Babylon Health

According to the company's website its mission is "to transform healthcare for everyone on earth" with the company being founded "with a single purpose: To put an accessible and affordable health service in the hands of every person on earth."

  

Babylon was founded in 2013 by former investment banker Ali Parsa. Until December 2012, Ali Parsa was CEO of Circle Health.

According to filings on the UK's Companies House there are three companies linked to Babylon Health:

Babylon Healthcare Services Ltd (company no: 09229684) - the operating company of Babylon Health registered in the UK. According to Companies House its two directors are Ali Parsadoust and Christopher William Bischoff (investment director)

Babylon Partners Ltd (08493276) - with directors Ali Parsadoust and Christopher William Bischoff (investment director)

Babylon International (11210368) - the newest company incorporated in February 2018, with Ali Parsadoust and Christopher William Bischoff (investment director) as directors

In addition, registered in Jersey, with details available from the Jersey Companies Registry is:

Babylon Holdings Ltd, registered at 31 Esplanade, St Helier, JE1 1FT.

In financial filings submitted to Companies House by Babylon Healthcare Services Ltd, the ultimate ownership of the company is the Jersey-based Babylon Holdings Ltd.

Babylon Healthcare Services Ltd is funded via Babylon Holdings Ltd, which issues shares for the required funds.

The most recent financial report filed with Companies House is for the year to the end December 2016. Babylon Healthcare Services Ltd reported turnover of £945,646 for the year, up from £247,182 in 2015. Profit for 2016 was reported as £56,739, compared to a loss of £48,965 for 2015. No tax on profits was paid in either year.

 

 
In January 2016 Babylon raised $25 million via the issuing of series A shares. The financing was led by Swedish investment group AB Kinnevik with other participants including the founders of BXR Group, a multi-billion dollar global investment group; Demis Hassabis and Mustafa Suleyman, the founders of DeepMind, the British artificial intelligence company acquired by Google, and Hoxton Ventures, the fund established to bridge European companies to Silicon Valley.

In April 2017, Babylon raised $60 million in a further funding round. Investors in the new round include, Sawiris, an Egyptian billionaire business family, Investment AB Kinnevik, NNS holdings, and Vostok New Ventures.

According to the Annual Return document (February 2018) filed on the Jersey Companies registry, the listed investors in Babylon Holdings Ltd are: ALP Partners (previously Babylon Partners (Jersey) Ltd - changed in 2013); Hanging Gardens Ltd; Gary Mudie (Chief technical officer Babylon Health); Longsutton Limited; Demis Hassabis (founder & CEO DeepMind); Hoxton Ventures; Kinnevik Online; Ali Parsadout; NTJL ATO Parsa; NNS Holdings; and Vostok New Ventures

 

 

Babylon Health’s business is centred on the development of digital technology and artificial intelligence (AI) in healthcare. The company has developed a smartphone app that uses AI to triage, diagnose and link with a GP for a consultation. At present the company has launched products in the UK, Ireland and Rwanda. The company also has contracts in Saudi Arabia and China.

In China, Babylon teamed up with Tencent’s WeChat social messaging platform in April 2018. The deal means the one billion WeChat users can enter their symptoms to Babylon’s app, which will then send back healthcare advice. In Saudi Arabia, Babylon has a contract with the Kingdom to provide its technology to the population.

The company's first smartphone app (an AI chatbot) was launched in February 2015 in the UK and is now also available in Ireland and Rwanda.

In the UK, the company has a business for private patients and under a contract with NHS England, a business based in London providing remote video consultations with GPs and in-person visits via the GP at Hand app. The private business charges £25 for a remote GP consultation plus a subscription charge.

Babylon launched its smartphone app in Rwanda in 2016. In November 2017, however, a partnership with the Rwandan government and the Bill & Melinda Gates Foundation, led to the launch of app to the entire population of Rwanda. The deal was part of a drive by the government of Rwanda to deliver affordable, accessible healthcare to the people of Rwanda. 

By asking a series of questions, Babylon's app can answer medical queries and can put the user in-touch (virtually) with a GP. The app is personalized by the use of a dashboard of the users health statistics acquired either by the phone (exercise regime etc.) or via supplemental devices. Babylon will supply users with blood testing kits for liver and kidney function, thyroid function, vitamin levels, bone density and cholesterol. The results of the tests are then incorporated into the user’s app settings.

By early 2016 the company was reported to cover 250,000 users with this app. By early 2018, Babylon was reported to have more than 1.4m users of its smartphone app. Almost half these are based in the UK, with the remainder spread across Rwanda and Ireland.

 

Babylon Health has two separate contracts with NHS England, one trialling an app to replace NHS 111 and the other known as GP at Hand in London.

NHS 111 trial

Babylon's smartphone app was one of the number of apps that NHS England trialled across England. For six months from the beginning of January 2017, the 1.2 million inhabitants of north central London, including the boroughs of Camden, Islington, Enfield and Barnet, had access to Babylon Health’s app that they could use instead of phoning NHS 111.

The app performed triage for urgent but non-life-threatening conditions. Users typed in their symptoms and the app decided how urgent their medical needs were. After each text, the app, responds with further questions to get more details of the problem, each time consulting a database of every symptom and illness in the world.

After the trial, however, the app was not adopted by the North West London Collaboration of CCGs. In a statement the organisation noted that in focus groups patients were more interested in using the app to avoid waiting lists. The report from the CCGs noted that  “Patients who might use the app could mainly do so because they believed it would get them faster access to GP appointments…..The focus groups had also commented that there is a risk of some people gaming the symptom checker to achieve a GP appointment.” This could involve overstating symptoms to get an appointment sooner. As a result, the CCGs decided to discontinue testing. 
 
GP at Hand
 
In London, Babylon Health, under a contract with NHS England, launched the smartphone app as GP at Hand in November 2017. The company promises that patients will be able to 'book an appointment within seconds' and have 'a video consultation with an NHS GP typically in under two hours of booking, anytime, anywhere'.
 
Babylon is working with the GMS practice of Dr Jefferies and Partners, based in Lillie Road, Fulham in West London. Under the Government’s ‘GP Choice’ scheme, which allows GMS practices to sign up patients from outside their traditional boundaries, Babylon has been able to target patients who live across London and those who work in zone 1 to 3. Patients who sign up for GP at Hand are de-registered from their own GP’s list and re-registered on the list of Dr Jefferies and Partners as an out-of-area patient. In the four months, since GP at Hand was offered out of area, the Lillie Road Medical Centre's total list size increased from 4,970 to 23,997.
 
Data from NHS Digital released in April 2018 show that a total of 85% of new registrations since November have been from patients aged between 20 and 39 years old. Of all new patients signing up since GP at Hand was opened up to out-of-area patients, 94% were aged between 20 and 49.

By April 2018, GP at Hand had 200 GPs on its roster, working for its private and NHS services. According to Pulse, Babylon offers a full-time salary of around £90,000 to work from home, or £108,000 if office based. The company also told pulse that it will have over 40,000 users of the NHS GP at Hand service once it has finished processing applications.

In March 2018, Pulse reported that GP at Hand had lodged 'further subcontracting applications' for 'sites elsewhere in London' and 'the provider has indicated they will seek to expand to sites outside of London in July 2018'.

 

There are a large number of concerns surrounding the GP at Hand app.

Cherry-picking

Babylon has advertised its GP at Hand service being suitable for ‘people of all ages whether you are in good health or not’, but its site lists 10 types of patients that the service may be ‘less appropriate for’. This includes patients with complex mental health conditions, learning difficulties, pregnant women or frail elderly.

Both the RCGP and BMA criticised the scheme for 'cherry picking' younger, healthier patients, leaving other GP practices to deal with patients requiring more complex care.

 
Destabilization of local health economy
 
In a March 2018 article written for Pulse, Dr Simon Brownleader, chair of Tower Hamlets GP Care Group, Dr Sam Everington, chair of Tower Hamlets CCG and Dr Jackie Applebee, chair of Tower Hamlets LMC, discussed the damage done to the local CCG by the GP at Hand model of business. 
 
The article notes that GPs rely on risk pooling and cross subsidy in that the capitation fee for younger fitter patients, who consult less often, provides the funds to care for the more complex and elderly. Operating models like GP at Hand threaten this system and risk diverting resources away from those who need them most to those who need them least.
 
In March 2018, Pulse reported that the success of GP at Hand was leaving the local health service with a deficit. Hammersmith and Fulham CCG has said the growth of the service could drive up costs by more than £10m and push it into deficit during 2018/19. In May 2018 the CCG reported that it would need an additional £18 million in extra funding to cope with the influx of patients due to the GP at Hand app.
 

Deskilling of GPs

There are also concerns about the affect on GP skill levels; GPs that move to work for Babylon will not face the great variety of cases seen in a normal practice. In particular, the GPs will lose skills in the area of care of the elderly and frail and in mental health.

In an article for Pulse, Tower Hamlets LMC chair Dr Jackie Applebee, who said practices in her area have so far lost around 1,500 patients to GP at Hand, said: 'I can see why it is attractive to go and work for them, because they are offering flexible working hours, I imagine a good salary, and it's an easy workload if it's young single-issue patients. But it's the long-term impact of dividing the GP workforce into those who look after complex patients and those who look after the more simple patients. It de-skills us as a profession.' 

 

Performance concerns

Babylon has published a research paper comparing its AI with a doctor or nurse. The paper was published on the non-peer reviewed site arXiv. It showed Babylon's AI outperforming doctors and nurses in laboratory conditions. In September 2017, however, David Wong, professor of health informatics, and Hamish Fraser, associate professor in eHealth, at the Leeds Institute of Health Sciences together with WiredUK found Babylon Health's app the "least accurate" in a test of three symptom checker apps - Babylon’s AI,  Ada and You.MD.

In an article for Wired, the academics noted that there needs to be stronger governance around this type app: "The great concern is that somebody puts information in and they have a serious illness and they get reassurance they're ok and that's a false negative situation, which could be life threatening."

An anonymous NHS doctor who Tweets under the name @DrMurphy11 has tested the Babylon app repeatedly, highlighting problems, including when he posed as 48 year old, 40 a day male smoker who wakes “with a shoulder pain radiating down his arm” -  the Babylon app told him his symptoms could be managed at home with a cold compress and painkillers. Other footage shows a bizarre series of triage questions for the symptom "I have a nosebleed".

In July 2017, an inspection of the service provided by the Babylon app resulted in a critical report, which raised concerns about the potential for prescription misuse and lack of information sharing with a patient's primary GP. However, the report also stated that most services “were safe, effective, caring, responsive and well-led.” Babylon Health tried to suppress the publication of this report, taking the CQC to the High Court in December 2017. The high court ruled that the report could be published; Babylon then criticised the CQC and questioned whether the regulator has the ability to regulate digital health services. In late December 2017, Babylon dropped the legal case against the CQC and agreed to pay £11,000 in legal costs.

 
 
 
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