I've Never Worked Harder

You can't generalise. Like in any industry, there are great outfits and there are less great ones, and invariably it's the less great ones that give the industry a bad name. You could point to a lot of projects — none, I think, looking back, that I've been directly involved with — but a lot of projects where you'd seriously question the outcome and the value for money. It's quite a nuanced discussion, though.

Take some of the recent coverage around COVID. I was really pleased with how the consulting industry properly stepped up. It's what the press and the public either don't want to hear or never hear: that when you need an army of people who'll work 20-hour days, with ambition, agility, massive amounts of intellect and experience across different functional areas — to get hospitals up and running, to get a test-and-trace programme up and running — it's not just about the consultants, but my God, they made a difference, and they made it happen quick.

Sometimes consulting projects are commissioned for all the wrong reasons, and then you're destined to fail anyway. I've had projects where the client either has no intention of doing anything with the recommendations, or you're brought in to be the bad cop — to identify something that someone else needs external validation to drive through. So it's never simply a good project or a bad project; there are always nuances. The challenge is accepting the right kind of projects, being as selective as possible about where you can really add value.

If you're on the front line in the NHS, I can understand the accusation. But when you step back and look at the bigger picture, at what some of those programmes have achieved, there's a much more rational argument for making some of those investments. I'm really proud of a lot of the things I've delivered over the past 15 years or so. In many cases it has saved people's lives — and that sounds dramatic, but it's identifying small-to-medium-sized district general hospitals that should not be dabbling in certain clinical procedures, or identifying massive inefficiencies that people have then been able to drive through, saving vast amounts of money. So I can understand the scepticism, but I'm still pretty proud.

I think you're right on the latter. There's so much pressure on the front line, and so much that needs to change, that in most cases you're going to really struggle to persuade a lot of people. You see the nub of it whenever there's press coverage — it's often about the daily rate. But what you don't see behind that daily rate is the 800 years of experience that have gone into creating that team, that combination of experiences that allows things to happen much more quickly.

Those are two massive questions. On the first, I think you're broadly right. You've got to have an opinion — it doesn't have to be the polar opposite of the crowd, but you've got to have conviction, which is always the word you hear investors use. Conviction around your thesis, around the growth opportunities. But — sorry to say — there are so many different flavours of investor, and so much depends on the expectations of your own investors. Are they expecting a 10% return, lower risk, nice steady businesses? That drives you down a certain thesis. Or do they want the game-changers, the category-defining businesses, the 20-to-50x returns? There's every kind of investor out there for different scenarios.

On average we see about 20 startups a week, and we'd back roughly one in a hundred. That's because of our own fund mandate and the expectations of our investors. So what I find myself spending a lot of time doing is directing a lot of those other 99 to the right home, where I can — assuming they're backable.

In terms of standing out from the crowd, if anything one of VC's biggest challenges is that crowd mentality. Very often I see a herd mentality: the same funds associated with a lot of the businesses, all chasing a smaller addressable market. A cap table is very often an extension of a startup's brand — the list of quality investors they've attracted. What I always love is seeing real breadth and depth of insight in the sector, as well as brilliant generalist investors. I'll be less impressed by some big-brand US VC on a cap table than by a brilliant angel here in the UK who has a network that can accelerate the growth of that business tenfold. And the final part of that jigsaw is risk appetite — what stage of investing you're prepared to go at. We invest from seed all the way through to Series C, and it's amazing how your risk appetite changes at each step of that journey.

On your second question — the thesis — there are three main areas the team and I look for. One is personalisation, as you'd expect: businesses that support the personalisation of diagnosis or treatment. The second is that fundamental decoupling of physical capacity — buildings or people — from the point of diagnosis or treatment, using technology. The telehealth providers were the first wave of that. Telehealth is kind of done now; it's commoditised, a bit of a race to the bottom. But that thesis around decoupling holds, in the same way we've seen it in every other sector of our lives — banking, insurance, you name it.

And the third area is removing friction from the supply chain, which is often where I get quite excited. One of our most recent investments is a business called Automata. They build literal robotics — not software robotics, but hardware robotic arms — to tackle the last bastion of inefficiency in healthcare, which is labs. When you think of labs, you think of technicians with a pipette doing a repeated action, prone to error, thousands if not millions of times. This is a super-low-cost robotic platform that lets lab managers turn the lights off and run 24/7. Those are the three main guiding principles, but they're not mutually exclusive.

An area that's really taking off is digital therapeutics — businesses like Big Health or Quit Genius, where they've developed technology so sophisticated it's now a genuine alternative to drugs. Tackling insomnia, anxiety, or in Quit Genius's case severe addiction — smoking, drinking, opioids. Health tech sometimes gets a bad name because you get a lot of apps with questionable efficacy, the equivalent of technology vitamins: helpful for a couple of weeks, but not great long-term. We prefer to look at the ones closer to a genuine alternative to treatment. Those businesses cover both personalisation and decoupling, because you don't have to physically be in front of a therapist for mental health treatment. As one of the biggest teams and funds in the market, we're incredibly broad — we look at pretty much everything across health tech. A lot of other funds have much more niche strategies; I met a family office the other day that only invests in MSK. Very often that's shaped around a family's personal experience. We tend to cover an amazing breadth.

What's interesting — having gone from effectively running a standalone fund to being part of one of the biggest VCs in Europe — Octopus is a team of 90, which in consulting terms is tiny but in VC terms is a giant. You start to see convergence with other technology areas like fintech or consumer tech. One of our recent investments you could call a fintech or a health tech business — it's probably both — where they use data analytics to provide targeted underwriting: understanding whether a certain drug is going to be effective in treating cancer. And they're operating not in the UK but in India, which is such a different market. There, unless you've got $30,000 to spare, the prognosis for a cancer diagnosis really isn't good. So what this business is doing is aiming to make those cancer drugs affordable by offering a process with the drug manufacturer where, if the drug doesn't work, the user doesn't have to pay. It sounds incredibly straightforward — it's not a straightforward business — but you can imagine the number of lives that could be changed when suddenly cancer treatment is affordable.

Another great example of personalisation and removing friction is a business called Ori Biotech. They're aiming to take the cost of personalised cell and gene therapy from around a million dollars per injection — it just blows your mind — down to closer to thousands of dollars. It's those kinds of businesses I just love seeing evolve, and backing in every way we can.

It's quite funny — as a team we've got a phrase: fences are criminal. You can never, ever be on the fence. You score any business out of 10, and it's either a six or a nine — to back it, it's got to be a nine. Indecision is the enemy of any investor. And it's amazing how, when you look at so many decks and meet so many founders, the consistent threads of quality just jump out at you: the quality of the team, their ability to hustle and create commercial traction without throwing 10 million at the product. Those traits are what you look for.

When you're in a sector growing so quickly, the biggest enemy is actually pace — there are just so many opportunities. Portfolio construction in VC is a whole different subject, making sure you create mutually reinforcing winners, but I won't bore you with the intricacies.

One thing on decision-making: I've been on the other side of the fence. While at EY I founded a couple of businesses — admittedly without the full risk of a totally standalone startup, but a fair amount of it. One thing we do as a team is give helpful feedback when we've met a business and decided not to invest, whether it's a "not now" or a "we're unlikely to invest at any point." We signpost where they might need to work on the team, the proposition, their geographical go-to-market. There's nothing worse for a founder than an unhelpful no. And if we've met a business and taken an hour out of their diary, we always endeavour — it's not always possible — to make at least one or two meaningful introductions off the back of it, even if we're not going to invest.

Oh God — you're probably best off asking people I've worked with. But no, absolutely not. I'd sincerely hope not. Actually, I'd say it's the polar opposite. Some of the best leaders I've known are the most human, the most grounded, the most authentic. To use a slightly more PC version of what you described: the ones who have to rely on hierarchy are the ones more likely to be the dicks. It's the ones who can inspire what — terrible consulting phrase — is called "followership." The teams that will run through brick walls for a cause, not for a leader, but because the leader is able to set that cause. I could count on one hand the number of leaders I've followed where I'd have been prepared to run through those brick walls.

So never be a dick. Even if it might help this week, or help this year's promotion, trust me — people will remember it. It's a cliché, but it's a very small world; you're only ever one or two steps removed from someone you might have treated the wrong way. And that's your legacy, in a way. On your tombstone it doesn't say "this person was a senior manager." It's how many people turn up and are actually going to miss you.

I'll start with the easy bit, the practicalities. A very wise person gave me advice about 10 years ago to have a "10x10." You don't have to over-engineer this. There are great tools out there — I'd always say pay for LinkedIn Premium, it's always worth it — but from a CRM perspective I just have a simple spreadsheet. Ten columns for different subsectors — investing, UK healthcare, US healthcare, insurance, you name it — and then allow yourself 10 rows. In each cell you put a name, and I try to go through it regularly. It's just a good nudge: "Oh, I haven't caught up with so-and-so for 18 months," or "I need to update so-and-so on X, Y, Z." That keeps your breadth. Otherwise you risk being really focused on your niche — an amazing deep network in one niche — but then it's bloody hard to transition from one subsector to another.

Other practical advice: don't ask for random coffees and catch-ups. Have a reason. It doesn't have to be a transaction, but have some kind of purpose around a conversation. And in terms of actually building relationships — always have something interesting to say, and think about it from their perspective. It's so easy to go into a meeting thinking, "right, this is what I want to achieve." But I'm a massive believer in paying it forward and helping others out. I've seen firsthand over the last few years the benefit of that: I've helped a lot of people, and now I'm starting to see incredible support coming back from people I might have helped five or ten years ago. So always put yourself in their shoes, think about what they want to achieve, and go the extra mile to help them.

From a general career point of view — if you interviewed my 12- and nine-year-old children and asked what the first thing Dad would say is, it'd be grit and determination. That hard-work element. You can't get anywhere without it. That doesn't mean working stupid hours for the sake of it, but it's table stakes: you've got to be prepared to put the shift in if you want to have a meaningful impact. And people's definitions of hard work vary a lot. My dad was a builder for a long time. Labouring on a building site in winter — that's hard work. Writing an investment deck? It's hours, but it's not particularly dangerous. So that's what I'd advise my younger self.

And the final point: don't waste time with other dicks. Life is so short to spend time with people you don't like. I love investing, and being invested in. What a lot of people don't see is the investors we have — I like spending time with people I enjoy spending time with. It doesn't mean they're all the same kind of person; there's huge variety. Just don't waste your time with people you don't like.

It's just ingrained. I've never worked harder. There's this perception that the more senior you go, the less you work — it's absolute nonsense. It's a cliché, but if you won the lottery, would you still be doing what you're doing? In my case, absolutely — I'd probably be investing with my own money rather than someone else's. It's just a necessity to do anything properly, and the biggest crime is wasting time. I make no apology for saying that. My folks left me far too young, and I'm hell-bent on making sure I don't waste a single day. To get the most out of any day, you've got to work hard.

There's a famous book, Grit by Angela Duckworth, which is amazing — I'd recommend it to any parent in particular. It charts the relative success of different people based not just on hard work but on resilience. An incredible read.

I use one app called Superhuman, which is brilliant for email triage, auto-responses, that sort of thing — super useful. But a lot of people revert to tools when, very often, it's your choice about which meeting you take that's the biggest driver of efficiency and productivity. And to be clear — I've been through periods of my life where I've pushed it too far, not got enough sleep. I'm not one of these people who sees four hours' sleep as a badge of pride. That's nonsense, and you'll do yourself a lot of physical harm. It's not about some daft macho "work as many hours as you possibly can." It's more about whatever you do, absolutely committing and leaning into it.

One of our behaviours in the team is: don't be British. Sometimes we're far too British. You can take it to the other extreme — there are certain parts of the world where they're maybe a bit too direct — but if it feels a little uncomfortable and a little non-British, that's probably the right place to be. Just cut to the chase. People would far prefer that to your dancing around. It's less about sugar-coating and more about trying to be useful and give proper advice. If you think someone's absolutely wasting their time, tell them. Some of my most important early interactions when I left EY — when I'd risked everything — were the ones where people tore me to shreds and said, "this is an absolute disaster." You get so much more value from those than from the "interesting, good luck, I'll be cheering you on" dance. That's really not helpful.

I was reflecting this morning about risk, actually. The advice I'd give my former self is that risk is all relative. Some people see risk in going from one big corporate to another. And — you might have seen it — Free Solo, the documentary about the guy who free-climbed El Capitan. That's risk.

There was a lovely moment when things had been quite scary financially over the last few years. I was explaining to my eight-year-old daughter why Daddy was a little bit stressed and a little bit afraid, and all she said was, "Can we still eat tuna pasta?" I thought that was so cool, because so often we get caught up in so much material crap. I said, "Yes, we will always be able to eat tuna pasta, I promise." Kids don't care — as long as you're there and you're happy, that's the important thing. It was a real grounding moment when you feel exposed and like you're taking a lot of risk.

Depending on the sector. From a VC perspective, I love Samir Kaji's Venture Unlocked — very cool for understanding what's happening, particularly in the US. In terms of must-read books: I mentioned Grit. If you're looking to launch a startup, there's a brilliant one by Ben Horowitz, one of the guys behind Andreessen Horowitz, called The Hard Thing About Hard Things — particularly on that progression from seed through to scale-up and the different challenges along the way.

Then there's Shoe Dog, which Simon Rogerson often talks about and I ended up reading — it's about the founder of Nike. It's less business, more biography, but with some amazing business lessons. And finally, of course, Impact by Sir Ronald Cohen, the godfather of impact venture capital here in the UK. If you ever find yourself questioning what impact or ESG means, or whether there's really something in it, I'd encourage anyone to read it. I'll tell you what impact doesn't mean: for all the small amount of savings I've got, I asked the guys who run my ISA to select a high-impact portfolio, and the best they could come back with was Volkswagen and BP. I said, my God, if that's the best you can do, then we're all in trouble. We've got a long way to go when it comes to proper impact — but read Ronald Cohen's book and you'll see why.