HeLP-Diabetes: From early-stage social venture to national roll-out

TRANSCRIPT

Episode 9

Transcript edited for clarity and context

 

Ana Lemmo Charnalia

00:00:02:05 – 00:00:04:04

Hello and welcome to our ninth episode of the podcast series from UCL Business ‘Big Talks on Big Impact’. UCL Business or UCLB is the commercialisation company for UCL, and this year-long podcast series celebrates the company’s 30 years of collaboration and impact.

I’m Ana Lemmo Charnalia, senior business manager at UCLB, and today I’m looking forward to discussing a social venture we are very proud of, called HeLP Diabetes, with my guest Orla O’Donnell.

This episode will focus on how social ventures can have a positive impact in people’s lives. For those who are not familiar with social ventures, they are businesses with a social or environmental mission, which will invest most profits back into the business to further their social mission or for the benefit of the community.

UCLB was, in 2012, the first technology transfer office in the UK to appoint a dedicated social ventures business manager. Our social ventures support and proof of concept funding helps UCL researchers to unlock impact from research that has a primary focus to make a difference to people’s lives, tackle environmental issues or meet community needs.

Before introducing Orla, I wanted to share that this podcast is very special because it’s an opportunity to celebrate Professor Elizabeth Murray’s life, who passed away earlier this year on 7th April.

Elizabeth was the co-director of the UCL Health Unit and led the development of HeLP Diabetes, a self-management programme for people with Type Two diabetes. She was a GP and will be remembered for her innovations and international reputation in e-health, and the development of digital interventions, aiming to find practical solutions to address a range of health problems.

Throughout her career, Elizabeth sought to make a difference and was driven by an ambition to see evidence-based practice implemented to make a difference to the lives of patients.

I would like to introduce you to our guest today, Orla O’Donnell, who is currently divisional manager at the Division of Bio Sciences at the UCL Faculty of Life Sciences. Orla was Chief Operating Officer for Health Digital CIC, a community interest company we incorporated in 2015 to commercialise HeLP Diabetes. She was also the project manager for the rollout of HeLP Diabetes, responsible for finance, sales and marketing, as well as the day-to-day operational delivery of the programme.

That’s quite a lot! Welcome, Orla.

Orla O’Donnell

Thanks, Ana. It’s nice to be here today.

Ana Lemmo Charnalia

It’s great to have you here.

I think it would be helpful if we talk about the first phase of HeLP Diabetes. Tell us a bit more about the programme and its benefits. Why was it important for Elizabeth and the UCL team to develop an online intervention for people with Type Two diabetes?

Orla O’Donnell

Sure, HeLP Diabetes, which stands for healthy living for people with Type Two diabetes, was originally developed as part of an NIHL programme grant, which Elizabeth Murray was the principal investigator on.

And so, we received a grant from the NIHL to develop, evaluate and implement an online programme. And Type Two diabetes cost the NHS about 10% of its annual budget and currently it’s NICE’s recommendation that patients who are diagnosed with Type Two diabetes be offered structured education programme on diagnosis but take up was quite low and a lot of those programmes are run face to face.

So, Elizabeth’s idea was that we developed an online programme set be more accessible for patients and that patients would be able to self-sign themselves up as well. It’s quite a holistic programme and we kind of included links to weight loss programmes and information for carers and family members as well. It was kind of a big, huge offering and that was developed and then we had successful trial results as well.

It was Elizabeth’s vision that it would be made freely available for the NHS as a service.

Ana Lemmo Charnalia

And yeah, yeah, I remember that was the first thing; that when I met Elizabeth, she told me

“Needs to be sustainable but it needs to be free for patients in the NHS” and that’s why we thought about a social venture.

So, let’s talk about the commercialisation journey, like the kind of that second phase. And if we go back to 2015 when we incorporated Help Digital CiC, can you think about or maybe just share with our audience why was a company needed, and also, what were the first opportunities

in terms of business development.

Orla O’Donnell

Yeah, so we… well, it was very much led by Elizabeth, but we looked at kind of different rollout options. We spoke to various different people. It was already being used in Islington Clinical Commissioning Group, Islington CCG, as part of the research.

But I think what Elizabeth realised early on, was that it needed to be sustainable; we did need an income stream. Obviously, it was grant funded (and that was a finite resource); given its kind of success and how many people liked it and used it (we got really good feedback from patients and health professionals who were using it), I think Elizabeth looked at different options, but as I say, realised we needed an income stream.

That’s when we got in touch with UCL Business and had conversations with them about different options and setting up a community interest company just seemed to be the right fit really.

We wanted a not-for-profit company that we could make it sustainable. Obviously, we had to think about… because it’s an online programme, so we needed ongoing costs for maintenance and insurance and those types of things. And so yeah, that just seemed to be the right fit.

And then we got in touch with UCL Business who introduced us to kind of a whole new world, really.  Being academics at UCL, it was something that I think neither Elizabeth nor I had ever done before but it kind of opened our eyes up to the world of business. We were part of the Innovator programme as well, which was really great.

Ana Lemmo Charnalia

Great. And I think I may know the answer to this question, but was it challenging to convince clinical commissioning groups to adopt HeLP Diabetes? And in your opinion, did it make a difference that the company was a social venture?

Orla O’Donnell

It was quite difficult to get it into clinical commissioning groups, but that’s more political

and to do with the kind of budget and challenges that the NHS faces every day; probably more so now than ever.

And what I think did make a difference was the successful trial results and the fact that Elizabeth was a clinician and, you know, they were kind of NHS clinicians.  We had health psychologists as well and we had a UCL brand. So, you know, it’s kind of been tried and tested and I think, the UCL logo was quite powerful and that definitely helped get us into the introduction meetings.

But then there were all kinds of challenges. You know, looking back, we kind of learnt a lot and it did

feel like quite a slog at the time. But you know, we managed to get the introduction meetings and get good contacts, through word of mouth, and just trust in the fact that Elizabeth was a GP working for the NHS was quite helpful.

Ana Lemmo Charnalia

Yeah, definitely the evidence, and the fact that yeah, the clinical trial and being done by UCL was really powerful when you’re talking to GPs who, at the end, are the ones that make the decision in terms of purchasing for clinical commissioning groups.

Orla O’Donnell

Yeah, I just think they were being asked to do, to take on different things all the time. So, this might sound like another thing, but we did end up signing contracts with seven CCGs in the end. So you know we didn’t do too bad.

Ana Lemmo Charnalia

No, that was wonderful accomplishment. And I think many founders underestimate the amount of time and effort that is required for an innovation to be adopted by the NHS. I think I heard one said it was around seven years. I think we did probably around like four years or something like that, which is, which is quite great.  But you, I remember you worked very hard with GP practices to encourage adoption. Can you please share some of those strategies and which ones were the most successful?

Orla O’Donnell

Yeah, so we kind of just requested introduction meetings, really, and then what helped us was the fact that we had done an implementation study in Islington, so we did have a lot of kind of experience with what works and things and, but in the role in my role as the Chief Operating Officer, I used to go along with one of our diabetes specialist nurses to practice meetings and things.

We adopted a model where we suggested that each CCG would have a Change Manager; just somebody dedicated to getting the leaflets out and going to the GP practice, meeting and talking to the nurses. It’s kind of selling the benefits, really.  We helped very much with the development of distributing the leaflets. We tried to make it as easy as possible really for the CCGs, so that it was a no-brainer.

You know, we did things like this, the patients could sign up for themselves and that was something that we adopted later on.  And then we realised we needed the structured education programme as well. We worked with two diabetes specialist nurses to develop that. And so that did, you know,

just kind of made it fit with what the clinical commissioning groups needed and what the patients needed, and to try and make it as easy as possible.

The good thing about online as well is you can make it freely available, you know, across the whole of the CCG if they had licences. So that really helped as well.

Ana Lemmo Charnalia

Yeah, that’s quite a scalable also in terms of costs for the CCG.

And the company benefited from seed funding from Health Ocean Innovators. There was a partnership between UCLB and THT social investments with backing from the Cabinet Office

Social Incubator Fund, which supported early-stage social ventures in health. I think you participated

in that accelerator program. How was the support and the investment helpful?

Orla O’Donnell

Well, the investment – I honestly didn’t think we could have done without it, because it was grant funded (our funding ended; I think in 2015 – 2016 I think we extended?)

We covered things like insurance costs, marketing costs. We also had to upgrade the system at the time. So, when we started out on this, things just changed so quickly in terms of the technology and stuff. There was a lot of work around that; that funding helped cover that and security. And I think we use some of it for marketing and things and but the programme itself was excellent as well.

As I say, you know, we’d been working for UCLB; so, it was completely unlike anything we’ve ever done before. And that was just invaluable as well because it is a different world really, you know, the business world and the academic world.

Ana Lemmo Charalia

Were any sessions particularly good? I remember you did some kind of like pitching.

Orla O’Donnell

Yeah, the pitching was quite scary. I think the one of the best things I remember was the context that we made to that programme.  It was just absolutely right fit. So, we’ve made lots of contacts

with charitable, you know, charities and very, quite senior people in organisations who were just really helpful in introducing us to other people. And we also did things like, we went to the NHS Expo and things like that. And so, you know, kind of having standards and things, and it was just brilliant really.

And yeah, the mentoring was really good. Yeah, the pitching was a little bit scary but good fun because that’s exactly what I needed to do to go in, you know, when I was pitching for the CCG.

So yeah, really good.

Ana Lemmo Charnalia

It’s opening kind of like the network that was probably the greatest benefit.

Orla O’Donnell

Yeah, absolutely.

Ana Lemmo Charnalia

So, tell us a bit more about the clinical trial and the implementation study.

Orla O’Donnell

So, the NIHR program grant and as part of that, we had five wet packages and we did lots of focus groups and information gathering with patients and health professionals about what they would want. And then we used all of that information to develop the online program and pilot it.

The pilot was quite good fun. Everything that we want, you know, that could go wrong, did go wrong. And that’s the whole point of the pilot, I suppose.  And in parallel, we ran a trial, as well as an implementation study. The implementation study was rolling out in Islington CCG and with the trial, we used the outcome measures Hb1C and PAID, which is the problem areas in Health diabetes questionnaire said measuring diabetes-related distress.

The trial results showed that it did work and with the implementation study it was a bit trickier because we did have challenges with uptake and that’s, I think, probably the thinking behind having a Change Manager. We were lucky enough to has Jamie Ross, our colleague who was going into the GP practices in Islington and kind of making people, trying to convince people and GPs to take it on.

That was all learning as well, which really helped us when we were doing it in real life, if you like; when we were working with and you know, setting up the CIC and to get it all going. So, it was all experience really. It felt like quite hard work at the time. But now, you know, given the success, it’s all been worth it.

Ana Lemmo Charnalia

Definitely! And when the company was incorporated, as you have already been working with a CCG, how the kind of relationship maybe change, or what are the things you needed to consider for a more kind of like commercial relationship.

Orla O’Donnell

So yeah, obviously it changes when, you know, money’s being exchanged.  So, it was all okay and hunky dory when we were doing it as part of the research obviously. (I think Islington kept on for it

for a bit of time afterwards). And then I think from our perspective and their perspective, it’s all about uptake and it’s going to be better value for money the more people who are using it.

It was kind of a struggle to go in and you know, because some CCGs are bigger than others as well.

It’s different numbers of GP practices that you need to engage with. We, kind of, took the stance of going into practice meetings and getting people to use it that way.

I think it’s just about raising awareness and that was kind of the biggest thing for us, because it’s so easily available because it’s online. It’s just getting people aware and getting those information leaflets out and things.

Ana Lemmo Charnalia

Wonderful. You were in charge of basically pitching for business then and I remember going with you once to the north of England to pitch for one of the contracts.

Orla O’Donnell

… which we won…

Ana Lemmo Charnalia

Yes, exactly.  That was wonderful. Can you share a bit about anything that you’ve learned, or things that were kind of like successful, when you were pitching? It probably changes, depending on the customer, but anything that you learned that you would like to share?

Orla O’Donnell

I think it’s about really selling the benefits really; you know. There are lots of information about diabetes and things online and lots of things that are free; so, we used to get asked “Well, why is this different? We can get this online and the websites for free. It’s just information.”

So, again, I think having the trial results is really important and also the fact that this was a holistic programme. It was quite different in the measured, you know, kind of talking about emotional distress. We had a lot of cognitive behavioural therapy input as well and I think that that made a real difference.

I think it’s just about selling the benefits of the programme, really, and having clear answersto those questions.  It was funny – the more pitches we kind of did, we got the same questions, and you know, it started to repeat itself. So, I did feel by pitch number ten that I had the presentation down.

Ana Lemmo Charnalia

You had the benefits log. It’s just changing from thinking about, obviously it’s a wonderful thing for patients, but it’s about how this benefit that particular clinical commissioning group has in, perhaps reduce time from from the staff or etc.

Orla O’Donnell

Yes, exactly.  So different areas have different demographics as well. And you know, we’ve kind of tried to include different menu options and things on there as well. So that was quite good fun. I remember going out to eat in Nigerian restaurant just to test some stuff. It was really, really good fun, things like were good.

Ana Lemmo Charnalia

That’s great. And if we talk about the third phase of HeLP Diabetes, that is basically the roll out. Elizabeth’s determination led to HeLP Diabetes being licensed to NHS England by UCLB for a national rollout, and based on HeLP Diabetes, Healthy Living is a web-based structural education programme that supports people to learn more about Type Two diabetes and improve their health and wellbeing.

Healthy Living is now available nationally for all people living with Type Two diabetes in England

to help them manage their condition. What are your thoughts about the programme being now available nationally?

Orla O’Donnell

I just think is absolutely fantastic. You know, it’s like all the hard work that we’ve put in has really paid off and I think that was always Elizabeth’s vision. And so, you know, it’s great that she’s kind of left that legacy.  It’s great that it’s sustainable as well. And I think there’s just, you know, it’s so easily available to people.

I’m really proud of it. I’m really proud of the team, really proud of Elizabeth. And I’m proud to say I was part of it. And it’s just great to see that it’s, you know, not just ended and that it’s going on and helping people. So, there’s a lot of emotional support as well, which I think makes it a little bit different. And I just think it’s just fantastic.

Ana Lemmo Charnalia

That’s great. And that’s wonderful, too, to finish with.

Thank you, Orla so much for your time. It has been an absolute pleasure to well, having had the opportunity to work with you, but now talking and learning more about your experience and also to celebrate Professor Elizabeth Murray’s legacy.

Thank you, everyone, for listening and please do not miss out the next episode of UCL Business.

Big talks on Big Impact. Bye for now.