#430 How NICE finds startups, with Tharni, Horizon Scanning Lead

0:00Welcome to the Health Tech Podcast. Here we talk about everything healthcare and technology. and I'm your host James Summery. Hey everybody, delighted this week to be joined by Thani who is a horizon scanning senior health technology lead at NICE. We're going to find out exactly what that means, exactly what that does and yeah exactly how Thani spends her time. She's also been at Hertility, she was head of scientific product research there so we've got loads of startup stuff to talk about and women's health stuff to talk about. Research tech at King's where she was a PhD student as well. She's a lab tech at Guys and Tommies, embryology assistant at the Centre for Reproductive and Genetic Health and also 14 other experiences on LinkedIn that I can't be bothered to click the link on that I'm sure Thani is going to tell us all about.

0:49So Thani, welcome to the Health Tech Podcast. How are you doing? Good. Thanks for having me. How are you? Really good. Thank you. Really good. You've met you've met my son, Levi. You've met my wife. You've met loads of our team and this is the first time that we're meeting so yeah i am delighted to finally get to have a chat to myself for yeah that was all order of importance as well reverse order of importance i think um so you've met you have met all the important people firstly which is good um really cool background i mean 14 other things below this stuff that we can go into and i'm looking forward to you getting into msc's rural veterinary college maternity support worker institute of neurology i mean you've done absolutely loads of stuff in healthcare and you're now at nice horizon scanning and so huge importance to health tech and startups and so what an awesome career I actually can't wait to hear about this so where does this all where's this all start for you and um yeah talk us through it first started out doing an undergrad in neuroscience um and that was at UCL and it was something that I thought I'd be good at because I was quite you know academic as a kid um but actually I was really really bad at it and I I almost failed a couple of modules actually during my undergrad I just it just didn't gel with me um and I don't know why but it just didn't so I graduated like I barely graduated and graduated with a tutu I think um and then just had no idea what to do with my life essentially um this is so relatable already i i i spectacularly failed my first medical schooling how did you yeah molecular biology like pretty much the the the fundamental building blocks of what all the other medical knowledge is then built on i spectacularly failed um so no completely relatable and then yeah well then i was like is this even for me like why didn't I even want to do the work like yeah is there something that did it so yeah I get it I get it and I you know then scraped it beyond that so I get it I think I think for a lot of those sort of life sciences degrees people come in um and want something that's quite like clinical and patient-facing and tangible and then you go in and you do your degree and it is like hardcore like receptors molecular structures and you're just thinking why on earth am I learning this it just doesn't yeah it doesn't convert but yeah I during my degree I was working part-time at an IVF clinic um which is where I sort of started being interested in infertility um and that sort of patient-facing environment and then I graduated really not knowing what to do and then I knew that I always wanted to work in the NHS but I just didn't really know how I would work there um so I was scrolling through the NHS job pages and found um an ad for this maternity support worker position um which is basically you are trained as a healthcare assistant but you work in a labor ward and postnatal and triage and all those other maternity specific spaces and i got it and that was really really fun um it was really exciting really sort of i mean you've worked in sort of emergency clinical situations it was like it was insanely thrilling in a way um but obviously sometimes really sad um yeah but I think you sort of thrive off like the excitement of seeing a child being born and all of that stuff and that was that was really really exciting it is actually an amazing side of medicine actually it's an amazing part of medicine because it's it's in a hospital and and this I've told the story in this podcast before but like it's it's in a hospital and I remember on my I did a neonates job and when on our first day of of neonates the consultant reminded us all all the new doctors on on the ward that were rotating in um reminded us all that bear in mind that this is a completely normal human process this is the only part of the hospital where you have completely healthy people doing a completely normal thing you need to remember that yeah and actually what you're supporting is you know humans coming into the world and this is what we need to do and it was like this amazing frame of like wow okay the the importance of this cannot be overstated and you know what i can actually remember as well you talk about um you know the the gravity of it and stuff like i i can remember feeding off that i i can remember the very first time you know a lot of babies are born you'll notice that that aren't breathing they actually need a little bit of support to take that first breath for various different reasons and it's relatively common um whether you know c-section particularly you know you're not forced down the the canal and therefore you don't expel the fluid off the lungs and if we just need a bit of bit of help anyway i can remember the first time i gave one little rescue breath to a lifeless baby and just saw the baby come to life and i just i just lost it and just started crying because i just didn't know how to cope with what i'd just seen like i was like what what did it not have that it now has how did that get there where does that come from like it yeah the the just the gravity of the whole thing and and how that just gave me so much energy for that rotation was crazy so I completely understand and I completely get it yeah it's so emotional isn't it I remember crying when I first saw a baby being born as well um yeah and it's funny you say that actually because the the role so my role is mainly working for c-sections and in the operating theatre and so you actually you forget what a normal I say normal a child birth without any sort of surgery is like a sort of vaginal child birth um you do and then I imagine also when you're a doctor it's the same thing where um you know if you are having a baby yourself like if you're if your partner is pregnant you often just fixate and all the horrible things that have happened to kids that you've seen and you forget that actually people have very normal experiences during pregnancy so i think that's when i got pregnant that's something i really struggle with because i just thought you just fixate on all the you know the very rare yeah like it's it's really bad isn't it but um you just think worst case scenario don't you that's where your mind automatically goes you do and it's because as humans we suck at interpreting statistics exactly when all you when your lived experience is seeing all of the stuff that gets escalated uh into and and you know all the pathologies basically because that's all you see there's no point you sitting in on loads of normal stuff you end up just with a very skewed idea of of how many things do go wrong and yeah i i did really struggle with that actually yeah um when when jess was pregnant particularly at the very beginning actually and just thinking about the frailty of you know embryology and just all of the all of the potential things that can branch at this stage one cell to two two cells to four four cells to eight like yeah like oh god we're right at the beginning of all of these branches and then you're thinking about god it's it's now it's now developing a nervous system and what if something goes wrong and i i was just i was just utterly paralyzed by this like i was yeah awful awful but got through it especially with all the information that they try and like overload you with during pregnancy as well like your baby is the size of a mango oh the fruit the fruit i do enjoy that though to be fair well let me let me let me tell you one thing that you might that you might not enjoy so i you know you've got all the apps that tell you all the different fruits and all the different things of all different stuff there was one that was like that was like cook a meal every week with the thing that your baby is the size of and it gave you a recipe for it i was like this is taking it a little bit too far for me I think that was, it's just weird, isn't it?

8:40It's just weird. Just strange. But it does exist if that is your thing. And so we listen, but we don't judge. Yes. Yeah, exactly. Exactly. There's someone out there for something. So yeah, sorry. I worked in a labor ward for a bit. And then because there wasn't really any room for progression, and I really struggle with night shifts, if I'm honest, I went back to the IDF clinic and I sort of worked there for a bit so my role was an embryology assistant so it basically means supporting the embryology staff and the andrology andrology staff with any of the procedures in the clinic that's a cool job it's really cool yeah just working in an IVF clinic is actually mad it's it's insane it's you can't believe it's happening when it's happening if that makes sense wow wow doing the procedures as well like what a procedural job no emails glorious oh no there's so many emails um so many emails so so much so much like um because you have to upload all your data to you know the hfpa and all that stuff so there's like lots and lots of paperwork involved if that makes sense um it's a shame so yeah no it's fine it's just part of the job isn't it um it is until until ai fixes it anyway but i'm sure we'll come on to that probably um did we get a few minutes in before i mentioned everyone's obsessed um so and then I decided I was a bit like put off about academia because of my experience with my undergrad but there really wasn't any where else to go so I decided to do a master's and then a PhD in women's health but the way I got my PhD was a bit weird actually because I did my master's really enjoyed it and I I expected not to enjoy it because it was academia but actually because it was a subject that I chose when I was a bit older and I sort of understood how academia works I like I really I feel like I thrived in that sort of environment and then towards the end I was like oh okay makes sense to sort of do a PhD now couldn't find any PhD positions in the subject of women's health which I was interested in so they were all super says a lot doesn't it yeah it does it does there were a few projects but they're all so competitive and you know everyone's applying for the same thing so it was really tricky um but I ended up getting a lab tech job at guys inst thomas's um and that was in a research group that studies maternal and fetal disease so they're there they were discard they were studying several different things but one of their main sort of things that they were looking at is intra intrahepatic cholestasis of pregnancy or some people call it obstetric cholestasis which um I don't know if you know much on but it's a very rare it's a rare disease but when it's severe it's like devastating because it causes stillbirth and preterm birth um yeah and it's not nice and even if you do have it and it's not severe sometimes you get a really awful itch and you're just not sleeping and you're worrying for the whole pregnancy so it's not ideal just explain what that what cholestasis is briefly just for people essentially it's basically there's like an imbalance in your bile acids that are going from the mum to the fetus so what ends up happening is that usually in a normal pregnancy the bile acids like they're exchanged between mum and fetus and then they're filtered out so they go straight to the mum and then it's fine but in cholestasis it feels like so what happens is the the bile acids accumulate in the fetus and then that can that is in theory leading to all these adverse effects like preterm birth and stillbirth so it's it's really the the most devastating thing is is that when the stillbirth happens it happens very suddenly um so you could be perfectly fine as in you'll have an itch and you'll have the symptoms of cholestasis and the next day you know things could go all all wrong um so really really devastating disease um and we worked really closely with this amazing charity called icp support who who do lots and lots of work in helping women with it with their condition and and now thankfully the knowledge on the condition has improved so we are now aware of the most like high risk groups who are more likely to have these adverse outcomes which is like which is a good thing because it means that you can hopefully help people with management and stuff and you know my old research green are still doing work in terms of like different other drugs that could be used that could improve management as well so um yeah so yeah just really awful disease and um that's what the research group were primarily doing but they're also doing work on gestational diabetes and um the whole sort of central point was like metabolic diseases if that makes sense um it does yeah amazing meaningful as well it's really meaningful yeah yeah yeah 100 and i i basically joined as a lab tech not expecting anything and then um the work that i was doing was already akin to a phd and my supervisor was really really supportive and she said if you want to do a phd i'll try and find the tuition fees and you can just do it here wow so i was very lucky in that respect lucky yes but also put yourself in the right place at the right time worked hard and yeah okay got a bit of luck but that wouldn't have happened had you not have been good at what you did or you know all the rest of the things that you were signaling right so you don't want to underplay that that's very kind to say um i think i think it was just i mean what i always tell people is that the tradition you don't always have to apply for a phd in a traditional route there are other ways to sort of get yourself get your phone in the door so to speak and then so the way that i got my phone door for in the door was via being a lab tech and then applying for a PhD.

14:30So one of the, I think the positive things about me getting the PhD in the first place was that because I had done all that lab tech work, I had pilot data. So I could just bounce off the pilot data and use that to sort of describe the scope of the project, if that makes sense. It does. Yeah. So that was really useful. And my PhD was focused on lots of different things. I was very lucky to be funded by one of the NIHR BRCs. So they focus on translational science, which means that no animal work, not really any hardcore sort of cell culture work or anything like that, which for me was really beneficial because, as I said before, I really struggle with the whole understanding how a molecule translates into a patient outcome at the end of the day.

15:20So having that sort of translational clinical trial type work was really, really useful. And so some of the work I did in my PhD was developing a biosensor that could detect bile acids and hopefully help towards diagnosis of intrahepaticolysis as a pregnancy, which is cool. Wow. Very much bench side. Detected them where out of interest? So it's basically you have, so you make the biosensor, but you have like an enzyme and it's like an enzymatic reaction. And then you, then that sort of translates into an electrical current and then you measure the current and then figure out how many bile acids are in the sample based on the current.

16:00Oh, wow. Yeah. So it's kind of, it's very much like experimental bench side. And then the idea is that if we had been successful, if we had the money, we would have like scaled it into a prototype and then you know um because it was the idea was that there wasn't a point of care test for bile acids there still isn't as far as i know um and it would have been useful as a way of keeping keeping um like maintaining the monitoring of women during pregnancy and so that it could just keep checking their bile acids because once the bile acids exceed 100 that's when you sort of get like the real red flags that something might happen so if we kept on monitoring that would be a good way to sort of make sure that people were staying underneath that 100 mark if that makes sense it does it does it's a shame that does not exist it's a shame that yeah i mean where's that ip set now i don't know i genuinely don't know i worked i worked i worked in a really cool lab in imperial and they were doing lots of like biosensor work and i don't know whether any of those biosensors are now in a different place than they were before but um yeah that was someone someone from imperial listening can just do a quick search for that or just it's difficult isn't it like you need the money you need the you need people to give you money to do this work and it's a commercializing research and commercializing academia as a whole tech transfer is a whole nother whole nother hour we could spend um yeah talking about that and and incentives and all the rest of it yeah but anyway we won't for now we won't for now but yeah that was part of the HD I also did um I also uh did a clinical trial where I was looking at um the fetal heartbeat so it's a I was looking at this non-invasive fetal ECG monitor so you basically stick it on your belly and then it looks at the fetal ECG but it's ambulatory which means that you can take it home and you can wear it for a day or even a couple of days if you want to I guess then i was like looking at the fetal ecg data and then seeing whether the fetuses from pregnancies which were which came from like a woman with icp compared to a normal pregnancy were any different um so that was quite exciting as well so you've always been into health tech really like you've always sort of gravitated gravitated towards it haven't you well to be honest like i didn't even think of health tech as a as a concept before doing my PhD if that makes sense like i didn't really realize it's interesting yeah i didn't realize all the possibilities that health tech could have um within the nhs within health care until doing my phd and my phd is like the title of it was i think it's like innovative ways of diagnosing and monitoring cholestasis in pregnancy um or something like that i can't remember the exact title um but yeah that was that was definitely where i sort of gained a passion i think for for health tech for sure in that hypothesis as you just said like here's here's a metric that if it goes up causes a problem is there a test for that metric no shall we make one yes okay cool now we've made it is there a way to commercialize it and then you know that's where you go from into tech transfer and then it becomes you know yeah different but we will wait before tech transfer it was very much just imagine me pipetting at a bench that that was it it's so funny though i think the equipment the equivalent in the tech world you see all these things of like people that you think something's automated and then you look into the box and it's just a human doing the thing yeah i think a lot of mvps are actually that like especially like image recognition stuff was it there was one recently wasn't it like image recognition was actually just a group of humans doing it to begin with or whatever but anyway when you visit these lab environments and it's literally just like cobbled together like a macgyver type situation like we found this bit of tinfoil at tesco's and we've like scratched it into a pool uh that is behind the scenes of every business ever so um everyone listening whether you're part of one or you own one or you run one will know that that is exactly what happens behind the scenes so at least again relatable for everybody that and then obviously hutility which is super cool yeah super cool um so I joined Hurtility when I was in my writing up phase for my PhD and I joined part-time I joined at the at a stage where the company was pre-seed whoa yes why very cool now now I'm really interested this is great you weren't interested before okay I definitely was but now I'm now I'm super interested yeah it was it was really exciting i mean i there were literally a handful of us we were trying to figure out what we were doing um so i basically i was very lucky in the sense that i was a bit of a nepo hire um basically the two of the founders so natalie getroy and hello no neil um went to ucl around the same time as doing my msc i actually did my msc with nat and we always like kept in touch through one way of one way or another um and then they sort of mentioned oh we're doing we're like working on this project like we need someone we need like a we need help with some of the the stuff basically and I said I'm more than happy to be involved because I was writing up and like I just need an excuse to get away from writing up my thesis because it was so it was so boring um so yeah then essentially what they needed was the because I don't know I mean I'm sure not everyone knows what um the Hiddity products are actually it's a more it's a much bigger platform than it was when I first started but the first the first course or product was an at-home blood test coupled with uh an online health assessment and the idea is that you can test biomarkers of your reproductive health at home and then you as you do the test you fill out an online health assessment and then you get a report after sending the sample off basically and everything's done by like finger prick sample so you don't need a healthcare professional to come in and take your blood so my my job was basically to figure out how to take the results of the blood test and the results of the online health assessment and automate that into a bespoke report that was relevant and flagged any conditions that needed to be flagged um so it was really cool because i didn't know anything about software engineering or or anything like that before i started and i what i what we basically worked on was you you'd kind of describe it as like a rules rules-based algorithm so if this happens if this happens then you need to say this in the report essentially yeah yeah and it was really exciting so we launched the launched the test um and we we We were just constantly iterating.

22:54Like it felt like I remember thinking like I remember finishing all the write up and like working with engineers and like remember that September launch day and it was launched. And I remember thinking, oh, probably don't have to do anything for a while. We need to update this. This is wrong. This bug needs to be fixed. So that was really funny. That shows how naive I was, I think, going into tech. And yeah, I was there for ages. So I only left like almost a year ago now. Um, and we then worked on improving the core products. So the first test, um, the first product had about 20 questions in the health assessment.

23:35And then we quickly realized that that number of questions doesn't capture all the information we need to, um, to really give a holistic picture of someone's health. So we improved the questionnaire, added a bunch more questions, um, which in theory sounds like a fairly easy thing to do, but it meant completely reformatting and rewriting the report. So that was a lot of work. And that was like my next big project at Hattility. But I was also doing lots of stuff like designing trials and everything to make sure that we had proof that finger prick blood tests were concordant with venous blood tests, you know, blood tests for your arm.

24:18So yeah, stuff like that. And it was just really fun. I really enjoyed it. That's awesome. And by the time he left you a head of scientific product research. Yes. What what does what does that mean? Why? Why? Why that job title? What? What? The reason the reason is because like, it's obviously to say all titles are made up to some extent, but they reflect in part the values of the organization in order to create that role. Right. So that's actually signaling that fertility care about scientific product research, which sounds like a very good thing. So I think that's what's interesting to me is that head of suggests as well, you had direct reports.

25:05So actually, there's a team of people now completely focused on this one thing. So that's why I asked the question of what were you exactly doing? Because I think it's an interesting signal. because my next question is going to be around like what do you think made utility so successful and in part i have a hunch it's focusing on stuff like this but both nat and helen are research scientists by trade so i think it would be odd for them to be founding a company but also have no interest in scientific rigor um so yeah i mean it it is essentially it's so it's not like a it wasn't a title that existed or i think they really thought about i think they just when we were first starting out we just assumed that all the things we were doing were going to be grounded by science and evidence so yeah it makes sense that we were so fully integrated into the product team um and the engineering team and they knew all of us and we knew all of them and it was very much like a co-production if that makes sense so yeah it does it was really nice because um the engineers the when we first out first started out the engineers didn't have any background in healthcare or health tech um and i'm talking about the first engineers the engineers following on did but they they were they were keen for us to tell them the problem and then they would find ways to uh fix that problem if that makes sense um and then yeah it's just it was great it was it was absolutely fantastic and then as we moved on and we started like creating like an operations team like we were sort of embedded in that we were we were everywhere we were I always this sounds like very arrogant but I always thought of ourselves as like the foundation of the entire company because we were in business development we were in operations we were yeah we were sticking our fingers in all the pies if that makes sense and you know it does we insisted on seeing the outputs of everything to make sure that they were scientifically accurate and and everything so yeah it really it really was like the core of the the whole company in a sense yeah i've been in this game a long time in health tech as well and and like when i hear something like that i have this big exhale moment because a company like utility that's achieved the scale that it has has done so doing this and that is a great sign that you can have this level of scientific rigor that touches every part of the organization and your business can be successful your business can be successful actually because of it not in spite of it as well and i think that again is a great signal because fertility being you know a b2c or b2b2c organization you know selling tests that eventually reach the consumer whether that's a direct sale or through through an employer or all the other models that utility have there's always this kind of all class one like let's just do class one or you know that mentality yeah let's get around the regulators let's get around the scientific stuff let's do let's go right up to the line but never cross it and let's let's suggest we go across it with our marketing and so and there's all of these things that I worry about in the b2c space and the b2b2c space because i i just you know scientists by background doctor by background klish my background evidence-based by background we're evidence-based beasts academics and it it just fills me with such hope that a company like utility can really set the bar at that kind of level and go we are putting scientific rigor absolutely everywhere and it makes us better thank you very much so please do the same i love i love that this is the thing like i think it that kind of stuff it will slow you down in a sense because it makes it more difficult to in product development to to do all these like checks and quality assurance and everything but in the end it hopefully like builds that patient trust and that clinician trust and all that stuff that's required um but you're right like i sometimes speak to companies and they have a product that's a medical device and i'm i asked them oh who who do you have board in terms of like i have on board in terms of your clinical staff and they have oh we don't talk to any clinicians he's just thinking why are you talking to any clinicians who are you talking to how did you develop this um yeah so what's he doing please stop everything you're doing immediately i know and that that stuff is a bit worrying and it's a bit of a red flag isn't it um but yeah hopefully the tide is turning and people are are more aware of that because you can just develop fast without the scientific rigor and put a product out but you won't get any retention because people will try the product and realize oh actually the the report wasn't accurate or i'm not i'm not going to try this again because it didn't it didn't fulfill my purposes in any way so it's almost about like it's fast versus far exactly you'll go fast but you won't go far because ultimately you will get caught out investors are becoming more sophisticated and you know getting getting investment from a whether it's a VC or any organization or person or whatever that knows this the people know what to ask for now yeah exactly people know this type of business model they know what leads to success they know the things that you're going to need to do from a regulatory perspective and they're going to ask for them at now so it it's yeah okay you might you might get around a few angels you might put a million quid or two together and and go as i say go right up to the line but ultimately you're going to have to cross it at some point and actually the sooner you built your qms the better because trying to retrofit that stuff is going to be a lot more painful than just doing it from the start exactly but let's talk about that kind of stuff now so you then moved to nice um so tell me about that move uh why you did it uh what you do there and yeah we can talk about some startup stuff yeah multiple reasons there wasn't like a single reason why i moved um i think i sort of felt that at hortility i delivered all i could if that makes sense um yeah yeah yeah so i've completed the goal so we put out version two of product which is like the longer online health assessment and the improved report um and that almost felt like magnum opus in a sense for me anyway not for everyone else but um it was like such a it was such a huge task and once we had done the bug fixing and we realized that actually the report is so much better the feedback is better people the clinicians are the clinicians who are checking the reports think it's so much better like that was so rewarding um but yeah it was it was it was I felt like I wanted to go back into the public sector and I didn't really know how to do that um and then I basically was just looking at job websites I saw the nice job came up and the role is horizon scanning and health tech and um that immediately I was a bit concerned because I was thinking oh it's not women's health and that's literally all I've ever done ever so that's a bit strange but I was really interested to learn a bit more about the ecosystem so to speak because I feel like I had not had a lot of exposure to that being within Hurtility because you are just focusing on your own thing you don't really care much about what else is happening or you know things like evaluation and procurement and all those things so I was keen to sort of learn about that side of things and especially how those things work in relation to the NHS and so it felt nice felt perfect because it's actually fairly academic which is kind of my background as well and the role is horizon scanning which is super super exciting because it means that you're looking for tech that's emerging and coming down the pipeline rather than looking at tech that's already here so it's a bit it's it's like the most i always i'm a bit biased but it is the most exciting part i think of the sort of health tech oh yes the fun end yeah yeah exactly the rock and roll end of health love it so i've got a load i've got a load of questions to you on this because i think first of all what i want to do is i i want to sort i want you to sort of break down my preconceived ideas of what nice is first because for me as coming from the medical world as a clinician once upon a time I have a view of what nice not nice equals nice guidelines so nice is you know the it's almost like the school teacher like that that's that's my that's my view of what nice is if nice was a person it would be like a school teacher like that that you know tells you what to do and you need to operate within here and you know they might send you to the headmaster for some punishment but they're the ones just setting all the stuff like that that's my view of what what kind of nice is coming from a medical perspective and i think that's useful for me to say it might be completely wrong and i i know logically and cerebrally it's completely wrong because of i know you have all the different programs the rest of it so i do know that but my feeling is still that and i think that's probably the same for quite a lot of people that probably does need to change so can you just explain nice the organization in terms of health tech what you guys do across the board and i guess how how people like us in health tech startups clinicians all the rest of it how should we be thinking about nice oh that's quite a hefty question um it's quite big yeah yeah it's quite big i totally agree with you because i i used to use NICE guidelines all the time for my job at Hurtility and I didn't realize all the different aspects of what NICE did until I applied for this job.

35:10So I guess you could describe NICE's, in relation to health tech, NICE's core role is to evaluate health tech for clinical effectiveness and cost effectiveness and then write recommendations and guidance as a result. um so the overarching aim for nice is to make sure that we are um producing guidance that provides um i guess that suggests where taxpayer money should be spent in a sense like what is the best value for the tax taxpayer which is where the sort of clinical effectiveness cost effectiveness this thing comes in um in terms of all the nice programs so we nice is very much like um system needs led so for health tech what the main sort of program is that we we get lots of information about what the system needs are what are the pinpoints and clinical pathways what are the issues are happening and we get that information from nhs england we might get it from the royal colleges we might get it from people you know at the front line who've told us various things and then our job is to basically look to see if there's any health tech out there that could be used to address those pain points and then we basically have a prioritization process we try and figure out you know is this the right thing for nice to be focusing on at the moment and then we go through a scoping process where we look to see what evidence is out there for that health tech that sort of that pain point that that health tech is supposed to address and then we go through evaluation which is like the clinical effectiveness cost effectiveness and then we write um write guidance as a result but we have lots of different programs so we are going through a bit of a what we describe as like a whole life cycle approach so we have our full guidance which is what people often think of immediately when they think of nice which is the guidance that does require like those full-on rcts um to to evaluate that bit of tech but we also have um an early value assessment program so um this is for tech which we know it would fit a system need um and it has potential but it doesn't have the evidence base yet so it's a bit of a program where we essentially guide the evidence generation so that's really promising i think for a lot of tech nowadays where they haven't thought about the evidence generation early which is fair enough because as everyone as i'm sure most people know there is no mandate for nice to write uh guidance on before it gets procured so people can procure what they want um there's no mandate for nice to to say whether they should or not um but it does improve your likelihood can i just ask on that thony one one question that i have on the early value assessment is who listening is that relevant for so who who listening should actually go oh i should do that or i should look at the website and check that out or like who what exactly in terms of organizational stage or size or what they do or do you know so it's does anyone know does anyone know does anyone know what's going on um no it's not a one-size-fits-all so we but so as i said we're systems-led so it's very much like we figure out what the problem is first and then we look at the tech afterwards um so it but early value assessment or you go and find it and then you tell them to go through that assessment what do you mean as in you said you were systems-led right so you're problem-led so you decide what the problem is and then you'd think about potential solutions do you then look for the potential startups and then get them an early value assessment is that the way around it yeah yeah so we get the problem first and it's not us deciding the problem it's everyone else who's you know um working within um the system yeah within the system who tells us the problems and then we um yeah we research and see what's out there um so the the type of tech the type of companies that go through either are the companies that there is some um there's some evidence to back up their value claim but it's not the full-on um like end-to-end studies rcts that you would expect from a full evaluation so they they've got something that suggests that there is evidence behind a value proposition but it's not it could be something that's very sort of sparse or not potentially not massively rigorous um and then the other thing they need is the the regulatory approval so yeah if you've got the regulations behind you then fantastic as well so those are the companies that are suitable for either um but it's it is systems-led so we would always focus on the problem first and then we'll scope out and so i i think there's probably a a bit of a misunderstanding where uh tech companies think they just need to be in front of nice for us to look at it but actually because we're systems led we'll look at the problem first and then if you fit the problem then great that being said we do have like a we've got a front door so the front door is intended for guideline updates but essentially if you're a clinical person who uses a lot of health tech in your profession and you know that there's a bit of tech that we should be writing guidance on and we haven't already that's a way for you to sort of signal to us that oh can you please have a look at this and then we'll do scoping to see whether that actually is a problem behind the tech and then it goes both ways is basically what i'm trying to say sure i haven't explained that very clearly no you have no you have absolutely you have i totally get it um and your job specifically so the horizon scanning component what does that entail horizon scanning well enhanced horizon scanning nice is fairly new there's health tech and there's medicine so we both work together um to have a bit of a more of a joined up process but horizon scanning is basically trying to look at the two to five year pipeline of health tech which might be coming through um and the reason why we set up in the first place is essentially preparedness so is there anything that we should be aware of that might be disruptive to nice or nicest processes or the nhs in general that we should have foresight of but in practice um it is really difficult to tell what is two to five years away with health tech because there are no timelines for everything um so so the way that we sort of figure that out is by technology readiness level which is like um which i think was originally developed for space tech but ukri now use that as like one of their frameworks and it's actually quite good because the technology readiness level you start at the tRL one and tRL one is like your idea you formulated an idea and then tRL nine is you know you're fully operational in a relevant environment um and then the latter the latter tRLs are sort of focused on demonstrating and demonstrating is kind of like akin to evidence in a sense so it works really well for NICE because um what we focus on is evidence um and sorry do you put companies into that framework and label them TRL or do you put certain technologies as a group into into those it's both so um it depends so the way that I horizon scan at the moment is I might focus on a topic area so this year I did a horizon scan on obesity i'm also doing a horizon scan at the moment on point of care testing for virtual wards so they're like areas they're pockets um of where tech might be useful the earlier on you go in terms of technology readiness the more likely you are to see a scientific advancement rather than an actual product with a use case so if you go on say like something that's very early on in terms of technology readiness what you're looking at is a nature paper that suggests that this signaling pathway is important for this condition and that's that's the level of information that you get um so it's unknown whether that will eventually translate into a product at that point but that's the foundational level of science that's required to eventually get a product yeah you're really it's really cutting-edge stuff then yeah i mean it's a bit it's all like it's very the the stuff that's fair like further on in the pipeline is obviously a lot more uncertain so and even sometimes the stuff that's very near in the pipeline can be really uncertain so it's a bit of a tricky one like people always assume that horizon scanning is just you know you definitely will know what's going to happen in the future and it's not like that at all it's sort of suggesting it's it's finding out signals of things that might happen and then trying to figure out whether that's important for you as an organization and where what i do is basically trying to figure out whether that tech might be disruptive um for nice and the the system as a whole so when i say disruptive i mean you know it might require us to change our evaluation methods because there's nothing like it at the moment it's completely brand new or disruptive in the sense that you need an entirely new clinical pathway for it to be implemented in which case yeah okay you know the powers that be nhs england dhse are going to have to figure out how to do that and so you have links to all of those different people when you're putting this stuff out to then get things done well okay so it's very early on in the process but um nice in general have very very strong links to all the system partners and we're sort of developing our horizon scanning to make sure that the right people are seeing at the right time but yeah it is very early on we're very much learning by doing and yeah i'd love to i'd love to come on again and give you like a real life example of how that sort of panned out perhaps um that'd be awesome yeah yeah you just tell me you just tell me when um i'd love that i've got i've got a few questions because this is fascinating how are you guys think i mean we got this far without talking about ai in any substantive detail but how are you guys thinking about llms and ai and i'll ask you like quite specifically on this because um you talk there about potentially needing to change frameworks and potentially needing to change the way that you evaluate stuff.

45:42And that's the kind of, you know, grenade that LLMs have really thrown in really. And people are baking them in in all sorts of different areas and parts of their software or stack. Or like there's lots of places where AI and LLMs are going to be assisting diagnosis or diagnosing there i say or you know in mental health and treating if they're part of that layer you know companies like limbic are gonna be building specific models around this stuff and yeah they've got loads of checks and balances and they are regulated but plenty aren't yeah all the rest of it so and there's a big gray area of what is a clinical action and what is not and so there's a gray area there so there's there's loads of there's loads of gray areas around around diagnosis, around treatment, around support, around autonomous.

46:39And so there's so much there that I'm just intrigued as to how you interface with AI in terms of what you do with horizon scanning and if NICE has got anything to say on all of this stuff. Oh, yeah. I mean, there's so much work going on at AI, on AI and NICE at the moment, so much. We published a statement of intent last year, which sort of acknowledged that, NICE have a role to be proactive about what we do with AI in the healthcare system. In terms of, so, I mean, there are always AI related topics that are going through our prioritization process and our scoping process. So, I mean, just like a couple of months ago, we prioritized an AI EEG topic.

47:24So things are happening in terms of like what's happening for scoping and stuff at the moment. um and i feel like nice are quite nice do seem to be fairly on the ball with that um i think yeah with horizon scanning we we're just kicking off like an ai horizon scanner actually at the moment and we are also thinking is there tech which might be coming down the pipeline that isn't directly relevant to nice as an organization but perhaps we should be thinking about evaluating um and i think that's where like all the stuff where you know the it's not controversy but the the difference in opinions about avts and stuff that all comes in and i think that's all stuff that we are actively thinking about and working on at the moment i'm being voiced for those people that don't know yes yeah sorry um how do people get onto your radar for a horizon scan and how on a super practical level how do you horizon scan there's sort of two branches which is i either get told um what's your horizon scan on because there's someone within nice who needs a horizon scan on a specific area and that might be related to you know an active piece of work that's going on at nice or or you know a topic that might be of interest um or or a guideline update or whatever it is um and so our horizon scan on that based on what someone has said but we also have a very we're developing a proactive horizon scanning process where basically trying to keep an ear to the ground to make sure that nice aren't missing things that wouldn't have automatically that wouldn't have sort of come under their radar in the traditional route um so so keeping keeping an ear to the ground in terms of like oh there's lots of funding going into this at the moment that might eventually translate into a product development that might be interesting for NICE and my like the whole overarching theme is disruption so it is impossible to be proactively scanning for all health tech ever so you have to sort of think of everything under a lens of is it relevant to NICE is it going to be disruptive and that's kind of like what I'm really interested in because that's the stuff I can sort of forward on as useful information and are you public around what you are currently scanning at any one time is that information available no but that's not a deliberate decision um that's purely because we're just setting ourselves up um i think i'm i'm very much happy to i feel like i i i'm very fortunate in a sense that because horizon scanning is it sort of precedes a lot of the processes at mice there is lots of room to be talking to innovators and chatting to them directly about what they're working on even if they haven't fully developed a prototype yet even if they're still like even if they've just got an idea and think oh it'll be really good to develop this um and i'm hoping the communication channels are a little bit more open now we've got these kind of processes in place because traditionally they haven't been it's it's all nice have been quite um siloed isn't the right word but it's been difficult to sort of get in touch with them because there are so many teams doing some really full-on work i think i think the difficulty is that people sometimes people assume that once you're in touch with someone at nice you know they'll automatically yeah exactly the whole organization will know and you'll convince the whole organization to root you for guidance and the truth is there's no single person that can decide what does and doesn't get through nice guidance and we've deliberately built it that way um yes i think it's important to be chatting to people early and sort of um showing that there's room for like it's not even co-production but just showing that there's room to talk about you know what we've seen in terms of system pain points and what we would like to see in terms of evidence generation for us to evaluate your product in the birth space because it's it's a shame when like you know companies that like you have to you have to develop so fast and sometimes there there won't be room to develop and launch and then go back and do a clinical trial like who's got the time or the money to do that you know um absolutely so be good to start early and and we've actually got like um am i allowed to plug this i'm not sure we've got a we've got a we've got a team called nice advice who are just absolutely fantastic they are fee-based but it's literally all cost recovery so they only charge enough to get back their salaries basically but it's it's essentially advice on how to how to develop your value proposition in the nhs how to what evidence what evidence gaps you currently have how to how to generate evidence how you can develop your model for health economics outcome research and that kind of thing so it's all we've got the the stuff there I think people just aren't aware of like the breadth of all the services at NICE and how how willing we are to sort of help you but it's it's tricky but I also understand like innovators probably are quite frustrated with us because we are a huge huge organization and sometimes it takes a while to get replied back and all that stuff um which yeah it does yeah and things do take yeah things do things do take time I think with the right leadership though you end up moving in the right direction and from what you've said from everything you've described it seems that way for me I think one of the very first things you said actually when you when I asked you to talk about nice was that you said yeah we've got streams for health tech and medicine i mean even in that phraseology you know putting health tech right next to medicines as important you know i i think that is and you know i'm obsessed with language it's what we do over here in my world but it's actions like that that make people believe it yeah therefore it does end up having that level of importance the way it's then talked about the way it's then regulated downstream the way other teams will appreciate what it is i think even just a simple action of just putting that you know on the same line at the same level and all the rest of it like this stuff is important it will be treating it will be diagnosing it will be doing all the things that you know medicines will be doing there'll be contraindications to it there'll be all of those things and i think for us to consider areas of health tech or devices or software that is treating just as you know medicines will treat i think they have an effect on us and therefore all of the things are still in play and i think that that even as an active leadership is so important um and so i'm interested in what the vision and the goal is here then and like you know phrase would be what does good look like you you guys are starting out in this structure and team and and trying to build something here and trying to build some infrastructure that interfaces with the health tech world so what what will make you have a feeling of success in terms of what you are trying to achieve here and in merging with the health tech world who um might just be that merging well with the health tech world yeah everyone being aware of us yeah probably all the things you've already said it's probably a rubbish question no no it's a great question i think i think partly is poly is that i mean i hope to eventually i hope that we eventually get to a stage where innovators feel like they can get in touch with us quite early on um to talk through what they're thinking about in terms of product development and that they are given good guidance about how how what they should be developing for in the first place and how they should develop it um that would be like an ideal an ideal situation for me because that that would feel like that we bridge the gap basically um and it wouldn't feel like we are just like going in our own worlds and going at different paths and different um at different progress and everything so that would be amazing and i think i think you're on your comment in terms of medicines versus health tech health tech that is something we're also actively thinking about like how do you is it how do you how do you look at health tech and medicines in a bit more of a holistic way um and that's kind of why horizon scanning we we are deliberately sort of like there's there's two of us and there's like there's the medicines lead who's who's a pharmacist and she's amazing but we we are always working together we we we are trying to figure out how best to to display our findings in terms of what's coming down the pipeline in a holistic way so that people who are decision making can figure out what to do with that information because um like alzheimer's is a really good example in the sense that there's a bunch of new alzheimer's drugs coming up but there's also a bunch of new alzheimer's blood tests which potentially might be coming down the pipeline as well so that's kind of like a a nice way of like thinking about how we can be working together and putting that information out together so that you know the right decision can be made whether that is you know suggesting a health tech over medicines or vice versa or you know um yeah a companion diagnostic or whatever that is i love it i think it's great and ultimately my overarching feeling of of you know coming out this podcast is that it's so good to know that nice as an organization with everything it can do is putting this level of scrutiny on health tech and it is has all of these programs that you're talking about and is running alongside us and just just knowing that gives me a level of comfort that that you know clinical effectiveness and value is being looked at constantly and that advice is getting to the buyers and guidelines are being written around this and it is being held in a you know in regard as a medicine i think that that's just so great to know from my perspective um and i'm sure for a lot of other people as well because it can feel a little bit wild westy without knowing that these things exist right and that's dangerous for everyone because as soon as fingers get burnt then confidence gets lost and when confidence goes you know buyer confidence is what drives our sales for everything yeah if buy confidence is gone then we're not going to we're not going to improve and things are going to stay the same so yeah it's it's it's so nice to know that nice is is over all of this stuff I guess my final question would be what's what's exciting for you at the minute like what out of everything you've talked about and everything in your job whether it's a particular clinical area whether it's a particular technology whether it's a particular thing you're scanning for or I don't know is there something that comes to mind with what's most exciting oh gosh um I'm so biased I will always go back to women's health good for you no but the reason why is because I think I mean women's health you has traditionally been there's been no money in the research um and only only which is where we started this conversation which is the only way we are but which which is which only recently i think people have started seeing like actually it's not acceptable um why aren't you giving money towards research and i think the tide has sort of turned a little bit like you are getting much more um news and interest in femtech than you were a few years ago so i think but i think the problem is though is that a lot of stuff hasn't because sometimes there isn't a baseline knowledge for women's health in the first place it's really difficult to develop tech on top of that so if we don't know truly how a menstrual cycle works how on earth are you going to develop tech to improve data gap yeah exactly data gap so i think there's a lot of femtech that's been developed that perhaps doesn't have the evidence base in terms of foundation which worries me slightly but i think there's such opportunity for tech to be collecting that data to fill that gap in the first place and I think that's quite exciting because I feel like that wouldn't have happened if there hadn't been like a femtech boom I think you know it just would have been academia trying to collect that data by themselves not getting that sort of real world evidence that that sort of end-to-end service pathways or anything like that I think it's so so so so so important everyone listening really takes on the notion that nice is our friend in this sector.

59:45There are plenty of programs. There are plenty of ways to get in touch with you. There are plenty of teams there and no less than yourself. So I think if people do want to get in touch with you, what is the best way for them to do so? So at the moment, I don't have an inbox or anything, but just tag me on LinkedIn or message me or whatever it is. I mean, I'm probably quite easily, easy to be found. So if you are developing something that you think, oh, this is going to be such a game changer, and I don't know how nice would evaluate it because it is such a big game changer, then please do just like message me and then I'll put it in front of the people who need to see it.

1:00:21Awesome. One other thing that innovators could be doing, which is super helpful, is registering themselves in the innovation service, the NHS innovation service. So if you do this, then that automatically puts you under nicest radar as well and also gives you a way to access nice advice too. So it's quite a good platform for doing that. thank you Thani and we will get you back on and we'll talk through some of the stuff you're up to fabulous great thank you so much 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