After a decade living in California, I’ve moved back to the UK. The most common reaction when I tell people I meet here is an incredulous “why?”. But we’re loving it: the food is great, the landscape is more beautiful than I remember, and it’s a joy to be close to family and friends again. My wife, who is from southern California, is even enjoying the rain - “it’s such a relief to not be in a drought!”

With the benefit of ten years of distance, it’s also clear to me that the UK has huge untapped potential. The familiar British self-deprecation has been noticeably (and understandably) amplified by years of grind, from Brexit to lockdowns to relentless political turmoil. At the best of times we’re guilty of talking ourselves down as an increasingly irrelevant rainy island. But now we seem at risk of becoming fully blind to the quality we have on these shores, and our potential to carve out a new leading role for ourselves on the world stage.

One area that’s particularly salient to me is healthcare. The NHS is known and respected globally, as a model for equitable healthcare delivery. For my wife, who has always lived in the US, it’s borderline magical. However, it’s clear to all that the NHS is in a perilous state. Rather than a reason to be disheartened, I believe that this consensus across the political spectrum presents us with a generational opportunity: to make the radical changes necessary to safeguard the NHS for the next 75 years, and reestablish the UK as a global leader in healthcare.

A key component of this will be the effective adoption of innovation, fueled in part by a thriving domestic startup ecosystem. Since I’ve been back I’ve spoken with thirty or so UK healthcare startup founders, and here are my initial observations on the state of play today:

1. We have no shortage of fired-up entrepreneurs

Compared to ten years ago, the number of founders tackling healthcare is an order of scale larger. Their passion is apparent and infectious: I’ve met clinicians stepping up to fill gaps they’ve seen in care, ex-patients channelling their frustrations into building better solutions, and passionate outsiders taking an optimistic leap into the unknown. This groundswell of entrepreneurial energy is an exciting asset, and will be a crucial ingredient of our future success.

2. Our startups skew early stage

There are very few UK healthcare startups that have achieved impact at scale. The overwhelming majority I’ve met are early stage, still seeking true product market fit.

The main driver of this is the lack of a clear path to reimbursement by the NHS for the majority of innovations. Leading innovation ecosystems like Silicon Valley benefit from a virtuous cycle: as startups scale up into mature businesses, operational knowledge and capital is generated that then seeds the next generation of startups. Without a clear and timely route to market, in a sector dominated by a (notional) single buyer like the NHS, it’s very challenging for early stage startups to find a viable commercial model and grow, so this cycle never gets going. One effect of this is a systemic deficit of operational knowledge on how to scale innovation.

3. The US market looms large

Due to this lack of a clear domestic route to market, almost every UK startup I’ve spoken with intends to enter the US market. There is an apparent consensus between founders and investors that the US is a critical step in building a sizable and impactful business, and a planned US market entry is often a necessary condition of VC funding. However, it’s also clear that the average level of knowledge of the US market, across both founders and investors, is low.

This creates a precarious situation: increasing numbers of UK-founded, VC-backed healthcare startups being drawn to the US, but without the knowledge and networks they would need to maximise their chances of success.

So the overall picture is one of huge potential, not yet fully realised. Let me know if I’m missing anything, or you disagree. I’m developing a perspective on what we need to do to address the challenges above, and believe it’s within our power to establish the UK as a leading exporter of healthcare innovation. But that’s a topic for another post.

Twelve years ago, my experience of insomnia and the struggle to get any treatment other than medication inspired me to found Big Health. From day one, our motivation has been to help millions with similar challenges back to good mental health, through digital treatments as scalable and accessible as drugs.

It’s amazing to me how far we’ve come since then. Our digital therapeutics are backed by more than 70 peer-reviewed clinical papers including 14 randomized control trials. More participants have taken part in high quality controlled studies for Sleepio, our treatment for insomnia, than for Ambien. Ten million people globally have reimbursed access to our products, thanks to pioneering partnerships with leading healthcare organizations from CVS Health to the United Kingdom’s NHS. Just a couple of months ago, the globally-respected guideline body National Institute for Health and Care Excellence (NICE) approved Sleepio as a recommended first-line treatment for insomnia ahead of medication – a first for a digital therapeutic.

We are finally on the cusp of digital therapeutics becoming a core part of the everyday delivery of medicine, with Big Health at the forefront of that revolution. At this moment of outsized potential, it’s become clear to me that we need to evolve our leadership in order to take advantage of the opportunity ahead of us.

I am excited to announce I am moving into the role of President, to continue driving strategy, partnerships, and vision full-time, in a way that best contributes to our growth. At the invitation of myself, co-founder Colin Espie, and the Big Health Board, I’m pleased to say that Arun Gupta, our Executive Chairman, has agreed to elevate his role to Executive Chairman and Acting CEO of the company. Arun joined our Board 3 years ago, bringing immense experience scaling health and technology companies. We were unanimous in our belief that Arun stepping into the CEO role would allow us to harness this moment of opportunity with additional high powered leadership capacity. In service of good governance, the Board, Arun and I will continue evaluating candidates to ensure the very best leadership configuration for this next chapter.

Since the day Colin and I founded Big Health, the mission to help millions has remained our north star. With this new leadership configuration, I’ve never been more convinced of our collective ability to reach the next level of scale, to provide reimbursed access to hundreds of millions globally, and as a result help millions back to good mental health.

Over the past year, we’ve seen a revolution in mental health - for better and for worse. The pandemic has provoked a sharp spike in mental health complaints, compounding the suffering of millions. But this dark cloud has at least one silver lining, thanks to the broad mainstream discussion on mental health: a rapid drop in stigma.

Although welcome, this catapults many workplaces into uncharted territory. Having battled the stigma associated with mental health for so long, how should employers manage an environment where mental health is suddenly discussed openly, everywhere from the water cooler to TikTok?

As the founder of a company focused on mental health, I’m aware that our work environment is probably less prone to stigma than most. So we’ve been mindful to focus on the next set of challenges beyond stigma - ensuring that, in a workplace where mental health is more openly discussed, team members get the help they need, and avoid making themselves vulnerable in the workplace.

This all starts with education. At Big Health, our clinical team has designed team training on the signs and symptoms of mental health conditions, the recommended treatments and resources available to employees, and clear signposting on where they can get more help - from our own digital therapeutics, through to traditional therapy, and any work-related accommodations.

By empowering employees to recognize when they have a problem that needs help, and leading them to access the appropriate help more quickly, this approach strives to “get ahead” of mental health challenges. That’s why we’ve built this training and education into our standard onboarding process.

Even if you’re not in need of help right now, given the focus of our work, it can feel natural to bring your own experiences of mental health to the table in the course of that work. Therefore distinguishing what is safe and appropriate to discuss, rather than something that could put you or someone else in a vulnerable position, is a key skill that all team members need to develop. So, as with other sensitive topics, principles of communication need to be part of this training, embedded into the “behavioral contract” of the workplace.

I’m so glad to see the dialogue around mental health burst into the mainstream - I’m sure much good will come of it. In the meantime, it’s critical that support structures race to keep up with the pace of change.