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 it receives during the meeting itself. However, the company can review all questions submitted today and publish responses where it's appropriate to do so. Before we begin, I'd like to submit the following poll. [Voting]

And I'd now like to hand you over to Mark Fletcher, Director of External Affairs. Good afternoon, sir.

Thank you, Linley. And welcome to Feedback Medical's half year results and company update. This is my first one of these; hopefully, not my last, but for those who are regular viewers and -- we have Dr. Tom Oakley, our CEO; and Anesh Patel, our CFO. And we've got quite a lot to get through. So we're going to go through our H1 operational highlights then our financial highlights then a quick post-period highlights before we are going to go for a product demo to see what is new and then a more general fireside conversation or however fireside you can have with 3 people in different places connected virtually. And so I'm going to hand over to Tom to go through our H1 operational highlights. Over to you, Tom.

Thanks, Mark. And nice to see everyone virtually. Not that I can see anyone currently, but it's nice to have you in the audience. And so just to cover off the main sort of points from the last period before we go into a bit more of a dynamic session that should give a bit more flavor for what we're doing and where we see the opportunities coming up. So during the period, we had some pretty big things happen actually. So this was the period when we first got our QVH contract around community diagnostic centers and pathways. So this was the first time we actually had a formal contract for the diagnostic work and the pathways that we've been delivering in the NHS. It's also the first time that we had really demonstrated that we could move and increase the average contract size from the sort of GBP 120,000 contracts that we saw for inpatient settings at individual hospitals such as the Royal Berkshire Hospital and also the Northern Care Alliance, who are our existing customers. It was the first time we could really actually say that -- if we were to expand the scope and to offer a more regional-based offering, that we would be able to enlarge that contract value. And typically we are expecting contract values in the order of GBP 450,000 to GBP 600,000 for an average CDC contract. And that contract award with Queen Victoria Hospital was the first real proof point of that. We also during the period expanded our sort of CDC offering. We undertook a number of additional pathways funded by NHS England, so we have now additional pilot sites for the breathlessness pathway taking place in Greater Manchester, again at Northern Care Alliance; and then also in Buckinghamshire, yes, as part of the Buckinghamshire, Oxfordshire and Berkshire ICB. We've done a lot of work both during the period and subsequently to really hone the value proposition of the product. This wasn't so much about actually developing new features within the product but about really working on making it more native to the NHS and on the interfaces that we have with other NHS systems. Primarily the focus on that was around how we connect into primary care, so the GPs, so that we could essentially reduce the barrier and resistance to referrals being made into the Bleepa system and therefore drive volume into the care pathways that we were facilitating for the provider trusts. And so we now have a bespoke and streamlined way of receiving referrals and passing information back into the GP system. We've also worked with a partner called Vertex to increase some of the functionality within the product rather than having to develop it ourselves. This was primarily focused around an enhancement to our image viewer to allow us to bring in 3-dimensional imaging, which is what is used by typically radiologists such as myself when we report. And it is an enhanced view that typically most clinicians don't need and therefore wasn't something we've developed in the core product, but what it does allow us to do is to now start selling Bleepa as a radiology-focused tool; and also, because of the regulatory approvals, to potentially move to selling that product into wider global markets as the opportunity presents. We also started thinking very constructively during the period around how we might grow different routes to market. And we were delighted to report that we signed an MOU with one of the largest primary care record providers in the U.K. to essentially help us both to scale the product into primary care so that we could grow our customer opportunity but also so that we could build out some bespoke coupling of that technology to create what we're calling the Neighbourhood Health Service and the Neighbourhood Diagnostics Solution. As we'll come to in the presentation in a bit, this is really about increasing the alignment of our product to the core missions of the NHS, which very much is about seeing care move from hospitals, into the community, what Wes Streeting, the Secretary of State for Health terms the Neighbourhood Health Service; and therefore creating an offering that would enable that transition and enable us to deliver more of that care closer to home and closer to the patient. Anesh, I'll pass to you to talk a little bit about the financial benefits.

Thanks, Tom. So let me get the slide up. Okay, so the financial highlights for H1 '25. Revenue, we reported as GBP 0.45 million, which is up 3% on the prior period. The increase is mostly due to inflationary increases on our existing client contracts and also the QVH pilot converting to full contract at a higher value of GBP 495,000 versus GBP 450,000 at the pilot stage. It's probably worth noting at this point that our first 2 Bleepa customers, the Northern Care Alliance and the Royal Berkshire Hospital, have both renewed with us now for 3 times since 2021, each year with that [ TPI ] uplift. And we're expecting those customers to renew the next year -- well, this coming March, which offsets, of course. So the fact that they've renewed with us 3 times points to customer longevity. And there is a large sales cycle, a lengthy sales cycle with the NHS, but once you're in, you're in for a long time is what we've seen. We also report sales, which is a non-IFRS metric. Our sales, which is the total customer contract value invoiced in H1, was GBP 0.59 million. And that's a 43% increase on the prior year. And that's mostly due to timing, where the QVH contract was built in H1 this year, whereas last year, the contract's extension was billed in H2. And sales is -- like I said, it's non-IFRS. It's the total contract value. And what we typically do is recognize the full contract value monthly. So we bill upfront, but we recognize it as revenue on a monthly basis, typically over 12 months. EBITDA loss improved 43% to GBP 1.43 million in H1. The improvement was due to a couple of factors. It's a lowering of costs. We had some one-off costs last year in relation to AWS architecture setup and tendering activities, which we did not need to repeat in this H1. We also took steps in H1 to reduce our burn rate in the spend ahead of having visibility on the fundraise, which closed right at the end of the period, which I'm sure you will have seen, where we raised GBP 6.1 million gross, GBP 5.6 million net. And that led to the cash balance as at 30th of November. We ended up with GBP 7.3 million of cash, which includes GBP 5.1 million of the GBP 5.6 million net proceeds from the fundraise. And 2 days later post period end, we had the remaining GBP 0.5 million come in from the retail offer, so pro forma towards the end of November, start of December, the cash was around GBP 7.8 million. That implies a prefinancing cash flow in H1 of GBP 1.73 million, again an improvement on the prior year because of the steps that we took to reduce the burn rate. The average burn rate in H1 this year was around 290,000, which is lower than the 325,000 in the prior period, again because we reduced OpEx and also software development CapEx until we had more visibility on the fundraise. So we leave H1 in a very strong balance sheet position and now feel well capitalized to deliver on the growth opportunities that we're going to talk about in more detail going forward.

Thanks, Anesh. I think we're going to look at the post-period highlights now. And I think that's back to you, Tom.

Yes. Thanks, Mark. So the key thing that happened, although actually technically happened, in the reporting period was that we unlocked a funding mechanism for Bleepa called the elective recovery fund. However, I've deliberately delayed speaking about it until the post period because actually a lot of the activity that we've been embarking on since the funding round and since the year-end annual report has been focused around the elective recovery funding mechanism. So just to refresh. The elective recovery fund is essentially a funding vehicle to pay for additional activity in the system. We were able to secure funding through this mechanism by submitting our outcome data initially through into parliament; and then taking that through into central discussions with NHS England, Number 10 and treasury. And what we were able to actually secure was a mechanism whereby, every time a patient goes through a Bleepa pathway and avoids a hospital appointment, that would be eligible for a GBP 206 payment. That payment would go to the integrated care board who are the commissioners of the service. And then that would be used to cover our licensing costs; the implementation costs of our partner, Moorhouse Consulting, and then also the NHS provider who provided that clinical service, and the idea being that, the more patients that we drive through that pathway and the more patients we divert away from outpatients, the more that we and all of the partners in that chain would be paid. That funding mechanism was due to run until the end of the NHS financial year, which is the 31st of March. And then we were waiting to see what would happen to it beyond the end of March, into the next financial year. And one of the things that we have observed is that it has become very difficult for ICBs and trusts to commit to a contract until the visibility of the future of that funding mechanism is secured. And so we're currently in a holding pattern where we have a series of engaged ICBs and trusts that want to contract with us but we are waiting for clarification around next year's position before they do sign those contracts. And whilst that has been slightly frustrating because we had hoped we would be able to move sooner, what it does mean is that we've been able to work up in the background a very deep pipeline of opportunity with these ICBs. We've been able to work very close with them around their modeling for pathways, their modeling for clinical change and to really think about how we would then move forward with them once ERF is confirmed. Now the process of NHS financial planning is what they call planning guidance. This is where the NHS England team issue guidance to the systems around what the financial envelope will look like next year. That typically is done in November, December time. However, this year, it happened at the beginning of February, so the ICBs and the providers are currently reviewing that and going through a consultation period which is due to finish on the 28th of February. After that consultation closes, the central team at NHS England then turn that consultation into technical guidance and formalize the financial envelope for next year, so we should have visibility of that between the sort of middle and end of March, at which point we will know what the ERF position looks like for next year and at which point we can then start converting some of our pipeline of opportunity into contracts. From what we have seen in the planning guidance to date, it looks really very encouraging, that elective recovery will continue next year. It's mentioned throughout the documents. We also see a lot of reference to advice and guidance and straight-to-diagnostic pathways, which implies very much the sort of thing that we are trying to do. The change and the diversions that we are delivering are exactly what they're going to be funding next year. What we don't have is confirmation around that payment mechanism and the value, although early indications are that actually it will be higher than the GBP 206 that we've seen this year because of an inflationary increase. So once we have clarity on that, we will communicate that back to the market. And then of course, naturally, we'll be working very closely with our partners to convert that into contract opportunities. This period has also given us an opportunity to continue to enhance the product offering, again to work with those NHS systems around referral streamlining but also to work with our strategic partner in order to augment the value proposition of the product even further. And we are now able to show you a live view of the patient's GP record within Bleepa, which hopefully I will be able to show you in a few minutes to bring that to life a bit for you, but that's a step change in the information that's available to the clinical workforce outside of primary care. And it has a meaningful impact in the sort of decisions that you can make as a clinician, so that is a key thing, a key development for us in our approach forwards. Our partnership with that particular provider also means that we have the ability to scale nationally across all of primary care in a very short space of time; and similarly, also into community pharmacy, where they also have a very established footprint. And that gives us the opportunity to potentially deliver other models of care such as diagnostics in new care settings such as community pharmacy, all of which is about bringing additional capacity into the NHS to help them to reduce wait lists, which is their current key national priority. It's worth saying for those who are following the news -- I think everyone will have seen Keir Starmer's focus around wait lists. It's 1 of his 6 missions is removing the elective care wait lists within his first term of government. And that is echoed by Wes Streeting, the secretary of state, who has created 3 calls to action, 1 of which is about moving care from acute providers, into the community; about moving from an analog to a digital system; and then also moving from a sickness service to a preventative service. And this is all about shifting care into the community, picking up patients early before they present with late-stage symptoms; and therefore, improving the experience of care for patients. And our value proposition is right in the crosshairs of that and as we move forwards.

Okay. Well, I think you alluded to it there, Tom, but I think a lot of people won't have actually seen sort of Bleepa in action. And for those who have seen it before, they may not have seen some of the new features, so if we can get the technology to work, I think it would be great to have a bit of a demo of it.

Yes, no, no, absolutely. I'm very conscious that actually, amongst the audience, there may be new faces. And even those who have followed the company for some time will not have seen the sort of features and impact that we now have, so it's definitely worth us spending a little bit of time just showing you that and bringing it to life, so I will share my screen now. Is that displaying, Mark?

Yes, we can...

It is, but I've got to unmute. [Presentation]

Okay, fine, all right. So first thing to say about Bleepa, for those who are not familiar with it. Bleepa is a web application, which means that you can access it on any Internet-connected device, so you can use this on a desktop. You can use it on a tablet or a mobile phone. And that gives huge flexibility to how clinicians can access this system. Now having worked as a clinician, I can tell you the reality is, most of the time, you are sat at a desk, strapped to a desktop terminal; and you can't really move from it. And that desk may be in a nursing station or it may be in a clinic room, but there is no flexibility for you to access information on the go. And there is no flexibility really for you to access clinical colleagues, so if you need to get a second opinion or advice based on this particular case, you have to pick up the phone, send an e-mail or physically walk down the corridor to get someone. And so these are all the key pain points that we are addressing with the system. We have a range of things here such as single sign-on. What this allows is for the NHS to manage their own user base, which reduces our costs of administering service. And it also means, from an information governance perspective, they're responsible for access to the system, which is a much better position for us commercially as a company. So let me log in, and I will show you the impact that we are unlocking. So this is the dashboard view within Bleepa. There's quite a lot of different features. And we won't have time to go through all of them, but I'll focus on the clinical chat because this is the core piece of what we offer. So when you log in as a clinician into Bleepa, what you will see is a list of patients that are of interest to you based on your particular clinical profile, so if I was a respiratory doctor or a cardiologist, I would just see patients that belongs to lung or heart workflows. I wouldn't see patients referred into other pathways unless I was asked to go in and have a look at them. You'll see that some of these patients have color codes around them. So we operate a traffic light system whereby amber means a patient is near to breaching a particular care pathway and red means that the patient has breached the care pathway. So [ they've been in ] part of the patient journey for too long, and therefore, we need urgent action in order to move them through to the next stage. So we actually track the patients as they move between the different care settings. This is something that really isn't currently done very well in the NHS. They have some visibility of where patients are within a particular environment, so within a hospital, you typically know where your patients are, but they have very limited visibility around where GP referrals are coming from, which pathway those patients are going through, let alone where those patients are along those pathways, so that's one of the features and capabilities that we have as Bleepa. In fact, if I show you here our kanban board: This is what is used by navigators to coordinate care services to patients. And if I come here into the CDC breathlessness pathway, what you can see is that pathway broken down into stages and each of the patients at each of the stage of the pathway. And I can, we can have as many or as few stages of that pathway as we want. It's completely configurable to what the NHS partner needs, but it means I can see at a very quick view where any patient is at any given time. And then I can click through to the patient and then interact with them directly. And that from a perspective of managing the flow of patients is a huge shift in value proposition and one of the great new features of the product. So if I come into the clinical chat. And let's come down to a patient who I know has got some really interesting things to show you, Dorothy Morrison. We're now logged in to the single patient, so everything we do from this point relates only to Dorothy Morrison. And anything that we do within Bleepa will automatically write back to the record for the patient in the hospital and also the GP, which means that what I do here goes straight into those services without me having to separately document and duplicate effort, so the chat that I'm having with colleagues becomes the clinical note for the patient. And that saves me so much time as a clinician, so it's not just about the ease of me being able to find colleagues to speak to. It's also about the fact that I don't then separately need to go and document. You will also see here a couple of tabs. For those familiar with the product, the first 2 tabs have been with us for a while. 1 tab over, this is where I show all of the imaging for the patient. And this is one of the unique features of Bleepa is that we are able to display radiology imaging within Bleepa at a certified diagnostic quality, which means that it is safe for a clinician to use, but it also means that the product has to be certified as a medical device. And our unique position in the market is that we are the only communication and collaboration platform that is certified as a medical device for image display. And when you're running diagnostic pathways, medical imaging is a fundamental element of that pathway. If you can't show an image, you can't really deliver a diagnostic pathway. I will come back and show you one of the images just to show you why that's so important and what it means, but I'm just quickly going to show you some of the other features. 1 tab over again, we're into documentation. So this is where we pull in other types of results data for the patient. So it's spirometry results, ECGs, lab results and referral letters. And what this is allowing us to do is to build a very comprehensive view of that patient and all of their clinical information. Now we pull this information not just from the GP but from hospital. We can even pull it from community diagnostic centers. We can even pull it from multiple hospitals so that all of the relevant information is here in one place, so I can just log in as a clinician and view it. And then the really impressive new feature, over here, is the GP record. So this is a live view into the patient's GP record. And I can see and interrogate any element of this, so if I want to look at the medications that the patient is on, I'm able to click in and then see a list of all of their medications. Now why is this important? Well, today, if you're a patient, you will go to see your GP. Your GP will refer you to see a specialist, and then that specialist will see you with very little information about you. And for any of you who have actually gone into the NHS, you will be familiar with this yourselves: You end up repeating your history many, many times. Every time you meet someone new, you end up repeating yourself. That is purely because that doctor does not have visibility of your core record. Now I can see all the medications that you're on. I can click in and interrogate into more detail. I can come back and I can see a summary view where I can see all of your medical history. What have you seen a GP about since the time of referral? What's changed from you since the time that was -- that you were referred? And in combination, being able to save this live view into the GP record and being able to see all of your diagnostic information means that I can log in as a clinician, and 90% of the time, I can actually create a management plan for you as a patient without needing to see you. And that's where the cost saving for the system comes in. And we've been able to demonstrate in our deployments in the NHS that, if we can send you via this route and divert you from our patients, we can actually save the system billions of pounds nationally whilst at the same time turning what would have been a 30-minute outpatient appointment into a 5- to 6-minute remote review by a specialist. And that means that, that same specialist can do 5x to 6x the same amount of work than they would have been able to do based on an outpatient appointment, which means that you can get a lot more delivery out of the same clinical workforce. And everyone will have seen the headlines around wait lists. The big problem with wait lists is we have a finite pool of clinical workers. We can't train up new ones fast enough and we can't recruit in new ones from overseas at the scale required, so we actually just have to do more with the clinical workforce that we have. And that's primarily the value proposition of Bleepa. Now I did say that I would show you some of the features here. So this is the sort of information that we're pulling through. This is a spirometry trace. It shows how the patient's lung is performing. And I did also say I would show you some of the medical imaging capabilities of the platform: So this is a CT scan of a patient. And the difference between the imaging that we show versus the imaging that you would, say, have if you took a photo is, one, I can scroll through this, so I can see all the various body slices as I move through, but two, because it's in a format called DICOM, I'm actually also able to interact with it and change the features. So you see here this dark area. That doesn't have any detail in at the minute, but if I apply a filter, you can suddenly see all the anatomical detail of that. So that's actually the lung. And by being able to change the gray scale, I can pull out certain features. I'm also able to highlight significant findings very quickly to colleagues. So here there's a small air gap called a pneumothorax. And what I can say is, "Pneumothorax detected, needs drainage," and I can press that as an add. And what that will do is it will add a message into the chat for the patient -- it will load up in a minute. And that means that anyone involved in this case will be able to see the note that I've made and click on the thumbnail and go straight through to the image and see the thing that I'm talking about. That is so much faster than the alternative, which traditionally would mean me as a radiologist writing a full report and then phoning or e-mailing colleagues until they answered to acknowledge that they've seen something significant. So in 2 or 3 seconds, I can actually inform an entire clinical workforce of a significant finding on a result; and that also is a huge value proposition for Bleepa as a tool. So I will stop sharing there because I think, if I go into any more, it will probably be too detailed, but I just wanted to show you and to sign -- to illustrate to you the significance of having all of this information in one place and being able to see a live view into the GP record and what that means for me as a clinician and how that translates into a benefit for the NHS. Because I'm able to make those decisions that much faster for the patient. And I'm able to do it remotely, on the go from any location and in collaboration with any clinical stakeholder that I need to bring in. And it just makes it that much faster for the patient.

Thank you, Tom. So we're going to do the fireside chat bit now. And I'm going to try and weave in some of the questions that are coming in, but you have certainly alluded to the sort of the new government and the general election back in July and Keir Starmer's sort of priorities. Have you had a sort of -- has it made a noticeable difference, having the new government in place?

Yes, without a shadow of a doubt. I mean not that I want to labor the point because I know obviously, Mark, being an [ ex-MP ], this is probably slightly close to home, but I don't think we'd be overstating it to say that, under the Tories, we had somewhat of a chaotic picture in the NHS with a sort of rotating door of secretary of state's that meant that having a sort of strategic decision-making force within the system, which wasn't really there -- and as a result, there wasn't really much cohesive action around wait lists and driving that agenda. However, now that we have the Labour government in and particularly Wes Streeting as Secretary of State, there really is an absolute clarity of focus around what the NHS needs to get done. I think that there is still some ambiguity around how it gets there, which is where we come in because our proposition is one of the best routes that they've got to actually addressing their wait lists, but the priority areas come all the way from Keir Starmer, down. I mean Keir Starmer has said 1 that of his 6 missions is elective wait list reduction, so that is one of the only areas of government funding that is coming through the system at the minute. And it's landing into the NHS and it's landing exactly where we want it to as a company. I've already mentioned that Wes Streeting has those 3 priority areas. And that move from acute service delivery, into the community, and being able to manage patients without them having to go to hospital is exactly core to the value that we are bringing with Bleepa. We're all about trying to divert patients away from outpatients and away from the hospital and allowing you to manage them in the community. That links also to the community diagnostic center program, which is all about using diagnostics more dynamically to get decisions for patients more quickly and, again, allowing patients to go to their local community high street rather than having to go to hospital for those tests. And one of the things that we are doing with Bleepa is driving referral volumes into the community diagnostic center but also taking the results from those community settings and embedding them into the care flow of the patient and so that you're getting decisions for the patient that much faster. Because it's not test results but decisions that actually move care for the patient forwards and decisions that get the wait list reduced. So I would say that the sort of mood music being set by government is very much aligned to what we want. I think it is very clear. I think that we are seeing that backed up by more structural changes within the NHS; for example, more aligned funding flows to elective activity, changes of key personnel. I mean, only today, the Chief Executive of NHS England has changed. It was Amanda Pritchard this morning. And this afternoon, it is Sir Jim Mackey, who is someone who we've been working very closely with in our program. And he was a big champion of what we're trying to do with the approach. And so I think those sorts of changes will be fundamental to driving ultimately the improvement in wait list performance. And it also creates really good and compelling scaled commercial opportunities for companies like ourselves. I'd say also that something that has changed this week that is of significance to us is that, on the 24th, so yesterday, the Procurement Act of 2923 came into force. This creates a much more favorable procurement landscape for SMEs and startups. It allows us to run frameworks and -- much more quickly than traditional procurement routes and to align funding mechanisms to those procurements so that we can go to scale, but it gives a vehicle by which the NHS can get behind companies like us and really drive that. I've always said that the 2 challenges really facing us was, one, around procurement; and two, around funding. We knew that the value proposition of what we were doing aligned to what clinicians wanted. We knew it aligned to what the system needed. And we've never walked into a room and had to convince something -- and had to convince someone that Bleepa was a good idea. We've always had to answer the question, "So how is it going to be paid? And how are we going to be able to buy it?" And I think -- between the new Procurement Act and the funding mechanisms like the elective recovery fund that we unlocked at the end of last year, I think we've answered those 2 questions, although obviously, as I said at the beginning of the presentation, there is still a slight question mark around the granular detail of what happens to ERF next year, which has delayed some of the contract signings. But once we have clarity on that, I think we'll have the answer to that second question again, and we'll be able to get going at pace.

You sort of touched on something that there's a few questions about, in terms of dealing with the NHS. And sort of a number of people sort of mentioned that, "Great product demonstration. Why isn't it being sort of snapped up?" And you've had a lot of engagement with the NHS. You used to work with the NHS. What are some of those challenges? And how do you overcome them?

It's fundamentally a people challenge. The NHS is very complex and it makes decisions in very complicated ways. It's very rare that you find an individual decision-maker who can make a decision on their own right, aligned to their own funding pool. Typically, decisions are made by committee and they are made at various levels of the system. And actually, if you want to grow the contract opportunity, you have to start small, prove your technology then take on a larger contract, prove it there and then gradually work your way up the value chain, which is what we've done strategically with Bleepa since we started. So we initially deployed Bleepa within an individual hospital site for a contract value of -- in the order of GBP 120,000. Then we took it out into the community diagnostic centers and started working between GPs, diagnostic facilities and hospitals; and therefore achieved a value uplift to a contract typically of GBP 450,000 to GBP 600,000, but again, a slightly different decision-making group had to go with that. Now we're taking it up to wider regional opportunities with integrated care boards and some national conversations linked to the elective recovery fund but where we're looking at contract values of -- in the order of GBP 2 million per ICB for delivering an elective care program using this pathway approach, so it is a very stepwise and methodical way of growing that stakeholder mapping, but we're also faced with the reality that the NHS is a very complex organization to navigate with a lot of changes of personnel, which means that often you find you'll make progress and then key people will change out and you have to start again. So it is slow and it is about persistence. However, that groundwork is now largely done. We have worked over the course of 6 years to get to the point where we are the key solution to a number of national problems that we are at the table talking to the national leaders, from the politicians, through to department of health, through to NHS England; and then also across all of the regions. So we have done that groundwork. Now we just need to see the execution around decision-making and funding, which, as we've discussed, I think is now on the verge of happening.

Let's swap markets briefly. There's 2 or 3 questions around India and what is happening in India. Perhaps you could give us an update on what is going on there.

Yes. I mean India is a really exciting thing for us. I mean it's our primary focus at the minute, as I'm sure everyone will understand, is on converting the NHS opportunity. That's what we've been funded to deliver. That's where we see the near-term real value creation. We only need to achieve 4 ICB-level contracts under ERF to break even, so we have a very tangible route to that break-even position through the NHS opportunity. However, I don't think it would be sensible for any company to focus entirely on one customer group. And therefore, we made the decision a couple of years ago to start looking at alternative markets; and India was the one that showed the most promise. It has been a slightly long route into India because of our accreditation as a medical device. We had to take the steps to set up our own operating subsidiary and then to essentially license the product to ourselves so that we can sell it in India. That's all happened now and we are starting to see the fruits of that labor come through. So we have a contract in place with one hospital group, quite a large hospital chain in India to actually show how Bleepa could be used around communication. So the traditional use case for Bleepa in the U.K. We also have a partnership with a nongovernmental organization called HEAL Foundation, which are delivering TB screening services. And this was quite an early use case for Bleepa that we discovered in India. And one of our capabilities is to be able to move diagnostic data around very flexibly. And therefore, we were able to connect portable X-ray units and push that information straight up into a cloud environment over mobile networks; and then work with partners in the AI space to interpret those images and bring a result back to the patient within 30 seconds of that X-ray being taken; and then if those results are positive, to bring in the relevant specialists to give advice around the patient. And that's allowed us to build out a TB screening program with HEAL. We actually signed that collaboration last year, but the first real-world deployment of that went live in January. And since we've gone live, we've almost already done 2,000 cases there, so the pace at which things move in India is very different. And the scale, of course, is much larger. And that early traction around those 2,000 cases has already generated a lot of inbound interest into what we're doing in India, both from central government in India but also from private funders and -- who are looking for philanthropic avenues of spending. So one of the nuances of the Indian market is that 1% of company's profit has to be committed to CSR activity, so corporate social responsibility activity, which means there's actually quite a large avenue of private funding for this sort of approach. And it is definitely a source of funding for us as we look to expand that program. So I think that, although we aren't putting huge amounts of resource into developing India, it's actually growing very nicely organically in the background. We do have an in-country resource in the form of Rohit Singh, our in-country MD. And we now also have a couple of people with him supporting that development of the product in the local market and also the integration and scaling of that product for the opportunities that he's unlocking. And I think it's growing very nicely and organically in the background. And we will be reporting more growth there, I'm sure, in due course.

Well, if we stick on product development. You mentioned in a few times in the slides around some of the new integrations that we've seen into the product's. Can you just sort of explain why they are particularly helpful, why they've been put in place?

Yes. So when you are acting essentially as a digital bridge or a digital glue, which is usually how we present Bleepa to the system, where we're taking an interface from primary care and an interface to secondary care, and diagnostic facilities somewhere in the middle. You've got to be able to integrate into each of those environments. Now if we are looking to drive volume into these pathways -- which we are, particularly under the elective recovery funding mechanism, because we get paid for the activity we deliver. So the more patients we put through, the more we get paid. It's absolutely essential that it's an easy referral journey for the GP, because that's where the pathway starts, so we focus a lot of time and effort on streamlining that referral mechanism from GPs. And so we now have achieved integration with the NHS' core referral systems, so the electronic referral service for pushing information into pathways; and a system called GP Connect for feeding information back into the GP. And this allows them to ever so easily initiate referrals into Bleepa and also to receive the results at the end of those pathways back in, in a way that doesn't create a lot of administrative burden for them. And for context: The alternative was essentially generating a manual referral into the system and then receiving information and results back via e-mail with a PDF attachment, which is how, I'm afraid to say, most NHS information is shared back into primary care. So this is a much more embedded solution which allows the information to come straight back and be added into the patient's record within the GP practice without a GP having to go into an e-mail inbox, review it and then manually attach it to the patient. So we take out a lot administrative work. It also means that we can be made available to any GP practice nationally in as little potentially as 30 minutes. It is really just switching it on for those GP practices. And that gives us a very credible story to go into national scale. We can turn up to any region and go live with all of their GP practices, and that is absolutely fundamental. At the other end of the equation, when we are plugging into hospitals and -- that really is a dependency on the availability of IT staff within those settings. We can do that as quickly as 2 weeks. It can take as long as 2 months or more based on whatever work they've got going on, but our capabilities around medical imaging integration, which is unique to what we are doing, allows us to do at least that side of things very, very quickly. And the other systems that we have to integrate, we typically do for a process called HL7, which is an interfacing language which allows us to basically listen to the messages going between different systems and to then take that information into Bleepa. So we have a very standardized approach into hospital integration. And we now have a very standardized approach into integration in primary care that will allow us to move at pace across any of those care settings and environments. And then of course, the live view into the GP record, which I demonstrated, that is such a compelling value add to any clinician to be able to have that additional information about the patient. It really transforms your ability to make those decisions. And that is -- able to be utilized across any GP service in the U.K., so again a very credible story to scale and value creation.

You have mentioned, more than once, partnerships and in particular the relationship with Moorhouse. How is that helping Feedback? What is that providing? And how do we -- how do they work together on that front?

Yes. Well, having just described how we plug the technology in: Actually the technology is the easy bit often. The bit that is more challenging is the change management and the program management that goes around setting up new pathways, and actually that is something that Moorhouse are extremely experienced about. So they are a consulting firm that have expertise around pathway design and pathway implementation. They have a very substantial workforce that allows them to deploy multiple personnel into multiple ICBs, so the moment that we get the nod on contracts, we will be able to do multiple deployments at once. And it means that we as Feedback can focus on what we do best, which is implementing our world-leading technology and getting it integrated and plugged into those care settings as quickly as possible, while they do the program management to bring onboard the users and to make sure that those pathways are optimized for the delivery needs of those NHS partners. And of course then, our other key partner is the primary care record provider, who we're not at liberty to name at the minute, but they have a very sizable footprint across the U.K. More than half of GP practices use their system and almost all of community pharmacies nationally use their systems. And that allows us to not only ever so quickly expand to scale there but also to look at more innovative models of care delivery such as delivering diagnostics, not in hospitals or community diagnostic centers but delivering them in community pharmacy settings. So actually allowing patients to go and have an ECG done at their local Boots or Superdrug, as opposed to having to go to a community diagnostics center or hospital to have it done. And one of the bottlenecks on wait list reduction in the NHS is the ability to deliver diagnostics. So we know that over 80% of the 7.5 million-long wait list are waiting for diagnostics and outpatient appointments, which is where our value proposition really sits as Bleepa. And so together with that partner, we are able to demonstrate not only the ability to deliver pathways but the ability to bring on capacity from other settings such as pharmacy.

We've had a few questions around the sort of reforming elective care plan which came out in sort of January. So that was the way in which effectively the department set out how we're going to get to 92% of referral to treatments by the end of this parliament. And one of the questions is effectively where is the value for the independent sector. "Why aren't -- or are you pursuing that line of business?" And so I'll ask that first and then I'll ask the other 2.

Yes, okay. So the answer is we are working with independent providers. We haven't [ being ] in a position to announce much of this yet, but we have announced our first one, which is with Medical Imaging partners. So they are a relatively small diagnostic provider based in the South East. And it's basically exactly as you just alluded to, Mark. It's about being able to translate what we're doing on the NHS side to the private side. I think it's also no secret that Wes Streeting and Labour have indicated that we're going to have to rely on increased use of private sector providers in order to address the wait lists problem in the NHS. And therefore, they are going to need an infrastructure that allows them to very robustly and safely transfer patients from the NHS setting, into the private setting, and back again. And one of the great features about Bleepa is we are completely agnostic as to who has access. As long as the governance and security protocols are in place, we can just as easily send the patient into a private provider setting as we can into an NHS setting. And therefore, our narrative into NHS England and department of health is very much around view Bleepa as core infrastructure. We are the plumbing that glues everything together. And we are the infrastructure that allows you to essentially send a patient to a private hospital provider or to the local NHS trust and therefore also enable patient choice around where they go for that treatment. In the same vein, together with our primary care record provider, we're building a combined platform called the neighborhood health record that would allow not just hospitals but allied health care providers such as the ambulance service, social care, mental health to all be able to access one core record and communication and collaboration platform for their patients. That neighborhood health record is deliberately named because it aligns with the Neighbourhood Health Service vision. And so there is that opportunity to also look at how we work with not just private providers but the allied professionals that deliver care to patients across the U.K.

Another question on the reforming elective care plan was around there's a strong focus in that document around the NHS App, whether that was encroaching in any way on the work that Bleepa does. I don't think it does, but Tom, over to you.

Yes. No, no, it's a brilliant question. Absolutely not is the answer. And in fact, I think it's a great opportunity for us to work with the NHS around something that they're prioritizing, so -- and the way I would describe it is it's almost 2 sides of the same coin. So if you laid the coin flat, on 1 side of it, you've got the clinician-to-clinician workflow. That's what we do. And on the other side of it, you have the patient-to-clinician workflow. So the bit that we don't really do is the patient interface, so things like the ability for a patient to schedule their own appointment, the ability for patients to receive referral information and for patients to potentially have a dialogue with a clinician. That's the bit that really needs to sit within the NHS App, and actually that's the bit that the NHS is trying to prioritize. So the way that the patient flows through Bleepa. As they go through those various stages of the pathway that I demonstrated, each of those stages can generate messaging which could then pass through to the NHS App and trigger something within the NHS App. That could be triggering an information form that goes to the patient that the patient can then complete within the NHS App and then be added into Bleepa so it's available for a clinician to review, for example. It could be that the patient within Bleepa is moved to the order of the diagnostic stage, and that triggers an appointment letter to go to the patient and then for the patient to be able to schedule an appointment. So I think the NHS App is a really great aligned vehicle for us to drive the opportunity. And one of the things I've always wanted to do and I think the NHS App will be the perfect vehicle to do it with is to -- that view of the patient flow that I showed you, that kanban dashboard. We're actually able to show a patient where they are on any care journey. And I don't know if the people in the audience feel the same, but my observation is that one of the things that makes patients most anxious is not knowing what's happening to them and not knowing what's going to come next. If we were able to show you as the patient a view of that dashboard so that you know which stage of a pathway you're at and what the other pathway stages are going to be, I think that would be a really useful tool for the patient. It's a bit like ordering a pizza on Deliveroo. You can see when it's in the kitchen. You can see when it's on the carrier, and you can see when it's arriving at your door. That sort of visibility is the sort of thing I think that they would really love to bring into the NHS App. And Bleepa already has it and we can just provide that interface into there, so yes, the NHS App, I see as an opportunity to really drive the service offering, as opposed to anything competing.

And the final question in that sort of area was around there was a sort of minimum 5% target, off the top of my head, I think it was, for each ICB. And effectively the same question is how long does it take to sort of secure a contract with ICBs. Are those targets proving useful in terms of selling into the health service? "Is -- has that provided a landing ground for you?"

Yes, it absolutely has. I mean the question coming down the line to every NHS organization is how am I going to deliver more using what I have available to me. And you're absolutely right, Mark. There is across the board a 5% improvement target on position across finances and wait lists and patient wait times, but there is also a requirement for every organization to deliver 118% of its baseline activity based on pre-COVID levels. So in order to get your full financial envelope for next year, based on the planning guidance that we've seen to date, it looks very much like you have to commit to delivering 118% of baseline activity plus an additional 5% improvement on all of those wait list targets, so really it's a 123% improvement on baseline. Now based on the fact that you can't recruit in or train staff quickly enough, particularly clinical staff, in order to deliver that, you can't really scale what you're doing today, so your only option as an NHS provider is to look at how you can do things more efficiently and more effectively. And as we said right at the beginning, core to the value proposition of Bleepa and our pathway approach is that we've taken a 30-minute in-person outpatient appointment and converted it into a 5- to 6-minute remote review that can be done from anywhere by anyone. And so what that means is not only could you at a regional level deliver 5x to 6x the number of appointments using the same clinical workforce, which is more than enough to get you through your elective wait list, but it also means that, if you were to take the solution nationally, you can actually start thinking of the clinical workforce as a national asset that can work on a national wait list. There's absolutely no reason why a patient in Newcastle couldn't be reviewed by a consultant in Plymouth if they had availability to do it. And the Bleepa infrastructure allows that flexibility, so I think the real value proposition for Bleepa will compound as you get to scale across the system, again one of the messages I keep putting into the center of the NHS at the minute. Because we like ICB contracts, but we love national contracts more. So we keep pushing. But yes, I think that we answer that fundamental exam question for them. And what's more, because of the funding mechanism from the elective recovery fund, there's actually a mechanism of payment there, which is always the second hurdle that we have to overcome. And because of the Procurement Act now coming into force yesterday, there's also a much more flexible approach to them buying and procuring it, so the barriers and resistance are falling away and the rationale and justification for doing it is growing. So I think that puts us in a very good position.

We are sort of very much nearing the end. And I'm going to warn Anesh that I'm going to come to him in case he has any sort of closing remarks and if he wants to wrap up, or anything that he thinks have been missed, but we did have a question around security of patient data. So Tom, when we come to you, if you want to sort of weave that into your answer as well, but Anesh, was there anything that you wanted to add?

Yes. I think, Mark, there's been a couple of questions around cash, so we should address those and just clarify the position. So obviously we ended the period with GBP 7.3 million in cash, had GBP 0.5 million come in a couple of days later. And in a -- what we would term a downside scenario where revenues stay at the same levels and where OpEx remains broadly at the same levels, we would have at least 20 months, 20 to 24 months, of cash from period end in that scenario. That's not what we're working towards. We are targeting, as Tom mentioned, in the short term -- or in the near term, I should say, profitability. And the way we see that occurring is through the ERF and large regional contracts given that the average ERF ICB contract on an annualized basis could deliver around GBP 2 million in revenue. There will be a step to get there, but we would need 4 of those to break even and such that we don't need to come to market again. So we are very well capitalized and cash is not a concern for us. And it -- we've got enough cash to deliver on the growth plans.

And Tom...

Okay. So picking up the question about security, yes. This is one of the fundamental things that keeps you awake at night as a Chief Executive in a health care organization, but it is one of the things that we're particularly strong on as an organization. And the security protocols that we have in place have been built on every stage of product development. It's how you handle and control the flow of data that is fundamentally important, so as you would all expect, there's full encryption in flight and at rest. There's also various access protocols that we have to put in place and -- to manage that user onboarding. I mentioned at the beginning single sign-on, when I was doing the demonstration. That actually allows for the NHS partner to control who has access to this system, and so if a doctor is onboarded, they can be added. If they leave the organization, they -- their access can be removed. And it just means that the NHS has greater control over that system, but it is also fundamentally a balance. Whilst you would always want to kind of lock the data up as tightly as you can, you also have to make it accessible in order to make those clinical decisions for the patient. And so having a bespoke tool like Bleepa that meets all of regulatory requirements, it gives the NHS a vehicle to allow it to operate more flexibly. And ultimately that's for the benefit of the patient, and -- but when you see the sign-off processes for a deployment that we have to go through and all the hoops that we have to go through, I think you'd appreciate the huge lengths that are taken to ensure security, governance and appropriateness of that service at every stage. And it is also worth saying that, because it's a cloud-hosted system, actually it's in many respects a very highly secure environment with industry-level encryption and security as designed by the large cloud providers. So it is right at the top of its class in security.

Well, I think that is our time, so Anesh, thank you. Tom, thank you. And hopefully, Linley is ready to take over again.

Tom, Anesh, Mark, thank you for updating investors today. Can I please ask investors not to close this session, as you'll now be automatically redirected to provide your feedback in order that the management team can best 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.

Brilliant. Thank you so much.

Thank you...