HealthInvestor May 2021

HealthInvestor UK May 2021 vol 18 • no 4

essential reading for the healthcare business

Fractured and forgotten Can social care provider market be ignored any longer?

Picture perfect How local imaging centres can address backlog

Lease of life The evolution of the social housing sector

Patient progress Controlling data risk in a fast-moving market

primary care • secondary care • social care • IT • infrastructure • markets • policy ISSN 1742-884X

THE AWARDS Advisory & Finance • Bank/Lender of the Year • Consultants of the Year – Strategic • Consultants of the Year – Transactional • Legal Advisors of the Year – Private • Legal Advisors of the Year – Public • Legal Advisors of the Year – Transactional Clinical Services • Diagnostics Provider of the Year • Primary Care Provider of the Year • Private Hospital Group of the Year • Recruiter of the Year Investment • Private Equity Investor of the Year Property • Property Consultants of the Year – Capital Markets • Property Consultants of the Year – Property Services • Property Developer of the Year • Property Investor of the Year Private/Public Partnership of the Year • Private/Public Partnership of the Year Social Care • Community Support Provider of the Year • Complex Care Provider of the Year • Domiciliary Care Provider of the Year • Residential Care Provider of the Year • Specialist Care Provider of the Year Technology • IT Innovator of the Year • Technology Provider of the Year Outstanding Contribution by an Individual • Outstanding Contribution by an Individual

HealthInvestor

Awards 2021

Early-bird tickets now on sale* The HealthInvestor Awards promote excellence and recognise innovation in the independent healthcare sector and attract over 1,200 guests each year to the Grosvenor House Hotel.

This year, the judges will be looking for organisations and individuals that have made an outstanding contribution to healthcare between March 2020 to March 2021 – and competition will, once again, be fierce.

Buy your tickets or tables at healthinvestor.co.uk/healthinvestor-awards Silver sponsor

Award sponsor

Become an event partner caroline.bowern@investorpublishing.co.uk +44 (0) 797 4643292 *Until 30 May 2021

CONTENTS

news Politics and policy

6

Acute care

7

Dentistry

7

Social care

8

Medical technology

9

Support staff

12

Education

13

Real estate

15

Imaging 24

Civitas Social Housing

28

features Fractured and forgotten?

Failings in the social care provider market must be urgently addressed, says Natasha Curry, deputy director of policy at healthcare charity Nuffield Trust

finance Deals The month’s latest transactions

20

34 Picture of health 24 Charles Wheeldon reports on a private equity-backed imaging company that has created a local clinic alternative to treatment in large hospital settings Live life to the full 28 Paul Bridge, chief executive of Civitas Social Housing, discusses some of the demand and solutions for social housing, the disabilities tenants live with, and how institutions have evolved to help educate and support them Right first time 30 An NHS review finds good practice by independent healthcare, reports Charles Wheeldon Balance progress with security We must plot a path to digitalising the NHS without putting patient data at risk, says Dr Owain Rhys Hughes, chief executive of digital healthtech Cinapsis

Social care

32

20

executive moves Executive moves

36

NHS review

4

30

Cinapsis 32

HealthInvestor UK • May 2021

UP FRONT

MANAGING DIRECTOR Vernon Baxter – +44 (0) 20 7104 2001 vernon.baxter@investorpublishing.co.uk HEAD OF DIGITAL TRANSFORMATION Sarah Hyman – +44 (0) 20 7104 2008 sarah.hyman@investorpublishing.co.uk REPORTER AND SUBEDITOR Charles Wheeldon – +44 (0) 20 3762 2556 charles.wheeldon@investorpublishing.co.uk ADVERTISING & SALES MANAGER Caroline Bowern – +44 (0) 20 3746 2617 caroline.bowern@investorpublishing.co.uk EVENTS MANAGER Gabriele Gineviciute – +44 (0) 20 3746 2615 gabi.g@investorpublishing.co.uk MARKETING EXECUTIVE Anum Hussain – +44 (0) 20 7104 2000 anum.hussain@investorpublishing.co.uk PRODUCTION MANAGER Jeremy Harvey – +44 (0) 20 7451 7053 jeremy.harvey@investorpublishing.co.uk DESIGN & PRODUCTION EXECUTIVE Craig Williams – +44 (0) 20 3762 2254 craig.williams@investorpublishing.co.uk PUBLISHER Harry Hyman FOLLOW US ON TWITTER @HealthInvestor

HealthInvestor is published 10 times a year by Investor Publishing Limited, Greener House, 66-68 Haymarket, London, SW1Y 4RF. The content of HealthInvestor is for your general information and use and is not intended to address your particular requirements. In particular the content does not constitute, nor does it purport or intend to constitute any form of advice, recommendation, representation, endorsement, promotion or arrangement by HealthInvestor Ltd and is not intended to be relied upon by readers in making (or refraining from making) any specific investment or other decisions. Appropriate independent advice should be obtained before making any such decision. Any agreement made between you and any third party named or otherwise referred to in the HealthInvestor publication is at your sole risk and responsibility. Any information published in HealthInvestor may have ceased to be current by the time you read it. Those responsible for the publication of HealthInvestor and/or the authors of articles contained therein may on occasion have an interest in the shares or options, futures or contracts for differences relating to shares in companies referred to in the publication. Such interests are disclosed on an issue by issue basis to the extent required under the Financial Services and Markets Act 2000 (Financial Promotions) Order 2001.HealthInvestor is a trademark of Investor Publishing Limited © Investor Publishing Limited 2021

ISSN 1742-884X

Signs of life, signs of strife

T

he healthcare market never really stopped. Even during the darkest moments of the Covid-19 pandemic, decisions were made, investments signed off.

Lead times for healthcare deals – especially new developments – can be notoriously long, and with the construction industry continuing (largely) uninterrupted throughout 2020, many asset-backed deals proceeded as planned – despite uncertainty around the safety of care environments.

For asset-light, operational or tech-focused businesses, the picture wasn’t so clear. As workplaces were emptied and home-working suddenly ubiquitous, the accepted norms for the deal-making communities were thrown out the window. Late-night team sessions to hit a deal deadline; face-to-face ‘crunch’ meetings between parties to overcome differences; even the simple act of signing papers – these staples of the transaction process had to be re-imagined virtually, from kitchen tables, garden sheds or desolate City offices.

Inevitably, deal-flow suffered. Processes that were nearing completion in March 2020 were paused or in some cases pulled entirely. And while this will have frustrated many of the protagonists, it was of course understandable.

Certainty was a scarce commodity in a world turned upside down; for deals with complexity and risk, the smartest move was often to wait and see.

Looking at this edition’s news pages, however, it seems a corner has been turned in the market. With significant deals closing

across specialist care, residential care, health technology and the physio and wellness sectors, there are clear signs the sector is back in business. Buyers from the world of private equity, US REITs, property funds and trade are all executing investment theses and deploying capital with confidence.

The movement of the M&A markets is in stark contrast to the policy environment – especially in relation to the social care sector.

In a special report on page 20, Natasha Curry and Camille Oung set out the long-unaddressed issues within the social care provider market, presenting a central argument that funding increases alone are insufficient to address the sector’s systemic problems.

With limited signs of material progress, the latest reports out of Downing Street suggest that the government’s thinking is still centred on the Dilnot Report of some 10 years ago.

The Telegraph reports that Boris Johnson supports the central recommendation – to cap costs at between £25,000 and £50,000, with the taxpayer covering the rest – but is said to be at a stalemate with the Treasury, which argues the cost to public finances would be unsustainable.

When it comes to responding to complexity and uncertainty, the investment world can only stand still for so long. For politics, it seems, another set of rules apply. n

Vernon Baxter, Managing director, Investor Publishing

Subscribe today to read our news and features healthinvestor.co.uk/subscribe

Greener House, 66-68 Haymarket, London, SW1Y 4RF

HealthInvestor UK • May 2021

5

NEWS

Politics and policy

NAO criticises government over adult social care in England Short-term funding and the lack of a long-term vision has hampered planning, innovation and investment in adult social care, according to a report published on 25 March by the National Audit Office.

The NAO found current accountability and oversight arrangements for overseeing the care market to be ineffective, stating that, although the Care Quality Commission rates most care as good, the Department of Health and Social Care lacks visibility of how effectively local authorities commission care and the outcomes achieved. It has no legal powers to intervene or hold individual authorities to account, which limits its ability to assess how well money is being spent, or what additional funding is needed to support care users.

The report notes that the DHSC has increased its focus on adult social care in response to Covid-19 and taken steps to increase its capacity and address data gaps, acknowledging February’s White Paper with its proposals to improve data collection and oversight of local authority delivery of social care.

The NAO noted the DHSC failed to meet previous commitments to tackle recruitment and retention challenges for the 1.5 million people who work in care, and hasn’t produced a workforce strategy since 2009, despite committing to do so in 2018. However, the NAO said it has been told by the DHSC that a workforce strategy would be dependent on the next spending review and wider reforms committed to in the White Paper.

The report goes on to say the DHSC has no clear strategy to develop accommodation for adults with care needs and doesn’t monitor the condition of current accommodation itself. Uncertainty

6

National Audit Office, London

about future funding and care policy mean providers are reluctant to invest in accommodation, and funding for new investment is ad hoc with no coordinated, longterm vision across government about how new accommodation will be developed or existing accommodation adapted to meet care needs.

The NAO said short-term funding settlements have hampered longterm planning for adult social care, and that it has previously emphasised the importance of clarity over funding beyond the end of a spending review.

Uncertainty has made it difficult for strapped local authorities to plan how much care they can purchase beyond the current financial year, constraining muchneeded innovation and investment.

For 2019-20, the DHSC assessed that most local authorities pay care providers below a sustainable rate for care.

The report maintains that stakeholders lack visibility of provider finances across the care

market. Pre-Covid-19, many care providers were not financially resilient, and the impact of the pandemic could have further consequences. Analysis by the CQC of the large providers indicates that government support has helped to stabilise the market, but falls in occupancy from around 90% prepandemic to 80% last month, raises concerns that ongoing support may be required.

Despite many years of government papers, consultations and reviews, the NAO notes the DHSC has not produced a long-term plan for care, however the NAO said it recognises the pandemic has delayed promised reforms affecting government priorities and noted the DHSC is leading reform plans and has committed to bringing forward proposals this year.

Noting that reforming the sector will be a significant challenge, the report said it will require a whole system, cross-government approach.

Gareth Davies, head of the NAO, said: “The lack of a long-term

vision for adult social care, coupled with ineffective oversight of the system, means people may not get the care that best supports them.

The Department of Health and Social Care has increased its focus on adult social care in response to the Covid-19 pandemic. It needs to build on this to ensure that its long-awaited reforms deliver affordable, high-quality and sustainable adult social care for the future.”

Care England, the representative body of independent adult social care providers, welcomed the report. Its chief executive Professor Martin Green said: “The NAO report gives clear evidence that the social care system is fragile and in urgent need of reform. The Covid-19 pandemic has shown the importance of social care and the need to regard it as part of the national infrastructure. Care England, stands ready to support the government in developing a new vision for social care, that is properly funded, understood, and respected by everyone.”

HealthInvestor UK • May 2021

NEWS

Acute care

Totally’s Urgent Care Vocare to take division awarded contract NHS 111 calls extensions worth £17.8m...

Totally’s Urgent Care division has been awarded a number of contract extensions worth around £17.8 million. Totally provides healthcare services in the UK and Ireland.

Of the contracts, six are for the continued provision of a number of urgent treatment centres located in Northwest London for six months from 1 April until 30 September this year and equate to around £12.5 million. The contracts have been awarded to Totally’s wholly owned subsidiaries, Vocare and Greenbrook Healthcare (Hounslow), which together form the group’s Urgent Care division.

Wendy Lawrence, chief executive

of Totally, said: “We are very pleased to announce further contract extensions within our Urgent Care division as we continue to strengthen our partnership with the NHS. As always, these extensions are a great reflection of the work our staff are doing in delivering quality care to the high standards required by commissioners.

“We are proud to remain the incumbent provider of these services and look forward to identifying further ways in which we can work together with commissioners in order to provide patients with additional benefits, whilst continuing to adapt to the continually evolving integrated urgent care demands of the NHS.”

Vocare has been awarded a contract to take 111 phone calls on behalf of Yorkshire Ambulance Service (YAS) NHS Trust.

The company will undertake Emergency Department (ED) validations and redirection with YAS’s Yorkshire and Humber Integrated Urgent Care/ NHS 111 service. YAS provides services to 19 clinical commissioning groups with a population of more than five million across nearly 6,000 square miles of Yorkshire and the Humber.

Vocare will clinically assess calls taken by NHS 111 and triage patients to appropriate alternate healthcare services in the region, helping patient flow and ensuring patients are properly directed.

The new framework agreement commences on Friday and runs until

31 March 2024. The agreement, which is on a call-off basis and dependent on call volumes, is worth up to around £2.7 million over the term. Under the initial draw-down contract for 2021/22, Vocare will provide up to 64,000 ED validations. Draw-down contracts for subsequent years will be agreed in line with regional service requirements.

Vocare has also been selected as one of a small number of qualified framework providers for local clinical assessment services in each of the Yorkshire integrated care systems geographies (West Yorkshire and Harrogate, South Yorkshire and Bassetlaw, and Humber, Coast and Vale). Totally said initial dialogue under this framework has commenced and the company will update the market as discussions progress.

Dentistry

...and GP out-of-hours and Riverdale Healthcare minor injuries services acquires Cambridgebased dentist group Totally also reported that Vocare has been awarded a 12-month contract extension valued at about £3.9 million to provide GP out-of-hours and minor injuries services to Vale of York Clinical Commissioning Group.

Lawrence said: “We are delighted to be one of the first organisations chosen to be a preferred provider of Emergency Department validations for the NHS as part of this shift towards the new ICS framework.

Being one of the few selected as part of this competitive process is testament to the hard work of our staff and the quality of services we provide in the region.

“As the NHS moves away from large public sector tendering for services it is looking to be quicker and more efficient in responding to shifts in demand across the country and, as such, is looking to appoint partners that it can proactively work with going forward, without

HealthInvestor UK • May 2021

the need for lengthy procurement processes. Having been selected as one of these providers, Totally can now rapidly mobilise services in response to the shifting demands of YAS without needing to go through further formal processes.

“I am also delighted to announce another contract extension with Vale of York CCG for the provision of services in the region. Our staff continue to work tirelessly alongside the NHS and the quality of the care we offer is reflected in the NHS’s confidence in our service provision up and down the country.”

Riverdale Healthcare has acquired Devonshire House, two dental practices in Cambridge, comprising 12 surgeries and 14 dentists and supporting more than 200 local referring practices.

Devonshire House offers general and specialist dental treatments including cosmetic and restorative dentistry. It has an onsite dental laboratory equipped for digital dentistry with design, milling and 3D printing capabilities. The lab supports implant dentistry from provisional design, through scanning and surgical guides, to finished units and full arch bridges.

The group also provides training programmes to postgraduates and dental practitioners.

Middlesbrough-based Riverdale Healthcare operates 25 dental

practices in Northeast England and is owned by healthcare specialist private equity investor Apposite Capital.

Emma Barnes, chief executive of Riverdale Healthcare, said: “We are thrilled to have Devonshire House recognise the complementarity of our ethos and values with their own. This is a really exciting acquisition which further expands our geographical footprint to a region where we will seek to add more practices to the group.”

7

NEWS

Acute care

Rutherford Health secures £40m infrastructure investment Cancer care healthcare group Rutherford Health has agreed a £40 million infrastructure investment with Equitix Investment Management.

Rutherford Health operates four centres in Wales, Reading, Northumberland and Liverpool, offering a range of cancer treatments.

The investment is backed by the freehold transfer of the Rutherford Cancer Centre South Wales, and supported by other security to be put in place over the group’s other centres. The agreement is for 25 years at normal commercial rates, after which Rutherford can opt to repurchase the freehold of the South Wales centre for a nominal sum.

Rutherford stated it will use the proceeds for further investment in its infrastructure and the provision of working capital for its mediumterm development.

Of the £40 million, £25 million is payable immediately with the balance payable in three equal tranches following the grant of additional security over the other centres. The additional funds need to be drawn down within six months although Rutherford anticipates doing so within the next three months. The initial payment will be used to repay its current debt of £18.6 million with TP Leasing in full, leaving the group debt free.

Offering proton beam therapy, radiotherapy, imaging and chemotherapy, the Rutherford Cancer Centre South Wales was the first Rutherford centre to be operational in April 2018. It was the first centre to offer proton beam therapy and the first to treat a patient in the UK. Mike Moran, chief executive of Rutherford Health, said: “This infrastructure investment is the next stage in our long-term development strategy and enables us to move forward debt free and with sufficient working capital for our immediate needs. The inflow of funds also broadens our options for the longer term. We are a resilient business, well positioned to grow further, bringing essential cancer

care to more patients and supporting the NHS to address the crisis in cancer treatment. We look forward to updating the market further as the group’s longerterm funding strategy is developed.”

Hugh Crossley, chief information officer for Equitix added: “We are delighted to work in partnership with Rutherford to provide the financing for the cancer centre. We have demonstrated a strong track record in our ownership and management of healthcare assets, particularly in this time of crisis where we have been working to support the NHS and, as such, we are pleased to be further consolidating our capabilities and adding these assets to our institutional investment portfolios.”

Social care

Sandstone Care Group acquires Lancashire care home Sandstone Care Group has acquired Ribble Court, a recently completed care home in Much Hoole, near Preston, Lancashire.

The 53-bed home is set on two floors and will provide a mix of luxury residential care and specialist/complex nursing care.

Sandstone expects to create up to 80 jobs when the home is fully occupied. It is currently seeking to recruit a registered manager, nurses, senior carers, carers and ancillary staff, with the aim of opening the home later this month or early June.

Funding for the acquisition was arranged by Simply, a Scottishbased property developer with a dedicated care division.

Ribble Court becomes the sixth home in the Sandstone Care portfolio, joining Longridge Hall and Fleetwood Hall, both in Lancashire, St Helens Hall, Merseyside, and The Oaks in Newtown, Wales. Last month, it completed the purchase of the Oak Springs Care Home in Wavertree, Liverpool.

8

James Parkin, a director of Warrington-based Sandstone Care Group, said: “Ribble Court is a high-quality, purpose-built facility and provides flexible space to enable us to offer a combination of luxury residential care and more specialist and complex nursing

care. Ribble Court will meet a need for more high-quality care provision in the area and also create a range of jobs for up to 80 local people.

“Being purpose-built means that we can tailor the room layouts to deliver outstanding person-centred

care within a supportive, carefocused environment with stateof-the-art facilities and nursing technology.”

Sandstone Care Group stated it is looking at several other opportunities in England and Wales to expand its portfolio.

A bedroom in Ribble Court

HealthInvestor UK • May 2021

NEWS

Social care

Schroder British Opportunities invests in Cera Care Schroder British Opportunities has invested in Cera Care in a transaction led by Evolve HealthCare Partners, a panEuropean healthcare-focused private equity firm.

Cera is a London-based home care provider launched in 2016,

employing close to 6,000 staff across more than 70 offices in Great Britain, delivering more than 30,000 care visits daily.

The new financing will be used to advance the company’s technology platform, as well as acquisitions of small and mid-

sized home care service providers in the UK. Tim Creed, head of UK and European private equity at Schroders, said: “We’re at the watershed of a major shift in healthcare, as innovation and technology change the way in

which traditional services are delivered – with Cera very much at the forefront of this change. We’re hugely excited to be investing in a business with such immense growth potential, and at the same time, an incredibly important social mission.”

Anchor Hanover completes £300m unsecured refinancing Anchor Hanover Group, a not-forprofit provider of housing and care for older people, has completed a refinancing of its bank debt, securing a long-term A+ credit rating from S&P Global Ratings.

The company said it is rebalancing its portfolio focusing more on financially benefiting from long-term stability from debt capital markets that will underpin its ambitious growth plans.

At the forefront of Anchor Hanover’s restructured portfolio is a new £300 million unsecured sustainability linked revolving credit facility. In addition to establishing the first syndicated sustainability linked

loan in the sector, Anchor Hanover becomes the first housing association to move its banking facilities to a fully unsecured basis.

The banks providing the revolving credit facility are Barclays, MUFG, National Australia Bank and Santander UK, with Barclays acting as global coordinator and National Australia Bank acting as sustainability coordinator.

Bradford-based Anchor Hanover offers retirement properties, including 114 care homes, to more than 65,000 elderly people at almost 1,700 locations across England and employs over 9,000 people.

Sarah Jones, chief financial officer at Anchor Hanover, said: “We are

delighted to have agreed the first sustainability linked unsecured banking portfolio in the sector, with current and new bank partners. This refinancing represents excellent value for Anchor Hanover and will underpin our strategy to provide more and better homes, to offer more opportunities for colleagues, to be more efficient, and to be a more influential voice for people in later life. The ESG component underlines our commitment to sustainability for our current and future residents, colleagues, and the communities in which they live.”

Centrus was sole financial advisor to Anchor Hanover, supporting the

development of the refinancing strategy as well as its structuring and implementation.

Phil Jenkins, managing director of Centrus Financial, added: “Centrus is committed to finance with purpose.

Therefore, we are thrilled to have worked with Anchor Hanover on this innovative refinancing which is designed to meet Anchor Hanover’s ambitious growth plans in providing housing and care services to older people. In establishing the first fully unsecured banking portfolio in the sector, Anchor Hanover will benefit from strengthened liquidity, improved asset efficiency and reduced operational risk.”

Medical technology

UK-based digital doctor service Babylon is considering going public via a merger with a Nashville-based special purpose acquisition company (SPAC) called Alkuri, which was established by former Groupon executive, according to Bloomberg.

SPAC mergers, where a business is combined with a publicly-listed cash shell, have become increasingly popular in recent months and if Babylon was to merge with Alkuri the business could be valued at between $3 billion and $4 billion according to confidential sources quoted in the report.

Alkuri listed in February of this year and states that it is focused on “next-generation technology businesses led by visionary founders

HealthInvestor UK • May 2021

and teams leveraging data and artificial intelligence in the areas of consumer internet and marketplaces, healthtech, fintech and mobility”.

Babylon was founded in 2013 by Ali Parsa, formerly chief executive of Circle Health.

In 2019 the business received a cash injection of $550 million led by Saudi Arabia’s Public Investment Fund, which valued the business at approximately $2 billion.

In an interview earlier this year Parsa said he expected company sales to reach around $300 million in 2021 and that there was pressure on the business to explore the public markets given they are “flying right now”.

Credit: Babylonhealth – Own work, CC BY-SA 4.0 (Wikimedia)

Babylon in talks for SPAC merger, according to reports

Dr Ali Parsa, Babylon

9

NEWS

Medical technology

Voicescape acquires patient messaging services provider Social housing technology provider Voicescape has acquired Message Dynamics, which provides patient messaging services.

Message Dynamics’ services have been built using Voicescape’s digital communications technology to provide messaging and telehealth solutions to patients for more than 10 years. Adult services departments in local authorities also use Message Dynamics’ services.

Richard Jackson, commercial director of Message Dynamics, said: “Voicescape has been a great partner over the years, enabling us to create pioneering and award-winning services for patients. Voicescape’s mission to help social purpose organisations engage more effectively with their customers, combined with the growing convergence of public health, affordable housing and social

care, makes the combination of the businesses a very complementary fit.”

John Doyle, founder and chief executive of Voicescape, added: “Public health concerns have been brought to the fore during the pandemic and our aim is to facilitate better, closer engagement with those groups that require a range of support services delivered in ways that suit their changing needs and personal

preferences.

“There are obvious synergies between our services and together we have a greater opportunity to support local authorities and other social purpose organisations transform the ways in which their services are delivered.”

Voicescape is based in Salford; Message Dynamics is headquartered in Lyne, Surrey.

HealthHero acquires French telehealth provider HealthHero has acquired French healthcare company Qare which is backed by healthtech venture builder Kamet Ventures.

Qare was founded in 2016 and last year acquired Doctopsy, which provides digital mental healthcare.

HealthHero offers direct-toconsumer, business-to-business and business-to-government offerings in the UK, Germany, Ireland and France, providing GP support, prescription services, mental health consultations and musculoskeletal specialists.

HealthHero stated that the

acquisition makes it the largest telehealth provider in Europe, now covering 22 million lives.

HealthHero co-founder and chief executive Ranjan Singh said: “This is the most significant telehealth acquisition in Europe in recent times, and firmly secures HealthHero’s dominance in the growing telehealth sector, in the largest healthcare market in the world. While we now provide three million consultations a year, the most any company will have achieved in Europe, with up to 70-80% of all GP consultations

across Europe able to be delivered remotely, this is just the beginning of HealthHero’s growth potential.

By working with the best in each market, we are aiming to deliver the best patient outcomes across the continent for each and every one of these consultations.”

Olivier Thierry, chief executive of Qare, who will keep his role, said: “Europe is seeing an explosion of telehealth businesses.

We are convinced that tomorrow’s healthtech champions will be European. We share with HealthHero a common European

vision for quality and innovative care accessible to all, powered by technology”.

Stephane Guinet, chief executive of Kamet Ventures, added: “We created Qare in order to empower patients by offering them access to a holistic set of personalised medical services that were previously only available inperson. Following its tremendous growth, we are delighted to see it join forces with HealthHero to set the gold standard of what patient-centric telemedicine can look like.”

Medical Imaging Partnership and Prime Health secure funding Medical Imaging Partnership and Prime Health, part of Imaging Holdings, have secured a significant funding facility from private equity firm Apposite Capital to support expansion of their diagnostic services. Medical Imaging Partnership acquired Prime Health in 2018.

The investment will support four additional mobile MRI and CT platforms, additional funding for an advanced CT platform at the Weybridge location, and investment in the MRI service capability at the central London site, all to be delivered this year.

Medical Imaging Partnership

10

and Prime Health participate in 24 NHS frameworks and agreements including the NHS Increasing Capacity Framework, the NHS Supply Chain Framework, and the NHS Shared Business Services framework for outsourced services.

The company’s services include diagnostic pathways and other health services for patients with cancer, musculoskeletal disorders, and cardiac conditions.

Medical Imaging Partnership and Prime Health operate in the Surrey, Sussex, Kent, London and Manchester areas and backing by Apposite dates from 2016. Over the past two years the companies have

expanded services in diagnostics, primary care, and sub-specialty consulting.

Imaging Holdings’ group chief executive Andrew Lennox said: “This is a very exciting time for the company; we have significant plans for the future for both continued support of the NHS intra and postCovid at our ‘cold-Covid’ locations, and also in growth of our private clinics. This first investment further underpins our leading position focusing on innovative delivery models of imaging diagnostic in the community. We look to support the roll out of the Richard Review and GIRFT Report findings and launch

additional services to support the wider UK health market.”

Imaging Holdings’ group chief medical officer Dr Paul ZollingerRead added: “Our existing network of sites across the UK have supported over 40,000 patients through this past year, and the addition of these advanced platforms will allow our clinicians to reach more people and deliver a greater range of services than ever before. The need in the UK for access to rapid and accurate diagnostic and clinical services has never been greater, and our vision to make a difference to people’s lives takes a significant step forward with this investment.”

HealthInvestor UK • May 2021

NEWS

Medical technology

Proximie raises $38m in Series B funding Proximie, a technology platform digitalising operating theatres, has raised $38 million in Series B funding in a round led by US venture capital investors F-Prime Capital, Questa Capital, Maverick

Ventures and Eight Roads, plus several existing investors, including Global Ventures.

London-based Proximie allows surgeons to be virtually transported into operating theatres anywhere in

the world to guide complex surgeries visually. The company stated that growth has been accelerated by Covid, with surgeons unable to travel.

The company said it has conducted

tens of thousands of interactions over thousands of surgeries in 40 countries and 300 hospitals. An increasing majority are in the US, including UMass Memorial Health Care.

Oxford Endovascular raises $10m for investment in brain aneurysm technology Medtech company Oxford Endovascular has raised $10 million in a Series A funding round, led by a £3 million investment from new investor Vulpes Investment Management, and funds from the Additio Investment Group.

Existing investors Oxford Sciences Innovation, Parkwalk Advisors, Perivoli Innovations, Oxford Investment Consultants, the University of Oxford, and private individuals also followed on.

Oxford Endovascular is a spin-out from Oxford University developing a treatment for brain aneurysms to overcome challenges with existing medical devices.

The raise will enable the company to complete development work and gain first in-human data through an early feasibility clinical study. This will set the scene for a further fundraise for larger US Food and Drug Administration and CE Mark clinical trials paving the way for entry into international markets.

Oxford Endovascular stated that the China market is developing strongly and presents strong opportunities for the company’s technology.

The raise follows on from previous non-dilutive grant funding won, including ¤3 million from the EU’s Horizon 2020 SME Instrument and £350,000 from Innovate UK, the UK’s innovation agency Smart Grant programme.

Brain aneurysms affect one in 50 people. If a patent has a

HealthInvestor UK • May 2021

rupture, he or she has a high chance of dying or suffering permanent brain damage. The company has developed a micro stent called OxiFlow, utilising Origami engineering, which can be inserted into the brain blood vessels via minimally invasive groin access. It lies across the base of the aneurysm and causes it to shrink and heal. Developed by professors of neuroradiology and engineering, this novel, nextgeneration ‘flow-diverter’ can be placed more accurately and safely than existing treatments, reducing the risk of complications and having to use multiple devices.

Mike Karim, chief executive of Oxford Endovascular, said: “The current device market for brain aneurysms is valued at well over $1 billion and is growing rapidly year-on-year. One of the biggest challenges when it

comes to treating neurovascular disease is having devices with high efficacy whilst minimising adverse events. Studies show that often multiple attempts are made to place treatment devices, as they often have challenges of landing accurately, opening and maintaining position. This can lead to adverse events and multiple devices being used.

“Procedures typically cost over $50,000 to treat a brain aneurysm and a next-generation flow diverter overcoming unmet needs, offers the chance for more effective, safer and cost-effective treatments, as well as allowing many more patients to benefit.

We plan to use this funding to bring Oxford Endovascular’s groundbreaking technology to the next stage and gain clinical data from human studies.”

Martin Diggle, portfolio

manager, life sciences at Vulpes Investment Management, said: “We believe this platform has the potential to become a world leader in its field.”

Alun Williams, investment director at Parkwalk Advisors, added: “This raise is testament to the extraordinary work and innovation of a great team of development engineers and inventors and will help the company through its next stages of research.”

Nick Dixon-Clegg, investment principal at Oxford Sciences Innovation, commented: “Oxford Sciences Innovation has invested in Oxford Endovascular since seed stage, and we are pleased to continue to do so whilst welcoming new investors Vulpes and Additio into the syndicate, allowing the life-changing OxiFlow device to be progressed towards the clinic.”

11

NEWS

Medical technology

LumiraDx to list on Nasdaq via merger with SPAC CA Healthcare Acquisition Corp, a special purpose acquisition company is merging with Londonbased LumiraDx, a point of care (POC) diagnostics testing company.

LumiraDx has R&D and manufacturing centres in Scotland, England and the US, and sales and marketing operations across Western Europe, the US, Japan, South Africa, Colombia and Brazil.

The company has more than 1,200 employees across 17 countries.

The merger reflects a value of $5 billion for Lumira’s existing equity. Since its founding, LumiraDx has raised $700 million in equity capital including investments by Morningside Venture Capital, U.S. Boston Capital Corporation, The Bill & Melinda Gates Foundation, Petrichor Healthcare Capital Management and other global partners.

LumiraDx has developed a high-sensitivity antigen test for Covid-19 on its platform and the test is currently being used by the National Health Service and Boots in the UK, CVS Health in the US, a number of accident and emergency rooms in Italy and other parts of Europe, and

is being deployed in partnership with the Bill and Melinda Gates Foundation in a growing number of African countries where access to laboratory diagnostics is limited.

The LumiraDx Covid-19 antigen test has received Emergency Use Authorization from the US Food and Drug Administration and achieved CE Mark. The LumiraDx platform and Covid-19 antigen tests are also available in Japan and Brazil and being rolled out in more than 60 countries globally.

The LumiraDx platform menu also includes point of care tests for Covid-19 Antibody, INR and D-Dimer – with high levels of accuracy comparable to central lab-based tests – all of which have achieved CE Mark and are commercially available in Europe.

The platform is designed to go wherever the patient is, whether in a hospital, medical setting, pharmacy, or in other areas such as schools or airports.

Ron Zwanziger, chairman and chief executive of LumiraDx, said: “LumiraDx is at the tipping point of driving a transformation in diagnostic testing. This new public

recognition will solidify our already growing presence in the point of care testing market. Covid-19 has demonstrated how important it is to have rapid and highly accurate diagnostic tests, at mass scale, and available everywhere. It has validated the performance of our platform and enabled us to partner with governments, health systems, retail chains and other customers to expand testing across community care settings both in high and low-and middle-income countries. This access to increased testing will change the way care pathways are currently practised, improving patient outcomes and saving human lives.”

Larry Neiterman, chairman and chief executive of CA Healthcare Acquisition Corp, said: “LumiraDx’s next-generation point of care solutions provide a significant opportunity for our shareholders.

Ron and his management team have decades of entrepreneurial success in innovative diagnostics businesses and the LumiraDx platform and testing menu offer healthcare providers and other customers major advantages over

traditional central labs. LumiraDx has a clear strategy for addressing the large and underpenetrated testing market to increase nextgeneration POC market share. In the near-term, demand for fast, low-cost Covid-19 tests is driving strong and transformational growth for LumiraDx’s solutions.”

International law firm Sidley Austin is representing CA Healthcare Acquisition Corp on the deal.

Support staff

Unison strike over Mitie pay dispute More than 150 porters, cleaners, switchboard and catering staff employed by Mitie at Cumberland Infirmary in Cumbria went on a 48hour strike on 26 March, followed by a 72-hour strike on 23 April, over missing payments for working unsocial hours.

Mitie is a London-based outsourcing and energy services company which provides infrastructure consultancy, facilities management, property management, energy and healthcare services.

The outsourced hospital staff had already taken two days of strike

12

action in February claiming workers in similar roles employed directly by the NHS receive enhanced rates, such as time-and-a-half and double time for overnight and weekend shifts.

The union said staff employed

by Mitie at Cumberland Infirmary haven’t received any additional payments for more than 10 years.

Unison added it has held extensive talks with Mitie and North Cumbria Integrated Care NHS Foundation Trust leading to all parties agreeing the outsourced workers should receive an unsocial hours wage uplift, but neither Mitie nor the trust

is willing to make the payments.

North Cumbria Integrated Care NHS Trust claims it included a substantial sum to cover the unsocial hours wage boost when it agreed contracts for outsourced services in 2010. Mitie denies it has received this funding.

Unison said it wants an investigation into the whereabouts of this funding and offered to withdraw the strike action if Mitie gives a written guarantee that workers would receive unsocial hours payments in the next two months, but the firm refused.

Unison North West regional

organiser David Atkinson said: “It’s incredibly disappointing that key workers, who’ve put their lives at risk during the pandemic, have been forced to take strike action yet again to get pay parity. It’s deeply troubling that North Cumbria NHS Trust says it paid a sum to cover unsocial hours payments that weren’t passed on to workers. This must be investigated urgently.

“These health staff are determined to achieve fair treatment. All of this could have been avoided if Mitie just provided a guarantee that workers will receive the unsocial hours payments they deserve.”

HealthInvestor UK • May 2021

NEWS

Education

Spire offers 270 nurse degree apprenticeships Private healthcare provider Spire Healthcare is launching a new nurse degree apprenticeship programme in partnership with the University of Sunderland, with roles available across Spire’s 35 English hospitals.

The nurse degree apprenticeship is open to applicants at all stages of life, including school leavers, university graduates and people looking to retrain. It is a workbased qualification providing apprentices with a combination of training and assessments via distancing learning and on-site placements applying practical knowledge. Placements will be delivered at a Spire hospital as well as at the local NHS trust and GP practice.

The apprenticeships will take a flexible, work-based approach, combining university study and workplace learning to develop new knowledge, skills and thinking while completing a degree. The apprentices will be paid a salary of between £18,000 and £21,000 while learning, depending on previous experience.

Each nurse degree apprenticeship will complete the programme with a BSc degree. Applications are open now, with successful applicants starting the programme in July.

Deborah Barker, group talent manager at Spire Healthcare, said: “Nurses have a vital role in delivering care and support to patients while in hospital and this programme helps to introduce more people into the profession.

“The appeal of an apprenticeship has risen in recent years due to the increasing cost of the traditional university degree route. Covid-19

has then compounded this with classroom-based teaching disrupted over the course of 2020/21.

“The programme has been developed to give people broad experience of healthcare in England: they will complete placements in Spire hospitals, NHS hospitals, and in the community. This ensures that every apprentice gets a fullrounded experience of the role and is well-prepared for their future career in the sector.”

The programme is open to applicants aged 18 years and

over. Unusually for a nurse apprenticeship programme, it is open to people coming straight out of education, with no existing healthcare background. Applicants need to hold a maths and English GCSE A to C/9 to 4 or equivalent, and have either a Level 3 in healthcare or 112 UCAS points.

The length of the programme is four or five years, depending on existing qualifications. This is reduced to two-to-three years for nurse associates or assistant practitioners to reflect existing experience and prior learning.

Entrepreneur Academy launched to support health and social innovators The Meridian Health and Social Care Entrepreneur Academy launched last month to support health and social care innovators across the West Midlands.

The academy is being led by West Midlands Academic Health Science Network (WMAHSN), supported by the Black Country and West Birmingham Sustainability and Transformation Partnership (STP). The new academy will launch a programme of activities to identify entrepreneurs within health and social care and develop their healthcare solutions, while addressing priorities within the West Midlands.

HealthInvestor UK • May 2021

The academy has two entry points; an intensive, free boot camp allowing attendees to explore entrepreneurship and develop transferable skills. This will be open to all health and social care professionals within the Black Country & West Birmingham STP and registration will be managed through Eventbrite.

An additional six-month, onthe-job workforce development programme will also provide health and social care professionals with the commercial skills, knowledge and experience needed to develop and spread innovative solutions to the health and social care

challenges being faced across the West Midlands. Applications will be managed through Meridian and are now open.

Tammy Holmes, head of delivery (innovation and commercial) at WMAHSN and creator of the Entrepreneur Academy, said: “There is no better place to find new ideas and enthusiastic individuals than in the organisations at the forefront of delivering patient care and looking after our communities.”

“WMAHSN is pleased to be working with the Black Country and Birmingham STP in offering both clinical and non-clinical

healthcare professionals, from the NHS and from valued social care organisations, the chance to develop their ideas and confidence around healthcare innovation, to really make a difference in the region.

“Helping people achieve their dreams and making their ideas a reality is something I’m personally passionate about. I’m excited to meet the NHS entrepreneurs of the future.”

The first Meridian entrepreneur boot camps take place this month and the first cohort of the Meridian Entrepreneur Programme starts in June.

13

HealthInvestor

Seniors Housing Awards 2021 21 October | The Landmark London SING

IORS HOU N E S IN E C N E L L E C CELEBRATING EX

Submissions now open New from HealthInvestor UK, the Seniors Housing Awards 2021 will recognise excellence and achievement in the burgeoning housing-with-care and retirement village market.

As the first dedicated Seniors Housing Awards, the independent judging panel will assess entries across five distinct categories – development, services, finance and operations, innovation and advisory.

Free to enter, leading companies from across this market can read more about the categories on our website and prepare their entries for the deadline of 28 May 2021.

healthinvestor.co.uk/seniors-housing-awards Main sponsor

Gold sponsor

Become an event partner caroline.bowern@investorpublishing.co.uk +44 (0) 797 4643292

NEWS

Real estate

Joint venture unveils luxury Berkhamsted retirement village project Real estate lender and investor Octopus Real Estate, Schroders Real Estate and Elysian Residences have formed a joint venture to create retirement communities.

The luxurious new communities will provide homes for retirees and are targeted to generate close to £200 million of gross development value.

Construction on the first scheme in Berkhamsted, Hertfordshire is due to commence in the autumn and will be branded as an Elysian Residences scheme. It will provide 103 apartments and hotel-style facilities including a double-height lobby, restaurant, bar, library, function room, gymnasium and treatment rooms, with homeowners able to access 24-hour care if required. It features three interconnected pavilion buildings, with the living spaces opening onto terraces, gardens and mature trees.

Kevin Beirne, director, head of retirement at Octopus Real Estate, said: “In line with our existing multi-

operator strategy, we will continue to work with partners to identify first-rate investment opportunities across the UK which deliver strong diversification benefits and returns to our investors as we invest to unlock the potential of the sector. By so doing we aim to give people more choice as to how and where they spend their retirement, with desirable real estate offering them an attractive

lifestyle and an opportunity to live some of the best years of their life through a fulfilling retirement.”

Gavin Stein, chief executive of Elysian Residences, added: “This latest development is part of our ongoing expansion plans and Elysian Residences are actively looking for new sites and investment opportunities as part of our vision to be the foremost provider of inspiring

and elegant retirement communities in the UK.” Patrick Bone, fund manager at Schroder Real Estate Capital Partners, commented: “The pandemic has highlighted the growing need for specialist retirement housing to support the elderly population in the UK and we are committed to developing high-quality retirement communities.”

PGIM Real Estate and Elevation enter senior housing JV Madison, New Jersey-based PGIM Real Estate has entered into a joint venture with Elevation, a specialist healthcare real estate investment management firm headquartered in London.

The venture will fund developeroperators of new build care homes across the UK and source and structure investments with operators. Elevation will provide ongoing asset and development management services.

PGIM Real Estate is the real estate investment and financing business of PGIM, the $1.5 trillion global investment management business of Prudential Financial. The venture has committed to its first investment with the development of two new purpose-built care homes in Exeter and Didcot, in partnership

HealthInvestor UK • May 2021

with London-based operator Care Concern Group. The new homes are expected to be completed and open by late summer 2021 and 2022 respectively.

Charles Crowe (pictured), head of UK transactions at PGIM Real Estate said: “During this challenging time, the importance of high-quality senior housing has never been more apparent. As the market recognises the demographic trends that are driving demand for senior housing, we are seeing compelling investment opportunities in this sector. PGIM Real Estate’s longstanding track record of investing in senior housing in the US and UK showcases our deep expertise and understanding of this sector and we are excited to launch this UK venture.”

Andrea Auteri, managing partner with Elevation, added: “The structure of this joint venture aligns operators alongside an experienced group of investors with a strong track record in healthcare. This innovative investment partnering

product allows operators to incubate freehold developments on their balance sheet whilst reducing their equity requirements, enabling efficient scaling of multiple developments at once. We are delighted to be working with PGIM Real Estate and supporting the next phase of growth for Care Concern Group.”

Manpreet Johal, owner and chief executive of Care Concern Group, commented: “This relationship now means that we can execute our pipeline of developments with a clear and efficient framework allowing us to proceed at a greater pace. We aspire to develop 60 homes over the next three-to-five years adding circa 4,700 beds to our portfolio; this partnership will play a significant role in our growth.”

15

NEWS

Real estate

Target Healthcare rents and valuations grow in second half of 2020 Target Healthcare REIT, which invests in modern, purpose-built care homes, has announced Net Asset Value (NAV) total return of 3.3% for the second half of 2020 (2019: 3.8%), driven primarily by rental and valuation growth of the underlying portfolio. Share price total return for the period was 6.8% (2019: 3.3%) and group specific adjusted European Public Real Estate (EPRA) earnings per share was 2.66p per share (2019: 2.72p).

Dividends increased by 0.6% to 3.36p in respect of the period (2019: 3.34p) and dividends in respect of the period were 79% covered by adjusted earnings, and fully covered based on EPRA earnings per share.

A dividend yield of 5.9% was based on the closing share price of 114p on 31 December 2020.

Target Healthcare had cash reserves of £18.3 million at the end of last year, together with £58 million available in undrawn revolving credit facilities, and low net loan-to-value of 22.2% (average

cost of drawn debt 2.81%, average term to maturity 5.34 years), providing financial and operational flexibility.

The REIT’s oversubscribed £60 million equity issuance was completed in March and Target stated that it has identified an attractive pipeline of investment opportunities.

Target said its portfolio value has increased by £30 million, or 4.9%, to £647.7 million, including like-for-like valuation growth of 1.3%, with portfolio total returns of 4.1% (2019: 4.7%).

Its contractual rent has increased by 4.2% to £40.6 million per annum (2020: £39 million), including a like-for-like increase of 0.3%, with the assets that were subject to rent review in the period delivering an average increase of 1.7%.

It has EPRA topped-up net initial yield of 5.97% and EPRA net initial yield of 5.8%, and a weighted average unexpired lease term of 28.7 years (2020: 29 years).

By 1 February Target said vaccinations had been made available to residents and staff in all of its care homes, with substantial uptake across both groups.

Target stated that it expects tenant occupancy to recover as new admissions can now occur more safely and residents are able to interact with visitors and local communities more regularly.

It added that reports from its tenants indicate significant levels of enquiries from prospective residents.

Full en suite wet-rooms now account for 95% of the portfolio, which is leased at sustainable rental levels, creating a portfolio which is diversified by tenant and geography.

Target Healthcare’s chairman Malcolm Naish said: “The extensive feedback we have received throughout the period from care home managers and their teams has confirmed that the standards of our modern, purpose-built real

estate have been vital to their efforts to provide dignified care for residents during the challenging circumstances of the pandemic.

“The Covid-19 vaccination programme provides a massive relief to residents, their friends and families, and care staff. While our outlook for our homes and the sector is optimistic, we recognise that trading conditions may remain challenging for a period for some homes as we continue to emerge from the worst of the pandemic. Positive relationships with our tenants are fundamental to our business model and we remain a highly engaged and supportive landlord.

“Our business model provides stable, non-cyclical returns from long-term, committed investment in UK care homes. Real estate standards across the sector remain generally poor and this significant undersupply of quality, and the increasing numbers of people over 85 years of age, allows us to invest with confidence for the long term.”

Target Healthcare’s Whittington House

16

HealthInvestor UK • May 2021

NEWS

Real estate

Record investment into UK healthcare property

The Priory, Roehampton

The UK healthcare property market saw record investment volumes last year totalling £2.7 billion despite the Covid-19 pandemic, 55% higher than 2019, as investors increasingly sought stable returns and longterm secure income, according to property advisor Knight Frank.

There was increased interest in healthcare property from investors in traditional sectors such as care homes and private hospitals, as well as rising demand for more specialist assets and providers such as mental health, learning disability and children’s services including children’s homes, foster care and schools.

An increasingly broad church of investors is targeting UK healthcare including a rising weight of institutional capital, a strengthening selection of REITs, and a growing level of overseas investors. Overseas capital has significantly increased, accounting for 72% of healthcare transaction volumes last year, markedly above the 41% share seen across the past five years.

The most significant deals were focused on the private hospital market, with North American REITs expanding their UK presence.

European entrants have also been involved in some significant deals already this year, with French

HealthInvestor UK • May 2021

operator Korian entering the UK elderly sector and Belgian REIT, Cofinimmo, acquiring assets in the Irish market. Both transactions are seen as restoring confidence and signal overseas capital is likely to play a role in the sector this year and beyond.

Despite healthy investment flows, the pandemic has posed an operational challenge for the sector, with hospitals, care homes, GP practices and other specialist healthcare facilities adopting stringent infection control measures, often at a cost, and private sector workforces being stretched in many of the same ways as the NHS. The greatest concerns were focused on elderly care home which impacted investment volumes with the elderly care sector representing 18% of all healthcare property investment, compared to 39% across the past five years.

Julian Evans, head of healthcare at Knight Frank, said: “Investment appetite for healthcare real estate remains strong, both in more traditional assets such as care home developments, as well as more specialist assets including the increasingly popular mental health services sector. This demand is only strengthened by the limited supply within the healthcare market combined with the awareness of

the ever-growing demographic fundamentals for these assets which are driving the sector and make it largely recession-proof amidst testing economic conditions in 2021.

“The year ahead will not be without its operational challenges as the sector looks past the Covid-19 pandemic. Despite this, we expect to see increased global and domestic capital directed at healthcare real estate as investors seek the safety provided by long-dated income the sector provides and look to de-risk and re-weight asset allocations out of retail and into alternative sectors; and the pandemic will likely accelerate investment into social infrastructure. We expect to see more investors target new

Julian Evans, Knight Frank

development opportunities through both direct investment and lending.

This inward investment is vital for the future of the sector.”

The strong fundamentals driving the need for healthcare real estate meant that the healthcare property sector outperformed the rest of the commercial real estate sector, with returns in the sector holding strong at 6.3% last year, while the wider sector saw returns below the longterm average. With a growing pool of investors and a diverse range of different asset types, healthcare transaction volumes have increased year-on-year since 2016 in contrast to deal volumes in the wider commercial real estate market, which have stagnated and fallen in recent years.

High-profile healthcare property deals that are on the market and in the pipeline include mental health services provider Elysium Healthcare (£900 million), children’s care and education services provider Keys Group (£250 million), in addition to another £3 billion of specialist (mental health, learning disability) providers and £1 billion of broader healthcare property transactions.

England’s largest mental healthcare provider The Priory Group was sold to private equity group, Waterland, for £1.1 billion at the start of this year.

17

MAIN SPONSOR

We are delighted to again sponsor the care awards for the 23rd year. This is going to be a special evening to recognise all the efforts, dedication and incredible sacrifice by the sector over the last year. It is always a fantastic event, but I am sure everyone is more that ready to get together and I am looking forward to seeing everyone already!

Richard Lunn Managing Director – Healthcare

The National Care Awards will be returning as a live event on Friday 19th November 2021 at the London Hilton Metropole

Entries now open!

#careawards

careinfo.org/award/national-care-awards-2021

Categories for 2021 include...

H Carer

H Care Home of the Year

H Care Registered Nurse

H The Dignity & Respect Care Home of the Year

H Care Team

H Care Newcomer

H Care Home Manager

H Care Champion

H Dementia Care Manager

H Care Leadership

H Care Operations / Area Manager

H Care Home Group Over 10 settings

H Care Activities Co-ordinator/Facilitator

H Care Home Group Under 10 settings

H Care Housekeeper

H Lifetime Achievement in Care

H Care Chef

H Care Personality

NEW NEW

Enter now! To submit your entry, visit: careinfo.org/award/national-care-awards-2021

CATEGORY SPONSORS

ASSOCIATED SPONSORS

Photo Booth SPONSORED BY

Dinner Programme SPONSORED BY

If you are interested in category sponsorship for 2021, or require further information please contact Caroline Bowern: caroline.bowern@investorpublishing.co.uk or 0797 4643292

As organisers, we will work in close collaboration with the Hilton to ensure the event takes place in the safest possible environment and follows best practice in relation to Covid-19. Government advice is constantly evolving and we will react accordingly to deliver an event that recognises the fantastic work of the sector in a setting where we can celebrate together safely.

SOCIAL CARE

Fractured and forgotten?

Failings in the social care provider market must be urgently addressed, says Natasha Curry, deputy director of policy at healthcare charity Nuffield Trust

20

HealthInvestor UK • May 2021

SOCIAL CARE

O

nce again, the newspapers have been full of discussion and speculation about if, when and how the government might bring about its long-promised ‘fix’ for the broken social care system.

As has been a feature of the social care reform debate over the past decade, the discussion focused on funding: Will there be a cap on costs? Will there be a penny on national insurance for the over 40s? Should there be a hike in inheritance tax? These debates have been rumbling on for so long, yet despite much talk, we’ve seen little action.

Although deciding on funding of the care system is indisputably crucial, it has become increasingly obvious that addressing only the funding and financing issues will not necessarily fix the deep structural problems in the social care sector. One of the frequently overlooked issues is that of the social care provider market. Covid-19 has brutally highlighted just how fragile many organisations that provide vital care and support are, but the underlying problems existed well before the pandemic struck. Our new Nuffield Trust report ‘Fractured and forgotten?’ argues that reform must urgently address the failings in the provider market if we are to pull social care back from the brink.

How the market operates The social care provider market is vast and complex, having developed somewhat haphazardly over the past 30 years following the shift of the majority of services out of public ownership. Today, upwards of 14,000 organisations provide services, ranging from care at home to high-intensity care in care homes, across more than 20,000 locations. Organisations come in all shapes and sizes: they span private, state and voluntary ownership; for-profit and non-profit; and range from large chains of care homes to single-site family-run care homes and small home care agencies employing a handful of local staff, or new models of care such as Shared Lives.

Complexity also lies in how care is accessed and funded. Unlike its sister service, the NHS, social care is not free at the point of use. Those who are deemed eligible receive public funding from their local authority for some or all of their care. Eligibility is measured both in terms of financial means – anyone with means of £23,250 or above is not eligible – and severity of need. Providers of services, therefore, typically care for a mix of individuals funded by their local authority and those paying for themselves, or some combination of both.

Money for care comes to local authorities from a mix of the national grant and local revenue collected via council taxes (including the ring-fenced social care precept) and business rates. To make things more complicated still, the NHS also pays for some care for those deemed to have a ‘primary health need’ and eligibility for NHS funding is often a source of contention at a local level.

▶

HealthInvestor UK • May 2021

21

SOCIAL CARE

▶ What’s not working?

“It’s the fees paid by councils for care” is the dominant explanation for the fragility of the market. That, to an extent is true, but it masks some of the nuance and complexity therein. Low fees do create an underlying uncertainty as I explore below, but there are other factors that need to be understood and addressed if we are to put the market on a more stable and sustainable footing.

Fees paid by councils Councils have seen their budgets slashed by more than 50% in the past decade and that has had a knock-on effect on care fees. Councils have sought to protect adult social care as much as possible – instead choosing to cut other council-run services – but, inevitably, tough decisions have had to be made about how to allocate resources. Councils have both raised the threshold of need at which people become eligible for care, so they are funding fewer people, but they have also reduced the fees paid to providers.

Many providers report being paid fees that barely cover operating costs. It is common practice for providers to fall back on charging self-funders considerably more (sometimes as much as 40%) for the same service than council-funded clients. This cross-subsidisation has created a deeply unfair system.

While providers may survive day to day, they don’t have the room to invest in premises or services or to innovate.

One of the consequences is that more and more providers are choosing to pull out of certain local markets or to exit the council-funded market and focus on self-funders only. Uncertainty over funding and differing abilities of councils to raise revenue locally has created instability and regional variation in the supply and choice of care.

Councils in more affluent areas are able to raise more in local revenue and pay higher fees.

The care workforce is a casualty of this low-fee environment. Low pay, challenging working conditions, unstable zero hours contracts and limited investment in training have fuelled high vacancies and turnover – facts painfully highlighted during Covid-19 as providers struggled to staff services.

22

Organisational structures breed instability While low fees are clearly a factor, opaque ownership and complex underlying business models of the large providers creates further instability in the residential care market.

The potential for making money through refinancing make this an attractive market for hedge funds, property investors and private equity funds. These heavily debtladen companies are highly sensitive to changes in the external environment and can quickly become unviable.

The high-profile collapses of Southern Cross, Four Seasons and Castlebeck demonstrate just how dramatically the market can change. In the event of a financial collapse, the provider bears no responsibility for care continuity – that duty falls on the local council – so there is little check on risky financial behaviour. The Care Quality Commission monitors the financial health of ‘hard to replace’ providers, but lacks the powers to intervene to prevent financial collapse.

Concern about ownership isn’t confined to the larger providers. At the other end of the spectrum, many of the smaller care home providers are often part of an owner’s pension pot, and the property is frequently sold to developers on retirement but the business is rarely continued. While the fallout from a small provider closing is relatively contained, it still brings with it the distress, anxiety and potential discontinuity of care for individual residents and their families. Much of the market is made up of small and medium-sized businesses, so this is a real concern for the future. As providers leave the market, there are growing numbers of so-called ‘care deserts’ with little or no provision, leaving people with limited choice.

Quality is high but improvement lacklustre In addition to the quantity of care available in some areas, there are also concerns about quality. While the quality of providers is generally high, there has been little improvement among low performers over time and few drivers of proactive improvement within the system. Cuts to council budgets have limited the scope

HealthInvestor UK • May 2021

SOCIAL CARE

and effectiveness of local authority ‘market shaping’ – far-reaching. The small social care team at the Department a duty bestowed on local authorities in the 2014 Care of Health and Social Care lacked sufficient capacity to deal Act, intended to encourage strategic development of with the scale of the Covid-19 crisis. With accountability local markets for all service users. Instead, most councils split between national and local government, a lack of undertake commissioning that is heavily transactional, good data upon which to base the response, and few established communication channels with providers, there without consideration of outcomes or improvement. was confusion about where responsibility lay or about the The forces of choice and competition are also weak.

Individuals and councils purchasing care are limited scale or type of need. Providers struggled with constantly by a lack of accessible and highchanging guidance issued without notice quality information which constrains and often more suited to NHS settings choice. Furthermore, once someone than social care. The government’s has opted for a care provider, they are efforts to bolster the social care team at the Department have been welcomed and generally reluctant or unable to switch This opportunity to (particularly in residential care), leaving it is hoped that the expansion indicates build a sustainable few strong incentives or rewards for a new focus on reform. proactive service improvement. system must The result is that the system is driven Now or never – time for be grasped by low-cost short-termist purchasing of comprehensive reform individual care packages, and lacks a With the Covid-19 pandemic having long-term drive towards innovation and brought the social care system’s improvement to build services around problems into sharp focus, public and the needs and wants of those who use political support for reform is high and them. There are some exceptions to this, of course, but this opportunity to build a sustainable system must be innovative models are difficult to scale and spread in grasped. However, attempts to reform social care will fail this environment and appear to have been driven by if insufficient attention is paid to the provider market. individual leadership and a willingness of councils to A fundamental cog in the wider delivery of services, a delve into their reserves. failure to put right the structural issues inherent within it will see reforms grind to a halt. To move to a more Lack of government prioritisation sustainable model of care in the long term, there needs The Covid-19 crisis has highlighted the consequences of a to be a better understanding of how the markets work sustained lack of prioritisation of social care within central and an acknowledgement that any reform to social care government. The consequences of this lack of focus and funding needs also to address the structural faults within understanding of the complex web of providers have been the market. n

HealthInvestor UK • May 2021

23

INVESTMENT

Picture of health Charles Wheeldon reports on a private equity-backed imaging company that has created a local clinic alternative to treatment in large hospital settings

24

HealthInvestor UK • May 2021

INVESTMENT

I

maging Holdings was in the news last month as it announced a further capital injection from its private equity backer of five years Apposite Capital to support the expansion of the diagnostic services provided by its two businesses, Medical Imaging Partnership and Prime Health.

The two entities have been united under the Imaging Holdings name following the group’s acquisition of Prime in 2018, though the two operate in quite different ways.

Medical Imaging Partnership began life in 2010 when a group of radiologists spotted a problem in providing topquality and timely radiology services to referring clinicians, which in the words of Imaging Holdings’ chief executive Andrew Lennox were “not too quick”.

The resulting operation followed a business-to-business model, contracting with commissioning bodies to provide managed radiology services to private and NHS hospitals including MRI, CT, X-ray ultrasound and DEXA (which

HealthInvestor UK • May 2021

stands for dual-energy X-ray absorptiometry, a means of measuring bone mineral density using spectral imaging, a particularly useful procedure for assessing the health of the elderly).

Lennox, who joined Imaging Holdings as chief executive in August 2019, has a particular insight into the company from its earlier days, as he signed up its services when he was hospital director of Nuffield Health’s Haywards Health Hospital in 2011. That arrangement, he says, proved to be “a great success”.

Prime Health was set up in 2011 from a single site in Weybridge, Surrey, offering MRI scans and private GPs and consultants operating a ‘poly clinic’ model. This is more of a business-to-patient business catering to the private healthcare market, with its patients either privately insured or self-paying, though it does also provide its services to patients of the NHS.

▶

25

INVESTMENT

▶ Expansion

segregation of acute diagnostics (to be done in hospitals) In 2016 Medical Imaging Partnership had attracted the interest with elective activity to be delivered in community settings of medically focused private equity firm Apposite Capital, to provide quicker access to tests and greater convenience to whose initial investment that year was supplemented in 2017 patients, as well as to relieve pressure on hospitals. when it pumped in more cash to facilitate the acquisition of The Richard’s Review says that CT scanning capacity needs the Queen Anne’s Street Clinic, just off Harley Street, and to be doubled over the next five years, which equates to 777 added even more support in 2018 with funding that enabled new scanners and 256 replacements. For MRIs, the figure is 273 the acquisition of Prime Health and the opening of a greenfield new and 193 replaced, for X-rays the figure is 300 new and clinic South Manchester Diagnostics, in Stockport.

749 replacements, while around 1,300 new and replacement Today the Imaging Holdings group operates from 13 (each) ultrasound scanners will be needed. locations in Sussex, Kent, Surrey, London and Manchester, It is estimated that the NHS can fund around 30% offering stand-alone and mobile services, as of the need, and that the funding well as remote reporting radiology, and has will specifically be allocated to the supported more than 40,000 patients over replacement of old equipment rather the past 12 months during the Covid-19 than increasing the number of scanners pandemic. available. The public sector is turning We can offer the The company holds 24 NHS contacts with to the independent sector to support agreements including the NHS Increasing delivery of the rest.

NHS flexibility Capacity Framework, the NHS Supply Chain Underpinning Imaging Holdings’ and can facilitate Framework, and the NHS Shared Business mission is the aim of shifting its services continuity of care Services framework for outsourced services. away from acute emergency locations The company’s services include diagnostic and hospitals into more communitypathways and other health services for based environments such as clinics and patients with cancer, musculoskeletal consulting rooms. Hospitals, particularly disorders, and cardiac conditions. large ones, contends Lennox, are now In addition, Imaging Holdings has a number of spot places where patients can easily become fearful because contracts with individual organisations including clinical they also accommodate infectious Covid-19 patients. commissioning groups for the provision of services such as “We know there’s concern for the future,” says Lennox, ultrasound in specific areas or locations. “because we can tell from the statistics that the number of Lennox says the company is looking to add five new patients who have not presented their symptoms to a clinic scanners this year and is currently tendering for contracts to has significantly reduced in the past 12 months. Unfortunately that’s not because the UK population has become healthier over extend its diagnostic services across the UK, which he says that period, and so we anticipate there’s an unseen number will prove crucial in supporting the NHS as it recovers from of patients who will present post-lockdown. If this has been the difficulties presented by the coronavirus pandemic.

He points to the Richards Review and the Get it Right going on for a year, many of those conditions by now will First Times Report which have highlighted the need for clear have become more chronic.”

Andrew Lennox, Imaging Holdings

26

HealthInvestor UK • May 2021

INVESTMENT

Sam Gray, Apposite Capital

Elective care In addition, Lennox says community-based services will help ensure that elective care won’t have to come to a stop in the event of future pandemics. District general hospitals, he says, can avoid grinding to a halt because there’s been nowhere to decamp care pathways in the face of the pandemic, hindering treatments such as hip replacements and cardiology.

Lennox says: “It we can deliver care outside hospitals, patients can receive care in infection-secure environments, and don’t have to go into the hospitals. We can offer the NHS flexibility and can facilitate continuity of care.”

The latest Apposite investment this year is earmarked for new MRI and CT delivered over the next 12 months. Lennox says the company is predicting a 60% increase in revenue as a result of organic growth through these investments, with a corresponding percentage increase in the number of patients it treats across both the NHS and private sectors.

Further investment will also be channelled towards an increase in the number of its private clinics; with multiple sites identified, the location of the two planned sites are yet to be revealed “for commercial reasons”, but Lennox anticipates these should be in place by next March.

UK under-capacity in radiotherapy at the time. In the case of Cancer Partners UK, Apposite helped fund the purchase of linear accelerators, machines that deliver the radiotherapy for cancer energy beams to attack various types of cancer which cost millions of pounds each.

“At the time,” says Gray, “the only capacity for this sort of treatment was to be found in hospitals with no community outpatient facilities available. We looked at various European healthcare markets and could see that community-based options were a much more preferable option for patients.”

Gray says Apposite could see that the UK didn’t have those local facilities and thus became investors in Cancer Partners UK – and later, saw parallels with what Medical Imaging Partnerships was doing with diagnostic imaging, given that the UK is towards the very bottom of the rankings in the OECD in terms of MRI and CT scanners per capita.

Gray also mentions the 60% forecasted increase in revenue for the business, though he adds that this figure could be even higher: “This is achievable because we have invested significantly in the necessary infrastructure for the business to grow rapidly – the IT, the clinical governance and the management infrastructure. All of the foundations needed have been built over the past few years.

“Furthermore, in the aftermath of Covid, expectations are for a significantly enhanced role that the independent sector will play nationally in addressing the resulting waiting lists and backlogs for diagnostic imaging,” he continues.

When pushed Gray defers from answering questions about any exit-date he may have in mind but says: “Imaging Holdings is one of the very few groups in the UK that are wellpositioned to grasp the rising demand in imaging diagnostics.

At the moment we are focused on delivering on a lot of growth initiatives. As the business develops and grows, outside interest will abound. This will trigger an exit at the right point.” n

Backing Apposite Capital’s managing partner Sam Gray speaks with confidence about his firm’s decision to back the company in 2016. He says that decision was informed by the success of its earlier investment in Cancer Partners UK, a radiotherapy clinic business model that it backed in 2007, which went onto to become Genesis Care. He says that model of investment in clinic-based equipment contributed to correcting a huge

HealthInvestor UK • May 2021

27

SOCIAL CARE

Live life to the full Paul Bridge, chief executive of Civitas Social Housing, discusses some of the demand and solutions for social housing, the disabilities tenants live with, and how institutions have evolved to help educate and support them

Civitas Social Housing property

28

HealthInvestor UK • May 2021

SOCIAL CARE

O

n 2 April, the UN marked World Autism Awareness Day, just a couple of weeks after World Down Syndrome Day, which took place on 21 March.

While the increasing frequency of days dedicated to awareness of this or that is often met with some cynicism, or indifference, I welcome the growing global recognition that people with Down Syndrome, Autism Spectrum Disorders, and other lifelong conditions and disabilities, are people of validity and importance, deserving of the same happiness, enjoyment and freedoms as the rest of us.

It’s easy to mark a single day, of course, and while fundraising and visibility efforts are always welcome, what’s just as important is a focus on the daily lives of people with disabilities – the accumulation of days which make up a life well lived. And the daily lives of disabled people have changed significantly over recent decades.

It used to be the case that a child born with Down Syndrome or severe autism would be cared for by their families, who sometimes struggled to cope; if this was no longer possible, for example upon reaching adulthood, then the person could expect to be housed in a long-stay NHS hospital or remote, often Victorian-era institution. These institutions were usually located many miles away from family and friends, in remote areas, and offered little in the way of stimulation, education or support to enable people to reach their full potential and live the sort of meaningful life which all humans crave.

Thankfully, things have changed. Since the 1980s successive governments have closed down remote long-stay institutions and enacted policies which enable adults with lifelong disabilities to live within their own communities, with appropriate professional care and support. All the available clinical evidence demonstrates that living as independently as possible, with support, results in far better mental, physical and social outcomes for people, than life in an institution. Supported housing, as it is known, has changed the lives of more than 175,000 individuals in the UK. The system is under some pressure, however. Demand for supported housing is growing and is expected to continue to do so, as medical advances lead to better rates of premature birth survival and longer life spans, and as mental health disorders are becoming more prevalent and more accurately diagnosed. The UK population has grown by nine million since 1980; the stock of social housing as fallen by 2.5 million over the same period. It’s small wonder that, in most parts of the country, demand for supported housing outstrips supply.

Civitas Social Housing, of which I am chief executive, is part of the solution. We invest to bring specialist supported housing and associated healthcare facilities onto the market for local authorities to offer as long-term homes to adults with lifelong disabilities, mental health needs, or those facing significant life challenges such as homelessness or domestic violence. Through long-term partnerships with care providers and housing associations, we provide homes for life which enable our residents to live full lives according to their capabilities.

HealthInvestor UK • May 2021

Paul Bridge, Civitas Social Housing

A study by The Good Economy, carried out last year, sought to qualify and quantify the impact of our work in terms of the health and wellbeing of tenants, the reduced isolation, improved relationships and enhanced opportunity for employment and/or attaining qualifications. The study concluded that, taking all these things into account, the Civitas portfolio, in the business year 2019/2020, delivered cost savings of £60 million for the public purse and achieved £55 million of additional social impact value as a result of the enhanced outcomes for tenants.

The Good Economy confirmed that Civitas is “an authentic impact investor according to the IFC Principles for Impact Management”.

As one of our residents, Victoria, recently told us: “My flat is perfect. I’m happier than I’ve been in a very long time. I’ve been in and out of hospital and lived in hostels…

I really appreciate having my own place.”

As someone who has spent their working career prior to Civitas entirely in the public sector, leading large housing associations, I firmly believe that adequate provision of specialist supported housing for everyone who needs it requires both the private and public sectors to come together in creative and collaborative ways to make properties available. I believe that the public and private sectors have different, but equally useful, skillsets and perspectives to bring to the game and that, when working productively together, the best outcomes can be achieved.

Gandhi is supposed to have said that the true measure of any society can be found in how it treats its most vulnerable members. World Down Syndrome Day and World Autism Awareness Day demonstrate that our society’s attitude towards disabled people has changed from one of ignorance to one of celebration and respect. But the true proof of that respect will lie in our commitment, not only to allow disabled people to be visible for one day, but also allow them to live fulfilling lives every day. n

29

INDEPENDENT HEALTHCARE

Right first time An NHS review finds good practice by independent healthcare, reports Charles Wheeldon

T

he NHS’s Getting it Right First Time (GIRFT) programme has published its first-ever review of independent healthcare services.

GIRFT is an NHS programme designed to improve the quality of care within the NHS by reducing unwarranted variations. It looked into orthopaedics and spinal services in a number of independent sector acute care providers including Horder Healthcare, Nuffield Health, Spire Healthcare and Practice Plus, visiting 63 hospitals as part of its review.

GIRFT analysed a wide range of independent hospital data, including hospital episode statistics and registry and professional body data. This data was examined to identifying unwarranted variations and areas for improvement around hip and knee replacements, arthroscopy of the knee and shoulder, orthopaedic surgery and spinal procedures, as well as and length of stay and infection rates.

The review identified a number of areas of good practice found in independent providers, including: • Assigned infection control nurses who regularly liaised with NHS trusts to monitor patients re-admitted for infections • Exemplar standards around theatre productivity in relation to turnaround times and laminar flow theatres • Low mortality rates, and • Seven-day physiotherapy services in most sites with excellent relationships between physio and ward staff.

The review also highlighted a number of areas for improvement, including variations in revision rates for hip and knee replacements and data entry to National Joint Registry and British Spine Registry.

In the report, GIRFT stated that independent healthcare providers exhibited “real enthusiasm” for the review process, with staff and the teams involved “engaging positively and proactively”.

The Independent Healthcare Providers Network (IHPN) said it will work with GIRFT to help roll out its methodology to a wider set of providers and specialities to ensure the best possible outcomes for all patients.

David Hare, chief executive of the IHPN said: “Independent healthcare providers are constantly striving to improve the care they deliver to patients, and GIRFT’s review into NHS-funded care in the independent sector pilot has been invaluable in enabling providers to

30

gain a more in-depth insight into their work and how they can further drive up standards of care.

“The methodology employed by GIRFT works extremely well since it holds up a mirror to providers and drives reflection and self-improvement using wellestablished benchmarks and broader comparison. IHPN looks forward to continuing to work with GIRFT as the programme is widened to include more providers and different specialties.”

Cathy Cale, group medical director at Spire Healthcare, said: “Ensuring the highest standards of patient safety and the quality of our care is at the heart of everything we do. We found that participating in the GIRFT pilot was particularly helpful in reinforcing areas of good practice, such as using PROMS and NJR data to explore variation and share learning across the group.

“It also made a number of recommendations that we are building into our continuous improvement programme. Together with our consultant partners, we look forward to working with GIRFT in the future as the pilot expands into other specialties.”

Horder Healthcare’s chief executive Richard Tyler added: “Horder Healthcare is fully supportive of the GIRFT initiative. The Horder Centre is a high-volume, orthopaedic centre of excellence, that was already working closely with Tim Briggs and his team through the National Orthopaedic Alliance.

“Through our work with the GIRFT team, we have been able to identify further improvements in patient care, as well as confirming existing aspects of good practice. The real strength of the GIRFT programme is the recognition that improved patient outcomes go hand-in-hand with improved productivity. In the face of unprecedented waiting lists, the widespread adoption of the GIRFT principles would make a significant difference.” n

HealthInvestor UK • May 2021

INDEPENDENT HEALTHCARE

Dr Cathy Gale, Spire Healthcare

David Hare, Independent Healthcare Providers Network

Richard Tyler, Horder Healthcare

HealthInvestor UK • May 2021

31

HEALTHTECH

Balance progress with security We must plot a path to digitalising the NHS without putting patient data at risk, says Dr Owain Rhys Hughes, chief executive of digital healthtech Cinapsis

A

mid escalating treatment backlogs and spiralling to tread the thin line between progress and security, we costs, the issue of digital reform within the NHS has must start by setting the highest of standards for new and never been higher on the national agenda. It’s an existing NHS technology partners. exciting and inspirational time to be a part of the sector, as Time to accept responsibility government ministers, health sector leaders, staff members As the result of a recent patient privacy breach from third and patients alike are keenly aware of the urgent need to party virtual GP consultation provider Babylon Health, users pursue digitalisation in order to tackle existing crises and of the GP at Hand app were able to access recordings of protect the NHS’s future.

However, the current escalated pace of digital other patients’ consultations until the problem was flagged transformation comes hand-in-hand with a new risk – the by a shocked customer. This provided a wake-up call as to security of patient data. The importance of this issue cannot the risks of under-regulation and the weak ring-fencing be overstated, yet it is in danger of being sidelined in the of patient data, but it also ignited debate over the degree of responsibility tech providers hold to protect patient race to meet transformation targets. confidentiality.

Precedent has taught us that, without due regulation and an acceptance of shared For too long, some external providers responsibility from third party technology have opted to hide behind their technology We must providers, the NHS digitalisation drive and neglect their responsibilities towards could be derailed. But let’s not throw their products’ users and avoided scrutiny. collaboratively away the incredible opportunities that We cannot let this continue. We need seek a way to lie ahead. We must collaboratively seek a to reset the status quo so that all NHS reap the benefits way to reap the benefits of digital without providers are contracted to abide by of digital without compromising safety. the letter of regulatory guidance (and compromising sometimes go above and beyond), taking Digitalisation and data: all possible steps to mitigate against safety what’s the danger? avoidable risk.

From remote consulting technology to Similarly, as the former NHSX director smart triage tools, digital reform in the of digital Professor Sam Shah recently emphasised, any new digital solutions implemented must NHS is already streamlining care pathways, cutting costs and eliminating unnecessary bureaucracy. However, effective come with guarantees to protect patients’ privacy, and not digitalisation often means sensitive patient data must be transfer data rights to the companies providing the system to uploaded onto online platforms or networks, or shared using do with as they see fit. Commissioners who are responsible the internet – and herein lies a major challenge. for patient data should take care to understand fully what Any information hosted online is vulnerable to leaks, rights to use patient data they are passing over to companies. attacks and security breaches, with criminal attempts to gain It’s vital that healthtech companies working alongside access to such information becoming more sophisticated our NHS have responsible leaders who welcome scrutiny every year. Personal data leaks are not only detrimental to and build a culture focused on transparency, clinical safety and good governance. Yes, this demands asking difficult patient trust in the NHS, but also pose a serious fraud and questions, but there are already so many examples of good exploitation risk. practice in the sector that can and should become the norm.

We can’t afford to ignore these threats in the name of This is a reform that is wholly in the best interests of everyone progress. We cannot stick our heads in the sand and call them unavoidable side-effects of modernisation. In order delivering and receiving care through our health service.

32

HealthInvestor UK • May 2021

HEALTHTECH

Regulation and partnership offer solutions As regulation begins to keep pace with innovation, the NHSX’s increasingly vigilant approach to risk management – and to the vetting of new tech partners – is an encouraging sign of a sea-change at the heart of the wider digitalisation project.

However, we’re still very much at the start of this digital security mission. Much ground remains to be covered. As the chief executive of a tech company providing digital solutions to several major NHS trusts, I’m a supporter of initiatives such as the Digital Ethics Charter: a set of common principles developed by digital leaders in the public sector that digital professionals and those working with “technology for public use” can adhere to. The next important step is for similar agreements to be made legally binding, and their acceptance a prerequisite to the awarding of a contract.

My ambition is to see NHSX working in partnership with independent providers to deliver the solutions and tools that doctors and patients need, while ensuring that patient data security is fully safeguarded every step of the way. I’m encouraged by what I have seen already and I am confident that this is possible – indeed, there are already examples of such relationships working successfully for all stakeholders.

Through the exercise of collaboration and regulation in equal measure, the story of NHS digital transformation will be positioned to enter the history books as a resounding success. n

Cinapsis SmartReferrals is an NHSX-approved platform that makes it easy for clinicians to communicate and share information to make smarter patient referrals. Founded by NHS surgeon Dr Owain Rhys Hughes, Cinapsis’s platform gives GPs, paramedics, optometrists and NHS 111 operators immediate access to specialist advice, resulting in smarter triage, faster decision-making and fewer unnecessary referrals. Clinicians can share images, video, voice calls or end-to-end encrypted instant messages about a patient’s condition with their colleagues or a specialist using their personal device or directly from within the electronic patient record system.

Cinapsis SmartReferrals makes collaborative treatment planning possible, significantly reducing the burden on emergency departments and specialist outpatient appointments and ensuring that patient care is optimised.

Dr Owain Rhys Hughes, Cinapsis

HealthInvestor UK • May 2021

33

FINANCE: DEALS

deals Medical Imaging Partnership and Prime Health secure funding COMPANY: Apposite Capital TARGET: Medical Imaging Partnership and Prime Health TRANSACTION: Private equity financing CONSIDERATION: Undisclosed Medical Imaging Partnership and Prime Health, part of Imaging Holdings, have secured a significant funding facility from Apposite Capital to support expansion of their diagnostic services.

LumiraDx to list on Nasdaq via merger with CA Healthcare Acquisition Corp COMPANY: CA Healthcare Acquisition Corp and LumiraDx TRANSACTION: Merger CONSIDERATION: $5 billion CA Healthcare Acquisition Corp, a special purpose acquisition company is merging with London-based LumiraDx, a point of care diagnostics testing company. LumiraDx has R&D and manufacturing centres in Scotland, England and the US, and sales and marketing operations across Western Europe, the US, Japan, South Africa, Colombia and Brazil. The merger reflects a value of $5 billion for Lumira’s existing equity.

Oxford Endovascular raises $10m for brain aneurysm technology COMPANY: Oxford Endovascular TRANSACTION: Fundraising CONSIDERATION: $10 million Medtech company Oxford Endovascular has raised Series A funding in a round led by a £3 million investment from new investor Vulpes Investment Management, and funds from the Additio Investment Group. Existing investors Oxford Sciences Innovation, Parkwalk Advisors, Perivoli Innovations, Oxford Investment Consultants, the University of Oxford, and private individuals also followed on. Oxford Endovascular is a spin-out from Oxford University developing a treatment for brain aneurysms.

HealthTech platform Proximie raises $38 million Series B COMPANY: Proximie TRANSACTION: Fundraising CONSIDERATION: $38 million London-based Proximie, a technology platform digitalising operating theatres, has raised Series B funding in a round led by US venture capital investors F-Prime Capital, Questa Capital, Maverick Ventures and Eight Roads, plus several existing investors, including Global Ventures.

Riverdale Healthcare acquires Cambridge-based dentist group COMPANY: Riverdale Healthcare TARGET: Devonshire House TRANSACTION: Acquisition CONSIDERATION: Undisclosed Apposite Capital-owned Riverdale Healthcare has acquired Devonshire House, two dental practices in Cambridge, comprising 12 surgeries and 14 dentists and supporting more than 200 local referring practices.

34

HealthInvestor UK • May 2021

FINANCE: DEALS

Rutherford Health secures £40m infrastructure investment COMPANY: Rutherford Health TRANSACTION: Sale and lease-back CONSIDERATION: £40 million Cancer care healthcare group Rutherford Health has agreed an infrastructure investment with Equitix Investment Management. Rutherford Health operates four centres in Wales, Reading, Northumberland and Liverpool, offering a range of cancer treatments. The investment is backed by the freehold transfer of the Rutherford Cancer Centre South Wales, and supported by other security to be put in place over the group’s other centres.

The agreement is for 25 years at normal commercial rates, after which Rutherford can opt to repurchase the freehold of the South Wales centre for a nominal sum. Of the £40 million, £25 million is payable immediately with the balance payable in three equal tranches following the grant of additional security over the other centres. The additional funds need to be drawn down within six months, although Rutherford anticipates doing so within the next three months. The initial payment will be used to repay its current debt of £18.6 million with TP Leasing in full, leaving the group debt free.

Sandstone Care Group acquires Lancashire care home COMPANY: Sandstone Care Group TARGET: Ribble Court Care Home TRANSACTION: Acquisition CONSIDERATION: Undisclosed Sandstone Care Group has acquired Ribble Court, a recently completed home in Much Hoole, near Preston, Lancashire. The 53-bed home is set on two floors and will provide a mix of luxury residential care and specialist/complex nursing care. Funding for the acquisition was arranged by Simply, a Scottish-based property developer with a dedicated care division.

Schroder British Opportunities invests in Cera Care COMPANY: Schroder British Opportunities TARGET: Cera Care TRANSACTION: Private equity investment CONSIDERATION: Undisclosed Schroder British Opportunities has invested in London-based home care provider Cera Care in a transaction led by Evolve HealthCare Partners, a pan-European healthcare-focused private equity firm.

Voicescape acquires patient messaging services provider COMPANY: Voicescape TARGET: Message Dynamics TRANSACTION: Acquisition CONSIDERATION: Undisclosed Social housing technology provider Voicescape has acquired Message Dynamics, which provides patient messaging services. Voicescape is based in Salford; Message Dynamics is headquartered in Lyne, Surrey.

HealthInvestor UK • May 2021

35

EXECUTIVE MOVES

executive moves Assura Warrington-based primary care property investor and developer Assura has appointed Emma Cariaga, Noel Gordon and Dr Sam Barrell as non-executive directors, effective 1 May. Cariaga is the joint head of Canada Water Development on the executive committee of British Land. She previously worked at LandSec and in development and land management at Barratt and Crest Nicholson.

Gordon has a background in digital technologies across several industries. His previous positions include global managing director in Accenture, chair of NHS Digital, and a non-executive director of NHS England.

Barrell is chief operating officer of the Crick Institute, responsible for leading the operational management and running of the institute. She was previously chief executive of the Taunton and Somerset NHS Foundation Trust and is currently a non-executive director of York Health Economics Consortium, a subsidiary of York University.

Jenefer Greenwood is retiring as a nonexecutive director of Assura after its annual general meeting on 6 July. Greenwood was appointed to the board in 2012 and is chair of the remuneration committee. Louise Fowler,

36

who joined the board in June 2019, will take over that position.

Changing Health Digital health platform, Changing Health, has appointed Jacob Sunol as chief technology officer and technical leader, responsible for focusing on the behavioural, organisational and technical challenges to preventing, reversing or surviving chronic conditions including diabetes, heart disease and mental health.

Sunol has worked at healthcare companies including Roche and Ipsen where he delivered artificial intelligence products and led a team working across digital biomarkers, patient engagement/support platforms and numerous R&D innovations. He has knowledge of web and mobile technologies, artificial intelligence and algorithms.

He also previously founded his own digital health business where he was responsible for product and technology.

Changing Health is headquartered in Newcastle upon Tyne with an office in Barcelona. The company recently recruited Ashley Duque Kienzle, formerly of Amazon and Facebook, as chief product officer, Tony Wallace as chief commercial officer, and serial entrepreneur Nick Imrie as chief of staff.

Hamberley Development Luxury care home developer Hamberley Development has appointed John Austin as its new managing director.

Austin started his career in construction in 1990 and has specialised in healthcare development for the past two decades. He was previously Hamberley’s development director and, before that, worked for Fed3 Projects, a specialist healthcare construction project management firm, where he supported the development programme for Gracewell Healthcare, which was then also led by the team behind Hamberley Development, backed

by Patron Capital.

Hamberley Development currently has care homes under construction in Basingstoke, Hailsham, Bedford Wixams, West Byfleet, Brampton, Cofton Hackett, Keynsham, Charlton Hayes, Enfield, Edwalton and Eastleigh.

In addition, it has a further development pipeline of sites in Cambridge, Dorking, Southampton, Basingstoke and Camberley.

Hamberley stated that since 2014 it has delivered more than 30 bespoke care homes and refurbishment projects with a gross development value in excess of £450 million.

HealthInvestor UK • May 2021

EXECUTIVE MOVES

Emma Cariaga, Assura

Noel Gordon, Assura

Dr Sam Barrell, Assura

Jacob Sunol, Changing Health

John Austin, Hamberley Development

Peter Nicklin, Tunstall Healthcare

Signum Surgical Signum Surgical, a Galway-based medical technology company developing solutions to treat colorectal diseases, has appointed Dr Bernard Collins as a non-executive director.

Collins is on the board of several US and Irish life science companies including, CroíValve, Aerogen, Atlantic Therapeutics and Vivasure Medical. He was formerly vice-president of international operations for Boston Scientific for 10 years and has held a number of senior executive positions in international life science companies, including at Baxter Healthcare.

HealthInvestor UK • May 2021

Signum Surgical is focused on developing minimally invasive technologies to treat colorectal diseases, principally the condition known as anal fistula. This painful, and often recurring colorectal condition, which severely affects patients’ quality of life, involves the infection of an internal gland.

Tunstall Healthcare Health and care technology company, Tunstall Healthcare has appointed Peter Nicklin as chairman.

Nicklin has been a senior healthcare

executive with Baxter International, Bayer Healthcare, Novartis and Bristol-Myers Squibb, working across a range of sectors, including pharmaceuticals, biologics, vaccines, medtech, dental, animal health and healthcare services.

More recently, Nicklin was chief executive of Amann Girrbach based in Koblach, Austria.

He is currently chairman of Versantis, a Swiss pharmaceutical company, and Healthcare at Home a pharma services company focused on chronic, rare disease and oncology medicine management services. n

37

ROUNDING OFF

companies index Accenture 36

Equitix Investment Management

8, 35

Oxford Endovascular

11, 34

Additio Investment Group

Evolve HealthCare Partners

9, 35

Oxford Investment Consultants

11, 34 11, 34

11, 34

Alkuri 9

Exemplar 30

Oxford Sciences Innovation

Amann Girrbach

F-Prime Capital

Patron Capital

37

Amazon 36

GP at Hand

Anchor Hanover Group

Greenbrook Healthcare

Apposite Capital

9 7, 10, 25-27, 34

Hamberley Development

11, 34 32 7

36

Perivoli Innovations

11, 34

PGIM Real Estate

15

36-37

Prime Health

10, 25-26, 34

37

Priory Group

17

Assura 36-37

Healthcare at Home

Babylon

HealthHero 10

Proximie

Barclays 9

Horder Healthcare

30-31

Prudential 15

Baxter International

37

Horizon 11

Qare 10

Bayer 37

IFC 29

Questa Capital

11, 34

Bayer Healthcare

37

Imaging Holdings

Riverdale Healthcare

7, 34

Bill & Melinda Gates Foundation

12

Independent Healthcare Providers Network 30-31

Roche 36

Bristol-Myers Squibb

37

Kamet Ventures

10

Rutherford Cancer Centre

8, 35

British Land

36

Keys Group

17

Rutherford Health

8, 35

Knight Frank

17

Sandstone Care Group

8, 35

CA Healthcare Acquisition

9, 32

12, 34

10, 25-27, 34

11, 34

Cancer Partners UK

27

LandSec 36

Santander UK

Care Concern Group

15

LumiraDx

12, 34

Schroder British Opportunities

9, 35

Maverick Ventures

11, 34

Schroders

9, 15

Care England Care Quality Commission

6 6, 22

Medical Imaging Partnership

10, 25-26, 34

Sidley Austin

12 37

Centrus 9

Meridian 13

Signum Surgical

Cera Care

Message Dynamics

Simply

Changing Health

9, 35 36-37

10, 35

9

8, 35

Mitie 12

Spire Healthcare

Cinapsis 32-33

National Audit Office

Target Healthcare

16

Circle Health

NHS Digital

The Good Economy

29

The Priory Group

17

Civitas Social Housing

9 28-29

NHS England

6 33, 36 36

13, 30-31

CVS 12

NHS Shared Business Services

Doctopsy 10

NHSX 32-33

Tunstall Healthcare

Downing 5

Novartis 37

Unison 12

Eight Roads

Nuffield Health

25, 30

Versantis 37

20-21

Vocare 7

11, 34

Elevation 15

Nuffield Trust

Elysian Residences

15

Oak Springs Care Home

Elysium Healthcare

17

Octopus Real Estate

38

10, 26

8 15

Totally 7 37

Voicescape

10, 35

Vulpes Investment Management

11, 34

HealthInvestor UK • May 2021

HealthInvestor UK is the leading news source for investors, operators, lenders and advisors focused on the UK health and social care sector.

As a subscriber you will receive: • Unlimited access to HealthInvestor UK online for the latest news, deals, moves and events, accessible from desktop, mobile and tablet devices • A summary of the latest news direct to your inbox each week before non-subscribers • Exclusive access to Fund Focus, a database of vital market intelligence from leading funds in the sector • The latest on business intelligence, thought leadership and research for the UK independent health and social care sector • Discounts on selected HealthInvestor UK flagship events and seminars, including subscriber-only webinars.

NOT A SUBSCRIBER? JOIN THE COMMUNITY TODAY* healthinvestor.co.uk/subscribe *Monthly, quarterly, annual and group subscriptions are available

Subs cribe for £70 a year Social care business management

the leading care home publication • published for over 30 years – the longest in the sector!

• news, business, financial, property, expert advice, policy and more...

+44 (0)20 7104 2000 | careinfo.org/caring-times subscriptions@investorpublishing.co.uk