Episode Transcript
Julia: Hello, I'm Julia Hoggett, I'm the CEO of the London Stock Exchange. In this series, we meet with CEOs and founders of listed companies and significant private companies to understand the journey that they're going on and where they want to take their companies next. Now, I am delighted to be joined by Ben Maruthappu from Cera Care today and to hear about the journey of a remarkable organisation. Ben, welcome to the Stock Exchange
Ben: Great to be here, thank you.
Julia: There is something in common for almost all the founders I meet, which is that they identify a problem that they're passionate about, and that's what drives them to create a company that then resolves it. It feels to me like Cera Care is almost the epitome of that statement. But you basically started as a doctor. So can you tell us a bit about your journey and how it took you from practicing medicine to what you do today?
Ben: When I started university, one problem that I was drawn to was that there's quite a lot of inequality when it comes to medical training. So I was fortunate to have great resources where I was studying, but if I look at other parts of the world, not everyone does. And so I was involved in setting up a charity that supported people in parts of Africa to be funded and go through their own medical training, and then I spent a bit of time abroad in the US which strengthened and reinforced my entrepreneurial spirit. Seeing what technology companies were doing there and how quickly they were moving to try and change parts of society or even change the world, I found really inspiring. And then I came back to the UK and started practicing in the NHS as a doctor, which was a long-term dream of mine, and it's great to make an impact on patients and support them and day-to-day. But I also really saw the challenges that the NHS was facing, where we've got a growing, ageing population with more long-term conditions and that place more demands on the health service.
Julia: And we hadn't really changed the model much to face that challenge, had we?
Ben: Exactly. And so it became very clear to me that more of the same wouldn't really cut it. There needed to be a change. And I thought, why couldn't technology help deliver that change? Given it creates opportunities to do more with less, to improve user experience, and many other sectors around the world had already started to be revolutionised by technology.
Julia: So let's talk about what Cera Care does. What's the issue that you're addressing and how do you go about doing it?
Ben: So at the beginning of 2016, I went through quite a difficult personal experience. My mum sadly fell and fractured her back and she needed care and support at home after she was discharged. And it was really difficult to get that care organised. So at the time I was practicing as a doctor in A&E myself, working very hard for the health system, but it was a struggle to get the care my mum needed. I was calling different home care companies and agencies, people wouldn't even pick up the phone. And eventually when care did start, my mum had this revolving door of different people trying to look after her.
Julia: No consistency of care.
Ben: Exactly. No consistency, different individuals. I didn't even know the name of some of these individuals, let alone how the care was going. And I thought, how is it in a day and age when I know the person who's dropping off my Amazon books or if my Uber's running late and what my Deliveroo is, I have no insight in the care my mum is receiving. And that's the case for thousands, even millions of other people out there going through a similar process. And so I thought that technology could help transform what is quite an outdated industry, both for the people receiving care, like my mum, but also the people delivering care. And that in turn formed the background and context for Cera's model. And so what we do at Cera is we look after people in the home, a bit like what my mother needed. We send carers or nurses to their home to support them. Almost all of our work is delivered on behalf of the NHS or local governments who will refer people to us, for us care for. But what is really different is that we've built our own technology that improves the quality of care, our ability to scale user experience, and even our sustainability as a business because it is a very tough sector. Now we have over 10,000 staff and we're delivering every month two and a half million visits to people in their home. So that's about a visit every second. What's crucial is in every visit, our carers or nurses will log information about how that person's doing on our app. Their symptoms, what medications they're taking, what their sleep or mood was like, what they may have been eating and drinking. This gives us quite a clear picture in terms of how their health is changing over time. We run AI on that, and this in turn allows us to predict if people are going to become unwell before they do, so we can intervene. Whether it's reviewing their medications, contacting their GP, reviewing their hydration and so on. And those actions actually allow us to reduce hospitalisations by up to 70%, which is a lot because the people we care for tend to be the oldest and most vulnerable in society. Without our technology, they would end up in hospital almost eight times a year, and we try and get that down to more like three times a year. And we've seen falls come down as well, which is important because falls are the number one reason older people do end up hospital. Studies have shown that our ability to improve health outcomes, to take pressures off the NHS, is saving the health system and the government about a million pounds every day. Because our model is almost 10 times cheaper than looking after someone in a hospital or another setting. So we've been able to create a model that is delivering better care and is better for staff, but crucially is also taking pressures off the health system and trying to make it more sustainable.
Julia: Well if that isn't a purpose-led organisation, I don't know what is.
Ben: When I looked at actually launching Cera in the first place, what I realised is people in health and care are very well-intentioned. Some of the most resilient people I know. But unfortunately in many cases, they're limited by the tools of their organisation, particularly in social care. Most organisations are using pen and paper. Some, when I launched Cera, weren't even using the internet, which is miles off other sectors. So we started by digitising a lot of the care process, parts of training, parts of regulatory compliance, parts of scheduling, payroll, all of the administrative parts of care so people could focus much more on the service they were delivering. And then as time went on and we became larger, we started to use data, which is where AI came in. And this initially kicked off with taking the data from the different visits that we were delivering and using that to predict and prevent health issues and hospitalisations. Our staff will see every time they deliver a visit a notification or recommendations as to what they should be doing. And this is important for staff, not just because we're reducing paperwork, which allows them to enjoy their job more, but it's really empowering. They get much more information at their fingertips, they get data and insights on the people they're caring for. If there's handover between different carers who are looking after the same person, that happens in a much more seamless way. They want to be delivering better care. It's really disempowering if a carer goes to someone's home, that person is potentially quite unwell. They try calling up the head office or an operational team member who doesn't pick up the phone, and then they don't know what to do, because they potentially have to go and look after someone else in someone else's home.
Julia: And they're reinventing the wheel each time by trying to understand what the circumstances of the patient are rather than having a continuity of care where they understand where they are today.
Ben: Yes. And so it's transformed the quality of care that we deliver, how our staff are feeling empowered, and now with later technologies like large language models which we've been using to automate care plans and some visit reports that we deliver in all of the appointments in people's homes, that is freeing up even more time. So about two hours per day for our care staff, which they can otherwise now reallocate to delivering care and looking after people. And so it's improving health outcomes, staff satisfaction, but also staff productivity, which is very important given the nature of staffing in the sector and the pressures that health and care are under.
Julia: So we've talked about the staff. The direct impact on the patients must be huge. How do you gather that feedback? I mean, obviously, you can do it empirically through the medical outcomes, but do you gather other feedback from patients compared to how it used to be as it were?
Ben: Yes, so we have lots of digital ways of getting that, so after every visit someone can give us feedback, their family members can give us feedback as well through the app. As I mentioned, health outcomes improve, whether it's hospitalisation, falls or other forms of health deterioration, which can be really life-changing for the people we care for. While we do get lots of objective and data-driven digital forms of feedback, we also get, and I receive, direct feedback from people all the time, and it's hugely fulfilling actually because that's why I set up Cera and launched the company.
Julia: It's almost like technology facilitating greater humanity, isn't it?
Ben: It is, yes.
Julia: The growth you've had to date has been remarkable. Where do you think it can go from here, and what further impact do you think it can have on the NHS?
Ben: Absolutely. So I think in terms of right now, the benefits we have to the health service are firstly we are looking after people in the home, which immediately takes a cost pressure and an attendance pressure from hospitals and primary care. Then because of AI technologies we're preventing health deteriorations, which can be a major reason of someone ending up in A&E, which in turn is very costly for the health service. And then we're able to accelerate the discharge of people who are already in hospital back home. And that's important because every day there are around 14,000 people in that position in this country, people on hospital beds. They don't need to be there. They want to be at home.
Julia: But they need a safe ecosystem to go back to.
Ben: Exactly. And so we deliver that. We support rapid discharge from hospital to home, which in turn creates more capacity in the NHS. And it's because of these different interventions and roles that we're playing that we are able to save the health service and government about a million pounds a day. And that's increasing rapidly. We're starting to partner with life science companies around research for older people, because what's interesting is, if you look at clinical trials and developing new medications, around two-thirds of people who receive medications ultimately and have diseases are above the age of 65. But that cohort, that group of people are just one-third of people in clinical trials. And so there is a mismatch there which we are trying to solve by working with life sciences companies, given the access, given the number of people we're caring for and the data we have. So that's one area that we're expanding into. The second is geographically. So we're delivering care in the UK and Germany, but we still have many more areas within those countries we can expand into and we're licensing our technology to get further reach. And the third way we're expanding is in terms of the services we provide. So we initially started with care in the home, which is what I had to organise in my personal experience. We then expanded to nurses, physiotherapists, OTs, and were expanding into other types of services as well in other healthcare professions. But we've even started delivering care with robots as of this year.
Julia: Talk me through this.
Ben: For some of the visits we're delivering now, we have robots who are, it's almost like a droid actually, if you've ever been interested in Star Wars. And it will give medication reminders, support people with their medications, hydration reminders. So by having robots who can be trained by our data to deliver that, it makes our workforce far more sustainable.
Julia: So are they basically sitting in someone's home?
Ben: Yes. They sit in someone home and they support with those types of tasks, which means the amount of human visits can potentially change. And a carer can focus on people who really need care the most. And this makes care much more accessible as well, because we're just almost expanding overnight the amount of care we can provide by around 20%.
Julia: The stereotype is that people in that cohort may be probably less comfortable with technology and change and that sort of thing. How are you finding those people who have the droid in their home, as it were, how are they responding to it?
Ben: So we'll ask someone before doing it and make sure they're happy. And some people will be quite keen to because the droid also supports with video calls. So they can make video calls to their family members in a way that if they weren't able to really use a smartphone properly before they now have that access. So there are some personal benefits to them which has really improved the uptake and the satisfaction rate. But of course, if they prefer to have in-person care, we are fully able to deliver that too. This is about ensuring that we have a model that works not just for us but for the whole sector in the UK and beyond that we fast forward 3, 5, 10 years' time. And I think given that the needs for care are only growing, in the UK there are over a million people who need care right now who are not getting it, it's crucial that we innovate and we look for other solutions to help provide a more rounded staffing and care solution.
Julia: And you mentioned doing it not just in the home care setting, but actually in what might be seen as more classical, already set up provision, physio, or whatever else. I mean, this is almost as if your app becomes a very significant mechanism of delivering healthcare across the UK or across Germany, even when the NHS is still struggling with its own technology and not quite there yet. Is that almost what's happening? It's sort of building into a broader and broader range of provision?
Ben: So we want to be and provide a holistic service in the home. So because the people we tend to care for have multiple care needs, not just a carer, not just a nurse, multiple. If they've fractured their hip, they will need physiotherapy to support them and get them back to where they used to be in terms of their mobility. So we want to be holistic, which means they don't need to ping pong to lots of different parts of the system, it's not confusing. It's a much more seamless experience for them. In the UK actually, the majority of care and healthcare in the home is delivered in partnership with the NHS. So it's delivered by small businesses that are commissioned by the health service or local governments. And so we fit very neatly into that model. And so the NHS absolutely is focusing on delivering care in hospitals, in primary care and GP practices, in mental health settings, but we're an extension of that working side by side to ensure in the home people are getting the healthcare they need.
Julia: And everything plugs together.
Ben: Yes.
Julia: So just to finish, I'm really struck by the purpose and the key aim of the organisation and that intersection between making sure technology can enable people to deliver what is still a very human delivery product. What's your, having learned what you've learned over the years you've been founding and running the organisation, what's your takeaways for the next generation of entrepreneurs who want to come next?
Julia: I think firstly building a mission focused company for me has been invaluable. I think that entrepreneurship is tough. You go through ups and downs, there are lots of learning curves, particularly if you haven't built a business before, or you're from another world, such as being a doctor. It is challenging. But having a mission in those long nights keeps you motivated, keeps you going. I mentioned some of the stories that I hear, which make me even more motivated to make a difference and scale our solution. And I think it's brilliant for giving a team a North Star to look towards, to align on goals, what we're doing. Mission is very, very important and powerful. And so for other entrepreneurs out there, there's so many societal challenges which can be solved using entrepreneurial solutions, and I'd really encourage them to take a risk and do that. A second suggestion, which comes more from my vantage point in healthcare, is there are lots of lessons to be learned, potentially, from other sectors. It can be easy to focus just on.
Julia: This is how we've always done it.
Ben: Yes. And even some of the innovation that's happening within one's own sector. But in Cera, we looked at how companies like Amazon and Deliveroo manage their logistics, so that we can manage our logistics more effectively and get a person in the right place at the right time. We've looked at companies such as DeepMind, who are looking at data in AI and how it can transform healthcare. And so, yes, healthcare is behind many other sectors in some ways, which is a challenge, but it's also an opportunity. An opportunity to learn from other sectors.
Julia: And almost to leapfrog.
Ben: Exactly, yeah, to leapfrog. Not reinvent the wheel and to accelerate innovation. In the world we live in now, where AI is moving so quickly and is potentially moving much faster than we thought it could have three, four years ago, the opportunity to leap-frog is there. And so sectors that are potentially slower, like healthcare and education.
Julia: It's almost a second-mover advantage.
Ben: Exactly. So that's a second area. And the third area is and which sounds a bit corny, but I think it really is all about the people. Before Cera, I hadn't really hired or managed anyone.
Julia: Now you've got a big problem.
Ben: But I've come to learn that talent is crucial. One person can make a transformational difference in a given team, in a department, in the whole company. And so a rigorous focus on talent, finding the most appropriate people, supporting them, building a great culture that is mission focused, I think is critical for any fast-growing organisation or any entrepreneur.
Julia: I couldn't agree more. I always talk about the role of the Stock Exchange as a convener. Our job is to bring together those who have capital with those who need capital in service of an objective, and everything that we do runs from that. And I would say that I spend a third of my time on people, a third of my time on strategy, and a third of my time on the day job. Because for the very point it takes a huge number of incredibly talented people to run this place. My job is to give them the best support and the best strategy that they can in service of that and to make them feel proud about the job that they're doing. And a lot of what I think we're trying to do is recognise that for people like you, the hardest thing you should do is come up with a really good idea and seek to execute it. It's not to try and figure out also how to navigate the labyrinthine language and world and kind of the financial markets, it's us to try to make a much more straightforward playbook for founders like you to use. And if I come back to our purpose, that in service of an objective, I can't think of a better one or a stronger one than what Cera does. So I'm really delighted to learn more about the story and also give you the opportunity to tell it because it is a remarkable one and I hope it enables more people to realise the remarkable work that you're doing. So thank you very much for coming in Ben.
Ben: Thank you. Thanks for having me.
