17 March 2015
Many years back, my first time in an operating theatre as a medical student was terrifying. It was terrifying. The rituals and rules were strict. From the way you put on your gloves and gown (the first attempt took me almost half an hour), to what you were allowed to touch (pretty much nothing). It felt somewhere between a place of worship and an airplane cockpit. It was cold. It smelt of antiseptic and anaesthetic which gave me an instant headache. It still does.
“The other people in the room had the intelligence and skill to do the job, and knew it inside out.”
There was the laid back anaesthetist in front of his monitors and dials, the frosty scrub nurse who had seen it all, the internationally renowned Chief of Surgery. Compared to theirs, my job was mundane. I was tasked with holding a retractor, which meant keeping a heavy piece of metal very still for a very long time.
Despite being a routine operation, it was not a smooth experience and everything that could go wrong did. An hour into the procedure, as my arm ached from holding the retractor, disaster struck. Blood filled the surgical field incredibly quickly; so quickly it was hard to find where it was coming from. This led to the patient's heart beginning to slow and then stop. Alarms were going off. The numbers on the monitors flashed red. Time slowed as I froze in panic.
Gently, I was moved aside by the scrub nurse. With grace and precision she reached for exactly the right instruments, almost telepathically knowing what the surgeon needed before he asked. The Chief's hands moved fast in a practised pattern, hunting out the problem. He did not look up. If he had, he would have seen the anaesthetist place two large lines into the patient's neck and fill her with drugs and fluids.
Private equity is different from practising medicine. Of course it is. It is focused on numbers not biology and it is infinitely less dangerous. Yet there are some similarities too. Having the right team around you is key. They need the knowledge and experience to ensure success. And like a good surgical team, they must work together, combining specialist skills, keeping highly focused on outcomes not egos and trusting one another at all times. Over the last three years, we have ‘rebooted’ the Healthcare group at Permira. Our core team is unrivalled:
As the newest sector team within Permira and one of the newest healthcare-focused teams in the industry, we have applied ourselves to identifying opportunities which are less obvious, and therefore hopefully more valuable. We’ve ensured a combination of the number and complexity of sub-sectors from biologic drugs and service provisions, to animal health and devices. We have also found that the geographical diversity of companies has raised many opportunities.
We have been forced to be highly selective about the opportunities to pursue. As with any specialised team, we are not right for every company but for a few. Typically these are businesses focused on growth, that are – or have the potential to be – international, that are disruptive and have a level of complexity. It is vital that we work alongside a strong management team, providing more than capital alone, and relying on our skills. The Permira funds' current portfolio of healthcare investments is looking highly promising. As with many surgical operations, the procedures have not always been smooth. Yet with each learning, we have grown stronger and the Permira funds' companies, more steady and valuable.
The Chief did find the source of bleeding that first day. The anaesthetist stabilised the patient. The scrub nurse's eyes smiled above her mask. Ultimately the patient recovered and was discharged. The experience of the way we worked together that day has stayed with me. And in the way we get it right, the current Healthcare group at Permira perhaps reminds me most of that team.