medtechbusiness blog

Harrogate Conference Centre, 12–15 October 2009

The annual Association for Perioperative Practice (AfPP) congress features the largest exhibition of medical devices in the UK. At this year’s event, 169 medtech companies and service providers exhibited across nearly 7,000 square metres of exhibition space to nearly 1600 visitors.

Changes in the process of commercial engagement between medtech companies and their customers mean that the purpose of the AfPP Congress is changing: B2B opportunities are becoming more important, the customer interface less so. However, a number of the Congress presentations reflected awareness of the need for the NHS to improve its procurement processes and to work effectively in partnership with suppliers.

Medtech comes alive

At this year’s AfPP Exhibition, Medtech Business had a stand for the first time and took the opportunity to meet many of our readers.

The exhibition reflected the creative energy of medtech innovation, and of imaginative marketing and sales professionals. Among many fine stands, the following caught our attention:

• Mölnlycke was voted Best Stand by the delegates for its impressive and varied display of orthopaedic, hygiene and dialysis products, offering a complete solution for operating theatre efficiency.

• Sheffield company Swann-Morton, the only European manufacturer of surgical blades, displayed a giant blue-lit wheel of scalpels.

• Eschmann demonstrated a specialised orthopaedic operating table for limb trauma operations.

• Huntleigh Healthcare won the Medtech Business Lucio Fulci award for its dramatic model to promote the Flowtron anti-embolic stocking.

• Biomet used a stark silver, grey and black stand to promote its Optipac vacuum mixing system with Refobacin bone cement.

• The ChloraPrep stand juxtaposed a living model with huge photos of skin areas to illustrate the effect of pre-operative treatment with the skin flora-removing agent.

• Ruhof’s stand ‘Ruhof Safari: Searching for the Temple of Clean’ featured staff in leopard-skin shirts and boots, promoting its cleaning chemicals for the care and maintenance of medical devices.

• LaproSurge’s roulette wheel and baccarat table, complete with uniformed croupier, put its surgical instrument range ahead of the game.

Imaginative marketing helped to capture the attention of the delegates – but what they will remember is the medtech companies’ proactive engagement with the clinical, financial and organisational issues facing health professionals who are working to provide safe and effective surgery and intensive care.

Cutting to the chase

The AfPP Congress reflected the growing commitment of the NHS, in the wake of the Darzi report, to promoting innovation and commercial engagement.

In a strand on theatre management, Sally Taber, Director of Independent Healthcare Advisory Services, discussed the impact of the changing healthcare landscape on the independent sector. The extended choice network means that private healthcare providers are competing with independent providers of NHS services: 5.2% of elective care patients are choosing the independent sector via Choose & Book. The biggest challenge for the independent sector, Taber argued, is healthcare informatics: accessing good quality information. Achieving a level playing field and influencing the commissioning agenda are also challenges. She pointed to the increasing number of joint ventures between NHS and private sector organisations as showing “the way forward”.

Brian Wells, Director of the Elective Orthopaedic Centre at Epsom Hospital, looked at the impact of patient choice on the healthcare environment. In the orthopaedic field, demand for treatment has increased by 25% in 10 years and patient expectations have risen. This has resulted in a greater product differentiation: customised implants, resurfacing implants and a growing emphasis on cosmesis. Independent providers need to define their USP and be proactive in managing the market, he argued: being ‘the private option’ is not enough in a crowded business environment.

Bonnie McLeod, a Clinical Nurse Educator in Canada, discussed how operating theatres can reduce their environmental footprint by minimising energy use and waste production. She emphasised the long-term dangers of medical devices that that include toxic substances, such as mercury and DEHP. Her recommendations included: asking suppliers to reduce packaging; choosing healthcare products that do not contain toxic substances; and investigating the possibility of reusing single-use products. She noted the urgent need for an international consensus on these issues.

Innovation nation

In a breakfast presentation, NHS Supply Chain and the NHS National Innovation Centre launched the ‘Innovation Scorecard’, which enables suppliers to register innovative products for consideration through an online portal. It gives companies of all sizes the opportunity to fast-track new products onto the supply chain. Each application registered on the Supply Chain website is analysed by a dedicated team. If the product is judged to be innovative and add value to the NHS, it can be put on a pilot contract to test adoption.

In a strand on procurement, Dave Dawes, CEO of Entreprenurses CIC, discussed how to prepare a business case. There were clear lessons here for suppliers. He noted that true innovations both increase outputs and reduce costs: those that increase both face too much competition, while those that reduce both are retrograde. One of his recommendations was to keep financial information clear and simple. The key questions a business case has to answer, he said, are: What difference will it make? and If not you, then who?

Bruce Ash, Business Consultant, ABHI, gave an important presentation on research and industry. He introduced the ABHI and explained its role in shaping the medtech industry’s policy, regulation and reputation. The key issues he identified as facing the industry are: the need to help patients realise the benefits of medical technologies; the postcode lottery for medical devices; and the need to balance the risks and benefits of adopting new technology.

Ash outlined the history of the NHS innovation agenda through such milestones as HITF, the Darzi review and the OLS Blueprint. He discussed some of the problems it faces: confusion across levels of procurement; the growing distance between supplier and end user; more products being labelled as commodities; the increasing administrative costs of doing business. While the NHS innovation agenda is being advanced, he said, the proliferation of bodies created to advance it is confusing.

The problem is partly one of perspective, Ash argued: where innovators see improvements, efficiency and a better patient experience, providers see staff and training issues, reduced patient throughput, delays, missed targets, disruption and integration issues. But it remains clear that quality and innovation are the drivers of efficiency savings.

Ash recommended that the NHS should: prioritise process improvement; avoid slashing capital budgets; offer a single adoption pathway; and allow more clinical input into procurement. Finally, he recommended that the AfPP should engage actively with medtech to improve outcomes in the operating theatre, building an ongoing relationship between suppliers and theatre staff.

The application of Web 2.0 technologies to patient monitoring and clinical communications offers a new healthcare model that will be essential to the NHS in the coming years. Barnaby Perks, Director of ERBI Medtech, talks to Medtech Business about what wireless healthcare means for the industry.

Barnaby Perks

ERBI is a not-for-profit membership organisation for international life science and healthcare companies, based in Cambridge. Its 370 members include pharmaceutical, biotech and medtech companies and associated technical and commercial service providers.

ERBI’s report Is the future of healthcare devices wireless? was the result of an ERBI and Cambridge Wireless joint workshop on 4 December 2008, when the region’s biomedical technology and wireless communities came together to discuss the possibilities for wirelessly enabled medical devices.

How are wireless healthcare technologies changing the healthcare model in the UK? Why is this of benefit to the NHS?

There is an increased awareness of the need for monitoring patients.

The practicalities of monitoring patients on a long-term basis have always been a challenge. In the past, typically a home-based patient would need to go to their GP surgery to undergo tests. Now people are taking blood pressure monitors home with them and monitoring their own blood pressure over a period, so that their clinicians can get a view of the patient over a long period rather than just a snapshot in the surgery. You always get a better understanding of someone’s condition if you can monitor it over time. So the driver is that better data can be used to generate information to enable better understanding of conditions, leading to improved treatment.

The benefit of that to the NHS is that it improves healthcare outcomes, but also lowers costs – because you’ll be applying appropriate therapies, and where a therapy isn’t working you can switch to an alternative and monitor its effect by monitoring the person. So more effective treatment and better outcomes should also lead to lower costs.

There’s a further application in the ‘wellness’ arena: people are increasingly starting taking control of their own health, because they have easier access to medical information than before. There’s a relatively well-off and educated group of people who can afford the time to find out about their own health, and are sufficiently motivated to monitor it themselves. These ‘worried well’ individuals are potential consumers of devices that enable them to gather data on their health and either make decisions based on that or put the data into e-health sites such as Google Health, which will process the data and aggregate it with others – thus enabling them to see how they fit into the population, how healthy they are and whether they need to take remedial action.

So there’s the NHS driver and the consumer driver. The latter has a direct effect on the NHS, because if people take better care of themselves they’re likely to need much less treatment for illness.

How does wireless healthcare enable the integration of different technologies (e.g. medical devices and diagnostics)? What are the implications of this for the medtech industry?

The integration issue has two aspects. On one level you have the integration of medical devices with biologics and drugs. That’s a fairly key area: there are a lot of medical devices that have some biological or chemical element to them now, which leads to some regulatory challenges

The other key integration area is one in which wireless technology is an enabler: it’s not really integrated into the technology, but it enables us to move data between different devices. That’s the integration of information management with medical devices and diagnostics, as well as with biologics and drugs. This is critical because now we’re in a position where we have a lot more data – but data in their own right don’t tell you much, you have to process them in some way to give you some information that you can use to develop some kind of decision support. These information management tools need to be integrated with the medical devices. The wireless part of it is just a way of connecting the device to the information management infrastructure.

There are some other implications that relate to how you integrate medical devices into mainstream communication devices. Regulation is a major challenge here. Medical devices are very tightly regulated, and different types of device mean different regulatory hurdles to be jumped. You don’t have that level of regulation in the consumer electronics world: for a mobile phone, a PDA or a digital camera, there’s no regulation beyond basic consumer safety. If you want to test a new model you don’t need any regulatory approval to do that, you can just modify your product and send it out. In the camera industry they even trial new features in the market that way.

With a medical device, however, you have to test every feature before it goes to market: you have to clear all the regulatory hurdles and be sure that the changes you’ve made won’t be detrimental to the patient. If the changes you’ve made to a consumer electronics product affect the user experience, that’s a bad thing in terms of sales but it’s not actually going to hurt anybody – whereas with a medical device, you need to prove the changes you’re making aren’t going to lead to either direct harm to the patient or erroneous data that could lead to a mistaken interpretation.

So how you connect medical devices into consumer electronics is an interesting area. There are three ways of doing it. First, you can integrate the consumer device with the technology for the medical device by licensing in the technology in some way, licensing in components or licensing in a technology-enhanced consumer device, so the onus for getting the device through regulatory approval falls on the electronic consumer device manufacturer. Second, you can license in or implement the communication technologies into the medical device.

Third, you can network the medical device with the consumer device in some way. For instance, if you have a medical device that can communicate with the outside world via a Bluetooth connection that can be used by a mobile phone, you’ve removed the need for regulatory approval of the consumer electronics device, but you’ve got the connectivity you need. You’ve also got some degree of flexibility, because if the consumer device changes more rapidly than the medical device (which is extremely likely) then as long as that communication route is open there’s no detrimental effect on the relationship between the medical device and the consumer device (which is acting as a communications hub).

How can Internet-based healthcare services overcome the difficulties that many users have with major ISPs (unreliable access, poor customer service, etc)?

Internet-based healthcare services highlight how critical universal connectivity is to user experience, because the more we integrate our Internet usage into our everyday life the more important high-speed connection becomes. That’s true in our working lives as well, of course.

In the integrated health environment, where people are carrying devices and measuring markers on their bodies and identifying conditions, the Internet health sites are the key to managing the data. As I said earlier regarding the integration of information management with medical devices, if you don’t manage the data then you don’t get any useful information. The internet health sites can help you to manage your data, to turn it into useful information that the ‘worried well’ can use to manage their condition rather than just seeing a list of numbers.

Also, we can aggregrate data to get much better population statistics on the general condition of people and the onset of illness. We have to be careful in doing that, of course, because the subset of people who use these systems is fairly small and you’d need fairly wide usage to draw any good conclusions from aggregated data. But clearly the people who are funding these sites believe that there will be some value from these data.

I think the problem highlights the importance of connectivity, and is yet another reason for industry to communicate the strategic national importance of having a well-connected society.

How will the impending years of severe restrictions on NHS spending affect the prospects for wireless healthcare in the UK?

The OLS Blueprint positions the NHS as a commercial driver that should stimulate innovation by adopting new technologies, with the view that these new technologies can both improve healthcare outcomes and reduce costs. Of course, the commercial world adopts new technology all the time to reduce its costs and improve its productivity. So if we can demonstrate now that adopting a new technology can improve health outcomes and reduce costs, then there is an opportunity here.

However, it all depends on the ability of the industry to influence the NHS, and particularly the Strategic Health Authorities. If they see adoption as a key driver for them to reduce costs, then clearly they will do that; if they see adoption itself as an additional cost, then we’ll see a shrinking window of opportunity. It’s really down to the ability of the commercial sector to influence the strategists of the NHS that this is a real opportunity to improve value.

What are the main challenges that companies offering wireless healthcare services need to overcome? How can they best achieve this?

Clearly, uptake by the NHS is the biggest challenge of all. A key aspect of the innovation agenda within the NHS, driven by the Darzi review, is the adoption of new technologies to deliver the services in different ways. If you can persuade the NHS at the strategic (SHA) level and at the hospital level of the value of this, then adoption can be an enabler – but the challenge is how you achieve that, how you make new technology seem an opportunity rather than just a cost.

Regulation is always a challenge. The group that came to the event that generated our report was split between medical device people and wireless technology people. The wireless technology community showed a clear aspiration to get involved in the healthcare arena – but a lot of them were concerned by the regulatory environment, because was an unfamiliar situation. My experience is that when most people become suppliers of medical devices, that is just something they get used to: they have to understand the regulations and work within them. But it means they have to work differently – it rules out things like market-based testing, as we said before. There are enhanced safety requirements, and that means that you end up with slower and costlier development. The technology is never quite as cutting-edge. It’s better tested, it’s more reliable, it’s more robust, because that’s what the regulations require.

Clearly there are issues to do with wireless connectivity – within the hospital environment in particular. That’s changing now, but it was very restrictive in the past, and finding the right standards and the right frequencies to communicate between devices in the hospital environment is still a challenge. As soon as there is acceptance of the need and then standardisation, that will become less of a headache.

The data management problem will be difficult to solve. At present, where patients have wireless devices that they use several times a day or wear constantly, and you get data feeds from these devices back into a data centre or the GP surgery, even if you have a number of patients at once the data feeds you’re getting in are fairly small, because you’re taking a device home and you’re logging data, there won’t be that many data points and relatively few people are under those sort of regimes – whereas if this becomes rolled out more widely, we’re potentially going to see very large volumes of data coming into these centres, and the infrastructure and process to manage and interpret those data is something we’re just not doing at the moment.

Patient compliance is another challenge. It’s very easy to make someone comply with a regime when they’re in the hospital or if you only do tests when they are in the surgery, but if someone’s actually going home with a device, making sure they’re using it properly and therefore giving you valuable data is a difficult problem. We know that patient compliance on drug taking, for example, is often quite weak. The engagement of taking a device home and using it on an ongoing basis should promote compliance, however. If you feel responsibility for something and have an interest in it and are seeing personal benefit from gathering those data, then compliance should be easier.

In terms of the design of the devices, there’s a balance to be struck between the simplicity of the interface (which helps to make sure that people will actually use these devices) and the complexity of the outputs you’re providing. That’s quite a major issue for a lot of these devices, particularly when you consider some of the groups in society who will be using them. The ‘worried well’ are likely to be in their 30s to 50s, well educated and able to understand these things; but when you’re dealing with people who need ongoing monitoring from a GP surgery, they are likely to be people from a lower socio-economic group, and certainly people who are older and may be less familiar with new technology and ideas.

There’s also the challenge of skilled installation and service for homecare technologies. If people are taking medical devices home for use and problems arise, you will need a network of people who can deal with those issues. It may be possible for the patient to bring a device back into the surgery to be fixed, but that may not be appropriate. You may need skilled teams to install and service various components.

Finally, having a business model that will work, so that the companies that supply these models can turn a profit on them, is always a challenge. Clearly there are a number of telehealth companies in the UK, and those business models are being developed. We’re at the final stages of that – but there’s a lot more experimentation and experience needed before we can decide on the best business models for this new form of healthcare.

For further information, please contact ERBI at medtech@erbi.co.uk or 01223 497400, or visit www.erbi.co.uk.

A key aspect of the innovation agenda within the NHS is the adoption of new technologies to deliver the services in different ways. If you can persuade the NHS at the strategic (SHA) level and at the hospital level of the value of this, then adoption can be an enabler – but the challenge is how you achieve that, how you make new technology seem an opportunity rather than just a cost.

Medtech’s version of Tarantino’s Mr Wolf (“If I’m curt with you, it’s because time is a factor”) continues his series of brief articles on things in business that don’t add value, are not cost-effective, waste time and money, and generally take you down a road of fail.

Presentation is supposed to be what all of us business types are really good at. Getting an audience engaged, holding their attention, winning their trust, putting your message across. Actors are trained in voice projection and communication skills – in making their presence felt. Verily, it is not rocket science. But when business people need to address an audience, what dramatic strategy do they employ? PowerPoint.

This year, Microsoft PowerPoint celebrates 25 years of boring audiences to tears at corporate events worldwide. It’s the business equivalent of your friends inviting you round to see their holiday slides.

Some PowerPoint presentations, inevitably, are worse than others. A screen filled with the words that are being read out to you is a world of tedium. A screen filled with facts and figures you can barely read, forcing you to ignore the speaker’s voice while you struggle to extract the salient facts, should be banned under international law. And a screen where words and icons move around, and acronyms spell themselves out like electronic cheerleaders… words fail me. As, apparently, they do the speaker.

That’s the crux of it. PowerPoint detracts from the integrity and force of human presentation. It makes you choose between listening and reading. However slickly the graphics move, the result is a static audience experience in which the message is drained of energy. Which is why it’s the presentation mode of choice for corporate bores and fakers everywhere.

Another world is possible. Use relevant images, not printed words, to illustrate your presentation. Restrict your screen text to a few crucial facts and quotes. Better still, give your audience something unexpected: a dramatic role play, a practical demonstration, a staged encounter with a heckler, a memorable video clip. If the context is too serious and professional for such tactics, then just talk. We’re supposed to be good at that.

Do you agree with Ted? Do you disagree? Let us know! Send your comments to Ted c/o joel.lane@healthpublishing.co.uk.

Peter Ellingworth, Chief Executive of the Association of British Healthcare Industries (ABHI), talks to Medtech Business about the opportunities and challenges faced by the UK medical technologies industry at a time of serious changes in the health economy.

The Office for Life Sciences (OLS) has been created at a crucial point for the economy and the NHS. Health systems face huge challenges, and medical technology is fundamental to doing things more productively. The medical technology industry can make a difference, not just to patients but to efficiency and effectiveness. ABHI has been closely involved in presenting the key issues to the Government. The issues were aired thoroughly at the ABHI’s UK Market Conference on 24 November.

What are the major challenges facing the UK medtech industry in the coming years? How can they be overcome?

The major threat to the UK medical technology industry in coming years will be reduced funding in the NHS. With predictions of budget cuts of up to £20 billion, the challenge to the device industry is demonstrating the value of its products and showing healthcare providers how medical devices can have a real effect on the efficiency and effectiveness of healthcare delivery and provide a real boost to the UK economy. David Nicholson, Chief Executive of the NHS, has already stated that “better quality and innovation will be the main driver of efficiency savings”.

A significant threat is the disconnection between policy intent and actual delivery. In a climate of fear, it is local organisations making the wrong short-term decisions on product choice that will impact on patient care and long-term efficiency. It is now up to medical technology manufacturers to prove the ways in which innovative devices can deliver improved patient care in times of tightened budgets.

How does the ABHI define innovation in medical technology? How can the industry best demonstrate the value of its innovations?

Innovation can mean a new way of tackling a clinical challenge and perhaps a disruption to the established way of doing things – which may change the ‘patient pathway’. Clinical data of various kinds may show that there are benefits to be gained in adopting such new technologies. Data for medical device technologies are different from data for pharmaceuticals, because of the way in which engineering development takes place. The industry works with health technology assessment and evaluation leaders to refine the methods through which medtech demonstrates its value.

What is the role of the Office for Life Sciences (OLS) in helping to advance the innovation agenda for the UK life science industries?

The OLS published the Life Sciences Blueprint in July of this year. The foreword, co-authored by Andy Burnham, Secretary of State for Health and Lord Mandelson, Secretary of State for Business, Innovation and Skills, states that in the establishment of the OLS “the Government clearly signalled the importance of the industry in building the Britain of the future”. The document clearly sets out the key actions that the Government will undertake in order to “transform the UK environment for life sciences companies”.

These are based around four key pillars. The central pillar for medtech is the place of the NHS as an innovation champion. Key to this is the creation of the NHS Life Sciences Innovation Delivery Board, which puts the NHS at centre stage in terms of accountability for the uptake of innovation, and will oversee that process. The Government also recognises the need to nurture a more integrated life sciences industry, and will focus on education and addressing the skills gap to this end.

The third pillar is access to finance, including a £150m investment fund aimed at leveraging enough private investment to build a £1 billion 10-year venture capital fund. There will also be an £18 million ‘RegenMed’ programme of investment to support key areas of commercial R&D.

The final pillar will be based around marketing the life sciences sector to promote UK and NHS brands at flagship life sciences events.

How is ABHI involved in the ongoing work of the OLS on behalf of the UK medical devices industry?

After the initial work to create business cases for the Blueprint in which ABHI led work on adoption and accountability, a number of working groups continue to deliver the plans set out in the Blueprint and ABHI is involved in a number of these. Through this involvement, ABHI is ensuring that medical technology gets equal billing with the other sectors involved and that the importance of the issues our sector faces is fully recognised.

The medical device sector is distinct and quite different from the others involved in the OLS, so it is crucial that we are able to demonstrate to policy makers the importance of addressing these needs directly. ABHI recently published our industry recommendations in a document entitled Enhancing Patient Care: The Role of Medical Devices, which outlines the factors necessary to support the devices sector. These include the need for the NHS to plan for the uptake of new technologies, as the current way of running budgets disincentivises early adoption. We would also like to see medical technology assessed in the appropriate manner, not merely by using the methodologies developed for pharmaceuticals.

ABHI’s main focus will be turning rhetoric into action. With the establishment of the OLS and the comments from David Nicholson, we have seen acknowledgement of the benefits that medical technology can have for patients, healthcare providers and the economy. ABHI will be continuing to work with the OLS to ensure that these words are now turned into direct action to support our sector, which the Government itself has stated could play a vital role in “driving growth and prosperity”.

How can the medtech industry help the world’s healthcare systems to deal with the challenges of the future?

The major challenges to healthcare providers in the coming years will stem from ageing populations and increasing numbers of people who are overweight or obese. Britain’s ageing population will add to the 17.5 million people already living with a chronic condition. There is also a shifting behavioural dynamic in patients, who are becoming more intelligent and assertive consumers of devices and healthcare. Industry has a significant role to play in supporting the NHS to deliver the care people demand in the settings they feel most comfortable in. There is currently huge growth in new products that enable people to spend less time in healthcare settings and more time at home, especially around areas such as telehealth and telecare. The real challenge for healthcare providers is adapting existing treatments so that they can be administered in the home and don’t require the patient to make frequent trips to hospitals or GP surgeries.

Future NHS budget constraints will mean that manufacturers have to offer increasingly innovative solutions. Industry must demonstrate the long-term benefits of its devices and prove to healthcare suppliers, at home and abroad, that investing in the most innovative technologies can have a reduction on the patient pathway costs and release money back into the healthcare system. ABHI continues to work with the Department of Health and associated bodies to demonstrate the value of providing patients with the most innovative treatments and to highlight the dangers of short-term cutting back on treatments – a practice that is both detrimental to patients and more expensive in the long term.

ABHI will continue to shape the healthcare landscape in the UK to make it a favourable environment for UK medical device manufacturers to thrive. We continue to play a significant role in the OLS, and will be working with the NHS and our life sciences partners to represent the devices industry and achieve our goals.

Peter Ellingworth

With predictions of NHS budget cuts of up to £20 billion, the challenge to the device industry is demonstrating the value of its products and showing healthcare providers how medical devices can have a real effect on the efficiency and effectiveness of healthcare delivery and provide a real boost to the UK economy.

ABHI UK Market Conference 2009

This year’s ABHI UK Market Conference provided an essential up-to-the-minute guide to new information, ideas and strategies and enable delegates to take advantage of the latest opportunities in the UK healthcare environment.

In 2009, the signals from the NHS towards the medical technology sector have changed radically. In July, the Government stated that “UK life sciences have everything going for them: world-class facilities, talented scientists and entrepreneurial flair. By championing innovation, the NHS can support the life sciences industry in developing ways to improve people’s health.”

Yet there are frequent reminders of cuts to come in the NHS budget over the next few years. “The NHS faces the biggest squeeze on its funding since it was founded in 1948, despite pledges by Labour and the Conservatives to spare health from spending cuts in the next parliament.” (King’s Fund/IFS, July 2009)

The ABHI UK Market Conference made sense of some of these conflicting messages. Senior government, industry and NHS experts informed, educated, stimulated ideas and promoted discussion on how the new drivers will work, what has changed, how they will affect the sector and implications for the future.

Look out for our report on the ABHI UK Market Conference 2009 in the December issue of Medtech Business.

Martin Levermore is the CEO of Medical Devices Technology International Ltd (MDTi), based in Wolverhampton. MDTi is the first UK company to specialise in commercialising medical device ideas generated by NHS clinicians under a common brand.

How is MDTi dealing with the challenges of the current business climate?

Compared to most, we’re not doing too badly: we’re seeing growth of at least 10% month on month. Obviously, like every company, we’re always concerned to improve cash flow: the more the cash flow improves, the more quickly we can bring products to market. The current investment climate is proving, not only to ourselves, a bit of a tiresome situation – but we feel that by weathering the storm, we can actually get to where we need to be.

What are your main priorities as CEO of the company? How do you divide your time between different aspects of the business?

My key responsibilities lie in four main areas. First, strategic direction of the company. Second, directional management on a day-to-day basis: leading the development of the company’s activities, including marketing, technical and financial control of the business. Third, corporate affairs: increasing the profile of the business, talking regularly with my shareholders, customers and partners and maintaining our visibility. Fourth, board affairs: we intend to go for market flotation further down the line, so attendance at board meetings and preparing board agendas are important.

How I split myself down in all that is: strategic direction takes 20% of my time, 50% is spent on day-to-day direction of the business, 20% is spent on corporate affairs, and 10% on board affairs.

How does the fact that MDTi’s products were developed from ideas generated within the NHS affect the way you do business with the NHS as a supplier?

Generally, our products are more easily taken on board by clinicians, and that’s a great plus. The fact that frontline individuals have come up with the ideas, after seeing the deficiencies of existing products or processes, has meant that there are earlier adopters for these products. Obviously the NHS is a peculiar type of buying organisation, as what’s taken on is not mandated from the centre – so as a supplier we still have to follow the traditional course of any medical device company of trying to talk to the key opinion leaders, not only the clinicians but also the budget holders. But ideally speaking, the acceptance of those products makes it slightly easier when doing business.

Your Wolverhampton HQ employs six people – yet you have reached markets in Denmark, Norway, New Zealand and the USA, as well as the UK. As a small company, how do you manage to maintain a global presence?

From day one, we’ve had to look at improving the skill resources of each of our employees. Multi-tasking and the ability to manage key relationships from a distance are highly important. How we’ve done that is through the help and support of our NHS partners, and through relationship positioning with our overseas marketplace. We have regular communications with our overseas customers, both by e-mail and by telephone, and also through visits. Those further afield, for example in New Zealand or the USA, generally come to see us rather than us going over there!

How did MDTi start? What are the key factors that have contributed to your success?

It goes back to Lord Hunt, who recognised as a Minister for Health that NHS clinicians were coming up with ideas that improved patient care and improved their own way of doing business – but what was lacking was a commercial arm that could take these ideas and make them real, and also reduce the risk of the products failing.

Recognising this gap in the market, we felt there was a need for a commercial company that could aggregate all the different elements of product realisation: proof of concept, design testing, regulatory approval, investment into manufacturing and putting the requisite sales and marketing structures out there. That would empower the clinicians to get on with doing what they did best, while ensuring that their ideas saw the light of day.

One of the key features of our business model was that every product that was sold not only into the NHS but also further afield accrued a financial return back into the NHS. It was looking not only at cost savings, but at providing a royalty-based income for the NHS.

We’ve grown through having a focused business model, predicated on stating that we wanted to get 20 products to market within a short space of time. We’ve already launched eight, with a further three to be launched this year and the objective of having 20 in the market by the close of 2010. We’re clearly on the road to achieving that.