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."
In the UK, Babylon is working in the NHS providing the GP at Hand smartphone app in London. The company is attempting to expand its NHS work via CCGs in other cities. In September 2018, HSJ revealed that the company had met or corresponded with 17 CCGs about expansion of its service.
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 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 focuses on the development of digital technology and artificial intelligence (AI) in healthcare. According to Babylon Health'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."
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. The company also has contracts in Saudi Arabia and China. InChina, 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.
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.
In the UK, the company offers a private service via its app; the service has a subscription charge plus extra costs on top, such as £25 for a remote GP consultation. Babylon's primary target in the UK, however, is gaining access to NHS patients. The company has a contract with NHS England for its GP at Hand app that was launched as a service in London in 2015 and has since acquired a lot of patients (see below for details).
A major part of Babylon's UK strategy is expanding this service to many other areas of the country. 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'. In July 2018, however, Pulse reported that commissioners in Birmingham have rejected Babylon's application to expand its GP at Hand with a centre in Birmingham. A letter from Birmingham and Solihull CCG noted that it 'would like to formally object to the variation on the grounds of clinical safety'. A variation refers to the addition of the Birmingham site alongside the five sites in London, already registered for the app. Babylon has blamed ''the financial and ideological interests of the few" for the rejection of the application.
The company's future in the UK was boosted in June 2018, however, with the appointment of Matt Hancock as Health and Social Care secretary. Mr Hancock is very enthusiastic about the use of new digital technology in the NHS and in July 2018 revealed that he is actually a subscriber to GP at Hand and found the service 'brilliant'.
In September 2018, Matt Hancock gave a speech at Babylon's headquarters in which he told an audience of Babylon Healthcare staff he wants to help the company expand “so loads of companies can come do what Babylon are doing” in the NHS. In the same month HSJ reported that via FOI requests the publication had found that at least 17 CCGs had met or corresponded with Babylon; some CCGs that did not reply to HSJ are known to have been in contact with Babylon or GP at Hand. The target cities for GP at Hand are Southampton and Leeds.
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 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.
One facet of Babylon's 'strategy' in the market is its resort to litigation in the face of criticism. In December 2017, HSJ reported that the company had failed to prevent the CQC publishing an inspection report of the company's service.
Babylon had filed a legal action in the High Court, challenging the publication of the inspection report; the CQC stated that the report was “not particularly adverse”. The court rejected Babylon's request for an injunction to prevent publication and the report was published. However, the court also heard that the CQC had agreed to remove a large part of the original report before it was published.
In September 2018, HSJ detailed various other attempts by the company to silence criticism and even reporting. These include Babylon's angry reaction to a CCG's board papers that documented doubts about the strengths of its product and Babylon's efforts to exclude HSJ journalists from an event at its headquarters at which Matt Hancock was speaking. The publication's journalist was only allowed in after the intervention of Mr Hancock.
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 four 'NHS 111' apps that NHS England trialled across England in 2017. 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.
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'.
in July 2018, Pulse reported that commissioners in Birmingham have rejected Babylon's application to expand its GP at Hand with a centre in Birmingham. A letter from Birmingham and Solihull CCG noted that it 'would like to formally object to the variation on the grounds of clinical safety'. A variation refers to the addition of the Birmingham site alongside the five sites in London, already registered for the app.
There are a large number of concerns surrounding the GP at Hand app.
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.
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.'
In June 2018, the HSJ reported that there are issues with referals for mental health services and community care. Other London CCGs and providers have said they are unable to accept referrals. After Hammersmith and Fulham CCG intervened and agreed to pay for the patients’ treatment, most neighbouring CCGs and services agreed to accept referrals. However, some have continued to refuse. The issue is complicated as the majority of patients registered with GP at Hand in H&F CCG live outside the CCG area. H&F CCG is now having to pay for a large amount of out-of-area treatment.
Babylon Healthcare, was highly critical noting in a statement that “some senior individuals in a few London CCGs and providers” were to blame, for placing “their narrow business interests or ideology ahead of patient care and NHS policy”.
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.