#450 : What it takes to get a "yes" inside the NHS

0:02And when we looked at the feed, I talked round about 14 ,500 students across the world in real time. I never thought a family would be watching a live stream of their own dad's operation. That kind of blew my mind. People talk about the NHS being very difficult to innovate. You're challenging that narrative quite clearly because the NHS is made up of people and there are innovative people and innovative people find a way. If you don't, nothing will happen. will sit in mediocrity and there'll be no innovation or lack of innovation, which is what happens in the NHS. So if you blame the lack of innovation, if you offend people around it, do you have the right leadership?

0:44Hey everybody, delighted to be joined this week by a man who really needs no introduction on the Health Tech Podcast, Shafi Ahmed. How are you doing, Shafi? I'm good, James, and we finally get to meet on your podcast. We finally get to meet on the podcast. it is an absolute crime on my behalf that you've not been on this podcast before and actually i'm going to tell you a bit of a story first because um i think it was i think it was 2016 or 2015 even that i was a something called the wearable tech show in uh london i think it was in the excel it was and i was walking around the wearable tech show with my friend andrew andrew birch who was doing at the time an mres in at imperial for medical devices and he's an anesthetist too and so one thing that we connected on was technology and he said oh do you want to come to the wearable tech show so came down and we were going around and he was telling me all the stuff he was learning on the mres and and we bumped into you and i can remember at the time i was i think i was at digitalhealth.london or just about to go to it or it was that sort of time in my life where I was sort of on the cusp of medicine versus health tech and Andrew was saying to me oh we definitely need to go and speak to Shafi you definitely need to get on the radar of Shafi he's like he's all over this like health tech stuff he does all this VR surgery stuff I love it I've been in theatre with him once it was like amazing he was such a good teacher you could hear him teaching the other the other junior doctors like all this sort of stuff and we came and chatted to you and you were so unbelievably nice to me and you were so unbelievably supportive to me and it was just one of those moments on the way towards health tech for my career that I can point to as being like it was another it was another door opened it was another green light it was another ah here's someone that's making a career out of it this is possible for me and so I can say that in uh in a not so small way uh you inspired me into the career I have now so I have to thank you for that first of all because I don't think I've had the pleasure of telling that story before thank you i haven't heard that i remember the wearable tech show uh very distinctly is that the exit yeah yeah so thank you for that it's really kind you're very welcome you're very welcome um so it's gonna be really interesting for for the listeners to hear your story in full because i'm sure everyone knows who you are i'm sure everyone has heard of you and some of your work across uh particularly the vr surgery stuff well in my back in my day in inverted commas that was the that was the stuff that really kind of had you on the map um but you do loads you sit on loads of boards you do lots across the health tech space still practice clinically i believe as well um and so learning how you keep and maintain that and build a career around remaining clinical and I don't know everything that you've managed to achieve in your career sort of before it was cool I can remember when it was called healthcare IT and I'm sure you can as well and I'm so intrigued to hear the full story Shafi so starting from the beginning where does this all start for you yeah it's a long story I haven't shared it that widely for a long time and actually it's one of the things I'll be doing the next few years is writing my autobiography it's part of amazing So I have been thinking about that for a while with my book agents saying how going forward.

4:19So it is a story that I want to tell at some stage because I think it's a good story. And it's interesting for a lot of people to hear about. So if you talk about my kind of what I do, first of all, so I'm a clinician, first and foremost. I'm a surgeon. I went through the traditional pathway and journey to become a consultant surgeon. I specialize in colorectal disease. I'm a GI surgeon and I've been a consultant now for almost 20 years. It's a long time, but I've been a doctor for 32 years. So I've been working in healthcare through various iterations in the NHS for over three decades. So I still consider myself first and foremost a clinician, having been through the hardcore academic route, you know through your basic training we used to call it basic it's called core training now then doing high surgical training all in London doing a PhD in London and in the east coast of America around Princeton and then to being a consultant and become an academic so this was a traditional hardcore surgical journey that I took you know the endless hours of work to improve our craft etc the hundreds of hours per week we were working there was no working time directive then was there no i'm people were shocked the bit longer shift i ever did was 120 hours in a week wow and that was really what yeah that was one long week um i still remember that where you're aiming on a friday morning and you're on call friday friday night saturday saturday night sunday sunday sunday monday finished at six or seven o 'clock uh and because it was a bonus right those were the old days uh thankfully they're long past behind us but people they see my journey they forget that part of my life they see the tech side innovation not the fact that i spent 30 years as a doctor and um korean surgery not the easiest so i was a cancer specialist i I became a co-doctor cancer specialist for a long period of my life.

6:29I had many leadership positions in the NHS. I sat on the RCS council as an elected member for five years. I was associate in the medical school at Barts for 10 years. I ran education programs. I sat on national assemblies for the NHS. So what I found was I squeezed a lot in in a short period of time. I think that's why I pivoted later on in my career, having had a full career in surgery. which I didn't compromise on so I'm glad that I had a full career and a very um satisfactory career that I've really enjoyed and I'll do it all over again of course give me a chance and so I love being a clinician still and I keep that practice now I work three days a month two clinics a month four day clinics at the Royal London Hospital and one theatre list a month and That's just a case.

7:25I gave up the major cancer surgery. And I pivoted around about 10 to 15 years ago when my life suddenly changed direction. And I guess I would call it a punctuation. In fact, because I use that word, it's because I use it in my book. And I talk about the punctuation of everything as a concept of how AI is going to change our world. So that's why I use that particular term and we can discuss it later. So I pivoted. I saw the future. I saw where we were heading towards medicine. I really enjoyed that part of medicine where we could almost predict that future and then be positioned to help create it and be part of that journey.

8:08So that's what happened about 15 years ago or so. And that changed my mindset entirely about what was possible. 15 years ago so what what are we talking 2011 that's right there so i think what i was always into innovation i was a kind of innovation thought leader in the world of surgery doing new operations trying to do new ideas and so interesting so i was always thinking about new ways of working for example i brought in keyhole surgery to royal london for cancer work and we built the whole laparoscopic surgical practice from scratch at the royal london which was quite late uh in its kind of journey into laparoscopy then i used to do what's called single incision surgery we took the multi-port surgery into single port through the belly button i did surgery through just one hole tiny hole through um the belly button taking out the whole colonel for example.

9:08That was called single incision laparoscopy surgery, which I kind of was one of the pioneers, I guess. With that, obviously, I went to a lot of these centers with Johnson & Johnson, Medtronic, and Comedian and companies to see how they're building their products and helping design some of the products for surgical practice. I was always thought to be innovative in surgery. And I guess that's where my passion came from. Surgeons generally are innovative and we're best of my nature generally. And that builds that kind of that creativity in what we do. Have experienced that. My first foray into real innovation and disruption was the whole goo glass thing that you might recall, right?

9:48I remember it well, incredibly well. And that kind of changed my trajectory entirely. So in 2014, if the audience don't know about this, let's share that story. I got a pair of goo glasses. and I streamed an operation live across the world using this smart technology. But let's go back a second about, I'll share the story with you in much more detail. So what happened was I was teaching in the medical schools, I was Associate Dean, I had a lot of medical students around me, I was a passionate educator. One thing that troubled me in the surgical theatre, which you will know, James, from your experience in anaesthetics in theatre, is the way that we teach in the operating theatre.

10:32and if you can imagine you sometimes have three four five six seven medical students in the room they come along for the entire day for theater expecting some kind of learning experience at the best part they're ignored they may scrub if they're lucky they may even assist if they're very fortunate but most will be the back of the room being ignored for the entire day. I used to look at them thinking, how is that learning? We expect students to come along with their goodwill and they want to experience surgical practice. They spend eight, ten hours a day largely being ignored in the operating theatre.

11:12One or two may get asked a question or may even get scrubbed up if they're lucky. The experience has been poor. We've accepted that for a long time for decades this is the way we teach surgery surgery sadly is built on dogma and tradition it's what we it's how we do this we don't want to change things because it's comfortable so i was looking new ways of teaching constantly for the surgical curriculum that i ran i was head of surgery for year three and four and five as well as been associate dean i signed a bigger responsibility. How do I teach people better to engage them to ensure they get good quality?

11:52So I was thinking about telesurgery, telemedicine as a concept. And the Google Glass came along. And the Google Glass obviously was a device that sat on your forehead, had a camera, you could see the display, it could be cool, it could take pictures. i remember when he came out when he came out it was 2014 and his amazing kind of marketing campaign globally so incredibly presented as this new wearable device in reality it was 10 15 years ahead of his time he probably still when he came out i remember you could apply to be an explorer with Google Glass. They opened up this portal on the Google saying, tell us why you want to use the Google Glass, the use cases, and if you're lucky, we'll allocate you a glass to be able to use it as per your description.

12:50Only open to the US, and they selected 5 ,200 people who were going to be the first explorers. Obviously, I'm not from the US, couldn't do it. Anyway, I said to myself, I'll bring these pair of glasses. So my FY1 called Sam, and he remembers the story really well. He joined on the firm around September of that year. And I said to him, Sam, you've got one job. He said, what's the job? Your job is get hold of Google Glass for me. I will sign you off for your four months attachment for surgery. But you have one job. And so he took them seriously. Every day he'd phone Google. He'd email them. He'd write to them.

13:30He'd try to find out the right way to get hold of them. In the end, he told me they've blocked me. Because I've been troubling them so much, they've just blocked all my phone numbers. And he felt really apologetic. But, you know, I thought he was great. He did a really good job. And Sam now is a plastic surgeon consultant, actually. So I see him. So then I saw, this is the funny story. So shortly after it was released, I was on eBay of all places. And there's Google Glass for sale in the UK, in London. And this was a Friday evening. I was literally bored on my phone looking at a few things. So I text the person on eBay.

14:08He said, yes, I have it available. I kind of, I'm in the UK. I live in London, blah, blah. I said, I'd love to get it. So he said, fine. Sunday morning, I met this gentleman at a coffee shop in central London, near his house. I had a long chat with him. We sat down, had a coffee. He was an investor from Silicon Valley Bank from the US. Interesting. In pair of glasses. He couldn't find any utility. You know what? I'll just give them away. We had a long chat. I said, no, I want to use it for training. I want to think about how we use it for telemedicine. He said, that sounds a great idea. Let's share that with me.

14:50And I'll share it with Google. It sounds like a good use case. So I took it off him on the Sunday morning. And during the Sunday, I was playing around with it, etc. Walked around the streets with it, walked around the trains and whatever. People were staring at me the whole time, right? Because I had this thing I was talking to. I was messing around with it. His first one in the UK, by the way. Wow. On Monday that week, I then was in my clinic. I called my two medical students. who are really good friends of mine, really good students, both very techie, Oli and Ali. I said, come to my clinic, I've got a pair of good glasses.

15:26They were super, they ran. I think they just missed all their lessons. They came and played around in my clinic. I said, look, what I want to do with this is see if I can do some training with it, do some live training. Can you see if you can figure it out for me? I gave it to them. They spent the next 24 hours working on this. Tuesday they came back and said, I think we've got it to work. we persuaded a company called live stream to release their software to us before anybody else because they like what we're trying to do with it so we had the first app on the first apps on google releasing just for us on within 24 and so we tested it tuesday the wi-fi it seemed to work you could stream it and live and send it out on their live stream platform so when jessa let's go to the operating theater went to the operating theater on thirt or wednesday to an open theater which was there's no operations going on, but I was going to check whether the Wi-Fi could work, could I do it, what's the experience like, just understanding it.

16:22And it was all perfect. It was working nicely. I could scream it. We could watch it on the cameras and on the computer, the laptops. I thought maybe we could do live operation with this. So I said, okay, I've got a patient tomorrow on my list who needs a right hemicolectomy. It would be great if we could do live operation and just train my medical students. I hadn't thought about bigger scale at that stage. So I phoned him up, and Mr. Porphy was the name. I said, look, this is what we're doing tomorrow. I just want to see if I can teach people on a wider scale with your consent. Obviously, we'll take every precaution, blah, blah.

16:58And, yeah, my patients are so supportive of me and my work. They have been all the time. So, of course, it's for you. Of course, we'll do that for you. It'll train people for the future. You have my consent. Absolutely. I spoke about the risks. and the benefits of that, and how I'd take caution and precaution around that. Then we thought we'd better tell the hospital. So I found out the medical director, said, this is what we're going to do tomorrow. Is that okay? I'd better talk you through it. They were shocked, first of all. I was going to say, I wonder what that initial reaction was. But what was really surprising, I said, no, Shafi, we love your innovations.

17:35Let's see how we can make it work for you. It wasn't a note. There's so much bureaucracy in this meeting. I will see how I can make it work for you. within a few hours you've got all the team together the ethical team the legal team everybody's saying how to make this work for shafi what are the pros what are the risks here within a few hours they figured out so we've got to do for our perspective is put a delay of 30 seconds to a minute so if something goes wrong you just stop your and carry on so that was the only precaution they had and of course i don't consent etc etc then um the somehow the the major tv companies heard about this and we were inundated with sky itv bbc al jazeera all saying can we be a part of this we heard about this right in the end we selected itn news at 10 they said we'll send the team down blah blah so that so on the day of surgery which was thursday only three days since i had the glasses in my hand we were then going live which is the right hemicolectomy cancer surgery to a global audience and we did the operation went really well i was teaching people in real time and when we looked at the feed we i taught around about 14 and a half thousand students across the world in real time um and they were what they could do of course on the app was they could type a question onto the app which would come on my glasses as i was doing the operation i remember this yes i could read the question and then respond to that person who's asking the question with and answer questions real time so it was a live interactive operation at first of its kind to a global audience 14 and a half thousand students in 118 countries joined that live feed of course itn covered the story is the main headline news 19 is at 10 that evening and that was the transition because it worked it seemed to be a good way of teaching people it was using google arts which was an entity that had a lot of controversy around it but it's a good use case so that was my first real attempt to scale education using that smart technology and that's what kind of put me on the map initially as someone who's a disruptive innovator because we merely want to say how can i teach better how can i improve what we do already do i have the technology available and that's when it came through that glass gave me the utility uh to be able to educate people on a global level and i've always i've always found one of the my passions and my kind of mantras is this um one to many we teach one for one and that's great it's good approach to teaching we can teach one to two one to three one to a few people in the audience one to a few people remember on a kind of perhaps a teaching session this was before covid where before there was telemedicine before there was this dissemination of remoteness i said the future is going to be remote it's going to be virtual and we'll be doing that for long term that's why they call me the virtual surgeon so this was six years before telemedicine or tele training or of surgery became real entity because of COVID.

20:52And so people thought I was a maverick, some people. People thought I was pushing the boundaries too quickly. And whenever you do these things, there's always consensus that this is dangerous, what are you doing? Are we not ready for this kind of thing? At the same time, they always say, this is great. This is what we should be doing in the future. So you have to manage that as a clinician, a senior clinician. You know, you have to be very careful and mindful of the criticisms, the critique that people give. and I was very mindful of that to ensure that what we were doing was safe for the patient.

21:20Forget the kind of value it might bring, it's my first question always, is it safe for the patient? Am I being unsafe? If I'm being unsafe, then that's unforgivable and that's something I couldn't do. And with my boundaries, if I think I'm being safe and not causing a risk, then I'm comfortable personally and I can justify what I do. so there's always been a a delicate balance to make sure that we can i just ask you about that shafi just sorry to interrupt i i i think that's it's an interesting part i think of being a true innovator and breaking new ground in healthcare in that it's a complex system it's a rigid ossified system and any attempt to bring something so new and not very well understood into it something so modern as at the time google glass vr remote teaching of a live surgery that there's there's so much fear i think in an ossified system like the nhs that so many things are going to break that understandably, yes, you'll have faced a lot of criticism.

22:39Now, I think this is important just to double click on a little bit. You got me in a tech mindset now, so I'm saying things like double click. But can I ask you how you dealt with that? Because I think as a practicing at the time, you know nhs consultant you've like we we we're we're trained to be very empathic right so we're very receptive to criticism and as medics we don't like it we're very high achievers that straight a's captain of sports teams we're you know we're always teachers pets if anything and so to face a load of criticism from the very people that you are actually trying to help and push forwards into a new world that you believe in you can end up being criticized by people that you actually respect quite dearly as well like fellow peers and fellow innovators even in different ways and so i wonder for people and the reason i think this is important right is because i think there is plenty there is so much innovation locked up in people's minds that have got plenty of healthcare experience consultants registrars etc whoever but there's a fear of if i try and do this thing i'm gonna face criticism so how how did you how did you deal with that how did you expect it did you plan for it and yeah did it hurt you did you like how do you push forwards in the face of all of that but yeah that's a very good question and i guess yes you face a lot of critique and criticism after these things because people want to bring you down right there's a lot of people that just want to see you as well it's part of medicine there's a professional jealousy that you might get yes that's slightly different you can kind of ignore that because that's just uh being fun to compete what i've always been mindful of is um if you look at the response i got on social media uh through all the channels fit at the time and everything else we had so much response about this procedure as you can imagine and 99.9 so it's amazing fantastic it's kind of wow you do this incredible stuff and that's great um and that's very supportive but the bit i was more concerned with is what are the criticisms what could i have done better that's anything i was interested in and i looked at those in much more detail i looked at those who are complaining about something or saying this is an issue, that's what I needed to be learning from.

25:10So I took those on board. It was okay, okay. Some of these are quite generally sensible and about, you know, if something goes wrong, what do you do? And do you get in your comfort zone? Are you doing it for yourself rather than the kind of bigger picture of education, for example, really pertinent questions. among one person who was really useful he was called online as the if i can get the skeptical surgeon or skeptical scalpel i can't remember what his name was but he's great handle by the way the skeptical scalpel that's amazing he reached out to me via email saying shafi uh this is who i am he's a surgeon um and he said i've looked what your operation in great detail and i these are the things i've commented on i'd love to get your feedback on it i'd love to talk to you about it i didn't see the email first i ignored i got busy he went to me again shakha we will talk to you about this so i engaged i said tell me what i'd love to get your thoughts and he gave such good insights saying this is what i thought shakha this is what you could have done this is what you need to be doing but in a very supportive manner so i'm being skeptical for a reason to support innovation so i remember him really well and a great conversation initially he just thought i wouldn't entertain this conversation he's really pleased i reached out to him and said this is important to me to know how i've done what i could have done better what i could learn from and how do we take this further forward so my view is always take those criticisms on board and learn from them.

26:43People generally want to help support you. They also have reasons to get in touch with you about how they feel things could be improved. That's the essence of it all. And that one learning for me then led me to do all the other innovations, which we'll talk about in a moment, to make that better to learn from those. Because that was the first experience anyone in the world had done this before, right? So you're not sure about where you stand from the legal framework, from the patient's perspective, from the family's perspective, which are - The Royal College, maybe? The college were, so my boss at the time, Sir Norman Williams, he became the president of the RCS.

27:23He himself was very innovative. When he appointed me at Royal London, he was known to be an innovative surgeon. New operations, new techniques. His whole life was littered with innovation. And that's where he appointed me. He loved what we do together. He said, Shaffi, you have my support. When you come here, innovate. I want you to do that. I'll support you. So I had his support entirely. the college of surgeons sadly couldn't reflect that uh as as boldly because it's too limited for a lot of people it's too disruptive and the college itself as you know is rather unfashioned at the time needed some modernizing we're kind of stuck in the old ways of thinking so that was always in contention with the own college yeah was going to be um not as supportive as they might have been but with good reasons so if we take that experience which was incredible a year two years later in 2016 it was I think it was I decided to go one step further I thought tenant medicine is about being remote you're here as someone is in the middle of some other country and you're communicating in real time what if I brought the audience into my theater rather than being separate, how do we bring the VR?

28:36This was the world's first VR surgery, the next step on this evolution. So again, we managed to do, I was building VR tools at the time, and we said, okay, what if we put a camera, a 360 camera in the OR, and everyone in their headsets or the VR headsets could then just beam into the operating theater and be around me almost, right? That was a really big undertaking. So again, we did this, and this was a really crazy story, right? We created this whole concept, created the platform with some colleagues working in another company who produced the cameras. And there was no real cameras. We had to literally design and 3D print a carousel that could house six GoPro cameras.

29:21We had to create it. And then clip them all at the same time. So they would take the videos and we could then capture that and then make it to a single feed that was 360. Before it had been done before. Now you can do a camera, it's really easy. It hadn't been done before. So some colleagues that had another company, they built this housing, the camera systems, they came on board. We then went live in March. Again, a similar operation in virtual reality. This story was incredible, which I will share when I write my book on this. The hospital worked all over it because I've done it before. They were very supportive.

30:00They were through the same process of governance, ethical, legal issues, and everyone was happy with it. This time we had Sky News, who really wanted to be part of this conversation, and they came into theatre. About two months ago at Sky News a second. So we had cameras everywhere, already set. the trust actually gave me a small fund to buy i think it was like about a thousand headsets google hardboard for the entire trust nice and we're giving them away so everyone in the part of it pharmacist care you know nurses doctors everyone was walking around with these um virtual reality headsets um google cardboards so we've got those built and then we have medical students in the theatre next door at the Bart's Medical School.

30:49They were the house and big lecture theatre already watching the stream and having their headsets in real time. And Sky News were there in both audiences, in my theatre and with the medical students for the first time ever. We went live, VR, streamed live globally. And that day, so the first number I'll tell you about is that it was streamed to, how many it was? Yeah, it was 55 ,000 people in 160 countries around the world in real time, okay? That's when people were visibly on the app watching the operation in real time with me. I was answering questions, interactive sessions, et cetera. Sky News, even crazier, were in the lecture theatre and in theatre and it's during the afternoon of that day i was operating what's two three hours operating okay they would on sky news live on sky news tv they go in and out the operation during the news channel we go back to live theater what's going on what's happening back to main news and then back to the or and the medical students it was like a real afternoon show live on sky news tv it was really incredible they love experience they shared it widely and then that went global and the story that i came across uh a while ago i said my son only a few days ago had the story i was famous in china before i knew i was famous in china i had billboards about me and you know what happened they heard about this china and they put billboards about the date of the operation me and what i was I had no idea across China.

32:29They took the feed from our sets, from the actual stream, and pushed it across China. So we think hundreds of thousands of people watched the operation. We have no idea how many people watched it, right? We have no idea. But I became this icon throughout Beijing. I had no idea. And so I went there, they were showing pictures of me on these big walls, me and the VR headsets and stuff. So it was a really funny story. So that was a real interesting concept. The next one I did was, okay, this was again 2017, a year later. Again, what I do, once I've done the operation, I don't do another one. I stop, pause to understand what we've done.

33:16And I just go for the next one, next one. I think that's dangerous. I reflect back on all the criticisms on all the feedback that people were giving me so logic why I was okay actually I will tell you one story about that which is again to me mind blowing when I did the operation I consented the family and the patient they're really happy so she's like that's great we'll support you our father we'll support our father through this and we're happy for you to do this obviously it's important to get that properly informed consent and I did it two or three times before the operation to ensure they haven't change their mind so they understand the process and they're very supportive when it comes to education and training everyone would love to support people globally right to democratize education and so i remember i finished the operation broadcast went well i came out the room and i came to find the family as i always do to speak the family about the operation i met them in the corridor and sat them down i said this is how the operation they said no stop there we watched the operation and that my jaw dropped we saw it live and we were really relaxed and very comfortable because normally when you have an operation you don't care anything what's going on you go out in the distance every coffee but we watched what was happening my father was in good hands we could see he's had the right operation done so we're thankful we could watch it i never thought the family would be watching a live stream of their own dad's operation that That kind of blew my mind.

34:44I didn't think about that and the consequence of that. It could have been alternative. It could have gone wrong, for example. There are risks around that. So that really made me pause about everything, thinking this is not just a fad. It's not television cinema. This is about real lives and real patients, right? So we have to be really careful. So that's really the next step from that, I thought, was the really big one, actually. this was the um snapchat surgery so a year later i was thinking about you know what's next um how do i teach people in different ways a snapchat uh obviously the social media platform came out with their spectacles these were fun spectacles that you could click and it'd record 10 20 second clips um onto your stories for example and you could create some nice narrative around it nice emojis, make it useful, and it would go into your story.

35:43So I got these spectacles really early, right, from America, the day they came out, thinking, how does this work? You know, these are glasses, you can record social media. I thought, would this be a utility for training? Hadn't been done before. 2017. So I thought about it, you know what, here's the deal. I'm young I don't really use Snapchat I don't really understand it very much but I do know it's my students use it it's their model and it's their platform and if you look at the use that time there are about 200 million users per month on Snapchat and 80 % were between the age of 17 and 25 now for us it's irrelevant what does it matter but actually I don't know it's not because those are my students are every day on those platforms so So I thought I would do an operation on social media.

36:37So fast forward 2017, it was a Friday afternoon. I found a patient, went for consent process weeks before. This is what I like to do. You're happy? He said, of course. Is it on social media? No, no, no. I'm okay with that. So what we did, I did a hernia operation. A hernia is nothing difficult. It's a standard operation. It takes an hour, right? And it's predictable. So I said beforehand, I said, okay, what are the clips that would be useful? So we break the operation down into about 20 segments in my mind. These are segments I can use for training. Then during the operation, I had one of my assistants click the button every time I wanted to record it.

37:14So record this bit, regeneration, and push it to my story live. I'd asked 200 of my medical students, closed environment, just give me feedback. This was, for me, the ultimate risk. Social media platform was before, right? so what we did with them we did these 20 second clips pushed to my story using some emojis and some nice ways of learning about hernias and we pushed it out i was this one i was really worried about the others two i was in control this was something that i'd be unclear about bad impact anyway at the end i got some feedback from them so how did it go this is great blah blah a lot of good engagement i tried to close the system so that we could control with the output I thought it was a relief that okay it's gone fine patient's gone home I'm happy fine I got a phone call from a friend who was a journalist said Jack I know you're doing this can I share a story I said you can now because I finished I'm happy with it it's gone well do share a story so he shared a story on some journal a tech journal in the US and a lot of people were interested that was on a Friday evening on Saturday night I got a phone call, a plus one number from the US, randomly on my phone.

38:31This was eight and nine o 'clock in the evening on Saturday. I was at home with the family. I took the phone call. I wonder who this is. And he said, a person on the other end of the phone said, you don't know me, this is Olivia Laurent. I'm the editor of Time Magazine. And I've got your story. I've got your number from friends. I heard what you're doing. I'd love to show you a story. If you're up for it, I am prepared to come into the office on Sunday morning to interview with you about what you achieved so this was really interesting Sunday morning I went to the hospital jumped on the call with Olivia Lauren we share the story about what I was doing and stuff and that day he pushed the story out into the Y domain it just blew up yeah every social media platform every journal every newspaper cover the story of the next few days it went imagine every news station cover the story and people even uh these holland a-listers were pushing out this was a great story right ashland creature shared that story to his entire audience across the world right he's big in tech now isn't he yeah he's in attack he's the best in tech and so when we looked at a month afterwards because i did the operation they covered it they shared it um mashable covered it aj plus covered it all these now this the future they covered it's more bits of video and it was watched we think well we saw the numbers it was watched by 50 million people in 30 days yeah it just literally went everywhere and that became the real scale of that procedure and that really put me the others were huge for me globally this put me in the international limelight because suddenly people use social media in a different way got me in a got me an article in cosmopolitan magazine for example right they cover my story in cosmo every tech journal was interested the last one of this foursome i talk about it was like that year uh where we developed some software for holograms and avatars.

40:40So I did the first hologram surgery where I was in theatre with a HoloLens on, an augmented reality device. There's two other surgeries around the world, one in India, the team in the US, who in real time with the avatars were in my theatre at the Royal London at the same time. And we're discussing a case. We got the model out, the anatomy, the CT scans, three of us in real time three time zones three countries or as avatars in my or in real life okay talk about a case that's so that was the first avatar hologram surgery those are the four things i really pushed hard thinking this is how we connect this would become virtual remember this was three years before covid hit us yeah and i experimented all these ideas and then we experiment with the AI at the same time to try to build an AI platform for this so I was kind of predicting this is where we should be heading towards and those are the four things that people may have not heard about and I haven't shared for a while because it's now in the distant past for me yeah but those are things that gave me the the energy and the I guess the the credibility of innovating in that space pushing the boundaries if you like yeah it's an amazing story Shafi and thank you shown it i think there's there's so much in there this that's interesting to me but i think if i was to kind of conclude almost i think what's what what almost seems disproportional or or particularly fascinating is the scale and it's and it's funny how quickly the world can sort of adapt and adjust to what to a new normal i guess but in the moment it was so unbelievably groundbreaking and that's what brings so much attention and because it's not been done before you get all of the kind of emotive and we're humans we're we're you know we're emotive creatures you know of course like you you'll get the emotion of excitement and passion and people love the new but similarly there's obviously people on the other side that will worry about risk and danger and they'll feel very passionately about those and you know it's an attention economy isn't it where those two collide then all of a sudden there's even more attention on it but I think for me the interesting thing about who you are that I'm learning now speaking to you because you've never actually sat down and had this conversation before what I'm learning about you is you're the you're the guy that will break the new ground and actually show the rest of the world what's possible and actually i i think that requires a certain skill set in order to do that and what's funny for me is that i talk about innovation a lot as you as you well know like i'm out and about on panels and doing talks about the ingredients of innovation particularly in health care what i think is fascinating is that yes you're a tech guy you love tech there are other people that love tech as well but what you were able to do that set you on this entire path that no one else was able to do was get a hospital to agree within 72 hours of you holding a google glass in your hand that you were going to put this in surgery and actually get this done you know the amount of people they say it's all about execution everyone's got the idea it's all about execution everyone thought what if i could order a cab on my phone you know was it travis at uber that guy went and created it you know i i think what it comes that what innovation comes down to in healthcare and i say this a lot is relationships and i think the most innovative thing you ever did was develop the equity in those relationships and the belief that people had in you that this is someone and something worth backing that you've got a whole group of people who are incredibly risk averse for the right reasons as you quite rightly pointed out as well they're risk averse for the right reasons, because they've got an NHS to protect, they've got patients to protect, they've got, you know, all of the status quo that has emerged for all of the safety reasons it has, they've got all of that to protect.

44:55And yet they believed in you. And yet they decided to go, I don't know what the upside is, potentially there is one. There's a massive downside, but hey, we're going to do it anyway. And we're actually going to figure out a way. And I think that's the thing as well, what you said, you know, we're going to find a way to do this. we took you know i'm on here a lot i feel like talking to people of a 500 episodes of this like people talk about the nhs being in being very difficult to innovate and it's very it's a not very innovative but i think you're challenging that narrative quite clearly because the nhs is made up of people and there are innovative people in what might be an ossified structure but there are innovative people and innovative people find a way and i think what you had and what you garnered and what you managed to uh galvanize people into doing was finding a way and i love that because it backs up this thing that i just believe wholeheartedly which is that innovation is so much in health care about building good relationships with people and getting them to believe in you and i i love your story for that and i think where you then convince people and it goes well and it goes right you then are able to do it again and push a little bit further and push a bit further i love the bit we said about you you take the time to reflect as well because i think that i think that's it that's the thing that people worry about in health care is that you know move fast and break things might be fine in tech but you don't want to do that in clinically facing innovation you do not want to move fast you do not want to break anything and actually taking that time to reflect and take criticism to heart and all that sort of stuff in order to build the next phase even better.

46:32I think it's a really nice story, I think, of how to innovate in healthcare and do the right things. And I'm so glad that it rewarded the relationships that you'd built over a huge amount of time. What's it like reflecting on all of that and looking at it as a whole? I haven't spoken about that for a while, actually, because I kind of forgot those stories, which we all share at some stage in an autobiography. Going from what you've said, I think there's two things that come out of it. One is leadership. So you're senior. You set and you have credibility and people respect and trust your decisions, which is built over 30 years of clinical practice.

47:13It's not just come overnight. They trust you. You've had leadership positions. You've built cancer services. You've had good outcomes. You're respected in your profession. And then, so it's trust. So then it's about understanding the problem you're trying to solve. Okay, here's the problem. Let's go back to Google Glass. What are the issues here? Yes, we've got a utility to stream. So, okay, fine. What are the barriers to that? If I have to go to do live stream, how do I articulate and define those limiting factors, the barriers for care, the risk for patients? Okay, right. Let's get consent, proper consent.