Feedback plc (FDBK) Earnings Call Transcript & Summary

Good afternoon, and welcome to the Feedback plc investor presentation. [Operator Instructions] The company may not be in a position to answer every question received during the meeting itself. However, the company will review all questions submitted today and publish responses where it is appropriate to do so. Before we begin, I would like to submit the following poll. And I would now like to hand you over to CEO, Tom Oakley. Good afternoon to you.

Thanks very much. Thank you to everyone in the audience for joining us today. For those of you who do not know me, I'm Dr. Tom Oakley. I'm the Chief Executive of Feedback plc. My background is as a clinical radiologist in the NHS and then also as a med tech enthusiast, having done a variety of roles with NHS England and across different private companies before joining Feedback. Anesh, would you like to just introduce yourself quickly, and then we can make a start.

Sure. Good afternoon, all. Anesh Patel, CFO. And by way of background, I'm a chartered accountant by training, and I've held various roles across the big 4 investment banking and industry, most recently within health care. And looking forward to taking you through the results today with Tom and answering any questions you might have.

Brilliant. So without further ado, we'll make a start on the presentation, and we look forward to all questions at the end. So just to give an overview of the company, I'll touch briefly on our history, again, for those who are not familiar. So Feedback plc has actually been a specialist in the medical imaging and medical devices software space for over 20 years in totality. Our background previously had been in offering PACS solutions. This is picture archiving and communication solution. Think of it a bit like a digital library for radiology imaging, which is how a hospital stores and then views their clinical images. And about 4 years ago, we changed direction to address the much wider clinical audience, leveraging our specialization in medical imaging and medical devices software. So actually think how can we bring good quality clinical data to frontline clinicians other than radiologists and to make sure that we could really create a compelling value proposition for them. So we very rapidly developed our product Bleepa, which we will cover in more detail in a minute, took that through into the NHS market and have been really refining that value proposition for the product over the last 3 or so years and are seeing some fantastic opportunities for both that product and the underlying cloud technology for it, CareLocker. So we very much are a company focused on the clinical front line, looking predominantly at how we can enable clinical teams to make better decisions for patients faster and from any location, really challenging that concept around how health care is practiced and where it is practiced from. We have seen growing routes to market for both of our core technologies, Bleepa and CareLocker. And I am delighted to say that we retain the position as the only clinical communication and collaboration platform in the U.K. market to hold medical device certification for image display. So we have a real USP both in our domestic but also international markets. And we are addressing some very large and sizable market opportunities, a GBP 10 billion total addressable market, for both of our products in our core target markets. You'll all be very interested in the top-level figures from the period that we've just reported. We've seen double-digit growth both in revenue and sales. Revenue up 74% and sales up 89% over the prior period. And we've retained a very strong cash position, GBP 7.3 million of cash at the end of the period with no debt, which puts us in a very good position for driving the strategic opportunities ahead of us and is a very enviable cash position compared to a number of competitors who we see in the market. In terms of operational highlights for the period, we have sustained our high-margin growth opportunities. We typically target a margin of 80% or more and have been able to deliver that on a number of opportunities to date, and we expect to be able to do so even more as we grow the opportunity in front of us. We have really been focusing on how we leverage our technology across different NHS care settings. So connecting both primary care, so GPs, the new and emerging community diagnostic centers and secondary care facilities, so hospitals. And we are delighted to have been able to report our first year outcome data during the period where we've demonstrated, essentially, a 70% reduction in patient wait times in Sussex compared to national targets. We'll look at that in a bit more detail in a few slides, and we'll pull out some additional figures from that research. But the real high impact headline figure is that 69 -- 70% reduction in patient wait times. During the period, we were also named as a supplier on G-Cloud 13. This is a procurement framework that allows NHS organizations to direct contract award to us and is a change in the way in which we can contract with the NHS. It's a much shorter process than the competitive procurements, which we are currently going through with Queen Victoria Hospital around the CDC opportunity. So definitely a favorable thing for us to be part of. It is also a hallmark of quality. You have to meet all of the NHS standards around cybersecurity, information governance and of course, the regulatory considerations, such as medical device, in order to be listed on that. During the period, we also have completed the latest iteration of Bleepa, version 1.5, which has a series of product updates led by the feedback that we've gathered from our customers to really ensure and refine that product market fit. And also during the period, we were able to demonstrate for the first time multiyear contract renewals for both the Northern Care Alliance and Royal Berkshire Hospital. It's been a long-term strategy of the company to move away from our legacy products that were not recurring in nature to more of a Software as a Service model with recurring annualized revenues and using ARR very much as an internal reporting metric, which we will start to convey to the market in due course. But this is the first real indication that our customers have such value and confidence in the product that they are taking on a multiyear contract basis and driving that growth in annual recurring revenues, which is a real step change from our legacy strategy and products. We are seeing continued progress in India. We actually established our own Indian operating subsidiary during the period, which is something, again, we'll cover in a few slides in more detail. And of course, completed the 200:1 share consolidation in the period. Anesh, if I hand over to you for this slide.

Sure. Thanks, Tom. So financial highlights for the year ended 31st of May 2023. Revenue was up 74% to GBP 1.02 million. This is because Bleepa/CareLocker now comprises around 74% of revenue. And as Tom has just mentioned, it achieves and enjoys a much greater average contract value versus legacy products, TexRAD and Cadran. In addition, in the year, we also benefited from a one-off GBP 0.19 million of revenue from the initial Sussex/QVH contract, which was signed in September. That covered the period from the 1st of April 2022. We expect Bleepa/CareLocker to become almost 100% in the near term of revenues, aside from Image Engineering license fees. In terms of sales, sales were also up 89% to GBP 1.27 million. Of this, Bleepa contributed around GBP 1 million and Image Engineering royalties for legacy Cadran technology around 11% or GBP 140,000. And a large part of that Image Engineering license fees are recurring, around $70,000 per year, which is the minimum recurring royalties from that revenue stream. Just to point out that sales is different to revenue. It's a non-IFRS metric, and it represents the total customer contract value signed or invoiced in a period and ignoring any accounting adjustments for deferred income and revenue recognition. In the future, as mentioned by Tom, we will replace that metric with annual recurring revenue as we get more visibility on contract conversions and we get a greater volume of customers flowing through. EBITDA loss was GBP 2.61 million in 2023. The increase over the prior period was due to an increase in OpEx as we scale up the operations, most notably, staff costs given the full year impact of our headcount expansion. As at year-end, we had 24 heads versus 19 in the prior period. We also invested and spent more in business development and marketing activities, including going to more conferences and outsourcing third-party -- outsourcing to third parties lead generation services to supplement and augment the internal team. We also spent additional funds this year on R&D, which were expensed rather than capitalized in relation to discovery work for system integrations between Bleepa and various NHS systems as well as working on our cloud architecture and working on optimization techniques in order to drive efficiencies going forward and help us achieve even better gross margins. In terms of cash, as of 31st of May, we remain in a very strong and comfortable cash position of GBP 7.3 million, giving us sufficient capital for our near-term requirements. This represented a net cash outflow in the year of around GBP 2.99 million, which is an average monthly net burn of around GBP 249,000. So clearly, sufficient cash flow for the near term and no problems there. We'll come to a bit more detail on the gross cash burn and breakeven point in a few slides. So Tom, if I hand back to you for the next one.

Thanks, Anesh. So just to pull out a couple of highlights from our post period, so up until this moment. And you hopefully will have seen on social media that we were able to present the findings of our Sussex pilots to the All-Party Parliamentary Group for Diagnostics just before the summer. This was a really significant event for us. The other panel members constituted: the NHS England heads of the CDC program nationally; the head of the digital diagnostic and digital transformation organization for the NHS; and then also Sir Mike Richards, who is the National Director of cancer services and screening. So 3 really key national stakeholders for us. I was able to present [ that alongside ] their investment in bricks and mortar and staff, actually, they really needed to prioritize an investment in digital because digital had the capability to unlock huge capacity in the system and was the only way that they were going to release capacity ahead of winter. That has led to a series of fantastic conversations over the last 1.5 months, and we are expecting to see some really exciting opportunities that rise off the back of that, which we'll communicate, of course, as soon as we're able to. We were also successfully awarded our import license for Bleepa as a registered medical device in India. This is fantastic news. Until we had received this, we weren't actually able to sell Bleepa within India. We will -- you will all have known that we have deployed a pilot of Bleepa with [ Odisha ] in India. And this is all about using Bleepa to connect remote care facilities with specialist centers. That was able to happen because it was a pilot and not a full commercial contract. But now we're in a position where we can actually start to pursue commercial opportunities for Bleepa. And linked to that, only the week just gone, we have appointed our new in-country Managing Director, Rohit Singh, who joins us from UKIBC, so the UK India Business Council. And he has spent 12 years at that organization supporting U.K. companies to come over to India, establish themselves and to become commercially successful organizations in India. So he has all the experience and all the connections to help us launch Bleepa within India and pursue our corporate strategy for that. So 3 really exciting things that have happened in the post period. Again, to pull out for those who may be less familiar with the company but also as a refresher for our long-term holders, the core products, so Bleepa and CareLocker, rather than thinking of these products in isolation, it's helpful to think of them as one symbiotic organism. Essentially, what they do together is plug into disparate siloed hospital systems or even at a regional level, disparate siloed hospital settings and GP practices and pull relevant clinical information about a single patient into one common view that can be seen across all stakeholder groups and to allow clinicians and other stakeholders to come together and collaborate around that common view of the patient's data. And by centralizing that data around the patient, we are able to move patients seamlessly between clinical care settings, between departments within hospitals and from primary care through a CDC, all the way into secondary care and back again. And that really removes the geographic boundaries of care. And because Bleepa has this asynchronous collaboration platform, clinicians are actually able to contribute to the case discussion in and around that other clinical work. You don't have to be together at the same time or in the same physical location. So in combination, we have removed both the geographic and the time restrictions on care delivery, allowing patients to be seen in any care setting and be treated by clinicians from any care system at any time. And that's really how we drive the efficiency and the benefits from both of these products. We'll come into some of the evidence around both of these products in a bit more detail, but I think it's really important to say that Bleepa, when used in an inpatient setting, actually reduces the time it takes to respond to referrals by as much as 74%. That is dramatic. And what it means is that you are getting senior decisions about patients much faster and much sooner in a patient's journey. And that means that in theory, you can actually get that patient through the hospital journey faster and back out into the community. And that's really where we see a lot of the cost savings and benefits of Bleepa. It also helps around flexibility for the staff. We all have seen the impact of COVID on NHS workforce, how tired they are, how often actually they're not able to attend physically in the way that they were before. Bleepa gives you the ability to bring in particularly senior expertise of people who would otherwise have retired from the system and bring them back into the front line in that remotely connected way. So it's a hugely important way of retaining those expertise within the NHS. As mentioned earlier, Bleepa remains the only collaboration platform to be certified as a medical device for image display, which is an essential component whenever you're doing anything around radiology imaging or even visible light imaging. So photos of patients are also included in that medical device function. We also are fully compliant with all of the data governance and GDPR regulations within the U.K., hence, our appointment onto the G-Cloud framework. And we are also benefiting from the recent ICO guidance, so Information Commissioner's Office guidance, around the safe use of clinical data and the processing of that data within an environment. We'll spend a bit more time on that in a few slides. And then CareLocker linked intimately to Bleepa is both the cloud environment in which we store that common view of the patient's data, but also a patient-facing application that allows us to give a patient access to that common view so that they can see their results in a safe and secure environment. And we also have the ability to gate the access to that so that clinical results aren't released back to the patient until the clinical team is able to review them and able to counsel the patient. And that's really important because you don't just want to be able to provide access, you actually want to be able to control that access. You don't want a patient suddenly to receive the results of a CT scan that says they have cancer without having a clinician available to actually then talk them through that diagnosis. So that's a key feature within the platform. And as we've indicated, the combination of Bleepa and CareLocker together has dramatic impacts on the ability to move the patients between care settings and to really optimize that patient journey, which we'll show some more data on in a minute. We have really defined our value proposition now by stakeholder with clear supporting evidence underneath each of these that have been independently sourced. And that's really important. This is the first time now that we have independent data to validate the claims that we have been making, and that is what is really needed to drive success and adoption across the NHS. So if we take, first, the proposition to an individual trust. This is for Bleepa and CareLocker as predominantly a pager and WhatsApp replacement. This was the first real value proposition that we had presented to the market around Bleepa. That now has been supported by an independent assessment for a company called Unity Insights. We'll show you the in-depth assessment of the product in a few slides. But the key thing that they found was that 74% reduction in referral response time and how that translated through to a reduced length of stay for patients and then also a cost benefit -- economic analysis of the product that really makes a compelling value proposition to that individual trust for taking Bleepa. The next is the cross-provider space. So exactly the same product suite, but this time focused around how we facilitate transactions between provider settings rather than within a provider setting. The connection between both primary and secondary care allows us to move patients through any number of care pathways. We've piloted with breathlessness. But actually, that can be broadened out to a number of clinical pathways to include cancer, general abdominal and musculoskeletal pathways, all of which we are in the process of designing with various parts of the NHS at the minute. And therefore, the scope to expand beyond breathlessness is really quite dramatic. And lastly, at the national level, something that has arisen really post the All-Party Parliamentary Group is a prospect to NHS England as a national proposition. And this is really leveraging that ability to connect into different provider sites and provide a connecting core infrastructure to the NHS as a whole linked to that individual patient. What we've positioned essentially is Bleepa and CareLocker as a digital glue that could be connected to every hospital in the U.K. and, by virtue of the national architectures around primary care, connected into every GP practice. If we're able to do that with the support of the national system, that actually creates an environment where a patient can actually attend any care setting in the NHS and be treated by specialists from any care setting in the NHS. So completely at a national level, removing all the geographic boundaries of care and giving huge flexibility to the system to leverage specialist staff from one area to provide a more national service and hopefully, help to address some of the staffing shortages. This proposal is still in the very early stages, but we are at least having the conversations about that now with the right tier of national stakeholder and could be a huge opportunity both for the NHS, but also, of course, for us as a company. I put this slide in really to draw your attention to it in the annual report. The sales cycle in health care is long, but it typically follows 3 stages. Validation, usually where you initiate a pilot of a particular use case with a particular organization, typically an NHS trust. You then undergo that pilot stage, use the evidence generated to then cause a conversion to sale and then use that sale and the supporting value and business case to then open up new sales opportunities and allow you to scale that use case across the system. We have actually implemented use cases around WhatsApp replacement with individual trusts; photo capture with individual trusts, so Royal Berkshire; and then also as a cross-provider connecting infrastructure between primary care and secondary care with Queen Victoria Hospital in Sussex. So these are 3 use cases that we have been taking through the validation, conversion and scaling stage. Now that we have the business case supporting this and all of the clinical evidence around it, we're actually at the scaling stage. And this is where things get really exciting, both for us as a company and also for you as shareholders as we begin to bring in all of those opportunities that we've been honing for the last 3 years or so. Linked to this and the expansion of those value propositions across the individual tiers of this pyramid, so trust to trust, we've actually also been able to leverage that value proposition up the pyramid, taking it to the more regional and now the national stakeholders of whom there are smaller numbers, but they can write much larger checks and they can help us to scale more effectively. And that's really been the focus of the executive team. So our sales team very much focused in driving that horizontal growth, that expansion of that proven use case across into other customers of the same type, with the executive team really driving those national conversations and trying, ultimately, to push the decision-making to a more regional or national level to get bigger contract wins. So this is the first time we have illustrated this data to the market. So this is all about the use of Bleepa within an individual hospital setting. This is an independent assessment of the technology by a company called Unity Insights that are very extensively linked into the NHS and the academic health science network. And I just wanted to illustrate and pull out a couple of key findings. So the first is that actually, we have illustrated a reduction in referral response time of, on average, 1.55 days compared to baseline. So we are, in theory, shaving 1.5 days of every patient's journey through a hospital. And if that translates to a reduced length of stay in total, that's getting everyone out of hospital over a day sooner than they would otherwise have been because of Bleepa. The other key metrics here are around the cost benefit analysis that they have ascertained. That's linked both to staff time savings, but also to that reduced length of stay calculation. And in essence, these figures relate to sort of 5-year programs of benefit. But on an annualized basis, that equates to about GBP 164,000 saved per hospital per year, and that's net of contract cost of Bleepa. So that's quite a substantial saving to those individual organizations. And if that was then taken up by all the hospitals, say, in Greater Manchester, that actually would equate to a GBP 1.5 million saving net per year for that regional body. So quite substantial savings. But the thing I really wanted to draw your attention to, and it's a metric that myself and the team are particularly proud of, is the 88% staff satisfaction with Bleepa. So 88% of staff noted that Bleepa was easy to use. This is a tool that the clinicians love to use, and that is a dramatic shift from the traditional health care IT that they have to use and is a core value proposition and one of the real reasons why clinicians champion the growth of Bleepa to other clinicians. And they start to drive that organic sale, particularly as junior clinicians also rotate to the different hospitals. And we are already seeing a number of examples of junior staff that have rotated to another hospital and are starting actually a sales conversation for us at that hospital because they've used Bleepa and they can't understand why the hospital that they've moved to doesn't have anything equivalent. So this is the first time we've really illustrated this information to the market. But this is the supporting evidence base that we have been needing in order to really drive those sales of Bleepa to individual trusts. I will also just mention quickly our deployment at Royal Berkshire Hospital, which has been, until now, very much focused around using Bleepa to acquire clinical photos of patients, both coming into and out of the hospital, linked to things like dermatology and tissue viability and wound management. We are in discussions with the trust at the minute around using and implementing a bring-your-own-device policy that will allow them to roll Bleepa to all the staff at the trust and that, in that situation, act as the full WhatsApp replacement that we've really been trying to get them to adopt. So that should, hopefully, be a change that happens in the near term and will be a big sea change for us at Royal Berkshire. And now to pull out the other value proposition linked to the transfer of patients between care settings. Some of these figures have been released in the public already but are worth revisiting. So the first is the 69% reduction in patient wait times compared to the 18-week RTT. So this is the referral-to-treat standard that the NHS bases its performance on. It's that target that you see in all of the newspaper headlines around growing wait lists and patients breaching. So we have a reduction of almost 70% of that wait time. Now the really huge bit about that is that we have delivered that reduction in wait time without needing any additional clinical staff. And the other thing you will have seen in all of the headlines in the newspapers are that there is a huge staff shortage in the NHS. So actually, being able to have that impact without requiring the additional staff is a huge thing. What we haven't reported to date and what we did report in our annual report is that actually, another metric that has been identified is that in 89% of cases, we actually remove the need for an outpatient appointment entirely from that clinical pathway. Today, if you go to see your GP outside of the QVH [ referenceless ] pathway, they will refer you to see a specialist in a clinic who will then arrange your investigations, and then you will go back to see that specialist in clinic for the results. And if it happens to be the wrong specialist, the wrong clinic, you go back to the GP and then you are re-referred to the different specialty. Now with our pathway, you don't have the outpatient appointment at all. The GP refers you directly on to this care pathway, and you automatically have the diagnostic results -- the diagnostic investigations that you require based on the rules and the presentation and the symptoms you're presented with. And what that means is that we can then get those results under the nose of multiple specialists at Queen Victoria Hospital that much sooner and as a result, also save the region the expense of providing that outpatient appointment. Now I can't disclose the exact figure because it's still being validated by various parts of the NHS. But if I tell you that the average tariff for an outpatient appointment is in the order of GBP 150 to GBP 200, that gives you an idea of the amount of saving that we are delivering for every patient going through this end-to-end connected pathway. So a massive value release back to the system. And I don't think Anesh won't mind me sharing that when we are having conversations with some of the regions at the minute, who are looking at patient volumes within the order of 200,000 across multiple pathways each year, that actually translates to a saving of about GBP 34 million back to the system if they were to adopt Bleepa. So huge cost savings as well as those operational elements. Sorry. When I escape your notice, I acquired a cold from my daughter's nurses. So apologies for that. And just to illustrate the wider CDC opportunity in front of us, this is a GBP 10 billion program work, which has had about GBP 2.3 billion injected into it in the last year alone. We are expecting there to be 160 CDCs built across the NHS. Those have taken slightly longer to get going than we had originally thought, largely because of the readdressive NHS capital budgets and the reprioritization of various things. But the NHS has started to approve the capital expenditure for these CDCs, and we are going to see the first 40 or so of those come online, hopefully, this side of Christmas. The great thing about Bleepa is that we delivered those impacts -- those impact results in Sussex, and they have yet to build their CDC. So what we have illustrated is that you can unlock capacity without even needing the CDCs to be built. And that, again, is one of the core value proposition that I pitched to Palm when I presented at the APPT back in July. That being said, 160 CDCs rolled out nationally, that represents a total addressable market of us for about GBP 96 million a year. So a very sizable domestic market that we are uniquely positioned to provide given our expertise around connecting both to primary care, secondary care and being able to present that common data within an application that is registered and certified as a medical device to image display. I thought it would be worth spending a little bit of time just taking you through the sort of landscape of the NHS. We keep mentioning ICSs. This is just to give you an illustration of how many ICSs there are in the U.K., so 42 integrated care systems. These are regional bodies that were meant to be set up at the beginning of last year. In fact, they actually became legal entities around July of last year and have spent the last year actually onboarding their digital leadership teams, getting and setting financial budgets and really prioritizing work programs. So we are only now really at a point where these customers, as a group, are mature enough for us to engage with CDC value proposition with all the supporting data and start to drive sales. So we are expecting to see some progress with these ICS-wide conversations now that these bodies are ready to actually contract and start engaging with suppliers like our sales. Anesh, I'll hand over to you at this point.

Sure. Thanks, Tom. On this slide, we have an illustrative analysis of our cash flow breakeven point. And I should cover here that this is high leveled and based on several assumptions, but it does showcase the rich profitability for the company. In 2023, our fixed cash cost base was GBP 4.7 million, which is the level of gross profit that we need in order to break even and then subsequently reach profitability. In terms of fixed cash costs, for us, that comprises OpEx, excluding depreciation, amortization and share-based payments; and CapEx, which is mostly software development of around GBP 1.2 million a year. The assumed average contract value for a single CDC for us is GBP 600,000, which is based on the undiscounted contract value for QVH Sussex. And at an 80% target gross margin, the gross profit for an individual CDC contract would be an average of GBP 480,000. Therefore, we need, in order to break even, 10 individual CDC contracts, which could derive actually from 3 to 4 regional ICS global contracts on the basis that each ICS has a footprint of 3 CDCs on average. As Tom mentioned on the previous slide, we are currently in dialogue with several ICSs at various stages of the sales cycle, but we believe this is achievable, especially given the compelling operational data from our existing customers and pilot sites, especially in relation to patient wait times and the cost savings that we could embed into the system. So we are -- we do believe this is a realistic and achievable route to breakeven. I would add, of course, that timing remains uncertain given the known and previously discussed protracted procurement processes of NHS organizations. And just to add on this slide that this is fairly simplistic in that it's a single scenario. It's just assuming CDC revenues. It ignores other sources of revenue. For example, Bleepa in an NHS acute trust setting, for instance, the contracts we have with NCA and RBH, this analysis, for simplicity, excludes that revenue stream, for which we think there's a TAM of around GBP 28 million. And next slide...

Thanks, Anesh. We both moved it. So to spend a moment on India, so our incredible opportunity. Again, same technology, a slightly different value proposition there in this market. Still around connecting, but actually the extent to which you have to connect care settings is much more dramatic, as I'm sure you would expect. Now the big news item is that we have just received our import license for Bleepa as a medical device. And that enables us to actually start selling Bleepa in earnest to Indian customers, both hospitals, governments and other organizations. Now the reason that we have approached India in this way is probably worth spending a little bit of time on. So because Bleepa is a medical device here in the U.K., in order to sell it in India, we only really had 2 options. We either had to license Bleepa to a wholesaler in country, which would have represented a shorter route to market. However, because of the requirements of Indian governance and regulation, we would have had to hand over all of our technical file and base code to that wholesaler. And we felt that, that represented a substantial risk to our intellectual property. And therefore, the only viable route, in order to ensure that protection, was to set up our own operating subsidiary in India, who we could then subsequently license and import Bleepa to, so that they could become essentially the in-country manufacturer and wholesaler of Bleepa. The other advantage of doing it that way, in addition to the IP protection, was that the feedback that we had from interacting with the market was that, particularly Indian health care facilities, they prefer to buy and procure from local in-country companies rather than importing from overseas. Whilst having the hallmark of NHS approval and being a U.K. company, particularly a public company with the heritage of medical device manufacturing for 20 years, whilst all of that is great stuff and gives us a unique positioning in the Indian market. The feedback is still very much that they like to do business with somebody that they can see and someone who they can meet on the ground. So that, for those 2 reasons, was the main driving force for actually setting up our own operating subsidiary and then licensing Bleepa essentially to ourselves via that [Technical Difficulty]. And linked to that, we have just, as I mentioned before, appointed our new in-country Managing Director, Rohit Singh. Rohit joined U.K. IBC. He's got extensive experience around bringing U.K. technology into India across multiple sectors actually. And I think that gives us an advantage because not all of the opportunities for Bleepa and CareLocker are particularly within health care. For example, there are applications in the NGO and Ministry of Defense settings. And so actually, it is worth having that sort of breadth of approach when we look at this market. I feel very excited, having spent the last week with Rohit around the numerous opportunities that he is already unearthing for us for Bleepa as a medical device in India. I'd also like to take a little bit of time to address CareLocker and what we've really discovered having deployed CareLocker on the ground in India. So for those who are not familiar, CareLocker, as well as being a cloud environment, is also a patient-facing application that essentially allows a patient to see the data that we store within their CareLocker. It's a way of giving them digital access to their scans and results. So that rather than having to go from the traditional model, which we see in imaging centers in India where they burn the DICOM images onto a CD or print the study on to film, we could actually present them with a digital version by CareLocker. Now we tested this and piloted it with an imaging center in Indore called Sampurna Diagnostics. Sampurna, like all the other imaging centers in Indore, relied very much on CD burning and film as their way of giving the information to the patient. So this was a really novel concept for them. And so we put it in and we piloted it, and we had a large amount of success in terms of onboarding clients on to CareLocker and driving that pilot. Whilst we were in the process of then converting them to a paying customer, we decided to test that use case in another city and we thought it would be sensible to test it in one of the large metropolitan urban settings. So we went to Mumbai. And what we found in Mumbai was actually a very different landscape to what we've seen in Indore. So imaging centers in Mumbai were actually providing digital access to the images via a WhatsApp link to their PACS, which was free to both the customer and the imaging center because that PACS company was, in fact, selling the data to third parties for research purposes. So they were quite openly selling patient data, and that was the revenue model. So they provided everything else for free. Now as a company in the U.K., governed by our principles and also by U.K. legislation around data sharing, that was not a business model that we are able to pursue and would want to pursue. And so we instead decided we would survey consumers within Mumbai and find out whether they were even remotely concerned about this. And that survey turned back that actually the consumers and the clinicians in Mumbai were not overly concerned about the sale of their data or the security of their data so long as they could have access to it. And so we, therefore, realized that there wasn't a good value proposition for CareLocker within Mumbai. And we also believe that, that's a practice that will probably spread from Mumbai to other centers such as Indore. What we have seen, however, from engagement with government and also something that Rohit has identified for us, the Indian government are on the verge actually of implementing a GDPR-like legislation in India that may have financial penalties associated with it, that may force the issue around data security and the sale of data, and that may actually become a huge market driver for us in the coming period. So we are pausing on CareLocker, and we'll revisit it as and when that legislation comes online. So instead, what we will do is now pick up the -- what we thought the original value proposition for India was, which is around Bleepa, driving sales of Bleepa both to large hospital groups, government organizations and state-level health care practitioners, both in the NGO and public space. And Rohit is already back in India on the ground, picking up those conversations and driving that strategy forward. In terms of the addressable market for India, the value proposition for Bleepa alone is in excess of GBP 1 billion annually. So this is an enormous market with huge potential. And even if we work with a small proportion of that initially in terms of the large hospital groups and regional government, that's a substantial market opportunity for us in the near term. I'll note briefly on Imaging Engineering, Anesh mentioned then on the previous slide. Imaging Engineering are a partner of ours in the United States. Their business is around upgrading fluoroscopy suites, taking legacy products and actually rather than having to buy a brand-new equipment, retrofitting and updating and digitalizing that equipment for a much lower price point. Part of our legacy software Cadran enables them to move from an analog to a digital system and therefore, as part of that upgrade process. And therefore, we received royalty revenue for that for every implementation that they deploy in the U.S. Revenue from that has been stable at GBP 0.14 million, both in the prior period and in this financial year. And we expect that revenue to sustain for at least the next few years and potentially grow as they begin to seize that opportunity post COVID to go back into hospitals and start to retrofit more and more of the suites and grow their own business in the U.S. This is worth saying that this is just a pure margin opportunity for us. We don't have any ongoing support commitments to that technology. And so it is just pure licensing revenue for us from an otherwise legacy product that was not driving any real value for the company. I'd like to just draw to a close by highlighting what we see as the near-term drivers of growth for the NHS. There's a lot happening in the NHS at the minute. And as we are approaching another general election in all likelihood that really focuses the mind around getting key operational and strategic principles over the line ahead of that election for the government. But more importantly, for the NHS and particularly NHS England, we're coming up to winter. The system is already experiencing some of the longest wait times in its history. Winter is only going to make that situation worse. There isn't enough time for them to address that through bricks and mortar and staffing. The only way they're going to do that is through digital. And Bleepa now is on everyone's radar as the leading example of how you can use digital to leverage capacity within the system. So I'll just take this one by one, just a little bit of time on them. So the CDC initiative that we've already mentioned, that was a GBP 10 billion program of work. It's been pumped [indiscernible] an additional GBP 2.3 billion this year, really to drive the conversion of those business cases to real building projects. And you'll see newspaper headlines of new buildings going up all the time at the minute, and that's because the NHS is finally approving these business cases for use. As I said, we are not contingent on those buildings being in place before we can add value. We can leverage what they've got today to drive that value, but it does help if there is a building going through because it shows a commitment to that area in that region to the CDC program. The next one over cancer target changes. You may have seen these in the headlines recently. So the government has changed the operating targets of the NHS around cancer. What had been a 2-week wait referral where you had to be seen by an outpatient specialist within 2 weeks of referral has now changed to a faster diagnostic standard, where you have to have a diagnosis confirmed within 31 days of referral. And that means having your imaging, blood tests and multidisciplinary meeting that much faster, which is great news for Bleepa and CareLocker because that's exactly what we deliver to the system. So we think these new diagnostic standards will really be a driver of growth for us in both the near and midterm. The next one over the Hewitt review, this was an independent assessment of integrated care systems and how effectively they were being deployed. I mentioned earlier that the launch of the integrated care systems was somewhat delayed because of political and financial reasons. So this was really to see, well, now that they're here, how are they operating. There were a number of key recommendations off the back of that report and a large number of those focused on the need for digital to improve the ways of working. We've dedicated digital channels to enable patient flow at a system level between provider sites, essentially speaking to the use case that we've demonstrated at Queen Victoria Hospital. They reiterated the need for better multidisciplinary working. So this is all around the asynchronous, multidisciplinary working environment that we provide in Bleepa. They mentioned that having multidisciplinary working via in-personal video meetings was not an efficient use of time. And therefore, the move to an asynchronous model is considered advantageous. And last, they mentioned that having this flexible digital infrastructure was essential to scaling broader innovation across the system and linking that back to retain -- to retention of staff who need those good quality digital tools to optimize their care and working environment. And then the next one over, this is actually extremely hot off the press. The Information Commission Office has recently ruled against the NHS for the first time for its use of WhatsApp. And this was a ruling against NHS Lanarkshire where there were 500 breaches of patient data via WhatsApp within a year. They issued very strong guidance and are reprimand to NHS Lanarkshire stating, in no uncertain terms, that there is no longer any reasonable justification for the ongoing use of WhatsApp for clinical care delivery, and that all NHS providers should move off the use of WhatsApp with immediate effect. Now that the ICO has made that ruling and they could be in a position to start issuing fines for NHS organizations, we are seeing a huge amount of interest from chief information officers and other stakeholders up and down the NHS who realize they now need to do something about WhatsApp. And we think that this will lead to a resurgence in our original value proposition for Bleepa as that WhatsApp replacement. And last, the CQC, the Care Quality Commission, who are the regulators of health care providers in the U.K., so hospitals, GPs and any other service provider, they have stipulated and updated their guidance that it is now a requirement for NHS employers to provide staff with appropriate tools for providing their day-to-day service, and that means that they have to provide an alternative to WhatsApp that is safe, effective and fully regulated, of which Bleepa is arguably the only one, given the requirements around imaging. And lastly, they are also required to maintain a contemporaneous record of the patient's care, which means that you can't have conversations stored on a different platform that doesn't link back to the patient's core record within the electronic patient record of a hospital. And of course, Bleepa writes back natively to those applications, which means that all that information that happens on Bleepa gets transferred into the patient's record. And therefore, we can demonstrate to hospitals that, by taking Bleepa, we can help them to meet that target. So just the last slide to conclude on. I hope we've been able to illustrate to you some of the value propositions that we have defined for the products and what we see as the growth opportunities ahead of us and what some of the core drivers are particularly within our domestic market and within the NHS. Although we are looking at opportunities in India and some other markets, our primary focus is around converting that NHS opportunity, particularly as we come up to the run-up to winter and decision-make focus on all of the key values that Bleepa delivers for the system. And lastly, [Technical Difficulty] continue to derive wherever possible, some revenue from our legacy products where that doesn't actually create a cost constraint for the company or a service commitment. And so we are looking at how we can license components of our legacy technology just as we have with Imaging Engineering. So at that point, I will stop presenting, and we'll go to answer some of the questions that have been submitted.

Tom, Anesh. Thank you very much indeed for your presentation. [Operator Instructions] While the company take a few moments to review those questions submitted today, I would like to remind you that a recording of this presentation, along with a copy of the slides and the published Q&A, can be accessed via investor dashboard. Tom, Anesh, as you can see, we have received a number of questions throughout today's presentation. If I may now hand back to you and kindly ask you to be other questions, give responses where appropriate to do so, and I'll pick up from you at the end.

Great. Okay. We'll do that. So starting at the top. Okay. So how big is the U.K. [Technical Difficulty] now and how fast is it expected to grow? Hopefully, we've answered that from the presentation. So a total addressable market of some GBP 96 million with an expectation that now that business cases are being approved, we're going to start to see contracts. What alternatives are there currently to Bleepa in the market? This is a really interesting question. So in answer, there is no other product out there that does what we do. There are products that do components of what we do. So for example, there are other applications that offer clinical chat, but they don't have the capabilities around handling diagnostic data, and they don't have the capabilities around integrating between primary and secondary care. And they also do not certify as a medical device for image display. So in that regard, we are unique. And of course, there are other companies that do integrate between care settings, but they don't provide a collaboration environment for you to then do something with the data that they're transferring. So bringing together those 2 themes is what we uniquely do, and that position is unique in the market as far as we know. Are you confident that the numbers from the Sussex Feedback can be replicated at scale? Yes, absolutely. I think that we have demonstrated that consistently across the 14 months that we've been running it. So that data has now stabilized, and those results are reproducible. There will, of course, be variation as we try to do this with different regions and different sites. But I don't expect that variation to be particularly wide. Typically speaking, the biggest impact comes from removing that outpatient appointment. And that's a pretty consistent knock-on effect in terms of the pathway. Anesh, should I get you to take one of the questions while I get some water, please?

Yes, sure. No problem. So next question is, I note there's a strong cash pile, which is pleasing. My question is, will the company continue investment in its products at the current rate in the absence of new contracts? So any investment project that we undertake, we do assess the returns and assess the royalty and ROI. And we wouldn't invest in further product development unless we thought we were going to make a return. So we will continue investment in products. But at the same time, if we get to a stage where we think it's not good value for money, given that most of our software development is outsourced, we can quite quickly stem the costs associated with any project, which we think is not going to cut it in the longer term.

Has Tom's meeting with the Diagnostic Parliamentary Group opened any new doors or recontract opportunities? It's all looking very positive. These national conversations take time, but the indications are all extremely positive. They have realized that digital solutions are needed, and they need it in a relatively short time frame. So we all expect to be able to come back to you on that in due course, and I don't expect it will be that one. Why did you set up an Indian subsidiary without more of a foothold? Is this not a costly way of approaching India? Yes, it's a really good question. And it was definitely something that we considered. Hopefully, we explained it in the presentation, but there was a decision to be made as to whether to license the product through to a wholesale in-country, or to set up our own operating subsidiary and take it to market. I think the rationale and the fear around IP exposure was significant. We have all seen examples of where companies have expanded internationally and then seeing that their product and associated IP ends up being repurposed and then undercut, so actually, it was essential for us that we retained that IP even if it took a bit longer. I think it's also important that we scope for market properly, and that we're confident of a value proposition into those opportunities. And this has given us a bit of time to actually focus on that to doing the soft engagement with the market. So now that we have our import license, we're in a good position to go and engage with customers. What else?

I think on India, just to add quickly to the India question. There's also a perception factor as well. The advice we received was trying to sell into the Indian market being a small U.K.-based company only, was going to be a lot more challenging than having your own operating subsidiary in-country, showing that we are committed to the country. But also the main reason was, as Tom mentioned, the IP and making sure that our IP is protected, which obviously now it is having -- we see the import license from a 100% to subsidiary.

Okay. So what improvements were achieved by Bleepa version 1.5? What was the overall cost of version 1.5? What were the software changes made by Graylight? Yes, okay. So this is a good question. Sorry, I forgot to cover this off. So the improvements in version 1.5 were mostly to do with the actual messaging interface. It was about being able to directionalize messaging to named individuals to give you the flexibility to either bringing a particular consultant to a case which is important in the cross provider setting, or in a situation where you didn't know the name of the individual you needed, but you had a particular role that you wanted to bring in, say, if a medical registrar on call. And this allows you to direct the message to them rather than just broadcasting it to a group. So if you have a particularly urgent finding or something that you need to see action, this was a vehicle for you to be able to do that. And in terms of the software changes, yes, these were implemented by Graylight, but also supervised and designed by our internal team, which is also part of our IP strategy. The design and the validation of the testing and the checking is all done by our internal team with the actual coding being outsourced to Future Processing. And I think we're probably at time there.

Yes, Tom, Anesh, thank you for that, and I think you have addressed those questions that came from investors. And of course, the company can review all questions submitted today, and we will publish those responses on the investor relations company platform. But before we direct the investors to provide you with the feedback, which is particularly important to the company. Tom, can I please ask you for a few closing comments?

Yes, absolutely. Well, firstly, thank you, everyone, for attending. It's great to have the opportunity to speak to you. I hope we have conveyed the excitement we're beginning to feel about the market. We are aware that things have taken a long time. The NHS is slow. But we are looking about building a viable business in the long term. We have sustained year-on-year growth. We've achieved double-digit growth this year. We're on track to do so next year. We have seen a number of companies that have grown enormously and then not have a sustainable business model underlying that and then fallen foul of it. We have a sustainable proven business model, which we are now going to scale. And I think that is a reliable investment proposition to all holders.

Perfect. Tom, Anesh, thank you once again for updating investors today. Can I please ask investors not to close this session as you will now be automatically redirected to provide your feedback and all that the Board can better understand your views and expectations. This will only take a few moments to complete, and I'm sure will be greatly valued by the company. On behalf of the management team of Feedback plc, we'd like to thank you for attending today's presentation, and good afternoon to you all.