James, perhaps you can start just by telling us a bit about the company. Who are you, what's going on?

We are a health-tech business at heart. We build technology, but for the last three years since we formed, we've been specifically trying to help people who've suffered from some kind of acquired brain injury. So maybe come back to the technology bit in a moment, just sort of explain sort of the reason why. So myself and my co-founder, who's also called James, so nice and easy to remember, but JB and JC.

So yeah, we'd worked together before in another health tech business. And probably about four years ago, we were sat around my kitchen table, as most tech businesses seem to start from. And the main thing we wanted to do was to help people. And I think the name Decently, you know, reflects that. We want to be a decent business to work with, we want to use decent technology. But ultimately we want to do some good with what we build. And I think the time had just come to say, right, what can we do that, you know, leaves a bit of a legacy.

And around that same time, a good friend of mine suffered a fall after a night out and unfortunately ended up going through the brain injury pathway. For me, that really showed me the sort of the challenges that, you know, it's a long recovery. And for him specifically, he started to deal with sort of changes in his behaviour as a result of that fall.

And so that's really what kind of lit the touch paper for us and gave us the passion to do what we've been doing for the last few years. Which is to build a technology platform, Melo, all around helping clinical teams who are looking after brain injury survivors, you know, go through their rehab journey. Hopefully, as smoothly as possible, by being able to look at the changes in their behaviour and what care and what interventions is most appropriate for that individual. So it's almost a personalized kind of approach through the use of data and technology.

I've worked in other startups or the, you know, sort of small and medium sized businesses. I also worked in the NHS for a while in the innovation arm. So looking at it from the other side of the fence, as it were, in terms of what clinical problems have we got on our patch or in our hospital and what technology exists out there on the market that we can bring in.

And I think that gave me a really good understanding of some of the barriers, some of the challenges that you have to overcome, because there's plenty of clinical problems out there to be solved. There's plenty of brilliant solutions and brilliant ideas. But it's actually how do you bring those two together?

I don't want to spend too much time talking about your personal experience, but were there some clear clinical challenges, some unmet needs in your friend's case? Did you see things? I think there really ought to be something that could help with that particular problem.

But for him specifically, I think his challenges really started as he got further into his recovery. You know, he was he was in a coma for three weeks. He came out of that coma, he was obviously then in an intense period of care in an acute setting, he then went into a post-acute setting.

And it was as time went on that these changes in his behaviour really started to sort of get in the way of his recovery, you know, he started to become more agitated, you know, more easily irritable. Beforehand, you know, pre-injury, he was probably the most gentle sort of guy in the gang, as it were. And then he went very quickly to sort of having quite a short temper, you know, becoming sort of lashing out.

So it was those behavioural challenges for him that really got in the way of his sort of ongoing sort of engagement with his therapies. And that's something that, you know, he's he still lives with and still deals with today. So I think it was probably a combination of those things.

He was, you know, one of the it's not everyone, you know, who has a brain injury, who goes on to develop challenging behaviours where he was. And I think that was accentuated by the lack of understanding of those behaviours early in his treatment plan so that his treatment could be, you know, sort of tweaked or, you know, the right interventions put in place for him.

And we spent a lot of time going into hospitals, running kind of what we call discovery sessions. But really, that just means listening and asking questions and finding out what, you know, what happens on the ground. Because I think so many technology solutions almost start the wrong way round, they build the tech, and then they try and find the problem.

So, you know, we tried to do it the other way round with Melo. So we had some ideas, you know, of what we could do, but we didn't want to jump too soon into building something. So as I said, probably about the first 18 months was spent talking to people from all over the country, you know, NHS, charities, private healthcare organizations, just trying to understand where the opportunity was to make a difference. And the obvious starting point was, yeah, data collection. So a lot of the assessment data, you know, that is gathered routinely, a lot of the data that is done when more specialized assessments are required to be done in 2025, is still largely done on pen and paper, and maybe ends up in an Excel spreadsheet.

So that was almost our starting point was to look at how we could create something to digitalize that assessment process, so that you had a standardized way of doing it. You know, we visited some hospitals where they use a classic kind of assessment called an ABC form. And you probably wouldn't believe me when I say it, but actually on two wards, they have three different versions of the ABC. So everyone was doing it in a slightly different way, which actually means that there's inequalities in the quality of care that is being delivered.

So it's not just about the technology, I think it's also about an opportunity to standardize the way that it's approached. To encourage best practice, because we can keep the assessments within Melo up to date. You know, we work with some great clinical partners to, you know, make sure that we're at the sort of the cutting edge of things. But essentially, you know, it's an app that the healthcare teams use. So it's not an app that a patient would log into themselves. But that team that I described, you know, the multidisciplinary team, they could all have access to Melo. They could then use Melo to record assessment data and observations and things that work and interventions about the patient and build up a holistic view of that patient and their behaviours. But then to take it to the next step to be able to piece together that information to start to see trends and patterns. Because if you do a one-off assessment on a bit of paper, and it goes in the office somewhere and never gets seen again, it might be useful in that moment. But you can't join that bit of data up with the bit of data that someone else collected a week ago.

If you were the physio, and you were seeing the patient this afternoon, and I was the speech and language therapist, and I'd seen the patient this morning, then actually the knowledge that's built up in that first sort of session should be available to you in the afternoon. Whereas, it just can't happen if you're relying on pen and paper and word of mouth. So bringing it real time was kind of another key benefit.

And then starting to look at, well, if we've got all of this data, what does that actually mean for a clinician who needs to make a decision about a patient's care? So we've got a lot of charts and visualisations around the data so that you can start to see those patterns and trends. So it may be that you spot that a particular patient has issues on a Tuesday afternoon every week, and you can start to then speak to the team about, well, do we make some adjustments? Is that because one of their triggers is noise, and that's the day when the ward gets cleaned, and there's lots of banging about? So you can look at triggers, you can look at causes, and much easier when you've got the data to do that.

And essentially, that's what Melo is all about. It's helping create a better, earlier understanding of patient behaviour for the clinical teams so that they can make the best decisions for that patient.

We have done that now, we've gone through that process with several different hospitals, and that allows us to have the right kind of technical policy assurance processes in place to do everything that we can to look after that data.

And I think that introduction has led us on to obviously do some work together, and you know, I will polish your head a little bit. I think it's been a fantastic meeting, you know, meeting you and sort of getting to work with you and the teams that you've worked with. You know, not every new idea is going to go all the way through to kind of, you know, become a fully developed product, and I guess first of all you've got to prove that it's going to add some clinical value or help the patients or help drive patient outcomes.

So I think you see a lot of innovations kind of only get so far because actually the problem is just not solvable or it's not big enough to be solved, but after that I think there is a sort of a well-trodden path now and there's organizations, you know, like yourselves, like other parts of NIHR, like the Health Innovation Network that exists within the NHS, that is there to help you overcome some of those things. But yeah, I think there is a lot of support. I think there can always be more.

Some specific examples of that, I guess to bring it to life, you know, we co-hosted a PPIE session last year. Which was the first time we'd done anything like that, and I'm happy to admit that, we were a bit nervous, you know, in terms of we spend a lot of time talking to clinicians and we've got some experience, some lived experience of people that we're close to haven't been through that. But actually being on a call with, what was it, you know, maybe 10, 12, 15 people who've been through some pretty, you know, tough journeys, that was hard for us as, you know, technologists. And I think having you there and the team to facilitate that, to create that environment where we can bring in sort of broader views from really important stakeholder groups. That was a really sort of key moment in last year, and that itself, you know, led on to some good product ideas that we've gone on to bake into what we're doing with Melo.

It's also sowed the seed for us for what we want to do this year, because we're going to do several more of those PPIE sessions. And also it opened up opportunities for us to work with other parts of NIHR, because as an organisation, obviously, sort of patient and public involvement is massively important to them, which we maybe hadn't had the experience of before, because we'd not worked that heavily with NIHR at that stage.

From a tech point of view, we've actually started to now look at how do we create a patient and family facing version of Melo. Right now, it is used by the clinical teams, but some of the people on that call were saying, well, actually, that information would have been really useful for me to have when my son or my daughter came out of hospital, because you're then their care team. You then have to provide the ongoing care for them and understanding what their triggers are, what some of their sort of, behaviours are. If we've got lots of information about that from when a patient has been in hospital, how do we easily get that into a format that someone can learn from and take forward?

So early days, we've got some initial sort of design work underway and we don't have a time frame for launch on it yet. But that's, I guess, an example of that workshop where it has actually led us to we need to build something different here.

You know, stage two for us was then, you know, actually trying that out in a real environment. So probably early parts of last year, we were at that stage where, you know, we had one hospital, Salford Royal up in Manchester. We're working with Dr. Alastair Teager, who's the neuropsychologist there. And that was our first chance to say, look, we've built something, let's test it. So that led us to then, you know, draw some conclusions from that piece of work. We were able to share some initial findings.

So the second half of last year was then about going, okay, well, if it works in one hospital, how can we start to now see whether it works in hospital two, hospital three, hospital four? So going into the start of 2025, we've got a number of hospitals that we're working with, not just in the NHS, but also in the charitable space and in the private space. So we're at that next stage of going, right, okay, let's now test it in a few more hospitals and continue to gather the feedback as we continue to improve the technology at the same time.

So from a kind of a longer term point of view, we know that we need to gather some more evidence. And we're going to do that this year. We're going to be working with NIHR. We were successful with some funding applications just before Christmas for the i4i call that came out. And we really see that that piece of work is going to help us build off where we got to last year. But start to create a much more robust kind of evidence base around the impact that it could have longer term, continue to develop Melo, and we've got some really exciting things that we're working on, but then really build out the clinical evidence base.