Meet Tony Doyle, Managing Director of Qbtech, whose company’s mission it is to transform the lives of people with attention deficit hyperactivity disorder (ADHD) through objective data to help streamline the diagnosis process and help support children and families. Tony tells us why it’s so important that people receive early diagnosis of the condition, and the benefits of innovator peer support through the NHS Innovation Accelerator.
Tell us about your innovation – what and why?
QbTest is a test using objective measures to speed up attention ADHD diagnosis and improve treatment evaluation.
ADHD is neurobiological – a disorder of brain development that impacts behaviour, affecting around 5% (1 in 20) of school aged children. ADHD is a treatable disorder, yet if left untreated, can have significant impact the lives of those affected.
What was the ‘lightbulb’ moment?
There are many associated difficulties with ADHD such as accessing education, social issues, a loss of self-confidence, isolation and anxiety. It can also have a severe impact on the family too if unsupported. Being diagnosed and treated can be a massive win for children and their families, because the worst thing you can do is cap the potential, or self-perceived potential, of a child. The mission of our company is to transform the lives of people with ADHD and one way that you can do that is be diagnosed earlier, or equally rule it out. ADHD can be incorrectly assumed as the cause of a child’s difficulties, so correctly ruling it out is important so families can be directed to other support services as needed.
In England, it’s very clear that there’s a long delay from the first concern of the parent, which is usually when the child is five or six years old, to diagnosis. The average delay is four years. Two years of that delay are pre-clinic and two years start at the first appointment. So even when a child reaches a specialist, who are often overwhelmed with assessments for ADHD, the sheer volume of work and the ambiguity that comes as a feature of ADHD can lead to delays to decisions. This means children can almost be finished with their primary school education before receiving a diagnosis.
The lightbulb moment for us as a company was realising that we could streamline the process with objective data and help support families and save clinicians’ time. Our first audit was published at Medway Hospital in Gillingham in 2014. It demonstrated that we could save an appointment per person, which can equate to a five- or six-month reduction, sometimes more, in a wait time for an assessment.
We know that once a child has the right diagnosis with the right treatment and support, they can thrive.
What’s been your innovator journey highlight to date?
The highlight from my point of view was building the evidence base. How could we demonstrate that the initial findings are true and clinically robust? We entered into several studies, the most significant being one called the AQUA RCT trial in ADHD, which ran out of the University of Nottingham and looked at the utility of QbTest in 10 NHS settings. We found some nice efficiencies and real validation of the clinical value of the test.
We then went into a demonstrator project of real-world data. This started in 2017 with the East Midlands AHSN. More than 1,200 young people were assessed across seven sites in three trusts. This supported our original findings of one less patient visit to reach a decision to rule an ADHD diagnosis in or out.
East Midlands AHSN then put QbTest forward as an AHSN Network national programme for 2020-23 to be rolled out by all 15 AHSNs across England.
The national programme started in April 2020, right when the coronavirus (Covid-19) lockdown began. We went from testing a couple of thousand people a month to just a handful. The national programme got off to a slow start until September 2020, and now we’re seeing clinics returning to way beyond normal levels due to long waiting lists, which QbTest can support them to reduce. The programme is now well ahead of the original targets and this is testimony to the hard work from staff at the AHSNs and Qbtech.
How have AHSNs supported you?
The AHSNs have really helped open doors and understand what’s going on locally in ADHD services, and broker introductions from a trusted source – AHSN staff are very much seen as part of the NHS family.
What’s been your toughest obstacle to date?
The argument for QbTest is easily won if you have the right clinical and economic evidence. To help clinical teams access funding within their own trusts, Kent Surrey Sussex AHSN created a budget impact model that really helps NHS staff build successful business cases. It still takes time, and is a delay point, but it’s no longer a massive obstacle.
Hopes for the future?
We’re trying to place QbTest in every child clinic in England, and we’re well on our way to doing that. And then of course we want to help them to make the best use of our technology to benefit as many patients as possible. We’re then looking to support the assessment of adults – there are a huge number of adults with ADHD who are unsupported.
Once the assessment bottleneck has been resolved, the next logical step is to use data to help fine tune the treatments and support patients to maximise the benefits. There’s a huge challenge to getting this right as treatment response is idiosyncratic and difficult to predict, which can result in a trial-and-error approach. Systematically optimising treatment outcomes will be a long-term mission for Qbtech and the clinicians we support.
A typical day for you would include:
I’m lucky that I have a really great team, so it’s about working on the strategic stuff. Where are we heading next? What more can we do? I liaise directly with AHSN programme managers most days, and I try and take care of the team like in any organisation.
Best part of your job now?
I think the best part of the job is when we get feedback from clinicians and patients about how it’s helped them. It’s very satisfying and the most important part, for me.
What three bits of advice would you give budding innovators?
- Work with the AHSN Network! But first you need to get that early evidence. It’s really, really important.
- I didn’t know AHSNs existed for an awful long time – I think that the sooner innovators understand the innovation landscape the better. I think it’s important to invest a lot of time in that and the different routes in – and not just for grant money but for how growth can be accelerated.
- Don’t underestimate how long it’s going to take you to get your first 10 customers. It literally took years to get 20 and months to secure the second 20. So don’t give up.
What has your experience been as an NHS Innovation Accelerator?
Working with the NIA has been very helpful and augmented the work with the AHSNs overall as they coincided. The AHSN national network has been the route to the decision makers to buy the product and the NIA gives you a peer group and support network that you can really learn from. There are some amazing innovators out there and we’re able to share painful and helpful stories with each other. We help one another a lot. It also helps raise the credibility of the product and the company. For a small innovator company such as ourselves, just getting people aware that that you exist is a big challenge. We now hear people use Qb as a verb!