Inside Babylon

Online GP-provider Babylon Health has found itself in the headlines recently, and not always for the right reasons. While GPs push back against the rise in private providers, the health secretary is pushing forward on his new vision for a tech-enabled NHS. Holding the middle ground is Ali Parsa, Babylon Health’s founder and CEO. In this revealing interview, he takes us inside Babylon

This is an edited version of an article that first appeared in The Telegraph.

Sometimes, “…the AI is just stupid” says Ali Parsa with a heavy sigh. It’s not something you’d expect to hear from a man who has invested millions in convincing the NHS that his AI chatbot is safe. As founder of Babylon, the Iranian-born entrepreneur has grand ambitions for how he’ll use artificial intelligence to transform Britain’s broken healthcare service. Making his vision a reality, however, is proving tougher than expected.

His company, Babylon Healthcare, offers a 24-hour GP video consultation service called ‘GP at Hand’. Its partnership with the NHS means anyone in London, and soon Birmingham, can use the service if they switch from their current practices. The idea is that patients can get access to a virtual doctor in minutes rather than waiting for days to see a doctor in person. Babylon also has an AI chatbot ‘designed around a doctor’s brain’ which provides medical advice for free on the web or via an app.

Health Secretary Matt Hancock has, controversially, described the services as ‘revolutionary’ and a much-needed change to the healthcare system. “I want to see GP at Hand available to all, not based on their postcode. Where a new service challenges the system, the right response isn’t to reject the new service but to change the system,” he said last year.

However, with his trademark charm Parsa, admits, “We’re a long way from successful. Everything sounds better on paper than it does in reality.” In fact, the company has posted heavy losses. In its most recent accounts, Babylon Partners Limited, a subsidiary of parent company Babylon Holdings which develops its technology, saw losses for 2017 balloon to £23.3m, up from a £12.9m the year earlier – but Babylon Health Services, another subsidiary which operates the GP at Hand video consultation service, saw revenue increase from £945,649 in 2016 to £1.8m in 2017.

It’s certainly has been, as Babylon’s CTO Caroline Hargrove describes it, a “very intense” period. “I’ve been here six months and it feels like much longer,” she says. “But it’s been amazing…there are not many [technology companies] that have this ambition to really deliver healthcare across such a wide range of populations.” We’re sitting in Babylon’s plush Chelsea offices, which are covered in dozens of giant fake tropical plants and motivational signs instructing employees to ‘Dream big’ and ‘Build fast’.

It’s one of the first times Parsa, a former investment banker, has given full access to his firm since controversy erupted around the accuracy of its chatbot and the impact of GP at Hand on the NHS.

Last year the UK medicines regulator probed the app after doctors complained that it was unable to correctly identify symptoms and in February this year it was branded a ‘public health danger’ when it failed to suggest to a 66-year-old woman that a breast lump could be cancer. One Twitter account is now dedicated to finding issues with the algorithm. “It became a sport to go and find this stuff on Twitter and make a big deal out of it,” says the eccentric entrepreneur.

Parsa, however, is no stranger to controversy. The physics-educated engineer left his previous venture – Circle – in 2012 after it fell into financial troubles. Circle was the first private manager of an NHS hospital. At the time, the company said Parsa would step down from his role as CEO to give him more time to fulfil ‘his passion for social entrepreneurship’. Critics claimed that, as CEO, he had made exaggerated claims about savings that could be made at the expense of staff and patients. Parsa denies this and says the hospital was in the bottom 10% of performance ranking before Circle got involved and attained top 10% scores for performance under his management.

The experience made Parsa think there must be a better way to deliver healthcare. “We had a few thousand employees, a few hundred million in revenue, we took it public,” he says. “What you understand when you run hospitals is that the vast majority of healthcare needs of people have very little to do with hospitals. Most of the healthcare we do is what goes on before going to hospital and after, but we do that in the most arcane way.”

He set about creating Babylon to solve the problem of getting access to a GP and help prevent illnesses before they get worse. With his enthusiasm and charisma, Parsa managed to convince high-profile investors – including Egyptian billionaire Nassef Sawiris and Deepmind founders Demis Hassabis and Mustafa Suleyman – to back him on Babylon.

He’s having a harder time, however, convincing doctors. “Babylon’s ‘probabilistic algorithm’ which has been available online is a cause for concern,” says Professor Richard Body, professor of emergency medicine at the University of Manchester. He believes that this algorithm, which advises patients how likely it is that they have a range of diagnoses, shouldn’t be available to the public until good evidence for its safety has been published.

“Anyone who works in emergency medicine would be concerned about those algorithms,” he says. Babylon disagrees. “The accuracy is not the concern,” insists Saurabh Johri, chief scientist at Babylon. “The controversy is about how we evaluate the accuracy.”

Johri is referring to an outcry in June 2018 when Babylon revealed results of a test on its AI bot at an event held at the Royal College of Physicians. The AI had been tested on what Babylon claimed were a series of questions from the exam for Membership of the Royal College of General Practitioners (RCGP) and achieved a score of 81% – almost 10% more than a human doctor. The RCGP, however, said there was no way to verify this claim.

Johir is confident that Babylon can still win over the medical community. “I’ve come from a meeting just now where we are tightening up a protocol for a larger scale evaluation of our services, and we’ll publish this in the next couple of months,” he says. “We’ll have it independently reviewed, so that should add additional rigour, that it’s going to be reviewed by, actually, some of the academics who criticised us.”

It’s not just the AI that Babylon needs to convince doctors about, however. Some in the NHS are also are concerned that Babylon’s GP at Hand video services allows them to ‘cherry-pick’ healthier and younger patients, leaving the NHS with less funding to care for those with greater needs; around 80% of the 50,000 patients with GP at Hand are aged 20-39. This means GPs are left with fewer, and older, patients with more complex health problems. “Babylon didn’t set the policy, the government did, and it’s been through parliament and people have a choice,” says Paul Bate, managing director of NHS Services at Babylon and a former adviser to David Cameron. “Nobody is coerced into doing it.”

Bate says there is a reason why so many people are flocking to the app. GP at Hand now has over 50,000 members – up over 10,000 members since the beginning of the year. The chatbot has been used well over half a million times. “Something would be very weird if people weren’t having those conversations,” says Bate. “This is quite a big change in the way that care is being delivered and it’s clearly attracted a lot of people.”

There remain concerns that these conversations can’t be had openly due to Matt Hancock’s clear support of the technology. Last year Labour MP Justin Madders demanded an investigation after Hancock backed the use of GP at Hand in an Evening Standard article. At the time Mr Madders said the interview breached rules on ministers becoming “associated with non-public organisations whose objectives may in any degree conflict with government policy”.

“I think Matt Hancock said two particular things,” says Bate. “He is at pains to point out that he has used the Babylon service and that it works really well for him, but he has constantly said that he is trying to drive the tech agenda, not a particular company. He has no affiliation with Babylon in any way other than being a patient.”

In spite of these worries – or perhaps because of them – Babylon is keen to rapidly expand outside of the UK.

The company is currently launching in Canada and plans to launch in the US in a few months time. It has carried out trials in China, in partnership with Tencent, and also wants to launch across South East Asia, across 10 other countries in 15 local languages. It currently has a chatbot service in Rwanda and says it will extend this to another African country in the near future. “We’ve been spending money like there is no tomorrow,” says Parsa; the company has grown from 300 employees in 2017 to close to 1,000 today.

Parsa is confident the expansion will pay off globally. Asked about further growth in the UK, however, and he’s less sure. “Look, it’s entirely dependent on the NHS,” he says. “We have solved a massive problem. We demonstrated it can be done. There is no reason anybody in Britain today should wait for a GP, if they choose to see a GP. In our view, it should be allowed for everyone in the UK to use it. If they give us permission, we would be honoured to do it.”

That permission may hinge on fixing its AI and winning over critics – challenges that could prove far more difficult to overcome than Babylon ever realised.

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