The fortnightly newsletter that unpacks system leaders’ priorities for digital technology and what impact they are having on delivering health services. Contact Ben Heather in confidence here.

Nine days after being appointed as health and social care secretary, Matt Hancock arranged to meet a small group of digital healthcare companies to talk about his priority for digital transformation in the NHS. (You can read the list of who attended at the bottom of this story)

It is no small thing, to be invited to meet the health and social care secretary. 

There are hundreds of digital health companies, from global behemoths to start-ups, that would give a lot to have a few minutes in the room with Mr Hancock, new to the role and with a known penchant for technology.

But executives from just 10 companies were invited.

And what was discussed at that table (data, industry relationships with providers, interoperability, spreading innovation, etc) is perhaps less interesting than who was invited (and who wasn’t).

None of the big players

Let’s start with who wasn’t invited. 

None of the major electronic patient record vendors across any care settings were invited, such as Emis, Epic, Cerner or TPP.

None of the big IT infrastructure and hardware companies or IT consultancy firms (no IBM, Microsoft or Accenture).

Really none of the IT companies where the majority of the NHS’s digital pound is spent were in the room.

It is possible Mr Hancock has met with these suppliers since (Department of Health and Social Care has refused to say), but these are not the companies he met first.

Attendees DeepMind and Babylon Healthcare are high profile and attracted a lot of headlines, but they are not (currently) large scale suppliers to the NHS.

DeepMind has a commercial arrangement with half a dozen trusts, but most of them with a relatively narrow and often research focused.

Babylon has had more success in the private market (and overseas) and arguably its most important relationship within the NHS is a partnership with a single (albeit very large) GP practice.

New kids 

Conversely, most of the companies Mr Hancock met are relatively young and, often, quite small.

The national programme for IT was the last time the NHS threw serious money at going digital and many of the dominant players now stretch back to that era (or beyond).

But when NPfIT limped to its sort-of end, most of these 10 companies did not exist yet.

The median ages of the companies Mr Hancock met is about three years. The oldest, Patient Knows Best, celebrated its 10th birthday earlier this year while the youngest, Forward Health, hasn’t even celebrated its first.

Some are connected to major backers with big pockets (DeepMind and Babylon again), but many are still small and nimble.

These are the companies that Mr Hancock chose to meet first and discuss the future of technology in the NHS. 

Scalpels rather than sledgehammers 

Most of the companies Mr Hancock meet offer very specific products designed to solve very specific problems.

None are attempting a one-stop shop for digitising a hospital or GP practice or even a department.

Fly Notes is a consent platform for healthcare. The NHS is rolling out a national “opt-out” service for patients to record their data sharing preferences.

Locum Tap is a software problem for managing bank staff more effectively and reducing rota gaps. The NHS has severe workforce shortages and is trying to reduce agency spend.

Forward Health has developed a secure Whatsapp-style clinical messaging and task app. Whatsapp use is rampant among NHS doctors, despite concerns about data security and care fragmentation.

Embracing disruption

Most of these companies, to a great or lesser extent, see themselves as a disruptor.

Babylon has arguably become the face of digital disruption in the NHS with its GP at Hand partnership and claims that its artificial intelligence scored better than most (human) doctors in Royal College of GPs entrance exam.

Echo, along with its many competitors, is doing its best upend the pharmacy market.

The founder of Cera Care has described it as Uber for home care (they also have a partnership with the actual company, Uber).

Even Patients Know Best, the most established company in the room, wants to shift control of health data from clinicians (and closed IT systems) to patients which, if achieved at scale and depth, would be a huge change in the doctor/patient relationship.

What can we surmise from the above?

It is only one meeting.

Mr Hancock will (or has already) met with more established IT suppliers, which still hold the majority of NHS patient data and will remain embedded in the foundations of NHS’s digital structures for many years to come.

But there is also a clear enthusiasm from Mr Hancock for new solutions from new faces.