HealthInvestor by investorpublishing

HealthInvestor UK April 2020 vol 17 • no 3

essential reading for the healthcare business

Coronavirus How the sector is coping

The numbers game

Patient or product? How Big Data is defining the future of healthcare

Is it time for change in specialist care?

Opening the door Recruitment challenges after Brexit

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

UP FRONT

MANAGING DIRECTOR Vernon Baxter – +44 (0) 20 7104 2001 vernon.baxter@investorpublishing.co.uk EDITOR Rob Munro – +44 (0) 33 0052 6193 rob.munro@investorpublishing.co.uk SENIOR REPORTER Jenna Lomax – +44 (0) 20 3762 2557 jenna.lomax@investorpublishing.co.uk REPORTER AND SUBEDITOR Charles Wheeldon – +44 (0) 20 3762 2556 charles.wheeldon@investorpublishing.co.uk HEAD OF SALES Michael Dee – +44 (0) 20 7104 2006 michael.dee@investorpublishing.co.uk SALES MANAGER Grace Mackintosh – +44 (0) 20 7451 7067 grace.mackintosh@investorpublishing.co.uk DELEGATE SALES & ADVERTISING EXECUTIVE Sohail Iqbal – +44 (0) 33 0052 6190 sohail.iqbal@investorpublishing.co.uk DELEGATE SALES & ADVERTISING EXECUTIVE Shakil Ahmed – +44 (0) 20 7104 2005 shakil.ahmed@investorpublishing.co.uk SENIOR EVENTS MANAGER Nicola Jones – +44 (0) 20 3746 2613 nicola.jones@investorpublishing.co.uk PRODUCTION MANAGER Jeremy Harvey – +44 (0) 20 7451 7053 jeremy.harvey@investorpublishing.co.uk DESIGN & PRODUCTION EXECUTIVE Craig Williams – +44 (0) 20 3762 2254 craig.williams@investorpublishing.co.uk PUBLISHER Harry Hyman FOLLOW US ON TWITTER @HealthInvestor

HealthInvestor is published 10 times a year by Investor Publishing Limited, Greener House, 66-68 Haymarket, London, SW1Y 4RF. The content of HealthInvestor is for your general information and use and is not intended to address your particular requirements. In particular the content does not constitute, nor does it purport or intend to constitute any form of advice, recommendation, representation, endorsement, promotion or arrangement by HealthInvestor Ltd and is not intended to be relied upon by readers in making (or refraining from making) any specific investment or other decisions. Appropriate independent advice should be obtained before making any such decision. Any agreement made between you and any third party named or otherwise referred to in the HealthInvestor publication is at your sole risk and responsibility. Any information published in HealthInvestor may have ceased to be current by the time you read it. Those responsible for the publication of HealthInvestor and/or the authors of articles contained therein may on occasion have an interest in the shares or options, futures or contracts for differences relating to shares in companies referred to in the publication. Such interests are disclosed on an issue by issue basis to the extent required under the Financial Services and Markets Act 2000 (Financial Promotions) Order 2001.HealthInvestor is a trademark of Investor Publishing Limited © Investor Publishing Limited 2019

ISSN 1742-884X

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HealthInvestor UK • April 2020

Dog whistle politics won’t solve the staffing crisis

he chronic shortage of suitable staff across both health and social care is causing providers significant and growing problems. The government’s proposals to introduce a points-based immigration system have left many in the care industry frankly aghast (see page 13). The Independent Care Group’s chair, Mike Padgham is particularly candid. “This [points system] would be a devastating blow for social care and would lead to hundreds of thousands more people not getting the care they need,” he warns in stark terms. The truth of the matter, however unpalatable, is that the Leave vote was substantially motivated by many British people’s desire to reduce immigration. Despite the evidence being against them, they feared large numbers of EU nationals were flooding into the country unchecked, taking jobs and overwhelming public services. Mr Johnson and Ms Patel are now keen to capitalise on those fears and have produced proposals designed to allay them, however unjustified they turn out to be. But another truth is that the UK’s health and care sector has relied on an overseas workforce for decades. In 1949 the Ministries of Health and Labour, in conjunction with the Colonial Office, the General Nursing Council and the Royal College of Nursing recruited large numbers of nurses, cleaners and other health staff directly from the Caribbean. In the 1950s and 1960s, Irish and Caribbean nurses were essential to the expansion of the sector, a pattern that was replicated in the early 2000s when nurses from Africa, India and the Philippines were recruited. A 2003 report revealed that nearly a third of NHS doctors were foreign-born and that more than 40% of nurses recruited after 1999 were born outside the UK. But the effect of the Brexit referendum was swift and dramatic. The percentage of nurses from the EU joining the NHS fell from 19% in 2015-16 to 12.4% in 2016-17, then further to 7.9% in 2017-18 and 7.6% in 2018-19. It is possible that this vertiginous fall prior to any actual immigration restrictions being put

in place is attributable to a perception that the UK is no longer a particularly welcoming place. While restoring the student nurse grant and making social care a more rewarding profession will go some to way to replacing the shortfall with a homegrown workforce, we must also make it clear that we still value all those who wish to contribute to our society and play a role in providing the very best care our citizens deserve. The dog whistle of blanket anti-immigration politics has no role to play in helping us achieve that goal.

Time for unity The coronavirus, or covid-19 to use the WHO designation, is wreaking havoc across the globe. The independent healthcare sector in the UK is making a considered response to the many challenges posed by this novel respiratory virus which includes limiting visitors to care homes, ensuring staff selfisolate when appropriate and offering to share resources with the NHS. At the time of writing, the government has yet to implement measures seen elsewhere in Europe such as restrictions on movement in Italy and the closure of schools in Ireland but the situation is fluid and fast-moving and we must expect interventions to be dictated by events. It is clear the emergence of covid-19 is unprecedented in modern times and as such there is no universally agreed way to contain its spread and limit its effects. What is certain though is that the government is taking advice from virologists and epidemiologists who are at the top of their fields. Such an approach, based firmly on scientific evidence and the latest research, is the only sensible option. Now is not the time for political pointscoring or ideological divergence over health and social care delivery. If the UK was divided by our painful departure from the European Union, now is the time for us all to come together again for the common good. n

Rob Munro, Editor, HealthInvestor UK 3

CONTENTS

news Coronavirus news stories

South Cliff Dental Group acquires three dental practices

Chronic wound start-up raises £7m

Government’s immigration plans ‘a devastating blow’

Harwell granted special life sciences status

features

NHS Digital and PHIN collaborate for data changes

myGP reaches 1.5m active users

News focus: Coronavirus

An arbitrary number 34 What is the current state of autism and learning disability care following demands for the CQC to scrap its requirement for all units to have no more than six beds? Kathy Oxtoby reports

Awards 2020 Finalists 46

Animal instincts 38 The UK’s veterinary and pet care sectors have attracted a great deal of private equity interest in recent years, which looks likely to continue, as Jenna Lomax reports A confident market 42 Jenna Lomax looks at some of the most recent industry deals and asks the experts for their predictions

cover story Patient or product? 26 The data universe is growing at an astonishing rate, offering unprecedented insights into every aspect of healthcare. Rob Munro examines the Big Data explosion and what it means for providers and investors

opinion How we can help 33 Cygnet Health Care director of Nursing David Wilmott suggests that the independent sector can take steps to allieviate the nursing recruitment crisis

Who’s to blame? 50 Law firm Bevan Brittan partner Dan Morris says the emergence of digital healthcare raises important issues about liability when things go awry

Devonshire Court

executive moves Executive moves

Executive CV

Getting to the point 52 Emma Brooksbank, a partner specialising in business immigration at law firm Freeths explains how Brexit will affect health and care workers seeking employment in the UK Home improvements 54 Recovering from a disappointing CQC rating can be tough, but not for the team at Devonshire Court residential care home, where management and staff excelled themselves by moving up from Inadequate to Outstanding in less than two years. Jenna Lomax talks to senior figures at RMBI Care Company and asks how they did it

Dr Anne Blackwood

rounding off Crossword 65 Companies index

HealthInvestor UK • April 2020

‘We are in the market for land on prime sites and existing care homes’ An important stage has been reached in the construction of a £12 million care home that will create more than 100 jobs in Northamptonshire. The Kingsley Healthcare Group development in Brackley has reached the highest point in its build and a traditional topping out ceremony was held to celebrate the landmark. Kingsley director Cameron Thayan and chief investment officer Muj Malik were joined on the Turweston Road site by executives of Midlands-based Deeley Construction which is building the 66-bedroom nursing home. To mark the scheme’s progress, both companies presented £250 to two local community groups, Brackley Athletic FC girls’ under-nines team and the 5th Brackley Scout Group. Mr Malik said: “We are excited to be working on this state-of-the-art care home project in partnership with Deeley Construction. “Kingsley Healthcare is passionate about providing facilities of the highest quality for residents in our homes. “We are proud to become part of the Brackley community, providing a valuable amenity and creating more than 100 jobs.” The care home, which is scheduled to open in the summer, will feature modern en-suite bedrooms. Luxury features will include a cinema room, library, café, hairdressing salon, quiet lounges and a conservatory. Outside, there will be extensive gardens with beautiful landscape architecture, including a water feature. Mr Malik said further new-build projects would be announced shortly as part of Kingsley’s Vision 2025 to double the size of the group. He said: “We are negotiating on a number of land deals and are in the market for more sites in prime locations.”

Executives from Kingsley Healthcare and Deeley Construction on site at Brackley.

If you have a land or home sale proposition please email muj.malik@kingsleyhealthcare.co.uk or call him on 01502-502747. Kingsley Healthcare Group Kingsley House, Clapham Road South, Lowestoft, Suffolk, NR32 1QS T: 01502 502702 E: info@kingsleyhealthcare.co.uk W: www.kingsleyhealthcare.co.uk

Part of the Kingsley Healthcare Group

NEWS

Coronavirus

Health minister diagnosed with coronavirus Health minister Nadine Dorries has been diagnosed with coronavirus. Dorries, MP for Mid Bedfordshire, first showed symptoms on 5 March – the same day she attended an event hosted by the prime minister at

Downing Street. Dorries is now self-isolating at home. Ten people with the virus have died in the UK, which has reported a total of 800 cases. More than 26,260 people have been tested for the virus in the UK.

The government announced last-minute measures in its first Budget in response to the effect the outbreak is likely to have on the UK economy. Chancellor Rishi Sunak has said the NHS will get “whatever

resources it needs” during the crisis. In addition, the Bank of England announced an emergency cut in interest rates from 0.75% to 0.25% in response to the economic impact of the coronavirus outbreak.

for covid-19. The health and wellbeing of the people we support, and our members of staff, is our absolute priority. We are working closely with Public Health England and following their instructions.” The announcement follows another case of coronavirus that was confirmed on 12 March at Oakridge House Care Home in Basingstoke, Hampshire. The home has since been closed to visitors

after the person tested positive for the virus and was taken to hospital for treatment. Hampshire County Council could not confirm whether the patient was a resident or staff member. Ten people with the virus have died in the UK. There are currently 596 confirmed cases in the UK, up from 456 on Wednesday. More than 26,260 people have been tested for the virus in the UK.

Care homes battle virus A case of coronavirus has been confirmed at Oakridge House Care Home in Basingstoke, Hampshire. The home has since been closed to visitors after the person tested positive for the virus and was taken to hospital for treatment. Hampshire County Council could not confirm whether the patient was a resident or staff member. Meanwhile, a member of staff at Heather Holmes in

Northamptonshire has tested positive for coronavirus. The care home, located in Desborough, provides care for up to 12 people and specialises in supporting those with learning disabilities and autism. It is run by Consensus, part of the Caring Homes Group. A Heather Holmes spokesperson said: “We can confirm that a member of staff has tested positive

BATM develops new diagnostics kit to detect covid-19 BATM, a provider of technologies for medical laboratory systems, has developed a new diagnostics kit to detect covid-19. The kit, developed by BATM’s biomedical division, has undergone testing by several central laboratories and hospitals that have now verified its ability to diagnose covid-19. The group has begun production of the kit at its Adaltis facility in Rome and is working with academic and

research institutions, mainly in Europe, to prepare for large-scale production. The kit, which supports all the Centers for Disease Control and Prevention recommendations, has already received interest from customers in several countries. Zvi Marom, chief executive officer of BATM, said: “We believe that the strategy we adopted in our biomedical division is proving to be correct, especially in light

of the current covid-19 outbreak. We are now able to quickly provide diagnostic kits for any new pathogen that appears.” He added: “We have already received extremely positive feedback and significant interest from several leading medical institutions that have started testing the first panel of Ador’s NATlab solution and adding covid-19 will greatly strengthen its appeal and value.”

PLMR launches coronavirus advisory team PLMR, a communications agency specialising in the health and social care sector, has launched a coronavirus advisory team to advise its clients on reputation management and corporate communications following growing concerns around the outbreak. London-based PLMR, which represents more than 2,000

healthcare and education facilities, has for several weeks been advising clients who are responding to and managing the emerging outbreak, also known as covid-19. This includes supporting clients to communicate with staff, customers, patients, residents, parents, stakeholders and regulators to provide clear communications that reassure and

outline contingency plans that are in place. Nathan Hollow, head of health and social care at PLMR, who is leading the coronavirus advisory team, said: “Over recent weeks our consultants have been at the forefront of decision-making and communicating around this outbreak, operating at pace and with precision to make sure our

clients can proactively engage their stakeholders and ensure business continuity. This is particularly important in the health and social care sector, given the many vulnerable people being supported across the country and the very understandable concern their loved ones may feel at the risk covid-19 poses to the continuity of healthcare services.”

HealthInvestor UK • April 2020

NEWS

Coronavirus

NHS red tape could stop retired doctors joining covid-19 fight If the government decides to call up a ‘Dad’s Army’ of retired doctors to help the NHS cope with the covid-19 crisis, the NHS will need to change its recruitment process drastically, according to Kit Latham, a doctor who specialises in hiring and compliance technology. As the number of people testing positive for covid-19 reaches 800 in the UK, Kit Latham, co-founder and chief executive of London-based healthcare tech firm Credentially, said that the “NHS’s HR processes need to revolutionise in order to automate the process of re-hiring, onboarding and compliance of retired staff returning to the NHS”. Latham said: “The government has said that the recruitment process will include the ‘emergency registration’ for retired doctors – if only it were easy to do this in an efficient manner to meet the challenges faced by the spread of covid-19.” Latham warned that healthcare HR departments currently follow lengthy and unnecessarily complex

hiring procedures, meaning that between 30-60% of applicants simply ‘give-up’ on their applications, and those that do persist can wait up to six months to complete the process. Latham commented: “If the government needs to recruit professionals quickly in times of crisis, it can make this much easier by empowering HR departments to hire as quickly and efficiently as possible. The criminal record checking system, the requirements to see ‘hard copy’ documentation, and unnecessarily insisting on things like wet signatures rather than e-signatures puts an expensive and time-consuming burden on stretched health providers. “NHS HR systems and processes will make it much harder to take on the rapid intake of new staff if the covid-19 pandemic takes hold in the UK. The government must modernise the requirements and invest in 21st century technology if retired doctors are to come back to work quickly and help with any crisis.”

Time is right to move to delay stage The time is right to move to the delay stage in response to the coronavirus, according to Niall Dickson, chief executive of the NHS Confederation. Responding to the government’s decision to move from the contain to the delay phase, Dickson said this move is “about giving us more time to prepare, more time to test procedures and do everything we can to prepare for a very large number of patients who will need care and support.” He added: “The good news is that our understanding of the virus is growing and that should help us predict how it will behave, better protect our staff and improve front line interventions, such as making best use of protective equipment. “Plenty of challenges remain, especially making sure we have the professional and other staff to tackle the pandemic. Again, the response already from the NHS front line has been terrific – our flexibility as a service has to be a key strength.” Dickson indicated that as well as supporting the NHS, there needs to be government support for social care services.

The NHS Confederation has also written to the Care Quality Commission to advise that it suspends is planned inspections so that providers can focus their energies on containing the further spread of coronavirus and make sure they are prepared to care for the much larger number of patients who will require support in the next period. Dickson said: “Our members recognise the value of regulation, but given the current and future impact of covid-19 infections on front line services, a temporary suspension of planned inspections would be the right move. Front line staff and managers do not need any distraction as they confront one of the greatest challenges the NHS has faced in its history.” The CQC wrote to providers in England to advise that it would take a pragmatic approach in light of coronavirus developments. However, the NHS Confederation said it does not feel that this approach “goes far enough and it overlooks the significant preparation that providers have to go through in advance of their planned inspections.”

are significantly more vulnerable to the coronavirus, hence why care homes are increasingly considering closure, or at least limiting visits.

In the first big analysis of more than 44,000 cases from China, the death rate was ten times higher in those aged 80 and over, compared to the 30 to 50 age group.

Care homes ban visitors Care homes are shutting their doors to care recipient’s friends and family in an effort to stem the spread of coronavirus. Many are also keeping residents indoors to stop the spread. The government has not yet officially told care providers to stop visitations, however many homes, including Barchester Healthcare, which runs more than 200 UK homes, has asked visitors only to turn up if it is essential. Barchester Healthcare stated: “We have not taken this decision lightly, and appreciate that this may cause some discomfort, but feel that this is a necessary step to take.”

HealthInvestor UK • April 2020

According to The Guardian, three care homes in Swindon, two in Northampton, two in Fife and all 25 homes run by the Balhousie Care Group in the northeast of Scotland have banned visitors. Balhousie, which has 900 residents and more than 1,200 staff, has given residents iPads to maintain contact with relatives and friends. Several care homes in Jersey are asking people to stay away. Downs View care home, Ashbury Lodge and Church View nursing home in Swindon, managed by Coate Water Care, closed to visitors on Wednesday. Statistics show the over 65s

NEWS

Deals and investment

South Cliff Dental Group acquires three dental practices South Cliff Dental Group has acquired three dental practices in Steyning, West Sussex, and Southampton. The three practices, Dale Road, Portland Street and Steyning Dental Care, were left under threat after a previous deal between NHS England and Swiss-owned dentistry chain Colosseum fell through. The failure to secure a deal would have left almost 15,000 people

without an NHS dentist and 30 clinicians and support staff jobless. The South Cliff Dental Group acquisition team was led by its chief executive, Ashkan Pitchforth while corporate legal advice was provided by commercial law firm, Brabners. As part of the deal, South Cliff Dental Group has pledged to spend £500,000 over the next three years to revitalise and modernise the practices.

Sk:n group acquires Adonia Medical Group The sk:n group has acquired Adonia Medical Group, the parent company for Courthouse Clinics, which offers anti-ageing aesthetic and wellbeing treatments, with centres located in London, Birmingham, Brentwood, Esher, Haywards Heath, Hereford, Maidenhead, Sheffield, Southampton, Watford and Wilmslow. The sk:n group was formed when TriSpan acquired it from Graphite Capital in February last year. Since then, sk:n group has acquired The Harley Medical Group – adding a further 19 clinics to its portfolio – as well as Destination Skin, a chain of 16 aesthetic skincare clinics. The group has also acquired the 7 Skin Health Spa and Flint+Flint Clinics.

Darren Grassby, chief executive at sk:n group, said of the Adonia Medical Group acquisition: “This is another great addition to our portfolio which will allow us to reach into new clinic locations while adding greater diversity to our group.” He added: “Our aim is to continue to grow and to develop while continuing to offer the same levels of service and support to all our clients and staff. 2020 will be a very exciting year for the group. We have great confidence in the future of the industry, and we look forward to giving our clients an enhanced experience in and out of the clinic.”

Nicola Lomas, legal director at Brabners, said: “Ultimately, thousands of people would have been left without a dentist had this deal not completed and I’m immensely proud of the work that’s been done to ensure these vital services continue to be delivered. NHS organisations are under pressure to deliver more care on a decreasing budget and the lifeline that a business like South Cliff offers them is often vital to their survival.”

Pitchforth commented: “This was an incredibly complex process involving significant restructuring of all three practices and could not have happened without the expert support of Nicola and her team. Our focus now is making these three practices more than just fit for purpose. Our mission is to create flagship practices across the South that offer top-of-the-line care for many years to come.”

Advanced Oncotherapy works with The London Clinic to offer cancer treatment Advanced Oncotherapy (AVO), a developer of proton therapy systems for cancer treatment, is to work with The London Clinic to operate AVO’s first commercial LIGHT facility on Harley Street in London. The London Clinic, a private charitable hospital, offers patients advanced diagnostic scanning, adaptive radiotherapy for bladder cancer, and the use of hydrogel spacers to minimise the side effects of prostate cancer radiation therapy. As part of a memorandum of understanding, The London Clinic selected AVO as its partner because AVO’s LIGHT system has been designed to generate a much smaller beam and, as such, is able to deliver more precise treatment for cancer patients due to the electronicallycontrollable energy modulation of the proton beams. Under the terms of the MoU, AVO will provide the LIGHT proton accelerator and treatment room equipment and The London Clinic will source and manage staffing, governance and other services necessary for the clinical operation of the facility. Al Russell, chief executive of The London Clinic, said: “Proton beam therapy is a very exciting

new treatment, but access has been limited due to the costs and size of equipment. Until now. AVO’s LIGHT system reduces size and cost, while providing the same high success rate for patients.” He added: “We’re excited to be the first hospital in London to offer this new treatment. The new service will adjoin our main site on Harley Street and enable The London Clinic to help even more patients fight and survive cancer while furthering our aim of advancing healthcare.” Nicolas Serandour, chief executive of AVO, said: “We are delighted to announce that The London Clinic will now operate our Harley Street LIGHT facility, the agreement with Circle Health having lapsed. The site is expected to allow us to treat a wide group of patients and help drive further awareness to proton beam therapy for the treatment of cancer. The London Clinic is one of the leading private cancer treatment hospitals in the UK and its decision to select our LIGHT system for proton beam therapy is a significant validation of our technology and capabilities. The proposed profit-sharing agreement with The London Clinic ensures that AVO retains an interest in the future success of the facility.”

HealthInvestor UK • April 2020

NEWS

Deals and investment

Veincentre secures Palatine Private Equity refinance from Santander sells Vernacare Veincentre has secured a sevenfigure refinance from Santander following investment from Palatine Private Equity last year. Veincentre uses endovenous laser ablation, a non-invasive, nonsurgical treatment for varicose veins and the new funding will facilitate expansion of additional clinics, as Veincentre looks to launch a Liverpool site in the first quarter of this year and a further two new clinics before the year-end. The company was backed by Palatine’s Impact Fund last July in a deal led by Beth Houghton, head of the impact fund. Since then Veincentre has launched new clinics in Glasgow and Leeds, which brings the total to nine nationwide, including Bristol, London, Manchester, Nottingham, Oxfordshire, Southampton and Stoke. Palatine has also sought to strengthen the Veincentre board since the investment with the appointment of David Harrop as

chairman last November. Harrop has experience in the healthcare sector, having held roles at Orla Healthcare, HCA, Medical Research Council and the NHS. David West, medical director at Veincentre, said: “Our ambition is to provide an affordable service to as many patients as possible, and a key part of this is making sure we have a presence in each of the UK’s major cities and regions. Palatine’s investment, along with the support from the team, is helping us realise that vision, and this additional funding will facilitate further expansion.” James Painter, investment director at Palatine Private Equity, added: “Veincentre serves as another great example of Palatine’s strong track record of executing rollout strategies. We are pleased to have opened two new clinics in the first six months of our investment and look forward to supporting the management team in growing the portfolio of clinics further.”

Palatine Private Equity has sold Vernacare, a Northwest-based healthcare products manufacturer to H.I.G. Capital. Established in 1964, Vernacare provides healthcare institutions with toileting and bathing solutions, from environmental cleaning and disinfection wipes to disposable medical pulp containers. The business employs more than 250 people from its Chorley headquarters, its manufacturing plant in Bolton and its Canadian base in Toronto. Since Palatine invested in 2015, Vernacare has increased its global footprint with overseas turnover almost doubling to more than £20 million. In 2017, the company acquired and integrated Synergy HCS, a manufacturer of wound care and surgical products. The existing management team will be joined by James Steele who has a private equity background in the healthcare sector, having been chief executive of Attends Healthcare for 12 years.

Matt Miller, chief executive of Vernacare, said: “We are delighted to be backed in our next growth phase by H.I.G. Capital. In working with the team on the deal it has become clear their ambition and enthusiasm for the business is as strong as ours and we look forward to an exciting and rewarding partnership over the next few years as we invest further in our buy and build and organic growth strategy.” Andy Lees, partner at Palatine Private Equity, added: “Vernacare has made substantial progress over the last four years. Matt and the team have done a magnificent job of growing the business both organically and through acquisition. We wish the Vernacare team every success on the next stage of their growth journey.”

Schoen Klinik in running to buy Priory Group as talks enter final phase

David West and Katharine West, Veincentre

HealthInvestor UK • April 2020

German healthcare operator Schoen Klinik is understood to be in negotiations to buy the troubled mental health provider the Priory Group. Priory is owned by Acadia and has been on the market for some time. The company has suffered a series of setbacks over the past year with various reports of poor care and patient abuse. Along with other UK healthcare providers, it also struggles to recruit and retain suitably qualified staff.

Schoen, which is backed by US private equity company Carlyle, operates mainly in the musculoskeletal field, but has a small range of mental health services. Australian hospital group Ramsay Health Care, Canadian investment fund Brookfield and buyout firm Capvest are also believed to be interested in buying. Sky News reports that offers for Priory from the various interested parties are in process. Priory Group and Carlyle declined to comment.

NEWS

Deals and investment

Chronic wound start-up raises £7m Cambridge-headquartered medtech company Inotec AMD has raised £7 million in a funding round led by Manchester-based Praetura Ventures, which invested £2.75 million. Existing investor Amadeus Capital Partners, Puhua Capital, Boundary Capital and a group of high-net-worth investors also participated. Inotec AMD’s product Natrox uses pure humidified oxygen to treat a range of chronic wounds, from diabetic and venous ulcers to nonhealing surgical wounds. Inotec AMD stated it will use the funding to build on its recent growth and target new international markets. Following several successful clinical

trials, the company wants to expand its foothold in the US, Asia, the Middle East and Europe. The business already provides products to the NHS and health providers in the US, Italy, Southeast Asia and the Middle East and has opened a second office in North Carolina. Inotec AMD is led by chief executive Craig Kennedy and chairman, Adrian Parton. Andy Round, a director and life sciences specialist at Praetura Ventures, is joining Inotec AMD’s board. Kennedy said: “The UK alone spends £3.1 billion treating chronic wounds each year, while the US spends $50 billion. Add to this the

significant escalation in costs, not to mention the considerable distress to patients and families if the only course of treatment for non-healing wounds is amputation. It’s clear that there’s a real need for innovation and new solutions in this area. He added: “We’re proud to have developed a product with the potential to revolutionise wound care and significantly minimise pain and suffering for millions of patients worldwide. Our next step is to continue our momentum and expand into new territories.” Round commented: “We’re always keen to back exciting businesses led by highly skilled, respected and

entrepreneurial management teams. We’ve been taken aback by the determination of the team at Inotec AMD to change wound care for the better. It’s especially important in the current climate that medtech entrepreneurs can flourish and bring their products to market quickly, which is where our support and expertise comes in. We’re confident that our extensive experience will help accelerate the team’s growth and allow them to provide groundbreaking treatment to more patients worldwide.” Praetura’s current portfolio includes Patchwork, a rapidly growing healthtech start-up which aims to solve the NHS staffing crisis.

Barkby Life Sciences to acquire Cambridge Sound Technologies’ IP Barkby Life Sciences a division of The Barkby Group is to acquire the intellectual property of Cambridge Sound Technologies, a privately-owned developer of sleep technology products. Cambridge Sound Technologies is the creator of the patented product, Sleep Infuser, which uses audio technology to help the brain reset its natural sleeping cycle. The product targets the underlying principal causes of insomnia and poor sleep patterns

that can lead to a range of health problems, including poor mental health, heart disease, diabetes, stroke and weakening of the immune system. Cambridge Sound Technologies plans to begin commercial production of Sleep Infuser in the second quarter of this year with first commercial deliveries expected in the third quarter. Barkby will own 75.1% of the acquiring entity, with the remaining shares held by the two founders, Frederick Donnet

and Colin Aston-James, who will remain involved in the business. Barkby has an option to acquire the remaining 24.9% of the acquiring entity for £5 million in cash or Barkby shares prior to 31 December 2021. The proposed acquisition is subject to completion of due diligence, documentation and compliance with regulatory requirements. Barkby Group chairman Charles Dickson said: “Approximately one in three people globally suffer from

insomnia and poor sleep patterns and the team at Cambridge Sound Technologies has developed a revolutionary product that tackles the underlying cause of poor sleep. Their focus on research and innovation has created a product that could potentially improve the lives of millions of people suffering from sleep-related issues. Barkby is committed to constantly seeking out new opportunities and delivering value to our stakeholders and this acquisition is firmly aligned with our strategy.”

PHP to fund new doctors’ surgery in Surrey Primary Health Properties (PHP) has contracted with a developer to fund the fitting of a doctors’ surgery in Epsom, Surrey. PHP will acquire the long leasehold interest of the property on completion of the work for a total cost of £4.1 million. The property will be let to the Ashley Surgery for an initial term of 20 years.

The letting will be accretive to the overall weighted average unexpired lease term of the PHP portfolio. The acquisition will increase PHP’s portfolio to a total of 490 assets with a gross value of just over £2.4 billion and a contracted rent roll of just over £128 million. Harry Hyman, managing director of PHP, said: “We are delighted to

be able to finance the relocation of an existing long-standing doctors’ practice with a patient list of over 9,000 to modern new premises, funded with the proceeds of our successful £100 million placing in September 2019.” He added: “The transaction continues the improvement of the quality of our portfolio by delivering a new facility with a

long unexpired lease term and located in a prime location in the commuter town of Epsom. We continue to have a strong pipeline of opportunities in the UK and Ireland and are well positioned to continue to grow our portfolio.” *Sister companies of HealthInvestor UK have an interest in PHP

HealthInvestor UK • April 2020

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NEWS

Policy and politics

Robert Kilgour importance when one considers the intertwined nature of the NHS’s and social care system’s future fortunes.” Siva Anandaciva, chief analyst at The King’s Fund, said: “Chronic workforce shortages remain the single biggest issue currently facing the NHS and social care, yet the Budget was light on detail of how it would boost recruitment and retention, and support under-pressure staff. The publication of a long-term, comprehensive NHS People Plan has been repeatedly delayed and held back to allow for today’s Budget commitments, so it is now essential to get this published as soon as possible. He added: “Following on from years of cuts to public health budgets, this begs the question of how seriously the government takes its commitment to improving people’s health.”

Nick Sanderson

Liz Kendall Nick Sanderson, chief executive of Audley Group, said: “It appears that the pre-election promises to focus on social care were empty ones. We can understand, given the current crisis gripping the country, that the chancellor has a lot to get to grips with, but it is still very disappointing to see so little on social care in the Budget – the silence was deafening.” He added: “The growing crisis in the system should be one of the highest priorities for any government. The promised Green Paper has been endlessly delayed. Returning to the problem “in a couple of months” needs to be a statement that the government acts on. This is not a subject that can be repeatedly kicked into the long grass.”

Jess Phillips

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Leaders and providers across the social care sector have hit out at the government for failing to address the social care crisis in the Budget. Chancellor Rishi Sunak delivered his first Budget in the House of Commons on 11 March, and pledged £30 billion to combat the coronavirus, but nothing for social care. Though the budget includes a promise to extend sick pay for UK workers and business rate relief for firms in England amid the virus outbreak, Sunak did not address the chronic underfunding of adult social care, despite Prime Minister Boris Johnson pledging to do so when he took office last year. The lack of any mention of funding for social care in the Budget was deemed “an out and out betrayal” for entrepreneurs in the middle of making deals, said Robert Kilgour of Renaissance Care. He added that it was a “kick in the teeth” for them, adding: “I’ve heard of a few sector deals that may have to be postponed already, because of this Budget. And to do it [present an early Budget] under the cloak of the coronavirus is cheap and underhand.” And as for front line social care, Kilgour said: “the government’s inaction will hit the sector severely.” Martin Green, chief executive of Care England, commented: “The £5 billion covid-19 response fund which aims to react to pressures in the NHS, support local authorities to manage pressures on social care and support vulnerable people, and help deal with pressures on other public services is welcomed by Care England.” “However, history has shown that the distribution of such funds has typically been one sided and focused upon fulfilling the NHS’s own goals. Instead, the covid-19 response fund should be allocated in a way which supports all parts of the health and care system, something which is of fundamental

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Budget branded ‘a kick in the teeth’ by social care sector Unison general secretary Dave Prentis, said: “This was a Budget to calm the nation and showed the government’s been listening – to a point. While a blank cheque to ease the NHS through the virus crisis will reassure health staff and under-pressure hospitals, social care and local councils barely got a mention.” Meanwhile, charities and opposition politicians took to social media to attack Sunak’s lack of provision for social care. Hft, the learning disabilities charity tweeted: “Disappointing to see that the Chancellor has chosen not to provide additional funding for #socialcare in his #Budget statement. The lack of a sustainable funding solution means another missed opportunity to allow local authorities to adequately commission much needed services.” Rhidian Hughes, chief executive of the Voluntary Organisations Disability Group, tweeted: “I think the Chancellor may have inadvertently skipped a paragraph in #Budget2020. £6bn for the NHS needs is very welcome. But people who use social care services and families must not be overlooked. We need direct investment in social care, and in its own right.” The decision has faced fierce criticism from Labour, with Liz Kendall, Labour MP for Leicester West, tweeting: “Pleased that the Chancellor says NHS will get whatever extra resources it needs to deal with coronavirus. But there was absolutely nothing in #Budget2020 on social care. This is a serious mistake & a gaping hole in govt’s plans. More money for potholes than social care? Terrible.” And Jess Phillips, Labour MP for Birmingham Yardley, tweeted: “Plenty to be pleased about in Budget, missing social care is so bad. Truth is that they know it has to be paid for but they cannot bear to be honest about it.”

HealthInvestor UK • April 2020

NEWS

Policy and politics

Government proposals to change immigration rules post-Brexit could “devastate” the health and social care sector, industry leaders have warned. Under the new plans, immigrants would have to reach 70 points to be able to work in the UK, with points also being awarded for qualifications, the ability to speak English, the salary on offer and working in a sector with shortages. Those who wish to work in the UK will have to have the offer of a skilled job with an ‘approved sponsor’, for which they would be awarded 50 points. All applicants will be required to earn a minimum salary of £25,600. Home secretary Priti Patel has said the new system is about bringing “the brightest and the best” to the UK. However, Labour shadow home secretary, Diane Abbott has said the low employment salary threshold “will make it very difficult to recruit people like social care workers”. She added that without social care workers from the EU “social care in London and the other big cities will collapse”. Skilled migrants from outside the EU currently need to have a job offer with a minimum salary of £30,000, however a Tier 2 (general) visa with a lower salary threshold is an option, if the applicant is on the Shortage Occupation List, which includes nurses. Despite this possibility, social care workers living outside the EU in particular are often unable to meet the current minimum salary threshold. Foreign workers currently make up a sixth of the 840,000-strong care worker workforce in England. If this new points system goes ahead, as it is expected to from 1 January 2021, social care workers outside the UK would further struggle to meet the new criteria, which could have a further negative impact on an already struggling

HealthInvestor UK • April 2020

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Government’s immigration plans ‘a devastating blow’

Priti Patel

social care sector, according to industry bodies. The Independent Care Group’s chair, Mike Padgham commented: “This [points system] would be a devastating blow for social care and would lead to hundreds of thousands more people not getting the care they need. The truth is that we already have 1.5 million people living without the care they need – a number that is growing every day. We need more care staff now and we are going to need many thousands more to care for an ageing population in the future. If the government prevents the sector from recruiting from overseas, then where are these extra staff going to come from? “This will heap further pressure on an already crumbling social care sector which will in turn pile more pressure on NHS healthcare, which will have to pick up the pieces when less and less social care is available. It defies belief and increases the urgency for the government to tackle social care, starting with measures to support care in the budget.” Martin Green of Care England, said: “The approach being taken by the Government to migration post-Brexit, will put significant

pressures on the social care system. If we are going to compete with other employers, we will expect our biggest customer, HM Government to pay significantly increased amounts for care services, so that we can give the salaries and benefits that our staff so richly deserve.” Danny Mortimer, chief executive of NHS Employers, commented: “If care homes close their doors or home care services are reduced because they don’t have the right numbers of staff to deliver the care needed, people and their families will suffer even greater problems accessing vital services and support.” Donna Kinnair, chief executive and general secretary of the Royal College Nursing, said: “We are concerned that these proposals from the government will not meet the health and care needs of the population. They close the door to lower-paid healthcare support workers and care assistants from overseas, who currently fill significant numbers of posts in the health and care workforce. She added: “While recruitment of overseas staff shouldn’t be used as a replacement for domestic workforce supply, it’s clear that it will need to continue in the short

to medium-term so that health and social care services in the UK can continue to function. We are clear that maintaining arbitrary salary thresholds will not enable health and social care services in the UK to recruit and retain the number of staff needed to meet the needs of the UK’s population.” Unison assistant general secretary, Christina McAnea, commented: “Suddenly ending this desperately needed supply of labour will cause huge problems across the country. The government simply has to think again. “Ministers must make specific allowances for social care, or the elderly and the vulnerable could soon find themselves without support. “The government needs to get to grips with social care urgently. It must fund care properly, with increased wages and training to make care an attractive career for UK residents and migrant workers alike.” Rhidian Hughes, chief executive of The Voluntary Organisations Disability Group, said: “These hugely concerning proposals by the government will only exacerbate workforce shortages in social care. Employers are already struggling to recruit and retain staff due to chronic underfunding in the sector. Central government now needs to significantly strengthen investment in the sector. Without that investment we should be in no doubt that in some geographical areas where organisations are struggling to secure staff, these proposals will signal the end of essential social care services.” Women’s Equality UK has tweeted: “This points system will disproportionately affect women migrants and leave a social care gap which women will be expected to fill with unpaid caring. It’s time care work was paid and appreciated in line with its invaluable contribution to society.”

NEWS

Policy and politics

FCA starts investigation in to NMC Health The Financial Conduct Authority (FCA) has commenced a formal enforcement investigation into NMC Health’s business dealings. The board of NMC has agreed to temporarily suspend its shares in line with the investigation. It has also been reported by The Telegraph, that NMC Health has fired its chief executive, Prasanth Manghat, after an investigation revealed the private hospital operator had been locked into secret loans to major shareholders’ companies without the knowledge of the board. It is understood that Manghat’s firing will leave the company with no board members.

The news comes after a series of senior resignations at the company, which followed a string of legal reviews and speculation over NMC Health’s business dealings. BR Shetty resigned as director and joint non-executive chairman of NMC Health mid-February, along with Hani Buttikhi and Abdulrahman Basaddiq who also resigned from their roles as directors of the company. The legal review, which commenced earlier this year, suggested that the holdings and interests of Shetty, Saeed Al Qebaisi and Khaleefa Al Muhairi have been incorrectly reported to the company and the market.

Al Qebaisi and Al Muhairi are NMC’s second- and third-largest shareholders, respectively. In addition, shares in NMC Health continued to plunge in December after some of its biggest shareholders sold a £375 million stake at below-market prices, sending the company’s stock down by 19%. That deal, led and confirmed by Al Qebaisi and Al Muhairi on 8 January, was priced at 1,200 pence per share. The drop in stock value follows a short-selling attack by US firm Muddy Waters, which, in December, questioned the value of NMC’s assets and cash balance while announcing its short

position. This in turn sent NMC’s share price down by more than half since the start of that month. A spokesperson for NMC Health said: “NMC Health is focused on providing additional clarity to the market as to its financial position and to restoring its admission to trading. The company will continue to be bound by listing, transparency and disclosure rules.” In response to FCA’s investigation, Carson Block founder of Muddy Waters research, said: “At this point, the company’s announcements speak for themselves and seem to be even more damning than our initial report was.”

Corridor care becoming the norm for nurses in England Providing care to hospital patients in corridors and other non-clinical areas is becoming normalised in England, according to the Royal College of Nursing (RCN). The RCN made the comments after it found 90% of nurses asked in its Emergency Care Association survey said the term “corridor nursing” is now being commonly used at their trust. Nearly three-quarters of 1,000 respondents told RCN they provide care to patients in a non-designated area such as a corridor on a daily basis. A further 16% say they do the same at least once a week. The RCN said NHS nursing care is increasingly being delivered to patients waiting to be seen at A&E and to those who have been judged sick enough to be admitted to hospital, but for whom a bed cannot be found. The survey found nine out of 10 respondents indicated that safety of patients is being compromised as a result of increased corridor care.

Survey respondents also highlighted a number of serious problems in providing care in corridors, such as the difficulty of administering urgent intravenous antibiotics; lack of access to toilet facilities for patients, lack of privacy and dignity, and increased distress for patients, particularly those with mental health problems. David Smith, chair of the RCN’s Emergency Care Association and an experienced A&E nurse in London, said: “As specialist emergency nurses, we are in a privileged position, as we care for people when they need help most. But we’re starting to see more and more care delivered in completely unsuitable locations, as this survey shows.” He added: “The responses reveal how demoralised nursing staff feel about working in these conditions – they are simply not sustainable and could deter future nurses from embarking on this unique and rewarding career.”

HealthInvestor UK • April 2020

NEWS

Policy and politics

Harwell granted special life sciences status Harwell Science and Innovation Campus in Oxfordshire has been designated as a Life Sciences Opportunity Zone by the Office for Life Sciences. Introduced in 2016, through the Life Sciences Sector Deal, the government has created a small number of specially designated ‘zones’ in the UK with the purpose of promoting UK life sciences capabilities. Harwell will be given this title for a 10-year period and is one of only seven locations in the UK to receive such status. The government will work with Harwell campus to attract national and foreign investment, establish trade agreements and promote the campus as a location for start-ups. Harwell is a 700-acre campus home to 6,000 people across 200 organisations and also home to the HealthTec Cluster which is centred

around £2 billion of open access National Physical Laboratories. These include the Diamond Light Source, ISIS Neutron and Muon Source, Central Laser Facility, as well as new the Vaccines Manufacturing and Innovation Centre and Rosalind Franklin Institute. Research and commercial work on Harwell campus spans everything from drug discovery, including fragment screening, artificial intelligence-enhanced drug design, vaccines, advanced medicines, through to environmental impacts on human health, biomaterials and ageing. The news comes a week after the government’s launch of the Nucleic Acid Therapies Accelerator (NATA) and the new Extreme Photonics Applications Centre (EPAC), both at Harwell. NATA leads research in delivering medicines that target untreatable

diseases, including Parkinson’s, Huntingdon’s and cancer. EPAC will be a new advanced imaging centre, housing lasers that produce 3D X-rays in just 40 seconds. Harwell Campus is expanding via a private public partnership between Harwell Oxford Partners and U+I, plus two government backed agencies, the Science and Technology Facilities Council (UKRISTFC) and the UK Atomic Energy Authority. Nadhim Zahawi, life sciences minister, said: “The UK is home to one of the strongest, most vibrant health and life science industries globally, with discoveries and improvements in health diagnosis transforming people’s lives. Collaboration is vital to growing this sector.” Adrian Hill, STFC-UKRI lead for the HealthTec Cluster at Harwell,

commented: “The campus continues to evolve in order to meet the nation’s technological and health challenges. The Life Sciences Opportunity Zone designation will be a key driver for future growth in Oxfordshire and along the M4 corridor, creating jobs and contributing to UK GDP.” Gordon Duncan, a partner at Harwell Science and Innovation Campus, said: “The life sciences industry contributes over £70 billion per annum to the UK economy and provides 240,000 jobs. Harwell Campus plays an increasingly important role at the centre of this sector. We have a unique platform here to help accelerate research and innovation around the country, taking applied research and turning it into commercial outputs using state of the art technologies and applications – this is unparalleled across Europe.”

The government must have “legal responsibility” to ensure there are enough nurses to provide safe and effective care to all patients, according to Mike Adams, director for England at the Royal College of Nursing (RCN). Adams made the comments in reference to a Commons debate led by Labour MP Mohammad Yasin, who stressed the negative impact the nursing workforce crisis is having on patient safety and staff morale. Yasin, the MP for Bedford, called on the government to address this and take urgent action to fix nursing staff shortages. Throughout the debate MPs focused on the detrimental effect low staffing levels are having on nursing staff and patients. They also spoke about the importance of recruiting and retaining NHS nursing staff, providing appropriate training for existing staff, removing financial

HealthInvestor UK • April 2020

barriers for nursing students, and establishing accountability for nurse staffing levels. The importance of international recruitment was also discussed with politicians echoing the RCN’s demands for nurses to be exempt from the immigration health surcharge, for nursing to be listed as a shortage profession, and for a review of the salary cap for overseas nursing staff. The debate comes less than a month after RCN members descended on Downing Street to hand in petitions with more than 220,000 signatures calling on the government to end the workforce crisis in England. In the days leading up to the debate, hundreds of members tweeted their MPs urging them to attend. The RCN said it will be meeting with the minister for care, Helen Whately, in the coming weeks to discuss its campaign further.

Mohammad Yasin

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Royal College of Nursing calls for safe nursing levels

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Acute care

Spire Healthcare reports increased profit Private healthcare company Spire has reported 2019 operating profit of £94.4 million, compared to operating profit of £71.1 million reported for 2018, a 32.8% increase. Revenue for 2019 was £980.8 million, compared to £931.1 million in 2018, a 5.3% increase. Revenue from the provision of private healthcare grew by 5.8% last year, compared to growth of 3.4% in 2018. Revenue from private medical insurance increased by 7%, self-pay increased by 2.7%, and NHS revenue increased by 5%. In its results release, Spire Healthcare addressed the Ian Paterson scandal and said it “fully support[s] all recommendations of the Paterson inquiry and will work closely with the healthcare sector to implement them”. This includes continued investment in to clinical governance yielding further improvements in patient safety. Paterson, a surgeon who worked at two Spire hospitals, was jailed in April 2017 after carrying out “extensive, life-changing operations for no medically justifiable reason”. He was found guilty of 17 counts of wounding with intent and has had his initial jail term of 15 years increased to 20. The inquiry report, released last month, has also recommended the recall of Paterson’s 11,000 patients and for their surgery to be assessed.

Justin Ash, Spire Healthcare

On a more positive note, Spire reported that its Care Quality Commission ratings increased to 85% Good or Outstanding, up from 81% in the first half of 2019. Nine reports published by the CQC from inspections of Spire institutions last year were all rated Good or Outstanding. Spire Healthcare chief executive Justin Ash said: “The recent Paterson inquiry report highlighted the continuing need for focus on patient safety across the healthcare sector. Our relentless commitment to high clinical quality is evidenced by the investments we have made over the last two years, and the improvement in our overall CQC or equivalent rating.” “85% of sites are now Good, Outstanding or the equivalent, with all published reports from sites inspected in 2019 achieving that rating. As a result of quality gains, and further improvement in our marketing capability, Spire had top-line growth of over 5% in 2019, with particularly strong growth in private income.” He added: “Operating profit and cash generation both improved materially. These were a good set of results, meeting our key financial and quality targets. Spire now has a solid platform for growth, and we look forward to the future with confidence.”

Healthcare tech firm launch new HR software tool Clinical experts at London-based healthcare tech firm Credentially have launched a new software tool to address HR issues that arose after an inquiry into the case of Ian Paterson. Credentially’s tool works to ensure patient safety while simultaneously relieving burdens on clinical staff and their employers by providing instantaneous access to clinicians’ records. The software is cost-effective,

offers automated verification and compliance tracking, which means the potential for human error is almost entirely eliminated. Paterson, the Birmingham breast surgeon, received a 20year jail sentence in 2017 after being found guilty of 17 counts of intentionally wounding patients. The independent report into Paterson found that a lack of accessible information about each consultant’s practice and

human errors were among the main reasons why the rogue surgeon was able to continue practising for years. Credentially chief executive Kit Latham said: “We believe Credentially will completely transform the way healthcare HR is run across the globe. It is a huge advance, not least because of its automated aspects. It is also significantly quicker and more efficient than existing systems. Clinicians’ data is stored securely

and in one place – which wasn’t the case at Ian Paterson’s clinic – and the system is fully GDPR compliant.” He added: “The Paterson report made it very clear that complete oversight is vital to ensuring patient safety. We bore all of its lessons in mind when we developed our product and hope to have a chance to help providers across the UK guarantee that Ian Paterson’s story will never be repeated again.”

HealthInvestor UK • April 2020

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Acute care

Another Spire doctor accused of unnecessary procedures A doctor who worked at the same private hospital as rogue breast surgeon, Ian Paterson, has been accused of carrying out unnecessary operations on a significant number of patients. Michael Walsh, a shoulder surgeon, was sacked by Spire Healthcare after numerous patients and colleagues reported him to the General Medical Council (GMC) with concerns about his work. Many patients have since filed lawsuits against Walsh, claiming he performed surgery on them between 2012 and 2018 without any medical justification, leaving many in pain, traumatised and unable to work.

The GMC has identified almost 50 patients it believes Walsh might have harmed. Walsh carried out shoulder operations, shoulder replacements and also administered injections. He has retired and is no longer licensed to practise as a doctor. The news comes just weeks after an official inquiry found multiple blunders by Spire Healthcare and the NHS enabled Paterson to carry out unnecessary and damaging surgery on hundreds of patients. He was jailed in April 2017 after carrying out “extensive, life-changing operations for no medically justifiable reason”, after

being found guilty of 17 counts of wounding with intent. His initial jail term of 15 years was increased to 20. When Paterson operated on women who did have breast cancer, he put them at increased risk of relapsing by using a technique which left lots of the breast tissue behind. Spire, which runs 39 private hospitals in the UK and employs 7,000 doctors and surgeons, has shelled out £27.2 million in compensation to Paterson’s victims. A spokesperson for Spire said: “After concerns were raised about Mr Walsh, an investigation was

started in April 2018, and he was suspended immediately. We have asked the Royal College of Surgeons to assist with this investigation and have shared the findings with the Care Quality Commission and the GMC. “Where we have identified concerns about the care a patient received, we have invited the patient to an appointment with an independent surgeon to review their treatment. This is a complex case and the review is ongoing. Spire reiterates its sincere apologies to those patients who have been affected by the treatment they received from Mr Walsh.”

NHS Digital and PHIN collaborate for data changes NHS Digital and the Private Healthcare Information Network (PHIN) have launched a consultation to align private healthcare data with NHS recorded activity. The consultation sets out a series of changes to how data is recorded and managed across private and NHS care, along with a series of pilot projects, based upon feedback from various stakeholders. It aims to seek the views of private and NHS providers, clinicians, the public and other organisations with an interest in private healthcare and will be used to help shape the future changes. The consultation, which has been launched following the publication of the Paterson Inquiry, will be hosted on the NHS Digital Consultation Hub. Under the changes proposed in the Acute Data Alignment Programme (ADAPt), PHIN will share the national dataset of private admitted patient care in England with NHS Digital, creating a single source of healthcare data in England. This follows the Paterson Inquiry’s recommendation to create a single repository for information about consultants’ performance in private and public healthcare across England.

HealthInvestor UK • April 2020

The repository will have common standards for recording and reporting activity, quality and risk in a consistent way across both public and private healthcare. It will allow providers, care planners, regulators and researchers to understand better how private and public healthcare data sits alongside each other and how it can be used to deliver better care. NHS Digital will also pilot collecting data directly from independent providers on privately funded care within its Secondary Uses Service, consolidating the data reporting processes and reducing the administrative burden on hospitals. This data will be shared with PHIN so it can assess whether it would be suitable to use for the publication of hospital and consultant performance information as mandated by the Competition and Markets Authority. Health secretary Matt Hancock said: “Regardless of where you’re treated or how your care is funded, everybody deserves safe, compassionate care. The recent Paterson Inquiry highlighted the shocking failures that can occur when information is not shared and acted upon in both the NHS and independent sector.”

Tom Denwood, executive director of data, insights and statistics at NHS Digital, said: “In light of the conclusion of the Paterson Inquiry the ability to provide greater transparency in quality and safety and to improve patient care is more important than ever. We would like to encourage feedback on this consultation, especially from patient groups, professional bodies, and providers of care, to help it draw its important conclusions on if and how to create this alignment.” Matt James, chief executive of PHIN, said: “The Paterson Inquiry showed that joined-up information is essential, and patients considering private healthcare can already use PHIN’s website to search information on more than 2,500 consultants covering both their NHS and private practice. The ADAPt programme

will make PHIN’s data on private healthcare more easily available to the NHS to improve governance. We encourage everyone to voice their support for this important initiative to improve patient safety.” David Hare, chief executive of the Independent Healthcare Providers Network, commented: “The recent Paterson inquiry report rightly called for much more of a ‘whole systems’ approach to patient safety and data transparency. In seeking to better align NHS and independent sector data, the ADAPt programme represents a key step towards the seamless flow of data along the patient journey – helping to ensure full visibility of the safety and effectiveness of care delivered by all providers, and enabling patients to make the most informed choices about their treatment.”

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Social care

Hft forced to close down services Care charity Hft is closing its residential and day service at Milton Heights, Oxfordshire by the end of May, because of funding problems which leave it with a significant weekly shortfall. Hft’s residential services will cease on 13 April and its day services, used by around 60 people, will stop on 31 May. Last month, Hft released a report which surveyed the impact of changes to the social care sector last year. In association with Cebr it asked 77 large and small care home providers for their reflections on 2019 and their predictions and requests for 2020.

The main consensus Hft found was that government intervention is desperately required in the social care sector to “end a prolonged period of mounting cost pressures and staff recruitment difficulties”. Hft notes that these two factors led to 45% of providers shutting down some services last year. Commenting on the Milton Heights closure, Hft’s chief executive Steve White said: “The financial pressures on social care providers are acute and Hft is not alone in having to make difficult decisions. A lack of alternatives has left providers with no choice but to

Care England launches market intelligence database for members Care England, the representative body for independent providers of adult social care, has launched a market intelligence information database for members, called MINT. MINT holds a variety of data and links to information from freedom of information requests, and private and publicly available data sources. It is searchable by local authority and clinical commissioning group, by parliamentary constituency, care home provider, post code and group name, and will produce reports by authority, search or advanced search criteria.

Martin Green, chief executive of Care England, said: “MINT will be extremely helpful enabling our members to have crucial data at their fingertips all in one single repository when discussing fees or quality with local authorities and CCGs. MINT is tailor-made for our members allowing them to be forewarned and thus forearmed.” He added: “MINT will help providers prepare for conversations and negotiations as they need to be au fait with their local markets in order to provide a basis for informed decisions. MINT is part of a raft of membership benefits that help providers operate to their optimum ability.”

make decisions culturally at odds with the way they want to run their organisations.” “The fees we are paid for the services we provide do not cover the direct costs of care. Without sufficient local authority funding, there is no long-term way for us to fund the service. It is with huge regret that Hft has been compelled to make this sadly unavoidable decision. We recognise that it will be both unwelcome and emotionally difficult for all those involved, which is why we are working constructively with the local authority and all the families

involved to minimise the distress and anxiety around the decision.” Martin Green of Care England, commented: “The closure of these services is a consequence of years of serious underfunding and will be replicated across the country unless we get a long-term and sustainable funding settlement for social care.” He added: “The crisis in care could well be exacerbated if the High Court rules that sleep in staff must be paid back pay. The crisis in social care is a self-inflicted wound by the government and we need urgent and immediate action to secure the future of vital services.”

Oakland Care opens new home in Essex

Oakland Care has officially opened Lambwood Heights, a new care home in Essex. Located within an area of protected woodland in Chigwell, the purposebuilt, luxury care home provides residential, nursing, memory and respite care for up to 73 residents. Facilities at the home include a café bistro, cinema room, hair and beauty salon, air-conditioned lounges, a private dining room, garden room and a library. The home was officially opened by the lord-lieutenant of Essex, Jennifer Tolhurst on 7 February. Oakland Care also invited local councillors and businesses and the home’s first residents and their

family members to the Great Gatsby themed opening. Welcome speeches were given by Sonia Kasese, Lambwood Heights’ registered manager and Joanne Balmer, chief executive of Oakland Care. Commenting on opening the home, Tolhurst said: “It was a huge honour to be invited to come and open Lambwood Heights. A lot of work has gone into the design of the building and the rooms and there are many things here that encourage residents to be stimulated and happy. Those are the things that really stand out to me and I can see that Oakland Care has addressed these in a big way.”

HealthInvestor UK • April 2020

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Social care

Growing need to provide age appropriate housing for over 65s The need to provide age appropriate housing to over 65s is only set to grow, according to Lauren Harwood, head of senior living research at global property advisor Knight Frank. Harwood made the comments in response to an Office for National Statistics survey which found almost three-quarters (74%) of people aged 65 years and over in England owned their homes outright, while the number of people aged 65-plus living in the UK is forecast to increase by 20% to 12 million by 2027. The ONS survey also found that the cohort of nonagenarians in the UK is expected to rise at an even faster rate – to more than 750,000

people over the next eight years. Harwood said that it is “evident that senior living operators are responding to these demographic shifts by providing seniors with a choice of tenure options”. In addition, over the past couple of years, financial investment in the sector has grown, and Knight Frank forecasts this will continue with the total value of the private senior living market reaching £55.2 billion by 2023, from £39.6 billion in 2019. As well as increased investment – from both the UK and overseas – advances in senior living design, scale, tenure options and healthcare choices are helping to move the sector forward, though challenges remain.

Knight Frank adds that a uniform plan for meeting these housing needs is required, and should include clarity on affordable housing, local authority financial savings through provision of care within seniors housing, and the release of local family housing back to the market via downsizers moving into seniors housing. The ONS also found that only 6% of people aged 65 years and over rent privately today, though the ONS notes that this is likely to increase in the future if younger generations – currently in their 30s, 40s and 50s – in the private rental sector remain so into older ages. Tom Scaife, head of senior living at Knight Frank, said: “Changing

demographics and trends in housing tenure are having profound implications on the property market. The UK’s population is ageing at a faster rate than ever before and the ‘grey pound’ is becoming increasingly influential. In response, the need for age appropriate housing has grown significantly.” He added: “Ranging from standard housing through to aged care facilities, the offering of senior’s accommodation has evolved markedly over the past decade, but when considering how to deliver this housing, the preferences and requirements of potential residents must be paramount, so the most attractive forms of age-appropriate housing can be delivered.”

Call for ‘social care visa’ to ease recruitment crisis Small business owners are calling on the government to introduce a ‘social care visa’ in a bid to ease the recruitment crisis in the sector. Under the new points-based immigration system proposed by home secretary Priti Patel, all workers must earn at least £26,500 if they are to be allowed entry to the UK for employment purposes. But the Federation of Small Businesses says that many of their members in the social care sector will struggle to find staff under the new rules. With near full employment and many UK citizens unwilling to work in social care,

the FSB says specific arrangements should be put in place to allow firms to hire lower-paid staff from overseas. “While it’s encouraging to see the government acknowledging the need to address skills shortages in certain industries, its policy statement includes no mention of the social care sector,” said FSB national chairman Mike Cherry. “That’s why we’re proposing a dedicated social care visa, enabling those struggling with mounting overheads and personnel shortages to recruit the overseas talent they, and our society, need to thrive.”

26 June is Care Home Open Day Care Home Open Day, in partnership with Care England, National Activity Providers Association and National Care Forum (NCF), will take place on 26 June for the eighth year in a row. The theme this year is music which encompasses music, arts,

HealthInvestor UK • April 2020

innovation and technology. Martin Green, chief executive of Care England, said: “Now wellestablished, Care Home Open Day, is a real marker in the calendar. Care homes really are the hub of their communities; let’s keep it that way and continue to connect. The

immense innovation throughout the sector needs to be showcased and enjoyed.” He added: “There is a link between music therapy and dementia and this needs to be made more widely known; Care Home Open Day is the perfect vehicle to do so.”

Vic Rayner, chief executive of NCF, commented: “I’m really excited about Care Home Open Day. There are so many creative ways in which music has become centre stage within homes. Get planning now – and get your care home firmly on the map this June.”

NEWS

Social care

CQC calls for industry collaboration to create culture of openness The Care Quality Commission (CQC) has called for leaders across adult social care to work together to create a culture of openness concerning sexuality and relationships – while ensuring service users are protected from sexual harm. The CQC’s call for collaboration comes after the release of its report Promoting Sexual Safety Through Empowerment which looks at what can be done to support people in adult social care to have safe sexual relationships. The report discusses the importance of an environment which allows people the basic human right to express their sexuality, and an open culture where people feel able to raise concerns around safety where necessary. Following engagement with people who use adult social care – including those who have been involved in sexual safety incidents, the CQC has called for staff to be empowered to discuss issues around people’s relationships and their sexuality. The commission has also called for the production of co-produced guidance for care managers and staff

that focuses on how to protect people using adult social care from sexual abuse and how to support them to develop and maintain relationships, expressing their sexuality. The CQC has said it will continue to improve the system of provider notifications and how its deals with reported incidents, ensuring staff are enabled to deal with these difficult and sensitive issues in a timely way. The report also includes more than 650 notifications of sexual incidents or alleged sexual abuse that took place in adult social care services and were reported by providers to CQC. The 661 statutory notifications of sexual incidents or alleged sexual incidents that were reported to CQC between 1 March and 31 May 2018, details 899 sexual incidents or incidents of alleged sexual abuse that took place in adult social care services such as residential and nursing homes. Almost half of the incidents (48%) have been categorised as allegations of sexual assault. The second most common type of incident (11%) was that of indecent exposure and nudity.

Commenting on the report, Kate Terroni, chief inspector of adult social care at the CQC, said: “Supporting people as individuals means considering all aspects of a person’s needs, including sexuality and relationships. “We know that an open culture, where staff feel they can share concerns without fear of reprisal, where people and families are empowered to speak about their wants and needs in a sensitive way, and where managers and providers proactively enable conversations

about sexuality to take place are the conditions that lead to people being empowered to stay safe and supported.” She added: “We are clear that abuse in any form can never be accepted and we must act on the findings of this report to help providers and care staff protect people from sexual harm, while enabling people to continue or develop intimate relationships. We are confident that with the right commitments across the sector we can achieve both.”

Cabinet reshuffle appoints Whately as minister of care

members.parliament.uk (CC BY 3.0)

Helen Whately has replaced Caroline Dinenage as minister of care after a cabinet reshuffle by Prime Minister Boris Johnson. Whately was previously secretary of state for arts, heritage and tourism. Whately was first elected in 2015 as the MP for Faversham and Mid Kent and increased her majority at the 2017 and 2019 general elections. During her political career, Whately has served on the House of Commons Health Select Committee and as deputy chair of the Conservative Party.

HealthInvestor UK • April 2020

NEWS

Mental health

St Andrew’s to overhaul services after CQC inspection Mental health provider St Andrew’s Healthcare, which had “repeated and systemic failings” in its governance, is to overhaul its current services and move out of its facility at Fitzroy House in Northampton, transferring to a smaller building, while reducing the number of young people it supports from 99 to 30.

The overhaul follows an inspection by the Care Quality Commission, which put the charity into special measures. CQC inspectors visited the charity on 23 and 24 October and found the use of physical restraint had increased, despite plans to reduce it. Inspectors also found staff were not always forthcoming in raising

concerns without fear of reprisal. In the report which followed the inspection, CQC told St Andrews Healthcare that if its service fails to improve within six months, it will close it down. Chief executive of St Andrew’s Healthcare, Katie Fisher, said: “We have already taken disciplinary

action against the small number of staff members in our child and adolescent mental health service whose treatment of our patients is completely unacceptable. There is no excuse for this behaviour, and for this we are sorry. We know we need to make significant changes, and quickly.”

The Priory Group opens new wellbeing centre in Bristol The Priory Group has opened a walk-in Wellbeing Centre in Bristol to meet increasing demand for mental health services in South West England. The Wellbeing Centre, located in Aztec West Business Park, close to Priory’s Bristol Hospital, is fully regulated by the Care Quality Commission. The centre is staffed by consultant psychiatrists, psychologists and a range of individual, group and family therapists, providing therapy and treatments for a broad range of mental health conditions including depression, anxiety, stress, eating

disorders, addiction, Obsessive Compulsive Disorder as well as bereavement and grief. It is hoped the new service will help to ease the pressures on local A&E teams, after University Hospitals Bristol NHS Trust reported that visits to emergency departments for mental health issues in the Bristol area had increased by 138% on the previous year, rising from 1095 to 2610. This opening of the Bristol Wellbeing Centre is the latest in a series of Wellbeing Centres launched by the Priory Group, in Birmingham, Southampton, Canterbury, Aberdeen, Edinburgh,

Greater Manchester, Oxford and London (Fenchurch Street and Harley Street). Mandy Ryan, manager of the Bristol Wellbeing Centre, said: “At the start of this new decade, our team is so proud to be opening this much needed clinic to allow swift assessment and treatment of people in Bristol and across the South West, where there has been a gap for patients for some time. She added: “Our ethos has always been to promote the importance of early assessment and diagnosis. We hope that by offering a friendly and discreet service that is accessible and

convenient, we can play an active part in supporting all our patients towards a better quality of life and long-term recovery.” Leanne Hayward, consultant psychiatrist at Priory’s Bristol Hospital and the Wellbeing Centre, commented: “The Wellbeing Centre will meet much needed demand in the Bristol area. Those with mental health conditions need to receive the right treatment as soon as possible, and at the wellbeing centre we offer the swift and specialist support patients require. I look forward to working with patients at this excellent new service.”

Digital and medtech

myGP reaches 1.5m active users Healthcare app myGP has seen a 50% increase in active users in the past six months, with 1.5 million people across the country now using it to manage their health. myGP, developed by iPLATO Healthcare, is NHS Assured and offers users and their dependents appointment booking at their registered GP surgery, medical record access and repeat prescription ordering, medication reminders, health tracking, e-referrals and a pharmacy service finder. myGP directly codes into a practice’s clinical system meaning that all actions taken on the app are instantaneously picked up by

HealthInvestor UK • April 2020

the practice’s system. According to myGP, this provides time and cost savings for practices and also gives patients the ability to cancel appointments online, freeing up appointments for those who need them most. Due to its large user base, myGP was recently asked by the NHS to assist in communicating guidance for the current outbreak of Coronavirus. myGP chief executive Tobias Alpsten said: “This is a fantastic achievement by our supporters within the NHS and our team. It means that we continue to meet more of our user’s healthcare needs at their own registered GP surgery.

The real winners are myGP members who previously had limited options for accessing online services and we hope that by using myGP their lives will be made simpler and more convenient.” He added: “We are continuously listening to app users and practices about features that would help them

in their day-to-day lives and continue to build these into the myGP app. We regularly get fantastic feedback from both practices and patients and our local account managers continue to work directly with practices to help them to help patients to adopt digital tools. It’s great to see that this is working.”

NEWS

Digital and medtech

University Hospital Southampton NHS Foundation Trust to roll out Netcall’s Patient Hub University Hospital Southampton NHS Foundation Trust (UHS) is to roll out Netcall’s Patient Hub, across all its departments from April. The Patient Hub, a browserbased portal, will enable patients to confirm, rebook or cancel hospital appointments online from anywhere, on any device and at any time. Those who have not logged in to read the digital version in time, or those who opt-out of the hub, will still receive postal notifications to maximise appointment attendance and cut down costly “did not attends”. The hub also supports patients who need reading or visual impairment tools.

The Patient Hub allows clinicians to receive a screen-pop of all the relevant patient data from the start of a patient’s call – meaning that patients don’t need to repeat information. The screen-pop functionality works even when the patient decides to call directly into the booking centre with a query. Digitalising appointment letters through the Patient Hub also boost’s the NHS’s paper-free agenda and reduces postage costs. In the future, UHS aims to further integrate the Patient Hub with its clinical portal My Medical Record (MyMedRec), which is designed to help patients with chronic illnesses manage their

Qlik partners with Cheshire care providers Qlik, a data analytics company, has partnered with West Cheshire Clinical Consulting Group, an NHS trust, to develop predictive tools, which enable front line staff to identify and support patients at highest risk of health deterioration. The initiative is in line with the NHS’s Long Term Plan, Population Health – an approach aimed at improving physical and mental health in the UK. Using Qlik enables healthcare staff to spot quickly patients whose conditions are not being managed in the best way. Qlik’s implementation has been overseen by the newly created business intelligence board, created as part of a drive by Cheshire West Integrated Care Partnership. Teresa Strefford, executive clinical director at Cheshire Clinical Commissioning Group, said: “With the CCGs across Cheshire merging in April 2020, we’ve been given an exciting opportunity to revisit best practice within a new single Cheshire Clinical Commissioning Group.”

She added: “Implementing Qlik technology to create powerful risk stratification systems has furnished us with a powerful tool to quickly identify the patients at highest risk. We look forward to equipping GP practices across Cheshire with this new technology – through proactive care and identification of the right patients, both clinical teams and patients will see a positive impact.” Sean Price, Europe, the Middle East and Africa, director of industry solutions, public sector and healthcare at Qlik, added: “We are proud to be helping Cheshire health and care professionals understand population health from both a strategic and tactical level. The pressure on our healthcare system continues to increase with growing demand and risk, combined with acute resource restraints. Now, more than ever, innovative leaders need to realise that data analytics provides the key to transforming ways of working to sustain and improve the services delivered to the public.”

care. Once the two portals are connected, patients will be able to review their appointments on the Patient Hub and then move to MyMedRec to check-in or upload clinical information ahead of time. Ian Brewer, head of information technology at UHS, said: “Netcall has been sending our outpatient appointment reminders by telephone and text for a few years. When we started to look for a solution to send digital letters to patients, Netcall’s Patient Hub seemed a natural fit. The additional functionality we have been able to deploy as part of the programme, including confirming or cancelling appointments, as well as additional

call handling facilities in our busy patient services centre, has made it a great choice.” Mark Holmes, chief sales officer at Netcall, added: “We are very pleased to continue our work supporting this innovative global digital exemplar. University Hospital Southampton NHS Foundation Trust has a clear vision and strategy for a future that is centred around excellence and patient experience. The experience that both the UHS and Netcall teams bring to the Patient Hub implementation, working alongside MyMedRec, means that the future looks very exciting.”

Clarity Informatics to expand its support tool globally IT healthcare solutions provider Clarity Informatics is to expand the reach of its clinical decision support tool, Prodigy. As part of a global initiative, Clarity Informatics will introduce the Prodigy service to primary and first contact healthcare professionals, particularly those working in English-speaking countries, which have similar healthcare systems. Prodigy is designed to provide GPs, GP registrars, paramedics, nurses, and pharmacists with evidence-based clinical guidelines, helping them to treat common conditions and symptoms. Prodigy forms the clinical content of the National Institute for Health and Care Excellence (NICE) Clinical Knowledge Summaries (CKS) service and is used by more than 400,000 clinicians every month. More than half of the NHS clinical workforce relies on clinical information and guidance

authored by Clarity Informatics – and Prodigy’s clinical content is continually monitored, reviewed, and new topics introduced each year. Though it is expanding globally, the Prodigy tool will remain free of charge to medical professionals in the UK, as part of NICE’s CKS. Tim Sewart, chief executive of Clarity Informatics, said: “We can see significant potential to expand the reach of Prodigy globally and create opportunities for healthcare professionals in other markets to benefit from rigorously reviewed clinical guidance available to them at the point of care.”

HealthInvestor UK • April 2020

NEWS

Digital and medtech

Patchwork and Wagestream deal allows clinicians to access wages Health technology company Patchwork has partnered with income streaming company Wagestream to enable its clinicians to track and access their wages. The partnership will allow NHS clinicians to check shifts through the Patchwork app to track and access their earned wages when they need it, without having to wait for payday. Incorporating Wagestream into the Patchwork platform means clinicians can choose when and how often they get paid; keep track of their earnings in real-time, and access budgeting tools. Patchwork also hopes that this added feature encourages more clinicians to book shifts directly through their hospital bank, thereby saving the NHS millions in agency fees. Patchwork is already used across 30 NHS hospitals by more than 10,000 clinicians and the platform has facilitated one million shift hours since its launch. Anas Nader, chief executive of Patchwork (right), said: “Adding the power of Wagestream to our platform is another step towards creating a more flexible, streamlined, and dynamic working

reality for NHS clinicians. We are seeing increasing numbers of healthcare workers leave the NHS citing poor work-life balance. Our technology is trying to redress this trend while removing the traditional financial burdens that temporary staffing can place on trusts. He added: “Offering temporary health workers financial stability is

incredibly important and a crucial move towards parity of experience between contracted and flexible staff.” Peter Briffett, chief executive of Wagestream (left), said: “The opportunity to partner with Patchwork enables us to continue to deliver our mission of providing financial flexibility and giving

clinicians within the NHS greater control; connecting flexible pay is an important pillar in the wider move towards flexible work. The financial wellbeing of NHS staff is of paramount importance and through this partnership we see the opportunity to increase financial stability and freedom for healthcare clinicians.”

Forescout Technologies and Medigate team up for medical security Internet security firm Forescout Technologies has partnered with medical device security firm Medigate to help healthcare organisations secure all their devices. Medigate enables IT, information security, biomedical and clinical engineering teams to identify, monitor and secure every medical device on a clinical network. The joint offering will enable

HealthInvestor UK • April 2020

clinicians and healthcare staff to identify and classify all connected medical devices and any company-owned information on their network, while minimising disruption. And customers will be able to design and implement segmentation and control access to their clinical network. Pedro Abreu, chief product and strategy officer at Forescout, said: “Connected medical devices represent a fast-growing threat

attack vector and the lack of device manufacturer standardisation and interoperability has created a significant problem for clinical care network operations. The combination of Medigate’s deep knowledge of medical devices and the healthcare industry, with Forescout’s breadth of device intelligence adds a new level of cohesive device insight, expertise and security for the healthcare industry.”

Jonathan Langer, co-founder and chief executive of Medigate, added: “The Medigate and Forescout partnership and integration provide healthcare organisations with rich contextual visibility into their IT and clinical networks, as well as sophisticated network analysis to detect threats and implement clinically-driven policies. These actionable insights will, in turn, reduce risk and improve patient safety.”

NEWS FOCUS

Coronavirus

Home guard Jenna Lomax asks some of the biggest care home providers how they are planning to protect their residents against coronavirus

he coronavirus has gripped the world’s attention and is big news everywhere. But when one steps back and studies the facts, it’s clear that many more people survive it than die from it. Yet, despite this, statistics show the over 65s are significantly more vulnerable. First detected in the city of Wuhan, China, the coronavirus is a family of viruses that cause disease in animals. Seven of these viruses are thought to have made the jump to humans, but most people will only experience common cold-like symptoms. But, in more severe cases, the virus significantly damages the respiratory system. According to the World Health Organization (WHO), the main symptoms of the coronavirus usually include a dry cough, temperature, tiredness and/or shortness of breath, and in more mild cases, patients may have “aches and pains, nasal congestion, runny nose and a sore throat”. More than 122,000 cases have been confirmed worldwide and the number of deaths from the virus has reached around 5,000 globally. The country most affected remains China which has, to date, reported approximately 80,800 cases. Italy, which has reported 10,150 cases, remains the most affected European country. The death toll there has now surpassed 1,000. Though any death is tragic, compared to these countires, the UK’s number of victims remain small. Perhaps extreme plans like the quarantining of cities won’t need to go ahead in the UK, but an awareness and preparation for the worst-case scenarios couldn’t hurt.

What we know In the first big analysis of more than 44,000 cases from China, the death rate was ten times higher in those aged 80 and over, compared to the 30 to 50 age group. This data, gathered from the Chinese Centre for Disease Control and Prevention, found that in more than 80% of cases the symptoms were mild, but the sick and elderly were most at risk. Basic advice from the WHO states that respiratory viruses can be avoided by washing hands and avoiding people who are coughing and sneezing. However, will this be enough to protect those who are, statistically-speaking, the most vulnerable? There has been much coverage surrounding care homes’ response to the outbreak. Many homes, including Barchester Healthcare, which runs more than 200 homes in the UK, has asked families and friends of care home residents to make only “essential visits” to try to help minimise coronavirus infections. It said: “We have not taken this decision lightly, and appreciate that this may cause some discomfort, but feel that this is a necessary step to take.” Many other care homes across the country have followed suit.

Safeguarding “It appears that the virus will have a significant impact in the UK and from the government plans, it is clear that they are doing all they can to minimise the current impact at this time”, says Julie Rayner, governance and compliance director at Hallmark Care Homes.

HealthInvestor UK • April 2020

NEWS FOCUS

Coronavirus “As a precautionary measure, and in line with best practice, we have requested that guests including family members and friends delay visits for the time being. ” Karen Johnson, clinical director for HC-One, comments: “To further minimise the risks to residents, the most up-to-date and comprehensive advice on how to prevent the spread of the infection is regularly issued to all HC-One homes, most recently updated this week.” Both HC-One and Hallmark Care Homes outlined to HealthInvestor UK extensive steps they are taking to prevent the spread of the virus within their homes and also detail the initiatives staff are currently setting in motion. Rayner comments: “Any visitors who have returned from any of the category one or two areas as detailed by the UK government will be asked not to visit the home for 14 days following their return to the UK.” Category one areas include China, Japan, South Korea, Japan and Iran. Rayner continues: “All team members who have visited any of the category areas will be placed on medical suspension for 14 days following their return to the UK.” “We will still ensure that vital medical visits are made, and will

HealthInvestor UK • April 2020

be sure that only visitors, such as similar to how it has spread in other health care professionals who have countries, such as Italy, in such a not visited any of the countries short space of time? identified by the government in the Johnson confirms: “HC-One has last 14 days and are not displaying comprehensive contingency plans in symptoms come in, and that they place in the event of a coronavirus outbreak and we are treating this wash their hands on entering.” Johnson says: “HC-One already matter with the utmost seriousness.” has comprehensive and robust At HC-One, a coronavirus steering infection control processes in place group, led by Johnson, has been to both prepare for and prevent the created comprising senior leaders spread of infection. These processes from all areas of the business. She apply to colds, the flu and other says: “This group engage with each contagious illnesses which may other regularly to review and further affect care homes, and crucially develop our plans in response to will also be the latest effective in advice from preventing the government and risks posed by the devolved coronavirus.” assemblies, the The health and “We are NHS and public welfare of our health bodies. currently residents, visitors The HC-One working with and team is our coronavirus our homes and number one priority our suppliers to steering group ensure continued continues to access to required closely monitor equipment, such this evolving as sanitisers, and situation and we are taking steps to make sure our engages with all relevant authorities supply chain remains robust as the to provide homes with the latest and most important information.” situation across the UK evolves.” At the time of writing, the virus If the situation worsens in the UK has infected hundreds In the UK, we are currently in the with 10 reported fatalities so far, delay stage of the virus, but what if though by the time you’re reading the situation worsens significantly, this, the number will most likely

have risen. We can all speculate, but no matter the inevitability of the spread, it’s clear from the homes HealthInvestor UK has spoken to that there are various safeguards and plans in place to protect some of society’s most vulnerable elderly citizens. Rayner concludes: “We have cancelled our community events and external entertainment for the foreseeable future. We have a committed and dedicated team that will do all they can in the interim to keep residents safe, entertained and comfortable.” “All of our team have already been provided with training on the coronavirus and we have asked our team to self-isolate for 14-days if they are displaying any symptoms of the coronavirus. The health and welfare of our residents, visitors and team is our number one priority and we will keep all stakeholders updated with further developments.” And Johnson mirrors: “In the event of an outbreak, we are well placed to draw on our workforce from across the country to provide continuity of care in an affected home. We would also work with the relevant authorities, in line with their long-standing pandemic response plans. The health and safety of our residents and colleagues is of paramount importance.” n

COVER STORY

Patient or product? The data universe is growing at an astonishing rate, offering unprecedented insights into every aspect of healthcare. Rob Munro examines the Big Data explosion and what it means for providers and investors

HealthInvestor UK â&#x20AC;˘ April 2020

COVER STORY

ig Data for many people equates with Big Brother. The recent exposés of dubious practices by social media companies revealed users being targeted by everyone from mainstream political parties to Russian trolls based on sophisticated analysis of online behaviours, preferences and opinions. Psychological profiling and so-called ‘microtargeting’ feels intrusive and sinister. Indeed, social media users lured into giving away every detail of their lives to platforms which offer seemingly limitless functionality ‘for free’ must now consider themselves products rather than customers. But however uncomfortable it may make us, Big Data is here to stay. But what does that signify, what is the scale of the information circulating in the data universe? To answer that question, it’s necessary to consider a few numbers. Just 15 years ago, The International Data Corporation (IDC) estimated the size of the digital universe to be around 130 exabytes. By 2017 it had grown to 16,000 exabytes or 16 zettabytes. In 2020, the IDC estimate the it will be in excess of 40 zettabytes. If you’re not familiar with the taxonomy of data metrics, now might be a good time to brace yourself. Like the physical universe, the data cosmos is almost beyond comprehension in its scale. The number of bites in a zettabyte is one followed by 21 zeros – large enough to accommodate 36 million years of high definition video. And there are currently the equivalent of 5,200 gigabytes of data for every one of the seven billion human beings on earth. And in common with our ever-expanding physical universe, the data universe is growing

at a phenomenal and quickening speed. By 2025, the IDC estimate that a staggering 463 exabytes of new data will be created on a daily basis.

Big data and healthcare So what does this ineffably vast and growing universe mean for healthcare and where do the investment opportunities lie in the brave new world of Big Data? Using artificial intelligence to analyse these huge datasets is at the heart of the coming revolution in healthcare and nowhere is there greater potential than in the area of diagnostics. For example, research recently published in Nature involving collaboration between Google Health, DeepMind, Imperial College London, the NHS and Northwestern University in the US found that computers using AI to analyse mammograms could detect breast cancer more reliably than expert radiologists. In fact the AI algorithm outperformed both the historical decisions made by the radiologists who initially assessed the mammograms and the decisions of six expert radiologists who interpreted 500 randomly selected cases. The potential for rapid and reliable clinical judgements made by machine is a holy grail for healthcare services worldwide and is coming ever closer. A scenario where a patient is admitted as an emergency and given a CT scan in the middle of the night with the results interpreted and treatment decisions made without human intervention is maybe five years away. The engine driving such revolutionary change is machine learning. In the Nature research, the algorithm used was developed after analysing nearly 30,000 mammograms.

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HealthInvestor UK • April 2020

Unit

Value

Size

bit (b)

0 or 1

1/8 of a byte

byte (B)

8 bits

1 byte

kilobyte (KB)

1,000 bytes

megabyte (MB)

1,000 bytes

1,000,000 bytes

gigabyte (GB)

1,0003 bytes

1,000,000,000 bytes

terabyte (TB)

1,0004 bytes

1,000,000,000,000 bytes

petabyte (PB)

1,0005 bytes

1,000,000,000,000,000 bytes

exabyte (EB)

1,000 bytes

1,000,000,000,000,000,000 bytes

zettabyte (ZB)

1,000 bytes

1,000,000,000,000,000,000,000 bytes

Data source: Visual Capitalist

DATA UNITS COMPARISON

COVER STORY

▶ The lure of the NHS To teach machines to make clinical decisions, they must be fed with huge amounts of information and that has to come from somewhere and that is why the UK’s universal health service, with its wealth of health data, holds such an attraction for healthcare companies. Adam Steventon of the Health Foundation says the speed at which we are capturing personal data is a double-edged sword, providing both opportunities and challenges. Writing in his blog recently, he said: “Data are being used to drive innovation in ways that can revolutionise healthcare, helping us to detect disease much earlier, move care closer to home, and encourage health promoting behaviours. The same technology also has the potential to exacerbate health inequalities, decrease social connectedness, and increase demand on an overstretched health and social care system.” Steventon also points out the seeming anomaly that, while being one of the largest universal health systems in the world, the National Health Service is grossly inefficient in its data gathering and analysis. “As a universal health system, the NHS should have the best health data in the world. However, currently data sets are fragmented and incomplete, offering only a partial view of the health and

experiences of individuals. Social care data are underdeveloped,” he says. Of course many commercial organisations would love to help the NHS resolve its issues in exchange for a significant slice of the data pie but there are problems with public confidence. Google for example encountered difficulties when it acquired the UK AI company DeepMind last year. DeepMind had contractual arrangements with several NHS trusts to provide services and research and there was widespread concern over the tech giant gaining access to patient data. University College Hospitals NHS Trust, one of the organisations involved, was quick to reassure the public that their data was safe from commercial exploitation. In a statement it said: “We will retain control over the anonymised data and remain responsible for deciding how it is used,” adding: “The anonymised data is encrypted and only accessible to a limited number of researchers who are working on this project with UCLH’s permission. Access to the data will only be granted for officially approved research purposes and will be automatically audited and logged.” Steventon at the Health Foundation says more needs to be done to build public confidence if health data sharing is to become a reality.

SIZE OF THE DIGITAL UNIVERSE 40,000+ exabytes

40,000

35,000

25,000

20,000 16,000 exabytes

15,000

10,000

5,000 130 exabytes

0 2005

2017

2020

Year

HealthInvestor UK • April 2020

Data source: The International Data Corporation

Data (exabytes)

30,000

COVER STORY

“The system needs to develop skills and capacity to ensure the NHS (and therefore patients) obtains the right value from any commercial data sharing,” he says. “Data outside of the health and care system can also be valuable, for example data held by social media or health technology companies, so we will need to broker new kinds of data sharing. We also need to build public trust for the use of data.” Mindy Daeschner of Daeschner Consulting questions whether the use of AI will lead to more personalised medicine and a move from ‘sick care’ to ‘health care’ as trends and behaviours that predict illness become apparent. “The global AI market is expected to experience massive growth with revenues increasing from $9.5 billion in 2018 to $118.6 billion in 2025,” she says. “Corporate America is expected to capture $16 trillion in AI gains over the next decade, so AI is going to have an impact across the board. But, policy and funding will be the big drivers for changing how we view healthcare. Personalised medicine needs a holistic approach and right now healthcare is still very siloed. Culture must change as those that collaborate will be better positioned and that means governments, industry and healthcare providers. Key to all of this is data. It is not an afterthought, but how value should be derived.”

HealthInvestor UK • April 2020

Daeschner predicts that the tech mantra to “move quickly and break things” will apply to the new healthcare landscape, but comes back to the issue of trust and confidence in who will do what with all that personal heath data. “We are going to see disruption and convergence that will challenge existing business models, so the transition is going to be painful, but ultimately rewarding. To understand the future opportunities, we first need to look at the healthcare model from the patient’s perspective verse provider or payer. Where is this data coming from? What value will it create? Can we democratise it?”

Changing the relationship So where does all this data come from and what are the barriers for companies keen to enter the market? “There are three primary sources of big data in medicine,” says Daeschner. “The first source of big data, including electronic medical records (EMRs), claims and billing data, imaging data, and pharmacy data, is providers and payers. The second is omics, including genomics, proteomics, and metabolomics. The third is patients and non-providers, ie, data from smartphone and internet activities, sensors, and monitoring tools.”

She points out that research shows that in the future, about two-thirds of all medicalrelated data will come from patient-created sources. Daeschner feels the need to maintain accurate datasets will lead to a renewed, more equal relationship between healthcare providers and patients. “The biggest barrier is access and interoperability, but this is changing,” she says. “There are also issues with data quality in many areas of healthcare with incomplete or up-to-date records, lack of information in key areas and generally just poor data, which also presents a legal issue as to liability; who is responsible for keeping this data up-to-date and accurate? The best person is the individual, as they have the biggest stake in owning their own health. The move to personal and portable health records will play a big role in the move forward regarding personalised medicine. “Although social media has been in the spotlight, we should not forget there have been big data breaches from the NHS as well. Patients wants great healthcare, and they want convenience. They will give access to their data if it means they can get these. They are already doing it in many other sectors, but it must be their choice.”

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COVER STORY

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Justin Crowther, head of UK healthcare at investment bank Alantra, also believes that the way providers and patients interact is due for a radical change as the data becomes increasingly commoditised. “Health needs to start thinking about people as customers. Health and social care need to be changing their language,” he says, adding that providers will seek to foster long-term relationships with patients in the manner of banks and other service-based industries.

Gazing into the crystal ball Octopus Ventures is spending a lot of time gazing into the crystal ball of healthcare investment, and Will Gibbs, a partner in the company’s future of healthcare team believes that data will drive innovation and transformation across the board. One area he points to as being ripe for AI innovation is fertility services. While traditionally the emphasis has been on female difficulties with conception, data analysis and prediction now gives clinicians the opportunity to investigate the relationship between sperm and ova and to understand the variables involved. Gibbs cites Mojo, a UK-based start-up, as an example. The company intends to launch a service to fertility clinics this year that will automate the procedure for producing sperm counts in the first stage of a strategy that will identify which sperm characteristics are associated with successful conception. Chief executive Mohamed Taha says that the data will help clinicians to understand “what is a good sperm, what is a bad sperm”.

Healthcare versus sick care The rise of Big Data will transform every aspect of healthcare across the globe from epidemiology, diagnostics, treatment, health economics and

management, but perhaps the most significant change will be in the way we take responsibility for our own wellbeing. The current interventionist medical model emphasizes the role of the patient as a passive recipient of care who consults a ‘expert’ clinician when symptoms of disease have become apparent. This fundamentally unequal relationship at best leads to a sense of disempowerment and at worse, an adversarial, sometimes litigious, environment. “Let’s face it, the cost of care and clinical negligence has continued to increase at an alarming rate,” says Daeschner. “We have to do things differently. Solutions will be created to drive transparency, real-time decision-making and embed continuous learning. Patients and providers will be partners, not adversaries.” “Patient-created sources (that is, data from smartphone, internet activity, sensors and monitoring tool) will be generating about twothirds of all medical-related data in the next decade. The pendulum is swinging in the patient’s direction.

“It requires a different approach and one focused on the goal, not the transaction. It requires collaboration, as the siloed approach of today isn’t going to produce the value or the benefits we need from pharma and healthcare providers. Solutions will be tailored given our medical history, our biology and our behaviours.” All good stuff, but these goals will be affected by resource pressures and workforce issues and Daeschner for one is clear that we have a mountain to climb. “We cannot magic up more trained resource and we are heading for a crisis as there will be a global shortage of qualified healthcare workers,” she says, but adds that automation and innovation may mitigate these growing pressures. “Referral and screen programmes are going to be transformed as are waiting times. Autonomous training and robotics will proliferate. We will have quicker access, faster diagnosis, better outcomes,” she says.

An opportunity and a challenge In the ideal healthcare world, always-on data that prioritises interoperability will promote closer collaboration between care givers and care receivers. New service models will be offered both by existing operators and disruptors. Interventions and treatments will be better targeted, simpler, safer and less expensive. We will have access to and, crucially, own our health data, making real and informed decisions about our care and treatment. But if this model is to work, investors must back businesses in which the public has confidence. Big Data is presenting us with a huge opportunity to change the way care is delivered, but the stakes are high and earning, and keeping the trust of increasingly empowered consumers has to be the highest priority. n

HealthInvestor UK • April 2020

Summit 2020

05 NOVEMBER 2020 LONDON The HealthInvestor Summit brings together the leading individuals and organisations across the UK independent health and social care sector for a major conference addressing investment activity, political risk and regulatory developments, market trends, quality and regulation and innovation from across the sector.

For more information about the event, registrations, sponsorship and speaker opportunities contact our events team on +44(0)20 7104 2000, email events@investorpublishing.co.uk or visit our website. #HISummit

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OPINION

How we can help Cygnet Health Care director of Nursing David Wilmott suggests that the independent sector can take steps to allieviate the nursing recruitment crisis

he challenges facing nurse recruitment for both the NHS and independent sector will be familiar to many. What will also be familiar is healthcare commentators calling for more money as the solution. But – as is sometimes implied – is that the only remedy available? The introduction of the £5,000-a-year maintenance grant for student nurses is, of course, to be warmly welcomed. But there are also a broader set of reforms which I believe can contribute to improving the recruitment of nurses in this country. Indeed, I believe that those of us in the independent sector need to speak up more about what we think can be done (and that we can do) to support nursing recruitment. And the good news is that there are several things that can be done now.

Understanding the problem The first thing to acknowledge is that across the public and independent sectors there are not enough new nurses entering the workforce in the first place. Indeed, on 5 March this year the National Audit Office warned that the NHS has 43,000 fewer nurses than it needs1. So, the point is that this is first and foremost a recruitment rather than simply a retention issue, with declining numbers of students applying to study nursing, coupled with a drop in the number of applications for nursing roles. Indeed, to put this decline into some historical context, while at the end of 2015 there were 103,826 applications for nursing and midwifery roles, this number had fallen to 91,189 by the end of 2017.2 At the same time, NHS statistics show that, sadly, the quality of applications are declining, with fewer applicants being shortlisted – a drop of 47.1% between 2015 and 2017. In other words, not only is there a lack of people wanting to be nurses, but there’s also a lack of the most able people applying for nursing positions.

David Wilmott, Cygnet Health Care

Treating the symptoms and the cause Money of course matters, so that is why it is good to see the government recently announce £975 million of funding earmarked to provide community mental health services. The introduction of the £5,000 grant for student nurses is also a progressive move, and the additional £3,000 top-up for those training in sectors where care is harder to recruit – such as mental health or learning disability care – goes some way to recognising the challenge facing the profession. Beyond more investment, however, I would advocate a focus on three important areas. First, while seeking to improve recruitment, we must not forget about retention. So we need to keep up the good work in changing work-life practices so that nurses stay in the profession. The good news is that the health service has started to tackle this and has, notably, included a commitment to flexible working policies as part of the NHS Long Term Plan. Second, while the government has a difficult job in trying to please everyone when

constructing new post-Brexit immigration rules, I hope (and I am hopeful) that ministers ensure we don’t limit the number of potential nursing recruits from overseas. But I also believe passionately that UK healthcare as a whole, and especially the independent sector must not simply wait around for government to act. We should instead play our role too. So the third area I would focus on is encouraging independent providers to develop new routes into nursing. This is something we have done at Cygnet Health Care and which we plan to develop further in the coming years. We call it our nursing associate apprenticeship programme – the first of its kind within the independent sector. In a nutshell, the scheme enables apprentices to work in Cygnet hospitals for a minimum of 30 hours a week and then spend one day a week with the rest of their group studying and being supported by lecturers from the University of Wolverhampton or the Open University. I am delighted to say that we welcomed our fourth cohort of apprentices last month and we’re looking forward to congratulating the first graduates from the two-year programme this spring. We are committed to expanding and developing the scheme going forward. We are also now rolling out a new child and adolescent mental health services apprenticeship to develop our staff and extend our nursing career pathways. I am of course realistic that the nursing gap facing this country will not be solved by one programme alone. Funding is a necessity and if we work collaboratively on sector-wide innovations to attract, retain and recognise nurses for their compassion and skill, then the money can have a greater impact that will ultimately bring benefits for the very people nurses are motivated by – their patients. n

1. politicshome.com/news/uk/health-and-care/nhs/news/110339/nhs-has-43000-fewer-nurses-it-needs-government-spending 2. telegraph.co.uk/news/2018/07/27/nhs-increasingly-desperate-nurses-midwives-applications-continue/

HealthInvestor UK • April 2020

AUTISM AND LEARNING DISABILITY CARE

An arbitrary number What is the current state of autism and learning disability care following demands for the CQC to scrap its requirement for all units to have no more than six beds? Kathy Oxtoby reports

housands of people with autism and learning disabilities are living in inappropriate settings. And it is all down to an arbitrary figure – six. So says Care England, which has called on the government to drop the cap on care home learning disability places. According to the charity that represents independent care providers, the limit of six places for adults with autism or learning difficulties in a care home has left more than 2,000 individuals requiring specialist accommodation in hospital or inappropriate assessment centres. “We are concerned this policy is consigning people with learning disabilities and autism to inappropriate services,” says Professor Martin Green, chief executive of Care England. He says the failure of the Department of Health and Social Care’s Transforming Care programme to close 30% to 50% of inpatient beds for those with learning disabilities and/ or autism by March 2019, is largely attributable to the Care Quality Commission’s limit on the number of rooms allowed in a learning disability home.

Unit limitation This unit limitation is having a large-scale impact on individuals and their families. According to the National Autistic Society, a survey of around 11,000 autistic adults and their families in England and evidence sessions in Parliament, published last autumn, found that: • Three in four (76%) autistic adults had tried to obtain mental health support in the previous five years; almost two thirds (64%) of families had tried the same • Six in 10 (58%) autistic adults say they need counselling, but only one in five (21%) get this support. Four in 10 (40%) of families need this support but only one in 10 (11%) get it • Four in five (82%) autistic adults believe the process of getting support from mental health services took too long; over eight in 10 (87%) of families believe this is the case • Only 14% of autistic people think there are enough mental health services in their area to meet their needs; 11% of families think this. The survey was part of an inquiry by the All Party Parliamentary Group on Autism, with support from the National Autistic Society, exploring the impact of the Autism Act 10 years after its introduction.

The inquiry heard that as a result of not getting support, many people with autism are becoming isolated and at risk of developing mental health problems. The National Autistic Society says: “Services like social groups, befriending, or help to get people out and about can make a huge difference to autistic people’s wellbeing, but are often not available. Too many develop mental health problems because they can’t get this support early enough and, as a result, an increasing number end up in mental health hospitals miles away from their friends and family – and in some disturbing cases, inappropriately restrained, over-medicated and kept in isolation.” The government has acknowledged the need to develop community services for people with a learning disability and/or autism – the NHS England strategy ‘Building the Right Support’ from 2015, set out the target to close up to 50% of the beds in the hospitals by March 2019. However, according to the learning disability charity Mencap, only 22% of beds were closed by that date. The new target of closing 35% of beds by last month has probably not been met, Mencap says. And another target, of closing 50% of beds was published in the NHS Long Term plan last year, to be achieved by March 2024. Data released from NHS Digital shows that in January this year 1,950 adults and 235 children “continue to be locked away”, Mencap says. “There has been little change in the number of admissions with 100 people admitted in January alone. While 140 people remained in hospital when they are ready for discharge, with the main reasons being a lack of social care and housing provision in the community,” the charity says. Mencap says discharge delays continue – that there are 140 people with a learning disability and/or autism who should be back home in their community. There are a high number of reported uses of restrictive inventions – 3,500 in one month, of which 805 were against children. It says this is likely to be just the “tip of the iceberg” as only data for three out of 18 private/independent providers and 28 out of 54 NHS providers was gathered. And the average total length of stay in in-patient units remains at 5.4 years. The charity is concerned that “there is still no robust cross-government strategy to ensure that health, social care, education and housing work together to stop inappropriate admissions and get people out of inpatient units”.

2,185 inpatients were in hospital at the end of January 2020*

32% of inpatients last had a review of their care over six months ago (700 people)*

HealthInvestor UK • April 2020

AUTISM AND LEARNING DISABILITY CARE

Dan Scorer, head of policy and public affairs at Mencap, says this “national scandal has been allowed to continue for far too long”. He says NHS Digital’s latest figures indicate that “the government and NHS England are set to miss yet another deadline while over 2,000 children and adults with a learning disability and/or autism remain locked away in these ‘modern day asylums’ at risk of abuse and neglect”. Vivien Cooper, chief executive of the Challenging Behaviour Foundation, the charity for people with severe learning disabilities and behaviour challenges, says children and adults with learning disabilities and autism remain in inappropriate services, often far from their homes, because the Transforming Care programme has not delivered what was promised in 2012. She says these individuals and their families are living with the consequences of “this failure”, as highlighted by this latest data, showing that incidents of restrictive interventions have increased, with 805 incidents on under 18s, including 80 incidents of prone restraint. “It is clear that another target – set by the government itself, and the lowest end of it – will be missed again.” Cooper says it is time for “a new approach, focused on investment in community support and action to protect the human rights of children, young people and adults with learning disabilities and autism”.

58% Professor Martin Green, Care England

effectiveness of management, and evidence base for the proposed care model. We share Care England’s concerns about the progress of delivering the ambition set out in Transforming Care. “Our ‘State of Care 2018/19’ report focused on how an absence of community services for people with a learning disability, autistic people and people with mental health CQC response to concerns conditions meant some were being cared for a long way from Responding to Care England’s call to end its current their homes and not receiving the best outcomes. requirement for units to be six beds or fewer, Kate Terroni, “As we highlighted in our ‘State of Care 18/19’ publication, chief inspector of adult social care at CQC we call for consistent community told HealthInvestor UK that the regulator’s provision to sufficiently meet the needs focus is “ensuring that people receive of people with a learning disability and/ We are concerned high-quality, person-centred care”. or autistic people.” “For providers of services that provide this policy is care, or that might intend to provide Inappropriate housing consigning people in hospital care in the future for people with a with learning learning disability and/or autistic people These people’s needs, extreme disabilities who display behaviour that challenges, vulnerability, and the importance of and autism to including those with a mental health ensuring a safe environment for them, condition, we will adopt the presumption were highlighted in 2011 with the inappropriate of small services “usually accommodating Winterbourne view abuse scandal. services six or fewer”. “People who should have been in shortterm care who were in a short-term crisis She says this position is “in line with should have gone home. Instead they were best practice as set out in ‘Building the staying on an average of five years,” says Scorer. And he says Right Support’”. She stresses that the CQC “do not adopt the NHS England 2015 strategy ‘Building the Right Support’ ‘six’ as a rigid rule for providers of any service for people “about closing beds in these hospitals and developing the with a learning disability and/or autistic people”. right housing in the community hasn’t happened”. “We may register providers who have services that are That more than 2,000 people were in inappropriately small scale, but accommodate more than six people, if they housed in hospitals in January this year according to NHS can demonstrate that they follow all of the principles and Digital, while the “CQC should be monitoring quality not values in ‘Building the Right Support’ guidance, and meet the size of facilities”, prompted Care England to call for the fundamental standards and other relevant regulations,” action, says Green. “The figure six is arbitrary – there’s no she says. CQC knows that “the provision of care to people with evidence for it,” he says. As a result “people are languishing a learning disability and/or autistic people is complex”, in long-term hospitals with nowhere to go”. she says. “There are multiple factors that affect outcomes The limit also affects care providers, as small services require “extra money to be invested in them – you don’t for people and that is why we do not consider the size of get the economies of scale”, Green says. service in isolation from other factors such as staff skills,

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HealthInvestor UK • April 2020

of inpatients in hospital at the end of January 2020 had a total length of stay of over two years (1,260 people)*

52% of inpatients have a date planned for them to leave hospital (1,130 people)*

*According to NHS Digital statistics

AUTISM AND LEARNING DISABILITY CARE

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Global investment manager AMP Capital agrees with was hospitalised. “When they wanted to return to the home Care England’s view. Julie-Anne Mizzi, AMP’s global coCQC wouldn’t register an extra bed,” says Green. head of infrastructure health says the business believes Scorer says many families are “battling to get loved ones that “person-centred care is not about a one-size-fits-all, out of these hospitals and back to communities. We know arbitrary standard”. of cases of physical restraint, people being pumped full of “In our approach to healthcare investments, there is a antipsychotic medication, and kept in isolation”. standout attribute which makes organisations attractive The limit on beds is also having an impact on healthcare to us – quality of care. The satisfaction of the people we as a whole. Green says people who should be in the community are in hospital ‘bed blocking’. And the limit is support depends on this same attribute.” She says maintaining a high-quality discouraging investment in community of care is “far more important than a care, he suggests. standard setting”. “We do not believe Currently, there are challenges there is a direct link between the number associated with having a new home We do not believe of beds and the quality of care provided, registered given the uncertainty and there is a direct which has a stronger relationship with unpredictability of the implementation link between the culture, talent management and support, of registering the right support, Mizzi and funding. Importantly there is no says. “This has meant that even in number of beds compelling evidence in any research of circumstances of strong user demand and and the quality of scale and applicability that ties quality encouragement from the local authority, care provided of care to homes with no more than six we are unable to proceed in procuring new accommodation to meet the identified beds – ‘the six-bed rule’. “Furthermore, there is an increasing need,” she says. recognition that an individual’s care path “There is a well-intentioned emphasis should be tailored to their preferences, and the prescriptive on providing care in a community setting, avoiding rural or isolated settings; but this kind of setting may not actually suit nature of the requirements means there will be less choice a person who enjoys a quieter environment, and taking such for the people we support,” she says. a prescriptive approach will reduce the options available to Impact on individuals and healthcare the diverse individuals who depend on our services,” she says. The impact of the ‘six-bed rule’ on individuals of inappropriate Unfortunately, many people requiring long-term care are placements can be devastating. One of the many cases that having to stay in hospitals for extended periods, rather than appropriate care settings. “Currently supply of care does stand out for Green is of an individual who had lived in a residential home for many years, then had a breakdown and not meet demand, and again, we believe the focus should

HealthInvestor UK • April 2020

AUTISM AND LEARNING DISABILITY CARE

New draft guidance – Care England’s perspective Care England discusses the ‘Right Support, Right Care, Right Culture’ draft policy and its potential implications

be on supporting those providers who offer high-quality and personalised care to make these services available to more people, rather than putting in place arbitrary accommodation restrictions which are not a necessary or sufficient condition to guarantee high-quality care,” says Mizzi.

A call for change For Mizzi, the solution for autism and learning disability care is to provide choice to people with learning disabilities and their families as to their preferred type of accommodation. Care England wants to see CQC focus “entirely on the quality of the service and to register the service on that, and not its size”, says Green. “We’re challenging CQC’s policy on the number of beds, and publicising it. We’re telling people about the impact it’s having on people’s lives, and if CQC won’t change its stance we’re asking the government to tell them to,” he says. Mencap and the Challenging Behaviour Foundation have called for urgent cross-government action and investment in social care to enable children and adults to get the right support in their community. Scorer says the government must now deliver on its “broken promises and develop the community services needed up and down the country so people who have been locked away for years can get out of these modern day asylums and get back home, close to their loved ones, with the care and support they deserve”. The National Autistic Society’s report makes a number of recommendations, including calling on the government to “set out and deliver an ambitious plan to move autistic people out of hospital and into the community – succeeding where existing programmes have failed”. The charity also recommends NHS England commits to improving and expanding community mental health care for autistic people, for instance by introducing an autism-specific Improving Access to Psychological Therapies programme. And it wants NHS England to make sure autistic people get the mental health support they need from professionals who understand autism. “We are raising this with CQC,” the autism charity says. “It’s vital that autistic people get to live in homes that are right for them – not just institutions by another name. So we’re asking how they will reflect this better in the final guidance.” If calls for change are not recognised and realised, Green warns: “There will be no new services developed for people with learning disability and autism. And those people languishing in hospital will be joined by many more because nobody is going to invest in [this care] – they’re just not going to get a return on it.” n

HealthInvestor UK • April 2020

“On 31 January 2020 CQC, via CQC, CitizenLab released two documents which concern the revision of the ‘Registering the Right Support’ (RRS) policy, which has now been renamed ‘Right Support, Right Care, Right Culture.’ CQC gave stakeholders a period of only nine working days to take a nine-question survey to provide feedback on the guidance. “The draft guidance seems to be aimed at changing the direction of the original RRS guidance in that it appears to remove any reference to a rigid adherence to particular models or configurations of care, and appears to recognise that the approach required needs a stronger emphasis on the services which commissioners, the individuals and their families actually want. “However, this proposed guidance does not address our continuing concern that CQC will neither register nor allow the continuation of registration for services over six beds. “This is evidenced by key wording from the original RRS guidance being omitted from the new draft guidance, namely, CQC ‘does not wish to be overly prescriptive, and it is not our intention to create a one size fits all approach’. “There is no compelling evidence in the NICE review, and indeed CQC has never provided any evidence, that care homes over six beds cannot provide good quality, person centred care. Our members can demonstrate compliance with the nine core principles of the National Service Model and have achieved ‘good’ and ‘outstanding’ ratings for services which are of more than six beds. “Consequently, concern remains that the viability of the adult social care sector, including services for people with learning disabilities and autism, is under threat and that the model of care which is already meeting people’s needs and ensuring community based support will be eliminated without any evidential basis to justify such an outcome.”

VETERINARY SERVICES

HealthInvestor UK â&#x20AC;¢ April 2020

VETERINARY SERVICES

Animal instincts The UK’s veterinary and pet care sectors have attracted a great deal of private equity interest in recent years, which looks likely to continue, as Jenna Lomax reports

he veterinary investment landscape is changing. Gone are the days where local vets just offered our pooches and felines simple check-ups and a dose of worm tablets. Many more services are now available, which means investment opportunities are abundant. Nearly half of British households own a dog or cat, equating to 11.1 million cats and 8.9 million dogs. These furry friends require a range of standard services, such as vaccinations, flea treatments, microchipping, and pet insurance policies. Though some of these are not compulsory, all are recommended. And there’s also a booming trade in superficial ‘designer’ non-essential pet services, including grooming, animal nutrition, toys, furniture, and now even IVF canine clinics. Vet Record, a veterinary journal, found at least 37 IVF canine clinics are currently in operation in the UK – a rise from just one known clinic in 2015. This reflects Kennel Club figures that indicate there were more dog IVF births in the UK in the past three years than there were between 1998 and 2015 – a trend linked to the rise in the popularity of brachycephalic breeds – dogs with short noses and flat faces such as pugs, shih tzus, and chihuahuas. But what is behind the rise of these kinds of services and why do the UK’s pet owners spend so much on their pets? Is it all about the ‘image? Are social media platforms such as Instagram, influencing us to buy pets with the right look, one that will attract the most likes or followers? Could it be a trend in Western countries to ‘humanise’ pets that is encouraging owners to spend more on their pet’s care? Or could it stem from the fact that fewer people are having children, or opting to have them later, which has led to a rise in individuals and couples opting for a pet instead of children?

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HealthInvestor UK • April 2020

VETERINARY SERVICES

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One particular study by the Organisation for Economic Co-operation and Development, showed that women in the UK are more likely to end up without children than almost anywhere else in the West.

He further explains that the UK veterinary sector is a fragmented provider landscape which, even just a few years ago, only counted for “a combined market share of less than 20%.” But this fragmentation is, and remains, a strength What the experts say as it “created a significant opportunity for businesses One reason for more income being spent on pets in the UK looking to scale rapidly and create market-leading integrated veterinary health platforms”, says Crowther. is “the willingness of the consumer to spend their disposable The need for such health platforms comes from the income on animal care”, says Justin Crowther, head of UK age-old law of supply and demand – in the UK these healthcare at Alantra. “Companion animal ownership levels vary by country which heavily influences demand for services.” services are needed and therefore those controlling the IBISWorld, a business analytics company supply will naturally try their best affirms this notion. In a recent veterinary to keep up. But the sector is not report, it said: “The level of household without its struggles, particularly in It is likely that these disposable income influences the amount the UK. spent on veterinary fees. When real As Crowther warns: “There are a groups, supported disposable income falls, households have limited number of corporate groups of by their financial less money to spend on veterinary services. scale in the UK with the knowledge, owners, will continue This hampers demand for industry services. scale and expertise to deliver marketto consolidate In 2019-20, real household disposable leading veterinary care services.” the market income is expected to grow, providing an There are also concerns about what the market looks like post-Brexit and opportunity for industry operators.” further in 2020 It’s clear there are specific consumer increasing scrutiny of some of the choices and lifestyles that have allowed sector’s dealings by the Competition private equity investors significant and Markets Authority. opportunity within the pet care and veterinary sectors, for Crowther says: “The CMA has begun to analyse proposed transactions by region. This has a material impact on quite a few years now. But how has the sector grown in such a relatively short period of time and what is the secret to groups well-established in certain geographies. If they wish investing opportunities remaining so abundant? – and how to make further acquisitions in these regions they may long can this really last? be restricted and, as such, other providers are exposed to relatively lower competition levels for high-quality assets. Crowther indicates: “Private equity, awash with liquidity, The relative lack of competitive tension has resulted in has played, and continues to play a major part in changing valuations somewhat plateauing and in certain scenarios the shape of the veterinary care ecosystem by securing the strongest veterinary platforms and subsequently growing has seen a decline in pricing when compared to 2018 them aggressively.” market highs.”

HealthInvestor UK • April 2020

VETERINARY SERVICES

He adds: “To date, they are yet to put a stop to proposed acquisitions, however, their mere presence has influenced several of the leading groups to seriously consider further acquisitions. To that end, these groups have spent significant money on legal advice to ensure a completed transaction doesn’t run the risk of being unwound by the CMA.”

Staff retention and Brexit Potential restrictions on the free movement of people between the EU and the UK could significantly hinder industry performance and inflate wage costs in the years ahead, according to IBISWorld. This is because the industry is “highly reliant on EU veterinary surgeons and nurses – a decrease in the number of EU migrants could therefore result in the industry’s labour shortage worsening over time”. The British Veterinary Association reports that, prior to the Brexit referendum, 40% of practices with vacancies already took more than three months to fill them, while figures gathered five months later, in November 2016, showed that this supply shortage had already worsened, with one-fifth of veterinary services reporting that it became harder to recruit staff following the referendum decision to leave. But Crowther says something adding further pressure to workforce numbers is the “increasing lifestyle demands of newly qualifieds, who are seeking flexibility and incremental earnings through locum agency-style arrangements”, which he says “could slow the growth in corporatisation as this approach is inefficient for providers and results in a higher total cost of care provision”. And where investment opportunities are concerned, Crowther says: “The more pertinent factor is the rate at which the leading groups are reaching market share saturation within domestic territories. These groups are having to look beyond their borders and a number of UK-based corporate chains have looked to Scandinavia, The Netherlands, Spain and Germany for further growth.”

hospital facilities of its kind in Europe – as well as a farm and equine practice, and 10 further veterinary practices in and around Derbyshire and Staffordshire. Elsewhere, VetPartners acquired Parklands Veterinary Group, a Northern Ireland-based group of mixed practices with sites in Cookstown, Dungannon, Coalisland, Aughnacloy and Portglenone in mid-Ulster. The acquisition expanded VetPartner’s portfolio to 107 small animal, mixed, equine and farm practices, with 4,600 employees working in nearly 400 sites. Overall, revenue from the UK veterinary sector reached £3.8 billion in 2018-19, according to IBISWorld, with compound annual revenue growth of 2.4% from 2014 to 2019. But what does 2020 have in store?

What’s ahead? Last year, August Equity, the investment service, acquired Hallmarq, a veterinary imaging company. Garret Turley, partner at August Equity explained to HealthInvestor UK: “The original investment thesis around humanisation of companion animals and the rising importance of advanced diagnostics has held true and EBITDA has increased significantly in this period [Q2].” Dissecting the sector on a national scale, IBISWorld estimates that UK revenue will amount to £4 billion for the financial year 2019-20, while Crowther predicts that investment in 2020 and beyond may not “follow the same path” as in previous years. He outlines that future investment “may come in the form of animal nutrition, pet wearables and ‘back-office’ technologies as opposed to veterinary clinic consolidation”, but concludes “the investment community likes certainty and for the foreseeable future we believe investment will remain strong in the veterinary ecosystem.” n

Recent deals Large chains, such as Mars Petcare and Nestle have invested heavily in the UK veterinary market in recent years, with the latter announcing that it has bought a minority stake in Independent Vetcare Group (IVC) in April last year. IVC is the UK’s largest veterinary care provider and has more than 1,100 vet clinics and hospitals across the world. The veterinary sector’s biggest companies – Mars Petcare (formerly Linnaeus), VetPartners, Medivet, Pets at Home, IVC and CVS “now account for more than 43% of total market share”, says Crowther. “It is likely that these groups, supported by their financial owners, will continue to consolidate the market further in 2020.” And, if we take a look back over the past six months, to what these big six and others achieved, there are plenty of examples to indicate that investment didn’t slow down in the second half of 2019. During this time, IVC acquired Scarsdale Vets (Derby), which consists of Pride Referral Hospital – one of the largest veterinary

HealthInvestor UK • April 2020

HEALTHCARE M&A

A confident market Jenna Lomax looks at some of the most recent industry deals and asks the experts for their predictions

HealthInvestor UK â&#x20AC;˘ April 2020

HEALTHCARE M&A

Kishan Chotai, August Equity

Justin Crowther, Alantra

he UK healthcare sector’s deal volumes have steadily most things, there’s always an element of uncertainty. How increased since 2015. And 10 years after the long can investors enjoy an ascending path in healthcare? financial crisis, it seems the sector has experienced What obstacles, if any, are standing in the way? a steady and promising upward trajectory. Could 2020 be Where investment is going following in the same vein? As mentioned, sexual diagnostics clinics, non-surgical care Recent data collated by financial services firm Alantra shows that 2019 was a record year for healthcare centres and transitional services are already providing the transaction activity in the UK, with capital increasingly sector with new investment and consolidation opportunities. invested into what it describes as “highly specialist services But what about other areas of healthcare – such as dentistry with potential for growth”, such as sexual diagnostics or veterinary care? clinics, non-surgical care centres and Veterinary care revenue is estimated to transitional services. amount to £4 billion for the financial year 2019-20, according to business analytics A total of 179 healthcare deals were completed last year, an increase of company, IBISWorld. It is one of many 17% on the sector’s 2018 total. And fragmented provider landscapes within Going into 2020, with liquidity high and interest rates healthcare which, even just a few years confidence is remaining low, experts say 2020 is likely ago only counted for “a combined market returning and to see more growth. share of less than 20%”, says Crowther. there remains “Going into 2020, confidence is Dentistry, which has less than 75% of plentiful liquidity returning and there remains plentiful practices under independent ownership liquidity,” says Justin Crowther, head of in the UK, “provides investors with both UK healthcare at Alantra. “These factors, an organic growth opportunity alongside combined with the strong M&A drivers an ability to consolidate”, says Chotai. “This is largely because of increased underpinning the healthcare sector, are creating a positive backdrop for attractive deal levels funding from the NHS and the rise of cosmetic dentistry this year.” such as teeth whitening”, he adds. “Investors have remained interested in healthcare As for healthcare real estate, Savills research shows that services because the sector has continued to demonstrate total UK healthcare real estate investment in 2019 amounted to more than £3 billion, double the £1.5 billion invested in buoyancy through the cycle especially in comparison to 2018. The firm highlights that this increase in transaction other traditional sectors such as retail and industrials”, volumes was “predominantly a result of continued appetite says Kishan Chotai, director at August Equity. In addition, the UK now has a more stable political from UK-based institutional investors and REITs attracted environment, with the Conservatives winning the general by long leases and indexed rental uplifts, as well as renewed election in December, and Brexit going ahead. But as with interest from overseas buyers.”

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HealthInvestor UK • April 2020

HEALTHCARE M&A

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Looking at 2020, the first three months alone have shown to £615 million in 2019, according to Savills. But Savills a promising upward trajectory in growth, albeit, not in all found that on the other hand, the primary care market healthcare-related areas. The biggest UK real estate deal of saw continued interest with 28 deals last year, following this year so far was conducted by MPT when it acquired 33 and 24 deals in 2017 and 2018, respectively. Overall, 30 private hospitals from Hospital Topco Limited for £1.5 since 2017, more than £750 million has been invested in billion. The deal was part of Circle Health’s acquisition of primary care facilities. BMI Healthcare, which comprised 54 hospitals in total. Commenting on these findings, Craig Woollam, head of MPT also paid £347 million for eight private hospitals Savills healthcare, says: “In a similar fashion to operators, from Secure Income REIT. investors are generally seeking care homes of the highest Elsewhere, Octopus Real Estate quality with strong profitability, and the announced it had finalised two significant paucity of new developments, not just in acquisitions in the healthcare space the last 12 months but over the past few this year. As well as raising a further years, has limited such opportunities.” £133.5 million for its Octopus Healthcare He adds: “Some investors and REITs Investors are Fund, the company acquired a portfolio have sought to counter this imbalance generally seeking by forward funding new developments, of six purpose-built care homes let on care homes of the which could not only add new quality long leases to Care UK, the UK’s largest highest quality with independent provider of health and social assets to their portfolios but also, in strong profitability... care, for approximately £110 million. theory, provide slightly better returns The real estate investment firm also than standing investments. With the began a joint venture with Audley Group, limited levels of supply we have seen a provider of luxury retirement villages, record pricing for investment products, and Schroders to fund the development however growth in trading multiples for the highest-quality homes and low interest rates have, of four retirement villages. The joint venture agreement covers the Audley Villages sites at Cobham in Surrey, for some owner operators, been sufficient to counter the Sunningdale Park in Berkshire, Scarcroft in West Yorkshire lure of investment funding and stick with traditional and Stanbridge Earls in Hampshire. debt funding.”

Elderly care

Looking overseas

In comparison to the strong growth in private independent hospitals, investment in the elderly care home market saw transaction volumes nearly halve from £1.2 billion in 2018

Looking abroad, international investors are seeking to invest significant capital into UK care services and REITs, more so since the general election.

HealthInvestor UK • April 2020

HEALTHCARE M&A

Crowther suggests that “European buyers have generally been more concerned about the UK’s exit from the EU than their North American and Asian counterparts.” But in the latter part of 2019 that concern seemed to ebb away. Crowther says this theme was highlighted in one particular acquisition – Ardenton Capital’s first investment in healthcare with the acquisition of Pebbles Care late last year. Pebbles Care is an operator of residential care for young people, situated across the North of England and Scotland. Discussing the acquisition, Crowther comments: “Ardenton Capital’s acquisition of Pebbles Care represents a clear opportunity for private equity and alternative capital providers to develop best-in-class services alongside successful incumbent owners and management teams seeking support to deliver long-term sustainable business growth by expanding services and increasing capacity.” Over the past year, investment into the UK healthcare real estate market has grown ever-more international, Savills research indicates, with 2019 seeing capital from the US, Europe, the Middle East and Asia competing with domestic money for buying opportunities.” Savills indicates that the largest care home deal last year was the £176 million paid by joint venture partners Cindat and Omega Healthcare Investors for a portfolio of 68 elderly care homes. Savills comments that this partnership of Chinese private equity and a NYSE-listed healthcare specialist REIT “demonstrates international capital’s growing appetite for the UK healthcare market”.

Opportunities for growth and consolidation Within the UK, Crowther indicates pressures on NHS funding are increasing demand for specialist outsourced solutions which are “increasingly relied upon to provide low-cost and highly efficient diagnostic and treatment solutions” in part to take the load off the NHS. He adds: “Government austerity measures, alongside the rationing of services deemed non-essential, continue to constrain those commissioning these services. The private sector is being used to absorb capacity and hopefully to improve NHS delivery through partnership models. Specialist services providing faster access to primary care through quicker diagnostics or the use of cutting-edge operational and clinical technologies are visibly helping to ease the growing public sector burden.” Although this burden is all too apparent in the NHS right now, elsewhere there is opportunity for those creating innovative products and outsourced solutions, especially within these specialist services. Ever-changing healthcare regulation and CQC rulings provide opportunities for tech companies to innovate and create new solutions constantly. Healthcare providers – whether they be management, clinicians or administrative staff – need to adhere to new rules, industry change and governmental regulation. As Chotai, says: “With the ever-changing and complex nature of healthcare compliance, specialist solutions help organisations adhere to regulatory requirements and improve efficiency.”

HealthInvestor UK • April 2020

Craig Woollam, Savills

Last year August Equity invested in CODE, a provider of compliance and HR services to dental practices in the UK. “The attraction of CODE is that once a customer uses the platform it becomes ingrained into their day-to-day operations as it digitises a manual paper-based process”, says Chotai, “making life easier for practitioners while ensuring they are compliant with the CQC’s regulations.” In addition, as aforementioned in the case of veterinary services, it is fragmented markets that also present consolidation opportunities and this also goes for many healthcare services. Some of the most popular healthcare services likely to experience more consolidation in 2020 are services such as physiotherapy, fertility and dermatology, Crowther predicts, as they “typically use a multi-site business model”. He adds: “The rising awareness of mental health and physical wellbeing is being reflected in consumer discretionary spending trends and, in turn, the emergence of a consumer healthcare marketplace. This can be categorised by both the level of medical need and the specialist nature of procedures.” Chotai comments: “Mental health, physiotherapy and dermatology are all markets which are yet to see any significant consolidation by investors and are growing strongly due to an increased focus on health and wellbeing.” He concludes: “There are still a number of consumer healthcare markets which have plenty of runway for consolidation. Other popular buy and build sectors still remain highly fragmented and attractive to investors due to their macroeconomic resilience.” n

10 June 2020 JW Marriott Grosvenor House, London

Finalists

Silver partner

Advisory & Finance Bank or lender of the year

Event partners

GB • AIB • Barclays & Yorkshire Bank • Clydesdale Fortwell Capital • HSBC UK • NatWest • OakNorth Bank • Shawbrook Bank • Consultants of the year – strategic

• Candesic • Carterwood Consulting • Connell EY-Parthenon • Marwood Group • PLMR • PwC • Rushport Advisory • ZPB Associates •

Consultants of the year – transactional

• Candesic Management Consultants • CIL Connell Consulting • EY-Parthenon • PwC • Corporate financier of the year Clearwater International Deloitte KPMG UK Lincoln International Orbis Partners

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ipevents.net/healthinvestorawards

Legal advisors of the year – private Bevan Brittan Browne Jacobson Bryan Cave Leighton Paisner Capsticks Solicitors CMS DAC Beachcroft Freeths Gowling WLG McDermott Will & Emery UK Pinsent Masons Shoosmiths Stephenson Harwood

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Legal advisors of the year – public

Brittan • Bevan CMS • DAC Beachcroft • Hill Dickinson • Mills & Reeve • Pinsent Masons • RadcliffesLeBrasseur • Weightmans •

Legal advisors of the year – transactional

Law • Acuity Bevan Brittan • Burges Salmon • CMS • Hill Dickinson • Lester Aldridge • Mills & Reeve • Pinsent Masons • Stephenson Harwood • Trowers & Hamlins •

10 June 2020 | JW Marriott Grosvenor House, London

RECOGNISING AND CELEBRATING ACHIEVEMENT IN THE BUSINESS OF HEALTH AND SOCIAL CARE

Technology Technology provider of the year Civica Healthcode Ltd London Ambulance Service Oxehealth Perfect Ward Person Centred Software uMedeor

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Clinical services Diagnostics provider of the year Alliance Medical UK London Ambulance Service Re:Cognition Health

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Primary care provider of the year Ascenti Fieldbay 2019 Inotec Premium Care Solutions Promedica24 Re:Cognition Health The Dermatology Partnership

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IT innovator of the year

Investment Private equity investor of the year Apposite Capital Downing Graphite Capital Intrinsic Equity (Orbis Partners)

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Private hospital group of the year

Healthcare • Aspen Health • Bramley HCA Healthcare UK • Kingsbridge Healthcare Group • Nuffield Health • Ramsay Health Care UK • Schoen Clinic UK • Spire Healthcare • Recruiter of the year

Recruitment Solutions • Appoint (Appoint Group) Group • Blackwood UK • Care Community Services • CareTech Meher • Gilbert Healthcare • Hunter Lewis Healthcare • Jane UK • Nurseplus • The Finegreen Group

For more information about the event and sponsorship opportunities, contact our events team on +44(0)20 7104 2000, email events@ investorpublishing.co.uk or visit our website.

Tickets and tables available now: ipevents.net/healthinvestorawards

• Ascenti Ltd • Healthcode HowDidWeDo? • Liva Healthcare • Log my Care • London Ambulance Service • My Clinical Outcomes • The Good Care Group • Zava •

Finalists

Silver partner

Event partners

Property Property consultants of the year – capital markets Avison Young BNP Paribas Real Estate Christie & Co Cushman & Wakefield Gardiner & Theobald Knight Frank

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Property consultants of the year – property services AECOM Aitchison Raffety Carterwood HealthCare Law Knight Frank MESH Construction Consultancy

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ipevents.net/healthinvestorawards

Property developer of the year Barchester Healthcare Care UK Frontier Estates Hamberley Development Medical Centre Developments Prime Renaissance Care Group

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Property investor of the year

Healthcare • Barchester UK • Care Social Housing • Civitas Advisors • Elevation Villages • Inspired Properties Trust • Medical Real Estate • Octopus • Patron Capital Advisers

10 June 2020 | JW Marriott Grosvenor House, London

RECOGNISING AND CELEBRATING ACHIEVEMENT IN THE BUSINESS OF HEALTH AND SOCIAL CARE

Public private partnership of the year Group • Keys Living Well, Taking Control • Mckesson UK • Regent’s Park • The Acute DataHealthcare Alignment • Programme (ADAPt)

Social care Community support provider of the year Eden Futures Gaudium Neural Pathways (UK) – part of the Active Care Group Venture People

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Complex care provider of the year

Care Group • Active Group • Christchurch Care Holdings • Complete Healthcare Group • Cornerstone Neurocare • Inspire & Co • Loveday Therapy and Care • Phoenix Care Solutions • Premium Oakleaf Group • The • Total Community Care

Domiciliary care provider of the year Careline Rochdale edyn.care Eidyn Care Gaudium Home Care Preferred MiHomecare The Good Care Group

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Residential care provider of the year

Care Homes • Athena Healthcare Group • Avery Healthcare • Barchester Healthcare • Canford UK • Care Court • Country Care Homes • Hamberley • HC-One Homes • Runwood • Strong Life Care

Tickets and tables available now: ipevents.net/healthinvestorawards

Specialist care provider of the year Accomplish Group Active Care Group Cornerstone Healthcare Group Eden Futures Horizon Care & Education Keys Group Loveday & Co Salutem Healthcare The Good Care Group Voyage Care

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#HIAwards2020

LEGAL LIABILITY

Who’s to blame? Law firm Bevan Brittan partner Dan Morris says the emergence of digital healthcare raises important issues about liability when things go awry

echnology is radically changing the way healthcare is delivered. Whether it’s patients consulting GPs through online primary care services, the use of clinically applicable artificial intelligence and deep learning in diagnosis and referral pathways, or robotic assisted surgery carried out across continents, rapid technological development is transforming the healthcare landscape. And it follows that the law needs to keep pace with these changes, particularly when things go wrong and questions of liability arise. But is it doing so? The reality is, liability in the digital age is an emerging area with many complex facets. It’s a challenge for legal regimes to move at sufficient pace, but ultimately legislators and courts will wish to ensure an equitable distribution of loss, coherence in the law, and effective access to justice – complexity and blurred lines of responsibility should not result in victims of harm being left uncompensated for their losses.

Existing liability regimes Broadly speaking, when a patient suffers harm while receiving healthcare the currently available avenues of redress are via tort, contract (both fault-based systems) or defective product laws such as the Consumer Protection Act 1987 (where strict liability can apply). In some situations, claimants might pursue an action under a combination of these regimes – for example, where a surgeon implants a prosthetic hip, questions might arise about: (i) The proper surgical technique (which would be dealt with in tort or contract, depending on whether the operation was performed in the public or private sector) and (ii) The safety of the hip implant itself (which would be dealt with under the CPA, as was the case in the Pinnacle metal-on-metal hip group litigation1).

Are the existing regimes fit for purpose in the digital age? The English law of liability has of course developed over centuries and has had to contend with every conceivable technological development along the way, whether that be railways, air travel, organ transplantation, or the latest endovascular stenting grafts. It is often said that the great beauty and elegance of the common law, in particular, is its fluidity and ability to adapt to the mores and problems

Dan Morris, Bevan Brittan

of each age. So in principle the law of liability should also be able to cope with emerging digital health technologies.2 But such technologies undoubtedly represent a step change. Because of their complexity, opacity, ongoing selflearning and intelligent adaptability, as well as autonomy – it can sometimes seem almost impossible to determine why a harm has occurred and who should be held responsible for it. There are also questions about scale and replicability of harm. If an individual doctor interacting with an individual patient makes a negligent diagnosis or recommends the incorrect treatment, the harm (albeit sometimes catastrophic) will be limited to one individual. But the same cannot be said about an algorithm. The widely reported Twitter spat3 between Babylon and @DrMurphy11 exemplifies just this point. Dr Murphy4 raised concerns about the appropriateness of advice given by Babylon’s chatbot to a 67-year-old obese, diabetic patient who smoked and was presenting with central chest pain. The point being that if the triage algorithm is flawed, as claimed by Dr Murphy (and I here make no judgment about that) then the same advice could be widely replicated and cause harm to a large number of individuals. It is little wonder then that some have questioned the ability of existing legal frameworks to get to grips with these issues.

HealthInvestor UK • April 2020

LEGAL LIABILITY

A modest proposal Various proposals have been made which suggest modifications that might be made to the law of liability to mitigate some of the difficulties posed by emerging digital health technologies. For example, the European Commission5 has made recommendations including that: • Strict liability (where someone is responsible for the damage without being proved to be at fault) is an appropriate response to the risks posed by emerging digital technologies, if, for example, they are operated in non-private environments and may typically cause significant harm. • Strict liability should lie with the person who is in control of the risk connected with the operation of emerging digital technologies and who benefits from their operation. • The producer of a new health technology should be strictly liable for defects in emerging digital technologies even if those defects appear after the product was put into circulation, as long as the producer was still in control of updates to, or upgrades on, the technology. • If it is proven that an emerging digital technology has caused harm, the burden of proving defect should be reversed if there are disproportionate difficulties or costs in establishing the relevant level of safety or proving that this level of safety has not been met. • If harm is caused by autonomous technology used in a way functionally equivalent to people performing the task, the operator’s liability for making use of the technology should be the same as where people cause the harm.

• There should be a duty on producers to equip technology with means of recording information about the operation of the technology (logging by design), if such information is typically essential for establishing whether a risk of the technology materialised. • If it is proven that an emerging digital technology caused harm, and liability therefore is conditional upon a person’s negligence, the burden of proving fault should be reversed if it would be disproportionately difficult and costly to establish the relevant standard of care and of proving that standard had been violated. This means the person causing the harm, will need to prove he or she didn’t cause the harm. But are such recommendations premature? My own view is that until questions of liability arising from emerging digital health technologies are litigated through the courts in significant numbers, we potentially risk reforming too hastily. As I have said, courts have had to adopt to every major technological advance and the harms associated with these advances, from antibiotics to x-rays. Undoubtedly emerging technologies pose significant new challenges, but courts are frequently asked to apportion liability in situations where it seems almost impossible to delineate true responsibility for the harm. Each case, each product, each app, each arrangement will have to be assessed on its own merits and subjected to the same robust forensic analysis that is applied where any question of liability has to be determined. A modest proposal would be to wait and see how things develop. n

1. Gee & Others v DePuy International Limited [2018] EWHC 1208 (QB) 2. As recognised by the European Commission in its report on Liability for Artificial Intelligence and Other Emerging Technologies (EU 2019) 3. See, e.g. digitalhealth.net/2020/02/babylon-health-twitter-critic-troll/ 4. Who recently revealed his true identity to be David Watkins, an NHS Consultant Oncologist. 5. Supra note 2

HealthInvestor UK • April 2020

BREXIT

HealthInvestor UK â&#x20AC;¢ April 2020

BREXIT

Getting to the point Emma Brooksbank, a partner specialising in business immigration at law firm Freeths explains how Brexit will affect health and care workers seeking employment in the UK The 2021 immigration system

By way of an example, residential managers (residential home), healthcare support workers, senior care assistants and team leaders (nursing home) all fall within the new immigration system. A significant change will be the ability to trade points. A prospective employee may score fewer points on salary but be able to make these up with points for working in a shortage occupation. For example, a nurse earning £22,000 may not be earning enough to score points for salary but may score additional points if this role was, as it is now, defined as being in a shortage occupation. Time to secure an immigration licence The government has also confirmed a reduction in If a care provider anticipates recruiting any overseas nationals salary threshold from £30,000 to £25,600 with a further into skilled roles, it will need an immigration licence. The reduction to £20,480 for shortage occupations and certain Ph.D level roles. As now, there will be government intends to open key routes from this autumn. Employers that are lower salary thresholds for new entrants not approved by the Home Office to be a to the labour market. These changes sponsor should seek approval now if they will be welcomed by the care sector think they will need to sponsor skilled which have been concerned about how Securing a licence migrants, including those from the EU, to meet its skilled labour requirements will now be at the from early next year. The licence process post-Brexit. When planning recruitment, top of the list of can be complex and time consuming and businesses will be able to recruit skilled priorities for many there’s likely be a surge of applications employees from anywhere in the world. UK businesses at the end of the year, so the sooner a provider can secure the licence the better. Lower skilled work Of significant concern to the care sector Key changes will be the exclusion of any scheme for Many providers already hold Tier 2 lower skilled workers. The government licences which allows them to sponsor skilled overseas proposes that employers look to the resident population workers. The system will become more open and new roles and proposes to introduce post-study work visas for international students and youth mobility to meet the will be available for sponsorship. Employers can expect to use their licence much more regularly as new European demand for lower skilled work. Care workers are considered recruitment falls under the licencing system. to fall into a lower skilled classification. The government The government’s announcement on 19 February confirms also suggest that investment in technology and automation there will be some changes to the skilled visa route. These could offer a solution, but it is difficult to see how this include the removal of the cap on visas issued and the will benefit the care sector. removal of the requirement to advertise a role to the resident labour market before offering it to an overseas national. What to do now These changes will make the system more open for use by The 2021 immigration will need to inform business planning and recruitment strategy for 2021 onwards. British businesses. The anticipated changes to the immigration system may Following the recent announcements, securing a licence well provide opportunities for a care provider to look to will now be at the top of the list of priorities for many the overseas market to recruit the workforce it needs. UK businesses. n From next year there will be fundamental changes to the UK’s immigration system for skilled workers, the most significant being the inclusion of European nationals. For the first time businesses that have relied on a European workforce will need to understand the requirements of the immigration rules to recruit any overseas nationals, including Europeans. This will significantly impact the health and care sectors which have relied on a European workforce to meet essential workforce skills requirements.

HealthInvestor UK • April 2020

SOCIAL CARE

Home improvements Recovering from a disappointing CQC rating can be tough, but not for the team at Devonshire Court residential care home, where management and staff excelled themselves by moving up from Inadequate to Outstanding in less than two years. Jenna Lomax talks to senior figures at RMBI Care Company and asks how they did it

t’s fair to say that the private health and social care sector has had a bad rap lately – whether that concerns the Cygnet Whorlton Hall scandal, or headlines about the Ian Paterson inquiry. Amid these bad news stories, newsdesks sometimes omit to celebrate the sector’s achievements – good news doesn’t often make the headlines, attract the clickbait or bring in the viewers. But every day, without fail and without any praise from newsanchors, the UK’s social care workers and their home managers carry out intensive and necessary tasks taking kindly care of others that we can all agree deserve more note. Devonshire Court, based in the small town of Oadby near Leicester and owned by The Royal Masonic Benevolent Institution Care Company (RMBI Care Co), is one of many that deserves such praise. The care home, which offers residential services for the over 65s, was rated as Inadequate by the Care Quality Commission in November 2016; Requires Improvement in May 2017, but managed an Outstanding less than two years on, in September 2018. But how exactly did Devonshire Court turn it around? What did staff do differently to others to achieve this accolade, and how are they planning to maintain this status for the future? Devonshire Court’s November 2016 CQC report, written after an unannounced inspection the previous August, issued the provider with a warning notice in relation to governance and safe care and treatment at the service and said it needed to improve. Juliet O’ Connor, Devonshire Court’s home manager, had been in her role just six months when that inspection was carried out and the verdict delivered. But she was determined to take the reins and do something about it.

One vision “A clear plan of where we were going and what we wanted to achieve with clear timescales” was how Devonshire Court managed a successful turnaround between 2016 and 2018, explains O’Connor.

HealthInvestor UK • April 2020

SOCIAL CARE

1842 the year RMBI Care Co was established

“There is great communication between our team – they Since O’Connor’s appointment Devonshire Court has are all singers using the same song sheet. It’s such a cohesive certainly steadied its operational ship, which O’Connor’s colleagues say is largely down to her resilience and vision, environment. If you walk around the home, you’ll see every an integral part of hoisting the sails and heading for an member of staff knows what they’re doing and they take pride in it. It’s a great example of how good care can be delivered.” Outstanding from the regulator. Lucy Tupenny, assistant director, quality and governance “I lead on policy and governance across all of our homes”, at RMBI Care Co, says: “Juliet was determined to get to comments Tupenny, “and Devonshire Court has become a Outstanding in three years and she actually did it in template of what we want to achieve in our other homes.” two. We knew when Juliet first came in, her leadership was going to be a Looking back new chapter.” Discussing her personal role in changing Everyone knows Devonshire Court for the better, Tupenny After the 2016 inspection, O’ Connor created a robust plan to improve says her approach was centred on going what their job “back to basics” with a “robust action ratings which was also shared with is and what is stakeholders. She explains that this new plan that was heavily evidence-based, so expected of them chapter involved a “strong experienced staff at Devonshire Court could confirm and they are busy leadership team” that reflected every action that had been taken and achieving it to the “a combination of strengths and what the outcomes were.” knowledge base.” And when asked about the main highest standard “The team had one shared vision and differences between Devonshire Court had clear actions to achieve within the in 2016 and Devonshire Court now, Tupenny says the main difference is “a plan”, she adds. This shared vision is the reason for a more strong ethos and change of culture within the home.” cohesive approach within the care home today, O’Connor Tupenny emphasises that the team “has worked and says. “Everyone knows what their job is and what is continues to work exceptionally hard.” expected of them and they are busy achieving it to the Discussing the vast level of change that has come highest standard, demonstrating pride in their work”, about at the home since 2016, Tupenny again accredits she says. staff, saying: “Once staff saw the new systems in place Tupenny also sung praises to the whole team at and the positive effects it was having on residents, that’s Devonshire Court, when she told HealthInvestor UK when the momentum really started to gather. They are the care home’s improvements were also down to the all immensely proud now of what they have achieved, commitment of “a very cohesive management team”. which is wonderful.”

1,000 number of people in RMBI homes across England and Wales

17 number of RMBI Care Co residential care homes

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HealthInvestor UK • April 2020

SOCIAL CARE

▶ New initiatives Devonshire Court has every intention of maintaining its Outstanding status and one measure, among other initiatives, ensuring the rating stays for good, is the Dreams Come True programme. This encourages residents to fulfill their unfulfilled dreams, or to resume activities they once enjoyed but haven’t done for a long time. It’s clear to see this initiative is one that senior staff and other members of the care home are particularly proud of. And, as O’Connor says, it is “one of the most inspiring things at Devonshire Court”. “We took a resident to the zoo, and another to see his favourite football team play; something they hadn’t been able to do in a long time”, comments Tupenny. “It sounds like a very simple thing, but actually, it’s not. When you see reactions from residents who never thought they’d be able to do these activities again, it’s quite emotional.” In February, a horse loving resident, had her dream come true, getting back in the saddle for the first time in years. She had mentioned to staff that she dreamed of getting back on a horse, having enjoyed a long and successful career as a professional horse rider and trainer. Activities coordinator Fiona Collins set about making it happen, arranging a special trip for the resident to visit Witham Villa Riding Centre in Broughton Astley. But Devonshire Court hasn’t stopped at the Dreams Come True programme. Not only has it introduced recreational activities, but it has also built facilities within the home to improve social interaction for everyone, especially those

who may not be able to travel far. The home has been adapted throughout to include a fully functioning mall which holds a cinema and hairdresser, which Tupenny describes as “really positive changes”.

Dementia care As a care home caring for the over 65s, Devonshire Court cares for a number of residents with dementia. Across its homes, RMBI Care Co offers 255 dementia placements across 17 of its 18 facilities. Away from Devonshire Court, RMBI Care Co’s Connaught Court in Fulford, York, celebrated the opening of its new enhanced care Dementia Support House at the end of February. The home provides residential, nursing and dementia care for up to 94 residents and was also rated Outstanding by the CQC earlier this year. In addition, the charity is in the process of creating its own dementia accreditation scheme. Set up by the Alzheimer’s Society, RMBI Care Co’s Dementia Friendly Area Scheme outlines different tiers of evidence to measure how care homes and other organisations can better their care and surroundings to enable a friendly and safe environment for those living with dementia. A community initiative, being carried out across England and Wales, the scheme outlines eight steps toward becoming a “dementia friendly community” and Anne Child, RMBI Care Co’s dementia specialist lead, is working toward gaining this accreditation, not just for Devonshire Court, but across the whole RMBI Care Co community and beyond.

HealthInvestor UK • April 2020

SOCIAL CARE

Child says: “This includes people in the community coming to the home. It’s about how we’re forging relationships with the communities where our homes are located. RMBI Care Co is working on this pathway so we can accredit our services – testing them to the standard that we want them to be.” Other aspects of the accreditation programme links to specific measures such as Dementia Care Mapping (DCM). Recognised by the National Institute for Health and Clinical Excellence, DCM is a tool designed to prepare and help carers take the perspective of the person with dementia in assessing the quality of the care they provide through a five-point ‘cycle’ guide. This includes observation, analysis, report writing and feedback, action planning and preparation, and briefing. Training in DCM is provided by University of Bradford approved trainers, and by the university’s partner organisations in more than 10 countries. Developed at the university by the late professor Tom Kitwood, the mapping tool has been revised and updated since its inception more than 20 years ago and used as a reference point by RMBI Care Co, among others. It goes without saying that dementia care is something Child is extremely passionate about. “Every day is different”, she says. “With dementia, the person always comes first. Good dementia care is really rooted in a relationship; it’s part of a feelings-based, relationship-based model of care – it’s person-led.” “The care recipient has to be at the heart of what you’re doing. And you have to know who they are”, Child continues. “You might know the basic needs of someone you don’t fully know, but to truly care for someone, you have to understand them very well.” Working with residents living with dementia within a care home that has achieved Outstanding “really does raise morale” adds Child. “To be recognised as Outstanding in a job that can be so challenging lets staff know that they are appreciated for the incredibly hard work that they do. I always feel we’re privileged to care for people, it’s a privilege to work for the organisation.”

What’s next? It’s impossible not to be inspired by the senior team at RMBI Care Co. It’s clear to see there’s now a cohesive understanding, enthusiasm and shared vision for what the future holds, especially among the staff at Devonshire Court. As for maintaining its achievement of Outstanding Tupenny says: “Right now it’s about how we carry on and develop the home and make the most out of it. RMBI Care Co. has three Outstanding homes now, which is amazing. It’s easy to have a preconceived idea of what a care home is like, but we like to think we have broken the mould a little bit. That’s what I’m most proud of. People’s wellbeing is really at the forefront of what we’re about and our residents at Devonshire Court love it – they absolutely love it. “I also have to praise the team; when the inspectors came back for the most recent inspection, they were quickly able to see the improvements.” n

HealthInvestor UK • April 2020

EXECUTIVE MOVES

executive moves 4ways Healthcare

with learning disabilities, physical disabilities, chronic and enduring mental health needs, and sensory and communication impairments. Parish is currently chief executive of the charity, Care UK and is also chair of the Samuel Ward Academy Trust. Achieve Together is owned by AMP Capital, an infrastructure investment company headquartered in Sydney, Australia, with a stronghold across the UK and Europe. Executive search firm Compass Executives advised on Parish’s appointment.

Radiology reporting service 4ways Healthcare has appointed Susan Veness as chief financial officer. Veness is a chartered accountant with experience across the biotech, housing, manufacturing and travel sectors. She was previously chief financial officer at Phlexglobal, a specialist technology provider, responsible for the delivery of financial planning, treasury and financial reporting. Before that, Veness was chief financial officer at Vivomedica. Veness replaces 4ways’s current chief financial officer Richard Holland, who takes up a new role as head of performance and strategy support, responsible for assisting with the ongoing growth and development of the business.

Cigna

Achieve Together Achieve Together, a provider of services for people with learning disabilities, autism and associated complex needs, has appointed Mike Parish as its new chair. Achieve Together was formed in 2018 following a merger of the two companies, Care Management Group and Regard, and provides specialist support services to children and adults

Mike Parish, Achieve Together

Global health service company Cigna has appointed Arjan Toor as chief executive of its European operations. As part of a company restructure, Toor will lead the newly-combined operational team which spans international organisations, European employers, and globally mobile individuals. Toor joining Cigna in 2011 and previously spent two years as chief executive of Cigna International Organisations, Africa and Global IPMI – Cigna’s business for globally mobile individuals.

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HealthInvestor UK • April 2020

EXECUTIVE MOVES

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He has also served as chief marketing officer for Cigna International Markets, based in Hong Kong. Phil Austin, who previously headed Cigna’s European business, has been appointed as head of strategy and global business development for Cigna International Markets. Cigna has offices in the UK, Belgium, Spain, Kenya, Dubai, the US and Malaysia.

Inspired Villages Inspired Villages has appointed Ben Ling as village manager at Great Alne Park, one of its Warwickshire-based villages. Ling joins the company from the hotel group Hilton where he was most recently operations manager for the Hilton Garden Inn Birmingham Brindley. Located in Alchester, Great Alne Park offers 166 apartments and cottages in its picturesque grounds. Residents have access to facilities including a bar, restaurant, bistro, swimming pool, spa, gym, library and event space, as well as numerous sports and arts activities. The home also offers flexible, on-site domiciliary care services.

Kingsley Healthcare Kingsley Healthcare has appointed Jay Lambert and Daniel Wellings as data analysts. Lambert is a maths graduate from the University of Kent and previously worked for a company involved in the offshore oil and gas sector. Wellings joins Kingsley after graduating in economics at Lincoln University.

Arjan Toor, Cigna

Both Lambert and Wellings will be based at Kingsley’s head office in Lowestoft, Suffolk.

L&M Healthcare L&M Healthcare, which provides homes specialising in dementia care, has appointed Donna Miles to the newly created post of group training manager. Miles has a degree in dementia studies and has written three co-authored publications based on her practice in the field. She has designed, implemented and facilitated a number of successful research projects which focus on innovation within dementia care and she has also developed a framework and training model called ‘Never Ending Story’

Ben Ling, Inspired Villages

which attempts to trigger reminiscence through theatre. She has also worked with Liverpool Hope University and lectured at Salford, Edgehill and Bangor Universities.

Legal & General Capital Legal & General Capital has appointed Ben Rosewall as head of investment within its later living team. Rosewall will be responsible for increasing the scale of Legal & General’s later living portfolio, working alongside Phil Bayliss, chief executive of the later living team. Rosewall has more than 15 years’ experience providing consultancy and valuation services to operators, investors and lenders across the healthcare and retirement housing sector and was previously senior director in the healthcare and retirement housing division at CBRE. The company has also appointed Dandi Li as investment manager. Li has six years investment experience in the hospitality and residential sector and was previously a senior associate at London & Regional Properties.

Liva Healthcare

Ben Rosewall, Legal & General Capital

Dandi Li, Legal & General Capital

Copenhagen and London-based health tech company Liva Healthcare has appointed Jonas Hjortshøj as chief commercial officer. Hjortshøj has more than 10 years’ pharmaceutical industry experience. He was previously associate global director of commercial partnering activities at Novo Nordisk, responsible for developing a digital platform for patients and driving the company’s digital health strategy for obesity.

HealthInvestor UK • April 2020

EXECUTIVE MOVES

NHS England Deborah Sturdy has been appointed as the strategic advisor for social care nursing at NHS England. The newly created post aims to ensure the voices of nurses in care homes are heard at the very top of the nursing profession. Sturdy’s appointment is also in line with the NHS Long Term Plan, which aims to give care homes stronger links with local GPs and community services. Sturdy will work closely with chief nursing officer Ruth May, providing her with advice from nurses working to deliver high-quality care for people living in care homes.

Nordic Capital Nordic Capital has promoted Daniel Berglund to partner. Berglund joined Nordic Capital Advisors in 2010 and has since advised on several of Nordic Capital’s major acquisitions and exits including Bambora, Trustly, ArisGlobal and ERT. Nordic Capital has a total of 20 healthcare and technology and payments companies in its current portfolio. Jonas Hjortshøj, Liva Healthcare

Octopus Real Estate Octopus Real Estate, part of Octopus Group, has appointed Marcus Adam as development director of its retirement team, responsible for underwriting, negotiating and coordinating the new developments for the retirement team, as well as overseeing the marketing of each development. Adam joins from real estate developer Amro, where he spent two years as development director, responsible for the overall direction and delivery of developments in build to rent and purpose-built student accommodation projects in the UK and Europe. The Octopus Real Estate retirement team partners with institutional investors, operator senior management and developers of retirement communities, helping to build modern fit-forpurpose retirement housing. Last year Octopus Real Estate formed a joint venture with the real estate arm of Schroders to fund the development of four retirement villages with the Audley Group, a provider of luxury retirement villages.

Daniel Berglund, Nordic Capital

Schoen Clinic

Marcus Adam, Octopus Real Estate

HealthInvestor UK • April 2020

Schoen Clinic has appointed Jasy Loyal as general counsel to its UK management board. Loyal has more than 30 years’ independent healthcare experience and was previously a member of the executive board at HCA International. n

Jasy Loyal, Schoen Clinic

EXECUTIVE CV

Dr Anne Blackwood, Health Enterprise East

HealthInvestor UK â&#x20AC;¢ April 2020

EXECUTIVE CV

Dr Anne Blackwood Chief executive, Health Enterprise East Education I grew up in North Lanarkshire, not far from Glasgow, and was educated at Airdrie Academy. I graduated with a degree in Chemistry in 1991 from the University of Strathclyde and subsequently completed a PhD in Biotechnology from the same university in 1994.

Work history Research fellow, University of Westminster 1995–1997 After I completed my PhD, I decided to continue in academic research and moved to London to work on an EU-funded research project in biocatalysis (using living systems to speed up chemical reactions). I enjoyed working on a cross-disciplinary project with scientists in France, the Netherlands and Germany.

Senior innovation manager & head of innovation, Health Enterprise East 2005–2010 After four years at Cambridge Enterprise the opportunity to join Health Enterprise East (HEE) came up. HEE was spun-out of Royal Papworth Hospital in late 2004, to commercialise innovations emerging from front-line NHS staff in the East of England. I was the third employee in the company, and it was exciting to be in at the start of the venture and to be working exclusively in healthcare where I really felt I could make a difference.

Research fellow, South Bank University 1997–2001 I then moved into another research role, this time looking into the structure-function relationships of dietary fibre in the bowel. I spent more time teaching as well as in the lab and implemented part of the course structure for a new degree course in Forensic Science. I’ve always wanted to be in roles where I could learn something new and Forensic Science was a very popular course at the time with all the new forensic shows on TV!

Chief executive, Health Enterprise East 2010–Present When my boss retired, I took over running the company and immediately sought an opportunity to develop a more sustainable business model that relied less on government grants. In the last 10 years HEE has raised over £16 million to support innovative medical technologies emerging from our network of NHS organisations. No longer just a regional business, we’ve expanded into London and the greater South East, commercialising 125 innovations to improve the quality and efficiency of patient care. We also work a lot with innovative SMEs seeking to understand the market opportunity for their products in the healthcare system: in the last five years alone we’ve undertaken over 60 health economic evaluations of products in this capacity.

Senior technology transfer associate, Cambridge Enterprise 2001–2004 After spending nearly a decade in post-graduate research, I decided it was time to shake off my lab coat and move into a role that still utilised my scientific background but involved talking to people rather than machines all day. I moved to Cambridge to work in their technology transfer office, supporting academics in the life sciences to commercialise their research. This is when I first got interested in business and innovation.

Non-executive director, Ablatus Therapeutics 2016–Present Ablatus Therapeutics, a medical device company, was founded with support from HEE to develop and commercialise a novel tissue ablation technology to treat the most challenging and often inoperable, solid cancer tumours. The start-up company was spun-out of the Norfolk & Norwich University Hospitals NHS Foundation Trust, where the technology originated, and I represent HEE’s interests on the board.

HealthInvestor UK • April 2020

Chair, Medovate 2017–Present Medovate was co-founded by HEE and two private sector investors to develop medical technology innovations emerging from HEE’s pipeline through to market. With an initial focus on anaesthesia, critical care and surgery, our first product should come to market this year. It has been very rewarding through HEE and Medovate to help drive these new products and services into the marketplace, putting new tools, techniques and processes in the hands of clinicians to benefit their patients.

Hobbies I like to travel and generally take a weeks’ holiday in winter somewhere in the sun to help me recharge the batteries. In March this year I am going to Brazil and looking forward to my first trip to South America. I also like to cook and have recently taken up running – which is harder than it looks at my age! n

TOP TIP FOR SUCCESS I’ve never had a formal career plan and have always taken roles because they interested me rather than as a route to anywhere in particular. The one piece of advice I always follow is to focus your energy on the things you can control rather than the things you can’t.

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Tweets of the month

UK Prime Minister / @10DowningStreet Protect yourself and others.

Wash your hands more often than usual, for 20 seconds each time with soap and water, or use hand sanitiser.

8 9

Across 1. 2. 3. 4. 7. 9.

This care home provider, has secured a Care Quality Commission Outstanding rating for one of its specialist dementia care homes for the second time since its opening in 2013 (4,10) Company that is to acquire the intellectual property of Cambridge Sound Technologies (6,4,8) The Financial Conduct Authority has commenced a formal enforcement investigation into this company (3,6) UK city where The Priory Group has opened a new walk-in Wellbeing Centre (7) NHS Digital and this company have launched a consultation to align private healthcare data with NHS recorded activity (4) This company has launched a new software tool to address HR issues that arose after an inquiry into the case of Ian Paterson (12)

Down 1. 5. 6. 8.

Palatine Private Equity has sold this healthcare products manufacturer to H.I.G. Capital (9) The county where Harwell Science and Innovation Campus is located (11) German healthcare operator in running to buy Priory Group (6,6) The communications agency specialising in the health and social care sector that has launched a coronavirus advisory team (4)

*Last month’s answers Across 2: EDM Group; 7: Hallmark Care Homes; 8: iPlato; 9: David Hare; 10: Matt Hancock Down 1: Worcestershire; 3: Vanguard; 4: One Dorset Pathology; 5: Jeremy Hunt; 6: Carillion

HealthInvestor UK • April 2020

Matt Hancock / @MattHancock I’ve written to colleagues in all parties to initiate talks on social care. We will seek a cross-party consensus – and deliver much needed reform.

Care England / @CareEngland Delighted @MattHancock @BorisJohnson have written to all MPs @HouseofCommons & Peers @UKHouseofLords asking for their comments on adult social care. We hope that Parliamentarians will seek comments from their local care providers @CareEngland members before responding

UNISON Northern / @NorthernUNISON The frontline of social care – a UNISON special feature investigates the state of social care in the UK. #Socialcare spark.adobe.com/page/Uqi4cwCnpwmlW

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companies index 7 Skin Health Spa 8 4ways Healthcare 58 Acadia 9 Achieve Together 58 Adonia Medical Group 8 Advanced Oncotherapy 8 Alantra 31, 40, 43 Amadeus Capital 10 AMP Capital 36, 58 Ardenton Capital 45 Audley Group 12, 44, 61 Audley Villages 44 August Equity 41, 43, 45 AVO 8 Babylon 50 Balhousie Care Group 7 Barchester Healthcare 7, 24 Barkby Life Sciences 10 BATM 6 Bevan Brittan 4, 50 BMI Healthcare 44 Boundary Capital 10 Brabners 8 Brookfield 9 Cambridge Sound Technologies 10, 65 Capvest 9 Care England 12-13, 34-37, 65 Care Management Group 58 CQC 7, 16-17, 20-21, 34, 54, 65 Care UK 44, 58 Carillion 65 Caring Homes Group 6 Carlyle 9 CBRE 60 Cigna 58, 60 Cindat 45 Circle Health 8, 44 CODE 45 Compass Executives 58 Courthouse Clinics 8 Credentially 7, 16 CVS 41 Cygnet Health Care 4, 33 Daeschner Consulting 29 DeepMind 27-28 Destination Skin 8 Downing 6, 15 EDM Group 65 ERT 61 Flint+Flint Clinics 8 Forescout Technologies 23 Freeths 4, 53 Google Health 27 Graphite Capital 8 Hallmark Care Homes 24-25, 65 Hallmarq 41 Harley Medical Group 8 HCA International 61 HC-One 25 Hft 12 H.I.G. Capital 9, 65 Hospital Topco 44 IBISWorld 40-41, 43 Independent Care Group 3, 13 IHPN 17

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Independent Vetcare Group 41 Inotec 10 International Data Corporation 27 iPlato 21, 65 IVC 41 Kingsley Healthcare 60 Legal & General 60 Linnaeus 41 Liva Healthcare 60-61 L&M Healthcare 60 London & Regional 60 Mars Petcare 41 Medigate 23 Medivet 41 Mencap 34-35, 37 Mojo 31 Muddy Waters 14 NHS Confederation 7 NHS Digital 4, 17, 34-35, 65 NHS Employers 13 NHS England 8, 34-35, 37, 61 NMC Health 14 Nordic Capital 61 Octopus Group 61 Octopus Healthcare 44 Octopus Healthcare Fund 44 Octopus Real Estate 44, 61 Octopus Ventures 31 Omega Healthcare 45 One Dorset Pathology 65 Palatine Private Equity 9, 65 Parklands Veterinary Group 41 Patchwork 10, 23 Pebbles Care 45 Pets at Home 41 Phlexglobal 58 PLMR 6 Praetura Ventures 10 Primary Health Properties 10 Priory Group 9, 21, 65 Private Healthcare Information Network 17 Puhua Capital 10 Ramsay Health Care 9 Renaissance Care 12 Royal College of Nursing 3, 14-15 Santander 9 Savills 43-45 Scarsdale Vets (Derby) 41 Schoen Clinic 61 Schroders 44, 61 Secure Income REIT 44 sk:n 8 South Cliff Dental Group 4, 8 Spire Healthcare 16-17 Synergy HCS 9 The Harley Medical Group 8 The London Clinic 8 The Priory Group 9, 21, 65 TriSpan 8 UNISON 12-13, 65 Veincentre 9 Vernacare 9 VetPartners 41 Voluntary Organisations Disability Group 12-13 Wagestream 23

HealthInvestor UK • April 2020

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