HealthInvestor June/July 2020

HealthInvestor UK June/July 2020 vol 17 • no 5

essential reading for the healthcare business

Friends in need How the public and private sectors bonded to fight Covid-19

Senior housing

Perfect practice

Impact assessment

The case for investment

Clinical governance in due diligence

Supporting healthcare during Covid-19

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

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UP FRONT

MANAGING DIRECTOR Vernon Baxter – +44 (0) 20 7104 2001 vernon.baxter@investorpublishing.co.uk EDITOR Rob Munro – +44 (0) 33 0052 6193 rob.munro@investorpublishing.co.uk SENIOR REPORTER Jenna Lomax – +44 (0) 20 3762 2557 jenna.lomax@investorpublishing.co.uk REPORTER AND SUBEDITOR Charles Wheeldon – +44 (0) 20 3762 2556 charles.wheeldon@investorpublishing.co.uk HEAD OF SALES Michael Dee – +44 (0) 20 7104 2006 michael.dee@investorpublishing.co.uk SALES MANAGER Grace Mackintosh – +44 (0) 20 7451 7067 grace.mackintosh@investorpublishing.co.uk DELEGATE SALES & ADVERTISING EXECUTIVE Sohail Iqbal – +44 (0) 33 0052 6190 sohail.iqbal@investorpublishing.co.uk DELEGATE SALES & ADVERTISING EXECUTIVE Shakil Ahmed – +44 (0) 20 7104 2005 shakil.ahmed@investorpublishing.co.uk SENIOR EVENTS MANAGER Nicola Jones – +44 (0) 20 3746 2613 nicola.jones@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 2019

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HealthInvestor UK • June/July 2020

Blame without shame

S

o who or what is to blame for the uncontrolled outbreaks of Covid-19 in UK care homes? Could it be the erroneous early advice from public health officials that the virus could not be spread by patients discharged from the NHS? Or maybe the lamentable lack of PPE for front line care workers? Or even the failure of ministers to read the conclusions of a major investigation conducted two years ago into the effects of a pandemic on our health and care sectors?

No, it’s none of these. According to the Prime Minister, it’s the care providers themselves who are in the dock for “failing to follow correct procedures” (see page 5).

For many, Johnson sank to hitherto uncharted depths in his blatant attempt to deflect blame for the close to 20,000 deaths in care homes since the pandemic reached our shores by attacking the workers who in some cases sacrificed all to care for their residents.

Who can have anything but admiration for care home owner David Crabtree, who told ITV’s Good Morning Britain with characteristic Yorkshire candour that Johnson had “picked the wrong fight with the wrong people”?

“There was a deliberate policy to discharge anybody and everybody into care homes with or without Covid for the sake of a two bob test,” he added, before calling the PM “despicable for saying such a thing against care staff.”

Spin doctors later attempted to repair the damage by unbelievably claiming that Johnson had been misunderstood, but a subsequent refusal at Prime Minister’s Questions to apologise for the effect of his ill-judged intervention made the whole business fundamentally baffling.

But, let’s face it, there is much to be puzzled about when it comes to the decisions that emanate from behind No 10’s shiny black door.

That ministers chose to prioritise the hospitality sector over schools has raised more than a few eyebrows and merely highlighted how central alcohol consumption is to our society.

Pubs are key in spreading the virus as demonstrated overwhelmingly in the US and Johnson’s decision to throw open the bar-room doors while the R is still above safe levels in some parts of the country is highly risky.

But, from the late lockdown decision, to care homes being effectively thrown to the wolves, to Dominic Cummings’ survival in the face of universal opprobrium, the flow of poor judgement has been fast and furious.

Meanwhile, Public Health England has been marginalised and, some say, will soon be abolished, and the Scientific Advisory Group for Emergencies is not really being listened to.

Then there is the emergence of a mysterious body called the joint biosecurity centre, which is going to be in charge of Covid-19 data and, according to a prominent epidemiologist, “nobody knows who they are or where they’re getting [the data] from”.

All this as our country faces the biggest challenge of recent times and the healthcare sector is deep in uncharted waters.

The Policy Exchange and IPPR both report that 31% of people were now less likely to seek residential care for an elderly relative than before coronavirus – a finding that will surely trouble operators more than Johnson’s buffoonish insults.

The truth is that, despite chancellor Rishi Sunak’s rampant spending of public funds in an attempt to avoid the coming tidal wave of unemployment, Johnson and his sinister team of backroom advisers are rapidly losing the confidence of providers, investors and pretty much everyone else.

And that’s even before the seemingly unstoppable No Deal Brexit Express hits the buffers in less than six months’ time. n

Rob Munro, Editor, HealthInvestor UK 3

CONTENTS

features

news News analysis Health tech

5 6-7

Deals and investment

8-10

Social care

11-15

Policy and politics

16-17

Primary care

18

Dentistry

19

cover story Perfect partners 20 Covid-19 has been a ‘game changer’ for how healthcare and social care is delivered. Kathy Oxtoby looks at how the public and private sectors are collaborating more during the pandemic

Lightning will strike again 26 Clinical governance is a relatively new addition to acquisition due diligence.

Ed Marsden, managing director of Verita, explains why understanding the reality of professional hierarchies and practices is an essential part of healthcare investment Senior service 28 Investment in the UK later living market has risen markedly in recent years, but what does the future hold? Tom Scaife and Lauren Harwood of Knight Frank survey the landscape

Patents 32

Cosmetic damage 36 For obvious reasons, cosmetic surgery has ceased during lockdown. But what impact has this had on patients’ mental health and what are the longterm prospects for the sector? Reece Tomlinson, chief executive of Uvence, has the answers Impact assessment 38 The impact of Covid-19 continues to stretch our healthcare systems and our economy. With the country on lockdown, people and companies alike are adapting and innovating at pace.

Ben Barker, regional head of portfolio at BGF, gives his perspective

Covid-19 38

executive moves Executive moves

Due diligence

4

28

Patently clear 32 Under normal circumstances the high costs associated with innovation and regulation in the healthcare industry make patents crucial for protecting and encouraging new research and development. But is the patent system flexible enough under exceptional circumstances such as the current pandemic? Andrew Pitts, patent attorney at Mewburn Ellis, discusses the matter Secondary concerns 34 The race to deliver NHS digital primary care services is entering the final stages, but are we addressing the need to transform how secondary care is delivered? Debbie Preece of PowerGistics discusses the situation

Partnerships 20

Later living

42

26

HealthInvestor UK • June/July 2020

NEWS

News analysis

Prime Minister Boris Johnson faced widespread anger from professionals and the general public after making allegations that care homes failed to follow correct procedures to limit the spread of Covid-19.

Speaking to reporters during a recent visit to Yorkshire, Johnson said: “We discovered too many care homes didn’t really follow the procedures in the way that they could have, but we’re learning lessons the whole time.”

Despite a Number 10 spokesperson and business secretary Alok Sharma attempting to row back on Johnson’s comments by alleging he meant that nobody knew what the correct procedures were, operators, advisors and representatives queued up to pour scorn on what is widely viewed as an attempt to deflect blame for nearly 20,000 deaths that have taken place in the sector.

David Crabtree, the owner of two care homes in West Yorkshire, both rated Good by the CQC, told ITV’s Good Morning Britain that Johnson had “picked the wrong fight with the wrong people” before accusing the government of moving patients from the NHS to care homes with no safeguards in place.

“There was a deliberate policy to discharge anybody and everybody into care homes with or without Covid for the sake of a two bob test,” he said, adding: “Mr Johnson, you are responsible, the paper trail

flickr.com/photos/foreignoffice (CC BY 2.0)

Johnson’s care sector attack is ‘the wrong fight with the wrong people’

leads all the way back to you. You are despicable for saying such a thing against care staff.”

Paul Ridout of Ridouts solicitors which specialises in advising the sector on regulatory and other issues called Johnson’s remarks “a disgrace”.

“It is clear that neither he nor his government nor the relevant civil service have a clue as to how care homes operate and the challenges they face,” he said.

“Care homes have had to make tough and unpopular decisions to protect and support their residents and their staff. One of those challenges was misleading advice from the government encouraging the discharge of patients without negative Covid test results into care homes to relieve pressure on the NHS, but exposing the most

dependent in care homes and the dedicated staff looking after them to greater danger.

“It is high time government faced up to the very real problems posed in the management of care in care homes, and where those residents are supported by public funds by woefully inadequate finance.”

Meanwhile, members of the public took to social media to express outrage at Johnson’s remarks.

A relative tweeted: “I am indebted to my mum’s care home. They locked the doors early and were under immense pressure to take people who had not been tested. Staff and residents have only recently been tested. They followed their own procedure. They are not to blame.”

And an NHS nurse said: “This is really not OK! 100% not okay. The

workers in care homes have also risked their lives in an attempt to care for their clients – some even living-in for many weeks.”

Despite the furore generated

by Johnson’s intervention, some expressed hope that the government is planning much-needed care sector reform.

Ian Kessler, a professor on public policy and management at King’s Business School, said: “As the initial terror of this pandemic begins to subside, it feels like the right moment to start talking about how to rebuild and re-regulate our health and social care system. It is not enough to just clap for our carers, it’s time to make meaningful changes to the working practices that have seen them undervalued and dismissed for far too long.”

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HealthInvestor UK • June/July 2020

5

NEWS

Health tech

Big Health raises $39m Big Health, the digital therapeutics company, has raised $39 million (£31 million) in a Series B financing, led by Gilde Healthcare and joined by co-lead Morningside Ventures, existing investors Kaiser Permanente Ventures (KPV), Octopus Ventures and Samsung NEXT. Janke Dittmer, general partner at Gilde and Isaac Cheng, partner at Morningside, will join the Big Health board, which also includes Liz Rockett (KPV), Alliott Cole (Octopus) and Arun Gupta (founder, Quartet). Big Health will use the funds to invest in new product development, expand its distribution channels, and scale its commercialisation activities.

“We’re excited about the mission of Big Health to provide fully

automated mental health solutions to millions of people worldwide,” said Janke Dittmer of Gilde Healthcare.

“Our investment philosophy is to support fast-growing, global businesses that deliver better care at lower cost and Big Health is a perfect fit.”

“We’re very pleased to add Big Health, the leading digital therapeutics company in mental health, to our therapeutics portfolio,” said Isaac Cheng, managing director, of Morningside Ventures. “Big Health has led the market in their commitment to clinical evidence, and in pioneering innovative goto-market strategies. We believe the company is ideally positioned to dominate the digital therapeutics space, and to help millions back to good mental health as a result.”

Babylon Health admits serious data breach Digital primary care provider Babylon Health allowed its users to access other patients’ consultations following a serious security issue in its app.

One of the app’s users reported to the company that they were able to view video recordings of consultations other than their own.

Babylon admitted that a small number of UK users could see each other’s sessions, but that it was a contained software error and not a “malicious attack”.

In a statement, Babylon Health said: “On the afternoon of Tuesday 9 June we identified and resolved an issue within two hours whereby one patient accessed the introduction of another patient’s consultation recording.”

Employees concerned that sharing health data will damage career prospects Employees are receptive to the use of technology to make the workplace safer in the wake of Covid-19, but have concerns that sharing personal health data could impact their careers, a new survey has revealed.

The study by Aetna International found that 71% of global workers believe their employer can help them manage physical health better through technology, while 61% say the same of their mental health.

Over two-thirds support the provision of a smartwatch or fitness tracker to benefit mental and physical health and three-quarters use or would use an app to help manage mental health.

6

Additionally 69% believe access to physical health services (provided by their employer) through their phone would help them manage physical health better, with that figure rising to 75% for mental health services.

But employees are also concerned about how personal health data is being used by employers or shared with third parties.

Over 60% of employees globally worry it could one day be used as a criteria for promotion, and a similar number that it might be a means of establishing salary grade (64%).

Overall, UK respondents were the most worried about their employers

using their health data as a form of providing recommendations for their next job (72%), compared with those in Singapore (58%), the UAE (59%) and the US (56%).

Most employees surveyed had concerns about their employer sharing their personal health data with government agencies or institutions (57%). However, UK respondent were also the most concerned about their employers sharing their health data with third parties (74%) (Singapore: 66%, the UAE: 61%, the US: 66%).

Richard di Benedetto, President at Aetna International, said: “Technology has not only revolutionised how we collaborate, communicate and work, but also how organisations help support and improve employee health and wellbeing. In the current climate, high-tech, high-touch corporate wellbeing strategies that include apps, devices, and virtual access to care services are high on the list of employee demands. Businesses

have a significant opportunity to embrace technology and innovation and fundamentally change their values, culture and approach to employee health.

“Of course, with more digital innovation comes more data, and a greater need to alleviate employees’ concerns about the use of their health data. All employers are responsible for the privacy and protection of their employees’ health data, ensuring that individuals retain ownership and control.

“Interestingly, our research shows that when data is used responsibly, many people are open to sharing anonymised health data. This suggests employees understand the powerful role technology can play in enabling and informing a business’s strategies. If handled correctly, it presents an incredible opportunity for employers to foster trust, and for all parties to help shape the corporate culture and approach to workforce health and wellbeing”.

HealthInvestor UK • June/July 2020

NEWS

Health tech

App launched to help police deal with people in mental distress Swedish health tech company Visiba Care has launched a smartphone app to access on-the-spot clinical support for UK police when dealing with people in mental health crisis.

Using the Livewell Connect app, police officers called to an emergency where they believe someone is mentally ill can immediately contact the Livewell first response team – a group of trained mental health professionals who can offer direct video support both to police officers and people needing mental health support – helping to reduce unnecessary hospital A&E attendances and easing pressure on the NHS during the Covid-19 crisis.

Chief inspector Rob Mooney of Devon and Cornwall Police said that the new digital platform was a “valuable tool” for police officers helping those in crisis.

“It is vital that police officers on the front line dealing with those in need at the time of crisis have as much information and guidance as possible to give the best outcome.

This app will be a valuable tool to assist officers in delivering the best possible service,” he said.

Livewell Southwest, an integrated health and social care provider of NHS services and adult social care in Plymouth, and community health services in South Hams and West Devon,

is also offering patients access to a range of other digital clinics and online consultations during lockdown.

Patients with conditions including depression or anxiety, who have been referred for therapy are being offered the chance to book, access a range of digital clinics, and have their appointments via the free Livewell Connect platform, which has been developed and is hosted

by Visiba Care.

The scheme, rolled out during the Covid-19 lockdown, provides online video appointments through an app, which can be downloaded on smartphones or tablets, and helps people to get the support they need.

Dr Kate Lovett, dean of the Royal College of Psychiatrists and a consultant psychiatrist at Livewell Southwest said: “Covid-19 has given us the opportunity to think very differently about how we do things. I am really enjoying using our Livewell Connect app to see patients virtually. I have had excellent feedback from patients who have appreciated its ease of use. I have also found it straightforward to use.

“I will take a lot of convincing to go back to running old-fashioned, traditional outpatient appointments.

In my view, the new digital platform is likely to revolutionise our services in the future.”

TDSi launches Track and Trace security module Poole-based Integrated security manufacturer TDSi has launched a new free Track and Trace module for its security management software to help organisations investigate and map the movement of people potentially infected with Covid-19 The module uses the company’s EXgarde software to make a detailed database enquiry, reporting on the movements of specific individuals as they pass through secured access points.

Track and Trace gives an accurate account of other individuals that have used access points that the infectious person has been in contact with. This data helps managers assess and test those in potential danger of infection, as well as enabling the cleaning of relevant areas and the introduction of isolation measures where appropriate.

TDSi’s managing director, John Davies commented: “The Track and Trace module has been rapidly developed in response

HealthInvestor UK • June/July 2020

to global requirements to help contain and fight the spread of Covid-19. Access control systems are very well placed to not only restrict movement but also to accurately record it. TDSi has an ongoing mission of delivering peace of mind, so we are offering Track and Trace as a free download to all users of EXgarde as part of our commitment to help organisations meet the current pandemic needs and requirements.”

Davies added, “A big part of bringing the Covid-19 pandemic to heel is tracking infections and preventing the further spread of the disease. We have already seen the likes of Apple and Google working on smartphone apps to track contact by infected people, but this requires individuals to actively participate. On the other hand, electronic access control systems do not just rely on people having the right device and app in place, they can track anyone who enters a secured area via their credentials.”

7

NEWS

Deals and investment

Montreux moves to sell Active Care Group The Montreux Healthcare Fund is reported to be actively considering the sale of its specialist care business, The Active Care Group.

The fund has appointed N. M. Rothschild to carry out a strategic review of the group which it believes may be of interest to infrastructure funds to whom in recent years specialist care has proved an attractive proposition.

The Active Care Group is a national provider of complex care and rehabilitation services and was created by bringing together over 40 care providers to form a specialist healthcare business with a national footprint and focus on complex care.

It offers an integrated pathway of support ensuring continuity of care and rehabilitation when leaving hospital, alongside flexible care and accommodation options to meet long-term and changing needs.

Oliver Harris, chief executive, Montreux Capital Management (UK) stated: “We have been closely monitoring the wider market and believe this is an opportune time to appoint Rothschild to assess the conditions in more detail.

Throughout our ownership of the Active Care Group we have maintained regular contact with our advisors and completed on a number of significant strategic acquisitions which have now been fully integrated.”

“Cash generative assets which have proven resilience during economic turmoil and the recent Covid-19 pandemic continue to attract significant interest from infrastructure buyers and other institutional investors. Due to this interest, we believe The Active Care Group is well placed as there are few high-quality, asset-backed

Oliver Harris, Montreux Capital Management (UK) businesses in a sector where several key actors are seeking opportunities to invest. With many traditional dividend-paying companies suspending dividends, investors are looking for alternative sources of income.”

The Active Care Group recently appointed Ruth Smith as chief executive and employs over 4,000 staff who support more than 2,000 clients across around 60 locations in England, Scotland and Wales.

WestBridge Capital buys Bespoke Health & Social Care WestBridge Capital has acquired Bespoke Health & Social Care (BHSC), a specialist provider of care services to individuals across England, for an undisclosed sum.

The private equity firm successfully completed the deal with funding support from Shawbrook Bank.

Nottingham-based BHSC provides specialist care support to individuals with long-term and high acuity medical conditions in their home environment, with provision of services across England.

Shawbrook’s unitranche debt funding package was successfully completed during lockdown despite Covid-19 restrictions and will support BHSC’s future merger and acquisition plans, with WestBridge having the option to enlarge the facility if required.

Paul Sais, BHSC founder, said the deal would allow the company “to continue pursuing growth while maintaining the highest standards of care”.

8

“The WestBridge team impressed us with their pragmatic approach and we look forward to working with them over the next phase of our journey,” he said.

Tim Whittard, partner at WestBridge Capital, praised Shawbrook’s approach to financing the deal, saying the bank was “diligent, professional and passionate about the project from day one”.

“As investors in high-quality independent businesses, we need to operate at pace. Speed, certainty and flexibility are the essential characteristics we look for in any funding solution, and Shawbrook delivered on all three,” he said.

Deepak Parekh, senior director with Shawbrook’s financial sponsors team, said they “were immediately impressed with BHSC’s service proposition and

understood the value WestBridge could bring as dynamic financial sponsors.

“Notwithstanding the unfortunate onset of Covid-19 and the nationwide lockdown measures, we have worked remotely alongside all other key stakeholders and are delighted to have been able to achieve the collective objectives of the sponsor and management team,” said Parekh.

HealthInvestor UK • June/July 2020

NEWS

Deals and investment

August Equity deal creates dental compliance player August Equity’s CODE – a dental compliance business the private equity firm invested in last November – has acquired Sheffield-based Isopharm, a provider of online continuous professional development (CPD) for dental practitioners.

The combined business will

serve the market for CPD, which all dentists are required to complete annually.

As well as online CPD, Isopharm also provides software and services for validation and testing to other healthcare providers.

Founder of Isopharm, Andrew Kemp said: “CODE is the perfect

platform for the next stage of innovative solutions we had planned at Isopharm; we are delighted to be joining forces.”

James Bakewell, a director at August Equity, said: “We are thrilled to have been able to unite CODE and Isopharm to create a highly unique and strategic

compliance-focused business in a market that offers significant opportunity. The combination of software-led compliance solutions and online training to the healthcare market is exciting – a market that’s undergoing a technology-focused structural shift. We are extremely excited about combining the businesses and working closely with Andrew and the team at Isopharm.”

Dr Sati Sian, chairman, CODE Group, said: “August Equity’s market knowledge, broad network in the dental and healthcare sector, and prior experience in creating industry leaders has been very important in getting to this stage of CODE’s development. We continue to be excited about building on this start and extending the reach of the group into more healthcare segments.”

August Equity raised its fifth fund (£309 million) in January, which will focus on businesses across healthcare, technology, business services and education markets.

Advisors to the deal included 8Advisory (financial); PwC (commercial); Squire Paton Boggs and CMS (legal).

Sharp rise in global healthcare deals

Home Instead Senior Care buys Supercarers

The number of deals announced in the global healthcare sector, including pharmaceuticals and medical equipment, grew by 13.7% during the week ending June 7, according to GlobalData’s deals database.

Deal activity has also remained inconsistent across geographies since the Covid-19 outbreak. While activity increased in key markets such as the US, the UK, Japan and China, activity fell in Canada, France and Australia.

Mergers and acquisitions, partnerships, equity offerings and venture financing deals volume

Home care company, Home Instead Senior Care, has acquired SuperCarers as part of plans to extend its ‘live-in’ care offering.

The company says the purchase is in response to the changing needs of elderly clients who are looking for live-in care as an alternative to care homes. This is where a carer provides aroundthe-clock care in a person’s home.

Martin Jones, chief executive of Home Instead Senior Care UK, said: “Acquiring the SuperCarers business is an exciting development

HealthInvestor UK • June/July 2020

increased by 78.6%, 24.2%, 14.6% and 19.4%, respectively, while the number of licensing agreement deals declined by 36.4%.

Aurojyoti Bose, lead analyst at GlobalData, said: “Although the healthcare sector has been relatively resilient compared to other sectors, uncertainty and volatile market conditions due to the Covid-19 outbreak caused deal activity in the sector to be inconsistent over the last few weeks. Growth in deal activity during the week ended June 7 followed a decline the previous week.”

for us and will allow us to build on our home care offer to support even more people at home for longer.

This can be from early stage care, which might only involve using technology to stay in touch with an older person to ensure they are safe, right through to more support around personal care, home help, and then eventually live-in care and palliative care.”

The SuperCarers operation will be implemented into the quality Home Instead Senior Care model in the coming months.

9

NEWS

Deals and investment

Waterland invests in med comms group Waterland Private Equity has invested in integrated medhealth communication (imc) group through a primary investment that will support ambitious plans to create an independent provider of global healthcare communications and consulting to the pharmaceutical industry. imc has offices in London, Cambridge, Toronto, Boston and Cairo and an employee base of 100 people. It provides healthcare communication and medical affairs support to over 50 pharmaceutical, biotech, vaccine, device and diagnostic companies globally.

Five integrated services are currently offered by imc: medical communication, interactive digital and virtual, creative marketing, customer insights and patient engagement.

Collectively, these are aimed at enriching the lives of patients through human-centric programmes that inform decisions to improve health. imc’s underlying markets are expected to grow at around 9% per annum as an ageing population boosts demand for new drug treatments and R&D investment supported by increasing regulation and outsourcing.

This in turn is boosting demand for effective healthcare communications.

The investment from Waterland enables the imc group to expand its global footprint through a buy-andbuild strategy with significant followon funding available to acquire and build out communications, digital and consulting agencies across the UK, North America and EMEA. The investment will also be used to add further capabilities and service offerings, further enhancing the group’s existing digital and technology capabilities.

Shairose Ebrahim, chief executive of imc group said: “The investment will allow us to accelerate my ambition of building a truly

global, independent healthcare communication agency group that provides clients with a diverse range of service offerings across the entire life cycle of a pharmaceutical product, as well as offering best-inclass initiatives aimed at improving patient outcomes. With the current unprecedented circumstances, we will work closely with Waterland to ensure that imc’s digital and virtual capabilities are market-leading and support the educational needs of healthcare professional and patients alike. I am thoroughly looking forward to taking imc to the next level with Waterland.”

Excluding PE-backed firms from government loan scheme branded ‘unfair’ EU rules that prevent private equity investors from taking advantage of the government’s Coronavirus Large Business Interruption Loan Scheme have been branded “unfair” by legal experts.

Tom Whelan, partner at law firm McDermott Will & Emery told HealthInvestor UK that while the rules prevent companies with accumulated losses greater than half their subscribed share capital from accessing loans, it is unlikely that many PE-backed firms in reality would exceed such losses.

“The share capital in private equity-backed companies is relatively low typically, as most sponsor equity used to acquire portfolio companies is typically (but not always) provided by way of a shareholder loan (typically 90% – plus of the equity invested by a private equity fund is in the form of such a loan) with the ordinary share capital typically being less than 10% of the total equity provided by the sponsor as part of the acquisition,” said Whelan.

“If there is an overall accumulated loss due to the impact of the

coronavirus on trading, plus, for example, the impact of interest charges on all loans (including bank and shareholder loans), tax, depreciation and amortisation, then it is likely to be easier to attain the threshold of half of the subscribed share capital in a typical private equity-backed business. As a result, if there are such losses, many viable operating businesses (absent the coronavirus crisis) backed by private equity sponsors, will find that they are unable to access such funding due to such EU rules.”

He argues that portfolio companies owned by private equity investors employ thousands of people in the UK and those jobs should not be put at risk unnecessarily.

“Just because an employee works for a private equity-backed company, why should the company they work for be disadvantaged by its inability to access such government schemes, leading to a greater likelihood of redundancy as compared to other UK companies?”

Whelan added that pensions could also be at risk were private equity firms to go to the wall.

Churchlake Group buys three care homes Churchlake Care is to acquire three care homes, via a a £4 million loan facilitated by ThinCats, the alternative lender to mid-sized UK SMEs. Churchlake Care operates residential and nursing homes across the UK and is working towards a five-year goal to acquire a portfolio of care homes providing 3,000 beds. It acquires homes to build into regional clusters.

10

The three care homes: Holmwood Residential Care Home, Hames Hall and Chichester Hall are all in Cumbria and are part of its northwest England cluster.

Alan Jebson, chief executive of Churchlake Care, said: “We were searching for a lender that we could work with long-term.

We have targeted plans to increase our care home provision over the next few years, and continue to deliver quality care to all our residents.

“ThinCats moved quickly to understand our business and offered a good funding structure with flexibility. We were very impressed with their in-house team and resources, and the speed in which they managed to turn around our funding application.

Jebson added that the company had no confirmed Covid-19 cases among its residents.

“The Churchlake Care board are indebted to the efforts of

managers, nurses, carers and ancillary teams across the group throughout Covid-19. Their diligence and hard work, in addition to following rigorous infection control measures, have kept residents safe from Covid-19. There are no confirmed cases across the group since the outbreak began,” Jebson said.

Law firm Wright Hassall provided legal support for the deal.

HealthInvestor UK • June/July 2020

NEWS

Social care

Call for VAT reform in care sector will become untenable for many businesses”.

Robert Kilgour (below), founder of Four Seasons Health Care and now

Covid-19 death rate higher among social care workers Social care workers have a significantly greater chance of dying from Covid-19 than those employed in healthcare, according to a new official analysis.

Of healthcare workers as a group, the Office for National Statistics (ONS) found that nurses are at the greatest risk from the disease.

Figures compiled by the ONS show that both men and women working in social care, a group including care workers and home carers, both had significantly raised rates of death involving Covid-19, with rates of 50.1 deaths per 100,000 men (97 deaths) and 19.1 deaths per 100,000 women (171 deaths).

Among health care professions as a whole, including those with jobs such as doctors and nurses, only men had higher rates of death involving Covid-19 (30.4 deaths per 100,000 men or 130 deaths) when compared with the rate among those whose death involved Covid-19 of the same age and sex in the general population.

Of the specific healthcare professions, nurses had elevated rates among both sexes (50.4 deaths

HealthInvestor UK • June/July 2020

per 100,000 men or 31 deaths; 15.3 deaths per 100,000 women or 70 deaths).

Suzie Bailey, director of leadership and organisational development at The King’s Fund said the numbers show the government has neglected social care during the pandemic and that the sector now needed to be prioritised.

“It is a tragedy that such a disproportionately high number of social care staff have died from Covid-19. Hard-working care staff have been on the front line in this crisis, but have been let down by government promises of support that have not been delivered. It is increasingly clear that social care has been neglected during the pandemic, with disastrous consequences.

“Lessons must be learnt. The virus still poses a very real threat and care workers need to be prioritised and protected. Social care must never again be treated as an afterthought to the NHS, but as an equal partner in an interdependent system.”

executive chairman of Renaissance Care supported the move to allow operators to reclaim VAT. “The proposed changes in legislation would be of great benefit to all UK care homes directly as they recover from Covid-19. My contention is that when the money is spent by care homes that it would have a sizeable net positive impact in boosting our ailing economy,” he said.

Parker (right) is calling for all care home business owners to reach out to him directly to

inform him that they would like to back the campaign.

He is contactable at: simon@spandp.co.uk

spandp.co.uk/our-team

Care leaders are calling on the government to change the law to allow operators to be able to claim VAT. The Care Leaders Network is asking the chancellor Rishi Sunak to reform legislation relevant to the tax status of care businesses.

This amendment would mean that care businesses would get help to ensure their sustainability during the Covid-19 crisis.

Simon Parker, founder of the Care Leaders Network said: “Without support from the government, this immense financial pressure

Health and social care needs CQC inspections ‘like a hole in the head’ Health service leaders have greeted with dismay the news that the Care Quality Commission intends to resume its routine inspection of health and adult social care providers across England.

Niall Dickson, chief executive of the NHS Confederation, said: “We need a new wave of inspections like we need a hole in the head. The NHS is embarking on what could well be the most challenging period in its history and this will not help.”

The CQC paused its inspection programme in March in response to the Covid-19 pandemic to take pressure off health and social care providers and limit the spread of the virus.

The announcement of resumption of inspections would put pressure of staff still struggling to cope with infections, said Dickson “The absence of routine inspections over the last three months has created a period of

respite as staff have struggled to beat this virus. That battle is not over. Indeed, a set of bigger challenges remain – dealing with the backlog of care, continuing to treat thousands with coronavirus, and being prepared for another surge and what will be a very difficult winter. And all of this with concerns over staff burnout,” he said.

Dickson added that there was now an opportunity to review the nature of regulation and look at new ways of working with providers to ensure patient safety and quality.

“There is an opportunity to reset the way that we think about inspection, regulation and governance and it is an opportunity our members are keen to explore. Let’s not rush back to the way things were. We will seek to work with the CQC to make sure the views of our members inform their thinking on the future approach to regulation and inspection.”

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NEWS

Social care

HC-One warns it may not survive Covid-19 impact The directors of one of the UK’s largest care home operators have warned that the company may go under as occupancy levels plummet in the wake of the Covid-19 pandemic.

In a note attached to the group’s 2019 accounts, the board say high numbers of residents dying from the virus casts “significant doubt on the group’s … ability to continue as a going concern.”

“The directors consider the specific downside scenario impact of Covid-19 on the group’s occupancy levels and cash flows to be so significant that it represents a material uncertainty,” they say.

The Guardian newspaper reports that HC-One bosses have written to councils asking that they continue paying them at 90% occupancy rates although actual rates have dropped below 70%.

Covid-19 care home deaths in sharp decline says Knight Frank Covid-19 deaths in care homes are in sharp decline, according to research from healthcare property consultants Knight Frank.

By the end of May, deaths of care home residents from Covid-19 had fallen from a peak in mid-April of 1,827 to just 541 with the decline expected to continue as the epidemic eases.

The news will be welcomed by many operators who have seen occupancy levels fall as the virus swept through the sector.

Knight Frank warns a return to business as usual will take some time.

Occupancy rates have dropped from the pre-Covid average of

87.8% to 79.1% and Knight Frank say it will take a least until 2021 before the sector sees a return to growth although this will be at a significantly lower rate than before the pandemic.

Under a worst case scenario, the company says growth will not return until 2028.

“This extreme scenario would involve a sharp hit to occupancy over the summer months, with the potential for further waves of the virus. Under this scenario bed demand and occupancy rates will return to pre-pandemic levels much later,” say the report’s authors.

‘Tragic consequences’ of untested NHS patients discharged to care homes Care homes in England lacked the protective equipment and financial resources to cope with the coronavirus outbreak, according to a report from council social services directors The Association of Directors of Adult Social Services (ADASS) says the discharge of patients that had not been tested for Covid-19 from NHS hospitals to care had “tragic consequences” for residents and staff.

Many care homes did not have adequate supplies of personal protective equipment or it was impossible to isolate them safely the report says.

James Bullion, president of ADASS said the report highlights the “devastating” impact of Covid-19 on the care home sector.

“The government must ensure that social care is never again left exposed to a pandemic. This starts by protecting those of us with care and support needs from the current and subsequent waves of Covid-19 and extends to ensuring

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social care is at the centre of all future emergency planning and preparation,” he said.

He added that, despite the government easing the lockdown,

care homes will continue to feel the effect of the pandemic for “a very long time”.

“Whilst the wider population may be moving out of the coronavirus

peak, Covid-19 will be with older and disabled people for a very long time. Easing the lockdown is about more than opening doors; it is about unlocking people’s lives – restoring care and support, assessing needs, preparing for the inevitable surge in demand for care and enabling us all to live our lives again,” he said.

Bullion said that the government “must seize the opportunity to reform and reset social care as part of the wider post-Covid-19 recovery”.

Sally Warren, director of policy at The King’s Fund, said the report showed that the care sector needed parity with the NHS in terms of resources.

“Hard-working social care staff have done their best with limited resources, but understandably feel let down by government promises of support that haven’t been delivered.

“In planning for future waves, social care must not be treated as afterthought to the NHS, but as an equal partner in an interdependent system,” she said.

HealthInvestor UK • June/July 2020

NEWS

Social care

Call for ‘disruption’ of ‘broken’ social care system The UK social care system is “broken, unfit for purpose and cannot be fixed by new taxes and spending or making more people eligible for free care, according to a report by the right-of-centre think tank, The Adam Smith Institute.

The authors say that while Covid-19 has focused attention on elderly people in care homes, half of social care spending actually goes on younger people with physical, mental health or learning problems, plus help

delivered to people’s own homes.

The whole system is in crisis they say, distorted by “perverse incentives, unfair and woefully out of date”.

While there has been much talk about raising public care spending and providing more free care, only widespread and disruptive change will solve the deeper problems and prevent future cases of neglect, says the report.

The think tank calls for “disruption” to the system and for

“new partnerships in new markets that embrace fundamental change.”

“People aren’t looking beyond how to get more money into social care,” says the report’s co-author Eamonn Butler. “And more funding is seen as a magic bullet that would solve all the problems. But an arbitrary boost to care budgets will do little good. We can only solve the crisis in social care by looking at and radically reforming the whole system, not just one part of it.”

Testing extended to LD and mental health care homes as government sets up new social care task force The government is extending whole care home Covid-19 testing to all adult care homes to include specialist learning disability and mental health units.

Ministers also announced a new Covid-19 social care task force, with representatives from across government and the care sector.

The new task force will help oversee the implementation of the government’s social care action plan and care home support package to help end transmission in the community and advise on a plan to support the sector through the next year.

Health and social care secretary, Matt Hancock said: “All remaining adult care homes in England will be able to order the whole care home testing service for residents and staff.

This service will benefit residents and staff in over 6,000 more care homes.

“It will mean that right across the care home sector everyone will have the certainty and confidence of a high-quality coronavirus test, whether symptomatic or not, certainty about whether or not they’re carrying the virus and confidence that they are doing the right thing both to protect themselves and others.

“During the first phase care homes for the over-65s and those caring for

HealthInvestor UK • June/July 2020

people with dementia were prioritised for whole care home testing to target those with the greatest need. The government is now able to offer testing to every adult care home in England, including specialist learning disability and mental health care homes.”

The Social Care Sector Covid-19 support taskforce which will oversee delivery of infection control measures as set out by the care home support package, backed by £600 million from the government, delivery of testing programmes, and effective deployment of the workforce.

Former president of the Association of Directors of Adult Social Services and director of adult social care at the DHSC, David Pearson, has been appointed as independent chair.

Outlining the task force’s remit, Pearson said: “The social care sector is on the front line of our coronavirus response. This task force will support the service by overseeing the delivery of the Social Care Action Plan and the Care Homes Intensive Support Package.

“This will play an important part in ensuring we are doing everything we can to reduce the risk of transmission of Covid-19 in the sector, both for those who rely on care and support and the social care workforce.”

Vic Rayner, executive director of the National Care Forum said the move to extend testing was “very positive”.

“Testing of all those receiving care and the staff delivering it has been recognised as an absolute priority.

It is very positive the government is moving forward with plans to extend the testing across all care homes, and it is vital that we set out a timeline to ensure that everyone who receives care gets access to regular and repeat testing as it is proving to be an absolutely essential tool in the fight against Covid-19,” she said.

Rayner also welcomed the task force announcement.

“This task force will provide a real opportunity for all partners to work together to ensure a coordinated focus on the core essential of managing this virus, and bring energy and attention to the way in which Covid is impacting social care now – and critically in planning and preparation for the future.”

Kate Terroni, chief inspector of adult social care at the Care Quality Commission said the move would be particularly helpful in the learning disability sector.

“Organisations including the Care Provider Alliance and Mencap have been calling for testing of people

with a learning disability, and last week CQC released data showing not only a significant increase in deaths of people with a learning disability, but that the impact of Covid-19 on this group is being felt at a younger age range than in the wider population. We were clear that this data should influence decisions on prioritisation of testing of people of working age with a learning disability,” she said.

Terroni added that the CQC is stepping up physical inspections of social care providers.

“As we continue to increase the number of physical inspections we’re undertaking, our inspectors remain in regular contact with adult social care providers to offer support, advice and information to help them deliver safe care – and I urge staff to contact CQC directly if they experience any barriers that impact on the delivery of this care.”

Care home providers are now able to access an online portal to order tests for their residents or staff regardless of symptoms and the DHSC is contacting all care homes to highlight this service and encourage tests to be ordered.

Test results for residents will be communicated to the care home managers.

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NEWS

Social care

Call for care fees to reflect living wage demands Fees paid to care providers by local authorities must be enough to cover the National Living Wage for workers, says Care England.

The representative body for independent providers of adult social care, has submitted evidence to the Low Pay Commission’s consultation concerning the National Minimum and National Living Wage rates.

The Low Pay Commission advises the Government on the level of the minimum wage. From 1 April the NLW increased to £8.72 with a view to more increases in 2021.

In its submission Care England presents both qualitative and quantitative feedback relating to the cost implications of the Covid-19 pandemic for the adult social care sector. Given that wage costs are a

large part of the adult social care sector’s overall cost base, it asks the Low Pay Commission to consider the implications of Covid-19 on the sector and its potential to interact the existing structural realities of the sector.

Professor Martin Green, chief executive of Care England (pictured), said: “Good and fair wages remain a lynchpin in the future sustainability of the adult social care sector. It is however incumbent upon government to ensure that such increases are reflected in the fees paid to care providers.

“It has become clear that during the pandemic we need further direction from central government.

There is a huge disconnect between policy announcements from the centre and delivery on the ground”.

Elysium opens neurobehavioural rehab unit

Elysium Neurological, part of Elysium Healthcare, has opened a specialised neurobehavioural rehabilitation service for adults in Swindon.

The Avalon Centre is a purposebuilt hospital providing a local and national service for men and women who have suffered

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changes in their behaviour as a result of an acquired brain injury.

The building has 18 individual en suite bedrooms and two selfcontained flats built around two enclosed courtyards.

Joy Chamberlain chief executive at Elysium Healthcare

said: “We had been searching for the perfect site for this service for a number of years. I am delighted that the refurbishment is complete and that we have recruited a first-class clinical team led by Professor Nick Alderman to deliver this important service.”

Elysium Healthcare was launched in November 2016 and has over 70 sites. The group provides specialist learning disability services, mental health services, neurological services and services for children and young people across England and Wales. The company is backed

by BC Partners.

HealthInvestor UK • June/July 2020

NEWS

Social care

Government failed to implement ‘radical lockdown’ of care homes The government reportedly rejected a plan to protect care homes proposed by Public Health England.

The Guardian newspaper claims to have seen evidence that PHE wanted to implement a “radical lockdown” to deal with soaring deaths from Covid-19 which would

include care home staff living in and the use of NHS Nightingale hospitals which had thousands of empty beds.

The 11-point plan was apparently submitted to the government on 28 April by PHE, as fatalities peaked in care homes and the virus spread

to half of homes in the worstaffected areas but was thrown out by health secretary Matt Hancock PHE officials asked ministers to “use NHS facilities and other temporary accommodation to quarantine and isolate residents”, and to “consider whether staff can

move into the care home for the next four weeks”.

According to official UK figures, over 16,000 care home residents are confirmed or suspected to have died from Covid-19, with cases recorded in 38% of homes in England and 59% of those in Scotland.

Knight Frank predicts widespread care home closures...

At least 6,500 care homes are at risk of closure over the next five years, equating to 140,000 beds, according to new research.

The report by property company Knight Frank says the shortage will be exacerbated by the increased demand for care homes by 2050, which will see a national bed crisis in the UK as the share of people over the age of 80 is expected to surge over the next 30 years, with one in ten adults set to be over 80 by 2050, compared to one in 20 currently.

Estimating that the UK requires in excess of £15 billion to upgrade existing beds in order to future-

proof for the ageing population, Knight Frank says that the Covid-19 pandemic has accelerated trends that will lead to closures of care homes that are no longer fit for purpose, resulting in a significant national shortfall of bed provision.

The UK ranks lower than other advanced European economies for its bed provision, behind Belgium, the Netherlands, France and Germany, with only 13,000 elderly care beds per 100,000 people over 80.

Belgium and the Netherlands have a significantly higher proportion at over 25,000 elderly care beds per 100,000 people over 80.

Julian Evans, head of healthcare at Knight Frank, said: “At present, there is not enough care bed capacity and there is a structural underprovision of beds in the social care sector. The pandemic has accelerated trends to scrutinise those buildings that are not fit for purpose whilst emphasising the insufficient funding available for reinvestment into existing care homes, which has therefore expedited the number of potential care home closures.

This will result in a national bed crisis unless significant inward

investment in the UK care home sector is taken.

“Once the situation resolves around the Covid-19 pandemic, we will see a number of changes around how operators fare and we expect that with the scarcity of stock and a continuing ageing population driving demand, the investment appetite for care home developments will remain strong.

There will undoubtedly be a flight to quality as investors seek defensive healthcare assets and we anticipate that investment into the sector will be robust, from a broad church of domestic and overseas investors.”

...however Carterwood predicts care home market set to recover from pandemic within three years Care home occupancy in England will recover to nearly 90% between October 2022 and September 2023, according to new research looking at the projected impact of the Covid-19 pandemic.

Care sector analyst Carterwood say it expects a “worst case” occupancy low point of 79.3% to be reached in April 2021 following 36,442 forecasted excess total elderly care home deaths during the outbreak compared to a five-year historic average.

Carterwood predicts that market standard (en suite) bed shortfall levels across England will increase by between 48,810 and 57,841 beds

by December 2024.

HealthInvestor UK • June/July 2020

Ben Hartley (pictured), Carterwood founder and one of the authors of the research, says: “We are not experts in viral pandemics, but we do understand the structure of the elderly care home market and the factors that drive it and we will be providing regular updates to our forecasts over the coming months incorporating more up-to-date information as it becomes available.

“This research is our starting point and has been prepared with the best information available to us at this time. The inputs, assumptions and our forecasts will become more refined as the pandemic and its impact upon the sector and wider economy evolves.

“The encouraging conclusion is that notwithstanding the immediate and very obvious short and mid-term pressures facing care operators, over the longer term we predict a stable and resilient picture for care home

demand. The long-term demographic profile will continue to drive demand and the sector has shown itself to have been remarkably resilient to material levels of bed loss over the past few decades.”

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NEWS

Policy and politics

Second wave could put 10 million on NHS waiting lists A second Covid-19 wave could see the number of patients waiting for NHS services increase by 1.5 million by the end of the year, bringing the total waiting list to almost 10 million, according to new findings Medbelle, a digital treatment provider, made the estimate using its free online waiting list tool for patients waiting for NHS services.

The tool also confirms that more than seven million people will be waiting for treatment by the end of July, under the current policies.

The tool, which makes use of publicly available data published by the NHS, allows users to estimate waiting lists based on former NHS capacity. Given that new medical guidelines around hospital safety are being constantly introduced which reduce the capacity of the NHS to help patients - users can toggle NHS capacity by scenario, such as a second peak, by treatment

and by their own hospital to get estimates on how long waiting lists will be in any given month.

In the tool, a second peak is illustrated by the NHS postponing normal services for an additional two months.

The figures would be a huge increase on the 4.5 million patients that were already on the waiting list at the end of February. Patients had already been waiting for an average of three months before the Covid-19 crisis forced all elective surgeries to be postponed by an additional three months.

This situation is unprecedented and will require patients to adjust their scheduling expectations for surgery going forward.

The estimation tool has two parts: an overview, which can be accessed online, and a hospitalspecific section, which can be accessed via email sign-up on the same site.

Leander de Laporte, chief executive and co-founder of Medbelle, said: “Understandably, the NHS is under extreme pressure to treat the onslaught of patients who have been admitted to hospital for Covid-19 treatment.

This necessary reallocation of resources has consequently led to immense uncertainty for those who had already been waiting for treatment for procedures unrelated to Covid-19. The possibility of a second peak dramatically increases the number of patients who will have to wait.

“We see that the most frustrating part for patients in these times is not knowing how long they will have to wait for surgery, so our tool provides patients with estimates of the situation of their local hospital, too. The information provided by our tool gives an orientation to patients when making a decision about how they will proceed in the

coming weeks and months. The tool is using official NHS data up to February 2020 and we’ve worked with the NHS data service to check our understanding of the data. We are working hard to improve the tool further, such as by providing estimated waiting times by hospital.”

Sebastian Winkler, head of new ventures at Medbelle and creator of the tool, said: “We originally created the waiting list estimation tool for internal planning however, it became apparent that there is high demand for this kind of information from patients who have been waiting for treatment.

At Medbelle, we strive to bring transparency and ease to the healthcare industry. By making the waitlist estimation tool accessible to patients, we hope to bring a topic that might otherwise be exclusive to experts to the general public as a starting point for discussion.”

Niall Dickson to quit NHS Confederation Niall Dickson, chief executive of the NHS Confederation, is to step down from his role in October.

The Confederation says recruitment for his replacement is under way and his deputy Danny Mortimer, who is also chief executive of NHS Employers, will take over on an interim basis.

As chief executive since the start of 2017, Dickson steered the Confederation through a challenging period coping with the impact of a decade of austerity, rapidly rising demand, Brexit and the Covid-19 pandemic.

Lord Adebowale, chair of the NHS Confederation, said: “Niall has had an outstanding career leading with distinction three major national healthcare organisations after many years as one of the most respected journalists covering health and social issues. At the Confederation he has been an

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Niall Dickson, NHS Confederation outstanding leader and leaves us in a much stronger place than when he arrived. With integrated

care systems and primary care networks having joined us, we are able to support and represent

the views of organisations right across the NHS. The future lies in more integrated care and more collaborative working and we are better placed than ever to serve our members in the challenging times ahead.”

Dickson’s previous roles include editor of Nursing Times in the 1980s and at the BBC where he worked for 15 years as health correspondent and then social affairs editor. He has been chief executive of the NHS Confederation since February 2017, and before that he was chief executive of the General Medical Council and chief executive of The King’s Fund. Among his international roles he chaired the International Association of Medical Regulatory Authorities.

He was appointed CBE in the 2017 Birthday Honours for services to patient safety.

HealthInvestor UK • June/July 2020

NEWS

Policy and politics

More cash needed for NHS but private sector has ‘important role’ in bringing down waiting times The government will need to spend an extra £560 million a year to meet NHS in England waiting list targets in the wake of the Covid-19 pandemic, according to an influential think tank.

The Health Foundation says “the rates of spending growth, set out in the NHS Funding Bill in February 2020, will not be sufficient to cover the cost of meeting the 18-week standard by March 2024, even before any additional costs and demand arising from Covid-19”.

The organisation estimates that spending growth would need to increase by a further £560 million a year and that is “assuming the NHS can prioritise patients to make the most effective use of available capacity”.

Its report adds that the independent sector may have “potentially an important role to play” in helping the NHS meet treatment targets.

“Over the coming years there will need to be long-term changes to how routine care is delivered, considerable effort at the front line, and potentially an important role for the independent sector if the NHS is to return to a position of meeting the 18-week standard, say the authors.

But even with extra funding and private sector help, the Health Foundation says longer waiting times for planned care “are likely to be a feature of the NHS in England for several years at least”.

Government denies ‘chaotic’ PPE supply by private contractor The government has hit back at media claims that the distribution of the national stockpile of PPE by a private contractor was “chaotic” and led to unnecessary delays in equipment reaching hospitals and care homes.

The Guardian and ITV News accused Movianto, the company paid by the government to manage a PPE warehouse on Merseyside, of failing to organise PPE distribution adequately during the acute phase of the Covid-19 pandemic.

After conducting a joint investigation, both news organisations say that allegations from delivery drivers and “well– placed sources” indicate that Movianto, the subsidiary of a US healthcare giant, was unable properly to manage and distribute the nation’s emergency stockpile of PPE. They also claim that Movianto initially stored the equipment in

HealthInvestor UK • June/July 2020

a fire-damaged warehouse where there was a risk of asbestos contamination, only later transferring the stockpile to a purpose-built facility.

But the government described the claims as ‘false, inaccurate and misleading”.

“We have been clear that the pandemic influenza stockpile has always been readily deployable. It has been able to supply products for the Covid-19 response as soon as they were needed,’ said a government spokesperson.

“There has been no damage to any of the stockpile and it has

been safely and securely stored at all times.

“Our supply chain for PPE was designed to accommodate delivery to 226 NHS trusts. We are now providing essential PPE supplies to 58,000 different providers, including care homes, GP surgeries, hospices and community care organisations.”

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NEWS

Primary care

PHP urges government to invest in primary care The government could address the shortage of primary care facilities and provide a boost to the economy with relatively little investment, according to the managing director of Primary Health Properties (PHP), a provider of primary care properties in the UK and Ireland.

The proposal comes as ministers outline plans to kickstart ‘shovel ready’ infrastructure projects to tackle the looming economic crisis posed by the Covid-19 pandemic.

Harry Hyman has written to communities secretary Robert Jenrick urging him to take advantage of the opportunity to create jobs and deliver value for money by supporting a primary care building programme.

“An annual rent commitment of just £200-300 million from government could unlock £3-5 billion of private capital investment, enough to build or

upgrade as many as 750 primary healthcare properties,” says Hyman in his letter.

He adds that the projects in PHP’s pipeline are “shovel ready, can be completed at pace and do not require CEDL allocation by central government”.

Meanwhile, Prime Minister Boris Johnson has said he wants to provide a “Rooseveltian” stimulus to the economy in the wake of the pandemic’s recessionary effect.

“The country has gone through a profound shock. But in those moments you have the opportunity to change and to do things better.

We really want to build back better, to do things differently, to invest in infrastructure, transport, broadband – you name it,” he said during an interview on Times Radio. *Sister companies of HealthInvestor UK have an interest in PHP

Harry Hyman, Primary Health Properties

Work begins on Assura-funded primary care centre UK primary care REIT Assura is developing a new GP surgery in Ware, Hertfordshire.

The extension and conversion of the former Meade House building will create new premises

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for the Dolphin House Surgery and will turn the former police, fire and Citizen’s Advice hub into a modern health hub with more space to serve the practice’s 14,000 patients.

The development will include facilities for a broader range of services including a pharmacy and outpatient clinics, and capacity for seven-day working.

Jill O’Brien, managing partner at Dolphin House Surgery, said: “In our current premises, we’re so short on space that we can’t provide the range of services we want to for our patients – we have big plans for the future and this new building will give us the modern space we need to grow our team and build capacity for local health services.

Most importantly, the new building will be a much more pleasant place for patients to receive their care – we’re delighted to see work under way.”

David Sadler, senior development manager at Assura, said: “There have been incredible efforts all round to get the build under way and we really look forward to seeing the first patients using the centre.”

Contractor Conamar will deliver the build, and the new centre is scheduled to open to patients next summer.

HealthInvestor UK • June/July 2020

NEWS

Dentistry

DenScreen launches triage and test service to increase safety in dental practices DenScreen, a partnership between dental and infectious disease specialists, has launched a new service to tackle and minimise the risk of Covid-19 in the dental workplace.

DenScreen plans to equip practices with all the tools needed to execute an effective Covid-19 screening system, minimising exposure risk for patients and staff while

allowing surgeries to offer treatment.

The three-tiered plan provides several levels of protection, simultaneously ensuring a safe service for patients and staff alike.

DenScreen’s training package enables all staff in all roles to get up to speed with the latest Covid-19 science, and what it means for dentistry.

The ‘Advance Triage Assistant’

risk codes a patient preappointment from a simple set of online questions. Answers are secured and then analysed

by DenScreen’s algorithms, risk coding patients into red and amber directly to the practices email inbox. Red coded patients are potentially infectious and should have their appointment deferred until they have fully recovered. Amber code classifies

a patient as not infectious, and should be offered an appointment.

DenScreen’s says it its antibody test is 99% accurate two-plus weeks post-infection. Only GDC registered dentists who have completed the DenScreen training programme can perform and interpret the test. A positive result from the DenScreen antibody credits the patients with green status.

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HealthInvestor UK • June/July 2020

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COVER STORY

Perfect partners Covid-19 has been a ‘game changer’ for how healthcare and social care is delivered. Kathy Oxtoby looks at how the public and private sectors are collaborating more during the pandemic

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HealthInvestor UK • June/July 2020

COVER STORY

C

ovid-19 has been a ‘game changer’ for how healthcare and social care is delivered. More than ever before the public and private health and social care sectors are collaborating during the pandemic.

Public service agencies operate at the forefront of the UK’s Covid-19 response and were required to adjust quickly to the pandemic. “Today the pressure on the public sector is immense and so it makes sense to leverage the skills, capability and manpower available in the private sector to help with the response”, says Niamh McKenna, health lead at Accenture UK. “In addition, this kind of collaboration can drive innovation and different ways of working – bringing a new sense of partnership between private sector suppliers and their government clients.”

Without question there has been a collective effort in the fight against the pandemic, with unprecedented levels of collaboration in the face of a sudden and momentous national and international emergency. For example, to increase NHS capacity the private healthcare sector has struck an emergency deal with NHS England to block book almost all their services, including facilities and many of their clinical staff.

The NHS has also worked in collaboration with the military, voluntary sector and government to create the Nightingale hospitals at a truly impressive pace. Likewise, the life sciences, pharma and biotech sectors are heavily involved in the pursuit of a safe and scalable vaccine, as well as expediting critical virus testing. But even further across the private sector there has been incredible support for healthcare services with top UK brands leading the charge on fundraising efforts, contributing to research and manufacturing PPE equipment.

“It is clear that the health emergency is a multidisciplinary challenge and in order to tackle the virus we need cross-sector and international collaboration,” says SJ Leatherdale, partner and head of healthcare and life sciences practice, of management and recruitment business Odgers Interim.

Barriers to collaboration The Covid-19 crisis has broken down the many barriers to public-private collaboration.

Integrated care has been high on the agenda for the health and social care sector for some time, however “the regulatory framework and financial challenges have limited progress in some areas,” says Leatherdale.

HealthInvestor UK • June /July 2020

“The impact of the pandemic has highlighted existing health inequalities and the impact of long-term underfunding for social care.

The work of Integrated Care Systems (ICSs) will be crucial to address these challenges and the write-off of NHS debt should relieve some pressure on NHS finances to invest in transformation,” says Leatherdale.

Technology and the challenge of information governance have also been barriers to collaboration. “The concerns around privacy and cybersecurity have prevented healthcare to act on the opportunity for shared data to improve patient experience. However, the pace of digital transformation over the past months has evidenced the need and shown it to be possible. Across the sector, we will be seeing further acceleration of digital transformation as a result of this health crisis,” says Leatherdale.

Public concerns about healthcare privatisation has been another barrier to collaboration. “It is drummed into people that any involvement of the private sector in healthcare is a significant threat - a slippery slope to losing universal free access,” says Erin Birch, healthcare strategy expert at PA Consulting, the global innovation and transformation consultancy.

The impact of the pandemic has highlighted existing health inequalities and the impact of long-term underfunding for social care

trust in the NHS is high and therefore associate their political messaging with supporting and protecting the NHS. Miraculously, they’ve been able to do this at the same time as praising private sector collaboration. This signifies a step-change in the potential for collaboration,” Birch says.

A major obstacle to collaboration is the NHS procurement process, suggests Dr Tim Ringrose, chief executive, Cognitant Group, which provides interactive and visual health information in 3D, and who also works part time in the intensive care unit at Oxford University Hospitals NHS Trust.

“Think of this barrier as a big city wall around the NHS, carefully guarded with sentries, who let private sector companies in, but only very large ones, who spend lots of time negotiating deals, for example providing electronic health records. But the NHS is now seeing the benefit of letting smaller providers to break down those walls,” Ringrose says.

Clinicians themselves can be a block to collaboration. “Quite rightly clinicians are always anxious to ensure there is good evidence for, say, a new drug, and understandably apply that similar level of scrutiny to new ways of working, such as video consultations with patients.”

From a social care perspective, there have been lots of barriers to collaboration between public and private sectors, a spokesperson from Care England says, “some of which were cultural, for example the public sector not liking to engage with the private sector.

“Furthermore, a lack of understanding and lack of professional respect. And finally, the public sector has been forced to realise that it cannot work without a care sector and the interdependence,” the spokesperson says.

Ways public and private sectors are collaborating She says fear of privatisation often stems from “limited public understanding” of how health and care systems in the UK function - for example the care sector already has significant private sector provision.

Birch suggests another barrier to publicprivate collaboration the NHS is also “romanticised as a post-war bonding piece of public policy enshrined in time”.

“It’s the only healthcare system in the world which has become emblematic of national identity. The emotional attachment to the NHS has historically been a barrier to public and private sector collaboration.

“However, during the pandemic, it has proven a real asset. The government knows that public

Since the Covid-19 outbreak, there have been many examples of collaboration. NHS and private hospitals are working together, private and council-run care homes are supporting each other to support older people, and there’s been an increase in the use of digital patient consultations provided by private technology businesses.

Director of operations and strategy, Helen Buckingham, of independent health think tank Nuffield Trust says there has been “much more collaboration between local NHS systems and the social care sector”.

“For example, regarding infection control CCG nurse leads have been at the forefront of providing infection control training and support to care home providers,” she says.

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21

COVER STORY

Niamh McKenna, Accenture UK

▶ eConsult eConsult, which was established and is still run by NHS doctors, offers digital triage to 3,000 general practices and also provides its eTraige product to patients within three A&E departments. Dr Mark Harmon, strategy and brand director for eConsult, and an A&E doctor, says that prior to Covid-19 about 90% of GP appointments were face-to-face. Since the outbreak “this has turned on its head, and 90% of a GP consultations are done remotely”, Harmon says.

He says in recent weeks, the business has collaborated with NHS England and clinical commissioning groups (CCGs) to roll out eConsult to a further 1,100 practices, and has worked with the NHS App team to allow patients access to their medical records, and to book appointments.

The company is also working with NHS Login, to help clinicians prepopulate their demographics, and speed up GPs’ knowledge of patients’ details so they can progress more quickly through the healthcare system.

Cognitant

Ringrose says before Covid-19 hit, Cognitant was already in “a great position, had our services and were ready to deploy them, including a programme to support outpatient clinics in west Berkshire, which it has since accelerated to meet the current needs of hospitals.

He points out that prior to the pandemic, most hospitals relied on face-to-face outpatients clinics for follow up but that now they are implementing more virtual care, delivered by phone or email. And Cognitant is delivering information to patients via its platform ‘Healthy Notes’ “to empower patients to understand and

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SJ Leatherdale, Odgers Interim

manage their condition to minimise its impact on future health”.

The business is also working with GP practices to provide consultations by phone or video, recommending information about health conditions, such as heart disease and diabetes to patients, using animations and avatars, “replacing the old way of giving printed information, and with details you can view on your smartphone straight away”, Ringrose says.

“The feedback we’re getting is amazing, as patients love the fact they can get information straight away on their smartphone, and the style of that information is very visual so it helps people of all ages and backgrounds to understand it.”

Odgers Interim

Leatherdale of Odgers Interim says the initial stage of the pandemic “naturally focused on the front line and building up the workforce of key clinicians – a talent area we don’t provide”.

However, more recently Leatherdale says, “there has been a distinct need for operational and workforce resource to support with the immediate response, as well as change and strategic management leaders.

“We are seeing a high demand from our healthcare clients for project management and subject matter experts to kickstart key transformation programmes, particularly in technology.”

Odgers Interim also supports the healthcare sector in its drive for diversity and new perspectives by providing key talent from outside the sector. “We are able to draw upon our networks from across a range of industries, enabling NHS organisations to bring in new

Erin Birch, PA Consulting

skill sets as well as developing the pipeline to deliver on the change and transformation they are seeking,” says Leatherdale.

Serco

Public services provider Serco provides nonclinical support to a number of NHS hospital trusts across the UK including: Forth Valley Royal Hospital, University Hospital Wishaw, Dumfries and Galloway Royal Infirmary, Langlands Unit in Glasgow, Norfolk & Norwich University Hospital NHS Foundation Trust, Great Western Hospital NHS Foundation Trust, Barts Health NHS Trust, James Cook University Hospital and University Hospital Southampton NHS Foundation Trust.

Throughout the Covid-19 crisis, a spokesperson for Serco says the organisation has focused on “supporting our customers and ensuring the delivery of essential public services. Our health business has seen additional requirements from customers for the hard and soft facilities management services that we provide and we have been keen to provide these additional services where we have the skills and capabilities.

“In the UK and in the other countries where we operate, this has been to help customers reconfigure hospitals in response to the coronavirus crisis, to support the development of additional hospital capacity and to provide additional contact centre services,” the spokesperson says.

Accenture

The NHSmail system supplier Accenture has been working with NHS regional teams, encouraging engagement and providing support for staff in the care sector to access NHSmail.

HealthInvestor UK • June/July 2020

COVER STORY

Dr Tim Ringrose, Cognitant Group

NHS Digital says NHSmail gives staff in care homes and domiciliary care the ability to share safely residents’ data and queries with doctors, nurses and GPs involved in resident’s direct care, and get timely responses. It also connects them to pharmacists, dentists and anyone else in health and care who also has secure email, such as NHSmail.

It can be accessed from mobile devices as well as desktops and includes a full directory of all NHSmail users, as well as collaboration tools such as Microsoft Teams.

NHS Digital’s Social Care Programme formed a partnership with the Care Provider Alliance to work nationally with all care providers to help them embrace the digital agenda. According to NHS more than one-in-three social care providers in England are now taking advantage of the benefits that NHSmail offers.

Post pandemic is this collaboration likely to continue?

These are just some of the ways that COVID-19 has boosted collaboration between public and private sectors. But will it continue once the pandemic is potentially over? To address both the health and socio-economic impact of the pandemic, there is “a real need for the NHS, social care, charity, housing, education, and other public and private sector providers to work together as system leaders, to deliver a comprehensive package of whole person care”, says Leatherdale.

To address the longer-term impacts and recovery of Covid-19, she says healthcare executives “stress the need for new care models to be deployed with further development of system leadership.

HealthInvestor UK • June/July 2020

Helen Buckingham, Nuffield Trust

“The pandemic has innovated the ways in which sectors can work together and this opportunity will continue to grow as a result. Medical and social research, track and trace technology and systems to address health inequalities are vital and should be pursued beyond the current health crisis,” says Leatherdale.

For Birch, the public-private sector collaboration is likely to continue but she believes private sector companies will need to be proactive to ensure this.

The pandemic has innovated the ways in which sectors can work together and this opportunity will continue to grow as a result

“They need to consider how to use this window of opportunity to work closely with public sector leaders to design a new, modern healthcare system that helps people access the best knowledge and skills from across the publicprivate divide.”

She says practical steps that private sector companies could take include incubating publicprivate sector innovation, funding research into the value of collaboration, sharing scientific insights into how better outcomes and a greater return on investment can be achieved, and, more tactically, help the government understand more

Dr Mark Harmon, eConsult

about what it can buy - services and outcomes rather than just products and units of activity.

She says the issues will continue be around technology, digital consultations, vaccines, and broader delivery capability because they existed before the pandemic, as well as consultant fees, and big service delivery survivors supported by government prior to the outbreak which should be continued afterwards.

Buckingham hopes that the collaboration she has seen between public and private sectors in recent weeks will continue. “People have built up stronger relationships between leaders and managers in the NHS and private organisations.

I hope it will continue. I would hope that people will have more strategic conversations about how providers can work together than perhaps in the past.”

She points out that kindness is an important word regarding healthcare, whether it is being delivered by the NHS or privately. “The vast majority of those who work in private healthcare motivations are similar to people working in public healthcare. They want to deliver a good service for patients and treat them well.”

And she dismisses suggestions that publicprivate care collaborations are a ‘back door’ way of privatising the NHS. “I see this [collaboration] as a continuation of a ‘mixed economy’ NHS, which it has worked with for many years,” she says.

Ringrose believes that following Covid-19 the way GP consultations work will “never be the same again”. “We can’t go back to the way it was it was, ringing at 8am for a GP appointment.

People won’t accept that.

“This has been a seismic event like an earthquake and patients won’t tolerate the way their services used to be delivered,” he says.

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23

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COVER STORY

▶

Harmon believes that the pandemic has “changed the game completely” and that technology used to triage A&E and GPs’ patients will “drive efficiency through the system so that patients get to see the right person for a condition whether it’s A&E, a doctor, a nurse or a pharmacist. And the sooner they see the right clinician the sooner I hope we can improve the system efficiency and clinical outcomes,” he says.

McKenna of Accenture says the organisation has “a longstanding relationship with our NHS clients and we pride ourselves in the depth of those relationships, keeping the best interests of the NHS at heart.

“The scale of the changes seen across all public service organisations over recent months suggest long-term shifts to new ways of working and delivering services to citizens. It is likely that as we emerge from the pandemic, some measures temporarily introduced during the pandemic – if proving successful - will be retained or further expanded in the medium and long-term. We hope to continue to work with the NHS and other public service clients to help them achieve their long-term transformation goals,” McKenna says.

Changing landscape of collaboration As to whether this collaboration will have changed the landscape of the way the NHS and private care collaborates in the future, Birch points out that healthcare in the UK “is a tough market”.

HealthInvestor UK • June /July 2020

“For a long time it has been characterised by a race to the bottom on price, and the rationing of care.” But she believes the pandemic has “shone a light on infrastructure, capacity and capability gaps”.

And she says the government will need to take action to address these issues. “The government are going to have to do something about this.

Public trust in the NHS brand is high, but it’s also widely accepted that it needs help. And this is even more pronounced in the care sector.

Continued collaboration across the public and private sectors will be critical to address the longer-term repercussions of this health emergency

“Because of the obvious gaps, the clear link between public health and the economy, digital innovation and changing ‘customer’ expectation on timeliness of appointments, tests and virtual consultations, we will inevitably have a different health and care landscape in the future.

“This will open up new market opportunities for services, outcomes, larger volume/consolidated

contracts, new market models for the care sector, and the digital transformation of services.

“People realise now more than ever that the NHS is a precious resource. The worried well will likely seek new avenues for reassurance.”

The NHS and private care have worked closely in responding to this crisis, integrating resources in order to reach full capacity of space, workforce and equipment. Coming out on the other side, Leatherdale says there will invariably be a greater demand for care to work together, “whether this is for the already exacerbated issue of waiting lists, which have only got longer during this period, or for the new demands on mental health services as we transition out of the lockdown period.

“Continued collaboration across the public and private sectors will be critical to address the longer-term repercussions of this health emergency,” says Leatherdale.

During this pandemic, McKenna says the NHS “has shown itself to be able to drive large-scale change across the organisation, at a scale that was hard to imagine. This has been thanks to partnerships with small and large enterprises, helping them to get change delivered at all levels.

“The challenge now is to embed this in a sustainable way post-pandemic, and I think the behaviours of asking for help, sharing problems and solutions and working in multidisciplinary teams from across the NHS and private sector will be here to stay.” n

25

DUE DILIGENCE

Lightning will strike again Clinical governance is a relatively new addition to acquisition due diligence. Ed Marsden, managing director of Verita, explains why understanding the reality of professional hierarchies and practices is an essential part of healthcare investment

I

an Paterson, a consultant surgeon from Heart of England NHS Foundation Trust, was known to his female clients as God. He was composed, confident and charismatic.

And yet he carried out thousands of dangerous, disfiguring operations on women who did not need them. He did many of these while working at two Spire Healthcare hospitals in the Midlands.

Paterson’s actions led to significant harm to patients and to his being jailed for 20 years. Spire Healthcare paid out £27.2 million in compensation to 750 private patients.

Its reputation was damaged.

The Paterson case is not unique in the Verita casebook.

Healthcare is an area of increasing interest for investors.

The current pandemic underlines how important highquality diagnostic and treatment facilities are when the unexpected takes hold. But delivery of healthcare can be high risk and even more so when the private sector gets involved. And the provision of healthcare services is rarely out of the news and is often in the public and political eye. More reason to understand exactly what you are buying and the benefits and risks that come with any acquisition.

How robust are clinical procedures?

Any investor rightly insists on due diligence. Yet when they invest in hospitals/healthcare, they often seem content to leave the due diligence to the accountants and lawyers.

Surely, they reason, we can trust that clinical procedures are robust?

Investors in healthcare need comprehensive and reliable information about concerns particular to organisations.

Analysts can assess the financials of a business and comment on commercial or strategic risks, but it is another thing to know how healthcare organisations function on the ground.

Verita recently carried out a clinical governance due diligence review for a private equity company buying a large international healthcare organisation. Our brief was to get under the skin of a business providing a complex range of clinical services; to find out for the new owners what was working well and where the risks lay. We looked at whether the leaders of the organisation understood their

26

responsibilities for safe care. We considered how much the board really knew about day-to-day clinical operations.

We sought assurance about how they responded when care went wrong. Overall, we thought that care was good, and the organisation well led. Our clients were reassured when we told them so.

Our judgements were based not just on the investigation but also on our 19 years’ experience of consultancy and investigative work in healthcare.

The reality of risk The Covid-19 crisis has been a reminder of the sheer scale of the NHS, which sees a million patients every 36 hours. Care and treatment on such a vast scale can never be without risk. A system may fail at the vital moment; a patient may react unexpectedly to treatment; a staff member may make a mistake through inadequate training. Despite the keenest efforts of highly trained professionals, patients sometimes come to harm.

The people managing healthcare organisations are obliged by regulations to do what they can to minimise such harm and act promptly and appropriately when care and treatment go wrong. That’s the unhappy point at which we meet them to start to investigate. Hard-won experience investigating untoward incidents has given us insights that help potential investors understand how a business really works – beyond what its finances and legal liabilities say about it. In short, that means understanding how good the care of patients is and how robust the clinical governance is.

The Department of Health & Social Care says ‘clinical governance is the system through which organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which clinical excellence will flourish’.

It is the system by which risk to patients is minimised (risk management); quality of care is measured and improved (clinical audit); staff have the knowledge and skills they need to do the job (education and training, care is based on good-quality evidence from research (evidence-based care); and the needs and priorities of patients are understood (patient experience). All of this must be complemented by having the right staff in the right numbers.

HealthInvestor UK • June/July 2020

DUE DILIGENCE

Ed Marsden, Verita

The due diligence review How do we carry out a pre-acquisition due diligence review? First, we use a multidisciplinary team, including members with clinical knowledge and expertise. Second, our assessment reviews clinical governance against seven domains. For example, we examine if quality drives an organisation’s strategy; whether the board/top team has the necessary leadership, skills and knowledge to run and develop clinical services; and whether the organisation is patient-centred.

Each domain contains a metric and/or industry-standard benchmarks that inform our assessment.

Our review for the private equity company gave us access to strategic plans, board packs, incident reports and external audits, among other documents. We interviewed the senior management team including the chief executive and the board director responsible for clinical governance. Our discussions ranged from the executive’s understanding of a healthy patient-safety reporting culture to their planning for Covid-19 and its likely impact on the business in the short and medium term. The documents and interviews gave us a rounded evidence-based view of how the business managed patient care. Most importantly, we benchmarked

HealthInvestor UK • June/July 2020

the effectiveness of the organisation against our experience of a large sample of organisations in the sector, including the NHS Improvement National Reporting and Learning System.

We formed a partnership with the legal advisors on the project and between us assessed the likely cost and reputational impact of care-related legal claims facing the company.

We challenged what we were told so that we could get under the surface of the data and provide positive and evidenced analysis and guidance to the potential investor.

And then we reported to the buyer on strengths and areas for improvement and targeted investment for the buyer to consider. We provided reasoned judgements about areas of risk and practical recommendations for areas of concern. Our advice included strengthening the clinical governance infrastructure and adopting modern technology for investigating patient safety incidents. We recommended strengthening the professional medical and nursing leadership on the main board and calculated what these investments would cost. Our investor accepted our findings and recommendations in full. They were able to complete their acquisition confident that they understood how well patients are cared for.

Avoiding harm The jailed surgeon Ian Paterson had admitting privileges at Spire Parkway Hospital from 1998 and Spire Little Aston Hospital from 1993. Verita’s independent review of those hospitals concluded that the management and governance both at the Spire hospitals and corporately were weak and that managers and professional colleagues had been expressing concern about Paterson’s clinical practice for years. We will never know if stronger clinical governance would have stopped Paterson. It would certainly have increased the likelihood of earlier detection. Untold harm might have been avoided.

They say lightning never strikes twice in the same place.

Perhaps, but the certainty is that lightning will strike again.

The difficulty is knowing where and when. The wise buyer wants questions answered. It’s even more important to question answers; to search beyond the work of the analysts, auditors and lawyers; to carry out not just due diligence but true diligence. n

27

LATER LIVING

Senior service Investment in the UK later living market has risen markedly in recent years, but what does the future hold?

Tom Scaife and Lauren Harwood of Knight Frank survey the landscape

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HealthInvestor UK • June/July 2020

LATER LIVING

L

iving through a global pandemic has had a significant impact on all of our lives, but undoubtedly it has placed a particular spotlight on the lives and welfare of those in their later years. People generally wish to live independent lives for as long as possible and it is vital that we provide age appropriate housing options to seniors. The need to address this issue is pressing, with demand only increasing as people live longer. Well-designed extra care retirement communities provide people with a housing option that delivers a good standard of independent living while also ensuring that high-quality care and support is available when required.

Despite recent weeks of temporary muted activity enforced by the lockdown, we have seen positive sentiment towards the UK senior living sector continue – especially among institutional investors. Clearly the full impact of Covid-19 on the sector has yet to become evident, however the strong fundamentals underpinning investment have not changed.

The Covid-19 pandemic will result in a reordering of decision-making priorities for tenants and residents. Topics like infection prevention and control will drive demand, and will require us to look at how new schemes are designed as well as staffed and managed. This in turn will lead to a greater desire from investors for professionally managed buildings with an operational focus. In short, the investment case remains compelling, supported by a number of key fundamentals.

First, the underlying demographic trends underpinning the sector will continue. The UK’s population is ageing and by 2037, it is forecast that 13% of the population will be 75 or older – an increase of more than 60% from today.

The second fundamental which supports the investment case for UK senior housing is price growth of independent living and assisted living, which outstrips other residential sectors. Knight Frank’s latest analysis suggests price growth within the sector stands at 55% since 2009 compared to average house price inflation across England of 42% over the same period.

Lauren Harwood, Knight Frank

HealthInvestor UK • June/July 2020

Tom Scaife, Knight Frank

In addition, we must also remember that our senior population represents the wealthiest demographic in terms of property values. The fundamentals of affordability are based on this property wealth, alongside income from pensions and investments, making it an attractive proposition for investors.

Finally, there is a substantial imbalance between the rate our population is ageing and the delivery of seniors housing, with only 9,500 senior living homes completed in the UK in 2019.

Investment into the UK senior housing market has increased over the past few years. This increase reflects the relative immaturity of the sector as well as its potential in the eyes of an increasing number of investors. The sector is currently in a development phase, with between 8,0009,000 new senior living units delivered in the UK annually.

In 2019 we forecasted that the total gross development value of private schemes in the senior living sector would rise from £39 billion in 2019 to £55 billion by 2023, with growth underpinned by demographic shifts and increased investment from both the UK and overseas. Given the current Covid-19 pandemic, the question now is how resilient is the sector in both the short and long term?

Certainly, 2020 started where 2019 ended, with investment in the first quarter totalling £430 million before the pandemic took hold across the UK and government restrictions on movement were introduced.

We believe this trend will continue once lockdown restrictions are fully lifted – a prediction supported by three key tenets: a suppressed supply pipeline, increasing tenant demand and affordability.

Analysis of the supply pipeline suggests that nearly 11,500 senior living units were due to be delivered this year, increasing year-on-year to a total of approximately 70,000 by 2023. However, a hiatus in construction activity with restrictions on access to development sites due to Covid-19 will apply further pressure on what is already widely regarded to be an undersupplied market.

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LATER LIVING

▶

It is also worth noting, that the demographic trends which underpin the sector remain unchanged. The UK’s population is ageing and is projected to continue to age. The number of people aged 75-plus living in the UK is forecast to increase by 49% to almost 8.5 million by 2035. Our in-house estimates suggest the average value of a house owned by a senior household is almost £280,000, some 8% higher than the average values for those aged under-75.

The fundamentals of affordability are based on property wealth, alongside income from pensions and investments, with seniors able to draw on a number of pools of capital in order to fund a move, a benefit that much of the younger generations do not have. Historic trends suggest this wealth is only going to increase. During the 2007/08 to 2017/18 period, UK house prices increased on average by 22%, with the gross income received per week from all pension plans increasing by 11% according to the Department for Work and Pensions, driven by substantial growth in occupational personal income.

Future trends The Covid-19 pandemic will likely speed up existing trends in the sector. Knight Frank predicts that we will begin to see larger schemes coming forward with the capacity to provide a greater range of services, offering flexible access to senior housing and offsetting increases in staffing and operational costs.

We will also see developers select sites that have a closer proximity to urban locations, developing mixeduse schemes and re-purposing sites currently in other land uses, such as retail. In addition, independent living schemes offering increased numbers of medically trained staff will also be in higher demand. Such schemes will

HealthInvestor UK • June/July 2020

enable operators to incorporate assisted living alongside independent living.

Offerings including mixed-tenure and rental-only propositions will also become more widely available, as will more variations on event fee structures, providing increased tenant choice best suited to their financial profile, budget and preference.

Higher levels of staff training, larger stocks of personal protective equipment and higher scrutiny of supply chains will be expected by residents and their families. In the future there will also be closer alignment between epidemiologists and the wider use of telehealth; the sector will better utilise technology in order to provide better care and service levels to residents.

However to continue moving into a mainstream asset class there are still concerns and issues that need clarifying. These include a uniform plan for meeting the housing needs of our ageing population, with local authorities held to account to meet local needs, while seniors housing should be given support in planning policy. Ultimately, there needs to be wider understanding of the benefits of seniors housing. This includes financial savings to local authority care services; release of local family housing back to the market via downsizing; local employment generation; reduced impact on highways and other local services; rejuvenation of high streets with facilities open to the public; and lastly contribution to housing supply targets. n

Tom Scaife is a partner at Knight Frank and head of the firm’s senior living team.

Lauren Harwood is an associate and heads up the firm’s senior living research team.

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LEGAL MATTERS

Patently clear Under normal circumstances the high costs associated with innovation and regulation in the healthcare industry make patents crucial for protecting and encouraging new research and development. But is the patent system flexible enough under exceptional circumstances such as the current pandemic? Andrew Pitts, patent attorney at Mewburn Ellis, discusses the matter

T

here are recent reports of medical professionals 3D printing parts for patented mechanical ventilators.

The reports say it was an emergency life-saving measure because the authorised suppliers were unable to make enough in time to treat the growing number of Covid-19 patients. Medical devices and their components are often patented and so there is a risk that some patent holders could begin infringement proceedings and try to prevent the making and use of their devices by enforcing their patent rights – despite the obvious moral implications.

Patent owners who are aware of emergency actions like this might choose temporarily to look the other way, because the last thing that medical professionals dealing with the Covid-19 crisis need to be thinking about is whether or not they are infringing a patent. They are instead focused on saving lives against the clock, by any means necessary and at great personal risk. Starting infringement proceedings against medical professionals under these circumstances would likely result in a public backlash against the patent owner, making it an unlikely outcome. However, if infringement proceedings were started in the UK despite these drawbacks, some rarely used legal provisions might be dusted off to join the fight.

Crown Use Given the unique circumstances, one possibility under UK patent law would be for the government to step in and allow the acts under the relevant patents for “services of the Crown”. The UK government has the power to authorise the performance of acts that would otherwise infringe a patent, without the consent of the patent owner. This authority can be granted retrospectively and is intended for use in emergencies. But it is the government that would ultimately decide whether to step in and protect medical professionals treating Covid-19 from patent infringement proceedings. The medical professionals could only lobby the government from the sidelines. This provision is rarely used, as disrupting the protection afforded by a patent is disconcerting for many

32

Andrew Pitts, Mewburn Ellis

patent owners and raises fears about the vulnerability of similar patents. Crown Use was lobbied for in 2019 during negotiations for the NHS to buy an expensive cystic fibrosis drug Orkambi. The idea was dismissed by the government because a commercial negotiation was not considered an emergency; however the current Covid-19 pandemic certainly is. The government would still be required to provide reasonable compensation to patent owners for any loss of profit. Interestingly, the government of Israel has just used its corresponding provision to make antiretroviral medications available to treat Covid-19 when the patent owner was not able to supply sufficient quantities.

If necessary, Crown Use might be invoked in the UK for the widespread distribution of a Covid-19 vaccine, when it becomes available.

HealthInvestor UK • June/July 2020

LEGAL MATTERS

Compulsory licencing Another possibility would be for the medical professionals to apply for a compulsory licence. Anyone may apply for a compulsory licence, but only more than three years after grant of the relevant patent. However, the government can also intervene and apply for a compulsory licence on behalf of a third party. It is a requirement that the relevant party has tried to obtain a licence from the patentee within a reasonable period and on reasonable terms. This could be a sticking point in an emergency situation similar to the above where there is unlikely time to do this until afterwards, meaning a retroactive effect would be essential. This would be unusual as a compulsory licence takes effect by default at the time the terms of the licence are settled. A court would therefore need to explicitly include a retroactive term in any compulsory licence that it grants. While it is unclear if this would be possible in the UK, licences with retroactive effect are known in other European countries in certain cases. Moreover, if the acts were not performed more than three years after grant, it is unlikely that this provision could be relied upon at all because the agreement of Parliament is required for any reduction in this period.

Obtaining a compulsory licence cannot be guaranteed and patent owners can also oppose the application, which could prevent or prolong grant. The parties involved would still be required to pay fair compensation to the patent owner under the terms of the compulsory licence. However, the outcome of this option is nowhere near as certain as if Crown Use was invoked.

Right to repair In cases where only a part of a patented medical device is made to replace a faulty or missing part, then medical professionals in the UK may be able to rely on the ‘right to repair’ as laid down in a UK patent case Schütz v Werit (2013). This is an implied licence that allows the legitimate owners of a broken patented product to restore it to its original condition. This could be useful in cases where every

HealthInvestor UK • June/July 2020

medical device counts and so any repairs must be performed immediately to keep the devices running to prevent loss of life – although it does rely on having the medical devices in the first place. There are many factors to consider to determine whether a patented article was in fact made (infringement) or repaired (no infringement). Therefore the outcome would very much depend on the specific details in each case.

The future As evident from this brief analysis, despite the social and moral desirability it is not clear whether any of the above would be effective as a defence for medical professionals in an emergency.

Indeed, it may be that infringement is upheld by a court, but damages are awarded set on the basis of royalties or fees which would have been due had the medical professionals obtained a licence beforehand. It could perhaps be argued that there is no time for a medical professional to consider whether a patent existed in an emergency. If successful, this argument would restrict the award of damages. But in either case it could still seem heavy-handed under the circumstances to find that there was infringement.

The healthcare industry is well aware that, as advances are made in 3D printing, the production of increasingly complex components may be carried out on site at hospitals. It is therefore conceivable that orders for medical devices (or their parts) could be placed legitimately using an online catalogue connected to a 3D printer. This could help eliminate supply chain issues, even during times of crisis. An order would probably include temporary access to a 3D printing design file and a licence to print the design a certain number of times. This distribution and manufacturing approach could be taken for any patented product that can be 3D printed.

By keeping up with developments in modern technology the healthcare industry could protect innovation without putting medical professionals in a difficult position during times of crisis. n

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DIGITAL HEALTH

Secondary concerns The race to deliver NHS digital primary care services is entering the final stages, but are we addressing the need to transform how secondary care is delivered?

Debbie Preece of PowerGistics discusses the situation

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t’s been almost 18 months since the NHS Long Term plan was first published, setting out an ambitious, decade-long digital transformation strategy which firmly underpinned the importance of technology to the future of the healthcare service.

Much of this is aimed at outpatient care, reducing the strain on GP surgeries, for example, by shifting to virtual appointments via videoconferencing. While it is by no means possible for all, this is the sort of engagement people are becoming more accustomed to and will only grow in popularity in the future.

When it comes to inpatients, NHS trusts are embarking on their own digital revolution, in many cases multimillion-pound investments in state-of-the art technology to transform the way staff work and to improve further the experience of the people they care for.

While this can extend to upgrading back office IT, applications and telephone networks, the changes will be most visible on the front line, in patient care.

The benefits here are obvious. Clinicians will be able

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to share information more easily, identify risks faster and make what could end up being lifesaving interventions even more quickly. Access to information is crucial. Doctors and nurses will have instant access to medical records of patients, providing faster diagnoses and treatments. Not only this, but moving away from paper-based notes will allow care providers to spend less time at their desks, or doing handovers between shifts, and more time treating people.

However, there is another way that mobile technology is being utilised in hospitals across the country.

The Covid-19 pandemic has been a steep learning curve for many trusts, but the necessary isolation of patients from their loved ones during treatment meant a reliance on mobile devices to keep in touch.

The digital revolution isn’t about doing away with hardware. In fact, it can mean the opposite. What this is leading to is an influx of mobile devices on hospital wards, which in itself can create its own headache. Simply, how do you track, trace and store these devices?

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DIGITAL HEALTH

The importance of staff engagement Any transformation project will have an impact on staff.

While a younger workforce will welcome an increased use of applications and mobile devices, there are others who will see any change as unwelcome, unnecessary and unfamiliar.

Robust training will go a long way to alleviating these concerns, but it is when changes are rolled out on the front line that pressure will be greatest.

What front line healthcare workers do not need is another thing to worry about. And keeping track of these devices – not least due to the cost – will no doubt give staff cause for concern. Not only that, but just like a personal device such as a mobile phone, keeping track of battery life so that they don’t fail you at a crucial moment is also of paramount importance.

This means that hospital wards and workstations will need to change to accommodate an influx of new devices, in a way that minimises the impact on care providers.

Debbie Preece, PowerGistics

Connecting people The need for visitor restrictions during the coronavirus outbreak caused heartache for many. Elderly people who may not have their own mobile device, were left without a means to contact loved ones, while new parents were forced to be apart from their vulnerable newborns on neonatal units.

There have been many heart-warming examples of charitable donations to enable patients and their families to connect.

Having seen first-hand the value of connectivity, it is hard to see these sorts of solutions dissipating once the pandemic subsides. Few would argue that Covid-19 may have fast-tracked the urgency for the NHS to embrace mobile technologies by many years.

Vodafone, for instance, teamed up with the charity No Isolation to distribute specially designed video units to elderly people, kept apart from their family and friends through social distancing.

But again, this influx of devices brings with it a need to manage these devices effectively. Bosses with at least one eye on the purse strings will not want to see devices misplaced, broken or, at worst, stolen. There is also a fear that staff using the same device might spread infection, so storing them with the means to wipe down and become surgically clean will also need be the new normal. The need for personal protective equipment (PPE) is universally understood. Infection cannot creep through via a shared mobile device.

The new workstation The phrase ‘digital transformation’ has become a catchall phrase because it means different things to different organisations. For some it may simply mean buying a new laptop, for others it might be an entire overhaul of their IT system. The NHS Long Term Plan has some grand ambitions – and time will tell if it is entirely successful as it rolls out. But there is an argument to be made that there is something that is fundamentally being overlooked

HealthInvestor UK • June/July 2020

– and that is the practicality of using mobile devices on the front line.

To illustrate the point, any gathering, particularly among those of a younger generation, leads to a clamour for phone chargers, lest their battery die. Many have known the dread of misplacing a mobile phone or tablet, let alone one belonging to your employer. The same pressures will be felt on a hospital ward and this cannot lead to confusion over charging points and who gets priority.

Hospitals that have adapted to the workstation of the future have championed the increased efficiency, the reduction in clutter, and confidence to use mobile devices without fear of repercussions. But perhaps most importantly (and least surprising) is the change that mobile devices bring to patient care.

For staff working on the front line, order is crucial. No two days are the same, so the increase in mobile devices cannot disrupt what are often delicate – and very deliberately designed – workstations. This is why the digital future for hospitals must never lose sight of the fundamental fact that doctors, nurses and other front line healthcare providers must be confident that mobile devices will always enable them, rather than be a drain on time, space and efficiency.

Putting the Long-Term Plan into action The impact the Covid-19 pandemic has had on the NHS is huge – and it remains too soon to draw any firm conclusions.

The NHS Long Term Plan certainly won’t be derailed.

In fact, the coronavirus crisis has sharpened minds and provided a platform to demonstrate the importance of mobile devices on the front line. During the early stages of the coronavirus pandemic, hospitals began adapting every inch of floor space for ICU and Covid-19 wards, demonstrating the need for more efficient workspaces.

What is clear is that trusts – and more importantly their staff – have proved themselves highly adaptable and focused, first and foremost, on providing the best patient care possible, in whatever way that must be delivered. n

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AESTHETIC SURGERY

Cosmetic damage For obvious reasons, cosmetic surgery has ceased during lockdown. But what impact has this had on patients’ mental health and what are the long-term prospects for the sector? Reece Tomlinson, chief executive of Uvence, has the answers

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n today’s society, thousands of Brits have made cosmetic procedures such as dermal fillers and botox a regular part of their lives, with many undergoing treatments as often as every two to three months. Cosmetic surgery has also exploded in popularity, with the number of surgical augmentations, reductions and adjustments for aesthetic purposes increasing every year.

However lockdown represents for many people the longest period of time spent without any enhancements, as social distancing measures prevent clients from accessing their treatments. With a specific focus on the cosmetic treatment arena, the precautionary pause may have forced many to ask themselves whether their go-to treatments – from fillers and botox to lifts and liposuction – are as essential as once perceived. This reconsideration has forced industry leaders to rethink the way they will accommodate their patients’ wants and needs.

I have observed the impacts of Covid-19 on the industry first-hand, and many are left wondering how patients are faring and what will happen after the lockdown is lifted.

When the lockdown happened, the first thing we had clients asking about was how much longevity the procedures would have. As many wondered when treatments would next be available, there was quite a lot of conversation around how to support our clients during a time that had the potential to be very stressful. There was a huge amount of uncertainty at the time and we’ve seen now that the lockdown has meant that many have gone months without any access to treatment.

The impact of a lack of procedures on mental health For many, looking good is synonymous with feeling good and for those relying on frequent cosmetic procedures, the inability to receive these treatments can be anxiety-inducing and have a negative impact on mental health.

Cosmetic procedures are becoming more of a regular staple to ensuring a client can look and feel the way they desire. For some, cosmetic procedures and the result thereof represent a major facet in their self-identity and confidence.

Similar to that of getting your hair cut or wearing makeup, cosmetic procedures (particularly non-invasive procedures such as dermal fillers and Botox) are becoming a major

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Reece Tomlinson, Uvence

cornerstone of one’s beauty regime. By removing the ability to receive treatments, some patients are experiencing higher levels of stress and anxiousness due to the potential impact that not having a treatment may have on their appearance.

Another stressor unique to the lockdown is the increase of video calls, which psychologically are very similar to sitting in front of a mirror all day. While video calls are making the transition to at-home working and socialising easier, they also present an opportunity to spend nearly the entire day staring at your own face – presenting hours on end for self-critique. Many people are also suffering from something described as ‘zoom fatigue’ where people are inexplicably drained after video calls. This has been attributed to being forced into a state of hyperawareness of how you look and present yourself while you are on the call. Cameras also do not show one’s true self. They are inverted images that can be unflattering, and lead people to believe that they need certain treatments to help with something that may be minimal in reality.

Conversations around self-care have dominated the beauty industry in recent years, and while there’s no magic button for avoiding stressors entirely, devoting some time to what makes you feel good can help offset the feeling that you’re out

HealthInvestor UK • June/July 2020

AESTHETIC SURGERY

of control. Whether it’s a haircut, a facemask or a cosmetic procedure, many people do rely on beauty treatments to feel good. When these self-care rituals are taken away from us, some people can feel that the control they are seeking is being taken away, and leave them feeling anxious and increasingly stressed.

During this challenging time, there is heightened anxiety and stress, eating habits have changed and sleep quality is being affected. Therefore, it is especially important for people to look after their body and mental health. While having a lack of access to beauty treatments can have a negative impact on people’s mental health and confidence, it is not recommended to use at home machines or devices as a replacement for medical aesthetic treatments, as it can be harmful when people try and perform these types of treatments on themselves. There are a number of concerns as to why this is the case: incorrect device settings may be used, the devices may not be used properly, and the device may not be suitable for the person’s skin type, all of which can cause harm.

We recommend that medical aesthetic treatments, such as micro needling, chemical peels, injectable treatments, and removal of skin tags are done by trained medical professionals only. It is difficult to say when clinics will be able to reopen again for medical aesthetic treatments.

For many who frequently receive cosmetic treatments, this involuntary time away can be stressful, therefore, looking after the body and mental health by using these suggestions can really be beneficial.

HealthInvestor UK • June/July 2020

We believe clients will have a more holistic approach to treatments after this. Treatments including PRP and micro needling, as well as natural and personalised treatments such as Uvence will be popular. In the meantime, it is important to look after skin and mental wellbeing.

How the industry will be impacted Our research indicates that the demand for cosmetic surgery will continue to grow, as we have observed a considerable increase in popularity in recent years. Two key components in the development of cosmetic surgery are to make the procedures less invasive and more affordable, but the recent boom in popularity of treatments such as dermal fillers, micro-liposuction and facelifts has also come with a reliance on these procedures as quick fixes for body-image issues, which can obviously be problematic.

This pause for the industry is likely to make many surgeons and firms take stock of what they are currently doing and the kind of treatments they are going to offer in five, 10 or 15 years. Now is a pivotal but incredibly exciting time for the industry where we are given a chance to regroup and focus on treatments that are not only more natural-looking in their results, but utilise standardised and more natural procedures.

As a company, we are doing everything in our power to ensure that, when safe to do so, we can begin providing treatments again to clients. Whilst we would like to get back to providing treatments, we are also not wanting to put any of our clients or staff at risk by opening prematurely or before it is deemed safe. n

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COVID-19

Impact assessment The impact of Covid-19 continues to stretch our healthcare systems and our economy. With the country on lockdown, people and companies alike are adapting and innovating at pace. Ben Barker, regional head of portfolio at BGF, gives his perspective

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HealthInvestor UK • June/July 2020

COVID-19

Ben Barker, BGF

Dr Bayju Thakar, Doctor Care Anywhere

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ltimately, as we continue to fight an era-defining position of, on average, discharging 1,000 patients a month crisis, seeing unrelenting leadership from the to 1,000 patients a week. healthcare industry offers some respite. Those that “But we know the communities and the care providers, we support our healthcare services are doing all they can. know the hospitals very well and they trust us to take on the Companies such as Inspiration Healthcare, Doctor Care greater level of work.”

Anywhere (part of Synergix Health) and CHS Healthcare Easing the workload on the NHS means looking to all deliver vital support and are doing so on a previously technology and adopting virtual healthcare where possible, unimaginable scale, pivoting operations to help where they but there have been hurdles to overcome, “coming into the crisis, we had an entire NHS workforce who didn’t really know are needed most.

Central to that is ensuring essential services – such as how to do virtual consultations,” says Dr Bayju Thakar, founder neonatal care or patient discharging – continue, despite the of Doctor Care Anywhere. “Shortly after the outbreak, we impact of coronavirus. started training GPs. Three weeks ago, 90% of all GP consults were done in person, now 90% are virtual.

“Even though hospitals can postpone certain things, the one thing that “We’re also providing virtual services to everybody wants to postpone, but can’t, over two million private patients, releasing A vast proportion is a premature baby,” explains Neil pressure on the NHS. Those people aren’t Campbell, chief executive of Inspiration having to use 111, go to A&E or GP of people are practices – they can access high-quality Healthcare Group. “Babies are still being medically fit to be born prematurely. We have the same services, reduce infection, and reduce discharged but pressure on the system. demand for neonatal intensive care cannot get the right products we’ve always had.

“Demand for our services has gone care to get them “The first thing we did [when the through the roof – more than 250% pandemic hit the UK] was to make sure compared with this time last year.” out of hospital CHS Healthcare is leveraging technology we were able to continue delivery of our products and service to neonatal intensive to better support the NHS when it comes to care units around the country.” reviewing approximately 70,000 complex care patients who qualify for NHS funding, moving “the Similarly, keeping the flow of patients through the NHS entirety of our service to work remotely.” is vital to keep beds available for critical care for Covid-19 patients, with Sir Simon Stevens, chief executive of the NHS, “We’re linking up with the families and carers of patients,” calling for 15,000 beds to be freed up through discharging says Silver, “to check they’re safe and well, that they’re receiving the appropriate care, and if they need further care as the crisis hit.

“A vast proportion of people are medically fit to be because of the crisis. We are the critical link between health discharged but cannot get the right care to get them out of and social care.” hospital,” says Dr Gabrielle Silver, chief executive of CHS Community spirit Healthcare, “so we work with the NHS to accelerate this.

Beyond the core services that continue to be delivered in the “Pre-Covid, our target was to have a patient discharged face of adversity, a strong community spirit of support and within five days of a referral. Now we have to get people knowledge sharing has evolved. out of hospital within three hours. We have moved from a

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HealthInvestor UK • June/July 2020

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COVID-19

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“We’ve set up free training modules, which have been viewed over 10,000 times,” says Thakar. “Having that many GPs go through our training programme is no small feat.

“And we’ve a lot of HR directors at companies asking how they’re going to look after their staff when they’re working from home. Our team have developed webinars for our corporate base, to help them take care of their staff and we’ve supported over 400 companies for free.”

Inspiration Healthcare is helping with the government’s call for more ventilators as a distributor (one of its core business streams) and joining VentilatorChallengeUK as an expert advisor.

“We’ve got experience in delivering novel respiratory equipment and we did that during the swine flu pandemic,” Campbell explains. “Companies come to us for advice – where they can get components from, whether the ventilator set-up makes sense from a user’s perspective or whether they can borrow our test equipment.”

“We’ve been pleased to be able to help, because in the end, it’s not a race between companies, it’s a race against Covid-19.”

CHS is using its expertise and connections to help solve issues outside its usual remit. “We were asked about phlebotomy services. Although that’s not something we do, we were able to assist and find a solution through our network, partnering with another provider that was able to deliver the services,” Silver says. “In the end, we’re united around a common purpose and we’ve all got a part to play.”

It’s not been easy to adapt and deliver both the quality and sheer volume of service. Thakar, Silver and Campbell all credit the efforts of their workforces and the quick decision to move as much of their operations to remote working as possible.

“As a healthcare business with approximately 400 people, we made the early decision to move to remote working,” Silver explains. “We needed to protect our workforce and take them offsite, because the important service we normally provide is now critical.

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“This meant we were ahead of the curve, to ensure we had the technology we needed and access to all our software platforms from home.”

For Doctor Care Anywhere, Thakar says it’s not only had to relocate 200 staff but manage growth: “We’ve had to hire fast and shift ourselves to train doctors and customer services remotely. The effort of the team has been in some cases superhuman. It’s been very humbling to see.”

For Inspiration Healthcare, remote working isn’t an option for some of its staff and services.

To help mitigate the risk, Campbell explains they took “a normal risk approach for extraordinary times”.

“We’ve split shifts. We’ve implemented social distancing in factories. Our staff are only going to hospitals for things like critical tech support. Obviously, if a ventilator breaks, it needs to be fixed. All our staff are being issued with PPE, because the safety of the staff is absolutely paramount.”

Flaws in the system This difficult time has also laid bare some flaws in our healthcare system, such as the disconnect between data systems or complex supply chains and presents the opportunity to improve things. As Campbell says “I think every company will have a bit of a moment of reflection to ask, what can we do differently?

“We’ve seen you can’t treble your medical equipment at a moment’s notice, so perhaps it will be about making supply chains more robust or more localised.”

HealthInvestor UK • June/July 2020

COVID-19

“There isn’t an integrated data system between stages of care,” explains Silver. “What the crisis has demonstrated is just how important it is to be able to follow-up with patients, providing ongoing care for what will be a pretty fragile population that’s had to deal with Covid-19 and other healthcare issues.

“We need to bring these systems together and bridge the health and social care divide.”

Thakar believes this is a seminal moment for digital healthcare. “Post-Covid, there’s going to be a huge demand for medical procedures. We’re working with the NHS on how we can support to get specialists on the platform to help triage.”

“The shift we’ve seen to virtual consultations has come far quicker than we could’ve predicted. It means, as a company, we also have to stay ahead of the curve, as what we do today will no longer be niche.

It’ll be normal.”

“Healthcare is fortunate in that most people understand there’s a duty and a responsibility beyond profitability,” Thakar says. “When you’re faced with adversity, people step up. You’ve seen it in the NHS and in other healthcare companies.”

“This is a time for authentic leadership,” says Silver, “which is caring about people, being honest about the things you can and can’t control, and letting people be themselves.”

While Campbell finishes by adding: “Our philosophy has always been patient first. Our people have risen to the challenge. We are a critical care company. If we don’t do our bit, then who else is going to do it?”

Within BGF’s portfolio, every healthcare business has its own unique set of circumstances and our investors, as board members, have been working with them to help make sense of the environment, to focus on priorities so we can provide the required support as we look ahead to the future. n Gabrielle Silver took part in a HealthInvestor UK webinar titled ‘Covid-19: What have the private and public sectors learnt about working together?’ on 12 May. To watch this recording, or anything else in our Covid-19 Webinar Series, visit ipevents.net/webinars

HealthInvestor UK • June/July 2020

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EXECUTIVE MOVES

executive moves Audley Group Audley Group, a provider of retirement villages, has appointed Emma Trinder as planning director.

Trinder will lead the planning team across all Audley and Mayfield villages within the UK. She will also assume responsibility for village design, quality build and planning. She will report directly to managing director Kevin Shaw.

Trinder joins Audley Group from ETG Consulting, where she advised clients on the planning, design and operation of a number of build to rent projects across the UK. Prior to that she spent nine years at Moorfield Group, where she was responsible for delivery of planning strategy for all alternative residential assets, including retirement living.

She has also held senior roles at JLL and Drivers Jonas, and is a qualified planner. Emma is also a board director for Spruce Homes, part of Southern Housing.

Kevin Shaw, managing director, Audley Group, said: “The demand for our retirement villages remains extremely strong and we are excited to welcome someone with Emma’s extensive track record on board. I’ve worked with Emma for many years in her previous roles and know from first-hand experience how much quality, energy and expertise she will bring to Audley. We are lucky to have her.

Retirement living is a long-term growth sector and Audley remains at the forefront of that growth.”

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Cambridge Innovation Capital

Emma Trinder, Audley Group

Carol Cheung, Cambridge Innovation Capital

Cambridge Innovation Capital (CIC) has appointed Carol Cheung as principal within the CIC investment team.

Since joining CIC in 2016, Cheung has been responsible for managing CIC’s investments into the technology companies, Cytora and Geospock.

Prior to joining CIC, Cheung was commercial director of speechmatics, a Cambridge-based start-up providing cloud-based speech recognition.

Cheung holds an MBA from the University of Cambridge and is a CFA charterholder.

Cheung said: “I am thrilled to be taking on this new role within CIC. It’s been nothing short of fantastic working with the team so far to find, build and shape world-leading companies linked to the Cambridge ecosystem, and I am looking forward to the myriad of exciting opportunities heading our way in the near future.”

Andrew Williamson, managing partner of CIC, commented: “Carol has proven herself to be an invaluable member of the CIC team over the past four years. Carol’s promotion reflects the significant contribution she has made to the ongoing success of CIC, and we are very excited to see what she will achieve in her new role.”

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HealthInvestor UK • June/July 2020

EXECUTIVE MOVES

Ben Kent, Doctor Care Anywhere

▶ Doctor Care Anywhere Doctor Care Anywhere (DCA), has appointed Ben Kent as its new chief operating officer.

Kent has joined the business to support the delivery of its objective to become a leading global player in digital healthcare. He will focus on continuing to develop DCA’s strategic presence and scaling up additional value streams, including for its virtual specialist capability and mental health services.

Kent has a track record of delivering strategic transformation and business development in healthcare, having held a range of C-suite roles at both regulated health and insurance businesses, including as chief financial officer at Simplyhealth and group director of finance at Bupa. He brings international experience from past roles in Australia and North America and will support DCA with its international expansion plans.

Bayju Thakar, founder and managing director at Doctor Care Anywhere, said: “I am delighted that Ben has decided to join Doctor Care Anywhere. His enviable experience and expertise will be a brilliant asset as we move forward with our strategic growth plans.

He is well liked and widely respected within the industry, and he shares our passion for empowering patients with knowledge and helping clinicians deliver better outcomes for all. We’re thrilled to have him on board.”

Kent added: “I am hugely excited to join Doctor Care Anywhere, a company at the forefront of much-needed innovation in the healthcare sector. DCA’s company mission has never been more important in today’s postCovid world. I look forward to starting work

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Richard Henry, ModuleCo Healthcare

with the team and helping the company reach new heights of success as it continues to deliver an industry gold standard of end-to-end care.”

ModuleCo Healthcare Cheshire-based firm, ModuleCo Healthcare (MCH), has appointed Richard Henry as business development manager.

Henry will be responsible for overseeing daily communications between the organisation and its healthcare clients, including multiple NHS trusts across the UK. He joins the team with more than 30 years of experience working in business strategy and development and will play a key role in supporting MCH’s clients with the supply and maintenance of wards, theatres and other clinical facilities.

Established in 2002, MCH has worked closely with NHS trusts across the UK to deliver more than 100 bespoke facilities for hospitals.

Alan Wilson, managing director of MCH, said: “I’m thrilled to welcome Richard to the team at what is an incredibly busy time for ModuleCo Healthcare. I’m confident we can make a real difference to the healthcare estate within the NHS in the coming weeks and months, and Richard will play a big part in that.”

He added: “Covid-19 means there’s never been a more crucial time to provide assistance to the NHS, who are working tirelessly every day to keep us all safe. Richard’s appointment will allow us to increase our resources and provide more support to hospitals across the country.”

Henry said: “I’m thrilled to be bringing my skills and experience to a role where I can make

Chris Wishart, Octopus Real Estate

a real difference to communities.”

He added: “Helping the NHS to operate as efficiently as possible has never been more important than it is right now, so I’m keen to hit the ground running and start delivering healthcare facilities that will benefit NHS professionals, patients and wider society.”

Octopus Real Estate Octopus Real Estate, part of Octopus Group and a UK real estate lender and investor, has appointed Chris Wishart as director of origination.

Wishart will take a leading role in Octopus Real Estate’s care home investment team, finding and delivering elderly and specialist care real estate acquisitions for its institutionally backed funds.

Octopus Real Estate’s care homes team currently manages a portfolio of 60 modern, purpose-built homes, including nine properties under construction, with a market value of over £750 million.

Wishart joins from Savills, where he has been a director in the healthcare practice since 2017. Prior to this he was a partner at Knight Frank where he was instrumental in building a healthcare consultancy team.

Benjamin Davis, chief executive at Octopus Real Estate, said: “Chris’s significant experience in the healthcare market speaks for itself, and we are delighted that he is joining us. Chris will add further strength to our market-leading care homes team as we continue to grow the portfolio and strive to enhance our offering to both investors and operators in a market that remains undersupplied.”

HealthInvestor UK • June/July 2020

EXECUTIVE MOVES

Susan Sarangapani, Ophthalmic Consultants of London

Ophthalmic Consultants of London Oculoplastic surgeon Susan Sarangapani, who specialises in cosmetic and reconstructive eyelid work, has joined Ophthalmic Consultants of London (OCL).

Currently clinical director of ophthalmology at the Luton and Dunstable University Hospital NHS Foundation Trust, Sarangapani is the sixth consultant to join OCL, a partnership of some of the UK’s foremost eye surgeons – who between them have expertise in all aspects of vision correction, cataract and corneal surgery, as well as the treatment of glaucoma and macular degeneration.

Sarangapani is an expert in oculoplastics – plastic surgery around the eyes, eyelids and face – as well as orbital and lacrimal surgery. She treats a range of cosmetic and non-cosmetic conditions, including eyelid problems, watery and dry eyes and eye socket conditions which require orbital implants. She also performs reconstructive surgery for patients following cancer removal.

Sarangapani said: “The founding partners at OCL have assembled an impressive team of consultants with comprehensive – and complementary – expertise in all aspects of eye surgery, and I’m thrilled to be joining them.

“In my work I focus on achieving naturallooking results in cosmetic and reconstructive surgery as well as non-surgical facial rejuvenation.

I’m looking forward to working with the clinic’s close-knit team of world-class surgeons and the most technologically advanced equipment to be found in the UK. Together we share a common goal – to give all of our patients the best treatment and the most personalised care available anywhere.”

HealthInvestor UK • June/July 2020

Julie Meikle, St Andrew’s Healthcare

St Andrew’s Healthcare St Andrew’s Healthcare has appointed Julie Meikle as director of quality.

Meikle was previously head of hospital inspection at the Care Quality Commission, where she has been for the past 15 years. She brings with her a wealth of experience, with the aim of helping to improve quality and performance across the organisation.

Meikle will focus on providing an honest and open assessment for each service at St Andrew’s, including the charity’s child and adolescence mental health service and the women’s unit, areas which are both undergoing substantial change.

Her appointment comes after St Andrew’s announced at the start of the year that it would be downsizing and reducing the number of inpatient beds, in order to deliver consistently high quality services with a focus on community care.

Katie Fisher, chief executive of St Andrew’s said: “We’re delighted to have Julie on-board. Her extensive experience at the CQC and in the mental health sector will be enormously beneficial to us, as we aim to continuously improve care for our patients.

“This is a new role and one which help us deliver sustained improvement as part of our turnaround strategy.”

Syncona Syncona, a healthcare company focused on founding, building and funding global leaders in life sciences, has appointed Danny BarZohar as a partner.

In this role, Bar-Zohar will use his expertise in clinical development, regulatory environments and medical affairs to help Syncona further

Danny Bar-Zohar, Syncona

build and establish its portfolio of life science companies.

Bar-Zohar has almost 15 years of experience in the pharmaceutical and biotechnology sector, having worked at Teva Pharmaceutical Industries and Novartis Pharma after practising medicine for over a decade. He joins from Novartis where, most recently, he was global head of clinical development and analytics, leading all latestage clinical development across neuroscience, immunology, oncology and ophthalmology, among others. During his seven years at Novartis, Bar-Zohar held multiple roles including global head of neuroscience development and chief scientific officer of Novartis Pharma Italy.

Before joining Novartis, Bar-Zohar spent seven years at Teva Pharmaceutical Industries’ global innovative products division where he headed multiple therapy areas and clinical programmes in neurology. Prior to Teva, he had practised general surgery at Tel-Aviv Sourasky Medical Center, having studied medicine at the Sackler Faculty of Medicine, Tel-Aviv University in Israel.

Martin Murphy, chief executive of Syncona Investment Management, said: “Danny has a wealth of experience in clinical development and we are excited to welcome him to our team. Having served as a surgeon for over a decade, Danny is acutely aware of medicine’s profound impact and we share his drive to improve patient outcomes through transformative treatments. Furthermore, we were particularly drawn to Danny’s deep understanding of the evidence needed to bring high-value therapeutics to patients as this aligns with Syncona’s commercially-oriented found, build, fund strategy.” n

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November/December 2019 Volume 18 Number 6

NURSERY MANAGEMENT TODAY

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Kingsley Healthcare’s Vision 2025 A vision of leading edge 21st century design It’s our passion at Kingsley to build the very best facilities for this generation and future generations of care home residents.

Our latest new build in Brackley, Northamptonshire, will provide the quality of life today’s generation of older people demand and deserve when it opens in October.

Every resident will enjoy the modern comfort of a contemporary-styled ensuite bedroom and the home’s appeal will be enhanced by a cinema room, library, café, hairdressing salon, quiet lounges and conservatory.

Our latest new build in Brackley, Northamptonshire.

Outside, there will be extensive gardens with beautiful landscape architecture, including a water feature.

Using the best, most creative architects we are also focused at Kingsley on bringing the same level of comfort and design quality to our existing homes.

We are immensely proud of our development plans for Brooke House near Norwich, The Willows Nursing Home in Bedford and Lilac and Lavender Cottage in Lowestoft.

Lilac and Lavender Cottage in Lowestoft.

Illustration of proposed development in North Norfolk.

Brooke House near Norwich

If you have a land or home sale proposition please email muj.malik@kingsleyhealthcare.co.uk or call him on 01502-502747.

Kingsley Healthcare Group Kingsley House, Clapham Road South, Lowestoft, Suffolk, NR32 1QS T: 01502 502702 E: info@kingsleyhealthcare.co.uk W: www.kingsleyhealthcare.co.uk

Part of the Kingsley Healthcare Group