The Cereal Entrepreneur
Florence is a platform that aims to revolutionise working within healthcare, it is a marketplace for nurses and carers to find shifts in the care sector - 10% of which comes from flexible working.
In this podcast Anna & Charles will shine a light on flexible staffing, and how this works with the NHS. Having a background as a doctor & looking into multiple sectors, Charles provides insightful knowledge on the problems currently facing the health sector & how we can work to provide care and dignity to all.
Anna Flockett0:00
Hello and welcome to startup magazine podcast, the serial entrepreneur. I am your host, Anna Flockett. And in today's episode, I will be chatting to Charles Armitage, founder of Florence and amazing health tech startup who actually featured in our last issue. Florence is a platform that aims to revolutionise flexible working within healthcare. Charles, first of all, welcome and thank you so much for joining me today. How are you on this wonderful day?
Speaker 10:27
Thank you very much for having me Anna. I'm very well thank you.
Anna Flockett0:30
Good, Good to hear in this current climate. I thought to start with, we could just talk maybe a little bit about Florence and how the company works.
Speaker 10:39
Sure. So Florence is a tech company and what we have built is a platform that helps healthcare workers work more flexibly. So today we connect care homes across the UK to nurses and care workers looking for extra shifts and are breaking down the agency model of temporary staffing. First how it works. How did it How did it come about I was before this I was a doctor. So up until about three years ago, I was working in the NHS as a surgeon and I guess all of the challenges around flexible staffing or temporary staffing, and I would occasionally kind of weekends holidays, try and pick up an extra shift here and there to you know, earn a bit of pocket money. And actually, across UK health, health and care about 10% of all shifts are filled by flexible workforce. So I pick up the shifts occasionally. And it's all done on the phone in front of recruitment agent agent who would try and do some shifts, you knew there'd be shifts just down the road, but they'd sent me to, you know, halfway across the country. It's got a huge amount of money across the top and news ultimately kind of bleeding the healthcare system dry even though the workers on the frontline often demonise these these agency workers, I met my co founder Dan, who is the COO, his background was he was in the military but also the chairman of a housing charity that manages a few care homes. So They were coming at the problem of finding flexible staff from a from a different angle from the provider side.
Anna Flockett2:06
Oh, well, and a little bit about like you and your background, obviously come in as a surgeon previously, and how long did you work in the NHS? And how long were you a surgeon or training?
Speaker 12:17
Yeah, so as a way of being a consultant surgeon, but I was on the training ladder, so I worked for the NHS for probably just over four years. So not a huge, not huge amount of time, but enough to kind of work out what what the deal was, I think,
Anna Flockett2:29
of course, yes. And did you always know that that's what you kind of wanted to go into and when you wanted to be when you were older?
Speaker 12:36
I don't know. I think, you know, the thing about medicine. I think this resonates probably quite a lot with like doctors is that you kind of made that decision to do that when you're relatively young. And it's kind of based on whether you're good at science school, and it's like a natural thing to go into. And actually, it's true for many things. I think, you know, age 15 or 16. You really don't have any idea around your personal character or what drives you or if you do have Lucky but you know, it's only after you've been working for a bit, you've been to a few jobs know a few different things you kind of realise Well actually, what is it that I'm good at? And what is it that energises me and don't get me wrong, there are certain aspects of being a doctor that are really really energising. But what I've kind of learned subsequently about myself, I still think there's a lot more I can learn. But what I've learned is about myself is that I get inspired by doing things creatively and taking risk. And I quite enjoy those two processes. Now, those character traits or create a risk take on exactly what you want from a surgeon because he probably end up in a bit of trouble. So whilst the rest of the job i really liked, it wasn't necessarily like the best use of my skill set. And I guess I kind of came to that realisation after a bit of time. Startup world, however, is because you can you know, you're you're meant to be taking risks. you're meant to be creative,
Anna Flockett3:47
of course, just going back slightly. What sort of technology do you use with Florence?
Speaker 13:53
We have an app, a web app and a mobile app built in back end built rails, Ruby on Rails, and then the front end is Either react or obviously, native app languages. And it's a platform that connects these cows to these nursing carers. So essentially, the way it would work is a care home says, I need a, you know, Care home needs a nurse, maybe someone's phoned in sick, or they've just had someone Leave, leave the rotor. So I'll post a shift and they set the kind of the skills that they need, the rate they want to pay, you know, when the shift is due to be worked, and then there's algorithms within Florence and then matches that to appropriate people in the area who get notified, and then can apply to the shift. And then the county manager can review them and get into work. The whole idea is that because of the whole cycle of that user journey within Florence, which actually isn't just about booking the shift, that's kind of the point where they meet on either side has a huge amount of functionality. So for example, if your health care workers, really important before you work a job, it's not just like working in a bar or you know, fixing a fence post or something. You need to be really, really sure that the person you're sending into that role is so you know, safe and appropriate qualified. So we have a huge amount of technology in the back end that help vet and continue to maintain the compliance of these workers profiles at scale. So the actual shift interaction is relatively small part of it. But anyway, these two people interact. And then there's, you know, some other great stuff about how you can build continuity and driven by things like feedback and ratings, you can prove quality with a system,
Anna Flockett5:16
or and when we founded, how have you, like have you launched and how many people are currently using it?
Speaker 15:24
So we founded in 20, end of 2016, was when we incorporated the company. We did our first shift in April 2017. And the founding, I mean, the founding was kind of, you know, I obviously knew nothing back then absolutely nothing. So we got my co founder, Dan put in a little bit of capital to start off. And we kind of did day one thought, right? Well, this is all the things we want this product to do. And we kind of went to the internet and said, Can anyone build this for us? We'll pay you basically no money and we want it done in two weeks. And someone on the internet says yes, so we had no idea of the concept of like an MVP or, you know, testing And it's racing and things. So we end up spending quite a lot of money on this process. It was absolute rubbish was completely completely unusable product, which was a bit stressful. And then we learned a valuable lesson from that had to really scale back. And actually then kind of our, our real working MVP was a Google Sheet where we just had a Google Sheet where a care home would go in, put on the shifts that need filled, and then we'd have some nurses that we'd on boarded ourselves, and then the nurse could go in and pick that shift. And actually, that core functionality turned out to be kind of all you did for the MVP to work. And then from there, we then kind of were like, Okay, well, now that we've kind of slightly proven the concept, we can go back in and start to build a product again, at that point, we had a in house tech team, we built it from there. But I think you know, key learnings from that were, number one, work out what is the minimum minimum functionality you need for your product to provide value, still something that you can get a bit blinded by today as you go like the only way to solve this is a really complex product solution, but actually, just trying, I say the most simple thing you can first and then the second thing is just me You're super close to users when you're building it. So we built the first product in a bit of an echo chamber. And then it was only after that when we were trying to put that into the nursing homes that we started speaking to the users, and they're like, Well, obviously, it wouldn't work like this. Obviously, it wouldn't work like that. And then from there, you kind of build up from there.
Anna Flockett7:17
Brilliant. Someone told me earlier, the best thing you can do is listen to your customers. And obviously, that's exactly what you did. Obviously, you kind of just touched on this about the sort of challenges that you face along the way. But do you think that being in the health sector is more difficult for a start up then in being in other sectors, for example?
Speaker 17:35
Yeah, I mean, the challenges are very different. So number one, you're dealing with like a very risk averse population and a population very averse to change. So if you imagine as a man say, I'm a doctor, I'm shifting, my job is to turn out to work. And if by eight o'clock in the evening, when I leave, no one has kind of, you know, died or become more on well, other than expected, then I've kind of done my job well, and the way I do that job is by Following a set of protocols, and then very evidence based, this is what you do in this scenario, and it's a bit of a decision tree. Now, that's great, because it means you can get really repeatable, safe healthcare for everyone. But the problem is that it means that you people are very averse to try something new. Because if you try something new and it doesn't work, the only thing that can happen is, you know, bad. Actually bad things that happen to the stakes are pretty high. So people are pretty resistant to change. And the fact that the stakes are so high means that that is also another, another barrier to change. It's not like I'm producing a platform that helps you book an exercise class. And if you can't book the exercise class, then wop dido you know, it's not great, but it's not it's not the end of the world. But if let's say you're in a pure health care play, where you're actually delivering frontline care to people, the impact of your product not working very well is very, very significant. And I think what that means is, you know, we're lucky that we sit somewhere in the middle where, you know, it's not like we've built a cancer drug. But at the same time, we haven't just built an exercise class booking tool with someone in where, you know, what we have what we do has a direct impact to patient care. But it could be could be more challenging than we have it today. And I think if you're at that end of the spectrum where you are building cancer drugs, or you know, you're, let's say, using AI to triage patients or something, you know, the concept of the MVP, though, is really challenging. Because I'm not going to go to hospital and say, Well, we've got this thing it might work, but give it a shot, because no one will want to use it. So in general, you need to I think, you know, be much, much more deliberate and certain about what it is that you're building, rather than just throwing things out there in testing it.
Anna Flockett9:37
Of course, and with the current climate of everything that's going on, and a lot of healthcare startups have had to step up and have adapted and have, you know, been in full force helping, I believe that the same for you guys. What have you been doing in the current COVID-19 crisis?
Speaker 19:55
Sure. So a few things. So we got together about six weeks ago. As a kind of leadership team, and, you know, we're getting a huge amount of concern from our clients, our nursing homes, care homes, because all that stuff, you know, going sick or self isolating, and you know, still today about across the UK cat says for about 20% of cast offer are unable to work. Now, Florence, our core product is matching workers to that sort of demands. But the challenge is that we can't magic workers out of nowhere. And you know, we've seen, even within Florence, lots of challenges around like, just making sure the shifts are getting filled. So we can't imagine healthcare workers out of nowhere but there's, you know, at the same time, there's a real drive in the population for people to help large cohort of people sitting at home who might be furloughed, or maybe even lost their job who really kind of want to help the effort. So, you know, we're pretty good at building technology, we're pretty good at scaling a workforce and credentialing them. And we're pretty good at matching that supply to demand. So we thought we'd use thorens ideas and learnings and build a volunteering platform. So we've built the national care force, which is a platform that connects today's care homes to local volunteers looking to help.
Anna Flockett11:06
And so do people. Anyone volunteer? Like technically could could I volunteer? Or do you have? Is there like, groups of people? Some have experience? Some don't have experience?
Speaker 111:14
Yeah. So So yeah, absolutely. Anyone could volunteer, the way it would work is you would sign up on the app on the website, and you just enter a very few small onboarding questions about yourself, whether you got any experience whether you do or don't have a criminal record check, you know, what sort of jobs you might be interested in doing. And then once you've gone through that process, you're then able to see care homes in your area that are matched to those skills. So if you let's say, don't have any experience and don't have a criminal record check, but there are some characters that need help with shopping or with their marketing or whatever it is, then it connects you to that.
Anna Flockett11:47
Oh wow, so there's like different types of jobs for different types of people and their skills.
Speaker 1 11:51
For sure. So if you were to sign up as let's say, a nurse who has experience in you know, giving medication and managing wounds, then cleaning appropriately You should be done collecting shopping for people, but there's definitely stuff that you can do to help within my car home. Yeah,
Anna Flockett12:04
Yeh definitely. And I mean, with the whole crisis that's broken out the NHS and doing amazing things and all the hospitals and the nurses stepping up. But the care homes need just as much we're not just as much but there's a big problem within care homes as well. That kind of wasn't necessarily brought to attention.
Speaker 112:22
100% Yeah, yeah, it's a bit of a it's, I think, a bit of a scandal in this country, actually. So the NHS is great. And I've worked for the NHS, I think it's a fantastic institution that we should be very proud of. But it's done a very good job of branding itself, and it's got clearly a very strong PR team. The social care sector on the other side is really fragmented. So it's made up of thousands of providers across the country doesn't have a unified voice and just doesn't have you know, as good PR and marketing. But you know, very few people know that there are three times as many beds in the social care sector as there are in the NHS. There are more staff working social coding on the NHS, but but at the same time, the amount of Funded social care is like vastly, vastly smaller the NHS. And I think, you know, everyone is touched by the NHS at some point in their life. And you know, we all think it's a great venerable institution. But people don't really think about the requirement of social care. And, you know, at the moment, the NHS has been a real focus of what the government is trying to do in response to Coronavirus and has done pretty well out of it. So the NHS is now very well staffed it is more or less, relatively well equipped in terms of things like intensive care capacity ventilators, PPE, although that's kind of an up and down story. But if you take it to the social care sector, the social care sector is completely on it's knees just hasn't received any focus or any attention. And ultimately, the people that are who suffer because of that are, you know, the oldies in nursing homes? He don't really have a voice, which is, I think, quite sad.
Anna Flockett13:52
Yeah. And so are the nursing homes in the care homes and the social care sector sorry, they're struggling just as much if not More than the NHS in terms of like the PPE and the staff and the the funding with this crisis. We know we need to kind of like highlight this more, is that what we're...
Speaker 114:09
Totally and I think Exactly, yeah. So, you know, in terms of staffing the social circle before the NHS had significantly worse staffing challenges in terms of and that's only been worsened by COVID-19. For example, you know, I know one care provider who had run some nursing homes and one of their, you know, more senior nurses who is a critical part of their organisations function was called up by the NHS to go and work in the NHS. This nurse was like, Oh, you know, considering going and you know, to completely leave those nursing homes in the lurch. So it's just we need to refocus our balance a little bit toward back towards social care.
Anna Flockett14:43
Yeah, it's something that is not really thought about in this sort of situation. Good to highlight it. Like you said, back to Florence. How have you guys had to adapt like as a company in terms of the crisis Have you had much change in this sense of like remote working and the whole isolation rules and...
Speaker 114:58
mean like everyone we're working remotely, we're lucky that you know, we're a tech company has been around for three years, I think. Therefore, our systems and processes are, you know, innately designed to be remote. So I can log into intercom or Florence or HubSpot or whatever it is in any any part of the world I need, all I need to do my job is a phone and a laptop. So, for us from an operational perspective, working remotely has been not a problem, it's been very easy. That doesn't mean it doesn't come with certain other challenges. So, you know, I think we've adapted on a personal level very well to it. I, you know, I can tell that some people in the team or extroverts social animals quite challenging and trying very hard to make a conscious effort, to communicate actively within the team, make sure we're having very regular catch ups, regular meetings, being very disciplined about that, you know, the flip side is you might you might get a bit of meeting fatigue, where people feel like oh god we are on another Google Hangout or zoom or whatever. But I think the other side of it, which would be that people could potentially slip off the radar and become a bit aimless is a is a bigger risk. The other thing about that as well is that As good as the communications are via things like zoom and Google Hangouts, which I think is fan, it's fantastic. And actually, it's completely changed my approach to what I think about remote working, I think post Coronavirus, I think we're gonna have a much, much better policy on how we manage as a company because I think everyone gets a lot of benefit out of it. However, there are moments where you really just want to be in a room with someone you know, and you're really trying to deal with a really sticky problem. Or maybe there's a bit of tension or a bit of a debate, you really need to have like a proper communication about you know, you do feel when you're on the other side of the camera, you miss a bit there. So they've definitely probably wants twice a week, there are times where like, I'd really like to be able to just sit in a room with someone for an hour work this thing out.
Anna Flockett16:39
Exactly. Even when you're remote working and you're, you're you're an email, you can't be on camera like eight hours a day. So then you're like, Oh, I just really need to talk this out and not type it out. It can be frustrating, but hopefully it won't be forever. And so in terms of obviously like adapting them to the remote working and you know, your team's growing and then also on the flip side of the work. You've been doing for the COVID-19 crisis. How would you describe the last few months have been for Florence?
Speaker 117:06
has been the most engaging time I've ever had with Florence. Definitely, I feel when you're, when you're in wartime like this, it kind of brings me back to the early stages when it was all about the hustle, which I really loved. So, one of the things I've you know, maybe personally found more challenging over the last maybe, like year or so with Florence is you get to a stage where, you know, you're a relatively decent sized organisation. So seventy people today and it's all about making sure you got a strategy and a plan. And people are tracking to goals and OKR's and metrics, all this kind of stuff. And, and that's great, and that's fine, but you kind of missed the hustle. And certainly there's been a lot of hustling over the last few weeks, there's been a lot of like fires to fight, a lot of new things to do things to set up quickly get done. And I found that pretty, pretty exhilarating.
Anna Flockett17:52
The silver lining of the whole COVID situation.
Speaker 117:55
Yeah, I'm not sure if my team would say that. I'm sure a lot of people would be like, What are you talking about speed Also, I think it's really good for organisational muscle, you know, I think you can get it, it's if you're constantly kind of rinsing repeating the same formula the whole time, which in itself is a difficult discipline to master. And something that I'm not very good at, you know, if you're, if you're doing the same thing again and again and again, and you're kind of like, you know, following the same recipe for growth, that's great, but you could lose a little bit of organised organisational muscle in that process, and sometimes a little bit of a crisis that comes along. And it really helps you kind of like galvanise exactly what you're doing, why you're here gives your team a purpose, something for everyone to rally behind and also gives individuals the opportunity to really shine. So you see it actually to the last few weeks, the people that have really stepped up and become accelerated their path of 3d organisation.
Anna Flockett18:43
Definitely. It's been really exciting to see a lot of startups not just in the health sector, obviously, that's one that's Shawn through but like there's a lot of startups that have really, I've said this word a lot but adapted and really stepped up to the market have really like grown and shown themselves Like in this time, so it's really refreshing to see from like a business point of view as well.
Speaker 119:05
And I think we're very lucky. So you probably another question to ask, but I think we're really we're pretty lucky because although we've got like these day to day challenges, and everyone's working sort of 14 hours a day and weekends and things like that, you know, I'd much rather that than being a lot of people who a lot of businesses at the moment who have zero business, so I know a lot of other kind of startup founders who have gone to almost zero. And that's a very unpleasant place to be. And we're also something that we need to remind people alot is, you know, we're dealing with our users are all nurses and carers who are on the front line, dealing with some really sick people that will put themselves at risk. And we're incredibly lucky to be able to sit here in our chairs in a comfortable home, even for 14 hours a day and have the ability to do our jobs in a safe environment. So I count ourselves as being incredibly lucky.
Anna Flockett19:50
Yes, definitely. Like they're telling you to stay at home. If this is all you have to do. I feel guilty that we're just staying at home but it's what we they want us to do. We should embrace it and yeah, like I say should consider ourselves lucky. So, back to Florent, what do you guys have planned? And both kind of short term. We don't know when Coronavirus is going to end but like, you know for the rest of the COVID crisis for the future and then also long term do you have like a five year plan? Did you have a five year slash 10 year plan before the Coronavirus breakout, which was obviously then flipped on its head.
Speaker 120:27
Tell me about the future for Florence,
This pandemic will be but a small blip on the horizon. You know, our goal over the next five years is exactly the same, which is we want to be the you know, the market leading platform for flexible staffing and across all of healthcare so and that means taking what we're doing today and then just providing more and more value to our users on both sides. So for example, for our nurses and carers we've built out or building out Florence Academy which is a place for them to do all their training and professional development and for our combs. How can we give them the tools To manage their own staff more flexibly. So, you know, those are our kind of guiding metric is what can we do to empower flexible working within, within within healthcare, and everything kind of feeds into that. So our plans are to build more products and to improve the products that we build and ultimately to delight our users. And then whilst we're doing that, we just need to be accessing more and more geographies. So today, we offer in the care sector, you know, at some point, we'll be moving into private healthcare or the NHS, we certainly want to be moving internationally sooner rather than later, whether that's to the US or Europe or wherever, and those plans are still very much on track. The only thing that changes slightly is the kind of funding landscape so you know, we have a core business model that we know works and we can operate and execute on and that's fine. But in order to make those like big step changes in what you're doing to operate, so whether that's launching a new market or entering a new vertical, it's important to have, I think the, you know, it's not important, it's probably necessary to have a degree of funding behind that. So whilst we're planning to read Cattle later on this year might still do that. But the somewhat be dictated by the markets,
Anna Flockett22:08
of course. And have you guys raised any capital up until this point? And how did you find the funding?
Speaker 122:15
Yes, we raised about seven, 7 million pounds to this point in a few different rounds. How do we find that I'm very good at forgetting about the pain in the past. So it feels like it's fine. But no, I remember on some occasions being very, very painful and a real roller coaster of highs and lows. I remember we did our series A last June and where we raised 5 million pounds and by that time, we had a decent sized Team 25 people and we go through the DD process, due diligence process with the with our new investors. And they uncovered like quite a few relatively significant skeletons in our closet that we hadn't really known about the just the, the business model of the way that these workers and care homes are interacting. So we you know, we thought and just about Before is about to close, it is all going to fall through, we'd have to, I don't know what we're gonna do, but it wasn't gonna be pretty. And I remember that'd be very stressful. But lots of moments like that. Yeah, it's good, though.
Anna Flockett23:09
And that leads us nicely on to my final question for you. Do you have any advice for other startups in general thousand pieces?
Speaker 123:18
So I guess, right really currently today, I think right now is an awesome environment to start a business. If anyone is thinking oh, you know, the markets not a good time to take the risk and start a business now is 100% the best time to do it? Because people have you know, you said yourself, you're not going out for dinner on Saturday night anymore. So you've got absolutely bags of time, the world is in a huge state of flux. And when the world is in a state of flux and change, that's when people are willing to try new stuff and buy things and try new business models when everything that you took for certain is no longer certain. That's when you have to start reassessing what you're doing so I think now's a fantastic environment people to start start building businesses and you know what, you know, it's all seems pretty chaotic. The moment but in six months time, 12 months time 18 months time, fingers crossed, it should all look a little bit rosier. But the caveat to that is it's not a good time if you already have a big bit like a decent sized business because it's a terrible time then. But if it's just you and you're on your own, and you don't have any you don't have any costs, it's just you know, your living expenses. You need to eat pot noodles or whatever. Now's a fantastic time start building something.
Anna Flockett24:22
Yeah, that's brilliant advice. Well, Charles, thank you so much for chatting with me today. It was really interesting, and it's been great and a pleasure to learn some more about Florence. People can also check out more about Florence that is still available online from our last issue.
Unknown Speaker24:38
No problem, Tthanks a lot. signup to the Nationalcareforce.co.uk