INSIGHTS / Report

COVID-19 has pushed technology into the forefront of everyday healthy living – whether that be accessing up-to-date medical advice, joining a virtual fitness class or needing an online GP consultation.

Historically digital healthcare has progressed at a slow rate, but the pandemic has catalysed the uptake of digital health solutions in ways we have never seen before. Right now, there is a significant opportunity to transform the delivery of healthcare both during the pandemic and after it.

SETsquared gathered together leading FitTech entrepreneurs and health academics for an online roundtable debate to explore the impact of COVID-19, the challenges faced and what the future holds for the industry. This in-depth debate was expertly led by Richard Vize, the Guardian columnist and writer for the British Medical Journal.

The impact of COVID-19 on the health and fitness industry

The COVID-19 lockdown resulted in the closure of gyms, the suspension of sports activities, and an enforced rule of only one form of exercise per day. This ignited a surge of people aiming to find new levels of fitness and engage with online physical activities in ways they have never done before.

“A lot of people who weren’t accustomed to exercise have been quite happy to get out and go for a walk, cycle or take up running,” reflected Maria Stokes, Professor of Musculoskeletal Rehabilitation at the University of Southampton. “I think limiting people’s freedom to exercise was a bit of carrot to encourage them to just get out and do it. I think a lot of people who weren’t previously active now are and it seems to be continuing.”

Mark Williams, CEO of Revoola, an interactive mind and body fitness app that provides virtual instructor-led classes and activities, supports this: “During lockdown, we saw a high proportion of people changing their fitness habits and incorporating outdoor activity, and that daily walk or run became quite a highlight for them.”

Move GB aims to keep people active for life offering unlimited access to thousands of live-streamed and on-demand exercise classes alongside in-person classes in over 6,000 gyms. Chris Wood, Head of Brand and Acquisition at MoveGB: “We had to transition the business to live streaming all of our classes and we saw attendance rise by more than 50%, which is a huge shift.”

Early research about lockdown has found a number of disparities about levels of exercise among different groups, and access to technology has been identified as being part of this, as Professor Valerie Sparkes, Director of the Biomechanics and Bioengineering Research Centre Versus Arthritis at Cardiff University explains: “Most people see the importance of exercise for their physical and mental health, however what’s really interesting is that this is not across the board. Younger people are far more likely to have done activity and it declines as people get older. So, there are real issues becoming apparent around the elderly who haven’t been exercising as much.

“The other big issue is social background. People in higher socioeconomic groups are more likely to have done activity than lower socioeconomic groups. There’s a myriad of reasons why areas of social deprivation have got high COVID incidence – I’m not saying low exercise levels is one of them but there’s a real collection of factors that requires more investigation. Also, there’s a divide between urban and rural areas; people in urban areas are likely to have done less activity.

“We’re seeing how important technology is as a means of exercise and therefore we need to start thinking about it in a different way. Technology has to support the needs of the elderly and be readily available and affordable.”

Lise Pape, CEO of Walk With Path focuses on improving mobility and reducing the risk of falls among people with Parkinson’s Disease, through the use of wearable technology. “We have mostly focused on hardware because we actually found that a lot of our users, who are elderly, aren’t necessarily comfortable with technology and many of them don’t have smartphones or if they do, they’re not adept at using it and engage with it infrequently.”

Traditional team sport is an area largely unsupported through technology and it has been hardest hit during the pandemic, affecting young people in particular. “The mass participation in the live streaming of Joe Wicks has been phenomenal to see but I think it dresses over a substantial void for lots of people,” explained Charlie Clarke, CEO of Playwaze, a digital platform designed to manage sport and physical activity.

“School competitions and traditional team sports competing in weekly fixtures and events across a lot of sports completely stopped overnight and there’s been no backfill. A lot of organisations moved to a virtual challenge model or a virtual competition which has been reasonably successful, but it’s not yet well supported by technology.

“We’re doing a lot of work to really define what a virtual competition can look like, how we can get people competing individually at home, do a skill and see where they are against others in a leaderboard. We also want individuals to represent a team, for example football but without bringing them onto a football pitch, which obviously presents all sorts of risks.

“We’ve seen a huge surge in small gym instructors and even national operators starting to use our system to promote their classes but that’s only serviced an audience of people who were going to the gym or going to group exercise classes. If you’re a club tennis player, you’re unlikely to be satisfied by a yoga class long-term. Uptake is high for online classes, but the popularity is only high in the groups who affiliate with that form of exercise.”

Participating in sport whether it be in teams, as part of a club or class ensures some level of interaction with others. Social distancing changed the face of that, and technology has been able bridge the gap.

Mark Williams of Revoola said: “Within our digital platform we’ve seen the importance of community grow. People can schedule their own classes with their own group of friends, so where before they would have met for a fitness class in a gym, they’ve been able to transition this to a virtual environment and still work out together and have fun.

“Our primary market is corporate and we’re seeing workplace teams really embrace it. It’s a great way to maintain a connection and a team mentality.”

Developing a sense of community through technology has also shown to be important among people with long-term conditions. Maria Stokes, Professor of Musculoskeletal Rehabilitation at the University of Southampton, is running a research study about physical activity in people with long-term conditions and their attitudes towards technology: “People really enjoy the social aspects of being able to engage with other people with long-term conditions. The time they spend with a physio or trainer is limited but they can find help and support through others. So, I think we need to develop more ways in which this can be incorporated into online platforms and apps.”

The sense of community is playing a key role in supporting healthy minds. Social distancing is presenting many challenges for mental health such as dealing with fear and anxiety and coping with uncertainty. Arjun Panesar is CEO of Diabetes Digital Media (DDM) which aims to empower its users to be in control of their health through the use of clinically validated digital health solutions. “At the start of the UK lockdown in March, we saw a 300% week-on-week increase in service demand, and this was because users were consuming more bandwidth asking questions, engaging in conversations and more activities, particularly those linked to mental health. We saw that pattern continue throughout lockdown and then peaks and troughs while lockdown has been easing.

“DDM collects mood and it’s been fascinating to follow in real-time how people have been feeling during this extraordinary period. We allow users to track their mental health through emoji centres. During lockdown we’ve had ‘happy’ emojis and a mix of ‘happy’ and ‘anxious’ but once it was announced that lockdown was ending – we didn’t have anyone happy; everyone chose ‘anxious’.”

According to Mark Williams at Revoola, anxiety was a feeling shared among their users: “We saw quite an increase in people using the mental health aspects of our platform including sleep and relaxation.”

Chris Wood at MoveGB: “The most attended live streamed classes are yoga and when we researched our users about why they chose that class, almost all said mental well-being.”

Lockdown has had a profound impact on the mental health of teenagers. Hugo Ward is CEO of Quol – a video platform pioneering positive-psychology strategies to help meet the growing mental health challenges and curriculum needs in secondary schools: “One of the first things that happened during lockdown was the closing all schools and that’s never happened before. It’s interesting because it forced schools to adapt to technology and digital learning, when in the past a lot of schools thought digital features were a nice add-on or bolt-on to the existing curriculum. Now it’s very much at the forefront. Secondly, is the impact lockdown has had on teenage mental health; 83% of young people reported feeling far more anxious than they did before the lockdown. It’s been a really challenging time for all of us, but I think especially young people, because their foundations have been pulled from under their feet and it’s been a very difficult thing to navigate.”

How and why anxiety has been felt by people differs as Louise Morpeth, CEO of Brain in Hand, a digital platform for people with autism and learning disabilities explains: “The rules during lockdown were very clear and this actually provoked little anxiety among our autistic users. However, we’re now seeing an increase in the use of our response service because individuals are needing extra help as they try to understand what they can and can’t do as lockdown eases.”

NHS digital – opportunity & challenges

Technology has long been championed as the solution to many of the long-term challenges facing the NHS, but it has been slowed by many obstacles such as technological integration and funding being diverted to more immediate issues. When COVID-19 happened, technological solutions that were previously overlooked became adopted with immediate effect.

There’s been a seismic shift towards remote GP consultations. According to NHS Digital during the first week in March, 80.5% of consultations were delivered face-to-face with just 14.2% by telephone. New figures suggest that it is now closer to 97% of appointments being held by telephone or video.

“COVID-19 has moved the use of digital in NHS and healthcare forward by a decade,” commented Arjun Panesar from DDM. “This has rippled throughout the rest of delivery, for instance, some doctors can now email patients – which is something many couldn’t do before lockdown.”

The impact of COVID-19 on the NHS is likely to be felt for several years such as the build-up of undiagnosed medical conditions, a backlog of elective care, and rehabilitation of patients worst hit by infection.

This presents a huge opportunity for technology entrepreneurs who have a digital solution for the NHS of the future. But it is not an easy institution to get inside of, as Louise Morpeth CEO of Brain in Hand explains:

“Our experience is that it’s incredibly difficult to meet the standards that have been set by NHSX. We’re successful selling to local authorities but the technology standards for the NHS are completely and utterly different and almost impossible to meet.

“I just wonder whether NHSX is going to enter into a dialogue with business about what’s going to need to happen if innovation is going to be nurtured and enabled and all these solutions to be actually available to the NHS. At the moment there’s a massive disparity which, I think, for a lot of innovators is just saying don’t bother with the NHS because it’s almost impossible to get in there.”

Arjun Panesar from DDM agrees: “The NHS is an extremely complex healthcare system. It presents very different challenges to other markets we work in such as Canada, Germany or even India. Organisations like the NHS Innovation Accelerator are helping to bridge the gap between innovators and NHS. When we first started in our Innovation Accelerator we were actually told, ‘Don’t look at the NHS as one organisation; look at it as 10% of GDP and 10,000 smaller organisations’, and I think that helps frame it.”

Chris Robson is CEO of Living With, an award-winning platform that allows clinicians to distribute apps to patients and monitor their data remotely. They have 9 different products on their remote condition management platform and they have achieved a high rate of penetration with various NHS trusts across the UK: “It’s very easy to come into healthcare and assume that primary care, an insurer and a private hospital are all the same and you can sell to all of them in the same way.

“I think the critical thing is to recognise where your strength is and only go after the bit that you are most likely to do well in to start with. And so, when it comes to looking at the NHS, again obviously it’s an amorphous organisation and it is all the stereotypes that people have said and that’s true and that’s not going to change.

“So, recognise where you want to play, whether you’re playing in primary care, secondary care or community care and build-up a strength and recognise it takes a long time – but there may be better places to go and don’t feel that you have to go to the NHS.

“There are a few digital health companies that have made a lot of money out of the NHS but they’re only a handful. So, don’t think you’re going to get rich out of them – you’re going to have to make money elsewhere. So, my biggest recommendation is work out who’s going to pay you the money as opposed to who’s going to give you the clinical validation.”

Partnering with universities to boost business growth

Collaborating with universities can help you gain clinical validation. Many start-ups and SMEs develop research and technology through working with the UK’s leading academics. SETsquared is a business incubator and enterprise partnership comprised of six research-intensive universities: Bath, Bristol, Cardiff, Exeter, Southampton and Surrey.

Alberto Casonato, CEO of TOKA, which combines 3D printing and data-imaging technologies for tailored solutions to knee pain, has brought his complex technologies to market: “For us, it was very important to partner with academia. Very often, being an SME, particularly in an industry like healthcare, you need to establish yourself before being accepted – and partnering with universities is a key to bringing more substance to the table.”

There are hundreds of opportunities to engage with universities. “I had no idea about the number of potential collaborations on offer,” added Hugo Ward, CEO of Quol. “We started our journey through SETsquared and are currently working with one of their academic partners, Cardiff University.

“As a start-up, you need to work very quickly. We’ve had successful collaborations with universities, but we did work with one whereby we just couldn’t make any headway because of the bureaucracy and the speed at which they were working – it was never going to fit into our timescale.”

Louise Morpeth, CEO of Brain in Hand, added: “The timescales and incentives on academics are completely different for those of us in business, and that is generally the main challenge.

“We’re starting work with an organisation that’s affiliated to a university and I think there’s something about that ‘middle space’, where you’ve got the rigor and the credibility of academia but a bit more connection to the timescales and incentives of industry.”

That is the experience from leading entrepreneurs in the health technology sphere, what is the feeling among academics?

James Bilzon, Professor of Human and Applied Physiology at the University of Bath works with SETsquared: “We’re judged on the impact that we make in the real world now and not just on the academic papers that we produce. So, I think that’s been a real driver for a quicker and more positive engagement with industry, and I think our internal processes are much more responsible as a consequence of that.

“I believe early engagement with industry is the way forward, because by early engagement we can get the ideas on the table, identify where the barriers are, when the more congested parts of the project might be, and we can start to work on them and move those barriers. Building relationships early on is also important to making things happen to an acceptable timescale for everybody.”

His academic colleagues also expressed how mechanisms for engagement with industry are improving. Professor Valerie Sparkes, Cardiff University: “I think there’s now a willingness to speed things up and I’ve had good conversations with our governance departments and IP teams, who are becoming more company savvy.

“My collaboration with SETsquared has been a unique experience and in the past, I’ve always struggled to get connected with SMEs. I think it makes a big difference.”

Professor Maria Stokes, University of Southampton added: “Academia is generally slow, and we have different incentives, but I think SETsquared is a really good platform for showcasing successful collaborations between industry and universities and I think it could lead the way.”

Looking across the pond, perhaps there are aspects that will help the leading UK universities become more commercial: “I’ve worked for American tech companies based in San Francisco,” explained Chris Wood at MoveGB. “They’ve got a really close working relationships with universities like Stanford and there is a far closer coupling of academia and entrepreneurs and the whole tech scene over there. There are entrepreneurial ideas coming through from the universities rather than entrepreneurs going to universities. I think we can learn a lot from the US.”

Collaborating with a university with or without the many benefits of SETsquared is a way forward, and increasingly we are seeing collaborations between SMEs and with larger corporates, who need to adapt to remain viable by partnering with pioneering smaller businesses.

“We’ve discussed partnerships with universities, but opportunity exists for partnerships between health technology companies and it’s getting over-crowded,” added Chris Robson, CEO of Living With. “Big corporates planning to partner with the healthcare tech industry are struggling to do it because there’s too much noise. There are way too many health technology companies starting up for the amount of revenue in the market. Consolidating and working together is a topic for the future.”

What lies ahead for the FitTech industry?

COVID-19 has completely changed the landscape for health and fitness technology companies and created huge opportunities for the future, but can we figure out what that future is and how to best take advantage of it? Here is a collection of thoughts from the entrepreneurs and academics who took part in the debate:

“I think we can’t look too far ahead, we know how the world’s changed and we’ve probably got a sense of what the world is going to be like in the next couple of months, but fast forwarding to a year, I’ve no idea, but we have seen a shift that will not revert to how it was before.” Louise Morpeth, CEO of Brain in Hand.

“The playing field is totally transformed. From our perspective, we were going into fundraising in the second week of March and in principle we weren’t going to struggle to raise the money and then all of a sudden COVID happened, and that’s presented a massive opportunity because we’re dealing in ed tech, online learning, mental health and that’s a really good place to be at the moment. That said, going back to the investors who had in principle offered us money before, I just think in terms of the funding and the appetite, we don’t know what’s going to happen with the global economy over the next 10 years and even though Quol is in a better position, equally there’s a huge amount of uncertainty and when it comes to funding and people putting their money where their mouth is, we just don’t know what’s going to happen.” Hugo Ward, CEO of Quol.

“COVID has opened so many opportunities, not here in the UK but elsewhere, because people want digital health and I think everyone here can be sure of the fact that regardless of whether it’s our services or not, these services will continue and it’s up to us to ensure that what moves forward are the very best evidence-based technologies.” Arjun Panesar, CEO of DDM.

“The opportunities created by COVID-19 will evolve and this is a question that I don’t think we can answer at this point; what’s going to be the long-term engagement for people when utilising technology? Professor Valerie Sparkes, Director of the Biomechanics and Bioengineering Research Centre Versus Arthritis at Cardiff University.

“If we’re going to make a meaningful impact on people’s healthy ageing, we have to build technology that’ll engage people long-term. I think there’s a big opportunity to personalise the offer to users, and the platforms that’ll achieve that are the ones that use data collected through AI and other statistical analyses.” Professor James Bilzon, at the University of Bath.

“I think what COVID has really taught people is that they can use technology in their health and fitness in a way that they hadn’t considered doing before, but I don’t think that necessarily means that everybody is going to want to do it.

“If you’re sick you generally want to see a health professional face-to-face because there’s a perception that you’re more likely to be treated successfully that way. Also, just because GPs can do online consultations doesn’t mean that every piece of software that provides it is going to survive. This is going to be commodity software. So, the real challenge is going to be if you want to keep people online then how do you entertain them in such a way that they actually want to be there as opposed to being outside in the gym or anywhere else.

“Technology is just the enabler. Ultimately, you’ve got to have a big enough market for you, there’s got to be a big enough need and you’ve got to deliver tangible benefits, so you can then put a moat round your business and be successful. Let’s not forget the basics on how to build a great business. Technology is just a facilitator.” Chris Robson, CEO of Living With.

“COVID meant that sections of healthcare had to become digitally integrated overnight, and I hope that growth will continue to happen and more so for the ageing population because it’s becoming increasingly important to remain independent at home.

“We actually had some quite shocking news also from somebody in our network who had a fall and was taken to hospital due to hip fracture, who would otherwise have been in isolation, and in hospital sadly the person got infected with COVID and then passed away a week later, so that really proves that you have to be safe in the home.” Lise Pape, CEO of Walk With Path.

“Impact is so important, particularly when applying for funding for academic research, and research that is COVID related is likely to get top priority. It’s important to package your application and focus on impact, and at the moment the impact is dealing with the COVID situation.

“An issue that needs tackling is how does the NHS recover over the next five years because the effects of COVID will be there for at least that length of time? How can we help make the NHS more efficient?” Professor Maria Stokes at the University of Southampton.

IN SUMMARY

It is most definitely a new frontier for the FitTech industry, but questions need to be asked with regard to what that future is – the global pandemic has forced almost every sector of industry into a state of flux and businesses will have to navigate their way through it.

Upon his appointment, Matt Hancock, the government’s Health Secretary, made technology the cornerstone of his tenure and this was a welcome step. NHS Digital is doing its best to cope with the level of adaptation that has been required for the pandemic. But until things change more – businesses can expect continuing difficulties getting into the NHS and that is unlikely to change during chaos.

“The NHS is very fragmented and getting into the NHS App Store is not necessarily going to guarantee you access to all the trusts,” explained Dr Aleksandra Love, SETSquared Scale-Up Sector Lead for Health & Wellbeing. “I think it’s very important to be aware that personal relationships will have to be developed and the individual trusts and healthcare parts of the NHS have to be treated separately and approached as separate customers.”

Engaging with universities early can help start-ups and more established businesses develop their business objectives and strategy through this unprecedented time.

“By joining an established network of academic experts and other innovative companies within our business incubator, you can open more doors and unlock the full potential of your business to maximise your level of influence with the healthcare industry.

“The SETsquared Scale-Up Programme is a partnership with leading universities which is also linked to an investor network. Throughout the year, we organise investor showcase events to give innovative SMEs the opportunity to meet and pitch to investors, and this activity will become more important as the global economy enters recovery,” added Dr Aleksandra Love.

Find how the Scale-Up Programme could support your business