HealthInvestor UK August 2020 vol 17 • no 6
essential reading for the healthcare business
Lighting the fuse How Covid-19 put a rocket under the telemedicine industry
A successful trip?
In for the long haul
New world order
The new opportunities in psychedelics
Neuro-rehab and Covid-19
The future of digital healthcare
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 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
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HealthInvestor UK • August 2020
Putting out the fire with gasoline?
A
s we go to press, health secretary Matt Hancock has announced the demise of Public Health England, a move predicted in our last editorial. While there were many flaws in the way PHE was run and it undoubtedly could have done better in managing the Covid-19 pandemic which still threatens to engulf us, there are some who feel justified in attributing Mr Hancock’s move to a desire to shift blame for the whole sorry mess away from himself, the prime minister and his cabinet colleagues. The decision to scrap a vital fighting force in the battle to protect the population from the virus in the middle of the outbreak has been likened to restructuring the fire brigade at the precise moment their hoses are trained on a blazing building. The interim appointment of Baroness Dido Harding to head up PHE’s replacement, the National Institute of Health Protection, has further added to the general bafflement and irritation at Hancock’s seemingly precipitous plans. Richard Horton, the editor of the Lancet medical journal, summed up the mood of the medical establishment when he tweeted: “It’s difficult to understand how someone with zero public health qualifications has been appointed to lead a national public health agency.” The Baroness certainly has a mammoth task on her hands and one can only admire the confidence that led her to accept a role for which so few people believe she is suitable. Let us consider the landscape in which she finds herself. Britain has the worst total Covid-19 death toll in Europe, with more than 46,000 killed by the virus. The UK also suffered the Continent’s second-worst “excess death” rate per head of population – twice that of France and eight times more than in Germany.
We did not protect our elderly population, the most likely to suffer serious illness, who died in nursing homes in shocking numbers. We let Covid-19 run riot across the land rather than imposing local restrictions that proved so effective elsewhere. We failed to restrict travel into the country from abroad, we gave up on contact tracing too early, set testing targets that were missed, designed government programmes that didn’t work and the three most senior figures managing the effort to control the disease, including the prime minister, caught the very virus they were fighting. Now the country faces the deepest recession since records began. The Office for National Statistics said earlier this month that there had been a dramatic plunge in output across the services, production and construction industries in the first quarter of 2020. In sobering language, the ONS says the pandemic has erased 17 years of economic growth in just six months. The level of the UK’s GDP is back to what it was in June 2003. On a more positive note, while infections may rise in the general population, the rates of hospitalisation and ICU beds occupied are gratifyingly low. The UK is also leading the way in developing a vaccine to protect against the virus and led research that uncovered the effectiveness of dexamethasone treatment. Only time will tell if Matt Hancock’s new Institute and its leader will prove up to the task of the long-term management of a health crisis that looks as if it will persist well into next year and possibly beyond. n
Rob Munro, Editor, HealthInvestor UK 3
CONTENTS
features
news Policy and politics Technology Covid-19 Primary care
6-9 10 11-13 14-15
Private hospitals
16
Digital
17
NHS
17
Social care Dentistry Deals and investments
18-22 23 23-25
Slow train coming 32 Mindy Daeschner of Daeschner Consulting outlines the results of her team’s survey into the future of digital healthcare After the flood 38 As the UK slowly comes out of lockdown, the care home sector is taking stock of Covid-19’s impact. In the next 12 months and longer term what will have changed, and what will remain the same? Kathy Oxtoby reports Procuring the future 42 Dr Dan Bunstone, who leads on safety issues/governance for digital provider Push Doctor, and was formerly CCG chair in Warrington, explains how flexible procurement models are key to helping GP practices and CCGs stay resilient during the ongoing Covid-19 crisis
Push Doctor
42
Beckley Psytech
48
Active Care Group
50
Keep digital data private 46 David E Rutter, chief executive of enterprise software firm R3, argues that the Covid-19 pandemic has highlighted the need for urgent reorganisation of the way healthcare is delivered and that the key to this is through a distributed ledger
Telemedicine 26
cover story The robots are coming 26 With the seismic shock that Covid-19 sent through the UK’s healthcare system continuing to power a tsunami of demand, providers are turning enthusiastically to emerging technology to help them cope. HealthInvestor UK asked leading industry experts to consult their crystal balls and consider the postpandemic future for telemedicine
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A useful trip 48 Psychedelic drugs are emerging from the shadows to play a role in treating conditions such as depression and alcohol use disorder. Kathy Oxtoby investigates a company advocating the clinical use of these controversial compounds The long march to recovery 50 Ruth Smith, Active Care Group’s chief executive, reviews neurorehabilitation for post-acute Covid patients and the challenges facing the medical sector ahead of the predicted second wave of the pandemic later this year
executive moves Executive moves
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HealthInvestor UK • August 2020
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NEWS
Policy and politics
Messaging on pandemic mitigation ‘clouded in confusion’ Health leaders have voiced concerns that the government’s messaging on pandemic mitigation is “clouded in confusion”. The comments came in the wake of ministers’ decision to re-impose lockdown restrictions in Leicester after a surge in Covid-19 infections. Niall Dickson, chief executive of the NHS Confederation, which
represents organisations across the healthcare sector, said that the Leicester outbreak “could well be repeated elsewhere”. “We need a transparent approach for any future local lockdowns with clear accountability and public messages that are transparent, consistent, and timely. This episode has been clouded in confusion,” he said.
“As we head towards a further easing of lockdown, there is real trepidation in the NHS that gains made at a heavy price may be lost unless the public observes social distancing and hand hygiene and our surveillance and test and trace systems are working effectively.” Shadow health secretary Jonathan Ashworth said he supported the lockdown decision but clarity was needed on how it would be implemented.
“The government’s response to the situation in Leicester has left people anxious and confused,” Ashworth said. “We support the government’s decision to reintroduce lockdown restrictions. However, there are a number of outstanding questions about how the government intends to implement these restrictions and get the outbreak back under control.”
Public Accounts Committee rips into government on social care The House of Commons Public Accounts Committee has released an excoriating appraisal of the government’s handling of the social care sector during the coronavirus crisis. The committee stated that the government’s “slow, inconsistent, and at times negligent approach” to social care in the Covid-19 pandemic has exposed the “tragic impact” of “years of inattention, funding cuts and delayed reforms”, leaving the sector as a “poor relation” that has suffered badly in the pandemic. The committee demanding the government produce a “threepoint plan” by September, ahead of the second wave, covering health, the economy, and procurement of medical supplies and equipment. The PAC called out the “appalling error” committed when 25,000 patients were discharged from hospitals into care homes without ensuring all were first tested for Covid-19 – even after there was clear evidence of asymptomatic transmission of the virus. It stated that thanks to the commitment of thousands of staff and volunteers and by postponing a large amount of planned work, the NHS was – just – able to weather the “severe and immense” challenges to health and social care services in England and meet overall
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demand for Covid-19 treatment during the pandemic’s April peak – “unfortunately, it has been a very different story for adult social care”. The committee was particularly concerned about staff in health and social care “who have endured the strain and trauma of responding to Covid-19 for many months” and who are now expected to “cope with future peaks and also deal with the enormous backlogs that have built up”. And it said failure to protect staff by providing adequate PPE has hit staff morale and confidence, while a lack of timely testing led to increased stress and absence. These same staff will be called upon in the event of a second peak and the NHS will need extra staff to deal with the backlog of treatment. As well as its calls for a “second wave ready” plan, for health and the economy, the committee said it expects an account to be provided in September of the spending under “policies designed to create additional capacity quickly” which – while necessary, especially in the haste the government was acting in – have resulted in “a lack of transparency about costs and value for money”. Professor Martin Green, chief executive of Care England, said: “This report makes a forensic
analysis of many of the positives and negatives at the peak of the pandemic. We urge the government to implement the recommendations in order that the nation is better prepared for future spikes and also to ensure that social care is recognised as an intrinsic part of the health and social care system. Health and social care are but two sides of the same coin and cannot be treated as separate entities”. “The adult social care sector has worked tirelessly to ensure the health and wellbeing of some of society’s most vulnerable.
This work must not go unrecognised. This report sets out some sensible actions which will help the long-term sustainability of the adult social care sector and Care England will be keeping a close eye on the implementation of the recommendations. We hope that these recommendations will help lead us into a new integrated and stronger future with services centred around individuals and free of much of the excessive bureaucracy and neglect within government that has characterised the attitude to this sector for too long.”
HealthInvestor UK • August 2020
NEWS
Policy and politics
Call for fairer pay and conditions in care sector Researchers from King’s Business School say that the care sector needs a new model of employment relations to tackle the challenges exposed by the Covid-19 crisis. In a paper Fair Care Work: A post Covid-19 agenda for integrated employment relations in health and social care the authors urge policy makers and practitioners to consider how public sentiment can be captured in the fair treatment at work of these health and social care employees. “The Covid-19 crisis is forcing a fundamental re-assessment of the socio-economic value traditionally placed on health and social care
work, with implications for how the employees delivering it should be rewarded. As these workers take risks and, in some cases, sacrifice their lives, the undervaluing of care work, long associated with the feminised nature of the workforce, is challenged,” they say. “One option would be for the current NHS Pay Review Body to carry out this dedicated one-off review to establish fair pay rates. Given the cross-cutting nature of the proposed review, this would involve extending the remit of the NHS Pay Review Body to cover social care, again with a view to retaining an
NHS and Social Care Pay Review Body to monitor and assess future pay movements.” The paper also addresses inequalities of employment conditions caused by outsourcing, lack of adequate training and professional development and the risks faced by migrant workers. Professor Ian Kessler, who led the research said: “These features of employment relations have cruelly hampered the capacity of health and social care providers to deal with the Covid-19 crisis. They have led to difficulties in recruiting and retaining frontline care staff, reflected in the
shortfall of around 40,000 registered nurses, and arguably contributed to a lack of preparation, not least apparent in the initial shortages of personal protective equipment for staff, especially in under-resourced care homes. “As the initial terror of this pandemic begins to subside, it feels like the right moment to start talking about how to rebuild and re-regulate our health and social care system. It not enough to just clap for our carers, it’s time to make meaningful changes to the working practices that have seen them undervalued and dismissed for far too long”.
Care England hits out at lack of visitor guidance
Virology experts question government’s choice of testing partners
Care England has hit out at the delay in government guidance on how people should visit care homes. The representative body says it is important that to find ways of supporting increased contact with families and friends for care home residents, but that this is approached in a way that is safe, sensible and does not undo all of the efforts of so many care providers to date.
A group of leading virologists has written to the chief medical officer for England to voice concerns that Covid-19 test and trace contracts are being awarded to private sector companies on “ideological grounds”. The experts also say they have been sidelined by the government and excluded from discussions on how to respond to the pandemic. They add that they have no knowledge of or information on
Professor Martin Green, Chief Executive of Care England, says he is ‘at a loss’ to explain the lack of guidance on visiting. “As the country unlocks, care providers are in the dark as to what is permissible in terms of visitors to their residents, or indeed residents leaving their homes on visits. This should have been a priority for the DHSC given that care homes are central to fighting this dreadful pandemic”.
the DnaNudge or LamPORE tests that the government is currently contracting to buy. The UK Clinical Virology Network wrote to Prof Chris Whitty, the chief medical officer for England, and Sir Patrick Vallance, the chief scientific adviser, on 10 July but told The Guardian newspaper they have had no response. The signatories mostly work in 40 NHS and Public Health England laboratories across the country.
Government considering over-40 social care tax The government is reportedly considering taxing the over-40s to pay for their social care in later life. Under the plan, the over-40s would have to pay more in tax or national insurance an the money used to pay for domiciliary or residential care as required. According to The Guardian newspaper, the plans are being considered by the new health and social care taskforce and the Department of Health and Social Care.
HealthInvestor UK • August 2020
Steven Cameron, pensions director at Aegon said taxing the over-40s was “worth considering” and might be an attractive alternative to having to sell property to pay for care. “Introducing an additional band of income tax or National Insurance ringfenced to go towards social care costs is worth exploring and would mean those on higher earnings pay more into the fund’” he said.
“Applying the new tax to those above say age 40 may raise questions over intergenerational fairness and the Government needs to look at the wider support it is offering for each age group. While paying more tax is not going to appeal to everyone, homeowners might see it as a price well worth paying if it came with a cross-party lifelong guarantee that in return they will not have to sell their home to pay for future social care.”
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NEWS
Policy and politics
CPA encourages use of EU Settlement Scheme The Care Provider Alliance (CPA) has called on staff and service users who are EU citizens to apply to the EU Settlement Scheme (EUSS) to ensure they are able to continue to live, work and access funding and services in the UK after 30 June 2021. The CPA represents the 10 leading care provider trade associations in England. While recent data indicates a high level of applications to the scheme, the CPA is encouraging all social care organisations to ensure their staff and people who use their services are aware of the EUSS and how to apply. CPA chair, Lisa Lenton said: “EU care workers, people who use
services and families are a vital part of the care sector. We need them to feel secure and confident in remaining in the UK after the transition period ends on 31 December 2020. “While care providers are not legally obliged to check if people have applied to the scheme, the CPA strongly recommends that they direct people to information on the EU Settlement Scheme, and encourage them to apply where appropriate. Covid-19 has resulted in some delays to applications, so again, it is better to apply as soon as possible. Our new guidance provides all the details needed, and we will be updating our information on a regular basis.”
Age UK says discharges to care homes without Covid-19 testing was ‘terrible mistake’ Older people were “catastrophically let down” by the government during the Covid-19 pandemic, says the charity Age UK. In evidence seen by The Guardian newspaper to an inquiry run by the all-party parliamentary group on coronavirus, Age UK said the initial policy of discharging the elderly from hospital into care settings without being tested for the virus was a “terrible mistake”. It said discharging people into care homes without testing was a “terrible mistake that was only rectified in mid-April”.
“Furthermore, while care homes were quick to reduce the number of visitors, many have been forced to rely on agency staff to sustain safe staffing levels. This certainly hasn’t helped, and, in some cases, it may well have facilitated the transmission of the virus between care settings,” the charity’s statement said. The inquiry has received 900 submissions from individuals, charities and public bodies in two weeks and public hearings will be held online on Wednesdays and recommendations for the government are due to be made by the end of summer.
Care providers call for more guidance Care providers called on the government to release guidance on reopening care homes in England to allow families and loved ones of residents to be reunited. Appearing on BBC Breakfast, MP Grant Shapps said much-awaited government guidance will be issued this week, almost two weeks after the promise from Matt Hancock, secretary of state for health and social care. Vic Rayner, executive director of the National Care Forum said: “The secretary of state for health and social care promised in early July that the government would publish guidance on reopening care homes to families and friends within a matter of days. It is now over 12 days since that announcement and the guidance has still not materialised, causing unnecessary anguish to many. “As the representative body for not-for-profit care providers we have endeavoured to work with the government to shape the guidance, and emphasise the urgency to ensure
8
residents are reunited with their families and loved ones. Safety is paramount, but it is also absolutely true that people need people, and as we reopen homes to visitors, we must make sure that we put in place all the measures needed for now and the future, so that we never again get into the position where families and friends are kept apart.” Shortly afterwards the government published guidance, Professor Martin Green, chief executive of Care England, said:
“This guidance should have been with care providers last month. We are at a loss to understand why the Department of Health and Social Care cannot act quickly in a crisis or why it is deaf to the comments and input from the sector”. As the rest of the country unlocked in June, Care England produced its own guidance for learning disability providers, but stopped short of providing guidance for services for older people, It stated that it acted thus in the belief that
the guidance would be delivered by the Department of Health and Social Care “imminently”. Care England further added that it was concerned that the guidance did not address a range of issues including: supported living; information about Local Outbreak Boards; volunteers; and support staff ratios. It also warned of a lack of information around how a dynamic risk assessment may affect the frequency of visits. Green continued: “This guidance fails to consider the issues around visitors and residents leaving the care setting. As lockdown lifts we are likely to see many care providers and relatives wanting to take their loved one out for visits. Also, we need to look beyond outdoor visits and recognise that these new conditions may be with us for quite some time. The failure to acknowledge this nuance underscores the lack of governmental understanding of the complexities present within the adult social care sector.”
HealthInvestor UK • August 2020
NEWS
Policy and politics
Call for government to secure learning disability care Care England has called upon Government to improve the future sustainability of the learning disability sector. The representative body for care providers says that, despite increased demand, the learning disability population in receipt of adult social care has been largely overlooked during the Covid-19 pandemic. Care England’s analysis of how the learning disability sector has been impacted by Covid-19
showsa slight decrease in overall occupancy rates and an increase in staffing costs driven by increased absence payments, sickness costs, shielding costs, overtime costs, agency costs and gratuity payments. Professor Martin Green, chief executive of Care England, said: “The learning disability sector is one of the fastest growing sectors in adult social care. As a result of increased demand induced
by demographic factors, historic workforce issues and increased difficulties in the access to care, the pertinence of the learning disability sector is likely to grow and demand greater governmental attention and action than what has been given previously. “Emerging systems to manage the virus have been put in place as a result of the change Covid-19 has demanded, however significant action is still required to better
meet the care needs of the learning disability population. We encourage Government to consider those cost areas which can be reduced to assist adult social care providers. It is important that due attention is given to addressing business costs, providing PPE free of charge, extending the Infection Control Fund and ensuring that all commissioners, local authority and CCG, pass on funds given to support the Covid-19 response”.
Care England welcomes Community Discharge Grant Care England, the representative body for independent providers of adult social care has welcomed the Community Discharge Grant. Professor Martin Green, Chief Executive of Care England (pictured), said: “It is imperative, despite the increased pressure the care system has come under in light of the Covid-19 pandemic, that people with a learning disability
and/or autism are enabled to enjoy their rights to live purposeful lives as active members of families and communities. This additional funding will be given to local councils to accelerate discharge of patients with learning disabilities and/or autism from mental health hospitals into the community”. In March last year, former minister for care, Caroline
Dinenage, outlined that the ambition for March 2020 was to reduce the rate of inpatients with a learning disability and/or autism by 35% from the total number of inpatients in March 2015. Figures released earlier this year in April by NHS Digital, showed that there had only been a 27% reduction, therefore missing the outlined target by 8%. This is almost 300 more adult inpatients than the target. Equally as significant, of those in hospital at the end of May 2020, 1,255 (61%) had a total length of stay of over two years. On 16 July the Department of Health and Social Care announced a £62 million fund to help discharge people with learning disabilities and autism into the community: • Funding will be given to local councils to accelerate discharge of patients with learning disabilities and/or autism from mental health hospitals into the community
• The funding can be spent on costs associated with discharge, including establishing community teams, funding accommodation and staff training • A new independent Oversight Panel has been set up to improve care and support for inpatients with learning disabilities and/ or autism. Green added: “Care England has long highlighted the issues around meeting the objectives of the Transforming Care agenda, accordingly it is encouraging to see a decisive step taken in the right direction. However, this money must be earmarked and used to meet the needs of the most vulnerable. We welcome this grant and look forward to working with Baroness Hollins to help reach a long-term solution to the admission of the most vulnerable in society into inappropriate settings”.
Top social care civil servant quits job Rosamond Roughton, the director general for adult social care at the Department for Health and Social Care, has unexpectedly stepped down from her role. Whitehall sources said
HealthInvestor UK • August 2020
Roughton “is now on a career break”, no other explanation was given for her departure. Roughton was the senior civil servant with responsibility for care homes in England and was
the key contact for care home leaders during the crisis and was tasked with beefing up the department’s response to the pandemic. Roughton was appointed earlier
this year and oversaw the roll-out of testing for staff and residents in care homes, which many in the sector criticised for being too slow and ineffective in managing infection.
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NEWS
Technology
Arc Health partners with EMIS Health to offer remote GP access to care homes Video primary care consultation company Arc Health has partnered with leading GP supplier EMIS Health to improve GP access in care homes with its remote diagnostic platform. The partnership will introduce Arc to 57% of GP practices across the
country using EMIS Web, the UK’s leading integrated clinical IT system. Arc gives the patient access to a connected stethoscope, pulse oximeter, blood pressure monitor, contactless thermometer, and a close inspection camera to check the ear, throat and skin.
The NHS-approved technology saves time spent travelling to and from care homes, as well as offering a cost-effective way to enhance support for patients and meet obligations for regular monitoring. Dr Zubair Ahmed, chief executive of Arc Health said: “Recent events
have made the problems facing care home residents even more pronounced. It is more important than ever to support the health of care home patients by offering timely access to good gold standard clinical care whilst simultaneously saving time for clinicians.”
Charity and asset management experts launch healthcare innovation investment fund Future Care Capital and RYSE Asset Management have launched a fund to invest in digital health and care technologies. The RYSE FCC Fund is aimed at early-stage companies whose innovations address the challenges facing the NHS and other health and care delivery systems. The ‘cornerstone investor’ of the Fund will be charity and think tank Future Care Capital – whose stated aim is “to improve health and care now and in the future”.
Andrew Whelan, chair of trustees at Future Care Capital, said: “As an independent charity, Future Care Capital is constantly exploring new ways to create social impact. We are delighted to announce our partnership with RYSE which allows us to ‘put our money where our mouth is’ and support investments aligned with our charitable mission of improving health and care. “By investing in innovation and technology, the new RYSE FCC
Fund will deliver tangible benefits for our beneficiaries - all those in receipt of care. We are excited to partner with RYSE who share our commitment to improving care and have a strong track record as an investment manager”. Shabir Chowdhary, managing partner at RYSE Asset Management, said FCC had a track record of identifying important developments in the healthcare sector. “We are delighted to be working
with such an innovative and established charity, FCC, that is active within health and social care research and policy. The management team at FCC has shown great vision in backing pioneering companies at a time in which we believe health and social care provision will need to evolve. We are keen to engage with and obtain the support of other organisations that share in the RYSE FCC collective vision,” he said.
Locum’s Nest and Earnd launch pay service for the NHS Technology companies Locum’s Nest and Earnd have announced a partnership to allow temporary NHS staff to access their money without charges, as they earn it, on-demand. Under existing processes, healthcare professionals who wish
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to be paid outside of normal payruns, have to pay for the privilege. The partnership between Locum’s Nest and Earnd will allow this service to be offered free to the NHS workforce. Up to now temporary staff frequently have to wait as many
as 60 days to be paid for additional shifts they work. Now they can be paid within days of their shift finishing, for free. The feature is available via the recently-launched Locum’s Nest Link product, Link which integrates core systems such as rostering and payroll into one function. Dr Ahmed Shahrabani, Locum’s Nest co-founder, said: “Workers who do additional shifts should not have to wait weeks and weeks and weeks to be paid; this system allows them to be paid much more quickly, and it won’t cost to do so. It’s a win-win.” Josh Vernon, chief executive, Earnd added: “Now more than ever we need to stand together to support our NHS. On-demand pay
makes booking additional shifts more attractive to both trusts and doctors, thus reducing the need to use expensive agencies. By offering Earnd for free to the NHS we make it easier than ever for trusts to reduce their agency costs, whilst also supporting their staff’s financial wellbeing. “Our research shows that NHS staff use overtime, bank and locum shifts to pay down debt, save for a specific financial goal, invest or even treat themselves. Having to wait up to 60 days to get paid causes unnecessary and often detrimental financial strain – regardless of how much you earn. Access to on-demand pay is, therefore, a right and not a privilege.
HealthInvestor UK • August 2020
NEWS
Covid-19
Government announces vaccine centre The UK government has announced an additional £100 million to ensure that any successful Covid-19 vaccine can be produced at scale. The money will fund a Cell and Gene Therapy Catapult Manufacturing Innovation Centre to accelerate the mass production of a vaccine. Due to open in December
2021, the Centre will have the capacity to produce millions of doses each month. Located in Braintree, Essex, the initiative will upgrade an existing facility to create a fully-licensed manufacturing centre. The new centre will complement the Vaccines Manufacturing
and Innovation Centre, which is currently under construction in Oxfordshire following a £93 million investment from the government. Business Secretary Alok Sharma said: “We are taking all necessary steps to ensure we can vaccinate the public as soon as a successful
Covid-19 vaccine becomes available. This new Cell and Gene Therapy Catapult Manufacturing Innovation Centre, alongside crucial investment in skills, will support our efforts to rapidly produce millions of doses of a coronavirus vaccine while ensuring the UK can respond quickly to potential future pandemics.”
Your.MD and Imperial College London to map Covid-19 symptoms Researchers from Imperial College London have joined forces with global self-care app and website Your.MD to map the spread of coronavirus with the launch of the Your.MD Covid-19 Symptom Mapper which compares, analyses and maps reported symptoms worldwide to help produce a set of global norms. The mapper has had nearly 140,000 respondents from 181 countries worldwide. It works by pulling together data from people experiencing Covid-19-type symptoms around the world to allow them to compare themselves, their illness and their symptoms with others of the same gender or in a similar area or age bracket. Your.MD is sharing the anonymised symptom data with Imperial to help Imperial’s research team map the pandemic and better understand how the disease is affecting people around the world. The cross-disciplinary collaboration is led by Aldo Faisal, director of the Centre in AI for Healthcare, and Dr Ceire Costelloe, Dr Austen El-Osta and Mansour Taghavi Azar Sharabiani from the School of Public Health, all at Imperial. The aim is to collect self-reported population data from people who have either already tested positive for Covid-19, or believe they have symptoms of the virus but have not been tested.
HealthInvestor UK • August 2020
Your.MD and the Imperial team hope to collect enough data from each country to help researchers better understand how the virus affects people who have not been admitted to hospital. Faisal said of the mapper: “Covid has rapidly accelerated and transformed the way we are thinking and doing digital healthcare and the Your.MD Covid-19 Symptom Mapper is one of the many ways we are doing so.” Professor Maureen Baker, Your.MD’s chief medical officer, added: “The data from the
Your.MD’s Covid-19 Symptom Mapper tracks symptoms globally, giving a unique perspective on the virus and allowing comparisons to be made between the UK and other countries. It is vitally important for us to continue collecting data on symptoms of Covid-19, particularly as there are so many unknowns about the clinical course of this illness.” The mapper will gather valuable data on Covid-19 which will also be shared with national governments to help map the outbreak. The new tool can help users assess
whether they have mild, moderate or severe symptoms and to understand how their symptoms compare with other people around the world. As more people use the tool, the information gathered will be used to make detailed comparisons about how Covid-19 is affecting different countries and communities. The Mapper asks users to input details including when they first experienced symptoms, and score the severity of a range of symptoms associated with C-19. The Mapper is free and can be used on iOS and Android phones.
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NEWS
Covid-19
Covid-19 intensive care mortality falls by a third A systematic review and metaanalysis of published studies from three continents shows overall mortality of Covid-19 patients in intensive care units has fallen from almost 60% at the end of March to 42% at the end of May – a relative decrease of one third. The review, led by the University of Bristol and Royal United Hospitals Bath NHS Trust and published in Anaesthesia, a journal of the Association of Anaesthetists, also shows ICU mortality for the disease is similar across the three continents included: Europe, Asia and North America. Review lead author Professor Tim Cook said: “The important message is that, as the pandemic has progressed and various factors combine, survival of patients admitted to ICU has significantly improved. There were no significant effects of geographical location, but reported ICU mortality fell over time. Optimistically, as the pandemic progresses, we may be coping better with Covid-19. “The in-ICU mortality from Covid-19, at around 40%, remains almost twice that seen in ICU admissions with other viral pneumonias, at 22%.” There are several possible explanations for the findings
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regarding decreasing ICU mortality over time. Cook said: “It may reflect the rapid learning that has taken place on a global scale due to the prompt publication of clinical reports early in the pandemic. It may also be that ICU admission criteria have changed over time, for example, with greater pressure on ICUs early in the pandemic surge.” The findings are also likely to reflect the fact that long ICU stays, for example, due slow weaning from a ventilator, take time to be reflected in the data. Critical illness associated with Covid-19 can last for long periods, with approximately 20% of UK ICU admissions lasting more than 28 days, and 9% more than 42 days. The ICU mortality did not differ significantly across continents despite some evidence of variations in admission criteria, treatments delivered and the thresholds for their application. This is consistent with research findings up until the end of May suggesting that no specific therapy reduces ICU mortality. In the last few weeks dexamethasone has been found to have significant benefit and there is hope this will improve survival further.
Largest testing programme for coronavirus publishes initial findings
The largest study into coronavirus rates of infection has been undertaken by Imperial College London. More than 120,000 volunteers tested across England between 1 May and 1 June, as part of the country’s largest study into Covid-19. The research examined levels of infection in the general population in England and will undergo peer review before a final report is published. The research shows rates of infection fell during May, the last month of lockdown, halving every eight to nine days. There were on average 13 positive cases for every 10,000 people, with an overall reproduction number of 0.57 – lower than previously reported. The findings show the virus was circulating with relatively low prevalence and was declining in May, ahead of the decision being made to begin to lift lockdown restrictions. Health Secretary Matt Hancock said: “This ambitious testing programme will help us better understand the spread of the virus to date, predict how it may spread in the future and inform our response to the pandemic. It shows the impact our national lockdown efforts have had and demonstrates that we have taken the right actions at the right time. “As a country we have made great strides towards beating this virus but we mustn’t take our foot off the pedal, and such studies will
be vital as we continue to fight this virus.” The report provides an insight into who was infected with the virus between 1 May and 1 June over lockdown, comparing geography, age, sex, ethnicity, key worker status and symptoms. The key findings include: • Care home staff and healthcare workers were more likely to be infected with Covid-19 during lockdown than the general population, at a time when the public was following government advice to stay at home, therefore limiting their exposure to the virus. Those who had patientfacing roles were more likely to be in contact with known cases as part of their work • Young adults, aged 18 to 24, were more likely to test positive than other age groups, reinforcing the need for this age group to adhere to social distancing measures to protect vulnerable friends and family • Those of Asian ethnicity were more likely to test positive than those of white ethnicity. It is possible that higher infection rates have contributed towards the higher death rates observed in this ethnic group. The report also shows anyone who had recent contact with a known Covid-19 case was 24 times more likely to test positive than those with no such contacts.
HealthInvestor UK • August 2020
NEWS
Covid-19
NHS deploys Covid-19 risk assessment tool to protect front line staff Norwich-based intelligent automation firm Rainbird has developed a Covid-19 risk assessment tool to help potentially vulnerable front line workers limit their exposure to undue levels of risk from the virus. The solution provides staff with digital, one-to-one automated reports, and aims to help occupational health teams to manage their workforce more effectively. Using intelligent automation, the tool evaluates a range of complex
and nuanced factors including age, health history, cultural and religious beliefs, disability, pregnancy and impact of Covid-19 on BAME groups. It has been deployed by multiple NHS trusts, including Norwich and Norfolk University Hospitals Foundation Trust and Royal Papworth in Cambridge, and is applicable to all front line workers, particularly those with risk factors that may make them more vulnerable.
Covid-19 concerns see significant growth of interest in private healthcare and PMI The number of people considering paying for private treatment or health insurance has significantly increased since the Covid-19 outbreak, despite the impact of the pandemic on personal finances, according to new research. A nationwide survey of 1,049 by Consumer Intelligence for health insurance provider Equipsme found that 15% were likely to have considered paying for private treatment or insurance before the pandemic but the figure has nearly doubled to 27% post-coronavirus. Younger people are the most likely to consider paying privately for healthcare, with 30% of respondents aged 18-34 answering this way, compared to 22% of respondents aged 55 and over.
HealthInvestor UK • August 2020
Concerns about waiting times for specialist treatment was the main reason given by those who said they would consider health insurance or paying a private hospital directly for treatment. Some 76% of people say they are now concerned about NHS waiting lists, and 67% are worried about the NHS’s ability to deal with non-urgent and non-Covid related illnesses and ailments. The survey also showed health insurance rising up the wish list of employee benefits – falling behind pensions and flexible working, but ahead of gym membership, childcare vouchers and a company phone. Matthew Reed, managing director at Equipsme, said: “People are inevitably thinking more about their health, and prioritising how they look after themselves and their families. The result is that interest in private medical insurance is actually rising – which at a time when many are facing financial hardship is pretty remarkable.”
The 24/7, web-based chat service consults with workers to determine individual risk, summarising its assessment in the form of a redacted report for line managers/ HR alongside a more detailed report for occupational health departments. This information is then used to determine whether workers should be shielded, referred for a health assessment or cleared to work in various settings, such as in clinical or non-clinical areas or from home.
Rainbird chief executive James Duez said: “Our tool is also very quick and safe to update as more is learnt about Covid and the risk model changes – workers can, and should, come back and be reassessed regularly as their circumstances evolve. Not only does it provide each organisation with a clear, bird’s-eye view of who is suited to work in which environment, it allows staff to benefit from a full consultation instantly, significantly reducing their individual risk.”
IHPN reports on successful NHS partnerships during Covid-19 pandemic
The independent sector has been working successfully with the NHS during the coronavirus pandemic, according to a new report. While NHS and independent healthcare providers have been working together to deliver high quality NHS patient care for over 70 years, with the onset of coronavirus earlier this year these partnerships have strengthened and renewed in recent months, says the Independent Healthcare Providers Network. In its report, the IHPN says independent providers across the acute, diagnostic, primary and community sectors - including
those who had traditionally only delivered privately funded care have stepped up and supported the NHS to ensure that patient treatment can continue during the pandemic. David Hare, IHPN chief executive (pictured), said: “Now that we are, thankfully, beyond the first initial peak of the virus, it’s important to reflect on what these partnerships have achieved and to celebrate the staff working across the public and independent sectors that have sacrificed so much to deliver care for patients during this unprecedented period.”
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NEWS
Primary care
GP practices in Staffordshire, Wakefield, London, Worcestershire and East Sussex have launched new partnerships with primary care property company Assura, which will provide specialist management for their surgery premises. The six practices cater to more than 60,000 patients. Warrington-based Assura has purchased and leased back the buildings to the practices for the long term. Over the past three months, Assura has invested a total of £35 million in primary care infrastructure. The sites include: • Park Medical Centre, Leek, which serves almost 12,500 patients. • The Grange Medical Centre in Hemsworth, which is one of three sites run by one of the largest practices in Wakefield, which cares for almost 15,000 patients as well as providing endoscopy and a range of outpatient treatment services • St Peters Medical Centre, Islington, which cares for more than 12,000 patients. • The Abbey Medical Centre in South Hampstead, catering to 11,000 patients. • Prospect View Medical Centre in Malvern, which is home to two practices serving more
than 24,000 patients and which form part of the SW Healthcare federation. As well as general medical services, the site offers community health services by Worcestershire Health and Care NHS Trust including audiology, podiatry, counselling and school nursing. • Herstmonceux Integrative Health Centre in East Sussex, a new-build centre which serves a growing local patient population due to local housing development. Patrick Lowther, Assura’s head of investment, said: “It’s always exciting to see GP practices so focused on creating the best environments for patients and staff, and we look forward to working with all of these teams to manage their premises more efficiently and sustainably for the future – at a time when easy access to health services in the community and capacity for services away from hospital has perhaps never been more important.” Assura is a real estate investment trust and long-term property partner to more than 570 primary care buildings across the UK, in which more than 500 GP practices operate and from which more than five million patients are served.
Kajima-led consortium secures full planning notice A consortium led by property and project finance development company Kajima Partnerships has received a full planning and decision notice to build a new £30 million community health centre in Newry, County Down in Northern Ireland. Occupying approximately 12,500 square metres, the new centre will bring together numerous health services for the local area and will house up to eight individual GP practices. The Community Treatment and Care Centre, as it will be known, will provide a number of outpatient services, mental health, children’s health and social services, as well as physiotherapy, a genitourinary medicine clinic, dentistry, diabetic clinic and hydrotherapy. Kajima Partnerships is the main developer, working in partnership with O’Hare & McGovern to form GPG O’Hare, the consortium that has been selected by the Southern Health and Social Care Trust to build and manage the project. With the consortium expecting to move onsite this year, the shovelready project is expected to generate jobs during its two-year construction timeline, and once the centre is up and running.
kajima.co.uk
Assura partners with GP practices
Jitesh Patel, social care sector lead at Kajima Partnerships said: “Newry Community Treatment and Care Centre will provide vital access to step-down care, outpatient treatment, mental health and children’s services that will be crucial to supporting the local community after Covid-19. As a shovel-ready project, the new health centre will also help the local economy recover from the impact of coronavirus. “The pandemic has shown the true importance of robust, resilient and flexible integrated healthcare and community services, which is why we are proud to be working hard to begin construction, create new jobs and provide first class services to people in Newry and the surrounding area.”
Pandemic encourages online consultations A report by the Royal College of General Practitioners suggests routine face-to-face doctor’s appointments may be becoming a thing of the past. The number of such appointments dropped from 70% to 23% within weeks of lockdown, and remains low despite the easing of lockdown. Doctorlink, a smartphone app and triage provider for the NHS, stated it has grown dramatically during the pandemic, acquiring 3.5 million
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users, 393 contracted GP practices and 196% growth in repeated prescriptions requested on its app. Doctorlink says its app allows online triage for patients, as well as appointment bookings and video consultations with local GPs. The app includes an artificial intelligencepowered symptoms assessment tracker which is indemnified by the NHS as a piece of medical equipment and took 18 years to build.
HealthInvestor UK • August 2020
NEWS
Primary care
Primary Health Properties, an investor in modern primary health facilities, has announced its interim results for the first half of 2020. The real estate investment trust’s adjusted European Public Real Estate Association (EPRA) earnings per share increased by 7.1% to 3p, compared to 2.8p a year ago, and an average uplift of 2.2% per annum on rent reviews was completed in the period. There was additional annualised rental income on a like-for-like basis of £0.9 million or 0.7%, from rent reviews and asset management projects, and the contracted annualised rent roll increased by 4.4% to £133.3 million. A portfolio of 22 purpose-built medical centres were acquired, one of which was acquired on 1 July for £54 million. Three forward funded developments were also acquired in the half-year, with a net development cost of £23 million at Arklow in Ireland, Epsom and Llanbradach. The property portfolio is now valued at £2.514 billion, up from £2.413 billion at the turn of the year, reflecting a net initial yield of 4.86%. A revaluation surplus was generated in the period of £10.5 million, representing growth of 0.4%. The company’s Irish portfolio now comprises 17 assets, valued
Athy Primary Care Centre, Republic of Ireland at £194 million, including two forward funded developments currently under construction which, if valued as complete, increases the total asset value to approximately £211 million. PHP completed the forward funded developments at Athy, Bray and Rialto in Ireland during the period and has six developments currently on site with a net development cost of £41.5 million. Harry Hyman, managing director of PHP, said: “The Covid-19 pandemic has highlighted the demands on health systems around the world, not least the NHS in the UK and HSE in Ireland, where the
underlying demand for healthcare is increasingly driven by growing and ageing populations. The need for modern, integrated, local primary healthcare facilities is becoming ever more pressing in order to relieve the pressures being placed on hospitals and A&E departments. “As a result of the Covid-19 pandemic, we see strong demand for extra space to help alleviate the backlog of consultations that has arisen as a result of the coronavirus, while facilitating the movement of activity out of hospitals and the continued care of patients that have suffered from Covid-19.
“The successful equity placing on 9 July raised £140 million of proceeds and was upsized from £120 million due to strong investor demand. The funds raised will help further accelerate our growth by funding near-term portfolio expansion, forward funded developments and asset management projects. “PHP looks forward to delivering further earnings and dividend growth and remains confident of its future outlook.” *Sister companies of HealthInvestor UK have an interest in PHP
Travel to see doctors cost UK businesses £1.5bn A report published by AXA PPP healthcare today claims that employee traveling to GP appointments cost UK businesses an estimated £1.5 billion in lost working time last year. The report notes that, while a face-to-face consultation is necessary in some cases, many patients could receive appropriate care via an online consultation, especially as a first point of call. The report estimates that, had virtual GP appointments been
HealthInvestor UK • August 2020
offered as a first point of call across all public GP practices in 2019, face-to-face consultations could have been reduced by 50 million. Dr Arup Paul, deputy chief medical officer at AXA PPP healthcare, said: “Our findings show that not only can highquality online GP services help to increase GP practice effectiveness, but they could also help reduce no-show appointments which depletes valuable resource.
Furthermore, by reducing the number of face-to-face appointments, UK businesses could potentially save up to £1.5 billion in lost working time. Patients stand to gain too – from reduced travel costs and, for those who are selfemployed, even a reduced loss of earnings.” Dr Kate Bunyan, chief medical officer at private online GP provider Doctor Care Anywhere, which supports the delivery of
AXA PPP healthcare’s Doctor@ Hand service, added: “Our purpose is to improve people’s lives. We aim to provide highquality care, through offering online GP services at a time and place that’s convenient to all. The more the healthcare sector can unlock such services, the more we can collectively support patient demand.” The report is entitled: ‘Digital health: the changing landscape of how we access GP services’.
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phpgroup.co.uk
Primary Health Properties’ results reflect growth
NEWS
Private hospitals
NMC Health administrators hire Perella Weinberg for Aspen sale NMC Health’s administrators have reportedly appointed investment bank Perella Weinberg Partners to advise on a sale process for Aspen Healthcare. United Arab Emirates-based private hospital operator NMC
Health acquired UK-based Aspen for £10 million in 2018. NMC went into administration in April after it emerged that the company was in debt to the tune of $6.6 billion.
Major Spire Healthcare shareholder warns of second wave threat Mediclinic, the international private healthcare services group, says it has seen “continued improvement in operational performance” as Covid-19 lockdown measures are eased globally. But the group, which owns nearly 30% of UK private hospital operator Spire Healthcare, warns that elective procedures may still be at risk if further outbreaks occur. In a statement issued ahead of its annual general meeting today, Mediclinic says: “There remains a risk to elective procedures and outpatient activity from a continuation or reintroduction of lockdown and other measures
in response to the pandemic; the availability of staff; and a disruption in the supply chain. Mediclinic is focused on fulfilling its vital role as a leading provider of essential healthcare services during this crisis. To this end, the group remains agile in its approach, optimising its response to overcome challenges and create opportunities while seeking to maintain its strong financial position and liquidity.” The company’s primary listing is on the London Stock Exchange in the UK, with secondary listings on the JSE in South Africa and the Namibian Stock Exchange.
Signs of recovery in private healthcare activity Activity in insurer-funded healthcare saw a steady increase in activity in June, particularly in oncology where volumes have already returned to pre-crisis levels, according to a new report Healthcode, the UK’s official clearing organisation for private medical bills, monitors activity levels on behalf of the independent healthcare sector. It reports that while activity for the whole of June 2020 was 53% down on 2019 and this trend has continued into early July, there is a significant advance on the monthly activity level for May 2020 which was just 29% of that in May 2019. In June 2020, England operated at 48% the level of 2019 while Scotland reached 31% and Wales 20%. By contrast the equivalent figures in May 2020 were 29% for England, 24% for Scotland and 13% in Wales. The West Midlands was the region which bounced back strongest achieving 65% of 2019 levels in June, compared with 43%
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in May. London has also rallied, achieving 55% of the activity in level of the previous year. For oncology, the activity level in last month was 99% of that in June 2019. Next was pathology/ haematology which was at 75% of 2019 levels while the equivalent figure for radiology was 54%.
ENT was at the other end of the scale, operating at only 19% of 2019 level, while physiotherapy was 23%. Orthopaedics, traditionally a strong area for PMIfunded treatment, only recovered to 25% of its expected level. Overall hospitals activity has recovered to 40% previous levels.
Within hospital settings, outpatient activity has recovered more strongly, returning to 42% of its 2019 figure, up from 24% in May. By contrast admitted care activity in June was only at 32%. However, this is an improvement on the May figure of 21% and Healthcode anticipate this will continue, based on recent levels of the consultant activity. Peter Connor, Healthcode managing director, said: “Since private providers were given the green light to resume treatment, everyone has been working hard to deliver high quality care to patients. As a result, we saw an increase of approximately 50% in activity in June compared with May across the sector, albeit there were still considerable variations. Reassuringly, that positive trend has continued into July which supports our view that this growth is sustainable and the independent healthcare sector is already well on the way to recovery.”
HealthInvestor UK • August 2020
NEWS
Digital
Ascenti reports virtual physio service is effective A study by private physiotherapy services company Ascenti of 27,000 virtual physiotherapy patients has concluded that digital physiotherapy must become a significant part of the treatment mix post Covid-19 – after results showed that it is just as effective as and, in some cases, more effective than, in-person treatment. The report captured data on patients’ openness to virtual treatment, pain improvements on a ten-point numerical rating scale, and satisfaction with outcomes. There is also commentary from
clinicians and patients on the benefits and drawbacks of virtual treatment. Although a relatively new practice, digital treatment delivered similar outcomes to in-person care at all injury levels. Adam Jarvis, Ascenti’s chief operating officer, said: “The results of this study – potentially the world’s largest study of virtual physiotherapy conducted so far – clearly demonstrate that patients who access digital support to help them with musculoskeletal injuries can achieve excellent results.
“Digital health services are in high demand right now due to the Covid-19 virus still being in circulation, but even when we eventually move past this, they
will still have an important part to play in addressing more familiar barriers to treatment such as lack of time, family commitments and inability to travel.”
NHS
Study says Locum’s Nest platform could slash NHS agency spend A study released by The Kent Surrey and Sussex Academic Health Science Network, has revealed that Locum’s Nest, a digital platform which maximises workforce, could provide a 72% saving on agency spending for NHS trusts. The research claims that every pound invested into Locum’s Nest would give the trust an immediate return on investment of £3.55, a 72% saving. With the NHS’s current total
locum spend at approximately £2.4 billion, the total saving would be approximately £1.73 billion. A sample of eight trusts of varying sizes across the country, covering almost 50% of South England were studied and analysed over a period of six months. Dr Nicholas Andreou, cofounder of Locum’s Nest, said: “We have long known the positive effects our collaborative ways of working can have on NHS trusts
across the UK. Today’s study allows us to put an external, quantitative and qualitative backing to these savings that we’d expected, but now know. The NHS could save almost £2 billion simply by switching from expensive agencies to Locum’s Nest. “We are an ethical company founded by healthcare professionals to help healthcare professionals, and we truly believe that these savings can help not just workers by maximising staff
available, but those who are within hospitals filling rotas and, most importantly, ensure patient care is optimised. “We are already active in 30 trusts across the UK and we are constantly expanding our services. We hope this new research will demonstrate to the NHS that when the right technology innovation is implemented, healthcare professionals are empowered as they are able to work in a safe and flexible culture.”
Capreon lets Harlow space to trust Capreon, the London-based real estate business of the Noé Group, has completed a major office space letting at the Kao Business Park, Harlow, to The Princess Alexandra Hospital NHS Trust. The long-term deal will see the NHS trust move to the high-tech facility on a 15-year lease. The letting is one of the largest north of the M25, following the agreement to lease 27,383 square feet of office space.
HealthInvestor UK • August 2020
Capreon signed the deal at the end of last year. However, due to the Covid-19 pandemic, the trust was unable to occupy the units until this month. The Princess Alexandra Hospital NHS Trust oversees three hospitals in the region, serving over 350,000 people and joins Pearson Education, Arrow, Raytheon and Virgin Care Services at Kao Park. The trust has begun to move its administrative staff to Kao Park.
Zvi Noé, partner at the Noé Group, said: “This deal was a great way to finish 2019. Despite the disruption from the Covid-19 pandemic we are pleased to see the trust occupying the property and hope to continue a lasting relationship in the park. The deal is testament to the quality of the park and the technology that it supports. Michael Meredith, director of strategy and estates at The Princess Alexandra Hospital NHS Trust, said:
“Kao Park has provided us with a fantastic opportunity to invest in our people and to transform the way we deliver clinical support services. This high-quality, great value accommodation is a cornerstone for our flexible working policy and provides the perfect collaborative working environment for our people.” Kao Park is being marketed by joint agents CBRE, Derrick Wade Waters and Lee Baron.
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NEWS
Social care
Councils ‘unprepared’ for senior living market Research produced by global property consultancy Knight Frank and law firm Irwin Mitchell claims that councils across England are underprepared to provide suitable housing for seniors. By 2037, it is forecast that one in four people in the country will be over 65. The research has identified 10 opportunity areas ripe for development of seniors’ housing across England. Knight Frank and Irwin Mitchell state they have distinguished areas where there is potential for senior living to develop, as well as those areas where local factors are creating a barrier to progress. Lauren Harwood, head of senior living research at Knight Frank says: “This research is released against a backdrop of the Covid-19 pandemic, which has placed a particular spotlight on people in their later life. This has made it clear there is a need for local authorities to put plans in place to ensure there is a suitable, age-appropriate choice of housing for seniors. “There is currently a huge supply and demand imbalance of senior housing in England, which is widening amidst a growing and ageing population. It is vital to increase the provision of seniors housing. This is part of the solution to create more capacity in the social care system while also supporting the wider housing market. With that in mind, it is crucial that developers understand where the opportunities are, and how they
can access these to help meet the needs of our seniors.” Key findings of the survey are: • Very few large cities appear to be close to addressing the challenges posed by housing an ageing population. Many major cities are a ‘D’ rating – including Birmingham, Bristol, Derby, Leicester, Oxford, Sheffield and Southampton. Leeds is an exception – it has an A rating for planning and performs well in the overall opportunity rankings also. • London is increasingly becoming an ageing city and London boroughs exclusively make up the nation’s top 10 ageing local authorities. Its 65-plus population is due to increase by 32% between 2017 and 2029. Despite this, London is underperforming when it comes to delivering housing for its senior citizens, with 22 boroughs currently holding a planning score of ‘D’. While the new draft London Plan recognises the importance of the sector, its record on delivery has been poor. In the first three full years of the plan (2017-2019 inclusive) just over 700 senior living homes per annum were delivered (totalling 2,100 units), compared to the target of 4,115 units per annum (12,345 units over the three-year period). • Analysis highlights there are opportunity areas, particularly
within the Southwest corridor of London, where there is potential for significant growth. Currently these boroughs perform relatively poorly in the planning score, but nonetheless have other factors firmly in their favour. • There are also some boroughs bucking the trend in London. Camden scored highest out of the London boroughs, and second overall in the overall opportunity score for private delivery. Camden has a specific policy supporting seniors housing. Its local plan makes clear affordable housing is likely to be sought with a flexible approach to the scale and location, and residential CIL charging rates apply. • Birmingham has a projected growth rate of 22%, and an existing 65-plus population of 150,000 individuals will increase to 183,000 by 2034. Birmingham has the potential to perform much better, but in line with other large cities, its adopted planning
policies do not prioritise senior living. Birmingham has no housing allocation, no policies supporting delivery, affordable housing is levied on C2 development and there are no CIL benefits compared with residential development. Since 2010, there has been an average annual delivery of 208 senior living units across the local authority, with no schemes delivered since 2018. Without a change in policy, the survey warns that the city will not meet the needs of its ageing demographic’s housing requirements. • By contrast Cheshire West and Chester is a ‘best in class’ local authority, having an allocation for seniors’ housing, a supportive policy environment, a clear position on affordable housing and CIL requirements for C2 use. It is also the only authority to appear in the top 20 opportunity areas for both private and affordable operators.
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HealthInvestor UK • August 2020
NEWS
Social care
UK care home industry short of beds The UK care home sector has seen a minimal increase in in the number of beds but this is failing to keep up with demand, with the number of care home beds per 100 people over the age of 85 falling by 5% since 2010, according to research by property advisor Knight Frank. The annual ‘UK Healthcare Development Opportunities 2020’ research report shows that while the number of care home beds increased by 2,500 in the last financial year, the number of homes fell to 12,170 nationwide. This is driven by smaller outdated care homes closing while larger, purpose-built care homes or existing homes are adding beds to create more efficient and viable schemes throughout the UK. While new stock replacing old and outdated stock is a positive step, the extent of home closures and de-registrations taking place means that the market is in fact struggling to expand at the pace required for future demand. In the 2019/20 financial year, a total of 7,058 beds (122 homes) were newly registered and 6,789 (233 homes) were de-registered.
The research points out that 70% of UK care home facilities were built before 2000. As such, many operators are considering how to upgrade their existing portfolio and refurbishment will remain important along with new developments to keep up with the long-term demand due to an ageing population combined with the accelerated closure of underperforming assets. Knight Frank’s research identifies a potential 6,500 care homes at risk of closure over the next five years, equating to 140,000 beds and estimates that the UK requires in excess of £15 billion to upgrade existing beds in order to futureproof for the ageing population. This shortage will be exacerbated by the increased demand for care homes by 2050, which will see a national bed crisis in the UK as the share of people over the age of 80 is expected to surge over the next 30 years, with one in 10 adults set to be over 80 by 2050, compared to one in 20 currently. Julian Evans, head of healthcare at Knight Frank, said: “The UK healthcare industry requires substantial investment in order to
keep pace with present demand, let alone the provision that is going to be needed for the future as the population continues to age. Whilst the overall bed numbers have increased, this is still nowhere near enough to address the crisis in provision and is likely to be further exacerbated as the next generation ages at a faster rate than new care homes can be developed. “This has been accelerated by the Covid-19 pandemic which has accelerated trends that will lead to closures of care homes that are no longer fit for purpose, resulting in a significant national shortfall of bed provision. “Once the situation resolves around the Covid-19 crisis, we will see numerous changes around how operators fare and we expect that with the scarcity of stock and a continuing ageing population driving demand, the investment appetite for care home developments will remain strong from a range of investors. There are opportunities for both investors and developers across the entire UK, with our Hotspots Index highlighting the range of opportunities nationally.”
The Index identifies which UK locations present the best prospects for investment and development. This year, Buckinghamshire leads the hotspots list in England, pipping Greater London. The top five in England and Wales are Buckinghamshire, Greater London, South Glamorgan, Berkshire and Cambridgeshire. The Covid-19 pandemic has placed additional pressures on the care home market which had already seen closures due to ongoing staffing challenges, with an acute shortage of qualified nurses, combined with restrained care home development owing to building material inflation costs. Knight Frank expects that care home design will adapt to meet future virus experience and that care homes will need to innovate their operational procedures post Covid-19, including an increased use of telemedicine. It expects that there will be an accelerated closure of tertiary assets while due to increased smart specifications necessary for future new build care homes, the cost of raw materials will further increase.
Senior living sector to grow 10% in five years Property consultancy Knight Frank has forecast 48% growth in housing with care in the UK, adding approximately 45,000 units in the next five years, while retirement housing is predicted to increase by 5% over the same period adding about 29,000 units. Seniors housing is a diverse sector, comprising both ‘retirement housing’ – age-restricted market housing designed with the down-sizer in mind, and ‘housing with care’, which provides high levels of services, care and support. The growth will take the total amount of seniors housing units in the UK to 800,000 – an overall increase of 10% by 2025.
HealthInvestor UK • August 2020
Tom Scaife, head of senior living at Knight Frank, said: “There are a number of clear trends emerging in the senior living space, driven primarily by demand from residents. Schemes in urban locations – such as Audley’s new Nightingale Place in Clapham – are becoming increasingly popular as more people seek a lifestyle-led offering. Developments of mixed tenure are also becoming more widespread, as people discover the flexibility that comes from renting instead of buying in their later years.” Knight Frank added that the growth of the UK’s senior living housing stock is still outstripped by the growth of the ageing population,
with predictions that by 2037, one in four people will be aged over 65. Therefore, while total delivery is forecast to rise, in real terms the number of seniors housing units per 1,000 individuals aged 75-plus is expected to drop to 120 by 2024, down from 137 in 2010 and 129 in 2020 – an overall decrease of 12.4% over 15 years. Lauren Harwood, head of senior living research at Knight Frank, said: “Currently, the forecast suggests that the projected delivery of seniors housing seems will not keep pace with our growing ageing population. A step change in new delivery is required if the UK is to reverse the huge imbalance between need and supply, which is only set to increase as people continue to
live longer and more of the population enters the 65-plus age bracket.” Knight Frank contend that a significant issue holding the sector back is planning policy. Its research suggests that only 18% of local authorities in England have clear planning policies and site allocations to support the sector – and 50% still don’t have either. Other Knight Frank research recently predicted that 6,500 care homes totalling 140,000 beds are at risk of closure over the next five years. Scaife added: “Private seniors housing has the ability to elevate pressure and increase capacity in the care system. Understanding this is crucial to ensuring delivery meets the needs of our ageing population.”
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Social care
Target reports stable rental income and invests in new care home Target Healthcare, the UK-listed specialist investor in modern, purpose-built care homes, says that 96% of the rent payable in respect of the recent quarter dates has been collected, after allowing for agreements in respect of a limited proportion of the portfolio’s 71 operational care homes to pay monthly in advance. As a result of the quarter’s strong rental collection, the Company reaffirms its intention to pay its fourth-quarter interim dividend, for the period 1 April 2020 to 30 June
2020, in-line with expectations and as per the normal timetable, with announcement due in early August 2020. Meanwhile, Target has acquired a new-build care home in Bicester, Oxfordshire for £15 million inclusive of costs. “The high quality, 66 bed, purpose-built asset is let to Ideal Carehomes, the Group’s largest existing tenant with leases on 12 assets including this one. Ideal has agreed a 35-year, fully repairing and insuring occupational lease
which includes annual, upwardsonly RPI-linked increases, subject to a cap and collar. The acquisition yield on the transaction is representative of assets of a similar standard and location within the Group’s portfolio, operated by a well-capitalised tenant,” said Target in a statement. Kenneth MacKenzie, chief executive of Target Fund Managers, said the company had taken steps to protect itself from the effects of the Covid-19 pandemic and revenue remained stable.
“While we postponed some acquisitions early on in the pandemic to ensure a robust balance sheet, we now have sufficient visibility to continue our mission of creating a stable income platform of scale, while working to our long held ESG values, providing modern purposebuilt care homes for their residents. We have been hugely impressed with the devotion and resilience of our tenants in their delivery of care to their residents during this difficult time,” he said.
Sanders Senior Living to open Worcester care home Sanders Senior Living is developing a 74-bedded purpose-built care home in Worcester. Each room will have en-suite wet room provisions and the state-of-the-art facility will also provide amenities including a dementia café, hair salon, lounges and communal areas, as well as private dining. The company develops luxury care homes and is a sister company to Runwood Homes Ltd, the UK’s largest privately-owned care home group that owns over 70 care homes nationwide, operating around 5,000 beds.
Alyssa Kelleher, communications manager, Sanders Senior Living, said: “Within our premium living environments, finished to a beautiful high standard, we help our residents enjoy happy fulfilled lives; enjoying long established hobbies, discovering new ones and being part of a vibrant community, with professional support and services on hand around the clock.” Mandip Bhogal, associate in healthcare, Knight Frank, which advised on the acquisition, said the construction of purpose-built care
Mandip Bhogal
homes was set to continue at pace as demand outstrips supply. “In addition to providing a significant facility locally, this development is also indicative of the types of opportunities we will see in the future as demand for fit for purpose care homes outstrips supply. Demand for modern purpose-built and future-proof care facilities will only continue to increase, owing to our ageing population and the national care bed crisis we face with many care homes in the market currently not up to standard,” he said.
Kibble re-starts work on Scottish specialist care facilities for children Scottish specialist care provider Kibble has restarted work on two new residential care units for children aged 5 to 12. Kibble had planned to open the residential houses in July 2020, however with work on pause due to the pandemic, it now hopes to welcome children later this year expanding on its services for primary aged children. The units will provide a therapeutic living space for children
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with experience of trauma. The new children’s service, located next the specialist child and youth care charity’s Forest View Primary School in Lochwinnoch, consists of a four bed and five bed house which has been designed to reflect family-based living. As part of the research for Forest View Primary School and Residential Houses, staff at Kibble looked at international examples in residential childcare, travelling
to places such as Finland and New York, to find exemplary models of care. Neil McMillan, executive director of community services at Kibble, said: “We’re really pleased to have work back up and running again for our new children’s residential service, allowing us to provide a safe and nurturing home for children that have faced significant challenges in their lives, and who need support and stability.
“Our new children’s houses enhance our existing provision at Forest View, with our primary school also within the grounds. Everything we do is based around therapeutic, trauma-informed principles from the forest environment to the therapeutic supports, positive relationships, ethos and culture. We are looking forward to welcoming the children soon and helping them to feel settled with the help of a great, supportive team.”
HealthInvestor UK • August 2020
NEWS
Social care
CQC to investigate integrated care for older people The Care Quality Commission (CQC) is to set up a programme of local reviews to investigate how effectively health and care providers for older people are working together. Provider Collaboration Reviews (PCRs) reviews will focus on 11 Integrated Care System (ICS) or Sustainability and Transformation Partnership (STP) areas and will support providers across systems by sharing learning, helping to drive improvements and preparation for future pressures on local health and care systems. In carrying out the reviews, CQC will use data it holds and undertake conversations with providers and ICS and STP leaders. This will include the experiences of people who use services and will focus on
the interface between health and adult social care for the over-65 population group. Rosie Benneyworth, chief inspector of primary medical services and integrated care said: “The speed and scale of the response required by the Covid-19 pandemic has highlighted the benefits to services and the people who use them of creativity and innovation through collaborative approaches. Responses to the pandemic have offered opportunities for partnership working, ensuring shared efforts to avoid fragmentation and drive best experiences and outcomes for those accessing care within the system. “These reviews will help identify where provider collaboration has worked well to the benefit of people who use services. Sharing
that learning will help drive further improvements across systems.” Lisa Lenton, Chair of the Care Provider Alliance, said: “By having conversations with partners importantly people who use services and providers as well as ICS/STP leaders in the identified areas, there is a real opportunity to share experiences - collaboration is key and identifying more effective ways to work in partnership is very welcome to swiftly evaluate what will need to happen in the event of a second peak to support people who access care and support.” The CQC plans to look at provider collaboration in all ICS and STP areas. Review teams will feedback findings to areas following each review to help them plan ahead. Themes from the first 11 reviews
will be reported in September in the CQC’s Covid Insight report and State of Care in October. The first phase, between July and August, will see reviews in: • Bedfordshire, Luton and Milton Keynes ICS • Norfolk and Waveney STP • The Black Country and West Birmingham STP • Lincolnshire STP • North East and North Cumbria ICS • Healthier Lancashire and South Cumbria ICS • Frimley Health and Care ICS • Sussex Health and Care Partnership ICS • North West London STP • One Gloucestershire ICS • Devon STP.
RMBI care homes install Covid-safe visitor pods
HealthInvestor UK • August 2020
deep cleaned between each visit and most have been installed by the Homes’ facilities teams. Among the residents to be able to have visitors again was Connie Jones at Albert Edward Prince of Wales Court in Porthcawl. Connie was reunited with her sister, Grace, on her 82nd birthday. Connie said: “It was wonderful to be able to see my sister again after such a long time. It was the best birthday present I could have wished for Connie’s sister, Grace Amroth, said: “It was fantastic being able to see Connie at last, just in time for her birthday. The visiting room is great, the whole experience was really positive. The Home has done a brilliant job looking after Connie through the pandemic, I can’t have asked for more.” Mark Lloyd, managing director. said: “Our teams have been working around the clock to find innovative ways to bring our residents safely back in contact with their loved ones. In normal times, our residents
are able to have visitors whenever they like, so not being able to do that has been difficult for everyone. We’re also continuing
to look at other ways to welcome visitors safely to our Homes again, including making use of the outdoor spaces at many of our Homes.”
rmbi.org.uk/news/residents-reunite-families-thanks-new-visitor-pods-rmbi-care-co-homes
RMBI Care Company Homes are among the first providers in the country to install Covid-secure visitor pods which allow residents to meet safely with their families again. The charity’s 18 care homes closed their doors to all but essential visitors before lockdown to protect residents. Staff have worked tirelessly to ensure residents have had regular contact with their families by phone or video call, but close up, face to face conversations have not been possible. The newly created partitioned spaces have an airtight glass screen, to ensure the safety of residents, their families, and the Homes’ staff. Visitors enter and exit from outside of the Home to minimise the risk of infection. Residents access the pods from a different door inside the Homes. The pods have an intercom system to allow residents and their visitors to speak with each other easily. Both sides of the pods are
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NEWS
Social care
Carefound opens West Bridgford office Carefound Home Care, which provides home care services to elderly people enabling them to continue living in their own homes, has opened an office in West Bridgford in Nittinghamshire. The office will support the company’s activities in and around West Bridgford, Keyworth, Beeston, Radcliffe-on-Trent and Arnold, and 24-hour live-in care across Nottinghamshire, Derbyshire and Leicestershire. Carefound states that its oneto-one care service is provided by fully vetted and trained carers and can include anything from basic domestic help, companionship, medication help, and personal care, as well as specialist support for complex conditions such as dementia, Parkinson’s, stroke care and end-of-life care.
Sarah Richards, registered branch manager for Carefound Home Care in Nottinghamshire, said: “We are delighted to be bringing our expertise to Nottinghamshire and are busy recruiting a fantastic team of professional carers who are caring, compassionate and can demonstrate a clear understanding of our ethos at Carefound Home Care.” “All of our carers receive specialist training from our office in West Bridgford and we look to attract the best people by offering great pay and benefits, leading training and professional development and unrivalled 24/7, local support.” “I have over 19 years’ experience in the care industry and feel privileged to be establishing the Carefound Home Care service in Nottinghamshire which I know will bring a huge amount to the local community.”
Care home deaths continue to fall Deaths in care homes in England and Wales have been below the five-year average for the past four weeks and deaths involving Covid-19 are falling significantly, according to official figures. The Office for National Statistics says that the proportion of deaths from all causes that occurred in
care homes continued to decrease to 19.0% in the week ending July 10th (Week 28). The proportion of care home deaths that involved Covid-19 also decreased; 5.8% of all deaths in care homes involved Covid-19 in Week 28, compared with 9.2% in Week 27.
Of all deaths involving Covid-19 registered up to last week, 63.5% occurred in hospital with the remainder mainly occurring in care homes (29.7%), private homes (4.6%) and hospices (1.4%). There have been more than 26,226 excess deaths in care homes since mid-March.
McCarthy and Stone looking for land McCarthy and Stone, the developer and manager of retirement communities, has launched a £100m land acquisition fund to redevelop a variety of health and social care sites currently occupied by residential care homes, GP surgeries and other similarly sized medical premises. McCarthy and Stone is looking to work with businesses and landowners to identify 60 or more sites over the next year which are suitable for the development of new
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retirement communities. The company is currently searching for land between 0.5 to 5 acres on central brownfield locations, ideally with level access to shops, and in a prominent location close to the high street or to local amenities. It will consider every type of land deal, whether unconditional purchase, conditional contract or option agreement. It will also consider building a healthcare unit within the new building, with operators and the
future residents benefitting from the end use, a doctors’ surgery or pharmacy for instance. John Tonkiss, chief executive officer for McCarthy and Stone, said: “We believe our land acquisition fund has the potential to yield long-lasting knock-on effects for the health and social care sector, not least because the regeneration of brownfield sites will free-up capital for operators, business owners and medical practitioners looking to reinvest in growth and create jobs.
What’s more, centrally located retirement communities have a role to play in the Government’s drive to revive town centres, and new developments which bring new customers into an area could provide a lifeline for local businesses.” McCarthy and Stone says it is in “a very strong cash position” and that it has secured £300 million from the Government’s Covid Corporate Financing Facility to support its plans.
HealthInvestor UK • August 2020
NEWS
Dentistry
Bupa Dental Insurance opens up to virtual care Bupa is expanding its range of dental insurance benefits to include virtual dental assessments, and remote emergency support. The enhanced dental insurance benefits will give customers different options to access oral care and encourage patients to seek dental care treatment they need, without leaving home. The virtual services will allow customers to have their oral health reviewed from home using camera and video technology. They will send in images and
videos through the service, and a dentist will review them and build a personalised assessment report based on individual oral health risks and offer suggested care and treatment options. Dental insurance customers who are midway through treatment or have an emergency, can also access remote emergency dental support. Consultations will be available either by telephone or a video appointment, even if they are not currently registered with a Bupa Dental Care dentist. This
service is complimentary for Bupa insurance customers and does not impact benefit limits. The guidelines for the reopening of practices requires dentists to implement safety measures to keep patients and dentists Covidsafe. This includes all patients, clinical and practice teams wearing enhanced PPE to minimise the risk of cross-contamination during treatments. Richard Norris, director of Bupa dental insurance said: “We have seen demand for remote access
services expand exponentially during Covid-19, and we are continuing to look at ways that we can provide continued care for our customers. We have introduced these new dental insurance benefits to ensure customers don’t delay seeking help for dental health worries, because it means leaving home to get help or having difficulty getting a face-to-face appointment. Whatever the dental concern, whether emergency or routine, we want to help our patients get the care they need.
Deals and investments
Global healthcare deal activity falls for second consecutive week The number of deals announced in the global healthcare sector fell by 12% during the week ended June 28, according to GlobalData’s deals database Mergers and acquisitions, private equity, partnership and licensing agreement deals volume decreased by 16.7%, 44.4%, 32.6% and 18.2%, respectively, while the number of equity offering and venture financing deals increased by 23.4% and 17.2%, respectively. Aurojyoti Bose, Lead Analyst at GlobalData, comments: “Though the healthcare sector has been relatively resilient compared to
other sectors amid uncertainty and volatile market conditions due to the Covid-19 outbreak, deal activity in the sector has been inconsistent during the last few weeks and this is the second consecutive week of decline in deal activity.”
HealthHero launches and acquires German platform London-based pan-European investment house Marcol has joined forces with digital entrepreneur and investor Ranjan Singh to launch HealthHero, a holistic digital health provider operating in the UK, Ireland and Germany. The new company delivers 24/7 access to doctors and experts via a suite of tools including video calls, online chats and phone. HealthHero has also acquired Berlin-based telemedicine platform Fernarzt.com, which was set up in 2017 to provide online consultations in Germany. HealthHero already owns, UK-based Medical Solutions, which has more than 20 years’ experience in connecting patients
with doctors remotely for insurance and corporate clients. HealthHero chief executive Singh said: “The world has changed, but healthcare is failing to keep up. Digital can provide the solution, but it has not yet succeeded. We are here to change that, What HealthHero offers is a fully holistic healthcare option. By bringing together digital convenience with real human expertise we can deliver a seamless experience which provides clinical consultations from a multidisciplinary team of GPs, specialists, musculoskeletal practitioners and mental health practitioners without leaving your sofa.”
Novai closes seed funding for eye disease detection Novai, a biotechnology start-up originating from University College London, has secured £500,000 in seed funding in a round led by SFC Capital. The funding will be used to further develop Novai’s AI-powered technology that enables standard medical imaging equipment to
HealthInvestor UK • August 2020
identify eye disease at a cellular level up to 18 months earlier than current gold-standard processes. Novai has also appointed Gordon Bethwaite as acting chief executive. Novai recently closed its first commercial agreement, a research collaboration with Santen USA, and is also actively responding
to significant global commercial interest. Rohallah Ghasemi, investment manager at SFC Capital, said: “Novai’s innovative combination of technology and biomedicine represents the future of preventative care, with the potential to make a massive difference for anyone
who might suffer from degenerative diseases in the future. The founders have assembled an extraordinary team of experts and advisors, and we are pleased to be supporting them as they continue to prove the capabilities of the technology and grow the company. We’re excited to see what they achieve next.”
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Deals and investments
The Barkby Group increases investment in VivoPlex Diversified business group The Barkby Group has invested £500,000 via a convertible loan agreement (CLA) in VivoPlex Group, a digital health company focusing on fertility and women’s health. VivoPlex’s first product is a wireless, battery free medical device to measure pH, temperature and dissolved oxygen level in the uterus continuously for up to seven days. The data from this is used by clinicians seeking to optimise and personalise current fertility treatments and improve IVF success rates. Abington, Oxfordshire-based VivoPlex is one of the Barkby investments which its owners, the Dickson family, had originally via contacts at the University of Southampton in 2015. The academic founders required funding to commercialise the technology and develop a novel medical device. The Dickson Family formed VivoPlex with the academic founders and begun funding the project. In 2018 VivoPlex completed a £3 million Series A funding round led by the Dickson family. The Dickson family has invested approximately £1.4 million over the past four years and has two VivoPlex board seats in. The family own 41.1% of the issued share capital of VivoPlex. The new investment is being
funded through the repayment of the group’s convertible loan note from Transcend Packaging. This takes the group’s total investment in VivoPlex to £2.5 million. The CLA has a term of 36 months and an interest rate of 8% per annum, which is non-compounding, and, if payable, will accrue daily. The CLA will convert to equity at a 20% discount to the lowest price paid by investors. VivoPlex’s recent fundraising is the second tranche of its clinical stage funding round, which included investment from the future fund. The proceeds will be used for a clinical feasibility study, given approval by the Medicine and Healthcare products Regulatory Agency and the relevant ethics committee in April 2020, whose start was delayed by Covid-19. The investment will also be used to gain a European CE mark for its first product, which will enable VivoPlex to sell the product in the market. Charles Dickson, executive chairman of the Barkby Group, said: “I am delighted that Barkby is able to continue supporting VivoPlex as it aims to transform fertility treatment and revolutionise understanding and improvement of women’s health. The business is making excellent progress and we expect their first clinical feasibility study to conclude in Q1 2021.”
Beckley Psytech raises £3m Healthcare industry leaders optimistic about post-Covid-19 recovery
Beckley Psytech has raised £3 million of Series A funding to develop a pipeline of psychedelic drugs into licensed pharmaceutical medicines for treating psychiatric and neurological diseases. Investors in the round include Richard Reed, co-founder of Innocent Drinks. The Beckley Psytech team comprises talent from the psychedelic and pharmaceutical fields. Co-founded by world-
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renowned leader in psychedelic research Lady Amanda Feilding and CEO Cosmo Feilding Mellen, the executive team also includes Marc Wayne as Chairman of Board and Dr Steve Wooding, Chief Scientific Officer. Wayne is a pioneer of the Canadian medical cannabis industry and Wooding is the former head of global commercial strategy for Janssen, Johnson and Johnson’s pharmaceutical division.
Among all the respondents in June’s Global Business Barometer reading from The Economist Intelligence Unit, executives in the healthcare industry appear the most optimistic. They are confident that their market share, operational agility and profitability will be ‘somewhat better’, yet they remain pessimistic about revenue growth.
The Barometer also reveals that healthcare and pharmaceutical firms are among those boosting investment or business spending. The Economist Intelligence Unit surmises that those initiatives are going into R&D for viral treatments or front line equipment and drug procurement or sales channel investment.
HealthInvestor UK • August 2020
NEWS
Deals and investments
Primary Health Properties exceeds fund raise target by £20m Primary Health Properties has raised £140 million through a placing of 96.6 million shares, to fund future acquisitions of asset management projects totalling £128 million. PHP had originally intended to raise £120 million in total, but the target was increased due to investor demand. This will include a short-term estimated pipeline of GBP92 million of active acquisition and development opportunities across the UK and Ireland as well as adding more value to existing assets, estimated at GBP36 million. The shares were issued at a price of 145 pence per share, reflecting a discount of 5.2% to Wednesday’s closing price of 153.00p. Managing director Harry Hyman said: “On behalf of the board I would like to thank all of our new and existing shareholders for their support of PHP. As
stated in our trading update this morning, operational and financial performance to date remains strong, and our portfolio continues to demonstrate resilience, and the additional funds raised will help further accelerate our growth by funding near-term portfolio expansion, forward funded developments and asset management projects.” PHP said in a statement it has sight of immediate opportunities totaling £92 million across the United Kingdom and Ireland and outlined plans to invest approximately £36 million in upgrading existing assets. Numis and Peel Hunt are acting as joint bookrunners in connection with the placing and the new shares will not be eligible for the third quarter dividend but will rank for all future dividends. In a separate announcement, PHP also released its results for
the first half of the year, showing adjusted EPRA earnings per share increased by 7.1% to 3.0 pence (30 June 2019: 2.8 pence). PHP also reported an average uplift of 2.2% per annum on rent reviews completed in the period, continuing the positive trend in rental growth (FY 2019: 1.9%; FY 2018: 1.4%). PHP’s property portfolio is now valued at £2.5 billion, with the 17 properties in Ireland contributing £194 million to the total, and net debt for the group stands at £1.15 billion. Hyman said: “The Covid-19 pandemic has highlighted the demands on health systems around the world, not least the NHS in the UK and HSE in Ireland, where the underlying demand for healthcare is increasingly driven by growing and ageing populations. The need for modern, integrated, local primary healthcare facilities is becoming ever more acute in order
to relieve the pressures being placed on hospitals and A&E departments. “As a result of the Covid-19 pandemic, we see strong demand for extra space to help alleviate the backlog of consultations that has arisen as a result of the coronavirus, while facilitating the movement of activity out of hospitals and the continued care of patients that have suffered from Covid-19. “Technology will continue to drive digital consulting and triage in the future and the crisis has highlighted the important role primary healthcare must play in the future provision of health services and continued re-focusing of services away from over-burdened hospital settings. PHP looks forward to contributing to this effort and remains very confident of its future outlook.” *Sister companies of HealthInvestor UK have an interest in PHP
Harry Hyman, Primary Health Properties
HealthInvestor UK • August 2020
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TELEMEDICINE
The robots are coming With the seismic shock that Covid-19 sent through the UK’s healthcare system continuing to power a tsunami of demand, providers are turning enthusiastically to emerging technology to help them cope. HealthInvestor UK asked leading industry experts to consult their crystal balls and consider the postpandemic future for telemedicine
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HealthInvestor UK • August 2020
TELEMEDICINE
Kaia Colban, emerging technology analyst, PitchBook “Robots and telemedicine software is already being utilized in the healthcare sector to bolster capabilities in responding to the coronavirus in a variety of ways including acute care and facility sterilization. We also expect to see strong demand for specialty telemedicine such as chronic care, behavioral health, or addiction treatment as patients seek care under home confinement. “Companies like UVD Robots are shipping hundreds of robots to hospitals globally to assist in sanitizing facilities to protect the health of practitioners and patients. Near term, we expect to see further as businesses and governments seek to scale disinfectant activity. Hospital Robotics: Robots that allow communication with patients, scan temperatures, sanitize rooms and deliver food and supplies are currently being deployed primarily in China. We expect to see increased investment in other countries as well. “Telemedicine startups in the US are experiencing a surge in demand amid the coronavirus outbreak, helped by a push from the federal government who removed restrictions on telehealth services for elderly Medicare patients and health insurers temporarily waived telemedicine costs. The volume of virtual visits roughly doubled for AI-enabled telehealth platform 98point6, virtual clinic usage at Amwell (formerly American Well) has surged roughly 40% during the outbreak, and startup Ro said it has seen “significant” growth in coronavirus-related online visits. We believe telemedicine will benefit in the long run from the outbreak as more patients, providers, and insurers will become accustomed to and realize the benefit of telemedicine. “There have been few remote patient monitoring devices targeted at Covid-19. However, BioIntelliSense’s BioSticker wearable sensor, which was released earlier this year, is being used to monitor a patient’s respiratory
HealthInvestor UK • August 2020
rate, heart rate, and skin temperature, as well as the frequency of their coughing, sneezing and vomiting. Additionally, Providence Regional Medical Center in Everett, WA used a telemedical robot (Vici robot from InTouch Health to take vitals from and interact with the first diagnosed case of coronavirus in the US. We expect that in the near term, telemedical robots will be used in a select few use cases, however, long term we have a favorable outlook on the technology which promises to streamline basic diagnostic tasks. We expect the pandemic to have major implications on healthcare technology, spurring rapid adoption of robotics and telehealth by healthcare providers. Furthermore, we expect to see increased government investment in healthcare as legislators prioritise public health over lingering privacy concerns which will boost centralised disease tracking, telemedicine, and health records.”
to get more accurate diagnosis. In addition to a wide range of online pharmacies that allow remote prescribing through online consultations via a computer or an App. Although this technology is in its infancy, better video conferencing via smartphones and the ability to undertake basic diagnostic tests (BP/glucose/ cholesterol/urine) via photo-booth like machines will improve this sector greatly. “There will be a huge demand for remote medical robotics/telemedicine after Covid-19. This is because it’s estimated that the partial lockdown could be for up to 6 months. This will allow a huge segment of the population to try this way of interacting with healthcare professionals. Once the ease, convenience and effectiveness is seen by the patients it will revolutionise the NHS and private sectors alike.”
Silas Campbell, head of marketing, Blueleaf Dr Earim Chaudry, medical director, Manual “‘Direct to patient’ telemedicine has never been more necessary - amidst the outbreak of Covid-19 and governments urging citizens to self-isolate and limit possible exposure. Over the next coming weeks, we’ll most definitely see a rise in phone and online consultations to help stagnate the spread of coronavirus. At a time like this, telemedicine is ideal as patients can get the advice and care they need from the safety of their homes. With the outbreak of Covid-19, any non-essential travel is in lockdown and because this is an evolving government position, we could reach a stage where Britain is in complete lockdown, like Italy, and the only sources of consulting are going to be telephone or online. “GPs and out-of-hours services are already using telephone consultations and sending prescriptions via EPS. Furthermore, some private GP companies are providing video consultations
The health and social care sector needs to look seriously at the role of technology in the future. The sector hasn’t evolved with technology and is now paying the price for it, however, you can hardly blame anyone for this as it is such a massive and complex ecosystem. But now is the time to get the right people around the table to look at the opportunities available with current technologies that could produce huge efficiencies, less wastage and errors and a better ‘user experience’. It’s not just the implementation of basic hardware and software to provide access for more people to a computer, but technology such as AI, Big Data and Machine Learning could have a dramatic impact in the way people access, interact with and use health and social care services in the future. The power of technology is far too little utilised for this day and age, I hope this crisis serves as a wake-up call and that we’ll see action that will provide a modern health and social care system that is fit for purpose for every future generation.”
▶
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TELEMEDICINE
situation, but leads patients and doctors alike to better understand the role of these technologies in delivering high quality care. “Understandably, we are getting a lot of interest from governments, healthcare systems and the private sector from around the globe. Everyone can see that we need to change how we provide healthcare and our system has been shown to work in Rwanda, the UK, and more recently we have launched in Canada, the US and a number of countries in South-East Asia. Do you think integration will be quicker now that it is more in need?
▶ Dr Keith Grimes,
AI clinician and GP, Babylon “Babylon has been innovating in the digital health space since our launch in 2014, delivering AI-powered symptom checking, guidance on risk of disease through healthcheck, helping people monitor their symptoms and track their data through Monitor, and speak to doctors and nurses by video chat on their phone. The coronavirus crisis has seen these technologies become even more important as the world rises to meet the challenge.
We’re already seeing barriers melt away and decisions being made quickly in an effort to combat the exponential growth and challenge posed by coronavirus. It’s tempting to think that this might represent a paradigmatic shift in how change is implemented, but we know from history that periods of challenge like this often herald rapid shifts in the norm. What is undeniable is that the way healthcare is delivered is being forever changed, and the use of agile methodologies in developing and deploying healthcare solutions is here to stay.
How is the app helping in a time where GPs are urging patients to stay away from surgeries?
Allowing patients to manage their own health more effectively, make informed decisions about where to seek care, and then enabling them to do so remotely has been a powerful tool in managing this pandemic. Using a ‘Digital First’ approach means the bulk of triage and support can be delivered at a distance, reducing the risk of transmission of infection. “When dealing with an infectious disease like Covid-19, it is vital that we take precautions to minimise face-to-face contact to only those times where it is required. In this way we reduce exposure to infection for our front-line workers, as well as limiting the need for people to travel for care. In this way we hope we can help ‘flatten the curve’ and reduce the rise of new cases, allowing the front-line a better chance of coping. “At Babylon we have pioneered the use of remote consultations and the use of AI in our digital health technologies, and we have already seen the benefit this can deliver in terms of improving access and reducing the cost of healthcare. The Covid-19 crisis has led to unprecedented demands on the NHS, and we’ve seen wholesale switching to video consultations and symptom checking as a result. Our hope is that this not only helps manage the current
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Dr Kit Latham, chief executive, Credentially “Covid-19 is the greatest public health challenge the UK has faced in a generation. A huge force of both workers and volunteers must be mobilised in response, and unfortunately the way that we traditionally hire healthcare workers acts as a major bottleneck to adequately combatting the virus. The average hire in the NHS takes between 3 and 6 months, and for every 10 clinicians that try to apply for a job in healthcare (not just the NHS), only 5 will ever work a shift, as up to 50% give up on the process. It’s crucial now more than ever that the those staff that are adequately trained, properly onboarded and safely validated can be on the front
Now is the time to get the right people around the table to look at the opportunities available with current technologies
lines as quickly as possible. As a doctor myself I had to go through clinical HR and compliance many many times, and our system was built from that frustration. Credentially was set up to make this process easier for healthcare workers and their employers, and our software reduces the manual work involved in getting a health worker on the shop floor by up to 90% for the providers using our service. Apps can serve millions of individuals with no marginal cost per patient treated. One doctor can only see a certain number of patients a day, however hard they work, an app can be downloaded and used by tens of thousands, and whilst software can never replace the role of a care giver, it can certainly aid in diagnosis, management or treatment of patients. Robotics has the potential to increase both the manufacturing capacity of both medical consumables and pharmaceuticals (as it has been for decades) and increasingly the delivery of care, including highly technical surgical interventions. Telemedicine has really shown its value during this crisis. Telemedicine when paired with remote patient monitoring technology can be used to provide care to patients in the comfort and safety of their own home, whilst reducing the potential for infection. Why should a patient risk exposure to viral or other illnesses by visiting their health professional if they don’t require a physical examination? Also, when we are asking retired nurses and doctors to come back onto the frontlines (who are high risk of complications from Coronavirus) it makes sense to utilise their hard work and experience in a way that takes the pressure off acute care services and protects both them and the patient from harm. I’m proud to say we work with the leading providers of telemedicine in the UK like Doctor Care Anywhere, GPDQ, Teladoc, we’ve seen a huge increase in demand for telemedicine services and it’s clear to me that this trend will continue long after Covid-19 has been adequately managed.
HealthInvestor UK • August 2020
TELEMEDICINE
to come back to work, by making it as easy, quick and secure as possible. • putting in place a 24/7 helpline • helping our partners recruit more short-term clinicians locally through increased digital recruitment activity • Addition of new digital tool ‘Covid Dashboard’ across all our platforms
Dr Nick Andreou, co-founder, Locum’s Nest We believe we can help the NHS ensure adequate clinical cover by getting more shifts filled across both primary and secondary care. Our technology allows healthcare organisations to immediately reach out to 30,000 clinicians to help fill short term vacancies. The entire company’s focus has shifted on our support to the NHS’ Covid Response and we have therefore decided to open the platform for free. Our platform has a live-integration with the GMC database. This means that as soon as the GMC activates a doctor’s license, that doctor immediately has visibility of all CV-19 shifts posted across the country and can apply to cover those shifts directly. We also ensure that support is in place for these doctors to be deployed to the healthcare organisations most in need. Our Covid-19 business intelligence dashboard, allows NHS organisations to see all the confirmed virus cases at a national level as an early-indicator proxy of imminent case surges in ICUs. As a business every decision we currently make is based on whether or not it is The Right Thing To Do, and following the call from the government for ‘constructive partnership’ amongst solutions we would encourage all companies in the weeks to come to do the same. In our case specifically, we’re helping by: • giving UK healthcare organisations the ability to immediately reach out to 30,000 clinicians to help fill short term vacancies • allowing Trusts to rapidly and remotely deploy our software within just five to seven days, giving them full access to staff - and doing it free of charge. • giving temporary, flexible, transparent and non-binding T&Cs to new partners to enable rapid and remote deployment • supporting those retired clinicians who want
HealthInvestor UK • August 2020
The feedback from Trusts has been overwhelmingly positive and we’re humbled by the responses we’ve received. And the tech is helping those most in need, for example, during the last week at a number of our UK hospitals, Covid-related shifts were oversubscribed by 130%.
technology is used and adopted across the healthcare system. Previously, the uptake of telemedicine and remote consultation tools was low and businesses struggled with the challenge of how to scale. We may now see a paradigm shift. For that to happen, a number of factors need to be considered such as funding, contracts, security, regulatory and infrastructure, all of which will play a part. The outlook has certainly changed for the whole industry though!
Rupert Spiegelberg, Doctorlink
Justin Crowther, head of healthcare, Alantra Apps that deliver remote consultations are playing a huge role in the NHS’s and Public Health England’s strategy for dealing with this pandemic in the short-term. Taking primary care as an example, prior to the Covid-19 crisis less than 1% of primary care consultations were delivered remotely. Apps and telemedicine are also playing a significant part in other areas such as in care homes and in a homecare setting. Different apps will have a range of applications from fitness apps to keep people active at home, remote consultation platforms as highlighted above, mental health apps aimed at helping people process the significant disruption and worry that currently exists. The use of robots in care homes or in the home environment is still in its infancy, especially in the UK however countries like Japan are seeing greater adoption. Again, the current crisis which is impacting on staff availability is likely to see a drive towards greater adoption across countries and healthcare systems. This crisis is likely to see governments, healthcare providers and users rethink the way
We have a hugely anxious population, everyone is worried about coronavirus, everyone wants to talk to their GP about it. But what the doctors have to do right now is access the patients that are severely ill and give them the attention that they need. Using Doctorlink is the only way they can really do that at scale. And that’s really at the heart of what we are doing – acting as a sophisticated sorting hat for the NHS primary healthcare system. When considering Covid-19, carrying out this system of sorting will be absolutely crucial. It’s not an understatement to say that Covid-19 has really changed the general population’s interaction with technology and how they interact with the healthcare system. Covid-19 has created two major structural changes in the healthcare system. The first is the realisation within the healthcare system that they need to create an operation or system that can deal with such rapid change. Historically, we’ve all been talking about the increased demand for healthcare with an ageing population as well as the limit of supply of doctors and nurses. But Covid-19 has really highlighted these issues and brought attention to the fact that national healthcare services need to have systems that can scale up and scale down rapidly. You can’t just magic armies and doctors out of thin air – that takes decades to create.
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TELEMEDICINE
▶
Amid this crisis, we need to ensure those that need the care get it at the right place and the right time. Scaling up and scaling down is crucial; this crisis will go away in a few months and then will be the time to scale down the healthcare system effectively. Technology is really the only way of tackling that. The only way you can have a scale up and scale down capability is by having properly scalable technology. We’re not trying to replace doctors; it’s about making sure the right patients get to the right clinicians at the right time. The second structural change is force – we are almost forcing the population to use digital as a form of interaction with healthcare. Once this crisis is over, digital will become the normal level of interaction. Doctorlink is another frontline way to manage the coronavirus pandemic. We are the right system at the right time in line with Public Health England’s (PHE) guidelines. Over the last months we have updated our algorithms to incorporate Covid-19 diagnosis and we continue to update them on a daily basis, in line with medical best practice, but also importantly with updates to PHE recommendations. In February and March, as the advice changed, we were constantly updating our triage recommendations. We always have a full, up-to-date coronavirus diagnosis triage solution. We are effectively acting as the first point of contact for patients, in particular those for whom getting through to 111 is proving very difficult. 111 is absolutely overloaded at the moment. You can get the same kind of support through the app which is available 24/7. It’s in real time and it doesn’t suffer from any queuing issues, because it’s purely an algorithm. In addition, if you have been diagnosed as “at risk” from Covid-19, and you’re not presenting acute symptoms, then the app will advise you to practice self-care and follow the various PHE guidelines and advice. If you are manifesting acute symptoms then it will be able to book you a video or telephone consultation with your doctor or advise you to call an ambulance. We are also working with the NHS to help them understand the geographics of the virus – where coronavirus outbreaks are occuring. Telecare medicine programmes need to be rolled out much more quickly. Recently the government has said they are making sure that all GPs in England have access to online consultation facilities, that’s something we are working with the NHS on. There also needs to be an awareness campaign to make sure these tools and technologies are available to the general public.
HealthInvestor UK • August 2020
We are very much in crisis mode as a country. Technology can alleviate that pressure very quickly. When the dust has settled, what we will see is a new normal in respect to acceptance of these digital front doors, digital diagnosis and triage systems, which in effect will lead to considerably better capacity utilisation by the NHS, a much better patient experience, and also better patient outcomes. If you can get a diagnosis and triage straight away and get to the right clinician first time, that will definitely lead to better outcomes for patients. The changes that will be made amid this crisis will go some way to solving the long-term equation of how to grow healthcare provision in line with the increased needs of an ageing and growing population, without having to break the bank. There are three factors that drive private sector adoption. One is providing better and more usable tools for their customers who are paying them a service – which is why these digitals are gaining more and more traction in this part of the healthcare sector. Secondly, private hospitals are just as keenly focused on cost and demand management as the NHS is. They start to see the benefits of how these kinds of tools can drive down costs for them. The third point is being able to collate and understand data patterns and the data that you can get out of these tools – tracking the aggregated data that you can see and predict – which is valuable in helping private hospitals design their healthcare coverage going forward.
Simon Devonshire, technology advisor, Alantra Since the pandemic broke, telecommunications have transformed healthcare in the UK. As recently as three weeks ago, transitioning GP consultations from face-to-face to digital, via
with video conference and/or telephone, was unthinkable - unimaginable even. And yet now, my local GP surgery is now effectively shut. If you want a consultation with a GP now your only option is via digital/tele channels. One of the acute challenges faced by the NHS is bed-blockages of elderly patients. The NHS needs the beds; however, worse than in non-pandemic times, the elderly are especially problematic to discharge - both family and care-homes are struggling to take back their elderly. Technology like Howz enables those concerned for the well-being of elderly friends and relatives to monitor how well they are doing, from a safe distance. Measurement is vital to the management and control of the rate of infection. Apps are vital to the scope, reach and accuracy of that measurement. Most of us now own smart-devices (especially smart mobile phones). Apps enable all us to participate in epidemiological control, either by managing our own health; our own immunity status; our exposure to other infected people. Immutably authenticating someone’s identity and their immunity status will become increasingly important to public health. App’s like Yoti.com (in which I have a vested interest) will be vital to this. Importantly, Yoti is a UK/London-based venture - pioneering world class tech. Robots are vital because they are able to process vast amounts of data with impartiality. Robots don’t tire; they don’t miss minor indicators that might otherwise go easily unnoticed; they minimise bias. And that is prior to the adoption of quantum computing and quantum analytics, which will shift those capabilities to another paradigm. Covid-19 has had a transformative effect on the application of technology in frontline medicine. It has positively transformed and vastly accelerated the use of tech by doctors. Perhaps more importantly it has transformed the public’s acceptance of that transformation, uncontested and unarguably so. Will it become the new norm? Yes. We must never revert. In this situation especially, we should not attempt to ‘untechnology’ ourselves. Post Covid-19 we must listen and learn in order to evolve the use of technology and improve on the current critical situation - for example, to use human-face-to-face consultation in the exceptional circumstances when it is most needed and adds the most value. n
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DIGITAL HEALTHCARE
Slow train coming Mindy Daeschner of Daeschner Consulting outlines the results of her team’s survey into the future of digital healthcare The transformation agenda Unlike retail, travel, and the finance sectors, UK healthcare’s rate of adoption of new technology has been glacial. There are many reasons given, but the politicisation of the NHS impeded the transformation agenda. Feast-and-famine funding, a fundamental lack of skills and expertise, problems of data integration and data silos have all hindered progress. Even before the ticking bomb of Covid-19 came along, the pressure building on the NHS was colossal. Our ageing population, obesity epidemic and over-run primary care system were all converging in a perfect storm to undermine the effective delivery of healthcare in the UK. Following discussions with several healthcare specialists we asked survey participants how they would prioritise the transformation agenda.
Data-driven world Unsurprisingly the increased adoption of data and analytics to improve patient outcomes came out just ahead of everything else as a priority with 30% putting this at the top of the agenda. Probably this area more than any other is a focus of growth within the healthtech sector. The application of revolutionary new applications which have the capability to process vast quantities of data instantly is here to stay. The rapidity with which the global scientific community is learning about Covid-19, its epidemiology, infection rates, etc and investigate the effectiveness of new vaccines and treatments is all testament to our ability and preparedness to share and analyse data at record speed. However, our more localised use of data across the NHS itself as it strove to plan for the pandemic and its onset was not all it could have been. Government pandemic planning originally highlighted the potential for up to 500,000 deaths, and the advent of the Nightingale hospitals which were never really used. This was revised down three times during the pandemic. Commenting on the importance of accurate data, Sir Jim Mackey, chief executive of Northumbria Healthcare NHS Foundation Trust, said: “Thankfully, in Northumbria, we have not had the terrible predicted Covid-19 surge. We have 900 bed capacity and we currently (May 2020) have c. 20 Covid-19 positive in-patients. In total we’ve had 180 deaths. That is clearly a huge relief but we now have anxious staff who want to start re-opening access, dealing with the backlogs, and getting busy again.
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“Throughout the pandemic there has been a real problem with the quality and access to data collated at the centre. Teams have had to resort to ringing colleagues in other regional Trusts. These networks and intelligence were invaluable but we should be able to rely on proper data flows and exchange.” Another example of poor inaccurate data was the shielding list which was inaccurate with many people on them that shouldn’t be and others that should be. The Daeschner Consulting team spoke to one patient suffering from chronic allergic asthma who was not on the list and had mistakenly thought she was not in the highrisk group because she hadn’t received a letter. The criteria referred to prescribed use of steroids and admissions – neither were applicable to her. Because of the seriousness of her condition, she is prescribed a biologic treatment and is now well managed. The patient, who receives nurse administered injections monthly, was subsequently told that she definitely should have been on the list was mistakenly left off. Not before she had been out shopping post-lockdown which could have placed her in serious danger.
The virtual world A close second in the priority list was the move to an agile resourcing and virtual service delivery across care settings. Pre-Covid-19 the Conservative government had already committed £45 million to help drive primary care’s adoption of digital services by supporting GP surgeries to implement online consultation programmes and piloting virtual services, with Babylon’s controversial video GP consulting services (GP at Hand) already making an impact. Covid-19 has served to accelerate this adoption and it’s hard to believe that primary care will ever go back to more singular ways of working with place-based, in-person only consultations. Virtual services have rocketed to the forefront of many patient’s minds, with over 99% of practices using remote consults, either telephone and/or video, in comparison to 1% pre-Covid-19 using video. The number of suppliers of services has also grown which should lead to increased competition, quality of service and value for money for patients. One such supplier is iPlato, developers of myGP®, which provides a range of services including online consulting, booking and messaging. It now has over 3,000 practices registered.
HealthInvestor UK • August 2020
DIGITAL HEALTHCARE
What are the biggest healthcare transformation challenges moving forward? 100% 90% 80% 70% 60% 50% 40% 30% 10% 0%
30%
29%
Use of data and analytics to improve patient outcomes?
5th priority
The move to agile resourcing and virtual service delivery across care settings?
4th priority
21% Individual patient responsibility for healthcare consumption?
3rd priority
“Lockdown was a bit like a Dunkirk moment when anybody with a solution that could support the NHS showed up, but the path to commercialisation of the technology is far from clear,’ said Tobias Alpsten, chief executive at iPlato. “For me the real question is what happens with investment post-Covid-19 when we are in recession. We need partnership from the NHS in order to continue in improve our services for doctors and patients.” For those thinking this is just a fad, think again. Although the worst may be over, Covid-19 is here to stay. Despite a move back to socially distanced normality for most, those more elderly constituents and for those practising shielding who may not survive being infected by Covid-19, virtual consultations could become the norm. The advent of virtual/remote GP or consultant consultations also necessitates a new agile working model which allows healthcare professionals to work from multiple locations, at a variety of times which suit their lifestyle and for multiple employers and into retirement if they choose. This may help solve some issues, but it highlights others, for example, the way in which primary funding is allocated, which has already reared its head when some patients choose to move to largely virtual services.
Caring collaboration Third in the line-up was the move to a more transparent and collaborative service delivery model. Commenting on the provider collaboration during the pandemic, David Hare, chief
HealthInvestor UK • August 2020
16%
4%
Move to a more Improvement transparent and of patient safety collaborative in healthcare service delivery provision? model?
2nd priority
Source: Daeschner Consulting
20%
1st priority
executive of the Independent Healthcare Providers Network said: “In the main the collaboration with the NHS has been brilliant. The crisis forced us all to work in different ways. The fact that we had a deal complete within six days that required massive changes to contracts, legal and funding, just shows what can be done when there is focus and the will to get it done.” Although there is much political debate about private and public investment the real debate is how primary, secondary and social care work better together for the improvement of patient outcomes. It is also how does the NHS work effectively with private organisations who bring deep expertise, products and services that the NHS cannot effectively offer on its own. Despite huge investments, the NHS has singularly failed to compete with private enterprises when it comes to the delivery of technology, resulting in lost investment. This could have been more effectively allocated to other pressing areas of need, based on the savings made through the purchase of proven technology solutions, which solve problems and enhance services from the start.
Patient-centred care With few exceptions the patient is at the heart of the transformation agenda. Early intervention, improved support and management drives the agendas of providers, clinicians and governments, but there is also an increasing swing towards the provision
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DIGITAL HEALTHCARE
How would you prioritise the areas of focus for digital innovation? 100% 90% 80% 70% 60% 50% 40% 30% 20% 10%
30%
28%
25%
12%
0%
Source: Daeschner Consulting
Diagnostics eg. predictive AI, self-testing?
5th priority
Patient Holistic patientvirtual centred and controlled EHRs support services which enable and behavioural change consent-driven tailored services? programmes?
4th priority
and initiatives which will ease the public health burden and encourage our ageing population to live healthier lives. There is already much debate about the need for individuals to take increased personal responsibility for their health and wellbeing at a time when investment is finite. This is a debate which will undoubtedly continue for many years. It’s a prickly issue and may not be as simple as just eating healthier diets but the need to consider more deep-seated health inequalities in our society – but the momentum is starting and closer scrutiny of lifestyle behaviours looks set to become the norm and is reflected in the transformation agenda.
A healthtech future Recognition of the need for transformation is absolute – without exception the world is moving to a digital health-driven future. This has to happen for society to be able to afford healthcare provision for its citizens moving forward and this is not a first-world challenge, it’s also a core focus for the emerging markets. China, India and Africa are all leap-frogging the West as they move directly to digitalfirst healthcare systems. The sheer size of these populations and geographies mean in-person consultations are often impossible and remote diagnostics, consultations and advice imperative.
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New drug discovery
3rd priority
▶ of better preventative behavioural change programmes
5% Process improvement based on machine learning technology?
2nd priority
Use of robotics in secondary care?
1st priority
Lack of existing and entrenched bureaucratic healthcare provision and infrastructure enables governments to accelerate the delivery of these services in emerging markets because there is no need to overcome the challenges of integrating with legacy technologies. Although it is impossible to eliminate in-person consultation completely there are a host of opportunities to better triage, prescribe and support patients virtually. The research highlights those technological areas which participants ranked as being the most significant in accelerating the transformation agenda. The list of technologies which are likely to shape the future of healthcare provision are to some degree interdependent, for example inaccurate data means increased risks in decision making and poorer outcomes. The group that was surveyed prioritised data and analytics at the top of the transformation agenda, so it’s no surprise to see diagnostics tools offering predicative analytics at the top of the list of digital technologies for use in clinical and operational provision. We are already seeing new technologies piloted in breast cancer screening, skin cancer screening, kidney disease and genomics – all areas where early detection can help prevent premature death – but this is just the beginning. This area of digital health is burgeoning, there are hundreds of new technology start-ups focused on using large-scale data to identify and highlight patients who may be at particularly high risk of developing a condition.
HealthInvestor UK • August 2020
DIGITAL HEALTHCARE
It is also being used to improve operations and management to solve problems in real-time, versus retrospectively. The use of truly artificial intelligence to fully diagnose conditions is not here yet but have no doubt it is coming. Ali Parsa, founder and chief executive of Babylon Health, is someone that firmly has his sights on digital healthcare transformation and believes that despite its horror, Covid-19 represents a great opportunity for change. “The pandemic has exposed our ‘unhealthy’ shortcomings. But what the pandemic has shown us is how we can make healthcare go further. New technologies, seminal advances in medicine and a radical worldwide awareness due to Covid-19. We are witnessing an inflection point. We truly believe that AI, big data and wearable tech can transform healthcare and enable each doctor to care for vastly greater numbers of people. New discoveries in quantum computing, AI, mixed reality, robotics, organ reconstruction, genetic engineering and synthetic biology will help us shape new possibilities that we would not even have imagined.” His passion for what is coming is clear. “In ten years’ time we will have automated so much – your wearable tech will not only be prompting you to change your diet, or do more exercise, but it will be monitoring you and letting you know when you’re becoming ill even before you realise yourself. AI will spot the alert and know whether to tell you to change your behaviour or see a doctor. The doctor will have all your information at their fingertips, and the AI will have given advice and reminders about the likely cause and potential rare cases. The system will monitor how well you do with treatment, alerting your doctor if there are any problems, help manage you back to full health
– and continue working to keep you that way. That will be truly personalised medicine and support which is affordable for all.” The population at large is already starting to realign to using self-testing and measurement of blood pressure, heart rate, non-invasive blood glucose monitoring and a plethora of mental health apps which seek to take a more holistic approach to a person’s overall wellbeing. Again, Covid-19 has pump-primed the wellbeing market in ways we couldn’t have imagined previously. As the population locked-down, more people have had time to invest in their personal wellbeing, giving a welcome boost to those wanting greater focus on healthy living. As the general population collect and analyse their own personal health information, the next big area for digital transformation is electronic patient health records (EHR). You may think, ‘we already have this, my GP has told me I can access my personal health record.’ Not true – if you are over the age of 25 most of your practice record is still paper-based. Even more importantly, primary and secondary care have totally separate health records for patients. The argument for ‘owning’ your own complete patient record is gaining ground and the person with the biggest vested interest is the patient themselves. Imagine a scenario where your ‘mobile phone’ is updated directly by the physician as you leave your consultation, whether that is the primary care or secondary care practitioner, along with all your blood tests, x-rays etc. Once you store all this information in your own secure app, you can ‘choose’ to share access to your record with your pharmacist, another thirdparty doctor or a research organisation looking to accelerate treatments for a condition you suffer from.
▶
What are the biggest barriers to transformation for healthcare providers? 30% 25% 20% 15% 10%
0% Funding
HealthInvestor UK • August 2020
Organisational structure of providers
Skill sets
Procurement Government policy
Regulatory environment eg. MHRA, CQC etc
Source: Daeschner Consulting
5%
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DIGITAL HEALTHCARE
Source: Daeschner Consulting
Will Covid-19 drive changes in healthcare provision in the future?
▶
95.5%
Yes
No
Personal EHRs could be the catalyst to huge change moving forward and will break down the silos that currently impede physicians accessing the absolute latest information on a given patient. Beyond diagnosis and treatment there is also the whole area of patient disease management. Technology has the potential to make managing your conditions much easier to monitor and manage. There are thousands of disease management programmes available – many low-to-no cost to the patient –but there is still a lack of engagement and access to these programmes. Greater collaboration between providers, tech companies and life-sciences businesses could greatly improve this situation. Commenting on the impact of Covid-19, Hassan Chaudhury, digital health lead at Healthcare UK, part of the Department of International Trade (DIT) and also co-founder of the TECH4CV19 community, said: “COVID-19 certainly appeared to create a sense of panic, which led to many of the ‘blockers’ in the system saying ‘yes’ to the adoption of virtual consulting services. On the surface this may seem like an obvious positive but I think it disguises a lot of fundamental transformation challenges which are yet to be addressed. “I work inside the system and feelings in the supplier community are strong. I am constantly asked searching questions about ‘the centre’ and there appears to be a lack of clarity around the roles and responsibilities of NHSI/E, NHS Digital and NHSX, especially from firms looking to invest in the UK. Who should suppliers go to, when and what for? Does the centre want to engage homegrown SMEs or are they always going to pick the bigger, often foreign players? “Troublingly, at the height of the pandemic response in late March, many innovators and suppliers believe, to this day, rightly or wrongly, that there was a lack of capacity to sift through the many offers of help which inevitably resulted in missed opportunities for them and I have my work cut out to explain otherwise.”
Thriving or slowing Making digital transformation a reality will not be straightforward but if there is one thing we have learnt from Covid-19, it’s where there’s a will there’s a way. The survey revealed that by far the largest barrier to success was funding, but lifting the lid on funding is really only part of the problem. If we could become more efficient at
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prevention and management, accrued savings could be used to provide more cancer drugs, additional doctors and nurses, and more scanners. Understanding where the NHS currently invests its money is helpful (see table below) in understanding the system we have, but also how we may help shape the system we want for tomorrow and where technology could help play an increasingly important role to help us get there. Although areas like curative care will always be significant – reducing surgeries through improved diagnostics and treatments could dramatically reduce costs and improve longterm outcomes. Greater access and use of virtual disease and medication management programmes could again improve adherence and outcomes in long term care. Dr Tim Ringrose, chief executive of Cognitant, a healthtech start up focused on delivering better, more engaging health advice and support to patients via their mobile phones, said: “Despite the lockdown we are busier than we have ever been as physicians and medication manufacturers look for new ways to support patients virtually.” Commenting on the barriers to transformation, Parsa has strong views. “Einstein used to say ‘the definition of insanity is doing the same thing over and over again and expecting a different result.’ I am going to be controversial here. The old methods of healthcare, with all their best intentions, have failed us and we cannot go back. Science and technology by themselves won’t transform healthcare. What is required is a change in attitude. “Healthcare has adapted faster than most thought possible to meet our needs for Covid-19. Only a few months ago, something as mundane as telemedicine was considered ‘a radical new technology’. Now, it’s commonplace. A doctor behind a phone is as expensive, and as much in short supply, as one sitting in a clinic. We must focus on our needs, and not the means. It’s not the technology that is the issue, it’s how we apply it to solve the root cause of a problem. “Hopefully this will be the moment that healthcare systems decide that innovative technologies can be applied to assist with significant challenges, such as management of chronic conditions, from diabetes to mental health. If healthcare systems can learn from the way we can now funnel care to the Covid-19 patients who need it most, while automating it where we can, to proactively think of new ways of harnessing technology to deliver care, it will reduce the pressure on clinicians so they can operate at the top of their licenses and divert their attention to where it is most needed.” Considering transformation from the private provider perspective, David Hare, chief executive of Independent Healthcare Providers Network, echoed some of these points. “There really needs to be a cultural change of attitude. We have seen a big uptake in online consultations, but that is a different channel to the same service. For me, the real question is how do you change the service? We need to use technology to drive service change and improve efficiencies, costs and outcomes. We are only at the foothills of this and unfortunately we are not desperately well organised to achieve it. The NHS locally should be allowed to get on, it cannot be over-complicated at the centre. “
HealthInvestor UK • August 2020
So, while funding is an issue, and technological change is starting to have an impact; skills shortages, poor operational data reporting, policy and operational structures are also significant barriers which need to be overcome.
The path forward The road ahead is unlikely to be smooth, but 95% of people that completed the survey believed that Covid-19 would drive changes in healthcare provision. Chaudhury said: “Covid-19 has led to the adoption of a swathe of solutions but there appears to be serious concern As one survey participant put it. “More virtual care at and frustration from firms feeling left behind, not listened to and feeling they have nowhere to go because all the last and I hope that people will take more interest in their channels are gridlocked. Some of these firms point out they own health behaviours.” But it isn’t just about individuals don’t feel they have the connections, contacts and PR to it is also about the system. “It has changed the attitudes of healthcare professionals and will hopefully encourage make it, having focused instead on the fundamentals of a good track-record and evidence of impact the government to be more proactive in and value. making effective changes for the future” “The frustration is palpable. It is not was the sentiment shared by another. just the suppliers. Local NHS buyers of Although there may be some variance ‘The global digital healthtech solutions need guidance that around how participants would prioritise agnostically evaluates the merits of the the transformation agenda, Covid-19 has health market solutions on offer, looking at economic certainly left its mark. is set to exceed impact, interoperability, safety records etc. Virtual services are here to stay, $504 billion by At the moment, more and more of these arguably professionals and patients are 2025. Success less fearful of the changes and more buyers feel they have to rely on informal in this area will positive about the benefits, but one thing networks to generate recommendations. “The UK genuinely has some of the is clear the appetite for change is growing. benefit everyone, best digital health solutions in the world. ‘Necessity is the mother of invention’ so let’s champion and, the pre-Covid-19 challenges are still I know this because my role at the DIT it and get ready for here and the pressures on our precious is to scout, engage and promote the very some disruption best. I know they are incredibly attractive healthcare system will only grow postto international providers, but we simply Covid-19. GLOBAL MARKET INSIGHTS To summarise with the words of must make it easier for the best firms to one participant: “The move to digital secure widespread adoption in the NHS. My hope is that Covid-19 will lead to consultations has been hugely expedited. introspection and, with that, positive New relationships have been established, change.” barriers to partnership have started Despite its horror and economic destruction, Covid-19 has to breakdown, both of which will drive reductions in refocused us on the fundamental nature of our healthcare bureaucracy.” And hopefully lay the path forward for positive provision but also the role that digital technology can play transformation. n now and in the future.
Source: Daeschner Consulting
DIGITAL HEALTHCARE
£bn
Percent
109.6
54
Long-term care
46.4
23
Medical goods
26.5
13
Preventative
10.3
5
9.7
5
202.5
100
Curative care
Other
HealthInvestor UK • August 2020
Source: BMJ Fig 2a.
HEALTH EXPENDITURE REPRESENTS 10% OF GDP (AT LEAST £208 BILLION) WHICH IS UP FROM 8% IN 2000
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SOCIAL CARE
After the flood As the UK slowly comes out of lockdown, the care home sector is taking stock of Covid-19’s impact. In the next 12 months and longer term what will have changed, and what will remain the same? Kathy Oxtoby reports
A
second-class citizen. That is how the social care sector, and particularly the role of residential care, was often viewed. All that changed this year with Covid-19, which has pushed care homes and the care sector up the health and care agenda. Professor Martin Green, chief executive of Care England, says that as a result of the pandemic, “there is a greater recognition and better understanding of social care, and in particular, the important role residential care plays”. The pandemic has also led to recognition that health and social care “are interdependent parts of the system - one cannot function without the other”, Green says. “Covid-19 has exposed how the NHS does not understand social care and sometimes treats it like a second-class citizen. Now people have finally woken up to the case that care workers have the same status as NHS workers,” he says. The pandemic has also exacerbated the already clear divide between the health and care sectors. “We can see this in the stark contrast in the speed at which support kicked in for NHS versus social care,” says Nuffield Trust deputy director of policy Natasha Curry. While NHS organisations benefited from central support structures, care providers were left to source their own PPE. And Curry says access to testing for care staff came “very late in the day” compared to in the NHS. “We did not see a full plan for the care sector until mid-April. While we have belatedly seen a focus on care homes, consideration for care at home remains largely absent,” says Curry. The most high-profile impact of Covid-19 has been in the residential care sector, “where occupancy levels have plummeted and costs have soared in a sub-sector, many of the participants within which were already heavily lossmaking”, says Nick Hood, business risk adviser at Opus Restructuring. He says the accounts of the four largest care home chains (HC-One, Four Seasons, Barchester and Care UK) for their last four years’ trading showed combined losses of £1.15bn. Hood points out that there is “no coherent data yet” for the scale of higher costs, which have come mainly from the need to deploy more agency staff to cover for permanent staff who have been ill or self-isolating - with some agencies charging triple the pre-pandemic hourly rate - and for PPE. “Some of this extra cost will be recovered through extra fees to residents, but by no means all of it,” says Hood.
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A clearer picture has emerged on the shrinkage in revenues. “It is widely accepted that revenues have now dropped across the sector by at least 10% from pre-pandemic levels, as residents have passed away either from the virus or other causes and as new admissions have virtually dried up. “On the basis of the declared turnover of the ‘Big 4’ care chains, this will be costing them some £700,000 per day. They represent some 10% of the market, implying that the sub-sector as a whole could see its top line shrink by £2.6bn for a full year,” says Hood. A rise in the mortality rate has been a major change to the sector. Almost 30,000 more care home residents in England and Wales died during the coronavirus outbreak than during the same period in 2019, ONS figures show – although only two-thirds were directly attributable to Covid-19. Julian Evans, head of healthcare at Knight Frank, says data shows that in a ‘normal’ year, care homes would lose on average 3% of residents per month. As a result of Covid-19, this was more like 4-5% in March and between 8-12% in April. That said, the surge in deaths has been relatively swift and mortality rates have normalised across the UK to 3% as of mid-June. As a result, occupancy rates have declined somewhat. “Encouragingly, these declines have stabilised in recent weeks and care homes are beginning to confidently admit new residents. It’s important to remember that this is not a blanket rule for all care homes. Many homes have excellent infection control and have resisted any outbreak as a result,” Evans says. Covid-19 has also highlighted the need for investment and innovation in the UK healthcare property sector, with longterm demand due to an ageing population combined with the accelerated closure of underperforming assets leading to a national bed crisis in care homes. “The pandemic has accelerated trends that will lead to closures of care homes with our research identifying a potential 6,500 care homes at risk of closure over the next five years, equating to 140,000 beds,” Evans says. For Tom Scaife, head of senior living at Knight Frank, “the last few months has placed a spotlight on people in later life”. “The need to provide safe, secure, age-appropriate housing for our seniors is pressing, and will only increase as people live longer. The Covid-19 pandemic will result in a reordering of decision-making priorities for tenants and residents.
HealthInvestor UK • August 2020
SOCIAL CARE
Natasha Curry, Nuffield Trust
“Topics like infection prevention and control will drive demand, and will also require us to look at how new schemes are designed as well as staffed and managed. This in turn will lead to a greater desire from investors for professionally managed buildings with an operational focus,” Scaife says. Craig Woollam, head of healthcare at Savills points out that many elderly patients have been discharged from hospitals to care homes without testing. “The impact of this is yet to be fully known but it will be substantial,” he says. As is the case for many care home groups, a large number of residents at independent care provider Barchester Healthcare contracted Covid-19, and sadly died because of it. The virus also had an impact of staff, with those feeling unwell having to self-isolate at home. Lockdown meant no visitors were allowed. To help residents and their families stay in contact, Barchester Healthcare made the most of digital technology, facilitating Skype and Zoom calls. Another impact of the virus was a fall in admissions. Pete Calveley, chief executive of Barchester Healthcare, explains it would normally receive 600 inquiries a week, whereas in mid-April, at the height of the pandemic weekly inquiries dropped to 250. More recently inquiries had risen to 450 a week, however, “occupancy has been significantly hit” as a result of the pandemic, Calveley says.
Cutbacks, losses, or revival? As the sector comes out of lockdown, Prof Green predicts that some smaller providers “will cease to exist”. “These providers may have fewer residents and may decide they don’t want to continue with their services anymore.” While he still believes the sector overall will survive because of a rising older population, “what we need is clear government action so it thrives rather than survives”. Green says while recently the government has given an “unprecedented amount of money” to social care, it hasn’t reached frontline providers. “Until the government stops using local authorities as a mechanism to deliver funding
HealthInvestor UK • August 2020
Nick Hood, Opus Restructuring
we will have a fragile care sector. It should be given straight to the care provider to cut out the ‘middleman’,” he says. Unless there is an unexpected change in government policy on residential care to fund local authorities to pay the full cost, and a profit contribution to the operators for the residents they support, Hood says “it is difficult to see investors being interested in care homes, except those in affluent areas, which can attract a predominance of premiumpaying self-funders”. He says that with domiciliary care, there was already a trend for major providers to hand back loss-making contracts to local authorities and focus instead on servicing selffunders. “This might make it a more attractive investment prospect as fear of health security in care homes lingers and prompts more of the elderly to opt for home care, creating the need for extra capacity in the sub-sector,” Hood suggests. Investment into healthcare, as in most real estate markets, has paused as investors took time to digest the impact of Covid-19. However, in the context of all property markets, Evans says “healthcare looks surprisingly strong and we expect to see continued appetite from well capitalised domestic and global investors looking to de-risk from hotels and leisure backed assets into healthcare”. Knight Frank also expects to see “a flight to quality, in particular new developments, which will provide a way for investors to access the prime end of the market.” Knight Frank’s trading survey, which is normally conducted later in the year will show just how much the market has been affected “but we suspect that smaller, outdated independent care homes will be hardest hit”, says Evans. “There are over 6,500 homes below the 40-bed marker – many of these homes are even less than 30 beds, do not have the security of a large group backing and were not fit-for-purpose even prior to the pandemic. “Hopefully, Covid-19 will elevate calls for an upgrade of much of the market, and there has already been a big drive by operators to acquire development sites during Covid-19 – as there remains a national bed crisis,” says Evans.
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SOCIAL CARE
▶ Fears about future investment
“And care homes have also become a more positive As for longer term investment in the sector, Hood points out choice of care, with people choosing to become residents there is “an overhang of desperate sellers with no buyers in for the companionship.” While Covid-19 has been a “massive blow” to the sector sight”. He says all four of the largest care home chains have now been up for sale for at least two years without any he believes it remains “resilient and a sound place for a transaction reaching the finishing line. good investment”. “A prospective sale of Barchester to Welltower was derailed by the pandemic, a harbinger of the drastically changing Boosting future investment profitability and viability prospects in the residential care To boost future investment, Hood says it is difficult to stray far from the simplest of all answers: cash. “The sector. “Given the dominance of these chains, accounting for over government has underfunded social care for decades, 10% of all available beds, there is a lot of dead wood to be leaving only small pockets of the sector still able to earn cleared from the investment forest before anyone except a reasonable return for investors. With the major care vulture funds are likely to be interested,” he says. chains losing almost a billion pounds in the past four Curry warns that there is a “genuine risk that without years, even creating further economies of scale through real reform, we will begin to see widespread failures in the consolidation seems to be a dangerous game. “Until the sector is properly funded, investors will care providers market”. She says the structure of the social only be interested in special situations, such as caring care market, and the fact that self-funders often subsidise for residents with acute medical conditions, which are local authority service users, mean that the most significant funded by the NHS or by medical insurers,” says Hood. losses are likely to be in more deprived areas “and that is In addition to properly funding local authority residents a real concern”. “The care sector went into this to improve profitability, Hood says the pandemic against a backdrop of chronic balance sheets of many of the larger underfunding. Councils saw their budgets operators need restructuring. “The sector cut by almost half between 2010 and as a whole borrows £6.4bn, which is Care homes are 2017 and that has left social care in a heavily concentrated among the top an essential part very precarious state. We know that the 100 chains. Some chains have gearing of the landscape. provider market is very fragile, with 75% at 300% plus, which is unsustainable. of councils reporting providers closing Either some of this debt must be written Hospitals would be down or handing back contracts, even off, or else converted into equity,” full without respite before the pandemic,” says Curry. he says. from care homes While there is still a lot of investment While the pandemic has heaped extra pressure on already burdened care services, money looking to buy into the care the social market remains extremely sector, similar to other investment diverse. “There are providers of all types markets, “arrangements need to be put and sizes delivering a huge array of different services, so in place to get the market moving again”, says Woollam. it is difficult to generalise about the impact of the last few Care homes are a particularly difficult as buyers and professional advisors still need to go inside to view/value months,” says Curry. and this presents a risk problem for residents. However, Knight Frank has “always been bullish on the long-term prospects of healthcare property, and remain so,” says there are measures that can be put in place to remove the Evans. “Although the pandemic will have an effect on our risk, such as temperature testing and use of PPE. elderly population, even the worse-case scenarios will not be To continue moving into a mainstream asset class there enough to derail the growth in the number of over 85s in the are still areas of the sector that need perfecting, says Scaife. approaching decades. This combined with growing investor “This includes a uniform plan for how we will meet the demand for assets that provide secure long-term income housing needs of our aging population. Future investment makes healthcare an extremely attractive investment,” he says. could be significantly boosted if local authorities are Pandemic or no pandemic, funding remains the biggest properly held to account and seniors housing is given long-term challenge for the sector – especially for those support in planning policy.” homes and operators that rely on local authority funding. Ultimately, Scaife believes there needs to be wider “Since the start of the new financial year, many regions have understanding of the benefits of seniors housing. This reported a rise in local authority fee rates, but it remains to includes financial savings to local authority care services, release of local family housing back to the market via be seen whether these rises are enough and sector experts continue to call for an overhaul of the funding of health and downsizing, local employment generation, reduced impact social care,” says Evans. on highways and other local services, rejuvenation of high Calveley does not fear for the future of long-term streets with facilities open to the public, and contribution investment in the sector. “Care homes are an essential part to housing supply targets. of the landscape. Hospitals would be full without respite “Once these benefits are fully understood by investors, from care homes. investment will grow,” says Scaife.
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HealthInvestor UK • August 2020
SOCIAL CARE
Pete Calveley, Barchester Healthcare
From an operational perspective, care homes will now need to place greater emphasis on infection control - although many are already doing so. PPE costs have been extremely high during the pandemic, “but hopefully prices will soften in line with reduced demand and PPE will not become another costly outlay that providers need to absorb”, says Evans. This pandemic will also have significant impact on care home design and specifications. This includes wider corridors to help enable social distancing, larger rooms with wet rooms as standard to promote resident isolation, adapted fixtures and fittings to limit touch points, and safer visitor areas with enhanced communication systems. “Those wanting to invest in the market, will no doubt want their assets and their operators to demonstrate protective measures against future pandemics,” says Evans.
Covid-19: longer lasting potential impact As for the longer lasting potential impact of Covid-19 and investment in the sector, the Covid-19 pandemic will likely speed up existing trends in the sector. Knight Frank predicts that larger schemes will begin to come forward with the capacity to provide a greater range of services, offering flexible access to senior housing and offsetting increases in staffing and operational costs. The real estate consultants also envisage that developers will select sites that have a closer proximity to urban locations, developing mixed-use schemes and re-purposing sites currently in other land uses, such as retail. In addition, independent living schemes offering increased numbers of medically trained staff will also be in higher demand. Such schemes will enable operators to incorporate assisted living alongside independent living. Offerings including mixed-tenure and rental-only propositions will also become more widely available, as will more variations on event fee structures, providing increased tenant choice best suited to their financial profile, budget and preference. “Higher levels of staff training, larger stocks of PPE equipment and higher scrutiny of supply chains will be expected by residents and their families. In the future there will also be
HealthInvestor UK • August 2020
Craig Woollam, Savills
closer alignment between epidemiologists and the wider use of telehealth - the sector will better utilise technology in order to provide better care and service levels to residents,” says Scaife. It will take time for the ‘new normal’ for elderly care finances to emerge. Simple demographics dictate that demand will increase over the next fifteen years as the ‘Baby Boomers’ need looking after. “In any normal market, this should push up returns for investors. But as the investors and financial engineers of the past fifteen years have learnt, pricing, revenue and profitability are not elastic in the UK because half of all residents are paid for by a cash-starved public sector,” says Hood. The most worrying aspect for investors will be the risk of a second and even a third wave of the current pandemic, or the impact of the next respiratory pandemic, whenever that might occur. “The first wave of Covid-19 has devastated the already fragile finances of the sector. What might another shock do?,” says Hood.
Potential positives While this has been a very difficult time for the social care sector, one of the few positives to come out of the crisis is that social care is very much at the forefront of public and political debate. “It is possibly more prominent than it ever has been”, says Curry. “It is good to see that it is widely recognised now as a vital service and I think the pandemic has boosted the public’s understanding of what it delivers. “We are hopeful that this could mark the watershed moment for social care. We owe it to those lives lost to this tragedy and to their families to see a positive legacy emerge from it,” she says. For Calveley, the pandemic has highlighted the “fantastic effort” of all of Barchester Healthcare’s care home staff when faced with a crisis. “Despite care homes being seen as a dangerous place to work, at the height of the pandemic people still turned up for work, and did extra shifts. They coped with changes to their training to e-learning, to system changes and new ways of working. And I’ve learned just how resilient care home staff are.” n
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NHS PARTNERSHIPS
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HealthInvestor UK • August 2020
NHS PARTNERSHIPS
Procuring the future Dr Dan Bunstone, who leads on safety issues/ governance for digital provider Push Doctor, and was formerly CCG chair in Warrington, explains how flexible procurement models are key to helping GP practices and CCGs stay resilient during the ongoing Covid-19 crisis
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he clamour of experts lining up to advise NHS At present it’s difficult to predict how quick patient leaders to prepare for the second wave of Covid are uptake will be so being able to be able to ramp up services not going unnoticed. Funding is tight, and time is when needed without the usual short-term expiry date of the essence, so building sustainable contingency plans on appointments has given these CCGs an extra level of is a real challenge. Recent localised Covid-19 outbreaks security. This is especially important while they don’t have clarity on when budgets will return to normal and the and infection spikes has also issued a stark realisation threat of localised re-lockdown is potentially imminent. to local services, that we must be able to dial up services In Bradford where they have used this PRIMED model, and ‘lock down’ procedures very quickly, effectively and GP practices across the patch can choose whether to and at short notice. The procurement of independent digital services for the when they introduce the digital appointments to their NHS has been controlled at speed by the Department of patients, switching it on and off as necessary. All 5,000 Health and Social Care and NHS England over the last appointments purchased initially by the CCG in March have now been used and have since been topped up few months. But this method of commissioning cannot continue indefinitely. We have also experienced firstwith an additional 2350, which shows a clear appetite hand how providers themselves are and real patient need. Not only does adapting their contracting arrangements this improve access for patients and to recognise and react to need. This provide additional capacity, practices The growth in flexible has been crucial to helping alleviate have been able to embrace the use of risk, when it comes to investment in this technology, some for the first time. purchasing options new services. Justine Joy, Head of Strategy, from independent When I was chair of a CCG I Change and Delivery, from Bradford digital healthcare experienced the need for dealing with District and Craven CCG told me: “Until providers has been emergencies and having contingency now patients suspected of having a very welcome plans in place, though fortunately Covid-19 have been seen and triaged nothing as devastating as Covid-19. at four dedicated hubs across the CCG. development Commissioning bodies face a difficult However, as we see patients coming task, I know. They struggle to predict back to primary care with other health when the increased wave of patient concerns, some of these hubs have been demand will hit, and how hard it will hit. While the disbanded. We are all too aware that without the hubs a government has issued the NHS with emergency funds second peak in Covid-19 infections in our community will have an impact on our services once again. Without the to help ensure crucial PPE supplies, there is little left to invest in other services. Being able to build resilience and added flexibility on offer whilst procuring these digital flexibility into their plans is crucial. services, we simply would not have been able to introduce The growth in flexible purchasing options from this service within our CCG. The risk would have too independent digital healthcare providers has been a very high and budgets would not permit a conventional welcome development. Push Doctor has worked with long-term contract. a number of CCGs to offer pre-purchase digital locum It’s so important for independent providers consultations in bulk, without the ties to usual contractual to understand NHS need and be nimble enough to adapt commitments. This type of model offers real flexibility how they sell their services during periods of uncertainty. In doing so CCGs can equally be much more fleet and means risk to the CCG is minimal. It has also given of foot and plan appropriately for future pressures on CCGs, like Bradford District and Craven the confidence the system. n to invest and react quickly.
HealthInvestor UK • August 2020
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WEDNESDAY 11TH – THURSDAY 12TH NOVEMBER 2020 VIRTUAL EVENT BOOKINGS NOW OPEN Plenary speakers • Parallel sessions • Workshops Symposia • Posters • Early bird sessions • Special events
We are pleased to announce that 15th UK Dementia Congress 2020 will go ahead as planned as an all-new virtual conference. The congress will feature a full programme, including plenary and parallel sessions, question and answer sessions, offer a virtual exhibition area and lots of opportunities to network with fellow attendees and more. We hope you understand our decision to make this change. We have been continuously monitoring the ever-changing circumstances surrounding Covid-19, and are focused on keeping our delegates, speakers and supporters safe during this time. As an exciting virtual event, we look forward to continuing to build on the success of the UK’s most well-loved multi-disciplinary congress on dementia care.
WHY SHOULD YOU ATTEND?
PLENARY SPEAKERS
• •
People living with dementia and their supporters
• • • • • • • •
CPD certified conference programme Plenary sessions, keynote speakers and a wide choice of parallel sessions, symposia and interactive workshops Over 40 parallel sessions to choose from covering the latest in dementia care, research, policy and innovation People with dementia and carers sharing their experiences Large and lively exhibition Themed and facilitated networking sessions Congress app Poster presentations Panel discussions and audience question time Opportunities to network and socialise with like-minded individuals
Paola Barbarino, Alzheimer’s Disease International Professor Linda Clare, University of Exeter Jackie Pool, Sunrise Senior Living & Gracewell Healthcare Dr James Warner, Imperial College London
careinfo.org/event/uk-dementia-congress
Programme: theresa.ellmers@investorpublishing.co.uk Sponsorship opportunities: caroline.bowern@investorpublishing.co.uk Bookings: events@investorpublishing.co.uk
in association with
academic partner
stream partners
satellite symposium sponsor
Association for Dementia Studies
A strong theme will be the way the Covid-19 pandemic has demanded changes in dementia care practice in all settings, the innovative ways challenges have been met and the way ahead. Sessions will include: • Covid-19 – review, reflection and the road forward in dementia care • Innovations and evaluations in staff development, training and education • Creative ways to connect through technology • Music and music therapy – Individual arts interventions – Intergenerational arts practice • The ‘uniform’ question • A review and new guidelines on responding to stress and distress • Self-management, peer and early support • Care and support at home • Experience of people with dementia from minority ethnic communities • New dementia service models: Co-producing services – Social prescribing of arts – Housing with care • Best practice in sustaining post-diagnosis support groups • Reducing polypharmacy / Supporting mobility – practical approaches – non pharmacological interventions • Younger people with dementia – diagnosis and support • Carers and Families – caring in lockdown – distance caring – living grief and bereavement • LGBTQ people living with dementia There are also dedicated special interest streams on: • End-of-life care in all dementia care environments – challenges for care homes, enabling a good death, advance care planning • Dementia care in acute hospitals – Covid-19 workshop, innovation and research, arts and intergenerational practice
organised by
JournalOfDementiaCare
@JDementiaCare
#UKDC2020
DATA PROTECTION
Keep digital data private David E Rutter, chief executive of enterprise software firm R3, argues that the Covid-19 pandemic has highlighted the need for urgent reorganisation of the way healthcare is delivered and that the key to this is through a distributed ledger
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HealthInvestor UK • August 2020
DATA PROTECTION
H
ealthcare workers across the world have done a heroic job in the battle to combat Covid-19 and save lives. But we’ve seen in many countries that the way health systems are organised has hindered, not helped, this effort. Technology can play a major role in making healthcare more efficient. The speed of recruitment into hospitals is a key example. In the US, it takes on average four to six months to recruit and onboard a new medical practitioner. In normal circumstances that is already a lengthy process, carried out at great expense to the hospital. In this environment, it’s simply unfeasible and fails to respond to the situation. Digitalised record-sharing could allow a network of hospitals instantly to verify and request credentials of licensed professionals from each another. Health professionals would be able to fill much-needed roles without waiting months for documents to come through. This would reduce the administrative burden that individual hospitals face without compromising on vital fitness-to-practise checks. The NHS has made moves towards digitalisation – ‘digital first’ was the pinnacle aim of 2019’s Long Term Plan. The NHS leverages The Spine, an IT infrastructure system which connects the service’s organisations; this system means 93% of English GPs can prescribe medication electronically and the NHS app allows patients to book appointments and order repeat prescriptions online. The NHS’s digital future has great potential. However, much of the UK’s digitalisation has been done on a hospital-by-hospital basis. The 2017 cyberattacks on the NHS highlighted how important it is to have up-todate, innovative healthcare systems. Our healthcare workers deserve better than inefficient procedures and our patients deserve better than outdated systems, which all too often leave crucial personal data vulnerable to attack. The point the pandemic has driven home is clear – we can do more to optimise all aspects of our healthcare system and we must overhaul inefficient processes. Technology can deliver the cutting-edge healthcare our medical teams desperately require. This pandemic has shown just how difficult it is to get resources quickly to where they are needed. The world’s healthcare systems were left unable to access PPE and efforts to secure critical resources were often rendered newsworthy due to confusion surrounding delays of ventilators, masks and even hand sanitiser. It is clear that there is a limit to the value of devolved decision-making to trusts and clinical commissioning groups in the UK during a national crisis. The answer isn’t to make NHS procurement monolithic, but to have a more flexible digital system. Using blockchain could allow real-time updates and secure data-sharing between healthcare services, which just isn’t possible on legacy IT systems. Blockchain would make it easy to see who has what equipment and where the shortages are. Not only could this make us better prepared should another national health emergency take place, but better procurement was estimated to be able to shave £700 million off NHS costs in 2016. The NHS, its healthcare workers and its patients would benefit from better digital healthcare systems – it’s a win-win.
HealthInvestor UK • August 2020
Each time patients enters a hospital, they cannot receive treatment until their medical history has been assessed and processed. If data was readily accessible on a secure and adaptable system, the moment patients enter a GP room, hospital or health centre, healthcare workers would be able to treat them instantly, contact other professionals, and resources could be located and prepared ahead of time. The same applies for discharging patients. According to NHS data, last February an average of 5,370 patients a day were delayed in leaving hospital. Almost 60% of these were due to delays within the NHS. Technology has the ability to expedite these processes and to free up the time taken by these healthcare workers so that they can focus on treating those most in need. Healthcare is on the right track; many countries are striving towards digitalisation, but the reality remains that new technologies could be implemented to much greater effect. If we could achieve digitalisation at the national level, lives could be saved, and shortages could be fewer. We could relieve pressure on the system and allow healthcare workers to do their jobs safely – saving lives. However, certain centralised ledger approaches towards healthcare digitalisation have compromised the privacy of sensitive personal data. With individuals’ health and location data shared with governments and private technology companies, many are faced with the fear that this information will be shared for purposes other than public health. For example, individuals’ data – such as their immunity status to Covid-19 or the network of people they’ve been in contact with during the past 14 days – might need to be accessed by various different parties in the healthcare ecosystem. Uploading this data to a centralised digital database essentially relinquishes control of it forever and introduces a host of data security risks. While the main consideration for a government must be, of course, protecting the health of its citizens and boosting the efficiency of such, there’s no reason why, if the appropriate technology is used, we must lose control of our personal data. The key to unlocking this balance between privacy and technology lies in enterprise blockchain. Blockchain is a viable alternative to these centralised digital databases as it doesn’t compromise individuals’ control over their personal data. With blockchain, the control of data remains in the individual’s hands, tackling this privacy challenge headon by using sophisticated encryption techniques, only revealing the data to those who have a need to know. Therefore, if developed appropriately, a blockchain-based decentralised ledger can enable individuals to exercise control over their digital footprint in a secure and sustainable way. Users can control which elements of their identity, location and health credentials are shared, as well as the storage of their data, such as medical records, as they see fit. Decentralised identifiers are just one example of a whole host of exciting new technologies in the field of identity and data management in the blockchain space. The current pandemic has highlighted the urgency for the digitalisation of healthcare, but this should not be at the expense of our personal data. With blockchain, this balance of efficiency can be achieved without the need to compromise on data privacy. n
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EMERGING TRENDS
A useful trip Psychedelic drugs are emerging from the shadows to play a role in treating conditions such as depression and alcohol use disorder. Kathy Oxtoby investigates a company advocating the clinical use of these controversial compounds
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ne in four people in England will at some point in their lives experience some kind of mental health issue, according to mental health charity Mind1. But looking at the efficacy of drugs used to treat depression they are effective only in forty to sixty patients in one hundred, studies have found2. “So, we need to look for new ways of treating conditions like depression. That’s what psychedelics offer us and what psychedelic assisted psychotherapy has the potential to offer patients,” says Dr Steve Wooding, chief scientific officer of Oxford-based psychedelic medicine company Beckley Psytech. Founded in 2019, Beckley Psytech is a for-profit company dedicated to helping patients with neurological and psychiatric disorders by developing a pipeline of psychedelic compounds into licensed pharmaceutical medicines. Its vision is for clinically validated psychedelic medicines to be integrated into modern medical practice in order to help patients in need around the world who have these profoundly debilitating conditions.
Healing potential Cofounder of Beckley Psytech Lady Amanda Feilding has been dedicated to the scientific exploration of psychedelics for the last 50 years, “in the belief that modern science can be used to understand, validate, and optimise the healing potential of psychedelic medicines”. This led Feilding to set up the Beckley Foundation in 1998, a non-profit NGO focused on scientific research into psychedelic medicines, and the development of evidence-based drug policy reform. At that time, psychedelics had ceased to be the focus of scientific research, says Feilding’s son and co-founder of Beckley Psytech, Cosmo Feilding. He explains that back in the 1950s and early 1960s there were numerous scientific studies focused on the potential of psychedelics to treat psychiatric disease. “But because psychedelic drugs got wrapped into a drug policy debate and had become associated with the counter culture [of that time] they were made illegal in the late 1960s and all scientific research was shut down,” says Cosmo Feilding. The Beckley Foundation’s mission was to “reinvigorate that area of research”. “My mother felt psychedelics were an untapped area of potential medical benefit for patients in need”, he says.
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Over the last 20 years the focus of the Foundation has been to initiate key scientific studies with academic collaborators around the world such as Imperial College, London, John Hopkins University in the US, and Maastricht University, Netherlands. “We’ve created a global network of leading researchers who want to conduct studies in this area. The Beckley Foundation was one of the pioneers of what’s known as ‘the renaissance in psychedelic science’,” says Cosmo Feilding.
Unmet need in patients The price of conducting large scale regulatory-standard clinical research is “very significant”, says Amanda Feilding. She and her son decided they could best achieve this mission by creating Beckley Psytech, “a commercial entity that marries the purpose of improving health and happiness for patients with potential profit for the investors”, she says. The company was created to build upon the Foundation’s work, “by developing safe and effective psychedelic medicines available to the patients who need them, and further to integrate these treatments into mainstream medical practice. On that note, the strategic partnership with the Beckley Foundation is very important to Beckley Psytech as a company,” she says. Wooding says the company is driven by the “unmet need we see in patients”. “There are obviously treatments for neuropsychiatric diseases but they work for a relatively small percentage of patients and carry with them a significant risk of side effects. “Our aim is to look at psychedelic drugs which clearly have an impact on the mind, and to see if we can determine benefits.”
Psychedelic compounds Beckley Psytech’s main activity is conducting research on psychedelic compounds. Its lead research programme concentrates on a compound known as 5-MeO-DMT, a unique psychedelic agent with a short duration of action, in the treatment of neuropsychiatric diseases. “We are focused on producing 5-MeO-DMT to a pharmaceutical standardised quality and synthetic form and also a novel formulation, as well as conducting pre-clinical research on the compound and preparing for the ‘first in man’ Phase 1 clinical trial,” says Cosmo Feilding.
HealthInvestor UK • August 2020
EMERGING TRENDS
Cosmo Feilding and Lady Amanda Feilding
He explains that while this compound is used by people in recreational and ceremonial settings, and there is observational and anecdotal evidence showing it could be effective in treating addiction and depression and anxiety, “there is very little rigorous scientific research on this product. “We intend to build upon the anecdotal and observational evidence of 5-MeO-DMT’s therapeutic potential by conducting the first placebo-controlled regulatory-standard clinical trials on this compound.”
Series A funding This June, the company raised £3m of Series A funding to develop a pipeline of psychedelic drugs into licensed pharmaceutical medicines for treating psychiatric and neurological diseases. Investors in the round included prominent British businessman and biotech entrepreneur Jim Mellon and Richard Reed, co-founder of Innocent Drinks. Beckley Psytech will use the Series A funding to advance its lead programme exploring the use of synthetic 5-MeODMT in the treatment of neuropsychiatric diseases. The funding will help with scaling up resources to develop novel pharmaceutical formulations and delivery methods for the compound, as well as to progress preclinical and clinical trials.
Attraction for investors Beckley Psytech has attracted investors who are “visionary business men in their own right and who saw the potential of what we’re doing immediately”, says Cosmo Feilding. Generally, for investors in the company “this is an opportunity to have a very meaningful impact on potentially many millions of patients suffering from the debilitating neuro psychiatric disease. Psychedelics offer an exciting potential new treatment model, which drives a lot of investors”, he says. For Wooding, Beckley Psytech’s focus “is really is about unmet patient need and a novel approach - that’s what investors get excited about”.
Another attraction for investors, and an achievement Cosmo Feilding is “very proud of”, is having brought together some of the leading experts in psychedelic science and having built a strong team of drug developers, including Wooding, former head of global commercial strategy for Janssen, Johnson and Johnson’s pharmaceutical division.
Ambitious plans Beckley Psytech is looking at additional research programmes to its platform over the coming months, which will require funding. “Our aim is to attract additional investment – we’re moving as quickly as possible and have ambitious plans for research. We anticipate research and the progress we’re making will speak for itself when it comes to attracting investors,” says Cosmo Feilding. For Foundation founder Amanda Feilding, “it’s great that there is so much interest and investment going into this area, after so many years in the dark – this change has been overdue for a very long time”. “As long as the companies are ethical, responsible, and committed to the highest standard of scientific rigor, then I see no reason for there to be any negative feeling hanging over the sector. Rather, it’s a win-win situation for society.” On a personal level, she says: “It is incredibly important for me to continue to fight against the social stigma and regulatory hurdles, and to shine the light of science onto the medical potential of psychedelic compounds. “This work has been hard and slow, but the great achievements of Beckley, and a handful of other pioneers, is that we have managed to generate enough compelling, high-quality research to show the world that these medicines cannot be ignored any longer. “We now feel we have finally entered a new chapter where patients will soon have legal access to these treatments. The Beckley Foundation will continue to conduct the vital exploratory research, and public policy work, that has opened the doors to large-scale clinical trials aimed at developing psychedelic compounds into licensed pharmaceutical medicines.” n
1. mind.org.uk/information-support/types-of-mental-health-problems/statistics-and-facts-about-mental-health/how-common-are-mental-health-problems 2. who.int/whr/2001/media_centre/press_release/en/
HealthInvestor UK • August 2020
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REHABILITATION
The long march to recovery Ruth Smith, Active Care Group’s chief executive, reviews neurorehabilitation for post-acute Covid patients and the challenges facing the medical sector ahead of the predicted second wave of the pandemic later this year
A
ccording to Statista, as of July there were 14,657,108 reported cases of Covid-19 worldwide – with the worst affected countries being the US with 3,898,550, Brazil with 2,099,896, India with 1,119,412 and Russia with 777,486 cases. The UK also fared poorly with 294,792 cases reported – a high infection rate when set against the size of its population - with the highest rates reported as 44,331 in the Northwest, 34,694 in the Southeast and 34,604 in London. Worldwide the advance of the pandemic has led to unprecedented demand for intensive care services and medical staff being stretched to breaking point. The only light at the end of the tunnel being that – according to the University of Bristol and Royal United Hospitals Bath NHS Trust in their latest review – “as the pandemic has progressed and various factors combine, survival of patients admitted to ICU has significantly improved”. According to the British Society of Rehabilitation Medicine (BSRM) now, more than ever, it is crucial that critical care, acute medical and specialist rehabilitation teams work together closely to develop rehabilitation pathways for patients recovering following treatment in intensive care.
• The home environment or place to which that the individual will be discharged • Individuals’ social context and economic circumstances • Occupation, whether paid, ‘informal’ or voluntary work.
Physical, psychological and neuropsychological complications
At Christchurch we work closely with our NHS partners to ensure that rehab starts while the patient is still in intensive care. On step-down from ICU our rehabilitation provision is delivered by comprehensive multidisciplinary rehabilitation teams including consultants in rehabilitation medicine, clinical neuropsychologists, rehabilitation nurses, physiotherapists, occupation therapists, speech and language therapists, therapy technicians, and specially trained rehabilitation assistants. Rehabilitation commences with a detailed assessment, followed by treatment and management to maximise physical functioning, cognitive ability and social and psychological wellbeing. Our goal is to optimise the patient’s quality of life and reintegrate them back into their normal lives, following a period of inpatient rehabilitation within our units.
Covid-19 is a multisystemic condition and some of the effects are long-lasting. Research from the BSRM reveals that of the patients discharged from hospital in China and Italy following treatment for Covid-19, at least a third had significant neurological needs and a similar proportion required assistance in activities for daily living. It is noted that some factors to consider that may affect an individual’s rehabilitation include: • Personal and environmental circumstances • Comorbidities • Premorbid functional abilities • Psychological mindset, for example, previous coping mechanisms, self-efficacy and resilience
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Part of the rehabilitation pathway offered by neurological rehabilitation provider Christchurch Group – a division of UK complex care provider Active Care Group – includes assessments designed to evaluate the aforementioned factors so they can be addressed as part of the rehabilitation process. Physical complications in patients recovering from Covid-19 include diabetes, obesity, fatigue and cardiovascular issues. Psychological and neuropsychological complications in patients recovering from Covid-19 include delirium/acute confusional state in the early stages of rehabilitation, ongoing cognitive impairment, depression, anxiety, protracted grief response, adjustment disorder and posttraumatic stress disorder.
Expertise
HealthInvestor UK • August 2020
REHABILITATION
Patient goals Patients requiring complex rehabilitation go through an admissions process which involves identifying clearly defined goals and receive: • Multidisciplinary rehabilitation led by a rehabilitation medicine consultant • Intensive, bespoke and structured therapy programmes • Access to specialist equipment, such as functional electrical stimulation cycling, electrical stimulation, postural management, mobility, gait and limb rehabilitation • Services which are well-integrated into the community with working relationships with local leisure centres and specialist rehab clinics • Support from community dietetics and nutrition nurse services and regular GP reviews. Patient goals are typically focused on restoration of functional independence and co-ordinated discharge planning with a view to continuing rehabilitation in the community. Patients typically require intensive rehabilitation from one-to-three therapy disciplines as part of relatively short rehabilitation six-week programmes and receive rehabilitation in the context of their Covid-19 diagnosis, encompassing specialist nursing input. All of our services are specialist and are led by specialist consultants.
Robust discharge planning and evaluation On discharge patients and NHS commissioners receive a discharge report clearly outlining achievements and featuring quantitative data – for example, Functional Independence Measure, a global measure of disability that can be scored alone or with the additional 12 items that formulate the Functional Assessment Measure, a Supervision Rating Scale which measures the level and type of supervision that a patient/subject receives from caregivers and Supervision Rating Scale, as well as other UK specialist Rehabilitation Outcomes Collaborate measures.
The challenges Patients with Covid-19 display a wide range of symptoms which appear two-to-14 days after exposure to the virus and typically encompass fever or chills, a cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headaches, loss of taste or smell, a sore throat, congestion or runny nose, nausea or vomiting and diarrhoea. But this list is by no means definitive – it is evolving on a daily basis, as is the treatment of Covid-19. With no long-term data available, navigating our way through a disease which manifests itself in so many different ways presents a huge challenge. It’s crucial that medical staff actively share their findings – for example, when it came to light that Covid-19 patients are more susceptible to strokes, all patients were contacted and were advised and treated where appropriate to avert the risk. Covid-19 is also taking an emotional and psychological toll on medical staff who are typically working extended
HealthInvestor UK • August 2020
Ruth Smith, Active Care Group
hours under intense pressure. The Active Care Group – including Christchurch and Remeo Healthcare – supported staff, providing them with a self-care app and psychological support programme, showing our appreciation and thanking them on a daily basis for going beyond the call of duty and being strong for those faltering under the pressure. This ultimately impacts and helps to maintain the high quality of care delivered to patients. Support in the form of transport to and from work to limit the risk of infection posed by public transport has also been much valued by staff. Fresh air, regular walks and exercise groups to stimulate the production of serotonin – the ‘happy’ chemical – have been integrated into the daily schedule to help staff maintain their wellbeing. Those required to self-isolate have received regular pastoral calls, food parcels when they can’t go shopping and alternative accommodation when required to limit the risk to families. Letters have also been sent home thanking the children of staff for their understanding and celebrating their mum or dad as a ‘superstar’ which has improved the wellbeing of their families.
Second wave contingency planning With the World Health Organization warning that millions more people may die in the event of a second wave of coronavirus infections, as was the case with Spanish Flu, we – like our peers worldwide – are currently gearing up to manage effectively a significant patient influx forecast for October. Having completed a scoping exercise to evaluate and predict potential national geographical hotspots, we are now expanding capacity organically by reconfiguring current services to achieve further growth potential and leveraging existing resources and capabilities across all our business divisions. We have also actively sought opportunities to expand our geographical reach in new locations and have two new developments and six extensions in the pipeline that will create 51 additional beds. n
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EXECUTIVE MOVES
executive moves Active Care Group Ruth Smith has been promoted to chief executive of Active Care Group – a UK provider of rehabilitation and complex care services for children, young people and adults – by The Montreux Healthcare Fund. During her time as chief operating officer at Active Care Group, Smith led a restructure of its six divisions spanning residential and supported living, care in the home, Christchurch rehabilitation services, Remeo respiratory services, case management and Jane Lewis Healthcare Recruitment Solutions. The Group brings together over 40 care providers to form a progressive, integrated, specialist healthcare business with a national footprint and a focus on complex care. It employs over 4,000 staff who support more than 2,000 clients across more than 60 locations in Great Britain.
Advanced Oncotherapy Advanced Oncotherapy, the developer of nextgeneration proton therapy systems for cancer treatment, made the following changes to its board of directors. Gabriel Urwitz, Peter Sjöstrand, Chunlin “Allen” Han, and Dr Yuelong Huang (all non-executive directors of the company), have stepped down from the board which has
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decreased from 12 members to eight members and will comprise three executive directors and five non-executive directors.
Aurora Group Aurora Group, which provides education, care and support for children, young people and adults with special educational needs and disabilities, has appointed Mark Costello as chief executive. Costello has been performance director of the group for the past eight months. He was previously chief executive of the Core Assets Group which provided foster care for children and supported accommodation for care leavers.
Clinova Clinova, the consumer healthcare company, has appointed former McKinsey & Company partner Masha Feigelman as organisational design advisor. Feigelman spent more than 20 years at the global management consulting firm, where she built up the healthcare restructuring and transformation service in her capacity as a global leader, including the set-up of the McKinsey healthcare practice in Russia. The Clerkenwell-based, science-led company has recently upped the production of its FFP2 certified Covaflu respirator masks, which have been essential in providing protection throughout
the Covid-19 pandemic. The company has also had success with its personal healthcare app Caidr, which allows users access to personalised medical and wellness advice.
Fund+ #Fund+, an investment firm focused on European life sciences companies, has appointed Luc Debruyne and Gérard Lamarche to the board. Debruyne was president of global vaccines and member of the corporate executive team at GlaxoSmithKline. Lamarche is a director and member of the standing committee of Groupe Bruxelles Lambert. Chris Buyse, managing partner and executive board member of Fund+, said: “We are delighted to welcome Luc Debruyne and Gérard Lamarche to the Board. Luc Debruyne brings outstanding scientific and commercialisation experience from GSK, where he led the global vaccines business; and a wealth of international expertise having worked across Europe and managed businesses globally including significant focus and experience in the US. Gérard Lamarche will leverage his track record of successful transactions and brings an invaluable perspective to the board following an impressive track record of strategic roles at well-established industrial companies.”
HealthInvestor UK • August 2020
EXECUTIVE MOVES
HC-One The UK’s largest care home provider HC-One has appointed James Tugendhat as chief executive. Tugendhat previously led the European and international division of US-based Bright Horizons, prior to which he was chief executive at Towergate Direct. He also worked at Bupa and is a non-executive director of the Royal Free London NHS Foundation Trust. Sir David Behan, who has been executive chairman of the company since the departure of previous chief executive Justin Hutchens in January, will be handing over executive responsibilities and reverting to his previous role of chairman of the HC-One board.
Lincoln International Lincoln International, a multinational independent investment bank and financial services company specialising in advisory services and financings on middle-market transactions has made three senior appointments. Dirk Loeffler joins as managing director and head of healthcare for the DACH region and Julian Knirim and Jens Gerlach join as directors. All will advise shareholders, management teams and financial sponsors on complex private and public M&A transactions in the global healthcare sector.
HealthInvestor UK • August 2020
Loeffler brings 17 years of experience providing M&A advisory to clients across the healthcare industry, with a focus in the healthcare services, medical technology, diagnostics, specialty pharmaceuticals and digital health sectors. He has executed sell-side and buy-side M&A transactions for private equity clients, publicly-traded companies and privately-held and familyowned businesses. Prior to joining Lincoln International, Loeffler was a managing director at Raymond James, where he led the Frankfurt office and built out its European healthcare activities. Previously, he was a partner at Richmond Park Partners and head of M&A at Berenberg as one of the most senior investment bankers. Knirim focuses on healthcare services, medtech, healthcare information technology, pharmaceuticals and dental sectors. He was previously an M&A banker at Richmond Park Partners and Bank of America Merrill Lynch. Gerlach has worked with companies in the hospital, rehab, physician practices, nursing and home care sectors. He has also gained experience in healthcare software and equipment manufacturing sectors. He previously worked in the investment banking division at Citigroup and in Berenberg’s corporate finance practice.
Penny Brohn Bristol-based cancer charity Penny Brohn UK has appointed Julie Worrall as chief executive. Worrall is currently director of fundraising and development at Above and Beyond, the official charity for the University Hospitals Bristol NHS Trust and will take up her new post in October. Stephen Rosser, chair of trustees at Penny Brohn UK said: “Julie is a strong strategic leader with expertise in driving change. Julie has over 15 years in the charity health sector, seven of these in formal leadership roles and has served on boards for national and local charities. Julie has a wealth of experience in programme development, income generation and developing strategic partnerships including working alongside the NHS.
The London Clinic Independent charitable hospital The London Clinic has appointed Gerard Smith as chief financial officer, effective immediately. Smith replaced outgoing chief financial officer Simon Reiter who has departed after five years in the role. He joins from Sermo, a global social network for physicians focused on improving patient outcomes. He has also held international chief financial officer positions within a variety of industries, including at Easynet (BskyB), Acxiom and Dell. n
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