that has an idea or is early stages mvp thinking about the model like this is for them mate this this this question because from everything i've seen in my career this this is where innovators in healthcare differentiate themselves when they nail the fly wheel yeah exactly so there's we think about it in a few different kind of layers so in the if first if you if you take let's take the individual out of it right which is i think the individual is often slightly um the undervalued like the so as an individual understanding their health and making their own let's just park that for a second valuable unfortunately but unfortunately that's hard for people to value and it does get sort of aside but there is value there but let's just put that aside for a second so we know now of over tens of thousands of nhs patients that we've screened in in in the last few months um you know the the um on average anywhere between 15 to 20 percent of them will have a q risk score of over 10 so that means that they're in a high risk category and um that that category is that 10 is the critical mark because over 10 you qualify for lipid lowering therapies and other therapies so you qualify for clinical intervention so in one very basic way we're and sorry the other the kind of the one-two punch on that is 65 to 70 percent of those people had never been screened before so this is not the worried well this is not this is not duplicative effort this is high risk untested untreated individuals who for pennies can be talked to about or connected into treatment so that's the first layer the second layer is we now have evidence from some of our nhs partners that where you deploy pocdoc not only do you find to untested untreated high risk individuals but there's a massive upswing in lipid lowering therapy prescription so it actually has an impact so being there in the mosque on friday prayers for example or in the you know south asian music festival in middlesbrough and screening people or doing whatever we do actually the value of that does have this downstream impact the only this is the first time that any point of care diagnostic has been able to demonstrate that because of our digital platform so we actually are writing results back into the record we are integrated we do deliver that's so important so that we can actually because otherwise you're just mired in i tested this many people the results look like this and then then there's like a and you know and so then then there's the kind of the real top layer which is you can't treat anyone that you can't test and diagnose and risk assess so if if you think that you're going to be preventing diseases by telling people or relying on gps who are massively overstretched in all kinds of different ways then you're really i think your head's in the sand a little bit so it's it's really a question of how for us it's how can we help the healthcare system deliver the clinical pathway for prevention for these conditions which they set down we're not telling them to change the clinical pathway but how can we make it 100 times quicker 100 times more effective for them and reach these untested untreated high-risk individuals so we know for example every every person with a cure risk of over 10 percent um so we've done our health economic analysis for every one of those that you get into treatment the healthcare system saves anywhere between you know 20 to 40 000 pounds every single one so the health economics on prevention are really really really clear and really laid down and really established so it's really around how can you scale up these programs so they have the impact that they that they they would have and with our technology platform and our kind of missions really geared geared around that fundamentally wow so where does this graduate to what's the next stage of this I know you're talking about various different you know cardiovascular and then uh renal and obviously there's different there's different systems here but tying in I guess your worldview of prevention as well and what do you want to achieve with PocDoc and where do you see the world going really good questions there there is no doubt in my mind that in every single country in the world pretty much these three disease areas already have clinical pathways that need to be delivered outside of a physician's office or a doctor's office at scale affordably usably using digitally driven technology um and by the way i think that's a very fair and very appropriate and actually quite an important conclusion and and flagging the ground to lay down because what I actually think lacks and sorry to interrupt you here I just feel very strongly about this is that I want to see that written down as something that then everyone in our community can pull in the same direction towards because I think we're missing some of that strong leadership on what's the image of healthcare of the future that we're all pulling towards here and i just think what you what you just said there is such a lovely articulation of it because it because i've been i've done those gp clinics i've been i've been the gp i've been the patient i've been like i've been in healthcare long enough to know that like as you quite rightly point out you you can't you can't load that cart horse with any more stuff like it's just not it's just not happening you know and there'll be there will be there'll be different things that happen and different governments will create different incentives around GP contracts, around hiring more and doing this and incentivizing that and changing coif and more of this, less of that, let's change.

1:02:25And that's all great. But as you say, that system's completely capped out. But let's get comfortable with this outside of it. Let's get comfortable because really - I think that's interesting. One of the load stars or the kind of reference points that we use is how can we create an experience for the system, which is our customer, right? The system is my customer. the patient might be my user or the pharmacist might be my user but in many ways the system is my customer how can i create an experience for the system that replicates what the system gets when it uses the gp pathway yeah but because if i as close as i can get to that and you know yeah the the the the less difference it perceives which helps everybody in the space anyway generally absolutely correct but it also means that that that um you you you're creating a kind of an equivalent or an accepted way parity there means yeah i mean look and gps will i'm not talking about i'm talking about some crazy theory of replacement with gps that's not what i'm saying it's more like if if one of the things that holds back screening efforts for anything outside of gp surgery is um whether or not you can create some kind of clinical equivalence of experience both for the patient and for the clinician interesting right so so that's a big problem and and a lot of innovators don't seem to want to engage on that concept they want to try and fight the battle on how innovative their technology is which is not exactly the same question right because because the system often isn't telling innovators they're not innovative that and if that's what they're hearing they're not listening properly they're not saying your diagnostic box isn't clever that's That's not it.

1:04:11What they're saying is that doesn't help me solve my overall problem, which is not the same thing and often takes a bit of unpicking and those type of things. So where do I see things going globally? It doesn't matter which country you go in. Cardiovascular disease, type 2 diabetes, and chronic kidneys are going to be the three things outside of cancer that kill the most people and cost the most money and yet are the most preventable in any kind of healthcare system. That's my particular opinion. So that each one of those conditions is anywhere between 80 % and 90 % preventable, depending on the literature that you read.

1:04:47But that requires early diagnosis, accurate risk assessment and connection onto treatment. So and the default for any health care system is that that is done by a physician and that's completely fine. so if you want to play in that space and you want to create an alternative then you have to be extremely aware of the level that you're trying to operate to and really solving the requirements that they have um and that's that's where we that's where we that's where we spend a lot of our time doing that um and so i don't believe i believe that in those three conditions those are the three biggest things in a outside of medicating the things away which is definitely one approach but like that's not particularly cheap and not particularly sustainable i don't believe um sort of morally ethically um let alone financially um and even if you do there's no some people are talking about you know let's give glp ones to everybody it's like that's not going to happen like that's you're going to have to still have some kind of clinical assessment or some kind of course some kind of clinical reason to do those things which again is like detection diagnosis um you know risk assessment all of these type of all of these type of things bundled up so you're still going to have to figure out how to do that at a population level you're not you can't another another way to think about this that that that goes around in my head is that you cannot screen a population by telling them to go to their gp surgery we've tried that and it we've tried that and you get to where we are now where like imagine if everyone in the population tried to go and see their gp for screening you're just not it's not gonna we did that and that's even without we feels like that eight o 'clock on a monday morning sometimes like but even saying that is not right because you're getting in the way of acute problems and if and it the you don't need to screw you don't you don't need to put preventative screening ahead of acute it shouldn't be an either or there should be another way because the health economics of it pay for itself the roi on it is super clear it's just you've got to figure it out so again you're not going to solve population health screening by saying that you should put a 4 000 pound diagnostic kit machine that can't be moved without being calibrated and is extremely sensitive to temperature changes in 9 000 pharmacies in the uk who's paying for that that's not feasible you know you can't send a four grand piece of kit to everyone's house etc no so you got to figure these things out let alone let alone before you get into kind of lower income countries and and things like that so i think the macro on this stuff is is is really really clear um and and where our technology stuff goes you know there's there's lots that we're interested in around going deep on each pathway because once you develop them you know these these these impact things and work out what the outcome thing is actually you really understand how to connect people into personalized programs we see that as hugely valuable because that creates true impact um which is that then you can actually demonstrate it's easier for us to demonstrate impact and potentially quite a lot of other things in the healthcare system because we own that we own that pathway or we're delivering that pathway so i think there's a lot that's super exciting internationally obviously there's some fairly big areas there's europe the middle east you know united states those are the sort of the big the big ones um but there's a lot outside of that the world's a really really big place um so i know we're very excited about the about the future and i think to give the government credit you know a lot of credit the 10-year plan is good i think if light on detail in some respects but it certainly was visionary and it certainly was aspirational and we certainly looking for a change and that's all all good and so i think it's just around how do we it can be tough it's tough out there the nhs is a tough market to work in but and i get yelled at for saying this all the time but it's no harder than any other b2b market it isn't interesting i get you i love that it isn't like i love that i don't believe having done it a few times i don't believe that to be true so i'm sorry i rather i believe what i just say to be completely true i'm not saying it to be controversial like another way that's your lived experience yeah your lived experience in your opinion another thing that the thing that blew me away when i came into this industry was how much free resource and help those available we you you try building an hr sas platform that you want to sell into like major retailers and go figure out what is there a health innovation network for hr sas retailers no there is not you know like there are not there is strangely enough not this massive bucket of government grant funding for you know like mechanics like it doesn't so so let's just kind of i don't know be a bit more sort of honest and those things have downsides as well because they sometimes create um i think that they sometimes create the grant funding particularly can be a double-edged sword because it can sort of it can create an impression that there's a business there when there isn't which is which which definitely is a downside so yeah because if something gets to market and it's not sustainable then nobody wins yeah and it creates it it sort of feeds into this i think the unfortunate outcome of of not scaling in the nhs is that the nhs often gets blamed which then hurts everybody that is also very true that is also very true um thank you steve i've learned so much here today mate um there's one question i want to ask you before i let you go um and it's again it's on this worldview of prevention and stuff and you know with 10-year plan in mind and all the rest of it the question is that if we assume sensibly that the earlier you pick something up the cheaper it is to sort out and the better it is for the individual once it's found if we assume that to be true where do you think the line is of what the nhs is responsible for versus what the individual is responsible for where do you draw that line i would take a different view which is in a in a in a nationalized it doesn't even have to be nationalized right if you took an economically rational argument right there's so there's an organization out there which incurs costs for people's health care problems and it takes the entire bill right now basically this is economically irrational to ignore paying now to save money later now there isn't there isn't there is an economic rational but in a in a in a system that that is in deficit for example like i know there's lots of icbs and special measures and things like that there's there is an economically rational argument as to what gets cut like that is economically rational but at a macro level in any organization there's there's there's a there's a rationality to um making small investments now to prevent big investments or big costs down down the line like like that that is completely rational it doesn't matter whether that's an insurance company or not i'll give you i'll give you the opposite example though so in the united states 80 percent of insurance is delivered through employers you move employers every two years so prevention is always someone else's problem why would an employer why would an insurer pay anything for prevention if you're going to be on a different plan in two years like why do they care interesting so that but that that also has a weirdly economically rational argument to it so i i would i would sort of take it's more around trying to fight the battle around rationality and um application of resources because you still need a and e departments you need ambulances you need nurses you need gps contracts you've got inflation you've got all of these different bits and bobs and so it's understanding and trying to work with systems i think the the prevention agenda and anyone in prevention we have to continuously up our game around why now not later and that's not that's that's a multifaceted question and actually it behooves all of us in the space to be continuously thinking about that and working on that and sometimes coming together and collaborating and doing all of these things um because if we don't do anything then we're in like all kinds of pickles but um it's it's it's but then to go back and answer your specific question about personal responsibility um any type of behavior change even injecting yourself with manjaro every week is behavior change that's personal responsibility you could stop injecting yourself like that's you know so there's there i don't think there's ever a point where there's no personal responsibility that's that seems that seems insane um to me that the where i see the healthcare system coming into play is that it's very very difficult for people for many many many people to understand the true nature of their health and also be encouraged or prompted or shocked into change unless there is an intervention and if there is no obvious clear easy way to have that intervention for whatever reason then how is that intervention ever going to happen so i think the responsibility of the healthcare service is to deliver as many of interventions or fund as many of those interventions as possible where there is an existing clinical pathway around prevention that's been costed that's been funded where the health economics are clear how can we deliver as many of those interventions as fast as quick as cheap as affordably as usably as possible while we track the income and the impact and outcome of that that's where i get to with it steve this has been a right education for me and all the listeners this would be wonderful um it's safe to say that you have thought this through i mean it is that would be a that would be a fair thing to say yeah i think i think about it a lot you know and and happy to liaise with anyone if anyone wants to find me on linkedin or find me on any of my platforms you know i love talking about this stuff and i i do think that as a as an industry anyone that works in and around prevention this is this is this is the debate this is the battlegrounds and for pocdoc specifically who is it that you're looking to get in touch with at the minute what what are you guys up to scale wise so we're now the number one diagnostic product outside of covid and pregnancy on the high street which is awesome for the healthy heart check we'd love to talk to anybody in and around the diabetes space from a healthcare system side with our diabetes health check so we're at the beginning of that process it's just come to market we're working on a number of small nhs contracts to begin with but we'd love to learn love to listen understand where that might help communities workplaces those type of places and anyone that really wants to have a discussion around prevention of of diseases community screening i mean we're very very open with our evidence even if you're not in an area that we work in clinically but you're interested in how to scale stuff up in communities workplaces or homes then give us a shout and you know we're pretty transparent and just want to help people succeed in the space.

1:15:51And for everyone listening, make sure you follow Steve on LinkedIn, Steve Roost. He does a load of awesome personal content. Steve, thank you, mate. What an absolute pleasure. Thanks. Thanks for having me on. It was an honor. It was a pleasure. Hey, everyone. Thanks for listening and making it all the way to the end of this episode. Remember to subscribe, rate us and leave a review. And you can head to the description of this episode to follow me on all of my social media. So you don't miss out on any of the latest health tech content.