The following interview is a conversation we had with Dr Thomas Oakley,CEO of Feedback PLC, on our podcast Category Visionaries. You can view the full episode here: £20 Million Raised to Build the Future of Patient Data Sharing
Thomas Oakley
Hi, thanks for having me.
Brett
Not a problem. So, to kick things off, could we just start with a quick summary of who you are and a bit more about your background?
Thomas Oakley
Yeah. I’m Dr. Tom Oakley. I am the chief executive of Feedback PLC. My background clinically is as a radiologist in the UK NHS. I left clinical practice about ten years ago and have been in and around the medical technology space ever since, with various roles across NHS England, which is one of the national bodies here in the UK. Before then, taking on this chief executive role with VBAC plc and taking us in a brand new direction, which has been a really exciting journey.
Brett
And did you always plan on eventually leading a tech company? Was that the master plan in the back of your head when you were going through school?
Thomas Oakley
No, not really. I wouldn’t say that I’ve had a particular life plan. It’s interesting that I ended up doing medicine, actually, probably more at the direction of my school than anything else. But it was a fantastic vocation for the period I did it in. A great subject to learn, but I certainly didn’t envision that I’d be chief executive of a public company, age 30, and trying to drive a new product and transformation into the NHS? No, definitely not.
Brett
I think a lot of entrepreneurs and founders and executives have a similar story. Now, a few questions we’d like to ask, and the goal here is really just to better understand what makes you tick. First one, what CEO do you admire the most and what do you admire about them?
Thomas Oakley
Yeah, so it’s probably not one you may have heard of, actually, but it’s a guy called Tim Spector, who is a very eminent nutritionist, who set up a company called Zoe, which is really looking at your microbiome and how your microbiome is linked to all of your improved health metrics. Longevity, reduced diabetes, reduced dementia risk. And he’s really translated science into a commercial product that has real life application and real impact for consumers. And I think it’s a fantastic piece of work he’s done. He’s a very interesting individual. He actually ran the national Twin study Centre in the UK, and that’s where a lot of his work was based, looking at the impact of diet on longevity and various health outcomes between twins, because obviously that removes the genetic variation component, and so you just see the impact of the diet and microbiome alone.
Thomas Oakley
But I think to take the deep subject matter expertise and be able to convert that into a viable business that is transforming people’s lives is something that is really inspiring.
Brett
Wow. Fascinating. I’ve not heard of him, but I’ll definitely have to check him out after this interview. Another question we’d like to ask is about books. So we got this from an author named Ryan Holiday. He calls him quickbooks. So a quickbook is a book that rocks you to your core. It really just influences how you think about the world and how you approach life. Do any quickbooks come to mind?
Thomas Oakley
Yeah, I think there’s one book I recommend to everyone who’s thinking about a sort of entrepreneurial commercial journey, and that’s the blue Ocean strategy book by W Chan Kim. It’s just a fantastic way of thinking about how you can position your company and your products into essentially a strategy that involves not competing, in fact, avoiding competition by forging into new areas, developing new markets yourself. That he creates this concept around most companies operating in red oceans where there’s lots of competition, everything is all about differentiation through technical features and on pricing, versus actually taking that proposition and putting it into somewhere new, often an adjacent market opportunity, and creating new uncontested customer opportunities, and that being a much more efficient way to grow.
Thomas Oakley
And I think from my experience of doing the same thing with feedback, that has definitely been true, especially in healthcare, which is a very congested space, typically particularly in the medical technology space. So being able to leverage technology, repurpose it, pivot it into a new direction where there aren’t existing competitors as being a really efficient way for us to grow and was really very much informed by that sort of strategy.
Brett
Well, I think it’s a perfect segue to dive into feedback a bit more. So can you just tell us at a very high level, what does the company do?
Thomas Oakley
So feedback, in its simplest form, provides frontline clinicians with a toolbox that lets them see all the information they need to see about a patient and connect them to any clinical colleague that they need in order to make a decision. So what we’re really about is making it faster for clinical teams to reach a decision about a patient. So we essentially remove the geographic and time based parameters of care so that you can see any patient, any location. The core product that we have, Bleeper, is a communication interface for clinicians. It creates a common view of a patient’s clinical data from multiple hospital systems, and in fact, even from multiple hospitals. So we can create a common view of a patient across a number of different clinical stakeholders.
Thomas Oakley
We can move patients between primary care and secondary care, so between gps and hospitals, and we can allow clinicians to come around that view and to create multidisciplinary discussions and management plans in a very flexible way. We’ve actually demonstrated in the NHS a 70% reduction in patient wait times without needing any additional clinical staff at all, and in a way that actually releases cash back to that system. And it’s probably true in the US. Here in the UK, the big pain points affecting our healthcare system are around staff shortages, short budgets and long patient waits. So we address all three of those just by thinking differently about how we bring clinical teams together and how we bring that data out of very siloed systems traditionally into one environment which they can access from everywhere and online.
Brett
I see that the company has a long history, and it wasn’t like a typical startup that was founded in the last three, four, five years. It’s been around for 20 plus years. So can you tell us a bit about the history of the company and then how you ended up becoming CEO of this company?
Thomas Oakley
Yeah, no, absolutely. We are a very unusual company for our size, in that we are both, to all intents and purposes, an SME. But we’ve been around for a very long time. So feedback actually started out as two different companies, a company called Cambridge Computer imaging and a company called Textrad, and they were essentially a Pax company, which is a picture archiving and communication system. That’s really how hospitals store their radiology images. Think of it a bit like a digital library. Your CT and MRI scans, when you pull them out, when you want to report them, that’s what the company started out doing. And they also developed some very early stage artificial intelligence programming around image interpretation, something called quantitative analysis. And that was really used in a research setting to help to interpret CT scans and pull out additional information.
Thomas Oakley
So it was very much a very technical, imaging focused company. One of the unique things about that is that in the UK and in fact, internationally, a lot of the radiology imaging is considered a medical device function, which means in addition to generating software, you’re also creating a medical device. And that may be worth us talking about a little bit more later. Because there is a friction between being an agile, lean startup and a medical device manufacturer. The two don’t easily go hand in hand. And that is a tension, a very healthy tension, within the company we’ve had to work through over the course of the last few. Reversed into a public company called Feedback PLC in 2014 and merged to create the operating company feedback Medical. That company then operated until I joined in 2019 and became chief exec on the 14 February.
Thomas Oakley
And as I often joke, I’m in a four and a half year relationship with Feedback. And since then, we have been looking at how we can leverage that 20 plus year heritage of medical devices software and repurpose it to address a much wider clinical audience. So we took our medical imaging focus and said, well, how do people that are not radiologists use medical images as part of their frontline work? And how can we create a tool that lifts and shifts that technology and gives it to them in the way that they want? And that’s essentially where we created bleeper. And bleeper. The best way of thinking about it is that it is a clinical grade version of WhatsApp, which provides you with a secure, chatty environment that is patient specific.
Thomas Oakley
So you’re only talking about one patient at a time, that instead of having photos and videos, you have ct scans and mris, blood results and ecgs. So that’s essentially what we created.
Brett
And can you talk to us a little bit about the decision to go public and why that decision was made? Was it for liquidity, for existing shareholders? Was it just for a funding event? What was that primary reason to go public?
Thomas Oakley
Yeah, so the IPO was actually before my time, so that was back in 2014. But the rationale was that there was a cash sell on the London Stock Exchange, which was Feedback PLC, and that provided a vehicle to go out and acquire interesting companies that otherwise wouldn’t be able to collaborate and sort of merge them together. And so Feedback PLC being that cash shell, went out and acquired Cambridge Computer imaging and Textrad Limited and bought them into that vehicle. And it was really the insight of the sort of Founder and the board at the time, a man called Tom Charlton, to bring those two entities together.
Thomas Oakley
I think he saw the synergy between the two technologies, the Pax, that digital library of medical images, and the research tool, the sort of quantitative AI tool, and how they could work together, and the company actually did reasonably well for quite a long time. They were able to provide those products into four NHS trusts, and they were supplying those four NHS trusts for over 20 years. The difficulty in the UK was that there wasn’t very much room to expand beyond those four sites, just because of the nature of the market and those products. And that market particularly got overtaken by much larger companies, such as General Electric, Phillips, Siemens, and it became very difficult to compete with those.
Thomas Oakley
So when I joined the company, it was very much in decline, looking at legacy products that didn’t have recurring revenue, and so it was really evaluating how we could transform that business model into one of sustained recurring revenues, focus at a new customer base that wasn’t full of existing competitors.
Brett
I have a lot of admiration for just executives and founders who come into turnarounds, and it sounds like this was a bit of a turnaround. What was that like for you, making that decision to come on board, knowing that it’s going to probably be difficult, you’re going to have to make a lot of big changes. What was that experience like for you in the turnaround process?
Thomas Oakley
Well, in many ways, actually, it took the best bits of my clinical background and turned them into a commercial way, because essentially you’re looking at a diseased company. Not that it was quite as bad as that, but working out which bits you need to keep, which bits are salvageable, and which bits you actually need to cut out and move away from. And you very much do look at it in a sort of clinical lens as to how are we going to resuscitate this company, and it’s often going to take something quite dramatic. That said, it has also been an absolute privilege, because the two original founders of Cambridge Computer imaging, who have been there right since the beginning, are still actually within the company. One is the CTO and one is the CIO of the company.
Thomas Oakley
So they’ve actually come along on this journey with us, and that has been absolutely fantastic to retain them within the organization. Both of them are complete geniuses that I think are really enjoying the opportunity to bring their innovations to market in a new way. And it’s been fantastic seeing the new life that has been able to be brought into the organization as a result. But definitely a very unusual and an interesting experience to go through, and also to do that on a public market is also quite an interesting story, one we may not have time for, but definitely something that I will remember for the rest of my life.
Brett
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Brett
What’s it like being the CEO of a public company? Do you feel like you’re very much in the spotlight and all of your business decisions are being scrutinized and watched?
Thomas Oakley
I think that it is more difficult in many ways than running a private company because of that level of scrutiny, but also the expectations of shareholders and the fact that a lot of those shareholders had been with the company for a long time and they had been over promised and often under delivered. So trying to change that round, to say that there’s a bold new strategy we’re going to under promise and over deliver, was just a complete transformation. And as well as bringing the staff and the team along with that, we had to bring our shareholders as well. And that also meant changing the type of shareholder that we had and bringing on more institutional investors that could come on that journey with us over the course of multiple rounds of investment and over multiple years.
Thomas Oakley
And that was a new experience for everyone involved in the company, trying to create a more institutional shareholder base. But I think the biggest frustration I have with being a public company, it is actually very difficult for us to communicate everything we would like to with shareholders, because a lot of it is inside information. If were in a private entity, we would be sitting much closer to our investors and they would be able to see all the amazing things we’re doing in the background. Whereas most of our news flow has to be highly controlled and it has to be released onto the London Stock Exchange as the primary mode of communication, which means that it is frustrating because you don’t have the relationship with investors that you would really want.
Brett
Is there a massive regulatory burden on you like it is in the US? I don’t know the exact numbers, but I know that founders have told me it can cost me, I think, 1020, $30 million per year just for the regulatory cost of being public in the US on a major exchange. I’m sure it’s not that crazy in London, but is it similar? Is there a big regulatory burden?
Thomas Oakley
Yes, I’m pleased it’s not as high as that, but yes, there definitely is. We have to maintain a lot of corporate advisors and there’s a lot of legal work. And also, in fact, when we come to report the company accounts in the annual report, we’ve only just finished working on that and it stands at almost 100 pages. I think it was 36,500 words we had to put into that. So it’s more than doing a phd dissertation, and you have to do that each and every time. So it is quite a lot of administrative and regulatory work. I suppose the flip side of that is that there are numerous advantages to having access to capital markets, both for us as a company, but also for our shareholders. They do have the flexibility to more easily acquire stock, sell stock where they wish to.
Thomas Oakley
And actually it means that we can usually raise money in shorter time period. So typically our roadshow cycle is about a week to ten days, and that enables us to raise money on that sort of timescale, which is a huge advantage over private equity raises.
Brett
One thing I talk a lot about with founders is how do you make sure that your team doesn’t get distracted by valuation? And this is something that founders always say is a big struggle and something they challenge with. And typically, I would say 99% of the time, these are private companies that I’m talking about. So it’s a totally different world there, where their valuation isn’t in plain sight and being changed day to day or hour by hour. So what’s that like for you, managing a team? And how do you make sure that the team doesn’t get too focused or too distracted by the day to day share price?
Thomas Oakley
Yeah, it’s a really good question. I mean, fundamentally, you can’t run the company for the share price. We have to focus on running the company, and we trust that the share price will take care of itself as we produce results, get, renew and drive sales, and by and large, those are the biggest items that do drive the share price. And it is often very frustrating and having a very challenging time in terms of the markets for the last couple of years. And we have seen a sort of erosion of our share price, actually often completely unrelated to the activity of the company, just by virtue of the market and the conditions. But what we do focus on is driving core value in the company.
Thomas Oakley
And our operational and core staff team are actually really focused on just delivering really great quality products to our customers and driving the sales and adoption of those. We as a company sit extremely close to our customers. We iterate the product based on consumer Feedback. We, particularly during COVID developed capabilities for those clinicians that allowed them to then treat and manage patients internationally. We had consultants who were treating patients in Manchester and advising on treatment plans whilst being at home with family in Delhi, india. And all of those changes were driven by our absolute obsession with sitting close to the customer. And when you do that and you keep the team focused operationally on the customer and creating value for the customer, actually, you tend not to focus on the share price so much.
Thomas Oakley
That is really the thing that myself and the chief financial officer focus on, and we try not to distract the team with.
Brett
That makes a lot of sense. And you mentioned their competitors. What’s it like having these big competitors like GE?
Thomas Oakley
Well, I actually think it makes it more interesting in many respects. We have competitors that do bits of what we do, but no one that brings it all together in the way that we have. So there are other tools, for example, that provide a chat interface, and there are other tools that provide integration between sites, and there are other tools that have medical image viewing capabilities, but no other entity has wrapped that up into one end to end package and offered it to a customer. And we are certainly in the UK, the only clinical collaboration platform that is certified as medical device for image display. And that means that we can do things that other vendors can’t.
Thomas Oakley
So, for example, were selected to run the UK’s first end to end care pathway between gps in primary care hospitals, in secondary care, and these new community diagnostic centers. And that was because were the only provider that had the capability to stitch the IT infrastructure together in the background and then present it in a collaboration environment that could bring stakeholders from hospitals and GP practices together around that view. And so that actually gives us a huge advantage. We’re able to move at a pace and a speed that large entities can’t compete with, and to create a user experience that is often far superior to the technology that these large companies generate. And that’s really because we’re able to sit that much closer to the customer than they can.
Thomas Oakley
But then we also have the regulatory capabilities that mean that we have a high barrier to entry to smaller companies who try to do the same thing as us. And that’s where the medical device has both a real term advantage for us, but also creates that slight friction because we can’t be as agile as we’d like to because we have to conform to quality standards as we develop the product. I mean, the big difference for us versus a typical software company is that if you are developing software in an agile way, you rapidly create a new version of a product, you see what works, see what doesn’t, and then you iterate those changes back into your product.
Thomas Oakley
You can’t do that in a clinical environment where if you get something wrong or there’s a bug in your software that could have an impact on patients. So the medical device way of developing software is to risk, assess everything that you’re doing, anticipate risk and try and remove it from the product before you ever put it into the hands of clinicians in the first place. So trying to move in that agile way where we want to try new things, but we have to do it within a safe and risk assessed parameter, is really quite a unique skill set that I think we have really nurtured within the company, and it’s not something that many companies can do from a.
Brett
Sales and growth and adoption perspective. Are there any numbers that you can share?
Thomas Oakley
Yes, I can share some of the latest figures that will be coming out with the annual report. The highlight figures are that we have seen a 74% increase in revenue over the prior period, and that’s being driven by an increase in sales of 89%. And this is actually a pretty consistent growth story for us that we’ve demonstrated over the last three years, pretty much delivering 74% growth year on year, and we are expecting to do even more than that, hopefully in the coming periods as we see more and more adoption of our product. We’ve also maintained a very good cash position, closing the period at 7.32 million of cash. So plenty of cash to drive our growth and strategic ambitions in the coming period.
Brett
What do you attribute to that growth and success? I’m sure there’s many factors that have played a role there, but if we had to choose maybe one big thing, what do you think that would be?
Thomas Oakley
Persistence. It is a very difficult thing to sell technology into any healthcare space, especially VNHs, where there are lots of budgetary constraints and where decisions typically happen by committee because they have to involve multiple stakeholders from multiple areas of the hospital. So typically it takes anywhere between ten to 30 engagements before you get to the point of contracting. Then you typically go through procurement, and that procurement process can take six to nine months, depending on the complexity. And there’s only then that you get a contract and start implementation. It takes a lot of internal discipline and drive to keep pacing and chasing and pushing, and to not give up on opportunities and to ensure that you close them.
Brett
In terms of the customer base. Are you selling just in the UK right now, or is it outside of the UK as well?
Thomas Oakley
No, we’ve actually started to work internationally. We were very lucky, actually, to receive some funding from Amazon web services to form a partnership with themselves and an AI company called Cure AI in order to deliver tb screening india. Part of our technology capability is that we also deliver services to the veterinary sector in the UK. And where that gets interesting is that a lot of the imaging that happens for horses in particular, actually happens in fields and stables, so not in a clinical setting where there’s Wi Fi. So we had to develop the capability to push imaging over mobile phone networks.
Thomas Oakley
And so what were able to do with Amazon and cure was to take an x ray machine to a rural location within India, acquire the x ray and then push it over a network straight up to the cloud, where we could pass the information through to cure AI for processing, bring the report back into the patient episode, show it to the person who had just taken the x ray, and then for those patients that were positive, have them then immediately connected through to a tb specialist who could give advice on management while the patient was still there in the screening episode. And so were able to deliver an Aipowered TB screening diagnosis within about 30 seconds of an x ray being taken anywhere india where you had 3g connectivity, which was pretty transformative, really.
Thomas Oakley
It was the first time you’ve really been able to take tb screening out of hospital settings and take it out into the community in really quite remote locations.
Brett
Final question for you, since we’re almost up on time, what excites you most about what’s next? Let’s say maybe the next three to five years, what are you most excited about?
Thomas Oakley
I think the thing for me is just seeing the transformational impact that you can have by thinking differently around technology in an industry that is quite stuck in its ways. A lot of healthcare, the data relating to patients are in multiple siloed systems, in multiple siloed care settings. Stitching it together, presenting it to clinicians in a way that they can actually use and interact with it, creates so much freedom and mobility, both for patients and clinicians, that you really can completely remove the geographic parameters of care. You can very easily create a system where patients can come and go from any care setting, have vax care setting add to their record, and be treated by specialists who could be anywhere in the world, and it just provides unparalleled flexibility and impact.
Thomas Oakley
And as I said earlier in an interview, we’ve reduced wait times in the NHS by 70% just by thinking differently about how we work. And I think that the impact is only in its infancy I think we’re going to see a huge improvement on that when we start to add in up tools into these patient pathways such as AI and third party technologies. And so I think our technology is going to become essentially a digital glue that pulls healthcare environments together and through party technologies can be deployed to a national or international healthcare audience. So I see a true international expansion for this company and certainly a national expansion within our domestic territory.
Brett
Amazing. I love the vision. We are up on time, so we’ll have to wrap here. Before we do, if anyone listening in just wants to follow along from a company building perspective, where should they go?
Thomas Oakley
They should go to our website, which is fbk.com. You can find out all the information about the company there. We’re actually just about to do a rebranding exercise and you will see a brand new website there with lots of exciting content and material. So please check it out and give us your feedback. And you can also follow us on social media, both through our company and also through our products. Bleeper Amazing.
Brett
Tom, thanks so much for taking the time to chat. It’s been a lot of fun.
Thomas Oakley
Thanks so much. Really appreciate it.
Brett
Hi, keep in touch.
Brett
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