The Secret Of My Success was a 1987 film starring Michael J Fox. The critics weren’t impressed but it still took more at the box office than other, more fondly remembered, films from that year such as Lethal Weapon and Dirty Dancing. It was a complicated story with Michael’s character posing as someone different for parts of the film but in the end, of course, he was successful.
Success doesn’t seem to be coming so easily to digital health start-ups in the UK. I recently attended the launch event for the next DigitalHealth.London accelerator and the Digital Health Technology Show and at both events I heard people bemoan their lack of success in selling to the NHS. Often the start-ups seemed to be blaming the NHS for not buying. To me, this feels wrong. Yes, the NHS needs to become more innovative and yes it absolutely needs to adopt some digital health solutions at scale. But if you target the NHS as a customer it’s your job to sell, the NHS has no specific obligation to buy your product or service.
I have written a couple of pieces recently (Doors to Manual and Opportunity Knocks) that help digital health businesses avoid some of the pitfalls of trying to sell to the NHS. I wanted to expand on that by persuading a couple of people I know who have sold to the NHS to share some of The Secrets Of Their Success.
The conversations were hugely enjoyable and they both shared more insights than I dared hope. It does mean that this is a long article but I think it includes some extraordinarily valuable lessons. I hope you find it useful and if you want help deploying these lessons within your business please do get in touch.
- IOCOM – Alan Lowe
Alan is a former NHS manager. He ran the outpatient service at St Mary’s hospital and later managed the service improvement programme for NHS Westminster where successes included the 2007 deployment of the first NHS IP video cancer network. In 2011 Alan co-founded a consultancy business, THP, working globally to deploy innovative technologies and services. This included the launch of www.nhsone.net. Alan has won several national awards for his transformational projects in health and in 2008 presented at the International Institute of Health’s World Conference.
In 2016 Alan led the acquisition of IOCOM and became CEO. IOCOM is a data and media collaboration platform. It offers ‘traditional’ video conferencing but also advanced collaboration tools too via its Visual Business Platform. The company targets healthcare and education primarily and its ambition is to transform service delivery on a global scale and deliver better care and education to individuals across the world.
Alan first encountered IOCOM as a customer. As a service improvement lead for the north and west London cancer network he needed a solution to link 15 London hospitals to improve cancer diagnosis and treatment. IOCOM was selected. It worked well and became the first IP video solution to be endorsed by the National Cancer Director. It also won a number of industry awards and the cancer teams involved thought it was so good they felt it should be deployed nationally.
However, IOCOM was unable to achieve the penetration that Alan felt it deserved. He became concerned as he saw other, more established, players begin to ‘out-muscle’ IOCOM with products that he felt were less effective for the NHS.
Although he had no real desire to leave the NHS Alan saw an opportunity and felt an obligation to act. He decided to set up a consultancy company to help deliver innovative technologies and services across the public sector.
This was a period of classic hard sales graft, learning about a market in depth, covering a lot of miles, working hard to listen to and understand people’s problems and building relationships at all levels across multiple NHS organisations. All told Alan provided advice to about 150 different NHS bodies.
Alan worked with many suppliers but gradually became closer to IOCOM, with his company becoming the UK distributor. Then, in 2016, Alan and a group of investors acquired IOCOM and relocated the company to the UK.
Alan’s first piece of advice is: there is no substitute for hard sales graft. The 10 years he has spent working in and with the NHS and the knowledge and relationships he has built up over that time are key enablers. For him the three key elements within that are:
- Know your customer and their challenges and use that to qualify and drive opportunities. The NHS is so big and diverse it’s easy to generate a lot of early stage sales prospects but few will convert so you need to qualify fast. Your main contact may be a clinician who has no real understanding of how to get a project approved by his or her local IT, procurement and finance teams so you will need to guide them through that process. You can only do that if you understand your customer, what they are trying to do and what barriers they face in doing that.
- Know your market and your competitors. You only have an opportunity if there is a problem that a potential customer needs to solve and you will always face competition. You competitor will either be someone doing something similar or, if what you have is genuinely new, the status quo. Competing against the status quo is often the hardest as “we’ve always done it this way” seems comforting and risk free to your potential customer. You need to know how to beat your competitors.
- Service over technology, every time. The clue is in the name: National Health Service. The NHS provides a service. If you sell technology it absolutely must fit seamlessly into an existing service and significantly improve that service. You won’t sell anything if your customer has to invest time and money in developing a new service just to use your technology. If that describes your technology then you should be thinking about how to sell a service which includes your technology and which makes things better for patients and staff.
Another important lesson concerned adaptability, pragmatism and pride. Look for creative solutions to commercial barriers and don’t be too proud to seek and accept help. Leveraging deep knowledge of his market and competitors Alan drove changes to the IOCOM product. These included improvements in functionality, of course, but also key improvements to ease the implementation. If it’s hard to set up your service an overworked clinician simply won’t be able to use it. He also recognized that he needed to get IOCOM onto a framework to ease procurement. Uncertain whether they had the skills within IOCOM to do that Alan hired an expert to write their framework application and, whilst that was going through, partnered with two big companies already on frameworks. Yes, the framework partners took part of the sale price as commission, but it’s better to have a big chunk of some revenue than 100% of nothing.
Alan’s final point is in many ways the hardest to achieve and the most important – be honest with yourself. As a child Alan was a very competitive athlete and won a place in Arsenal’s academy side. As a sportsman he learned the value of coaching, accepting feedback and advice from those who knew more than him and working hard to use that feedback to improve. Even more importantly he learnt the value of teamwork in getting results. When he moved into business he applied the same approach, seeking out support, advice and team mates where he felt he needed it. This applied to consultants – in fact I first got to know Alan when I helped him develop the business case for his acquisition of IOCOM – and even more importantly it applied to mentors. When he started he knew his sales and business skills needed to be developed so he sought out great mentors and he asked for and implemented their feedback.
- Mapmyhealth – Dr Matthew Goodman
Matthew was an NHS hospital medic who then specialised in endocrinology and pharmaceutical medicine. He spent time in the pharmaceutical industry, initially with Sanofi then Novartis where he worked in both Switzerland and the US. In 2009 he returned to the UK to lead the clinical research programs of Prosidion, an Oxford based biotechnology company focused on the treatment of diabetes and obesity.
In 2012, Matthew founded Mapmyhealth, a company dedicated to the use of innovative digital technologies in the treatment of long-term conditions, from diabetes to cancer. Mapmyhealth now delivers digital therapeutics to thousands of patients across the NHS and beyond, helping to advance care, improve disease management, prevent complications and reduce costs for the NHS.
Matthew started our conversation on a positive note – if your product or service works then the NHS does want to buy. People are dying from preventable diseases and digital health solutions can be part of the solution. The NHS has an obligation to try to resolve this and is staffed with people who do genuinely want to help so yes, the NHS does want to buy.
Almost immediately however there is a very big BUT. The NHS does want to buy but it cannot make decisions in a rational or timely manner. One driver for this is the inherent complexity, after all it certainly isn’t just one organisation. But even within individual NHS bodies the decision making is tortuous. There are armies of people, any one of whom can say ‘no’ but with no one person empowered to say ‘yes.’ People who clearly have the clinical or operational obligation to make a decision don’t have the budgetary authority to do so. Those with the budgetary authority don’t share the clinical or operational objectives.
Compounding this is the fact that most people are genuinely trying to make a difference but also have little understanding of the realities of the commercial world. This makes the NHS a very damaging time waster, especially for small companies. The message will frequently be “yes, if” so you will be asked to return again and again to meet more and more people and jump more and more hurdles but it’s rarely clear how much closer that is getting you to a sale.
So, it’s not pretty. But it is the reality and if you decide you want to sell to the NHS you need to understand it, accept it and plan for it.
The Mapmyhealth team has done this by optimising everything about the company to sell to the NHS. They have done the homework up front and they know that what they have is a well-structured, cost effective service that genuinely addresses a known, significant issue. So they are pushing at a very open door for a major issue.
They have also done all the hard work to make sure that when they get through the door they have all the ammunition necessary to deal with every hurdle. They have built the data sets and prepared the documentary evidence. Mapmyhealth is still a tiny company but its regulatory and QMS documentation runs into the hundreds of pages.
All of this, in Matthew’s view, is just a ‘ticket to the game.’ Then the real hard sales work starts. A key tip here concerns CCGs. As with other NHS bodies there is rarely one person who can say yes but normally a lot of people who could say no. One way around this is to go after a specific line item on their spreadsheet. If you can show a CCG that your service can genuinely move the needle on a significant budgetary line item you are in a good place. Then you just need to find the person who owns that line item and get them and the finance director in a room to discuss how you can help.
Matthew describes the overall process via a “four horsemen of the apocalypse” analogy. His horsemen are Regulation, Evaluation, Commissioning and Implementation. They get progressively harder so, sorry, but the sales or commissioning part that this article discusses is not the hardest and you need to crack all four to build a sustainably successful company:
- If you can’t understand and comply with relevant regulation you are in the wrong industry.
- If you can’t show – and ideally prove – how your service improves clinical outcomes and saves money you won’t get far in the sales process.
- You do need to sell. As this article shows it’s hard but it can be done.
- Once you have sold don’t expect someone within the NHS to drive take-up and usage of your service. You need to somehow ensure that happens yourself. And if you don’t do that the message in a year will be “well, clearly it didn’t work as no one used it so we’re not going to renew the contract.”
Summary and Conclusions
The overall conclusion is that selling to the NHS is not easy, but it is doable and two of the most important rules are:
- You need to know your customer and know that what you have will genuinely solve one of their existing problems. An early lesson for me in this area was trying to sell a service to the CEO of a Foundation Trust and, as part of my pitch, pointing out how many ambulance journeys I expected to eliminate and so how much money I would save. The CEO told me the contract he had with the ambulance provider was a fixed price so he wouldn’t see any savings. D’oh!
- Sales is always hard work and there is never a short cut. This is doubly true if you have chosen to try to sell to the NHS. So if you don’t know how to prospect, qualify, present a proposal and close then you need to get help from someone who does.
If you want help understanding and implementing these rules please get in touch.