#436 Lessons from a healthcare investor with T.N. Giridhar from SSG capital

27:12T.N. Giridhar:You know, and I think we probably spoke about it earlier when we said the color of money is kind of money is money, right? So in a sense, you need to be able to kind of be in front of these people so that they will come and talk to you. Yeah. So that's in the first phase of identifying the investments. And then the second phase is once you have identified someone, you will then go into, shall I say diligence, you know, understanding more about the company, you know, kind of headline Prima FAC looks good. Does it really good look good? Is it is it something that I really want to be investing in?

27:50T.N. Giridhar:So you kind of go through that evaluation phase, and then you make that investment. What you know, if you look at it from the entire lifecycle perspective, this is actually a small part yeah that that whole identifying and the actual investing is actually a small part yeah time wise it is yeah no not just time wise in terms of importance the real work actually starts after the investing happens you know so one you do any amount of diligence you know you You kind of meet the company a number of times. I think I can't remember an instance where after you make the investment, go into the company, everything is exactly the way you expect it to be.

28:45T.N. Giridhar:Almost never. You know, something is different. You know, the people, the someone, you know, they were probably being very nice to you or, you know, whatever, you know, think of it that way. I mean, so things are, things do turn out slightly different, ever so slightly different. And then you learn about the business and then every day there are new challenges coming up in the business. And so you're kind of dealing with those or you're helping to deal with those and all of that. Through all of this, that relationship, you're building every day, you're building a relationship with the company, with the CEO, with the management team.

29:30T.N. Giridhar:It's not just the number one level. You're building a relation with maybe the two down, three down. Those people are also very important from your relationship perspective. And what we also used to do is, you know, we have different people in the fund, right? I mean, so I'm dealing with more often than not the board level, the CEO. And then we have other people in the fund who are dealing with the junior people in the company. that relationship is also very important from both an investor perspective and also from the company perspective sometimes that has been a like a back channel if you will sounding board what's what do you think of this one you know they they they do it kind of deliberately they do it intentionally.

30:30T.N. Giridhar:They kind of push a seed up the chain in a sense. And frankly, we do that as well. And it also helps to understand what is happening in the company. So that engagement across different levels in the company is very important. So a trust, the relationship is built across levels is built over time. And that is what helps you to handle these kind of situations. So going back to the previous example, Germany was something that came up completely out of the blue. Turns out that the people down below didn't have a clue. They didn't even know that there was a Germany being planned. Right. Right? So this guy, he found someone in one of his trips.

31:28T.N. Giridhar:He found someone there and he got quite interested. Nothing wrong with it. But my only point was we have so much of a market that we could potentially capture here in the UK. And if you're going to add Ireland as well, then we've got UK and Ireland as such a big playground. do you need to add another geography? I mean, for a start, it's like a two-hour flight. Then you have the language issues, right? I mean, do you need to do that? If you feel you're saturated in one market, fair enough. You go to another market. But when you don't think, and that's what, so we had this conversation. Do you really think that we have saturated in the UK?

32:22T.N. Giridhar:And he goes, no, we can. We can do a lot more. I mean, of course, his point was, I can do this and I can do that. So I was like, you're going to do the UK. You're going to do the expansion in the UK. You're going to do the expansion in Ireland. You're going to do the expansion in Germany. Like, how many are you going to do? Right? And it's not like there are too many of those salespeople who have those relationships. NHS is, surprisingly, believe it or not, there's a lot of relationship that is important. in the NHS. So, you know, I said, you're going to be able to do all of these yourself. I mean, you're going to drive all of this?

33:00T.N. Giridhar:Because for us, the CEO is a very important person. The driver is very important. So this goes back to the point that, you know, before, you know, when we were just talking about, do something consistent, you know? Don't try to be sexy all the time. don't try to be kind of do something that's flamboyant and kind of grabbing headlines it doesn't matter if you don't grab headlines do something even if it's boring yeah sometimes boring is good yeah you know as an investor i absolutely don't mind someone being boring in that sense you know because i'll tell you one thing i have seen you have plans you have all the business plan, everything, right?

33:47Dr James Somauroo:But execution is most important.

33:51T.N. Giridhar:Where a lot of companies fail is on execution. At the VC stage, of course, capital is one thing and we haven't touched on, we haven't talked about capital and all of that yet. But capital is, of course, one big reason why a number of companies fail between, say, the seed stage and a pre-series A or a pre-series A to series A and then a series B and all of that. And that's where they come up with a pre-pre-series A and I've seen all kinds of terminology being used. The reason why companies fail is capital, of course, but a bigger reason is execution. The discipline of execution is so important.

34:36Dr James Somauroo:yeah how do you look for that in a founder how do you assess maybe not in the founder even or do you look for it in the track record of company like how how are you assessing their ability to not get distracted do you do that in interview do you do that looking what how do you assess that

34:55T.N. Giridhar:it's a bit of um shall i say soft skill yeah um you know it i mean obviously a lot of books have been written on that sort of, on that subject. But end of the day, what's written in a book is like, shall I say, theoretical knowledge. You have to apply that one. And it's down to you to kind of apply or translate that. And I think where, I mean, pretty much for at least the last 15 to 20 years in my career my job has been on my the role has been to assess people it's all about assessing people and that is by far the most important i'm really getting that from you by

35:41Dr James Somauroo:the way i'm really getting that so much of what you're good at and what has led to your success is your ability to do that as well because that's going to have levels to it yeah yeah i mean that

35:51T.N. Giridhar:That people, identifying the people, looking at, say, the culture in that person. You know, like someone said, don't bring me attitude. I have enough of it. Right? I mean, I don't want someone who is just a smooth talker. And so many founders, when they go to pitch, when they go to present, they think they need to be smooth and slick. It doesn't matter. I mean, in fact, to me, that's a red flag.

36:30Dr James Somauroo:That's really interesting.

36:31T.N. Giridhar:If someone is trying to be extremely smooth, that's a red flag for me. I mean, I become cautious. I become more sort of, in a sense, my more investigative antenna then come up. Interesting. Because I imagine that's quite seductive for quite a lot of people. Yeah. But I don't get carried away by that one. It's very, very, I mean, in that sense, I'm a bit probably old school, boring. I don't know what you call it. But I definitely don't get carried away by smooth talkers. Okay. Look for, I look beyond. I mean, so there are, I mean, I have had people who are not very good with English. Yeah. You know, I've invested in Indian companies.

37:14T.N. Giridhar:They're not the best in English language. You know, you're kind of trained. And that's one of the things that I got trained in. Over a period of time, you learn that someone who speaks very well is not necessarily the best at doing whatever they're doing. And likewise, on the flip side, someone who is not very good at talking doesn't necessarily become a bad person. Yes, talking is important. You have to keep doing talking all the time. You have to talk to maybe the government. You have to talk to the regulators. You have to talk to your investors. You have to speak to your other board members and the management team.

37:56T.N. Giridhar:You have to talk to your own other employees. You're making an impression. Every time you talk, you're making an impression. So yes, how you talk, what you talk is important, but you have to look beyond just what is spoken. You have to look at something more. And that's, I don't know, I think it's kind of, I would call it definitely, I'd call it experience in being able to identify who is likely to be, shall I say, a winner. And again, it's got nothing to do with age. you know i mean initially i used to think that the more mature a person the you know the person has seen a different uh sort of thing so the person is mature i've had you know we've invested in a company uh with you know someone who's just come out of engineering uh just completed engineering uh maybe 23 24 ish i don't know the guy was so mature i mean i was so impressed with that guy wow i mean so it's got nothing to do with age and that's what i have seen over a period of time yeah i mean you can have a 45 or 50 year old who is um we've had we haven't had too many 50 year old kind of you know startups if you will um we've had definitely people in their 40s and i think the the 40s the late 30s 40s is a very very good age um i mean i absolutely love those kind of people because they have the maturity.

39:28T.N. Giridhar:They have seen a lot of, you know, they've been through the hard bits of life, corporate life of they've probably managed a team. They know the challenges of kind of recruiting, of holding a team and then carrying a team and all of that, that side of it. They also have the energy and the enthusiasm and the youthful vigor in a sense. You know, so they have that hunger in them to do something more so you know the late 30s early 40s is a very good age i absolutely love

40:00Dr James Somauroo:that that bracket yeah i can attest to the fact that the uh i'm 39 so i i'm in that i'm in that sweet spot so i would love to get an exit here and go and do the next thing raise some money and and go again i could do i do yeah i definitely definitely still feel like i've got the energy um the slight complicating factor in that age range you'll have seen that when you use my bathroom upstairs we jess and i were just laughing because you probably saw my one-year-old's toilet seat was on the toilet so that is the challenge about being that age is that you do start to have those dependents don't you and you start to think okay maybe i need to start playing a little bit safe and all the rest of it but maybe i don't know i'm one of the more risk averse entrepreneurs i think in a really in a service i've got a services company as you know like it's it's a it's a different risk appetite to going i'm gonna you know raise or borrow 10 mil and you know on this idea that may or may not work i think that's a totally different personality um but i like the boring i love the boring i love the consistency um but yeah it's really interesting so one question i had actually you've invested across sectors you mentioned healthcare that you've done yeah you've also done a lot of energy green tech clean tech a lot of that side of things and you know esg and rest of it um what do you notice about health care that's perhaps different to

41:24T.N. Giridhar:other sectors one of the things um about health care is is obviously the sort of um shall i say the regulatory element involved in it the the greater amount of um sort of the number of hoops that you need to go through before you can get your product out in the market. Yeah. And that's obviously one very important thing. And then the second thing is I think there's not been very many entrepreneurs who have been, shall I say, doctors who have become entrepreneurs. You know, you've had entrepreneurs who are more coming from the commercial side And then you've had these sort of technocrats, if you will, the technical people who have been immersed in that space for a long time.

42:21T.N. Giridhar:Like we've seen, say, oil and gas engineers, or we've had some robotics engineers who started companies. So we've had these technocrats come up, identify a certain niche or a gap in the market, start a company and then come up for funding. We've seen some of those. We haven't had too many, shall I say, doctors. So, for example, we were looking at a company that was making a product for a diagnostic, a product for cancer screening, cervical cancer screening part of it. But that was not started, that was not by an oncologist, if you will. It was a science graduate who's been an entrepreneur who just kind of liked this area.

43:15T.N. Giridhar:We've had another testing kit develop. Someone developed a testing kit that could test for COVID. Of course, initially it was COVID and then it came up to, they came up with three different things, COVID and Dengu and something else. So, and this was, again, this guy was not, wasn't a doctor, wasn't any kind of a technical specialist. He was someone who was an entrepreneur and he had one of his, I think, nephew or niece, someone kind of who succumbed, who he lost to dengue because it was not diagnosed as dengue. And, you know, the platelet count kept dropping and didn't know why that was happening.

44:07T.N. Giridhar:And by the time they actually realized it was that, it was too late.

44:11Dr James Somauroo:Yeah.

44:11T.N. Giridhar:I mean, yeah, they thought it was malaria. they kept treating it for malaria yeah but he wasn't that and so you know that that's the sort of yeah you know he came up with that as a solution so i think one of the things that i have at least in in the situations that i have seen we haven't had too many um like a like a doctor coming up with identifying a product a gap in the market and saying this is something that i would like to do. You know, the diabetes company that I talked about earlier, the guy wasn't, he had nothing to do with diabetes. He was just an entrepreneur. So I think that's one thing that I have seen.

44:51T.N. Giridhar:I mean, if you could have more, shall I say, doctors, the trained technocrats, sort of technical people who also have the entrepreneurial mindset and then that commercial, because it's a different world. You know, that entrepreneurial world and the commercial world is completely different. So if you are able to bridge that gap, in a sense, someone like yourself, for instance, I think that'll be really good. I'd love to see more of those opportunities.

45:25Dr James Somauroo:Yeah, and there are far more coming through. I definitely was part of a generation that it felt like the early adopters of that. There were clinicians in my era, doctors in my era that definitely have left to start companies. I think what's interesting to me is that they've not, you know, not too many of them have come across your radar. And I think that's partly because it might be because of, I don't know, just where people's ambition is. Because I think, and I don't mean that in a pejorative way. I mean that quite often clinicians will see problems in their day-to-day lives. It just might not be a problem that's a problem absolutely everywhere in the world that requires VC scale.

46:05Dr James Somauroo:And so they don't necessarily start companies to get to that level. They might do a small angel round and that might be the only investment that they ever get. And they actually scale it to a point where it's profitable and they're happy there. I've definitely seen that and I see that quite a lot. I'm actually starting to see that a bit more even now as well, because as the barrier to entry starts coming down in terms of the amount of capital required to bring something to market, it doesn't necessarily... where it can actually be a very bad idea to get venture capital money. Because all of a sudden, you come on my board and you're like, James, you're doubling revenues every year for the next five years.

46:41Dr James Somauroo:And I'm going to be on your back if you don't. So just to let you know, that's actually not necessarily a good thing in healthcare when there's a lot of examples of people trying to do that and the scale not being able to be achieved.

46:55T.N. Giridhar:I mean, I don't know what the reasons are for why we haven't had too many, shall I say doctors coming into the sort of entrepreneurial space one reason could be that they're way comfortable they're making a lot of money already in that that is not the reason that is not that is not the reason absolutely I think that's that's the NHS in you coming out now

47:18Dr James Somauroo:neither comfortable nor making loads of money so let's just let's just make that clear I think

47:23T.N. Giridhar:I think it's probably that the, shall I say, the fear of the unknown or the hesitation of, you know, it's a different world. And believe me, it's not an easy world. No, it's not. Setting up a company and trying to run that, talking to investors, it's not an easy thing.

47:44Dr James Somauroo:No, and also neither is medicine, right? And the blinkers go on in medicine. And I think, you know, the system's evolved in such a way that I think we as clinicians, and especially when I trained, you just never thought about doing anything else. And that's not because anyone was forcing you. It's just the way it was. It's a vocation. And it still was. It was still taught in that way. there was never ever any assumption ever that you would do anything else it's not part of the language it's not part of the way that we speak to each other it's not part of any appraisal at the end of the year it's always just assumed and so because of that assumption it's just so ingrained that to consider anything other than just being a doctor is the weird thing it's odd it's different and therefore it has a resistance to it and so you're you're always kept within that boundary of resistance and so as you start exploring other things well then there's and i've heard it very recently on this podcast you know then there's then there's the comments oh why are you doing that silly tech thing and like oh why are you doing that why aren't you concentrating on your exams why aren't you doing this and none of these things are said i i don't think or feel these things are ever said to cause a problem or to be intentionally difficult or occasionally of course they are but i think that is just the system working it's fear of the unknown it's it is strange for people within medicine why you would and certainly wasn't in my day um so i think there's a lot there's a lot to that and your son's a doctor right so yeah i think it's um

49:36T.N. Giridhar:I think it's a mindset. Number one, I think it's a mindset. And I think what I mean by that mindset is if I have been, shall I say, an investment banker, we think about or we talk about a progression in certain different ways. I have been covering one particular geography. My idea of progressing is I move to another geography. So I started with, say, UK. I move on to EMEA, Europe, Middle East, Africa. So I kind of start UK and Western Europe. And then I move to the whole of Europe and then the Middle East. And then Africa gets added. And then you move to maybe you just get transferred. You move to Singapore.

50:28T.N. Giridhar:You start looking at Asia Pacific. You start looking at ASEAN countries. You start looking at the rest of Asia without Japan. And, you know, so that's our idea of progression. We look at or I have been doing transactions or deals that are, say,$50 million. My idea of progression is I want to do$100 million. I want to do that a billion dollar deal.

50:53Dr James Somauroo:Yeah.

50:53T.N. Giridhar:No, I want to do that. I have if I have been doing M &As, for example, I have been doing sell sides. I want to do buy side. I want to do a hostile offer. So I'm looking for variety, if you will. A doctor, on the other hand, is almost, I don't know if it's trained or if it's the mindset. They're not looking for variety in that sense. I have been doing oncology. I will keep doing oncology. Within that oncology, there are, of course, a lot of differences. We just keep specializing. Each patient kind of presents differently. They come up with, what shall I say, different either comorbidities or conditions that they have before they have walked into your clinic.

51:44T.N. Giridhar:So that is the variety you have. Whereas when I, from an entrepreneurial world, when I look at variety, it's completely different. And I think it's that kind of a world. You have been so engrossed in that. And you are literally saving lives. You know, it's not a figurative thing. You literally are doing that. So you're kind of completely engrossed in that. You don't have time to think about anything else. A lot of people don't even know what to do with their surplus money. I mean, I have had people who have come and said, doctors have come and said, I have got about$100 ,000,$200 ,000,$250 ,000.

52:20T.N. Giridhar:I don't know what to do with it. Would you suggest I put my money or give my money to this wealth manager? Or what do you suggest I do? You know, that kind of a thing. So people don't even know what to do with their personal money, let alone what you're going to do with a company taking on someone else's money.

52:38Dr James Somauroo:Yeah.

52:38T.N. Giridhar:You know, so I think it's just I think it's not so much that one is the blinkers that you've talked about. They've just been so focused on their area. So they're not looking at it even from a broader healthcare perspective. I think it's more of, you know, how do I, and genuinely there are, like, I mean, when you run a company, you're looking at the HR side of things. You're looking at the marketing side. You're looking at the finance side of things. You're looking at investor relations. You're looking at, you know, a whole load of regulatory side. There's a number of different things. And then each one is an area in which people have specialized for all their life.

53:18T.N. Giridhar:So if you want to become the CEO, then you kind of have to have an overview of all of these. And you should. Because, you know, when you talk about the, you know, the kind of people, someone who is a technocrat, who is only focused on this. And we've had that not long ago, like in the last six months. I've had an instance where we've had a brilliant technocrat, good guy, talk about his, very good with his subject work. The guy doesn't understand any finance. He doesn't understand margins, nothing at all. You know, how do you expect him to run? And he wants to be the CEO. How do you expect him to run the company, drive sales, focus on margins?

54:06T.N. Giridhar:and being a finance guy and being in investing and I'm like, for me, everything is bottom line. You do anything, what's the bottom line? For me, it's that profit and that bottom line is so important. It's kind of like, wake me up in the middle of the night and that's what I'm focused on. Like so focused on the bottom line, that's important. You can grow revenues, you can invest in any line of business, in anything. What is the bottom line? That's so important. And I think that's one of the things that has actually helped me in the investing, that you being so steadfastly bottom line driven has actually helped in the investing.

54:45So how do you expect that CEO to focus on that bottom line,

54:51T.N. Giridhar:which is so important for you, when he doesn't understand any of finance at all? So we had to let go of that investment opportunity. Good one otherwise, but had to let go. um there's a few things actually that that that reminds you of to talk about so i just think to

55:07Dr James Somauroo:conclude on that bit the the i think the if if if medicine did have more of a fluidity to it in terms of almost free movement in and out of medicine to go and acquire different skills there's one school of thought which would be you've then got a brain drain everyone leaves But then there's another school of thought where if people can still retain some of their medical work and work on these things outside, then can we build a world where this medical knowledge starts making its way into more businesses, more businesses are started by clinicians, that kind of thing. I've been very much an advocate for that.

55:48Dr James Somauroo:I've had a lot of pushback recently of just the volume of people leaving is really causing a problem. like i'm seeing more and more of it on socials and all the rest of it so yeah i i still have the belief that can i jump in and ask you a question when you say people leaving where are they leaving to do you want the truth anywhere and i don't mean that that sounds a little bit facetious but like people are my i'll talk i'll talk about the people that i know okay so the people that i know are not leaving at will to absolutely anything but they are going okay is this a firm branch that i can hold on to yeah that just buys me some time to then think about the next part of my life and i think people are finding that in fellowships which is an easy kind of one foot in one foot out um and even on this podcast last couple people i've spoken to have said the same thing which is that on their fellowship here they got time and then with that time they realized okay i've got my medical knowledge but i've also got my interests and my passions can i combine the two what job hypothetically would combine the two right i mean that's where comms and marketing for health tech and biotech came from yeah it originally was that i did a fellowship year and thought what are my interests and skills design creativity communicating all these things and so there's a lot of people in that camp that find a way to buy themselves some time and then just try and do the work that figures out where can they combine their skills their passions their the rest of it with their medical knowledge which i think is interesting but some are going to venture capital some are going into startups and i think with that with the health tech world the way it's evolved there's far more jobs for people in startups now different jobs you can work in marketing you can work in clinical products that's an interesting route for clinicians right now because that seems to be a really nice mixture of being able to lean on your strengths and your abilities as a clinician knowing where the product needs to be clinically and you can appraise it based on would i use it how would i use it how would i interact with this that's a very comfortable place for clinicians to be and also we're trained to find problems in things and so actually that's quite a nice one but there's lots that regulatory is another one that people are moving into but the health tech ecosystem is now that it's now an ecosystem of stuff rather than again you know when i left it was you leave to start a company or nothing like you you might be able to join as a chief medical officer maybe but even that has got levels to it now so there's lots of different things that people do but honestly people are leaving to just you know have a tiktok account people are leaving to to change sector completely you get the usual management consultancy stuff where people are going there you know transferable skills somewhat that's always existed i think but there's a lot more routes there's a lot more optionality for people now um but on some levels a lot of people are being pushed out rather than being pulled in by something else and i think that i worry for those people a little bit because i'm not sure how how how much longevity that's got for them in their career um whereas i always advise people if i can to like just try and find something that you're being pulled into not that you're just being pushed out of bad working conditions but again you know any port in a storm right like that's that that seems to be the case for for a lot of people i think that's um you

59:31T.N. Giridhar:know you know what you said about in the in the beginning of surf um you know where you are an advocate for you know sort of diversifying mobility and diversifying the skills i actually quite like that idea i mean i i think that um will be a good thing i don't know what's the sort of uh you know reality of how things work but i think you know if you think about it from a corporate perspective there's an hr department right and and the job the role of that hr department is to ensure motivation of the people, retention of people. Yeah. Right? And retention, so if things are getting, say, boring for them, or if things are getting stressful for them, it's the job of that HR to try and see where they can move them.

1:00:31T.N. Giridhar:So, for example, if someone's just getting too stressed out with, shall I say, the life of London, for example. Yeah. Okay, moves them to, say, Shefid. I'm just throwing a name, right? Some place that's kind of less intense. I'm not sure if NHS has that sort of an HR perspective. And I think part of the problem is that you have all these different trusts, right? You are employed by one trust. Although you call it NHS, it's not one NHS. The problem is that you have like 100 different or multiple trusts. and each trust looks at life very differently. Each trust has a different, the hospitals and the conditions in the hospitals are very different in each of the trusts, in several of the trusts.

1:01:22T.N. Giridhar:And I think if you're lucky, you get into a good trust that you're happy with and you're like, I can't be bothered. I don't want to, because you get to an age where you've got kids going to school, you don't want to disrupt them, move them from you know like in in our sort of line of business uh my son was one year old when i was told you're you're moving from bombay i was in bombay at that time i had just come i had just then not just then maybe about a year ago i had moved from hong kong yeah to to mumbai yeah And then within a year or so, the fund that I was working for, the company I was working for, decided to shut down their Mumbai office.

1:02:12T.N. Giridhar:I didn't want to go back to Hong Kong. And so they gave me an option. They said, which geography do you want to go to? So it was like New York, London or Munich were the options. you know and so through a series of sort of discussions internal and at home discussions we kind of zeroed in on on london so there was that sort of you know you don't see that kind of a thing happening in the nhs it just doesn't happen you're in say the royal free you're in royal free that's it for the rest of your life you're in royal free the only way out of royal free is where you resign, get out. Either you go completely out of the medical field or you go to another place, say, in Africa or South Africa, I mean, or Australia or New Zealand.

1:03:05T.N. Giridhar:You know, these are places that are kind of quite often talked about as sort of greener pastures for the doctors. They're doing the same thing. They are still a doctor. They're just getting paid more. Maybe they have a better quality of life. I don't know. That's what they say. But that's what doctors are going out for. You don't see a situation where doctors have like a secondment into, say, a digital health NHS or some, you know, I mean, imagine if you had an NHS incubator, right? If you had an NHS accelerator or an incubator where, you know, people come in, bring in their ideas. NHS is funding those.

1:03:47T.N. Giridhar:And so you run that one for some time and then they get bored with that. Or, you know, this is one thing I have seen. The skill set that you need for a company to take a company from, say, a zero, from a concept stage into its minimum viable product stage to a first million dollar sale, to scale it up to 10 million and then to 100 million and then to go from 100, each of these is a different skill set. You can't, in general, I mean, I know Mark Zuckerberg is sitting there at the top for whatever reason, but you don't generally have a lot of people who will be able to take a company through those different phases.

1:04:30T.N. Giridhar:So you could have potentially NHS rolling out this kind of an incubator scheme or an accelerator scheme where they say to people, anyone who's got these entrepreneurial ideas bring in your ideas you know like you have these in in universities and then you let someone else externally come in and commercialize that idea and i think then venture studio type model exactly it's like you know it's like it is literally an accelerator where your the nhs hospitals become your initial sort of testing ground or the trial fields and and then you commercialize it so nhs benefits from that the doctor benefits from that and the commercial the people benefit from that so it can potentially be a win-win situation it can the challenge though

1:05:21Dr James Somauroo:i mean i ran something very similar to that for a little while um it becomes the problem that you mentioned before there's no single nhs there's no one door yeah there's no one sale and the different information governance rules and the regulatory stuff and the this and the evidence requirement at this place versus this place is different and because that place has got it well that place doesn't actually want to have it because they like to be different to that place and there's all of that that starts coming in because it's it's just so it's it's that fragmentation and that lack of kind of ability to go but the question is does it need to be that

1:06:02T.N. Giridhar:fragmented that's a great and that's a great question yeah if if you are having end of the day everyone is pretty much being funded by the government right i mean some are self-sufficient yeah either largely self-sufficient or or completely self-sufficient or partly self-sufficient you know there's there's a gap funding that everyone pretty much keeps taking from time to time But I don't know if there is a need for the government to rethink the whole NHS structure.

1:06:36Dr James Somauroo:Oh, they do every couple of years.

1:06:38T.N. Giridhar:Yeah, but I think look at the number of the integrated care boards that you have in London. There's like six or five or six of those. Do you really need so many of those? Yes, I understand the demographics are different. in each one. But, you know, from a management perspective, do you really need to have all of that way? You know? I don't know. I mean, I think that is something that does require a little bit of thought. I mean, I don't know if your podcast is going out to those people, the policymakers. I'm sure some. But it'll be interesting to kind of rethink this whole NHS structure. Approach doctors as, you know, like, in Goldman, they used to say, and this is true for every investment bank, my assets are walking out of the door every day.

1:07:33T.N. Giridhar:You don't know if that guy is going to come back. You never know he's going to resign someday and he or she is going to resign and say, that's it, I'm not coming back. So they kind of look at you as an asset and say, how do we make sure you're retained? yeah you know that i don't know if is there in the nhs it's so funny because i say this i've

1:07:57Dr James Somauroo:said this a lot i remember saying yeah since years ago but there is no business model for improving staff morale there's no business model for staff retention so it seems so any kind of idea that someone has that says hey why don't we bring this thing in because it saves me a couple of hours a day well any cfo is going to go well that's not a cash in hand saving that's just time you're going to spend doing something else i've still got to pay your salary so that's not a saving at all so no thank you and and this is the thing there's no there's no mechanism by which staff can vote with their feet at goldman someone can move and go jp morgan or go somewhere else that doesn't exist and so because people can't vote with their feet there's no incentive for any one site it's like you said someone's at the rule free they're all free it's actually worse than that by the way you're actually just picked out of a hat now if you're junior doctor as to

1:08:53T.N. Giridhar:where you go so see so it's even worse you know you know you talked about my son being a doctor right i mean i have seen that process it's right it's computer generated random allocation by computer it's not even you know you don't get to pick yes it's it's and can you see then there's

1:09:10Dr James Somauroo:no business so there's no business model there's no incentive i say business well there's no incentive for one site to treat their staff any better than another because the staff can't move to the place where they're treated better they can't choose that and they don't even know

1:09:26T.N. Giridhar:where they're treated better they don't know what is being treated better that's also correct and that's actually do you have a do you have a performance appraisal for a doctor at the end of the year that says yes or you have been mine have always been incredibly hostile to your patients oh you have been so harsh to your patients how is there a feedback system it's called ARCP

1:09:49Dr James Somauroo:and it's a it's more I'll talk about the ones that I've been through they're very tick box in nature so you might have in your folder you might have some uh you might have some feedback letters from patients that have said you were nice to them but someone will just look at it yeah okay tick

1:10:05T.N. Giridhar:it's it's not it's not how many patients care to give you feedback yeah I mean again there's different kinds of conditions, right? I mean, you get someone who is in a typical tertiary care hospital. You know, you get the really difficult cases. Like, I have been horribly disappointed with my GP. Yeah. Right? And I think there's like a million people in the UK who are disappointed with their GPs. What do you do? What feedback do I give? I mean, does it even matter to that GP? I mean, he doesn't care. I'm stuck with him. He's not stuck with me in a sense. He's making money off me. But that's the way the system is.

1:10:51T.N. Giridhar:I'm not mobile. I can't just go somewhere else. I can't go see a GP somewhere else.

1:10:57Dr James Somauroo:And that's why I do think that if you were going to change policy in order to enact greater change, and I think that actually flows down into health tech and the way we bring digital health in and all this sort of stuff. i i just think if people had more choice as to where they could get their care it would start to show these different things and it's the same for staff if they could choose in some way where they received their employment again it starts to show these things up i even wondered if there was you know do you have some do you have like a staff survey and then financially incentivize the people that perform that the sites that perform incredibly well yeah is there something this is just something that we can do that means that a focus turns to actually rewarding people because if we if we create these incentives then maybe it just gives some momentum but yeah unfortunately unfortunately still hasn't happened so yeah coming back i mean i think how

1:11:58T.N. Giridhar:does all of this translate into sort of shall i say investing and creating that sort of entrepreneurial thing. I mean, I think there is a lot of opportunity within the NHS to create more health tech or healthcare related entrepreneurial ventures and ideas. There's, you know, the doctors are brilliant people. I mean, you know, everyone there, obviously they're high IQ. That is exactly why they have in the first place become doctors, right how do you nurture that iq and keep it sort of high and help them to sort of break the monotony it's not just the monotony it's also the stress that goes with it i mean you know in a day in and day imagine if you are a psychiatrist for example you are listening to stories day in and day out every single day that's all you're doing for all your life it can get to you at some point.

1:12:59T.N. Giridhar:How do you break that monotony? Give them something else they can do. I mean, help them to create. You could partner with a university. So say NHS sends a psychiatrist to go to, say, an Oxford university and develop a product that is good for the patients. yeah you know maybe that that the doctor will then realize that yeah he's more cut out because people have a lot of people have people skills yeah yeah yeah it's just that it's not nurtured

1:13:33Dr James Somauroo:it's not uh yeah i do you know i what i think is fascinating in this chat that we've had over this hour or however long we're talking is that we've central to the way that you see value creation

1:13:48T.N. Giridhar:is people absolutely there's nothing else that we've talked about you could have mentioned

1:13:52Dr James Somauroo:any one of a hundred different problems that the healthcare system has but you've you picked the way it treats its staff and the way therefore that patients are treated like the it's the treatment of people you see is the big that's the big ship and how you turn the wheel to turn towards something important you see that as it's all to do with people for you absolutely

1:14:17T.N. Giridhar:Even in the investing as well, like I said to you, you write a business plan based on your sort of best, shall I say, assumptions or your view of the world at that point in time. Things change. You know, nothing ever remains. I mean, imagine we invested just a little before COVID. I mean, I'll give you an example. We invested in a company that was into IoT, Internet of Things, and was relating to the -

1:14:47Dr James Somauroo:That's a throwback of a phrase.

1:14:50T.N. Giridhar:Right? Yeah. And that was dealing with or they had developed a product that was specific to the aviation industry. Yeah. In like about a year or less than a year, yeah, about a year after COVID hit. Yeah. I mean, nobody was going anywhere. There was no aviation sector. It was pretty much dead. What do you do? They had to pivot into something else. You know, that's just classic example of how when you invest in people, when you invest in a company, you're not investing in just the company. You're not just investing in the idea. You're investing in the people. And I think that is something that I have, that's been my mantra.

1:15:35T.N. Giridhar:So for me, that management team is most important. The quality of that management team is very important. Do they have the ability to pivot if needed? Do they have the ability to kind of tighten their belts if needed? Do they have the ability to kind of see beyond what is? So, you know, you start with a certain problem statement. Halfway down the road, for example, you could realize that it's not as big a problem or someone else is coming. You don't know what's happening in the rest of the world because there's so many of these products that are easily transferable across geographies, right? I mean, Trump or no Trump, whether you have tariff barriers or no tariff barriers, things are transferable.

1:16:22T.N. Giridhar:So you can actually bring in a new product that you did not foresee. And so you may have to change your sort of direction. you have to address a slightly different problem or you know it's not in the same way so you should have the ability to do that and i think that is why the management team is so important and then of course there are other things you know that that become important from an i think that's a

1:16:51Dr James Somauroo:really nice thread to end on i've got a few quick questions to ask you but just to summarize i just I hadn't appreciated that even at the level of investing that you've that you've done as you said you've done the five million you've done the 50 you've done the 500 you've done and and the the one billion and and above you've you've done it all I hadn't quite appreciated how important people and relationships are along that whole journey I always whenever I've spoken with people about later stage investing and even later stage even series b can feel late stage when you're talking seed but c d e you know all the rest of it um people talk about you know the metrics become more important the financial data becomes more important and all of that relates to what you said is a very small part of it that's the investment decision and then actually there's the very human elements of running a company making decisions that influence the entire direction of the company that's all people that's all relationships your ability to influence the company at board level your ability to convince the founder something's a good or a bad idea your ability to counsel them your ability to hold that relationship with them so that they trust you all of this stuff is just people and relationships and all of that is what contributes to a successful investment and exit and hopefully liquidity event for everyone involved and so I think that's what i've learned i guess that a good investor it's like we talked about goldman's i thought that was fascinating that at goldman's they teach this or they teach this of you in in you know the way that you do things the way you present yourself or introduce yourself all of this is creating the relationship and they're going to make the decision on the relationship because you know money's money i've definitely learned that from you i think that's that's fantastic so thank you

1:18:46T.N. Giridhar:for that and don't get me wrong i mean it's not like metrics are not important absolutely metrics are obviously important. But it's the people who are driving those metrics. And more importantly, metrics are always historic. You get the metrics as a validation of a strategy you have had. There are no metrics for the future. That's an assumption. And that's where you're relying on the ability of that person you know it's almost like in the olden days right someone looks up and says hey there's traffic jam down there okay so you're kind of assuming that that guy has got a clear eyesight and he's able to see he's able to differentiate between you know and the next road and this one that you are on so it's i mean you know i'm kind of sort of civilizing some of the but but it is it is important no question about it the metrics are important but i think more important is the drivers behind the metrics some quick questions to finish uh one piece of advice

1:19:55Dr James Somauroo:for a first-time founder raising right now or let's say series a i you know i think one thing

1:20:02T.N. Giridhar:i would definitely always say to people um raise more money than you need um maybe not double though Not double, but definitely, you know, and this is a very important thing in terms of in a balance between diluting yourself too much versus having enough runway, kind of creating enough runway. You know, you have to assume that, you know, fundraising takes time. You know, it could take three months, it could take six months. There are times when it takes a year. Do you have that runway? You don't want to get desperate. And the thing about investing and the thing about money that I have seen, whether it's an equity investor, and I have done both equity and debt, right?

1:20:50T.N. Giridhar:Everybody wants to give you money when you don't need the money. Nobody wants to give you money when you are desperate for money.

1:20:57Dr James Somauroo:It's going to cost you more in that moment as well.

1:21:00T.N. Giridhar:So that is something that founders should always remember. Never leave it to the last minute. That's number one advice. Number two, I would say definitely go with an advisor, someone who knows the thing. And there's two very good reasons why. Because their view of the world is, of course, different from whatever is your view. You know, you work together in tandem as a team. Definitely, that is true. But you don't want to be spending all your time in doing that fundraising. You don't want to be. You have 20 conversations. 10 will say we are very interested, sign an NDA, take the book or something.

1:21:43T.N. Giridhar:Ultimately, three will do a diligence and, you know, hopefully one will invest. But you have spent your time talking to 20 people. Yeah. You would rather be focusing, spending the time on building your business. And because, you know, businesses at that stage are, you know, thin staffed. You need every hand on the deck. You can't afford to have someone and your CEO is usually the most important person. You can't have your CEO focusing on a fundraise to the exclusion of running the business. So I would say definitely get an advisor. So I think those would definitely be my two very important pieces.

1:22:25T.N. Giridhar:And third, execution is most important. Absolutely. There's no question about it. execute the plan that you have.

1:22:34Dr James Somauroo:One question every founder should ask an investor before taking their money.

1:22:41T.N. Giridhar:Why are you investing? And it's funny, it's such a simple, cliched question, but why am I interesting to you? Why do you want to invest in my company? you could potentially invest in literally a hundred other companies why are you interested in my company and that is one question that can give you so many different answers and and i say this because i have been an advisor i have helped companies to raise money and i have actually been an investor and you know when i was an advisor and and and when the companies asked this question And I actually told my companies to ask this question to the investor.

1:23:30T.N. Giridhar:We've, you know, there was, I mean, this is a large transaction we were doing almost, it was close to a 400, almost 500 million transaction. And this company asked this question, why are you investing? Why would you like to invest in my company? And this is towards the closing stages. You know, we've kind of opened the data room to these people and it's kind of, but it was still non-exclusive at that stage. And then, so we had, we were having this conversation and it was an informal setting. We were sitting in a hotel, in a restaurant, having drinks and then drinks dinner thing. So it was a very informal, it was not a boardroom kind of thing setting at all.

1:24:18T.N. Giridhar:So we asked this, the guy asked this question. And the answer, something that the investor said in that answer, it just kind of ticked him off. And, you know, he just thought, he's not the right guy for me. Wow. You know, and it was actually a good thing that he did not take the money from that guy. So, you know, I can't tell you much more about that. But, you know, it's definitely asked that question. Why am I interesting to you?

1:24:53Dr James Somauroo:What's one thing you tell founders to stop doing in their investor updates? What does a good investor update look like to you?

1:25:01T.N. Giridhar:Don't just focus on metrics for me. Do not just keep giving me the metrics. And one thing I, sorry, I did not tell you. one thing I always tell the the investee companies is you can delay the good news never delay the bad news never delay I don't want those surprises absolutely oh dear my final

1:25:31Dr James Somauroo:question I think with everything that you've seen and and all the companies that you've invested in the boards that you've sat on you've seen a lot of decision making and in the startup world there's a lot of decision making with uncertainty what advice would you give people listening that have to make so many decisions in so much uncertainty um i think that's a very good question

1:26:02T.N. Giridhar:always think a little ahead um you know it's good to have like a five-year view or two three-year view at least based on that make your decisions you're a startup you're a young company you may be struggling for survival you don't know if you'll be around in six months time never stop

1:26:24Dr James Somauroo:thinking about two years and three years or longer because a lot of times you will see that the

1:26:30T.N. Giridhar:decisions you make will be different if you were thinking about it from a five-year perspective versus if you were thinking only six months perspective. So make those decisions based on a slightly longer term basis. But of course, don't be sort of ignorant or don't be overlooking the short-term problem. So you kind of have to balance, be looking at the short term, address the short term, but think from a long term. Because if you don't handle the short term, there is no long term. But at the same time, if you are only thinking short term, there is no long term. So it's kind of both. You have to balance the two.

1:27:14Dr James Somauroo:I'm going to take that to heart because we've made this mistake before, taking on bad revenue in the short term to solve a problem, and then it obstructs, really obstructs the long term. um good it's been a pleasure thank you so much the the wisdom that you brought us today in investing has been absolutely superb um if people want to find out more about ssg capital they want to have a look um you invest in among other things health care clean tech green tech lots of different things um what's the best way for them to find out more i'd say we are largely sector agnostic

1:27:52T.N. Giridhar:but I like to see some sort of innovation, innovative element in everything that is done. Just look me up on LinkedIn or our website we have. You know how to reach me. Perfect.

1:28:09Dr James Somauroo:Best thing is they can contact you. And they can contact me and I'll put you in touch. Girola, thank you. It's been a pleasure. It's been a pleasure.

1:28:16T.N. Giridhar:Thank you so much.

1:28:17Dr James Somauroo: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.