HealthInvestor September/October 2020

HealthInvestor UK September/October 2020 vol 17 • no 7

essential reading for the healthcare business

Here we go again How will the sector cope with the second wave?

Private hospitals How the acute care sector is responding to the pandemic

The drugs don’t work Investing in pill-free pain relief

Social care Covid-19’s impact on investment strategies

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 REPORTER AND SUBEDITOR Charles Wheeldon – +44 (0) 20 3762 2556 charles.wheeldon@investorpublishing.co.uk SALES MANAGER Grace Mackintosh – +44 (0) 20 7451 7067 grace.mackintosh@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

Has the test and trace fiasco damaged public/private partnerships?

T

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Pride and avarice

ISSN 1742-884X

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HealthInvestor UK • September/October 2020

o paraphrase Jane Austen, it is a truth universally acknowledged that the most effective way to control the spread of coronavirus is to identify individuals already infected and isolate them from the general population for the period during which they can pass on the infection.

Despite Boris Johnson’s ambitious ‘Operation Moonshot’ plan to deliver 10 million tests a day, other countries have shown that effective track and trace is far from rocket science so why has the UK has drifted so far off course in delivering one of the few effective strategies for stemming the spread of coronavirus?

Quite rightly, when the pandemic first raised its ugly head, the government identified the need to vastly expand and scale up the NHS’s capacity to control the spread of Covid-19 in this way.

But the route they chose was to outsource much of the process to private sector providers and effectively side-line local public health protection teams. Quite why this happened is unclear but cynical voices have been quick to accuse ministers of prioritising ideological agendas ahead of the most effective means of pandemic control.

While coronavirus testing in clinical settings remains largely in the hands of the NHS, community testing was handed over wholesale to private operators with a puzzling shortage of domain knowledge.

Add to the mix the appointment of Tory peer and ex-TalkTalk chief executive Dido Harding to head up the public health system and many were reeling at the apparent lack of expertise behind the single most important weapon in the UK’s anti-coronavirus arsenal.

The government has spent a truly staggering £12 billion on total provision for test and trace in England but less than 70% of contacts are being successfully identified and only a quarter of tests are done within the required 24-hour time frame.

Manifest failure The manifest failure by those given government contracts to deliver an effective test and trace system has bought into sharp focus the potential pitfalls of public private partnerships and is in danger of inflicting significant damage to the reputation of other longstanding and successful relationships between the health service and the private sector.

If anyone is in any doubt as to the extent of private consultants’ involvement in the test and trace programme, a simple roll call of the companies currently involved should help to put the record straight. Serco, Mitie, Boots, Amazon, G4S, Sodexo, Sitel, Randox and Transunion are all on the public payroll to deliver the system.

While HealthInvestor UK has no issue with the private and public sectors joining forces to provide the best services – indeed some of the greatest benefits for patients come from such partnerships – a dogmatic belief in handing over all services to private companies in the total absence of any supporting evidence does no one any favours.

Meanwhile the noise and dissatisfaction surrounding test and trace is making the public more aware of and increasingly concerned about private sector involvement in the NHS. The results of a recent poll by Survation published on the HuffPost UK website show that 74% want local public health teams to run the service.

Perhaps the time has come for contractors and their investors to think carefully before taking public funds to provide services which they are ill-equipped to deliver. n

Rob Munro, Editor, HealthInvestor UK 3

CONTENTS

news Clinical services

6

Deals and investment

6-9

Social care

9-13

Private hospitals

13-14

Mental health

14-15

Technology

15

cover story

18

Health sciences

32

features

something new An alternative to pills 16 Founder Rick Rowan explains how his struggle with chronic pain led him to form bioelectronics company NuroKor which has seen a 100% increase in investment this year, with 12 clinical investors in the last six months alone

4

Private concerns 24 A block-booked NHS deal, a drop in privately funded care, and the potential to cut NHS waiting lists are just some of the factors shaping the future of independent hospitals.

Kathy Oxtoby reports on how they fared during the pandemic, the challenges they face, and their prospects in the coming months and years

cover story

Care sector investment 30 and Covid-19 What are the implications of the Covid-19 crisis for investment in the adult and specialist care sector?

Vincent Buscemi, Wendy Wilkes and Sarah Greenhalgh of Bevan Brittan give their views

The second coming of Covid? 18 As the UK faces a ‘second wave’ of Covid-19, Kathy Oxtoby looks at what preparations are, and should be, in place and potential challenges for the health and care sector

Business as usual 32 The effects of the Covid-19 pandemic have been felt across the globe with huge consequences for healthcare investors. HealthInvestor UK looks at the outlook for the sector

finance Deals The month’s latest transactions

34

executive moves Executive moves

38

HealthInvestor UK • September/October 2020

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Together

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Clinical services

Care Fertility acquires Woking Assisted Conception Service Nottingham-based Care Fertility has acquired Nuffield Health’s Woking Assisted Conception Service (ACS), backed by private equity house, Silverfleet Capital.

Operating since 1997, Care Fertility is an independent provider of fertility services in the UK and a global presence in the treatment of infertility, genetic diagnosis and

screening techniques and associated fertility preservation procedures.

It operates clinics and satellite facilities in 19 UK locations.

It is Care’s third bolt-on acquisition since Silverfleet Capital acquired a majority stake in the business last year and follows on from the acquisition of Tamworthbased IVI Midland and the Countess

of Chester Hospital’s fertility clinic.

Care chief executive David Burford said: “We are delighted that Nuffield Health Woking ACS has now become part of the Care group. We feel that the clinic’s culture and ethos are closely aligned with those of Care Fertility UK, and the whole team are looking forward to working with our new

colleagues to take Woking ACS into the future. There are exciting times ahead as we expand the specialist fertility services we provide. The huge support that the Care team provide enormously enhances our abilities to assist those patients needing our help.”

Law firm Browne Jacobson advised Care Fertility.

Fortius opens new sports injury clinic UK healthcare REIT Assura has announced the pricing of its first Social Bond in an amount of £300 million with a tenor of 10 years after a series of UK fixed income investor meetings generated strong institutional demand.

Assura says the bond will bear interest at a rate of 1.5% a year and is issued by Assura Financing plc and guaranteed by Assura and a number of the Assura group’s subsidiaries.

Following the issuance of the bond, Assura’s weighted average debt maturity will increase from 6.8 years to 7.8 years and the pro forma weighted average cost of debt will reduce to 2.69%.

The bond is the first issued under

the Assura Social Finance Framework and the proceeds will be used to fund or refinance eligible social projects, specifically the acquisition, development or refurbishment of publicly accessible primary care and community healthcare centres.

Jayne Cottam, Chief Financial Officer, said the move was part of a strategy to “become the UK’s number one listed property business for social impact”.

“The issuance of our first Social Bond demonstrates our commitment to contributing to the communities in which we operate and will be used to support our continued investment in providing more fit-for-purpose primary and community healthcare centres,” she said.

Deals and investment

ClearCourse acquires veterinary practice system London-based software company ClearCourse Partnership has acquired Practice Point, the owner and provider of the Assisi veterinary practice management system.

Assisi is designed to integrate into practices including small animal, farm and equine.

Its core components include e-billing, integrated payments, online booking, reporting, and maintaining client and patient records, all accessible through a mobile app.

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Assisi is currently installed at 181 veterinary practice sites across the UK and Ireland, in a variety of practice types including small independents and large vet consortiums.

Gerry Gualtieri, chief executive of ClearCourse, said: “We are thrilled to welcome Practice Point and its Assisi platform to ClearCourse. The deal comes at an exciting time in Assisi’s journey, with a growing customer base and expanding products. It also provides opportunities to further

improve and enhance its interface and optimise the user-experience.

ClearCourse is well suited to support the continued growth of Assisi, with identified pathways for integration with software solutions from within the Group.”

Gary Pender, co-founder of Crewe-based Practice Point, added: “The team at Practice Point are excited to join the ClearCourse portfolio of companies. Being part of the group will give us access to greater marketing and technical expertise allowing for a rapid

development of our product road map. The marketing opportunities facilitated by the expert team at Clear Course will allow us to move to the next stage as a PMS supplier.”

Mark Lafferty, Practice Point cofounder, said: “The Practice Point management team will remain with the organisation, as will our industry-leading support team. We feel the future is very bright for us, Assisi and our clients.”

The financial terms of the deal are undisclosed.

HealthInvestor UK • September/October 2020

NEWS

Deals and investment

Liaison Group invests in Infinity Health

Assura issue social care bond

Liaison Group has completed an undisclosed investment, giving it a minority stake in digital workflow provider, Infinity Health, the creator of the Infinity digital tool, which helps healthcare professionals coordinate care and communicate around patients.

Liaison Group’s chairman, Bruce Thew, said: “Investing in Infinity Health supports Liaison’s mission to change the global health economy. Infinity Health represents an opportunity to take Liaison Group to the heart of the NHS and health economies globally, enabling us to work in the area of care coordination and communication, and contributing to our core expertise in NHS savings and efficiencies.”

Liaison Group stated it continues to prioritise research and market analysis into identifying the leading tech solutions to support the NHS and its essential operations. Thew

UK healthcare REIT Assura has announced the pricing of its first Social Bond in an amount of £300 million with a tenor of 10 years after a series of UK fixed income investor meetings generated strong institutional demand.

Assura says the bond will bear interest at a rate of 1.5% a year and is issued by Assura Financing plc and guaranteed by Assura and a number of the Assura group’s subsidiaries.

Following the issuance of the bond, Assura’s weighted average debt maturity will increase from 6.8 years to 7.8 years and the pro forma weighted average cost of debt will reduce to 2.69%.

The bond is the first issued under the Assura Social Finance Framework and the proceeds will be used to fund or refinance eligible social projects, specifically the acquisition, development or refurbishment of publicly

continued: “We have seen the benefits that innovative technology solutions have brought to the NHS during the Covid-19 pandemic, and how the right solutions have improved patient care and workforce management at a time when swift digital transformation was needed most. As with this growth capital investment, we will continue to support the right technology solutions to further health economies going forward, both in the UK and overseas.”

Elliott Engers, chief executive at Infinity Health, added: “We are delighted to begin this partnership with Liaison Group, who have unrivalled expertise and experience within the NHS. We are united by a shared vision to support front line staff with the tools they need to safely and efficiently care for their patients. Together, we aim to bring the benefits of Infinity to as many health and care teams as possible.”

accessible primary care and community healthcare centres.

Jayne Cottam, Chief Financial Officer, said the move was part of a strategy to “become the UK’s number one listed property business for social impact”.

“The issuance of our first Social Bond demonstrates our commitment to contributing to the communities in which we operate and will be used to support our continued investment in providing more fit-for-purpose primary and community healthcare centres,” she said.

Alantra establishes UK healthcare real assets offering Independent global mid-market investment banking firm Alantra has established a UK healthcare real assets offering, to meet demand from healthcare investors, as well as real estate and infrastructure investors, to invest in healthcare property and infrastructure.

The offering is being delivered by partner Justin Crowther (pictured), who heads Alantra’s UK healthcare team, and Hoong Wey Woon, who heads the UK real assets team.

Crowther has more than 20 years of transaction advisory experience delivering M&A and raising equity and debt capital for clients across the healthcare services sector.

Woon, a partner who joined Alantra last year from KPMG where he was co-head of its real assets corporate finance division, has over 20 years’ experience in the

sector and has completed more than £5 billion of real estate transactions over the past decade.

Crowther said: “All our clients, whether business owners and operators, funders, investors or developers across elderly and specialist care and retirement and senior living, share the same objective of getting the best use from their healthcare property and infrastructure. In the UK, Alantra is well known for helping owners through each stage of their business’s life cycle, ranging from growth to ultimate exit. By establishing the healthcare real assets offering, we are ensuring clients know this expertise includes property and infrastructure solutions across the value chain, whether it is a corporate disposal, identifying capital partners to help fund a development pipeline,

HealthInvestor UK • September/October 2020

acquisitions, sale and leaseback arrangements, or realising value from complex real asset situations.”

Woon added: “With interest rates at near all-time lows, investors looking to generate stable, predictable cash flows are increasing their allocations to real assets. Elderly care, specialist care, retirement and senior living are major growth sectors over

the next decade and beyond due to tailwinds including favourable demographics, upgrading and future-proofing facilities, and the robust response to Covid-19. We are working with a range of investors from the UK, Europe, the US and Asia that are keen to support highquality operators and well invested, fit for purpose infrastructure and development opportunities.”

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NEWS

Deals and investment

Awell Health raises £1.9m UK-focused and Brussels-based healthcare technology start-up Awell Health has raised £1.9 million in funding in a round led by early stage venture capital investor LocalGlobe, with participation from Moonfire.

NHSX approved supplier Awell Health said the investment will facilitate the introduction of a software platform to enable healthcare organisations to create, implement and continually update care pathways to improve patient outcomes.

In a statement Awell Health said that while public opinion and many new players in the digital health space believe data is the answer to solving the healthcare crisis, Awell Health believes the focus needs to be on reorganising largely paperbased and disjointed processes.

The company’s co-founder and chief executive Thomas Vande Casteele (pictured) said: “Technology has enabled teams in almost all industries to digitise and reinvent their workflow, but

healthcare is still largely stuck in its old ways, using outdated traditional paper-based processes.

As consumers, we are led to believe the industry has rapidly transformed – with news of innovations in robotic surgeries, new treatments, apps and wearables – but the way care delivery is organised has changed very little.”

Awell Health’s statement added that healthcare organisations have had to use tools like text-based PDFs to create and implement complex

guidelines, clinical protocols and care pathways, which makes the path of progress from evidence to practice incredibly slow. One study revealed it takes on average 17 years for scientific knowledge about the best care to be applied to clinical practice.

Thomas adds: “Making existing care processes evolve to reflect the latest clinical insights continues to be an archaic, slow and cumbersome process. New evidence is generated at a rapid

pace yet takes ages to be included in the standard of care. In the Netherlands, for example, certain guidelines have a maximum validity of five years before they should be reassessed, in practice, we see many guidelines older than five years old. The reality is they should be updated much more frequently as clinical research is published which has been rising exponentially over recent years.

Existing solutions are not built to support these complex needs.”

Allegra Care and Moorfield Group launch nursing home partnership Care home operator Allegra Care and Moorfield Group, a real estate fund manager, have formed a partnership to create an initial £125 million portfolio of nursing and dementia care homes.

Moorfield will initially invest on behalf of Moorfield Real Estate Fund IV and Allegra Care will be responsible for originating and operating the assets and will also invest in the partnership, which is targeting a portfolio of 15 to 20 homes over the medium term.

The partnership stated it will employ a strict investment criteria, targeting modern, fit-for-purpose homes with large communal areas, in demographically supported locations across Central and

8

Southern England. It will seek to acquire both operational assets, including those offering asset management potential, alongside newly developed homes, and is in advanced discussions on a number of acquisition opportunities.

Founded in 2018, Allegra Care is a specialist care home operator owned

by Seniors Living Group. Moorfield invests in retirement living via its Audley platform, build-to-rent, and student accommodation. Earlier this year it entered the family home for rent sector with the acquisition of a portfolio of show homes leased back to UK housebuilder Avant Homes.

Moorfield Group chief executive Marc Gilbard said: “The nursing home sector is a logical extension

to our demographically driven investment strategy, as we look to build on our successful track record of investing at the early stages across the ‘beds’ sectors.

“The fundamentals for the UK’s elderly healthcare sector remain strong, and we expect the impact of the Covid-19 pandemic to be profound, accelerating the muchneeded delivery of fit-for-purpose homes, of which there is a chronic undersupply in the UK. Allegra Care has the deep sector knowledge required at this unprecedented time. We look forward to Helen and the Allegra Care team using their experience and passion to deliver the level of service that is desperately needed.”

Helen Jones, chief executive of Allegra Care, added: “We are excited to be partnering with Moorfield, which has an enviable track record of supporting the growth of businesses with a commitment to service quality.

With our model based on the core principles of the household model, resident and staff wellbeing, service quality and staff development, we are focused on delivering on our acquisition plan with Moorfield Group, and adding value to the homes and teams that become part of Allegra Care.”

Allegra Care was advised by CBRE and Farrer & Co. Moorfield Group was advised by Connell Consulting and Shoosmiths.

HealthInvestor UK • September/October 2020

NEWS

Deals and investment

WEP Clinical joins with Wren Healthcare London-based WEP Group Holdings is making a strategic investment in Wren Healthcare, a clinical nursing healthcare provider in the EU. Wren works with key industry stakeholders across Europe, including national health services, pharmaceutical companies, and private healthcare providers, to provide and administer treatments in the patient home. Its team of registered nurses have years of clinical homecare experience, ensuring care is delivered to exacting protocols and drug summaries of product characteristics.

Under the new agreement, Wren will become part of the WEP team, allowing WEP’s patients, partners, and customers access to home nursing care services, such as: at home patient support for complex drug treatment and associated procedures; home nursing support for clinical trials and expanded access programmes; clinical

and disease area education; and provision of cross-therapy nursing support across multiple clinical specialities.

Jas Khera, managing director of WEP Clinical, said: “WEP and Wren’s shared philosophy of putting the patient and customer first make this new partnership a very exciting step forward for us at WEP. The energy of the Wren team, combined with WEP’s long history and track record, will create a solid platform for future growth. We look forward to providing these new services that will help patients lead healthier and more fulfilling lives.”

Iain Campbell, managing director of Wren Healthcare, added: “Recent challenges within healthcare have highlighted the importance of clinical homecare.

The Wren Healthcare team remain committed to providing evidence-based patient centric care that continues to positively

impact those we support. WEP’s partnership, shared values, proven industry knowledge and experience further enhances the clinical services provided by Wren Healthcare. We look forward to

future collaborations building a platform for growth and shared philosophy of helping patients lead healthier and more fulfilling lives.”

Wren is headquartered in Sandwich, Kent.

Social care

Call for social care complaint pathway to be made clearer The self-pay social care sector should be obliged to provide customers with details on how to make official complaints, according the Social Care Ombudsman.

The Annual Review of Adult Social Care Complaints published today calls for “mandatory signposting” to make it clear how complaints can be made.

The report outlines the trends the Ombudsman has seen in the complaints received about adult social care in England during 201920.

During that time, the Ombudsman received 3,073 complaints and enquiries but only 430 were from people who arranged their care privately with independent providers.

The disproportionately low number of complaints about

independent providers raises concerns that the independent sector is missing out on an “untapped seam of valuable learning and potential improvements to their services”.

Michael King, Local Government and Social Care Ombudsman said: “We’re pleased with how the adult care sector has worked with us to make almost 600 improvements to its services last year, which were agreed in our investigations. This is 7% more than the previous year, and they include things such as policy changes and staff training.

“However, people who fund their own care are still underrepresented in the complaints we see, and the number has plateaued for the past couple of years. Each missed complaint is a lost opportunity to improve care services.”

HealthInvestor UK • September/October 2020

The Ombudsman upheld 69% of those complaints it investigated in detail – higher than the average uphold figure of 62% across all the organisation’s work. That uphold rate rose to 71% for cases specifically about independently provided care.

The Ombudsman is now calling for the government to use the planned social care reforms to require providers to tell people, if they are unhappy with the services they are receiving, how to complain not only to the providers themselves, but also how to escalate that complaint to the Ombudsman.

“Mandatory signposting will also be better for businesses. The social care complaints system in England is not a voluntary scheme but the current level of engagement varies considerably.

This is placing greater burdens on more conscientious providers while allowing weaker operators to avoid public accountability,” said King.

“This undermines fair competition and consumer choice.

Instead, there should be a level playing field, where the rules are applied consistently – in the best interests of users and businesses.”

Professor Martin Green of Care England gave the review cautious welcome. “There are some interesting recommendations and we look forward to discussing how mandatory signposting would work. During the pandemic the sector has worked extremely hard to deliver the best possible care and I want to pay tribute to the adult social care workforce for its incredibly hard work,” he said.

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NEWS

Social care

Heathcotes to open supported living in Bradford

Care home sector shows resilience despite Covid-19

Chesterfield-based care provider Heathcotes Group is opening a new independent supported living site near Bradford later this year.

Heathcotes, which specialises in services for adults with learning disabilities and complex mental health needs, is redeveloping an existing property in Clayton to create Horton View, featuring 14 spacious apartments providing enhanced supported living for individuals who are stepping down from a hospital or full-time residential care setting.

Designed to help residents develop independent living skills, each property offers self-contained accommodation with a lounge, bedroom, bathroom and kitchen area. The service will include an on-site office and a team of around 30 staff providing 24-hour care support when needed.

Horton View has been designed by Heathcotes’ inhouse architectural consultancy, JDS Design, with internal reconstruction and external improvements carried out across two phases by contractors John Ryan Developments. Open from November, Phase 1 will feature 4,069 square feet of single person accommodation including six apartments alongside laundry facilities and office space. Phase 2 will total 6,415 square feet including eight apartments as well as a communal lounge, laundry facilities, staff break-out space and additional office space.

Heathcotes’ director of business development, Natalia Lysiuk (pictured), said: “Independent supported living is a model of care that Heathcotes have developed over the last two years, to complement our fulltime residential care services, offering the next step in the care

The UK care home sector is beginning to recover following the impact of Covid-19 in Q2 2020, with occupancy measuring 80.2% and a steadily increasing admission rate, as confidence in the sector begins to resume, according to the latest research from property advisor Knight Frank.

The Covid-19 care home occupancy tracking survey by Knight Frank surveys 21 operators managing 1,391 care homes and 79,848 registered beds and encompasses approximately 15% of the UK care home market. It has found that overall occupancy as of mid-August 2020 measures 80.2% which is 8% below the pre-pandemic level but has been increasing robustly since July as confidence levels improve within the sector.

Care home operators have also been devising and implementing new procedures to ensure they are best prepared in case of resurgence of the virus in the winter months, with barrier nursing and isolation measures crucial steps to maintain infection control.

This follows Knight Frank’s findings that the Covid-19 pandemic highlighted the need for investment and innovation in the UK healthcare property sector, having 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.

Knight Frank’s research identifies a potential 6,500 care homes at risk of closure over the next five years, equating to 140,000 beds and estimated that the UK requires in excess of £15 billion to upgrade existing beds in order to futureproof for its ageing population. This comes as the share of people over the age of 80 is expected to surge in the next 30 years, with one in ten adults set to be aged over 80

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pathway towards full independence for our service users. It has been exceptionally successful and we have introduced a range of supported living properties across Yorkshire, Lincolnshire and Northamptonshire. Last year we opened our largest supported living service in Leeds, which has been hugely successful. We worked in partnership with LCC and are pleased to see the service at full occupancy, having only opened in January 2020. A real sense of community has developed amongst the service users, fostering social inclusion to complement their increasing independence.

“Horton View is even larger, with enhanced provision for service users and staff. It follows our established model, offering a spacious, homely environment which is ideal for service users seeking to develop their daily living skills. Alternatively, these apartments are also suitable for individuals who require a single-person service due to their complexity and inability to live with others. We will soon be announcing an open day for the benefit of local authority representatives, care professionals, service users and family members.”

Heathcotes Group has 72 residential care services nationwide and has been a partner to more than 50 local authorities and clinical commissioning groups since 2004.

by 2050, compared to one in 20 currently.

Julian Evans, head of healthcare at Knight Frank, said: “The Covid-19 pandemic has shown the very best of the UK’s healthcare sector, with outstanding collaboration between the private sector, social care sector and NHS at this time of need and the strength in controlling infection levels. Having scrambled exceptionally well given the lack of government support, the operators are now much more prepared for the potentially imminent risk of the second wave of the virus, with new procedures in place and higher volumes of PPE at their disposal.

“Despite the fantastic work of the UK healthcare sector, the pandemic has also unfortunately highlighted the lack of investment by successive governments into the sector, and therefore the urgent need to prioritise preventative and crisis funding. Covid-19 has merely 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. We are at a vital crossroads where we face a national bed crisis unless significant inward investment in the UK care home sector is made immediately.”

Pete Calveley, chief executive of Barchester Healthcare, said: “The social care sector has faced an unprecedented event. Without doubt our front line staff have managed the situation with extraordinary courage. We’ve been through the eye of the storm but of course a Covid-19 rebound is a risk.

That said we are well prepared for a rebound but do urge government to fully commit to provision of testing kit and PPE.”

HealthInvestor UK • September/October 2020

NEWS

Social care

National Care Forum welcomes Adult Social Care Winter Plan The National Care Forum (NCF), the representative body for UK notfor-profit social care providers has welcomed the government’s plan announced yesterday to protect care homes from Covid-19 over winter.

The Adult Social Care Winter Plan aims to support care providers in preventing the spread of coronavirus in care settings. Care workers will be provided with free PPE; a new dashboard will monitor care home infections and help local government and providers respond quicker; and a chief nurse for adult social care

will be appointed to represent social care nurses and provide clinical leadership to the workforce.

Vic Rayner, NCF executive director said: “It is very positive that it appears the government has listened to the needs of the care sector in its headline announcements about the Winter Plan.

“NCF have been raising the issues facing providers – including the substantial costs of PPE and the importance of the Infection Control Fund in all its discussions with the Department of Health and Social

Care. We also welcome the role of the chief nursing officer for adult social care, having been consistent champions of the role of nursing in social care, and feel that this role will do much to stimulate interest and recognition of the vital contribution of nurses to the social care sector.

“It is less clear that the plan will cover other essential issues, such as improving the reward and recognition for our 1.5 millionstrong care workforce, who continue to work 24/7 to provide care and support across our

communities. And while we support effective oversight and regulation, the headlines suggests yet more strong action and enforcement in an already tightly regulated and monitored sector. This does not give confidence at a time when we can only deliver on our ultimate shared objective around the provision of quality care in the midst of a pandemic in winter by working together in partnership. The devil will, as always, be in the detail – we need to see the full plan now to ensure it meets expectations”

Impact Healthcare acquires nine Scottish care homes Impact Healthcare REIT has acquired nine care homes in Scotland from Holmes Care Group in a sale and leaseback deal.

The net purchase price before transaction costs is £47.5 million and the initial rent £3.5 million, reflecting a yield of 7.4%. Impact also agreed a deferred payment structure with Holmes under which Impact will pay up to £3 million based on the trading performance of the nine homes, in exchange

for an annual rent increase of up to £225,000. The initial rent cover on the portfolio is in excess of two times.

Family-run Holmes Care Group pursued a sale and leaseback route as it allowed the owners Shiraz and Indumati Lakhani to retire while allowing the couple’s daughter to continue to operate and grow the business.

Sharifa Lakhani, managing director of Holmes Care Group,

said: “Providing excellent care to everyone who makes their home with us is our absolute priority. We are very pleased to have concluded this deal, which will allow us to continuously invest in our homes across Scotland whilst maintaining our proud tradition as a familyrun business. This long-term arrangement will see us continue to operate all of the homes, and is great news for residents, their families and our team.”

Specialist business property advisor Christie & Co facilitated the deal. Martin Daw, senior director at Christie & Co, said: “This deal is the largest care home transaction to happen in Scotland in over 15 years. For the deal to be agreed and concluded during this very difficult time we find ourselves in goes to show the confidence in the Scottish care home sector and our client’s quality of operation.”

Audley Group enter JV to build luxury retirement village Audley Group, a provider of luxury retirement villages, has formed a joint venture with the Royal London Pension Property Fund to deliver a new development in Buckinghamshire.

Audley Wycliffe Park will become the 21st village in Audley Group’s portfolio, with a GDV of £80 million.

The JV agreement is Royal London’s first investment into the retirement living sector and covers a 25-acre site at Horsleys Green, between Stokenchurch and High Wycombe. The village will provide a total of 156 high quality retirement living properties and luxury facilities.

Royal London will provide the capital for the development and retain freehold ownership when all properties are sold.

Audley Group, owned by the Moorfield Audley Real Estate Fund, will then enter a 250 year lease, taking on the operational running of the village, including the sales and marketing of all the properties.

Throughout the development phase Audley will support Royal London and oversee the design and fit out which they say is is a first for the expanding retirement village sector and Audley Group has been active in this market for over 20 years, and

HealthInvestor UK • September/October 2020

the 21 villages in its portfolio, when completed, will provide over 2,000 properties nationwide.

Nick Sanderson, founder and chief executive, Audley Group, said the JV approach was an indication of the attractiveness of retirement living to investors.

“We are delighted that such a major new entrant to the market has recognised the stability, security and longevity of this sector. The demand for retirement village living continues to expand and we have no doubt that this is just the start of a fruitful working relationship with Royal London,” he said.

Andrew Johnston, head of alternative property investment, Royal London Asset Management, echoed Sanderson’s analysis.

“The retirement living sector in the UK presents significant investment opportunities.

Changing demographics with an ageing society and a significant under supply of modern, purposebuilt age appropriate housing points to strong sector growth in the years ahead. Investors have an opportunity to make a real difference and make a positive impact while securing attractive returns,” he said.

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NEWS

Social care

Care homes to get extra £546m Covid-19 funding The government has announced an extension to the Infection Control Fund, pledging an extra £546 million in funding to bolster infection prevention and control measures in care homes during the winter.

The news came after a series of calls from the care sector for the government to make its plans known urgently before the deadline of the initial fund on 30 September.

Vic Rayner, executive director of

the National Care Forum said: “In the nick of time, the government has announced an extension of the Infection Control Fund. This ring-fenced finance has been a vital lifeline for many providers of care to ensure they are able to support staff who are isolating, and to minimise movement of staff within and between homes.

It is imperative that this funding reaches the front line quickly.

We welcome the funding, and

need urgently the detail to enable understanding of the criteria and time frame.

“The clock has been ticking on the government around a number of major announcements this week – the Infection Control funding is most welcome – but needs to be understood against a wider set of commitments for winter and any second wave. The well documented breakdowns around testing, rising rates of infection and increases

in local lockdowns mean that we need these government plans to be shared today – preparation is critical and last minute announcements serve no one well.”

The National Care Forum brings together 120 of the UK’s social care charities. Collectively, these deliver more than £1.9 billion of social care support to more than 135,000 people in 6,500 settings. The NCF membership body collectively employs more than 85,000 staff.

L&G donates £5m to Newcastle for elderly care schemes Legal & General have announced a £5 million charitable donation to Newcastle City Council for elderly care in the city.

The gift will be used for two projects. Initially and with immediate effect, it will help fund additional independent living facilities for older residents within the Future Homes Alliance project at Newcastle Helix, managed by the City Council’s housing partner, Karbon Homes.

The facilities will be made up of 66 affordable units along with five demonstrator homes to test the latest innovations and products to help support ageing and environmental sustainability in a real-world setting.

The second, larger component of the donation will provide core funding for a 20/25-bed ‘new

model’ residential care home. This project, for which Newcastle City Council will identify a site, will be a prototype which moves away from the traditional large-scale care home to a more domestic, clustered, communal setting.

Its design and operation will incorporate key lessons learned from the Covid-19 pandemic, including on infection control and operation of lockdowns and ‘support bubbles’, helping to minimise negative effects on residents, particularly those living with dementia. The care home’s construction will be led by the City Council which will also own and operate the facility.

Both the independent living facilities and the care home

will be built to enable best use of new technology including telehealth, telemedicine and remote monitoring using the internet of things. Both types of accommodation will provide data to help grow knowledge of how best to operate care facilities in a postCovid environment, facilitating maximum collaboration between facilities and the UK National Innovation Centre for Ageing, Urban Observatory as well as other researchers and providers of care.

Nigel Wilson, chief executive of Legal & General, said: “With an ageing population, elderly care was already a major issue for L&G and many of our customers, and Covid was a further tragic blow for many in the care sector – including in the

Northeast. We have to find better ways to care for older people, and these prototypes will accelerate the process, demonstrate what can be done and what is viable, and complement the academic work we already sponsor. Doing this here, alongside brilliant partners, cements Newcastle’s position as a national leader in care.”

Nick Forbes, leader of Newcastle City Council, said: “The population in Newcastle is growing older and many of our residents live with complex needs that require different levels of support. I am passionate about ensuring we have the right level of care, available at the right time and in the right place that helps all our residents live long, happy and healthy lives.”

Care Workers’ Charity makes mental health appeal The Care Workers’ Charity is appealing for financial help to issue mental health grants for people working in the social care sector offering sessions of therapy or counselling from licensed professionals tailored to the needs of the individual.

Research from the charity showed that the mental health of care and support workers was suffering before the coronavirus pandemic.

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The findings reported care workers are finding themselves inwork poverty, and worse, suffering from mental health issues due to their low paid and emotionally charged frontline roles as carers.

Since then, the charity says “the toll on mental health has been and continues to be massive”.

Karolina Gerlich, executive director at The Care Workers’ Charity said: “The coronavirus pandemic has shown the resilience

and determination of care and support workers as they have continued to care for the most vulnerable members of our society.

The toll on the mental health of care and support workers has been great, long before the pandemic.

However, Covid-19 has exasperated the mental wellbeing of individuals who may have struggled with their mental health previously and people who have never previously struggled with anxiety or depression

are now finding their mental health is suffering.”

She said the charity is appealing for support and donations to the fund to help it ensure care workers receive “the right type of guidance and support to help them through what has been a very dark period for most”.

Donations to the Care Workers’ Charity can be made at: https:// thecareworkerscharity.enthuse.com/ cf/mental-health-appeal

HealthInvestor UK • September/October 2020

NEWS

Social care

Hallmark enters retirement living market UK care home provider Hallmark Care Homes has entered the retirement living market with the launch of a new brand called Santhem Residences.

The first project is Santhem Residences Shenfield, a retirement living village in Shenfield, Essex with 55 one and two-bedroom apartments for sale and scheduled

to open in spring 2021.

Santhem Residences will work closely with its sister company, Savista Developments to source land, obtain planning permission and build and fit out Santhem’s next generation of assisted living projects into the next decade.

The Essex-based company will be overseen by Avnish Goyal as

chief executive , running alongside his role as chief executive of Savista Developments and chair of Hallmark Care Homes.

Goyal said the new company was continuing in the tradition of Hallmark’s family ethos.

“I am pleased to launch our first retirement village scheme Santhem Residences, which has

been named after our wonderful parents, Santosh and Hemraj. This exclusive retirement village in Essex is the first of its kind but its creation and ethos have been decades in the making. It began with myself and my brothers and our aspiration for our parents to have the retirement lifestyle they deserved,” he said.

Private hospitals

London clinics integrate oncology services Cleveland Clinic London (CCL), a non-profit healthcare provider which will begin operations next year, is entering into a clinical partnership with The London Clinic, an independent charitable hospital The two will provide comprehensive oncology services to patients at their respective facilities in central London.

Surgical oncology will be a core service offered by CCL, which will open a eight-story, 325,000-squarefoot building in central London in early 2022. The hospital will be

preceded by CCL’s first outpatient centre in the Harley Street Medical Area in autumn 2021. As part of this partnership, The London Clinic, in Harley Street, will provide medical, radiation and other oncology services to patients who have surgery at CLC. The London Clinic has a cancer treatment centre in its Duchess of Devonshire Wing, a facility spanning eight floors.

The two organisations stated they are working to integrate their IT systems to be able to share

patient information securely and electronically, and enable a seamless multidisciplinary team approach to patients with cancer, with groups of specialists overseeing each patient’s care pathway to deliver the best possible clinical outcome.

Dr Brian Donley, CLC’s chief executive, said: “Cleveland Clinic’s focus on driving research and innovation enables us to deliver the safest, most effective patient care.

We are proud to be partnering with such a highly regarded provider in The London Clinic which has

a similar patient-centred ethos.”

Al Russell, chief executive of The London Clinic added: “We’re delighted to announce this partnership with Cleveland Clinic London. It’s an organisation that aligns with our values and interests, prioritising exceptional patient care above profit. Working together we will create integrated pathways to support huge numbers of cancer patients in the years to come, all the time learning from each other for the benefit of the patient.”

Spire Healthcare revenue falls victim to Covid-19 Private hospital provider Spire Healthcare reported a pre-tax loss of £231.3 million for the first six months of 2020 compared with a £9.6 million profit a year earlier as revenue fell 18% to £401.9 million.

Announcing its interim results, the hospital group said that the Covid-19 outbreak had effectively ended its principle revenue source of elective surgery, but that a blockbooking deal with the NHS England had allowed to business to continue.

Spire in now gradually returning to private patient activity while retaining some NHS beds to deal with a growing backlog of patients. in a statement the company said: “The group will remain within the NHSE contract for most of 2020

and if current trends continue, the board expects operating profit in H2 2020 to be at least in-line with H1 2020. December 2020 net bank debt is expected to be in the range of £320 million to £360 million. There has been a return of private activity since lockdown and there is significant national unmet demand for both private and NHS procedures. Subject to any significant change in the Covid environment, the board anticipates trading returning to 2019 levels in 2021.”

Chief executive Justin Ash (pictured) said the combination of meeting demand from private patients while retaining some NHS beds bodes well for future commercial prospects.

HealthInvestor UK • September/October 2020

Ash said: “The first six months of 2020 has witnessed unprecedented challenges but Spire Healthcare has been able to play a critical role during this time of national public

health crisis whilst continuing to invest in its future. We are now well-positioned to continue supporting the NHS in urgently tackling growing waiting lists, while meeting the increasing demand for treatment from private patients.

“Challenges remain, but I am optimistic about our future prospects with our admissions now close to the levels of last year. On the back of rising private demand and increased efficiency in our patient pathways, I firmly believe Spire Healthcare can look forward to the future with confidence in its mission to bring together the best people, dedicated to delivering the highest-quality patient care in the best clinical environment.”

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NEWS

Private hospitals

Canadian REIT bags four London hospitals Toronto-based NorthWest Healthcare Properties Real Estate Investment Trust has acquired four private hospitals in London from Aspen Healthcare for £260 million.

The Canadian company, which bought six BMI hospitals for £97.8

million in February, said the latest deal provided it with ‘an attractive portfolio with which to seed a future UK joint venture’.

“The addition of the London portfolio is strategically important to have as it increases the scale of the REIT’s UK portfolio to more

than $620 million and positions it for further growth in partnership with the region’s leading healthcare operators,” the REIT said in its Q2 trading statement. “It also diversifies the REIT’s UK operator mix and brings its focus into major UK healthcare markets.”

North-West’s move follows on the Medical Properties Trust £1.5 billion acquisition of 30 BMI hospitals as the start of 2020 and is seen by some as part of a growing interest from North American investors in the UK private hospital sector.

New data reveals patient safety incidents in private acute care The Private Healthcare Information Network (PHIN) has published new information about serious patient safety incidents for private acute care. This is the first time that a comprehensive dataset of ‘Never Events’ – serious patient safety incidents, involving privately funded patients has been published in the UK. The information covers the care provided at 287 independent hospitals and NHS private patient units offering acute private treatments, which between them account for an estimated 86% of

privately funded admitted patient care.

The data, for the whole of last year, show that 21 Never Events involving non-NHS (insured or selfpay) patients were reported. They were: Wrong site surgery (5); Wrong implant/prosthesis (11); Retained foreign object post procedure (2); Mis-selection of a strong potassium solution (1); and Administration of medication by the wrong route (2).

The data adds to the wealth of information already published about serious incidents involving NHS patients, which is routinely

collected and published when they receive NHS funded care in a NHS or independent hospital.

Dr Andrew Vallance-Owen, chair of PHIN, said: “The publication of these Never Events is an important step-change in transparency. This will be helpful for patients when deciding the right provider for their care, but it is also important that the information is available to hospitals, consultants and others within the sector.

“Never Events have to be reported so that lessons are learnt and actions taken to ensure they cannot happen

again. This means that the reporting, investigation and learning is a powerful safety ‘call to action’ in itself and should always lead to an improvement in processes and quality of care as a result. We hope publication of this information will stimulate that process of continuous improvement.”

The publication of this information follows a 2014 investigation by the Competition and Markets Authority, which found there was a lack of information about quality, safety and price for patients considering private treatment in the UK.

Mental health

Cygnet mental health hospital abused patients The Care Quality Commission has taken action following the identification of physical and emotional abuse of patients at a Cygnet mental health hospital in Essex.

The CQC inspected Cygnet Yew Trees in Kirby-le-Soken, on 24 and 30 July, and on 4 August. There were eight people using the service at the time of inspection, although there is no one currently resident at the service.

The unannounced inspection was prompted by allegations of patient abuse, raised with CQC by Cygnet Health Care, which were substantiated when

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inspectors viewed closed-circuit television revealing some staff physically and emotionally abusing patients. Footage also showed some staff acting disrespectfully towards people in their care, intimidating them through aggressive behaviour and violating their human rights.

In response, Cygnet suspended staff, made referrals to the police and offered psychological support to patients who experienced abuse.

CQC deputy chief inspector of hospitals and lead for mental health, Dr Kevin Cleary, said: “Our latest inspection of Cygnet

Yew Trees revealed that people who lived there were being subjected not only to poor care, but to abuse. Some staff who had witnessed this abuse did not escalate it. Although they may have feared the consequences of speaking out against colleagues who had abused patients, their failure to act perpetuated abuse and allowed a culture of poor care to become established.

“Cygnet’s leadership has made efforts to address the harm people experienced while in its care, including suspending staff and making police referrals. This does not change or excuse the fact that a culture was allowed

to develop at this hospital which led to people suffering abuse.

“Any enforcement action we may take will be published as soon as legal restrictions allow.”

Cygnet Yew Trees is a 10bed hospital which cares for women over the age of 18 living with learning disabilities and mental health needs. It is rated Inadequate by CQC and subject to enforcement action. Last year a number of Cygnet hospitals were placed in special measures by the regulator and Whorlton Hall in Cheshire was closed after a BBC Panorama undercover investigation revealed evidence of patient abuse.

HealthInvestor UK • September/October 2020

NEWS

Mental health

Elysium acquires Huntercombe eating disorder unit Elysium Healthcare has acquired the specialist eating disorder centre, Cotswold Spa Hospital from The Huntercombe Group.

The site in Broadway, Worcestershire, provides specialist hospital care to young people and adults with serious eating disorders.

Joy Chamberlain, Elysium Healthcare chief executive said: “The

Cotswold Spa Hospital provides a highly specialised service caring for very vulnerable young people and adults who have serious eating disorders. This is a very complex service and I have been so impressed by the level of expertise within the hospital. I am looking forward to welcoming the service into our Cchildren and education division.

Sylvia Tang, chief executive of The Huntercombe Group added: “Cotswold Spa is a brilliant service with an excellent reputation and I am pleased it will continue to be supported

by Elysium, a provider who has experience in operating NHS Englandcommissioned specialist services, including CAMHS Tier 4 services.”

Elysium Healthcare was launched in

November 2016 and now has 75 sites.

The group provides learning disability services, neurological services and specialist mental health care through secure services, child and adolescent mental health services, rehabilitation services, acute and intensive care services, and private outpatient services across England and Wales.

Technology

DrDoctor raises £3m to expand digital platform Health tech company DrDoctor has closed a £3 million Series A funding round from venture capital firms Ananda Impact Ventures and 24Haymarket.

The company said it will use the funding to hire across the business and add new functionality to DrDoctor’s patient communication platform, which it claims improves the way hospitals communicate with their patients, ensuring fewer missed appointments across the NHS, lower administrative costs for hospitals and clinics, and more timely and clinically effective care for patients.

DrDoctor added that new funding

will help it to expand its remote patient management and data solutions, reducing face-to-face appointments and helping improve clinical risk stratification. Results from these products have shown a 40-60% reduction in face-to-face appointments.

DrDoctor is currently partnered with 27 NHS trusts and health boards across England and Wales and has increased its staffing complement by 43% since the beginning of the coronavirus pandemic, as hospitals and clinics across the country use new ways of communicating and treating their patients with hospital

visits severely restricted. The company currently employs 60 staff and expects to add another 35 staff over the coming year as it expands its development and sales teams to meet the demand for its services.

During the pandemic DrDoctor said it offered its Covid-19 Toolkit free of charge to any NHS trust who wished to use it. The toolkit helped oversubscribed hospitals and clinics broadcast messages to their patients, ensuring appointments that had to be cancelled were rescheduled with minimal disruption. The company said it is now helping clients break the backlog in patient appointments

– now estimated to be ten million across the NHS – by implementing recovery programmes built on remote assessments, patient-initiated follow-ups, and video consultations.

Ananda Impact Ventures and 24Haymarket are both early stage investors with a key focus on accelerating the growth of digital healthcare companies. It is the first investment for both firms in DrDoctor.

DrDoctor was founded in 2012

by Tom Whicher, Rinesh Amin and Perran Pengelly with an initial seed investment of £15,000 from Bethnal Green Ventures.

Virtual healthcare provider Medefer raises £10m Medefer, a business-to-business virtual healthcare provider today announced a £10 million funding round led by private investment firm Nickleby Capital.

The company was founded

by NHS consultants Dr Bahman Nedjat-Shokouhi and Dr Andrew Millar, who still works in the NHS. Medefer is a digital platform that connects GPs, consultants, and patients. Underpinned by its outpatient operating system, and a nationwide ‘grid’ of contracted remote NHS consultants, Medefer stated that it manages the entire patient pathway from referral to triage, to investigation, diagnosis

and discharge, without the need for physical outpatient appointments.

The company stated it will use the new funding to invest in people and technology to service new contracts, enable new product development and ensure scalable growth from its pipeline.

Medefer said it has already helped over 20,000 NHS patients claiming patients experience improved care, with their case reviewed by NHS consultants within 10 hours on average, compared to 18 weeks using traditional models. Medefer also said that due to its alerts-driven digital tracking process, patients cannot fall between the tracks,

HealthInvestor UK • September/October 2020

which is a significant problem within the NHS. It adds that for NHS trusts and clinical commissioning groups, outpatient costs are cut by a third, and waiting lists reduced by 70%, improving consultant capacity and creating far better use of resources.

Nedjat-Shokouhi, chief executive of Medefer and consultant gastroenterologist at Whittington Hospital NHS Trust, said: “Medefer was born out of a desire to empower the NHS to deliver a radically faster, safer and more effective service from referral, through diagnosis, to treatment and discharge. Our software can fundamentally

transform the delivery of outpatient services. This funding round will enable us to support the NHS during its most challenging times in its 72-year history, and to continue to innovate in virtual specialist care.”

Marco Schiavo, managing partner at Nickleby Capital, said: “Medefer is a business whose time has come. They have a unique model with huge, growing, demand.

They help the NHS slash waiting lists and save money, as well as improving patient outcomes. The Medefer team is outstanding and we’re very excited about working with them to help achieve their incredible vision.”

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SOMETHING NEW

An alternative to pills Founder Rick Rowan explains how his struggle with chronic pain led him to form bioelectronics company NuroKor which has seen a 100% increase in investment this year, with 12 clinical investors in the last six months alone Solving the problem NuroKor was born from my own 30-year struggle with chronic back pain. I first saw a GP about back pain was when I was just 10 years old. By my late teens it had become utterly debilitating, triggered by anything and seemingly nothing at all. Like many people with chronic pain, I resolved to live with it as best I could, usually leaning on different variations of anti-inflammatories and strong painkillers.

In hindsight, it was risky, but when you’re in that much pain you reach untold levels of desperation in an attempt to make it stop, even for just a brief moment.

The opioid and painkiller addiction crisis is never far from the headlines, and a week seldom passes without a stark reminder of how the problem is impacting people, families, health systems and communities. From my own experience, it’s easy to see why: I remember one GP who gave me a daily 3000 milligrams of paracetamol to take indefinitely. Knowing the side effects from long term pain medication, as well as just how addictive they could be, I wasn’t prepared to accept that as my future.

I was fortunate enough to be given the opportunity to trial a basic nerve stimulator, which provided me with my first foray into the world of bioelectronics. Initially, it gave me relief I had never experienced before; it was a revelation, but the next time I tried it, nothing happened. Disappointed, I lent it to others and their results were also varied. Clearly the technology that had the potential to make a difference, but if it was going to work it clearly needed to be refined and repurposed.

Repurposing bioelectrical technology for today These experiences consequently resulted in my own investigation of non invasive stimulation modalities, scouring scientific studies to understand how it worked and why sometimes it did and sometimes it didn’t. Through the enormous and compelling body of clinical

16

evidence, I noticed that various frequencies and currents were used but there was no real consistency in the methodologies.

I started to question whether frequency combinations could be the answer and with my new understanding began exploring possibilities.

As my knowledge grew, I saw the potential for bioelectronics grow too - by the time I founded NuroKor in 2018, although there was no formalised product, our purpose was more than just addressing pain. Now, our company mission is to use the science of bioelectronics and the application of electroceuticals to transform quality of life for people worldwide.

At NuroKor, we develop and formulate programmable bioelectronic software for clinical and therapeutic application via wearables.

Despite being less than two years old, we already have several fully regulated, FDA cleared, CE marked medical devices distributed throughout the UK, Norway, USA, Australia and New Zealand with Malaysia on the horizon.

As testament to the efficacy of bioelectronics as a credible medical intervention, ahead of our series-A funding round, we’ve already received

a huge influx of investors from clinical and healthcare backgrounds. Whilst it may seem like NuroKor is at odds with pharmaceutical intervention, five of our investors also own pharmacies, with seven more who are doctors, including an orthopaedic surgeon, an anaesthetist and a professor of wound care and tissue viability.

Redefining the future of pain management – and beyond Thanks to bioelectronics, I have not taken painkillers or anti-inflammatories for almost 5 years, so I was excited but unsurprised when NICE recently released draft clinical guidance for assessment and management of chronic pain in over 16s, stating: “a number of commonly used drug treatments for chronic primary pain have little or no evidence that they work and should not be prescribed.”

The final guidelines are yet to be published – but the medical community has so far responded encouragingly, signalling a growing transition away from traditional pain relief towards medication-free alternatives.

HealthInvestor UK • September/October 2020

SOMETHING NEW

GP, Nutritionist and NuroKor investor Dr. Leah Austin explains, “People living with chronic pain can often find themselves on something called the ‘analgesic ladder.’ Once on the ladder, the need for stronger medication grows exponentially which usually results in lifelong use of stronger and stronger analgesics. Seeing the impact this had on lives, I felt compelled to explore other options that I could safely and confidently recommend, which ultimately led me to NuroKor. For me and the people I treat, I want to provide a reliable alternative that doesn’t nudge patients further up the ladder.”

Pain, however, is not only chronic. Most people will have experienced pain at some point in their life but for professional sportspeople, pain and more crucially injury can be detrimental to an entire career. In 2019, International hockey player and Commonwealth athlete Lewis Prosser broke his foot, putting him out for three months. He used a NuroKor device as part of his treatment regime, incorporating the peripheral nerve stimulation (PNS) and microcurrent stimulation (MCS) to provide natural pain relief and reduce inflammation and the neuromuscular stimulation (NMS) function for physical therapy and as a result, Prosser was able to successfully return to playing a month earlier than predicted.

HealthInvestor UK • September/October 2020

A bioelectronic future As a company, NuroKor is at the forefront of bioelectric medicine research, uncovering and developing new technologies that can make a real difference to individuals and transform healthcare. The medical potential for bioelectronics is significant with an extensive body of clinical and scientific research studies demonstrating its efficacy in pain management,

I want to provide a reliable alternative that doesn’t nudge patients further up the ladder

sports recovery, injury rehabilitation, muscle recovery, and countering muscular atrophy in ageing populations.

The team is united by our shared belief in the expanding potential for bioelectronics and we continue to lead pioneering research into new areas including its use in wound care and tissue repair. Driving this work is world-

renowned wound healing, skin scarring, and tissue repair expert, Professor Ardeshir Bayat, who has recently joined the board as Chief Clinical & Scientific Advisor.

Our research in wound care so far is promising; we’ve even witnessed ‘non-healing’ ulcers actually healing. The implications of this for the NHS are compelling too, with some of our health economic data indicating that improved wound healing alone could save each NHS Clinical Commissioning Group up to £50,000 per year.

There is no doubt in my mind that as medical use of bioelectronics becomes more and more advanced, it will also become increasingly commonplace in treatment too. The clinical investment NuroKor has received has served to accelerate us in our work and research; such demonstrable belief from doctors, pharmacists and healthcare specialists in our technology, serves as powerful motivation that drives us towards our purpose.

And that’s what we’re doing at NuroKor: driving forward clinical bioelectronics to deliver high-quality personalised, reliable and efficacious treatment and management, because we truly believe in the difference it makes.

The tide is rising on the opioid and painkiller crisis and as doctors and patients look for more natural alternatives, the case for bioelectronics is impossible to ignore. n

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COVER STORY

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HealthInvestor UK • September/October 2020

COVER STORY

The second coming of Covid?

As the UK faces a ‘second wave’ of Covid-19, Kathy Oxtoby looks at what preparations are, and should be, in place and potential challenges for the health and care sector

“P

erilous turning point”, “invisible enemy”, “inevitable”. This is the language describing the second wave of Covid-19, voiced by the Prime Minister Boris Johnson, reported by the media, and disseminated to a population that has faced so many U-turns in strategies to limit the spread of the virus that it’s hard to predict what the next turn will be.

But while the narrative of what measures are required to tackle the virus is constantly changing, one constant has been the likelihood of a second surge of Covid-19. The UK is “now seeing a second wave”, Johnson said in September, adding: “It’s been inevitable we’d see it in this country.”

This second wave – a widespread transmission of the virus throughout communities across the whole UK – was predicted by the vast majority of doctors in England in September. A poll by the British Medical Association showed that 86% of more than 8,000 doctors and medical students believed a second peak was ‘likely’ or ‘very likely’ in the next six months.

The survey also found that a second peak is the number one concern among clinicians who want to avoid a return to the “horror and tragedy” of the early days of the pandemic.

Plan for the worst Dr Ahmed Shahrabani, co-founder of digital staff bank Locum’s Nest and a junior doctor who recently rejoined the NHS workforce during Covid-19, says: “We only have to look at our neighbours on the continent who adopted a similar strategy to us in combatting the virus.

“France and Spain have seen significant rebound rates in confirmed cases, surpassing anything seen in the first wave of the virus. It is therefore prudent for us to plan for the worst, however high our hopes remain,” he says.

HealthInvestor UK • September/October 2020

Lessons were thought to have been learnt in places like care homes, and infection control is said to have improved in hospitals, “but with infection rates rising rapidly, these assumptions are about to be tested,” says Nick Hood, business risk adviser at Opus Restructuring.

“The other factor will be the arrival of winter, when there will inevitably be more close contact between people in the confined spaces of homes, public transport and offices, and when other illnesses leave some demographic groups physically weaker. Other coronavirus strains are highly seasonal – we do not yet know if Covid-19 will be too,” Hood says.

The potential challenges a second wave will present to the health and care sector can be predicted based on initial experiences of the pandemic. Health and care leaders suggest we will be better equipped to deal with a second wave because of the lessons learned during the first outbreak.

Experience of tackling tough times Niall Dickson, chief executive of the NHS Confederation says: “The challenges ahead are clear. Last time around when the virus hit hard, there was frantic activity in parts of the service and an eery calm in others. It will not be like that this time.”

Looking at what lies ahead, Dickson says: “We are in a much better place than we were when we first had to deal with a coming pandemic.

“We know how to provide Covid-19 secure services for non-Covid-19 patients. There have been major advances in treatment for Covid-19 patients. There are better and more secure supplies of PPE. We have better, but still inadequate, testing. Local relationships are more developed, and we have the experience of tackling tough times,” he says.

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COVER STORY

Nick Hood, Opus Restructuring

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For all its herculean efforts, the NHS may have just about coped with Covid-19 but “only at the cost of abandoning whole swathes of patients, such as those needing cancer diagnosis or treatment and others needing ongoing disease management care”, says Hood.

“Waiting lists have ballooned alarmingly, with around two million people waiting more than 18 weeks for routine NHS treatment. The ability of GPs to deliver an effective primary care service through the present preferred medium of telemedicine remains in doubt,” he says.

He suggests a second wave extending across the whole community beyond the recent local outbreaks focused on young people will risk a repeat of these overall healthcare issues piling further pressure on waiting lists in all parts of the NHS, and heightening the risk of substantial excess deaths from causes other than Covid-19.

More reliance on private sector However, he warns staffing, which has “always been an issue” will become more of one, when the second surge appears. “PPE and social distancing necessarily affect productivity, and it will be different in different specialties and will be differentially affected by the local physical infrastructure.

Flu, norovirus, and all the other joys of winter will affect how services can cope,” he says.

Running Covid-19 and non-Covid-19 services simultaneously, and as near normal as possible, will be “more demanding than first time round”, Dickson believes. He says in hospitals, it will be essential to “create effective flow” with measures such as ‘111 first’ to help prevent unnecessary admission, and discharge to assess to avoid any blockages.

Dickson says governments, their expert advisors, and the regulators – can make a difference to the NHS, “by providing some flexibility about what can be achieved, clarity about funding for the next six months, and actively resisting attempts to impose bureaucratic regulatory impediments.”

“This will be a new phase, and clear support for the NHS as it embarks upon it will be essential,” says Dickson.

Just because the health service is better prepared for a second wave – from how to spot and treat the virus to how to manage staff – does not make it any less challenging.

Shahrabani points out that doctors, nurses, healthcare assistants “and all other heroes who have been blocked from taking annual leave, moved onto challenging rosters, and

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have been working non-stop, are the same group of people who we are all expecting to deal with a potential second wave.”

“Front line workers are tired and they need all of us to support them,” he says, adding that NHS trusts need to “lower their guard, break down their silos and start working together.

As the virus moves from region to region, it is imperative that trusts enable their staff to help each other out, work across NHS trust boundaries and take the fight to the virus head-on.”

Private hospital finances have benefited “significantly from what was effectively a bailout by the NHS through its block booking of capacity with the guarantee that all costs would be covered,” says Hood.

“They are only just starting to return to their historical operational model now, but with the loss of some vital revenue streams, notably from treating health tourists,” he says.

But a second wave would suspend their normal activities once more, assuming that the NHS experiences similar capacity issues to

Niall Dickson, NHS Confederation

HealthInvestor UK • September/October 2020

COVER STORY

the first wave, he believes. “The good news is that they could once more look to the NHS for another cost underwrite. The bad news is that the sector and its clients would be plunged back into uncertainty once more with potentially serious adverse financial implications in the medium and long term,” he says.

Given that the NHS already has a substantial backlog and waiting lists of non-Covid related treatments, this will be “further exacerbated with a second outbreak and is likely to result in more reliance on the private sector to alleviate the delays. This could be as a result of NHS commissioning or people self-funding their care rather than waiting further,” says Colin Rees-Smith, healthcare director at Savills.

Vital lifeline for providers of care The care home sector has learned a lot during the past six months and has also come a long way, with a higher profile in the eyes of the public and central government. This is evidenced by the additional support that was provided for the sector in September when the government announced an extension to the Infection Control Fund, pledging an extra £546 million in funding to bolster infection prevention and control measures in care homes during the winter.

Vic Rayner, executive director of the National Care Forum says this ring-fenced finance has been “a vital lifeline for many providers of care to ensure they are able to support staff who are isolating, and to minimise movement

Professor Martin Green, Care England

of staff within and between homes”.

But the sector will require still more consideration and support in the coming months as front line workers continue to care for some of the population’s most vulnerable people. Care England wants care services to be placed at the forefront of future policy decisions in order to prepare for a second wave, arguing that adult social care can no longer remain an addendum to the NHS. Professor Martin Green, chief executive of Care England says: “The government cannot

Dr Michelle Tempest, Candesic

HealthInvestor UK • September/October 2020

again invest vast amounts of its organisational capacity into the NHS whilst neglecting adequate consideration of the adult social care sector. Nor should care providers ever be pressurised to admit untested individuals in order to preserve the structural integrity of the NHS.” In planning for a second wave and the coming winter he says the government must set out how it intends to ensure the funding, PPE, testing and clinical support is ready and available to continue to sustain the sector.

Rees-Smith says operators are “better placed” to manage any further outbreaks that may occur, with specific protocols and procedures in place, with infection control well-managed, and controls over access. But he warns the danger is that “those operators in this sector that are already struggling, possibly those in smaller, older converted buildings, may not be able to cope”.

Homes that serve the self-funded market can pass on any increased costs associated with extra staff and PPE and so on, to clients. But a second wave would mean “those outside of the private sector that were already exposed are likely to be more at risk,” Rees-Smith says.

Hood believes a second wave with further occupancy reductions “is likely to prove catastrophic for a sector where the major operators are carrying excessive debt, and where profitability across the board was marginal at best even before the crisis”, adding that “government intervention on a major scale would be both unavoidable and essential”.

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COVER STORY

Digital to the rescue

Julian Evans, Knight Frank

▶ Ability to cope with another spike

As for the healthcare investment market, over the course of the pandemic, “operators have proven that they are very capable in utilising their resources and expertise to manage the risk of the virus,” says Julian Evans, partner and head of healthcare at Knight Frank. “This is because they already have experience handling threats arising from norovirus, influenza and other viruses. Having dealt with the threat during the first peak, investors can have confidence in their ability to cope with another spike. Investors have understood during this period that healthcare can improve the overall asset quality in their real estate portfolio whilst also minimising reputational risk.”

Evans says Knight Frank is now seeing lenders divest assets in sectors such as leisure and hospitality. “This is perhaps most evident in how investment has shifted from retail assets into healthcare given confidence in the sector’s performance against other real estate segments, which face more uncertain prospects,” he says.

Rees-Smith says the market has remained active throughout the pandemic with the secure, longterm covenants and underlying demographic fundamentals providing reassurance to investors.

This is evidenced by the recent announcements by investment banking firm Alantra of a UK healthcare real estate assets offering, Assura’s £300 million fundraise for further medical centre acquisitions, and Moorfield Capital confirming a new fund to support the expansion of care home group, Allegra.

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Given the strong demand for product, combined with a supply/demand imbalance across the board in terms of facilities and the likely lead in time and desire to maintain or build a pipeline, there is also a “strong appetite” for land and development projects, Rees-Smith says.

He adds that the call on ‘healthtech’ is likely to continue, in various forms, while a vaccine is sought and potentially beyond one or more being produced.

Digital has come the rescue in terms of Covid and has been able to reduce infection risks by teleconsultations and home treatments, says Dr Michelle Tempest, partner for life science and healthcare consultancy Candesic. “But there is still a long road ahead and digital care will need investment in terms of government money, design time and getting implementation right,” she says.

Technology is a “potentially brighter spot”, as biosecurity issues push more and more healthcare activities, such as routine primary care and physiotherapy, online. However, “as always with technology investment, picking winners can be difficult”, cautions Hood.

He says only investors “with deep pockets, who thrive on uncertainty or who can take the long view” are likely to be interested in taking any new positions in businesses operating healthcare facilities in the event of a full blown second wave. “There will of course be opportunities to pick up assets at bargain basement prices, but not without risk,” he says.

Overall, the health and care sectors “should be in a better position to manage and mitigate the early stages of any second wave,” says Hood.

The medical community has learnt much about the virus, both in terms of treatment techniques and drug therapies, “so we should expect that fewer of those who are badly affected by infection in a second wave to die or suffer long-term health issues”, he says.

HealthInvestor UK • September/October 2020

COVER STORY

While there is a huge focus on getting ‘Test, Trace and Isolate’ (TTI) right, “the existing arrangements seem to lurch from disappointment to crisis and back again”, Hood says. Capacity issues dog these efforts, either in terms of test kit availability, suitably qualified testing staff, or laboratory processing of the tests. Nevertheless, research by the Academy of Medical Sciences in July highlighted that even an effective TTI operation will only reduce transmission by 15%, “so it is not the silver bullet most people hope it could be”, says Hood.

The worldwide efforts to produce a vaccine are prodigious and their speed highly impressive, but despite some politically motivated gun jumping in some countries, there’s no certainty as to the timing when working vaccines might become widely available, what level of efficacy they might have, or indeed even whether one will be found at all.

Some in the virology community are advocating ‘multiplex’ testing, which could

HealthInvestor UK • September/October 2020

simultaneously identify and differentiate between Covid-19 and influenza. “A major uncertainty as we go into the forthcoming winter is the risk that patients will be unable to tell the difference between the symptoms and either overwhelm testing systems and hospitals, or not report symptoms that turn out to be Covid-19,” says Hood.

Get the basics right Unlike the early days of the pandemic, Tempest says this time the consequences [of not being prepared] are clear and the government cannot hide behind calling this ‘novel’. “We have seen what works globally – South Korea and Germany are both solid examples. The consequences of not testing and any lack of track and trace is not an option– the economy needs our government to get the basics right in terms of public health so local outbreaks can be rapidly identified and contained”, Tempest says.

Without preparation for a second wave, the outcome will be “an overwhelmed NHS

and devastated private hospital sector, the collapse of the residential and domiciliary care subsectors, and huge numbers of excess deaths from non-Covid conditions such as cancer – and an economy that might take decades to repair,” says Hood.

The risk of a third wave “will be a function of how we tackle and learn from the second one”, he believes. Some medical experts are now talking of ‘Long Covid’, referring to ongoing lung health management post-infection, as well as post-Covid heart attacks and strokes because of clotting issues and ongoing chronic fatigue.

“While the understanding of the causes and remedies for these problems is at an early stage, there seems little doubt that the pandemic will leave a serious long-term health legacy with some of its victims,” says Hood.

And future spikes cannot be ruled out given the transmission trends witnessed so far. As Evans says: “It is a risk that will be present until we have a vaccine or have developed antibodies to the virus.” n

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PRIVATE HOSPITALS

Private concerns A block-booked NHS deal, a drop in privately funded care, and the potential to cut NHS waiting lists are just some of the factors shaping the future of independent hospitals. Kathy Oxtoby reports on how they fared during the pandemic, the challenges they face, and their prospects in the coming months and years

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HealthInvestor UK • September/October 2020

PRIVATE HOSPITALS

T

he NHS and the private hospital sector have always worked closely together. Then came Covid-19, which led to the two sectors forging even closer connections through an historic deal.

This March saw independent hospitals putting virtually all their capacity at the disposal of the NHS, as well as an agreement for all independent sector CT scanning capacity to be used by the NHS to support the accurate diagnosis of the virus.

More than 8,000 private beds at 600 private healthcare outlets were bought in March at an estimated cost of reportedly £2.4 million a day, with the expectation that NHS hospitals would be overwhelmed.

Right for the sector to respond Commenting on the deal, David Furness, policy director, Independent Healthcare Provider Network (IHPN), the membership body for the independent sector, says: “We were facing a huge global health emergency. There was a real prospect of the health system being overwhelmed

by Covid-19 and it was right for the sector to respond by making its facilities, staff, and equipment available to the NHS.” But the health service’s intensive care wards were not swamped during the height of the pandemic, and it was reported that most of the private beds went unused, prompting criticism and concern from healthcare professionals and patients about operations and procedures being cancelled.

However, Furness says that “it’s wrong to say that because some beds were empty ‘this wasn’t quite what everyone signed up for’”.

“The NHS was looking to secure the maximum number of beds because nobody was sure what level of demand we would see.”

He says that “independent sector providers were “absolutely central to maintaining essential services over the Covid emergency period, whether that be private care

David Furness, IHPN

HealthInvestor UK • September/October 2020

– where cancer surgery has continued – or NHS care”, and that “hundreds and thousands of NHS patients have benefited from this deal”.

In addition to the NHS-private hospital deal, another immediate effect of Covid-19 on the sector was that “patients shied away from attending hospitals in fear of the infection risk and then as the lucrative health tourists disappeared”, says Nick Hood, business risk adviser at Opus Restructuring.

Private care fall and rise The sector also saw “an initial and dramatic fall in the use of private hospitals by the NHS, as it became totally focussed on combating the rapidly spiralling ICU and aftercare demands of victims of the virus”, Hood says.

The Covid-19 pandemic led to a “dramatic fall” in privately funded healthcare in the UK in April (86%) and May (87%) – when the country was in lockdown, according to data from The Private Healthcare Information Network (PHIN). However, June and July saw a steady increase, with July seeing an estimate 32,000 private admissions. This is about half of 2019 activity, but up significantly from 8,400 in May this year.

During the pandemic there was a continuing baseline of urgent activity, such as medical oncology, which grew from a relative low of 3,800 in May to an estimated 6,900 in July, with 21% of market share by activity.

Dr Jon Fistein, PHIN’s chief medical officer, says: “As hospitals diverted their resources to support the NHS effort private care took a back seat,” but that “it is reassuring to see that urgent care – such as medical oncology – continued to be provided during the height of the pandemic.

“Over the last few months we have begun to see private care rise again. It’s perhaps too early to say when or whether it will return to previous levels. but we will be keeping an eye on the situation and what happens over the coming weeks and months.”

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Dr Jon Fistein, PHIN

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PRIVATE HOSPITALS

▶ Rapid response to NHS needs The private hospital sector’s initial performance during Covid-19 has shown that it is able to respond rapidly to NHS needs during the most challenging of times. “The private sector scrambled incredibly well to deal with Covid-19.

Frankly, given how shambolic the government was in providing Covid-19 guidelines, testing kit and PPE provision, you’d have to say the private sector performed brilliantly well,” says Julian Evans, head of healthcare at Knight Frank.

“In a matter of days we saw a transformation [in the sector] with virtually all of that capacity being made available to the NHS,” says Furness.

He says there have been “some inspiring examples of independent hospitals rapidly changing what they were doing to care for patients, being flexible and innovative, and really showing the best of what the sector is all about”.

The pandemic highlighted that collaboration is one of the sector’s strengths, says Furness. “The independent sector and the NHS sometimes are seen as being on almost opposite banks of a river, but we’ve built a bridge across it.

“It’s clear we are all part of one system and that system needs to work as effectively as possible for both NHS and private patients. There’s an important opportunity here to break down barriers and build on those partnerships in the future,” says Furness.

businesses and potentially vulnerable to a prolonged period of low or non-existent demand and revenue flow interruption,” says Hood.

He suggests Covid-19 created “not just precisely that business interruption, but a level of uncertainty greater than ever seen before”.

“Without the NHS deal, it is probable that a number of private hospital groups would have been forced into major restructurings with consequential damage investor value.

“Investment in any sector thrives on certainty, so inevitably there has been a pause on new project investment, as well as on strategic investment activity of the like seen in 2019 when healthcare real estate activity doubled to £3 billion”, says Hood.

Covid-19 has exposed some weaknesses in the private healthcare provider sector relating to digital adoption. Most interactions in the private hospital sector have traditionally been face to face and paper based. But the pandemic has “forced digital adoption on a massive scale – for both doctors and their patients”, says Ashish Goel, health lead for Accenture in the UK. “Digital and physical journeys don’t always end at the hospital, which creates further opportunities for the private healthcare providers to refresh their digital strategies to create richer citizen experiences,” says Goel.

Working in partnership

Backlog of NHS cases

The March deal to boost capacity during the pandemic highlights “more strategic partnering between local NHS systems and the private sector”, says Helen Buckingham, director of strategy and operations at independent think tank the Nuffield Trust.

“Too often in the past the private sector has been seen as a fall back in winter, or at times when waiting lists were rising.

“Now, as we move to more local commissioning, there will be a greater recognition of some of the benefits of working in partnership and, I would hope, a more strategic approach to doing that,” says Buckingham.

Hood says that as long as the NHS remains a state-run service, which is available to all and free at the point of use, “the private hospital sector can be differentiated as a premium provider capable of generating a good return for its investors”.

In contrast, other healthcare sectors, particularly care homes and domiciliary care, are “virtually entirely in private hands and are negatively affected by government underfunding”.

Now that the initial Covid-19 peak has passed, Furness says a challenge for the sector will be to help put the health system back on a normal footing again, by dealing with the backlog of NHS cases that built up during that time and restoring access to private care.

“We know there’s going to be huge demand for independent healthcare provision, whether that’s from people who are self-paying or insured, and from NHS patients too.”

He predicts the NHS waiting list could hit the 10 million mark by the end of the year “so the focus will be on how to utilise independent sector provision alongside the NHS, and on the return to normal of private care where we know there’s lots of pent up demand.

In an effort to cut waiting lists fuelled by coronavirus, this August the Government published a prior information notice (PIN), which sets out a potential spend of £10 billion on independent sector provision to deal with waiting lists, with a contract start date of 30 November 2020, ending December 2022.

The services in scope are NHS inpatient and outpatient, (including full supporting pathology and imaging services) and urgent elective care and cancer treatment to service users in line with nationally set criteria, and NHS inpatient non-elective care (either direct admission or transfer from an NHS organisation).

The President of the Royal College of Surgeons of England, Prof Derek Alderson, has estimated that the NHS will need at least five years to address the backlog of elective surgeries.

“This will be a huge undertaking, requiring theatre capacity and surgical capacity optimisation, co-operative working across organisations, sectors and regions, alongside increased

Level of uncertainty While the private hospital sector has performed well during Covid-19, it has faced challenges. As the sector “went into the crisis”, the UK’s ten largest private hospital groups were loss making overall and many of the major unlisted private companies had been unprofitable for some years, says Hood.

Debt was another major issue, he says, with some of the largest private hospital providers accounts showing “stratospheric gearing ratios of over 300%”.

“This made them heavily reliant on debt to finance their

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HealthInvestor UK • September/October 2020

PRIVATE HOSPITALS

Helen Buckingham, Nuffield Trust

staffing wherever possible,” says Vikas Yadav, senior vice president, UK and Europe Healthcare Advisory, the Marwood Group, and author of its recent report, ‘Europe’s elective surgery backlog – a boom for private clinics?’ Further information about the report here.

“This presents a unique opportunity for the private sector to leverage its capacity and staff not engaged in pandemic efforts and help the NHS deliver its targets,” Yadav says.

The surge in waiting lists is also a chance for the private sector to “recruit and retain a patient base which may never have considered private care prior to Covid-19”, he suggests.

Boosting investment appeal By assisting in the drive to cut waiting lists, the sector also has an opportunity to boost its investment appeal. Hood notes that “the talk in the private healthcare investment market is now turning from the short-term financial impact of the pandemic to the medium and longer-term opportunity represented by the backlog of private patients and the need for the government to be seen to get NHS waiting lists back under some sort of control.

“This is generating an element of optimism, for example prompting one source to upgrade the shares of one listed provider to ‘buy’ after rating them as only a ‘hold’ for the past three years.

The sector will need to consider its investors when looking at the long-term consequences of working with the NHS to address the backlog of patient cases, Buckingham says.

“My sense is negotiations will probably be more challenging because the independent sector will continue to want to support the NHS and want to be seen to be doing that. But it won’t be able to sustain this with no return for investors over a prolonged period.”

She predicts: “There are going to be some genuine discussions about what level of capacity is actually needed, what the NHS is prepared and able to pay, and how much the sector can balance supporting the NHS with returning to ‘normal’ and treating private patients.”

HealthInvestor UK • September/October 2020

Ashish Goel, Accenture

Retaining referred patients With a new ‘normal’ starting to emerge, Lewis Cone, senior B2B analyst, Mintel, and author of the UK Private Healthcare Inc Impact Of COVID-19 Market Report, envisages private healthcare will continue to provide “an alternative to the NHS that will remain financially and resource-burdened unless there is a significant shift in its operating model.

“On the other hand, the private healthcare industry will need to combat usage barriers such as affordability”.

Longer-term, “the real benefit to the sector would come from retaining referred patients, as opposed to the current scenario where patients referred from the NHS for surgical intervention revert to the NHS for post-operative care and follow up,” says the Marwood Group report.

“Operators who can find an economic model to serve and retain these patients within their ecosystem through rebates on follow up or creative incentives to remain in their system are likely to be able to extract more lifetime value per consumer,” the report suggests.

Broader church of capital Having proven “once again to be a highly defensive asset class”, Evans predicts “you’ll see a broader church of both domestic and overseas capital looking to invest into the sector.

He suggests, “the accelerated decline in retail and vulnerability of other asset backed sectors such as hotels and leisure means institutions will need to de-risk out of those sectors and invest into healthcare”.

The degree to which Telemedicine has become accepted by patients after GP surgeries effectively closed their doors to visitors provides another opportunity. “The private hospital sector can lead the way in the use of technology to enhance this patient experience. Virtual physiotherapy has been an unexpectedly successful development, which can be expanded,” says Hood.

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PRIVATE HOSPITALS

While there are numerous opportunities for independent healthcare providers, Buckingham points out that the flip side for the sector is that when the economy is hit hard, and there are job losses, private health insurance is one of the first costs to be cut.

With the devastating impact of the pandemic on the economy and the impending surge back to unemployment rates not seen for decades, the sector can no longer rely on self-funding as “an engine for future growth and profit generation,” says Hood.

He says the pandemic has also served to increase political speculation about the future of the NHS, “not just because of its disruptive effect on primary care, but how it has highlighted the parlous state of every part of the social care system”.

“In theory any radical changes to UK health and social care should increase investment opportunities, but as always in these areas, the devil is in both the detail and in the funding.

“Simply shifting responsibility to the private sector without also guaranteeing adequate funding through some form of health and care insurance arrangements will make sensible investors rightly very wary,” Hood says.

There are many unknown factors and uncertainties in the current climate, including the prospect of a second and even third wave. Another wave would be “devastating” if it stoked demand levels within the NHS and reduced it in private hospitals to the same or greater effect than the initial shock”, Hood believes. He says current indications are that recent localised case increases are amongst younger and fitter victims, “but with winter coming, nothing can be taken for granted”.

What seems certain is that NHS waiting lists are unlikely to go away any time soon “so despite the push back from treasury, the opportunity to partner with the NHS will continue to exist as long as the private providers can bring in imaginative thinking and richer, inclusive value propositions for the NHS and citizens,” says Goel.

Interesting sector to watch With private healthcare services deemed to be somewhat of a ‘luxury’ investment prior to the Covid-19 outbreak, Cone says potential users of the private healthcare sector will still need to be convinced of the high-quality treatment for the relative higher cost.

He says that despite the reduction in those with PMI, the number of ‘self-pay’ patients has risen in the industry, “so this could still be an avenue for hospital operators and insurers to explore, in the form of diversifying products”.

The Marwood Group report notes that “those who manage to build deep local relationships are likely to continue to be seen as partners in demand management rather than as cherry-picking profiteers, an image that has traditionally attached itself to them”. And the report adds: “Riding the positive tailwinds of the pandemic make this an interesting sector to watch for investors and operators alike.”

As “the NHS doesn’t have the capacity to deal with the burgeoning ageing population and mental health tsunami

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Lewis Cone, Mintel

we are facing and as we race into recession”, Evans believes the private sector will remain in high demand through NHS contracts, PMI and elective surgery.

And he says Government will also need to look at “more nuanced and strategic partnerships” with the private sector, such as virology and pathologies.

While it is hard to predict exactly where the sector is heading, at least not until there is some sort of long-term resolution to the virus, Furness believes it will continue to be “a crucial part of the UK health system, and will play a major role in recovery efforts over the months and years ahead”.

Signs are that close relationships will continue to be built. As Evans says: The Government desperately needs the private hospital sector and it will be a flight to quality for investors too.” n

For case studies of how independent providers are supporting the NHS during Covid-19 visit the IHPN website: ihpn.org. uk/resources/case-studies/

PRIVATE SECTOR ACHIEVEMENTS

BY NUMBERS 8,000 hospital beds across England Nearly 1,200 more ventilators 33 more scanners More than 10,000 nurses, over 700 doctors and over 8,000 other clinical staff In London over 2,000 hospital beds Over 250 operating theatres and critical beds

Source: NHS

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HealthInvestor UK • September/October 2020

CQC on the horizon?

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Get in touch: Duncan Astill Partner duncan.astill@mills-reeve.com +44(0)1223 222477 Amanda Narkiewicz Principal Associate amanda.narkiewicz@mills-reeve.com +44(0)1223 222267

INVESTMENT

Care sector investment and Covid-19 What are the implications of the Covid-19 crisis for investment in the adult and specialist care sector? Vincent Buscemi, Wendy Wilkes and Sarah Greenhalgh of Bevan Brittan give their views

T

he care sector came under enormous strain during the height of the Covid-19 pandemic and indeed for a period of time was viewed as being at the epicentre of the outbreak. The resilience and professionalism of care operators and staff helped the sector come through the worst of the crisis and now, fortunately, there is a quieter period in which to take stock – and prepare for any possible second wave or localised spikes in infections.

But what are the implications of the crisis for investment in the adult and specialist care sector? The sector, along with healthcare more broadly, has traditionally been seen as a safe harbour for long term investment due to its relative immunity from market cycles of boom and bust. And indeed, one positive arising out of the pandemic could be to attract new investors who have not historically taken a stake in the sector as they turn away from other asset classes like commercial real estate which have become much more challenged.

Short and mid-term challenges At the same time, however, there is no denying that parts of the care sector face challenges of their own. This especially applies to elderly care. It was already grappling with financial pressures long before the coronavirus appeared but now it is wrestling with a double whammy of occupancy rates becoming depressed while costs (such as providing PPE, extra staffing and carrying out additional cleaning protocols) have risen.

Some analysts believe that occupancy rates are likely to fall by 10% or more from their pre-pandemic levels – pushing them down into the low eighties or even seventies.

Carterwood estimates that occupancy rates were at 87% in January 2020 and will fall to a low of 79% by April 2021 – not recovering to prior levels until late 2022 or 2023.

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Other pressure points include the ever increasing difficulty of obtaining and retaining staff in a traditionally low paying industry, while recent flash quarantine restrictions on countries such as Spain and then France make managing staffing levels even harder. Ensuring compliance with evolving regulatory guidance and requirements from CQC as the pandemic progresses is another management challenge.

Adult specialist care, meanwhile, appears to be in stronger health. It did not suffer the same pressures or high profile problems that the elderly sector did during the height of the pandemic. There is growing demand in the private funded market and ongoing investor interest in supported living settings for adults with long-term healthcare needs such as mental health or learning disabilities.

How to address the challenges and thrive?

Despite all of the challenges facing social care, we believe that there are models of investment and partnership that offer a robust way forward for the future. Some of these were already emerging before the crisis, but have been accelerated and expanded because of it. These now need to be built on as the industry takes stock and moves forward.

Collaborations and joint working

One of the keys to surviving and thriving is to maintain and embed the temporary/emergency collaboration arrangements made during the pandemic.

Through the crisis, there was a growing and powerful sense that the NHS, local authorities, registered providers of social housing (RPs), commercial providers and indeed investors are all part of the care ecosystem alongside formal care operators, and need to find innovative ways of working with one another as part of a ‘national health and care system’.

HealthInvestor UK • September/October 2020

INVESTMENT

Vincent Buscemi, Bevan Brittan

There were a myriad of examples of care homes collaborating with health care providers such as hospitals and GP practices to access and share additional staffing resources and equipment. There was also a growth in collective purchasing agreements so as to secure the necessary PPE and leverage scale to obtain better value for money. RPs also worked with care providers, local and health authorities and the NHS to provide and source ‘safe harbour’ accommodation.

The result of these temporary measures has been growth in a more collaborative way of working, and these bonds are now being formalised into a contractual footing. This will only serve to increase resilience and efficiency in the sector, strengthening operators financially as well as operationally.

Investor models

As new investors enter the market, there is a real opportunity to shape sustainable delivery models for the future.

We have begun to see more instances of investors working with local authorities to set up new RPs to increase delivery of new facilities and address shortfalls in local markets. With the greater commercial freedoms available to local authorities today, there are many models of investment partnership and collaboration possible. In the RP scenario, a care package can be overlaid onto the housing being provided. The care made available is not dictated by the terms of the housing contract. There are many different models – ranging from home or domiciliary care to extra care housing, supported housing, and care villages.

We have also seen a gradual increase in lease-based provision through RPs, although this is an evolving model.

Under this approach, investment funds effectively act as an infrastructure investor, buying assets that are then leased to an RP. However, strong financial and governance arrangements are needed to ensure such arrangements are successful. There have been some high profile cases where RPs have been unable to manage the lease terms in a sustainable way, and the Regulator of Social Housing (RSH) (which regulates RPs) has taken regulatory action.

One case resulted in the RP appealing against the RSH’s actions to the High Court earlier this year. The Court upheld the RSH’s judgement.

Whilst controversial, there are ways to adjust the model to ensure that it works for both RP and investor and to allay regulatory concerns. This model may yet emerge as a more sustainable long-term source of growth.

HealthInvestor UK • September/October 2020

Wendy Wilkes, Bevan Brittan

Joint ventures

JVs are nothing new, but are likely to form an increasingly important part of the investment mix for adult social care.

The trend of moving more services out of primary care into secondary and community settings is likely to continue, with hospitals becoming ever more focused on providing acute services. JVs can bring public and private parties together across health and housing to renew under-utilised sites and old facilities to help meet today’s needs. We are likely to see growing demand for intermediary care facilities, whether that is offering step-up/down and rehabilitation/recovery services, or longer term care such as supported living or residential care services. As a firm we have seen an increasing number of successful long-term cross-sector JVs, with organisations working together to provide tenures and services across the same site to fit customer requirements for the long term.

A solid outlook The pandemic has shone a powerful spotlight on the key role played by social care in supporting the wellbeing of countless individuals up and down the country.

This, combined with the UK’s aging demographic, only reinforces the fact that the care sector is likely to remain of inherent interest to investors. There may be short and medium term challenges to the elderly care sector in particular, but demand is likely to renew itself over time. As Carterwood observed in their briefing note referred to earlier: “Notwithstanding the immediate and very obvious short and mid-term pressures facing care operators, it is encouraging that over the longer term we predict a stable and resilient picture for care home demand.”

Independent care operators, local authorities, RPs and investors need to continue to explore alternative models of investment and partnership to unlock new value, drive innovation and deliver the services on which so many people depend. n

Sarah Greenhalgh, Bevan Brittan

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COVID-19

Business as usual The effects of the Covid-19 pandemic have been felt across the globe with huge consequences for healthcare investors. HealthInvestor UK looks at the outlook for the sector

W

hile the precise economic fallout of Covid-19 will approaches to provision were highlighted,” says Long. vary by sector, none are completely unaffected.

We may also see a heightened focus on prevention, and Such widespread disruption often catalyses a consumers increasing their out-of-pocket spend. In the UK, shift in market structures, with oligopolies’ strength tested it has become apparent that Covid-19 is hitting people with by nimbler businesses. The pharmaceuticals and medical underlying and often preventable conditions the hardest. devices sectors are no exception.

We have seen an increase in the area of prevention at As in many industries, the pandemic has accelerated European LifeCare Group, one of Europe’s largest providers previous trends already under way, with technology a of vaccination services. The firm has opened 10 new clinics major driving force in this. Ben Long, a in London since partnering with Inflexion partner at Inflexion says: “Just as remote in 2018, and more recently has seen a rise working has been enabled by technology in patients self-funding private healthcare Clinicians’ time is previously unheard of to many, the services. And Lintbells, a leading producer healthcare sector too has seen changes of nutritional supplements for pets in the less monopolised underpinned by tech innovation. This is UK backed by Inflexion in 2017, has seen by larger players having a dramatic effect in a sector which a marked uptick in interest in pet as well now and they’re typically changes very slowly given the as pet parent health in 2020. increasingly willing The UK government is taking steps human risks involved.” to engage with towards building a fitter Britain. Over The Covid-19 crisis has shone a light the summer, it announced a £2 billion on how countries spend their healthcare digital channels budgets. While all aim to maximise plan to overhaul cycling and walking in limited funds, the pandemic exposed areas England by creating thousands of miles where some countries found themselves of new protected bike lanes, cycle training for all who want it, and bikes available on prescription. under-provided, for example in intensive care provision or prevention of comorbidities which were then aggravated The government statement said: “Tackling the causes of

by Covid-19. “We may see shifts in macro allocations ill health, not just the symptoms, it’s vital to help reduce to healthcare and within healthcare as variations in the demand on the NHS.”

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HealthInvestor UK • September/October 2020

COVID-19

Opportunities for smaller players “We expect a big change to come from digital technology bringing distant markets closer,” Long says. This can create the ability to have high-quality communications with customers or distributors in locations otherwise inaccessible without an onthe-ground sales force – effectively enabling smaller companies to reach global audiences. He points to a recent surgeons’ conference held by a UK manufacturer of surgical instruments in Latin America. Typically, large delegate numbers are the preserve of the global majors, requiring big budgets and vast marketing organisations. However, in this instance, a smaller player was able to attract more than 2,000 attendees given the virtual nature of the event.

The shift in route to market may be a boon to smaller firms, previously faced with large barriers to entry as more established, global pharmaceuticals dominated. “The ability to reach end users with what you are selling has increased,” Long says. “Clinicians’ time is less monopolised by larger players now and they’re increasingly willing to engage with digital channels.”

In the medical devices field, fewer representatives in hospitals is another sign of changing times, with fresh restrictions on numbers on-site and during procedures making it more difficult to access surgeons or clinicians.

Medical professionals are increasingly willing to build up their education remotely as a result. “This is an incredible opportunity for smaller innovative firms with new technologies as the bar is raised for accessing surgeons,” Long says.

Day of digital The enforced use of digital technology will also leave a lasting mark on how the life sciences industry brings products to market. A relatively new need for speed in drugs trials combined with reduced access to research sites (such as hospitals, where patient numbers are restricted) is driving the use of technology – namely remote patient monitoring to collect data in trials. Prior to Covid-19, remote monitoring was evolving very slowly, but now even the US Food and Drug Administration has been flexible in adapting trials protocols to allow for the use of remotely collected data, thereby reducing the need for site visits by trial participants. “The evolution is sensible, but it took a pandemic to instigate it,” Long says.

This casts a spotlight on the importance of data and tech in helping to track and analyse it. “Connected devices and other digital technologies look set to be leaving their mark in the devices industry as well,” Long says, pointing to the fact that performance and outcomes are monitored remotely rather than through in-person clinician visits. “The big question now is whether there remains a quickening of time frames going forward, or whether it’s just for now.”

The technologies adopted over the past six months are likely to be here to stay, and they have brought with them myriad benefits, from enabling working from home to facilitating ongoing patient and doctor communication through telehealth. As these benefits become more apparent with time, we can expect a continued uptick in adoption. n

HealthInvestor UK • September/October 2020

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FINANCE: DEALS

deals Aedifica acquires East Sussex care home COMPANY: Aedifica TARGET: A care home in Hailsham, East Sussex TRANSACTION: Acquisition CONSIDERATION: Undisclosed European healthcare real estate investment trust Aedifica has acquired a 60-bedroom care home in Hailsham, East Sussex, due to be completed in the first quarter of next year from luxury care home developer Hamberley Development, which is backed by Patron Capital. Under the deal Hamberley’s operating company, Hamberley Care Homes, will lease back the building from Aedifica for 25 years.

Allegra Care and Moorfield Group launch nursing home partnership COMPANY: Allegra Care and Moorfield Group TRANSACTION: Partnership deal CONSIDERATION: £125 million Care home operator Allegra Care and Moorfield Group, a real estate fund manager, have formed a partnership to create an initial £125 million portfolio of nursing and dementia care homes. Moorfield will initially invest on behalf of Moorfield Real Estate Fund IV and Allegra Care will be responsible for originating and operating the assets and will also invest in the partnership, which is targeting a portfolio of 15 to 20 homes over the medium term. Allegra Care was advised by CBRE and Farrer & Co. Moorfield Group was advised by Connell Consulting and Shoosmiths.

ArchiMed raises €1bn for its MED Platform I fund COMPANY: Archimed TRANSACTION: Fundraising CONSIDERATION: €1 billion Europe-based global private equity healthcare specialist ArchiMed’s MED Platform I fund has closed above its €800 million target at €1 billion.

ArchiMed said the MED Platform I partners with growth companies in the European and North American mid-cap healthcare sectors, buying majority stakes for €50 million to €500 million in association with existing owners and managers.

Awell Health raises £1.9m COMPANY: Awell Health TRANSACTION: Fundraising CONSIDERATION: £1.9 million UK-focused and Brussels-based healthcare technology start-up Awell Health has raised funding in a round led by early stage venture capital investor LocalGlobe, with participation from Moonfire.

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HealthInvestor UK • September/October 2020

FINANCE: DEALS

Care Fertility acquires Woking Assisted Conception Service COMPANY: Care Fertility TARGET: Woking Assisted Conception Service TRANSACTION: Acquisition CONSIDERATION: Undisclosed Nottingham-based Care Fertility has acquired Nuffield Health’s Woking Assisted Conception Service, backed by private equity house, Silverfleet Capital. Law firm Browne Jacobson advised Care Fertility.

Complete Care acquires Amegreen Complex Care COMPANY: Complete Care Holdings TARGET: Amegreen Complex Homecare TRANSACTION: Acquisition CONSIDERATION: Undisclosed Complete Care Holdings, a subsidiary of MC Care Holdings, has acquired Amegreen Complex Homecare, which is backed by healthcare specialist private equity investor Apposite Capital. Amegreen Complex Homecare was advised by MSNI Consultancy and Spratt Endicott Solicitors. Complete Care Holdings were advised by Anthony Collins Solicitors.

DrDoctor raises £3m to expand digital patient services platform COMPANY: DrDoctor TRANSACTION: Fundraising CONSIDERATION: £3 million Health tech company DrDoctor has closed a Series A funding round from venture capital firms Ananda Impact Ventures and 24Haymarket, both early stage investors with a key focus on accelerating the growth of digital healthcare companies

Elysium Healthcare acquires specialist eating disorder service COMPANY: Elysium Healthcare TARGET: Cotswold Spa Hospital TRANSACTION: Acquisition CONSIDERATION: Undisclosed Elysium Healthcare has acquired the specialist eating disorder centre, Cotswold Spa Hospital in Broadway, Worcestershire from The Huntercombe Group. The site in Broadway, Worcestershire, provides specialist hospital care to young people and adults with serious eating disorders.

Gen inCode raises £3.4m funding round COMPANY: Gen inCode, TRANSACTION: Fundraising CONSIDERATION: £3.4 million Gen inCode, a genetic testing business specialising in the risk assessment and prediction of cardiovascular disease, has raised funding. £1.5 million of the funding was provided by private equity and property manager Maven Capital Partners, with the rest supplied by another institutional investor and existing private shareholders. Gen inCode was advised by law firm Addleshaw Goddard.

HealthInvestor UK • September/October 2020

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FINANCE: DEALS

Hallmark acquire ex-MHA care home site for redevelopment COMPANY: Hallmark Care Homes TARGET: St Raphael’s care home site in Bromley TRANSACTION: Acquisition CONSIDERATION: Undisclosed Hallmark Care Homes has acquired the former Methodist Homes (MHA) St Raphael’s care home site in Bromley to redevelop into a state-of-the-art new care home with assistance from care home construction company, Savista Developments. Carterwood are one of MHA’s key advisors.

Impact Healthcare acquires nine Scottish care homes COMPANY: Impact Healthcare REIT TARGET: Nine care homes in Scotland TRANSACTION: Acquisition CONSIDERATION: £47.5 million Impact Healthcare REIT has acquired nine care homes in Scotland from Holmes Care Group in a sale and leaseback deal. The net purchase price before transaction costs is £47.5 million and the initial rent £3.5 million, reflecting a yield of 7.4%. Impact also agreed a deferred payment structure with Holmes under which Impact will pay up to £3 million based on the trading performance of the nine homes, in exchange for an annual rent increase of up to £225,000. The initial rent cover on the portfolio is in excess of two times. Specialist business property advisor Christie & Co facilitated the deal.

Liaison Group invests in Infinity Health COMPANY: Liaison Group TARGET: Infinity Health, TRANSACTION: Investment CONSIDERATION: Undisclosed Liaison Group has completed an investment, giving it a minority stake in digital workflow provider, Infinity Health, the creator of the Infinity digital tool, which helps healthcare professionals coordinate care and communicate around patients.

Limerston Capital consolidates its position in high end home care COMPANY: Limerston Capital TARGET: Trinity Homecare Group TRANSACTION: Acquisition CONSIDERATION: Undisclosed Limerston Capital has acquired Trinity Homecare Group, which delivers home-based care and support with services ranging from visiting care at home to round the clock live-in care

Private healthcare clinic raises £5m to fund London start-up COMPANY: Med24 TRANSACTION: Fundraising CONSIDERATION: More than £5 million Med24, a membership-based health service in London, has raised a seed round. Investors include Irish businessman Dermot Desmond and principals from private equity firms including The Capital Partnership, Round Hill Capital, EFM Asset Management and Stirling Square Capital Partners.

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HealthInvestor UK • September/October 2020

FINANCE: DEALS

Virtual healthcare provider Medefer raises £10m COMPANY: Medefer TRANSACTION: Fundraising CONSIDERATION: £10 million Medefer, a business-to-business virtual healthcare provider has closed a funding round led by private investment firm Nickleby Capital.

Canadian REIT bags four London hospitals COMPANY: NorthWest Healthcare Properties Real Estate Investment Trust TARGET: Four private hospitals in London TRANSACTION: Acquisition CONSIDERATION: £260 million Toronto-based NorthWest Healthcare Properties Real Estate Investment Trust has acquired four private hospitals in London from Aspen Healthcare.

Healthcare platform provider raises £8.7m COMPANY: Visiba TRANSACTION: Fundraising CONSIDERATION: 100 million Swedish krona (£8.7 million) Swedish digital healthcare platform provider Visiba has closed its biggest financing round from a broad suite of investors including CNI Nordic, Swedbank Robur, Blue, JCE Ventures, Starbright Invest and Mertiva.

WEP Clinical joins with Wren Healthcare COMPANY: WEP Group Holdings TARGET: Wren Healthcare TRANSACTION: Investment CONSIDERATION: Undisclosed WEP Group Holdings, a specialist contract research organisation which delivers lifesaving drugs to patients that have an unmet clinical need, is making a strategic investment in Wren Healthcare, a clinical nursing healthcare provider in the EU.

Deals database Our deal database tracks UK health and social care transactions, providing details including pricing, finance and advisors involved.

Search at healthinvestor.co.uk Access the deals database by becoming a subscriber: healthinvestor.co.uk/subscribe

HealthInvestor UK • September/October 2020

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EXECUTIVE MOVES

executive moves Caresolve Care sector consultancy Caresolve has appointed Maxine Parry as a new regional director, responsible for overseeing the day-to-day management of the company.

Parry was previously a senior consultant at the Warrington-based company, which she joined in in 2016.

Caresolve was established in 2011 and provides strategic and operational support to care home operators and their investors. The company also works closely with local authorities, the Care Quality Commission, insolvency practitioners, banks, sales agents and solicitors. It also undertakes management contracts for investors and providers, as well as having experience in achieving the turnaround of many care homes.

Castleoak Later living and care development company Castleoak has made two board-level appointments.

Kate Still has been appointed as chief operations officer, focusing on the business’s performance and organisational development, responsible for all non-financial aspects, including people; customer satisfaction; communications; supply chain management; and health, safety and environmental management.

Still was previously chief operations officer at Citizen Housing with responsibility for 850 staff, 30,000 properties and revenue of more than £150 million. She has worked with some of the UK’s largest social housing companies and was previously national housing director at Sanctuary Group.

With a background spanning finance, housing maintenance, social enterprise, local government and management consultancy, Still has over 20 years’ experience as a business strategist and operations leader with a focus on innovation, continuous improvement and transformational change.

Maxine Parry, Caresolve

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Lisa Gledhill also joined Castleoak as managing director, developments with responsibility for the company’s development business and joint ventures.

Gledhill has more than 25 years’ experience as a development and construction leader and a background spanning real estate, infrastructure and property development, investment, construction and consultancy. She started her career with Arup, spending her first 10 years in technical, digital and project management roles. After gaining financial qualifications, she moved to Laing O’Rourke and then to Lendlease, working in investment, construction and development roles, latterly leading major mixed-use redevelopment schemes in London and Singapore.

She is the non-executive director and chair at EdCity Development, a not-for-profit development which aims to create an education and charity hub in White City, London. Gledhill is also a chartered engineer.

EY EY has appointed Sylvester Oppong as head of healthcare services M&A in its life sciences and healthcare corporate finance team in the UK. He will be responsible for originating and executing transactions across the UK healthcare sector at EY, and leveraging the firm’s global reach to introduce international opportunities to clients.

Oppong will work within EY’s corporate finance team led by Fraser Greenshields and alongside David Scourfield in the life sciences and healthcare corporate finance team. Scourfield and Oppong’s team advises entrepreneurs, management teams, corporates (including founder-managed businesses) and private equity firms within the life sciences and healthcare sectors.

Oppong was previously head of healthcare M&A and a corporate finance partner at Smith

Kate Still, Castleoak

Square Partners. He has more than 16 years’ corporate finance experience with a focus on the healthcare services sector during the past 10 years.

GK Strategy Strategic research and communications agency and due diligence provider GK Strategy has appointed former Conservative MP and health minister Alistair Burt and ex-Financial Conduct Authority chair John Griffith-Jones as strategic advisors.

The pair have been appointed to bolster GK’s political, policy and regulatory offer to the private equity sector. They join the former Liberal Democrat education and treasury minister David Laws and Labour’s former care minister Phil Hope on the agency’s advisory team.

Burt served as minister of state for care at the Department of Health, overseeing primary and community care and mental health. He has held several ministerial roles over a 33year career as an MP, including at the Foreign Office, the Department for International Development and the Department for Social Security. He left the government and stepped down from Parliament last year.

Griffith-Jones was the inaugural chair of the FCA from 2013 to 2018. He was previously UK chairman and senior partner at KPMG. GK advises investors and management teams on both sell-side and buy-side in a transaction process, and has provided political due diligence and environmental, social and corporate governance advice on more than 325 deals worth over $15 billion across a range of sectors. GK also works with investorbacked businesses and public providers on their communications strategies and engagement with policy-makers, providing support in the political and regulatory environment to mitigate risk and create value.

▶

Lisa Gledhill, Castleoak

HealthInvestor UK • September/October 2020

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EXECUTIVE MOVES

Sylvester Oppong, EY

▶ HealthHero Holistic digital healthcare provider HealthHero has appointed Aseem Sadana as chief operating officer Sadana has a range of leadership experience in the technology sector including strategy consulting, entrepreneurship, and scaling up an enterprise cloud software business. He was previously group chief operating officer at IMImobile, a publicly listed enterprise cloud software business.

HealthHero has also appointed Dr Jonathan Hill as adviser on medical affairs. Hill is a physician and cardiologist who has pioneered many new treatments during his 25 years working in the NHS and for the private sector.

The company appointed Professor Sam Shah as adviser, NHS. Shah is the founder and director of the Faculty of Future Health at Ulster University, and was previously director of digital development for NHS England and NHSX. He has worked across the UK health system in primary care, public health, acute services, education and training, and digital transformation. He is a digital health advisor to a number of health and technology companies spanning a range of industries including telecommunications, assessment of apps, scaling new technology into the NHS and workforce solutions. He has worked on a number of initiatives including the flagship project to digitalise urgent care in the NHS.

Heathcotes Group Chesterfield-based care provider, Heathcotes Group, has appointed Tim Elliott as regional manager for its supported living services in Yorkshire and Humberside.

HealthInvestor UK • September/October 2020

Alistair Burt, GK Strategy

Heathcotes Group provides specialist care for adults with learning disabilities and complex mental health needs.

Elliott joined Heathcotes’ supported living management team in February last year and has been involved in the regional development of the company’s supported living for service users who no longer require full-time residential care.

Elliott is experienced in working with adults with learning disabilities and mental health needs, and managed supported living and community support services in previous positions at The Wilf Ward Family Trust and the Avalon Group. In his new role, he will oversee operations in support of four general managers across five services in Wakefield, Bradford, Grimsby, Rotherham and Leeds. The accommodation enables individuals to make a progressive step down from a hospital or residential setting to a self-contained environment with 24/7 support available.

L.E.K. Consulting Global management consulting firm L.E.K. Consulting has appointed Dr Adrienne Rivlin as a partner in its healthcare practice, based in London.

Rivlin previously led KPMG’s healthcare and life sciences strategy team. She advises private and public sector organisations across the pharmaceutical, biotech, medical devices and consumer healthcare sectors. She supports clients with commercial challenges, including corporate and portfolio strategy development; product launchs; pricing and market access; clinical governance structures and processes; and commercial and regulatory due diligence.

John Griffith-Jones, GK Strategy

Before her 10-year career in consulting, Rivlin was a researcher, public policy consultant and tutor at the University of Oxford. During this time, she worked with the Home Office, the Ministry of Justice and Department of Health to research and review health policy in prisons. She has also authored numerous articles in academic journals on key issues impacting the global healthcare and life sciences sectors.

Spire Healthcare Private hospital provider Spire Healthcare has appointed Dr Catherine Cale as group medical director, effective 26 October, following the decision to retire by the current interim medical director, Fergus Macpherson.

Cale has served on boards as medical director in three organisations, each in different parts of the health sector, most recently with Hillingdon Hospitals NHS Foundation Trust in London. She worked alongside Professor Tim Briggs as clinical ambassador for the Getting It Right First Time initiative in London until February 2019 and maintains strong links with the programme. Cale trained in paediatric immunology and infectious diseases and is a Fellow of the Royal College of Pathology.

Spire also appointed Gillian Fairfield as group general counsel on 1 September. Fairfield is a senior lawyer with more than 20 years’ experience in corporate law, regulatory, finance, and governance who has worked with listed companies across a number of sectors. She was previously a partner in the corporate division of international law firm Herbert Smith Freehills and was a non-executive director and committee member of Lonmin, a FTSE-listed public company.

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EXECUTIVE MOVES

Aseem Sadana, HealthHero

▶

In addition, Spire has appointed Professor Clifford Shearman as an independent nonexecutive director with effect from 1 October. He will also join the clinical governance and safety committee from 1 January 2021.

This appointment will increase the number of Spire board members with clinical experience to four. Shearman was a consultant vascular surgeon for 26 years and is currently vice-president of the Royal College of Surgeons. He is also nonexecutive director at the Royal Bournemouth and Christchurch NHS Foundation Trust.

St Andrew’s Healthcare St Andrew’s Healthcare, a UK charity providing specialist mental healthcare for

Tim Elliott, Heathcotes Group

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Dr Jonathan Hill, HealthHero

patients with complex, challenging mental health needs, has appointed former health minister Paul Burstow as its new chair after Peter Carter said he would step down from the role due to ongoing shielding requirements.

Burstow was the Liberal Democrat Member of Parliament for Sutton and Cheam from 1997 to 2015 and has insight into mental health and social care, having served as care minister during the Coalition government.

He is a professor of mental health public policy at the University of Birmingham, and chair of the Tavistock and Portman NHS Foundation, as well as the chair of the Social Care Institute for Excellence.

Dr Adrienne Rivlin, L.E.K. Consulting

Professor Sam Shah, HealthHero

Your.MD Global self-care platform Your.MD, creator of the Healthily app, has promoted Jonathon Carr-Brown, founder of NHS Choices, to chief operations officer.

Carr-Brown joined Your.MD from NHS Choices in 2015 as head of partnerships, before becoming director of operations in 2019. He founded and launched NHS Choices (now referred to as the NHS website), in 2007, growing the site from three million visits a month to 48 million in four years. Prior to that he was speechwriter to then Labour secretary of state of health Patricia Hewitt, health correspondent for The Sunday Times and political editor of the Independent on Sunday. n

Jonathon Carr-Brown, Your.MD

HealthInvestor UK • September/October 2020

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