Patients Felt Better After Talking to AI | Sara Siegel, Deloitte

The patients reported higher feelings of well-being after speaking to the AI. It's delivering better clinical outcomes, right? Readmissions are down, mis-screening appointments are down. It's solving all the clinical problems that was there to do. And it's providing this added benefit, which we haven't anticipated. The prize is going to be in making our clinical processes, like our higher quality, more efficient, triage treatment. They always ask, "What's the best health system?" Health systems that seem to have key elements figured out. I was completely enamored, and I still am of the NHS. I think the next two or three years are going to be the most exciting time we have-- Big shout. In health care, in the last 20 years that I've been in the sector. Well, we've never had, at our fingertips, access to the sorts of powerful tools that we have now. Hello, and welcome to this week's Health Tech Hour with me, Steve Roost. Each week, we bring you the best news, views and interviews, with the leaders, CEOs, clinicians, founders, investors, journalists. The list goes on, people that are changing the face of health care in the UK and beyond. As regular listeners and viewers will know, I am a founder and CEO of a health tech venture myself. The venture being called Pockdoc. Pockdoc's flagship product, the Healthy Heart Check, has now been done by someone in every single UK postcode area within two and a half years of launch. And the Pockdoc Healthy Heart Check is the number one tool the NHS uses outside of a GP surgery to screen for cardiovascular risk. We're super proud about the progress with Pockdoc. If you'd like to know more, go to Pockdoc.co. That's P-O-C-D-O-C.co. And thank you, as always, to Pockdoc for supporting the show. Thank you also to all of you who are listening live on UK Health Radio. We love, love, love being on UK Health Radio. Thank you to Johann and all of his crew for making that possible. UK Health Radio has a ton of other presenters doing all kinds of different contents. I'd recommend that you listen and you check them all out. And we're really super grateful to Johann for having us on the live platform. Thank you if you're listening on any of the podcast channels. Also, if you're watching us on our YouTube channel, Health Tech Hour on our Instagram channel, Health Tech Hour, or on my own Instagram, which is Steve Roost. We love having you here. We have downloads now from people in over 50 countries. And we just crossed the 1 million views mark for the last 30 days. So thank you so much for delivering that. We love the fact that you're part of the community. We really appreciate your time and your attention. So thank you so much. Right, on to today's show. We haven't ever had anyone from this sector on the show. So I love having doing firsts. We have Sarah Siegel, who is the global health care sector leader at Deloitte. 2025 year veteran within health care and health care change. And really big system, big system change. One of the things that we didn't get into that Sarah mentioned before the show was that she was instrumental in helping the UK government change the way that the NHS pays for prescription drugs as part of a major project that she did. And that was one of the first things that she did in health care, which is super interesting. So I'm really interested to get into this. We always love having new and exciting and different perspectives on the program. As a founder in this space, we know already that Deloitte and others, but to be fair, Deloitte probably is the leader in the UK about trying to bridge the gap between traditional consulting and helping innovation thrive, particularly within a health care space. So it's great to talk to you, Sarah. Welcome to the show. How are you? Thank you, Steve. It's great to be here. Great. Can I make one quick clarification for your audience? Yes. Despite the global title and American accent, I am resident and citizen of the UK. Oh, congrats. You made the right decision. Well, I mean, it depends on anything about how long have you always been a citizen? Or did that happen at some point? I moved here after business school in 2003. And then when I was pregnant with my first son, I thought, oh, we better, we better be legal. We better be legal. Yeah. Okay. Cool. And you've been working in health care for a while. Pretty much since I moved to the UK, when I was still in the US, I did a few health care projects and consumer health, some biofarmer. But working with the NHS was my real introduction to health care when I got here. Okay. And like going back before that, how did you get it? How would you explain the world of consulting to people that might? We're a broad church, see? So when people probably heard the name, maybe seen it sponsor some stuff, but what is it? And why do why do companies use them? Okay. Maybe I'll start by telling you what I thought it was and how I started. That's good. So I went to university like many people do and coming to my senior year and my final year in American university, I didn't know what I wanted to do. So my hypothesis was I'll join one of these consultancies and that will help me work for lots of different companies. And so doing, I'll find the company that I like and I'll go work there. That was what was in my head. So that didn't happen. I'm still in consulting. But consulting or professional services, you know, as it's more widely known, is another really broad church. This is services provided to all sorts of companies and governments on a range of topics. So for a Deloitte, which is very, very large, it is tax. It is audit. It is support with M&A and it is a lot of consultative services, which could be help with an organization's strategy. It could be help approving efficiency or operations. There is a lot of work to implement and optimize technology. And why do you think the organizations tend to work with consultants like this? As opposed to self-solving. There's a lot of reasons why organizations do. I think there are different reasons why they should. Yeah. So firstly, why they should is if they are seeking to do something, which is either beyond a skill set that they have or beyond the sort of capacity that they have. So for example, to bring it to healthcare, hospitals implement electronic medical records. You know, the two biggest globally are epic and oracle. Most hospitals do not have a ready band of teams inside their hospital who are intimate with these software packages and can train up their managers and clinicians. That's a short term need while they're implementing a tool that they should bring in from the outside and not pay for on an ongoing basis. Okay. I mean, that's a very good use case for them. Right. So they need something to be installed. They don't necessarily have the capacity to install it. They don't want to keep people on. Okay, that makes sense. Okay. So what was your kind of transition like into? Well, when you said what did you think it was? Was different to what it is? What was that kind of transition like? I guess I had a really good first couple of years of my career in that I got to do a very large set of different projects. So I worked for a big automotive manufacturer. I worked for a big US telecom. I worked for a university. I worked for a Canadian bank. And I did, as I hypothesized, get to see the inside of a lot of different organizations. But what was happening was I was realizing that I loved what I was doing, which was always getting to answer a new question, always getting to work with a different team, always getting to see the inside of another new organization. And I think didn't dawn on me consciously until many years later. But what had dawned on me subconsciously was, I actually enjoyed that more than going and being in one place. Right. Okay. And then your story as to how you kind of transitioned across into health. We were talking about before the show. It was kind of interesting. Okay. Oh, and by the way, I just want to thank you for the banana muffins. You're the first guest to have bought us actually some food to the show. So just future guests that was greatly appreciated, was noted. I'm hoping for a very kind edit. Yeah, there's no edit, but we loved it anyway. We don't edit. Oh, I did get some time with the weekend to bake, which I find very cathartic. But to your question, so I was working on a project for a French building materials company in a basement in a town called Valley Forge, Pennsylvania. And I was negotiating prices to ship sheet glass across the country. All right. And I was working 14 hour days. And let's just say I wasn't having a great time. And I just thought, what is this all about? Yeah. Is this really how I want to be spending my time? And then, fortuitously, the next project that I was put on, as you mentioned in your intro, was to support UK Gov and negotiating what was then called PPRS, which is the prescription pricing regime for all branded drugs in the UK. Which was amazing, because what the UK government does is, it asks all of the major biopharmus to come together behind their industry body, the API to negotiate what at the time was a five-year deal, which is, and it's a profit maximization scheme instead of a pricing scheme. What's the difference? Well, the UK government doesn't set a price for a branded drug, a lipitor, or whatever, but it sets a profit cap. And so the companies have to figure out their mix of their different products, excuse to try to stay within that cap. And if they go over it, then there's a clawback mechanism. Wait, hold on. So just, we're quite a technical geeky show sometimes. So we're quite happy to take into details. So basically, what you're saying is that, and sorry, was this the case before you involved in the project, or was this the project kind of thing? This was not anything to do with my doing. I was basically there to assess, to assist. As I said before, this is where extra person power is needed when there's a big negotiation like this. The government sets up this scheme. They brought us in to help with analytics. Okay, because I was going to, that was going to be my question. It's like, to be able to execute on that, you've got to have really good data, right? Because all the drug companies have to declare their profit, presumably. Yeah. So is it all secret? Because no one really wants their profit data? Or maybe it's public, because they're public companies, I don't know. - Like, how does it go? - This, all of this was negotiated before I arrived. This was the renewal of a scheme, which already existed, and the term that I worked on it, new elements were added. For example, in the money saved for the UK citizen, patient, an ultra-orphin drug scheme was implemented, a pediatric drug scheme was implemented to create funding for research for these categories. So, summing it all up, it was a complicated project. It felt hugely valuable to doing that work. It was intellectually interesting. We were saving money for the taxpayer. We were improving healthcare for millions of people. - You probably didn't have too much interaction with the NHS at that point. So, what were your first impressions? - I was completely enamored, and I still am of the NHS. Obviously, it has problems, and we all worked to solve those problems. But compared to the system in the US, I just thought it was incredible. Every citizen or resident, or frankly, even people who just happened to be here can walk into an A&E and get treated for whatever ails them, free at the point of need. In the US, healthcare is either the second or the third cause of personal bankruptcy. - Wow. - Healthcare costs are incredibly sky high, and even though there are big government programs like Medicare for the Old and Medicaid for those who don't make enough money to have insurance, there are huge holes, and there are people who aren't eligible for insurance. We may be working very hard, maybe working several jobs. And it's a very complicated system in the US, and it's something which creates a lot of stress amongst the population. It also creates a lot of poor health outcomes. So, when I got here and saw the NHS, I thought it was amazing, and I did see that it could be better, and I thought that was a worthy cause to work for. - Did you know about it before you started the project, or were you kind of like learning, and you were like, "Wait, what, that's how it works?" Like, "Wait, what, that's how?" And like, "How, what was your kind of ramp up on that?" - I mean, it was a steep learning curve. I guess my first 6, 9, 12, even 18 months here. I was learning so much, health care is a hugely complicated world, full of acronyms, and layering on top of that, I'd come from a different country, so I had to learn the system of government here as well. Yeah, there was a lot of learning. - I bet. And so then your journey in health kind of began, right? And you've never really moved away from it. - I've never looked back, 'cause I realized that I could marry sort of my love of solving business problems with sort of having something which was purposeful, and felt like worth working hard for. And health care's complicated enough. I mean, you'll know this from your own venture, that we never get bored, do we? - No, there's always another, I mean, there's always patients to look after. There's always clinicians. There's always problems to solve, for sure. And, you know, as populations grow and health priority shift and things like that, then yet, that's always busy, I think, is the fair way to explain it. And so throughout that period of the things that you sort of, the big trends that you've ended up focusing on and thinking about in this space. - There are so many trends to think about. I suppose the thing that I've always been very interested in is how can we modernize health care so that we can improve quality, improve access, reduce variability, the sort of big things that we always want to focus on. And especially, I mean, as citizens, we just notice this, right? In all walks of our life, in our grocery shopping, in our banking, in our media consumption, things now feel very slick and modern and digitized. But when we have an interaction with health care, it feels like it's from 10 years ago sometimes. And things aren't as digital. We find our information isn't all there. We find we're still on paper or scanned paper. We find ourselves waiting in cues where we think that this could be a, I always look at process, like this could be avoided. So I've always just thought we can do better. And I understand why health care has been slower to modernize in this country and in others than other sectors of society. But I also see, especially now, with all of the new technology, we have at our fingertips a very exciting future. - And how does that, because I mean, look, I'll show you this show, The Health Care, it's all about positivity in the future and how do we get to the future faster and while still maintaining patient safety and things like that. But what do you think of some of the big, there's a lot of the, and we see this at Pockdog, where everyone knows about the concerns around cardiovascular disease, type 2 diabetes, chronic kidney disease. A lot of these things are known and actually one of the areas where we've had a huge amount of successes by calling out the fact that these things are known and then highlighting what we think the obstacles to solving them as opposed to continuously trying to make people aware that the problem is the problem. I feel like everyone knows what the problems are and the issues is around how do you, how can you create some positive realism about the actual problem that needs to be solved? - Or just put some solutions in front of people and say, what about this? Do you wanna have a go at this? 'Cause I totally agree, like we talk about the problem all the time and yes, it is important to understand. It's important to have a baseline. But it's important to, and that's sound like Ted Lasso, but to believe, right, to have something that you're focusing on in terms of where you're trying to get to and to have a picture of the future. And I don't know, there's so many examples that I could give, but I've seen change happen really rapidly in healthcare in the NHS and not always just with tech, but just sometimes with showing people data and just with transparency. So an old school example years and years ago, we were looking at GP prescribing and trying to get rates of generic prescribing up. And there was a big discussion about how to do this. - And just for the broad church of our listeners, that's good because generics are cheaper than branded. So it lowers the overall cost of the drugs to their healthcare system. - But chemically equivalent, so they should have the same clinical outcome. A lot of much discussion about what to do. In the end, we had done a bunch of analysis, which basically just showed the rates of generic prescribing across a series of categories of drugs, GP practice by GP practice. And then the client looked at it and sort of said, could we just anonymize this and put a dot showing each GP where they sat on this chart? And we were like, yeah, did that. And the bell curve flattened. - Oh wow. - We didn't say change anything. We just said here's where you are. - Right. - And it was just that transparency, just giving people information and knowledge changed behavior. There was that famous example about putting prices on things in an inventory stock room would change behavior about, you know, how many things you would request on a surgery. - I didn't know that. Or there's all kinds of information like that. And I just think that's one tool. - Like Nudge Theory kind of thing. - Yeah, exactly. And I think it's hard because the NHS is so big and so sprawling, you know, targets are always used and I understand why. But I also think that there's lots of choices that people would make on their own if they had more information. - We had Penny Dashon, who I know that you know, Chair of NHS England a few shows ago. And she was amazing, really authentic. It's always a bit of a gamble when you get a senior folk on about whether or not they can be authentic but Penny absolutely smashed it. So I know one of the, you and her have similar feelings about some of this. Why can't we just do, why can't we just do this kind of thing? One of the things that Penny and I spoke about quite some length was this electronic health record, single patient record. Long-mooted, long-disgust. It seems like a lot of people are in violent agreement about it and yet here we are. But that project conceptually strikes me as speaking directly to the value add of a delight or there are other consulting companies available, obviously. But that strikes me as a kind of a really meaty issue. So what's your sort of take on this whole thing? Help us understand where you think this is. - Sure, a single patient record is a brilliant idea. I don't think anyone's gonna argue with that. The issue that people are sort of grappling with is the how question. If you ask even healthcare leaders outside the UK about this, they would assume that there already is a joined up longitudinal healthcare record for all 60 million citizens and that it's being used for research, for day-to-day care management, for population health. But that, as we know, is not the case. It's very complicated to do both from a technology perspective, from a sovereignty perspective, and also because since the national program for IT years and years ago, the pendulum has swung the other way and there's been a great deal of freedom given to individual organizations to make their own choices for technology. And what has resulted is a lot of different things springing up around the country. So for a national single patient record to take hold, you also need, I would say, to take account of what's been happening locally and regionally. Because a lot of the regions have gone ahead and developed it, the Greater Manchester's one. - I would call London and Greater Manchester, they both have very different, but very developed. We can call them single patient records. - Yeah, shout out Greater Manchester and London. - Yes, exactly. And so do we throw the baby out with the bath water? There's been great work done there or do we try to plummet altogether, but we have to help some of the areas of the country that haven't done all that work. They shouldn't be left behind, which tech vendors do we choose? It's not a simple question. And it raises, and so I have a huge amount of love for the teams in Greater Manchester and London. So PockDock just launched with some work in Greater Manchester with the British Heart Foundation and the Health Innovation Network up there. So, you know, and London we're doing quite a bit as well. So I've got a lot of love for those regions. The thing that strikes me around some of this single patient record thing was buried in the sort of list of reasons why you would do it, which I think is something that isn't necessarily aware is that part of the benefit of having a single patient record is. around the research benefits. And those research benefits can accrue to the system and to the government, but they can also accrue to pharmaceutical organizations. The single patient record is as much a state asset as it could be a revenue generating asset for the state, hypothetically, in a safe way. Or is that a conspiracy theory? I don't know. I think that's a great thing, by the way, because I think that you can't. It's a great thing. You know how difficult it is for pharma companies to find eligible patients. It's really hard. If you are a patient sick with a disease and approved treatments weren't working for you, I don't know about you, but I would want to be found for a relevant clinical trial. That's the sort of thing that we could do a lot better on. Yeah, I mean. Because we have the data. It's sitting right there. Yeah. Yeah. No, I agree. So I might. You know, my back in February, my wife was diagnosed with cancer, and she. Sorry. with breast cancer. Yeah. And she. Luckily, she has an oncology background, but even for her to try and do the research to find out where the trials were, was actually very difficult. So. Yeah, I think there's. When, when, when. I mean, the cost per patient for a clinical trial is sky high. And it's now that we've got AI at the front end of R&D for pharma. This is the real bottleneck. Yeah, it could be really powerful. And I think those regions are now at the forefront. But then it kind of creates. Does it create conflict with the national? I don't really understand how that sort of all fits together. These are all choices that need to be made. You need a consulting company to come in and help you bring this all together, I think. I do think that looking at spans of control and healthcare is super interesting. Because one of the questions I get asked a lot, and Penny actually spoke about this. Her interview was brilliant. I was a bit intimidated coming on. No, you're doing great. She didn't bring muffins, though. Penny, so if you're listening, you didn't bring any muffins. Next time, Penny. One of the things I find super interesting, because I do. I'm very lucky. I do get to travel a lot. I do get to see a lot of different health systems. And when people, they always ask, "What's the best health system?" And that's not really a question that you can answer. But I will say that in my travels, health systems that seem to have key elements figured out very well do tend to be smaller. Yes. If you go to Israel, Hong Kong, Estonia, Singapore, you know, you're looking at a million, two million, three million, or sub-ten million population, right? And these are guys that have been able to digitize in a cohesive way. They do have what we would probably call a single patient record. It is easier for, to our last question, pharma companies to get access to patients. They are able to do more holistic screening and population health in a consistent way. So it does beg the question. When you have a population, this big, 60 million people, what is the right span of control? What is it about a bigger population that makes it harder? Because I agree with you, right? I completely agree with that kind of assessment, which is, again, you've got more experience about traveling internationally and looking into these things, obviously, than I do, as this pennies clearly. But, you know, the smaller populations seem to have better, sort of digital, first single patient record type setups. But is it just, is it kind of exponentially harder, the larger the population is, or is it sort of a straight line, or what, what is it that drives that complexity other than just, like, more people? I'm not sure what the slope of the curve is. Yeah. You haven't plotted it. I haven't plotted it. But I do think there is something about, about how, when you, in any organization, right, you always need to break up into smaller groups. And then it just is always grappling with this. We're always reorganizing, right? SDPs, ICBs, 28 SHAs, 7 regions, trying to figure out what the right span of control are. It's a really difficult line to talk. Yeah, framing it like that basically makes you think that maybe this restructuring is just about trying to continuously land on the right span of control. I've not thought about that. But I think it's a Venn diagram, right? Like, there's overlapping issues that we're trying to solve for. Spans of control and having good grip and control is one of them. The right footprint to implement technology on is another one. Clinical governance is another one. And I would say, and there's probably two or three more I haven't mentioned, that all of those different factors don't have to have the same spans of control, which makes the problem more complex. Yeah, exactly. They may not be the same at all. Yeah, that's interesting. Like, I don't see, and I'm not a clinician, but I don't see why our national clinical directors shouldn't set clinical pathway policy, getting it right. First time all these programs nationally for the whole country. I don't see a need for clinical variation. Wait, do they not? I didn't do. I know it's not a trick. There's variation is there. Of course. If you and I both have to have a knee replacement. Okay. And you go to Newcastle and, you know, I go to Milton Keynes. Okay. Both great places. Both great places. Not picking out these hospitals at all. No. I'm willing to bet that the clinical pathways that we follow, even depending on the surgeon that we get assigned to, are going to be slightly different. Interesting. And then the next question that arises from that is to what level of granularity should those things be nailed down. These are all great open questions that clinicians, you know, not me should answer, but to that spans of control point. Yeah. Interesting. Because I know that nice publishes clinical pathways on his websites. Absolutely. Right. So there are, I know, I, to be a first surgery is not, not an area that I spend a lot of time looking at. So that take that, take that as sort of as moot pointer as a caveat. But do they, are you saying that nice sort of publishes these kind of meta pathways, but then they're interpreted potentially differently in different ways locally? Is that sort of not willing, not, not meeting to get into like the depth. No, I'm just curious. Just wondering about sort of spans and spans of control and how things should be done to the best possible effect because variation is an issue. And if you talk to clinical staff, especially nurses and people who work shifts and work at different places, they will say things are done differently in different places and it's confusing. And yes, clinical risk. That does. I think that is, you know, the point to be made there. The second point to be made there is back to technology. Now that we have all these new tools at our disposal, how could we think about clinical processes in a way where we can simplify them both for the clinician and the patient, reduce variability, increase speed and improve quality? So what's stopping that happening? Because like in theory, those are good things that everyone probably is in violent agreement about needing to do. So I think it is starting to happen. So back to the sort of believe and be positive point. I think it is starting to happen. And this is another discussion that I think needs to happen locally at the call phase with clinicians, but also sponsored nationally. And one of the things that I get to spend time on is a spending time with the big tech vendors as well as spending time with NHS leaders. And to the extent that I can, you know, trying to bridge gaps where they exist. And what I would say is there's a ton of technology now that can aid clinicians, which can help with the challenges I've just laid out. And the first thing which has happened, which I think we've all seen, which has been really positive is a wide skepticism on AI, shifting to be more positive with ambient voice technology. Yeah, AVT, you guys are crushing it. I don't know who the you guys are, but clinicians love it. It's saving pyjama time. They're actually having eye contact with their patients. Patients feel they're having a better quality experience. It's win-win-win. Yeah. And I think what's interesting about that? So there's like, I mean, the main players, I'm going to forget some, but you've got tortoise, also an NIA company like Pop Dockshire at Dom. You've got Heidi, then you've got tandem, then there's another one which I can't remember that's to Blue Blue Bird, Blackbird, Baby Bird, something like that. Anyway, and the thing I love about that story is that that was, I think it's a really good example around tech adoption because it was frontline staff that adopted it organically. And GP surgeries and other providers were paying out a pocket to do it. I think it's a really great example of how you can get this spread. And then you look and then the national system and the regulatory system is sort of playing catch up to the fact that this thing's been adopted wholesale, basically. Yeah, but back to our like very early point in the interview, I think when something's put in front of individuals and they see a solution and then it's good, they'll go for it. So that's the job. And that's just one example and I think it's probably part of my job is to put more of these examples in front of NHS leaders and they'll know what to do. And do you think that there's in every type of, for every problem, right, of which, of every problem where, where a technology solution could be a solution? Do you believe that there is a solution that can scale organically like AVT to the problem of like, oh my god, it's really pain in the ass to actually have to write notes and creates risk and there's duplication and so on. But do you think there is something out there for every issue? I mean, I know it's a big question. I'm no idea the same for every issue, but I do think if you sat down with an NHS manager or a clinician and said, like, what's really bugging? You give me your top three. You could probably put options in front of that person and they could say, wow, yes, you know, this is something that could help me in my job. This could help, you know, and also for patients, you know, it's something that's boggled my mind for years is, why do we go to A&E and wait in line? Why don't we know A where to go and how long the wait's going to be? So if my son has a fever and I live in central London, it would be great to know within, you know, 10 minutes, two or bus of my house, where should I go and how long the wait is and what are the appropriate outlets? Like, again, all data that exists, that we don't readily put in a hands of patients. I know this is being worked on and I think it's very exciting. Is this this online hospital stuff or what is it? Is that different? Uh, and NHS online, I believe is going to start with a couple of clinical pathways. Okay. But I do believe that, again, big cities like London and Manchester are working on some of these customizations for their local populations. Oh, what, so that you can see kind of which A&E is busy and where to go and that? As, I mean, that's that's an example. Cool. I think navigation services are something that would help patients. So I just wanted to raise the point that in addition to helping clinicians who you know we do need to make their jobs more enjoyable, you need to keep them in the NHS. I think it's also important that we start empowering patients as well. Makes sense. And let's go back a bit to the international question because I know that's something that we talked about before and it was definitely something that was penny was quite interested in off the back of I think me asking this is one of the things that I've having done the show now for 155 episodes or whatever this is and you know been around in the industry for a while. My background also not in health is what one of the things I've noticed that I try and sort of fight against is this NHS is broken type of trope and it's like well actually what that implies a judgment and a judgment implies a comparison. So who are we comparing ourselves to? What is this comparative set? And I think it's a really interesting question because there I don't believe there are many people that really would swap if you look any kind of country with a similar population level that you would swap their health care system for the NHS that readily. But I don't know what you're I totally agree and I don't think that's a helpful comparison either because every country is structured so differently it's not that's not useful. What's useful is what are good things happening in other places that are applicable to the NHS and you know should we be looking at them. So for example in Canada which is a system not entirely like the NHS but with many many similarities. Yes we've got some really cool pilots running where we have an AI avatar doing outbound calling to elderly patients post-discharge that surgical episode and I was very dubious about this pilot because I thought older people wouldn't want to talk to a computer. Do they know it's a computer? Yes and it's purposely made to look not real. Okay so it's not like a Simpsons cartoon but it doesn't look like you or me. Okay so it's very obvious it's not a human. Not a human but it's you know she has a face which has expressions and it does mirror your expression so she shows emotion and empathy. Anyway I was dubious I thought that would be two sci-fi but it's gone super well and the issue it was solving was there weren't always humans doing the outbound calling post-discharge. Yeah there's a resource issue. There were re-admitts that could have been prevented infections that could have been prevented you can imagine. Now we have a hundred percent coverage of the outbound calling we're covering all the clinical issues we're rooting into other questions that patients had. The time they're spending on the phone is something like two or three acts as long as they were spending with the humans. Oh why is that because the basic is the hypothesis behind that basically that the AI doesn't get bored. And it has all day. Right it doesn't have Christmas. Yeah and the most astounding thing is that we did a survey afterwards because it was a pilot and we wanted to measure you know all elements. I found it really surprising and I think it is about the amount of time that they spent on the phone. The topics covered were broader than just the clinical checklist that maybe the human had covered before. And you know the AI will stay on and listen to the individual talk about their garden or their cat. And I think it's amazing. Okay we have a lot of people living alone and that feeling of connection even though it's not with an actual human which is why I feel a little morally confused about that. It did make them feel better which I guess is the point. But it's what's interesting is like the I mean AI is throwing up all kinds of quasi philosophical and existential questions but it sort of it is it the fact that it works enough if that makes sense. As in it delivers a higher it doesn't matter how right it's actually working and delivering a higher level of well-being. So that means it's a good solution. But without that it's still it's delivering better clinical outcomes. Right. Read missions are down, miscreening appointments are down, it's solving all the clinical problems that was there to do and it's providing this added benefit which we hadn't anticipated. And that is something that you think should be scaled to other systems. I think that's a that is just one of probably a hundred potential use cases that we should be considering. Now obviously this is a clinical use case. And I think this is going to be one of the sticky issues that you know tech issues, governments, houses. Is it a regulate? Is it a metaphise? To grapple with. No. The different countries have different rules on this. They tend to be sort of aligned. You'll know that in this country we've just done something for AVT giving a bit more space. So I think this is a very fluid and evolving sort of area of regulation. But invariably AI is going to come into the realm of software as a medical device. Because it's already here. Yes, it is. Even though it's super helpful for admin and back office, you know, the real prize is going to be in making our clinical processes, you know, like our higher quality, more efficient triage, treatment etc. So the thing that makes me nervous about that is the regular so we're what's known as an in vitro diagnostic device. So we've been through all the regulations. You've done it. Yeah, we've done all of this. The UK, the EU, we're about to submit to the FDA. By the way, the FDA is the absolute standout notified body in the world. So congrats to the FDA. They're absolutely incredible. And you add out to Lauren's talent in the image array for hiring half the FDA. Is that what they did? Because they left interesting, great job, MHRA. But my concern is that they've got a mountain to climb, a real mountain to climb to try and keep up with or even get close to being able to regulate aspects of this, you know, in a logical sensible way that on the one hand actually regulation fundamentally should be about providing a level of clinical safety to the patient and clinicians using it. Being able to actually do that in a way that is sensible logical, I think it's just really hard in this space, particularly when it's when it's non-deterministic, so using a generative AI or, you know, agentic AI less so because it's a bit more about process type stuff, but it's hard. It's really hard. I mean, this is a massive simplification, but I was, I was lucky enough to get to serve on the MHRA's commission on AI, which is just wrapped up. Oh, cool. And they had a whole subgroup for vendors, for technology vendors, and they really were great at sort of soliciting opinions. Yeah, I remember that actually. You know, how can we get you guys to keep innovating without slowing down too much, but also keep everything safe, is I mean, it's an exemplified exam question. And again, I think the hypothesis was using pharma as an example, you know, they have a yellow card system for once a product is already on the market where you can flag issues. And so the discussion really turns to for software as a medical device. Can we create stage gates where we feel that products or organizations have a level of safety and then let them put products on the market, but retain a lot of oversight and continuous reporting and some kind of yellow card-esque system to report things back so that we can keep progressing and not, you know, wait for like some final approval and then you're free to run. It's just not going to be like that because AI is just going to evolve constantly. So all of that to say it is massively complicated, but I think they are doing the right things by trying to lose everything advice. I mean, the concern that I have is if you go down the medical device route and if it's a medical device, that's that's a couple of years in regulatory, right? By which point do what's happened to the world? So you sort of end up with what I'd want to say, A/B/T is a really good example where there's one provider and I won't, I won't name them because I don't want to do anything about the market, but there's one provider that's very specifically taken a route to try and force everyone to be a medical device. So they've gone down the route of kind of creating that's their angle to try and win, which is to try and force everyone else's solution to be a medical device because they were the first medical device in AVT. Well, nobody else wants to do that really because that will slow them down massively. So there's this tension where if they can convince, and again, I'm not an AVT expert, so I don't know what's going on, but if they can convince the NHS institutions to implement some kind of governance that says any AVT solution has to be a medical device, then they're going to win by default. Then they get a moat. Then they get a moat, but nobody else wants to do that and these other solutions are going absolutely gangbusters. So I think it's tricky, right? It's a huge issue and I mean, a lot of those, that's a funny market because some of those companies are like Microsoft and Dragon and they're really big companies and some of them like Heidi and Tortoise, they actually are kind of getting bigger, but they're smaller. They have startups. So you have this really interesting dichotomy in that market. I think software's a medical device is also really interesting with big tech because a lot of the frontier labs are getting very close to the edge of what would be software's a medical device. Oh, if they're not already across it, right? But is it them or is it the people within healthcare providers who are using tools to create assets for themselves at what levels is that? Technically, if you really want to geek out on the actual regulation of it, a software as a medical device has to be deterministic right now in everyone's rulebook, even the FDA's rulebook. So I don't know how you move away from being able to be deterministic, but by definition, the software, the AI models aren't deterministic. They're almost there. You probably get roughly the same response, but you can't guarantee it. It's very great. It's going to be super exciting, but I'm a big believer in regulation and introducing that safety, but allowing people to grow. But that's just such a narrow needle to thread with this. I think it's an important time to be a health regulator, and I wish I would. - I wish them all the best, I really do. - I think the other thing I would say just on this topic is I do get to spend a lot of time with the big tech players. I was out in Silicon Valley two weeks ago, spent time with Anthropic, with Google, with Salesforce, heard from a lot of the bankers that support these companies in the public markets, talking about the underlying fundamentals of these companies and we obviously work with them in the UK and in lots of other countries as well. And what I would say is there's huge, huge interests to work in healthcare, to customize, to invest, disproportionately I would say, and having said that, I would say to NHS leaders, we can ask big tech for things. We can be bold and say we need A, B, C, D, E from you and this is what we wanna do together. And I think coming at it in more of a partnership approach unless of a vendor supplier kind of mindset would be a great place to be. - It would be good. Sometimes that's a hard political one, isn't it? - Sure. - 'Cause they get, I feel bad sometimes because I think a conversation is always better. If you can have a conversation, it's always better and you're gonna have a discussion. But the NHS has gotten slapped so many times for seeming to cozy up or whatever phrase you want with technology and so on and so forth. I think it's hard for them to, I just think they're conflicted. I'm sure they'd love to get around the table and have that chat and to try and work on the art of the possible but then are they gonna feature in some kind of expose, you know? It's hard. - That is what needs to be managed. - But is that where companies like Deloitte come in 'cause you can bridge it, right? - That's where we can help because I guess without putting too fine a point on it to paraphrase what some colleagues from the NHS would say, they feel a bit like maybe their data's being held captive by some big tech vendors right now. They feel locked into contracts. These are the sorts of things that we, collective we, need to help solve for and I don't think they're insurmountable and I think that would help with that problem because if you felt like you had agency, you had switchability, you had multiple vendors in some kind of consortium so you were keeping competitive tension, you had placed all your asks on them in terms of data sovereignty and ownership and open APIs and whatever else you want. Then that conversation is different because you're getting what you need from your supplier. And is there any kind of like comparator for that type of relationship in any other country with big tech? I'm just curious. Does that like, if that sounds great? (laughing) But I don't know if that's based on anything like that you've seen elsewhere maybe. - Sure, so I think there's lots and lots of different models. Things that are springing up now because the landscape is so complex and you need multiple parties to get something big and complicated done is lots of joint ventures, special purpose vehicles, even charities that will involve a selection of healthcare providers, partner like ourselves, one or two of the big tech vendors working together to get something done. So an example of that is, we have something in the US called Kaya, which is the Cancer AI Alliance, which is four major cancer centers, Google and Vidya ourselves and it's a charity. - Okay. - Any ideas federated learning, all the data say sovereign inside the cancer organizations, but they can each learn from each other, both in terms of diagnostic and treatment pathways for the major cancer tumor types. So that's sort of a model, which is in a traditional sort of contracting supplier model where we're working to solve a big problem. - You know what, like in theory, the government isn't necessarily, 'cause the government, it's the NHS institutions that do the procurement. So I just wonder whether there's a role for certain government departments to be able to try and broker some of these discussions and things like that. - I don't know, there's a lot to think about. - There's a lot in there. - Yeah, there really is. So what are you looking forward to in the next two or three years as far as your role concerned and global health and things like that? What are you excited about? - I think the next two or three years are going to be the most exciting time. We have seen - Big shout. - In healthcare in the last 20 years that I've been in the sector. - Well. - We've never had at our fingertips access to the sorts of powerful tools that we have now. And we just need a little bit of help fixing our tech debt, data curation to take advantage of this. And of course, good regulation, in which we already spoke about. I would say that in three years from now, let's say 20, 30-ish. - Yeah. - As patients, we will be interacting with the NHS in a totally different way to what we see today. - Really? Like give us some examples. - I think using the NHS app are similar. We'll be able to modify our appointments, easily check our results, not have the TPP app and the Epic My chart app. And I have other things in my little health folder on my phone. I think I will probably be able to have a shared care record with my elderly parents don't live in this country, but if they did, check in on them, create a constellation of cares around them where we're all checking in on them. I think we will be able to compare. This is a big one, this might not be true. But I would love, let me rephrase. I would love to be able to compare volumes and clinical outcomes of surgeons on major pathways and to my surgeon. - Oh, lead tape would touch them. - Yeah. - Well, that data exists. - It exists. - That data exists. - I beg on transparency of data. - Yeah, that would be, yeah. I know that's been talked about for a while. That would be cool. I mean, look, the NHS should take a lot of credit with the NHS app. They've built a really good platform to build on. So I agree with that. And how, I know Deloitte also plays quite a lot of a big role in around the innovation ecosystem, particularly in the UK. So how do you help innovative businesses sort of access and grow and things like that? - Yeah, sure. So I mean, I personally have a real soft spot for small health tech startups. Pac-Doc and others are solving great problems. It doesn't take a huge tech behemoth to get to the heart of an issue. The tricky thing is Deloitte's a big organization. Really, you should use Deloitte when you have a big multivariate complex problem. - Yeah. - So one of the things that we're able to do is work in partnership with big tech vendors to help small startups. So again, in a joint or co-funding model, we can help startups with all kinds of things, different technical issues, scaling, operational problems, go-lives, et cetera. And those are projects that I know the startups love help with 'cause they're-- - Starts-ups need load of help. - They are just very busy. Everyone's making the coffee, doing the exact presentations, everything. And our teams love it too, because we love working with startups, and I think startups have a huge role to play in the innovation agenda. - Yeah, and what, but it's not that common, you know? So that's what I love about Deloitte. And we've been involved with some Deloitte things and maybe involved in some Deloitte things in the future, potentially, who knows? - Yeah. - And I think it's really noted that you try. So there's a Deloitte, for example, cardiovascular disease, there's a really cool title which I can remember what it is, but it's basically, it will come to me in a second. There's basically a working group to try and prevent cardiovascular disease, and they bring together all kinds of really important, exciting people. And it's just, you guys really try. - Oh, we do. - That's what I mean, you actually try. - And our healthcare team works in the healthcare team for a reason, as we talked about earlier, everyone is there because of purpose. We also have an absolute huge number of clinicians of all sorts, and we have a really strong clinical network both here in the UK and globally. And yeah, I mean, if you ask anyone on our team, they will have a story as to why they chose to work in the sector. And I think that's the best way to do your job 'cause every day you're coming to work doing something that you wanna do. And it means something to you. - Good, well look, on that note, we've come to the last bit of the show. So I ask everyone that comes on the show, throughout all the difficult times, the tough bits, what's your kind of self talk or your motto that you go to, that you wanna share with the listeners, so 'cause it might help them get through what they're dealing with. Like a pay-up forward kind of concept, but with words. - Wow, deep. - Okay, something I've learned over the years, because the more you live, the more you work, the more you go through hard things, and good things happen too. Whenever I'm in a really tough situation, I think of the other tough situations that I have weathered, but professionally and personally, and I just tell myself, you did that, you can do this. - Great, I agree with that one. Bit like this two-shell part, so you've done this before. - Yeah, you're tough enough. You're tough enough, right, Sarah? Thank you so much for coming on the show. - See you. - Thank you for coming on, and thanks to everyone for listening, we'll be back again next week.