DECEMBER 2017/JANUARY 2018 | Volume 21 | Issue 10 … · 2017. 12. 8. · DECEMBER 2017/JANUARY...

Xxxxx xxx xx xxxxxxxIn focus

Is the current model of GP care still fit for purpose?

The new GPKeep the home fires burningHealthcare at Home CEO Natalie Douglas makes the case for complex care at home

Independent. Intelligent. Insightful.HealthcareMarkets

A new model of integrated urgent care is opening up new opportunities but are they worth it?

Outside the box

DECEMBER 2017/JANUARY 2018 | V o l u m e 2 1 | I s s u e 1 0

Transforming urgent care

New technology has the power to transform primary and out-of-hospital care, but will it be let off the leash?

Funding innovation in healthcare

Ima

ge

cour

tesy

of I

BA

As providers of specialist fi nance to the healthcare sector for over 20 years, at Shawbrook we understand the dynamics and equipment utilised within this industry. Our dedicated team takes the time to understand your requirements and will tailor funding solutions to meet the demands of your business today, tomorrow and beyond.

Contact us today

0345 604 [email protected]

Proudly different

Together

final advert Shawbrook Healthcare A4 Ad Nov 2017 v1.indd 1 28/11/2017 12:21

Introduction

WE ARE DELIVERING SOME GREAT SERVICES FOR THE NHS BUT IT’S THE FACT THAT MORE

COULD BE DONE THAT’S THE ISSUE

Kick down the doors

Rapid advances in technology could revolutionise primary care and see more patients treated at home - if the barriers can be broken down

This issue, we focus on the changing primary and out-of-hospital care markets, in particular the power of technology to vastly increase the amount and type of care delivered away from traditional healthcare settings. Healthcare at Home CEO Natalie Douglas makes the case for complex home healthcare (Inconversation p16) while the latest research from LaingBuisson reveals a growing market for virtual GP services (Infocus p20).

Plus, Ann McGauran asks if the new integrated urgent care contracts are really worth it? (Infocus p24) And Dr Druin Burch from Candesic explores the changing role of the GP (Indepth p26).

laingbuissonnews.com | DECEMBER 2017/JANUARY 2018 | 3

Natalie Douglas, p16

Funding innovation in healthcare

Ima

ge

cour

tesy

of I

BA

As providers of specialist fi nance to the healthcare sector for over 20 years, at Shawbrook we understand the dynamics and equipment utilised within this industry. Our dedicated team takes the time to understand your requirements and will tailor funding solutions to meet the demands of your business today, tomorrow and beyond.

Contact us today

0345 604 [email protected]

Proudly different

Together

final advert Shawbrook Healthcare A4 Ad Nov 2017 v1.indd 1 28/11/2017 12:21

ContentsIndependent. Intelligent. Insightful

This month…

4 | DECEMBER 2017/JANUARY 2018 | HM - LaingBuisson

Editor, Maria Davies looks at this month’s key issues

COMMUNITY

Visit HM’s bloglaingbuissonnews.com

Join LaingBuisson’s linkedin grouplinkedin.com/company/LaingBuisson

Follow us@HealthcareLB

It’s a bleak mid-winter for the NHS. The usual pressures on its limited resources are compounded this year by a steadily lengthening waiting list and a stream of EU nurses packing their bags for home. Even the Chancellor’s £6.3bn of extra funding won’t come in time to save it from some difficult decisions in the dark days ahead.

Technology is no panacea but it does have the power to alleviate some of the pressure. The latest research conducted into the out-of-hospital market by LaingBuisson indicates that there is real appetite from consumers for digital health platforms and virtual GP apps. Yet, no sooner was it announced, than babylon’s ‘GP at Hand’ partnership with London GPs was accused of ‘cherry-picking’. Likewise, home healthcare services such as those provided by Healthcare at Home are being under-utilised despite well evidenced benefits.

Of course, these services are not suitable for all patients: some will always need to see a GP or be admitted to hospital while other, often less seriously ill, patients can be treated elsewhere. But surely, that’s the point?

“I’m not advocating selling it at all. Actually I am advocating that it’s going to be positioned correctly.” Joey Jacobs

12 Inpartnership NHSPN chief executive David Hare looks at the legal challenge to ACOs

16 Insider Fiona Booth of AIHO warns providers to prepare for GDPR

30 Inlaw Udara Ranasinghe from DAC Beachcroft talks about some of the possible solutions to the staffing crisis

Regulars 6 News One Healthcare opens second site and outlines plans for growth IPT hikes forcing people out of PMI Budget focuses on the NHS PHIN enables consultants to review data babylon partners with GPs Bupa launches self-referral for cancer services

35 Inbusiness BMI results and Priory Group ‘not up for sale’ 50 Inpost Key appointments in the sector

One Healthcare opens the doors at its second hospital, p6

Healthcare at Home CEO Natalie Douglas says the NHS could make better use of home health

services, p16

Events JOIN US! Visit laingbuissonevents.com to find details of forthcoming LaingBuisson health and care conferences, seminars and report launches

HM


REGISTER NOW 020 7841 0045 [email protected] laingbuissonevents.com

ConferenceInvesting in Healthcare Thursday 8th February Royal College of Physicians London

Healthcare Real Estate Tuesday 24th April Grand Connaught Rooms London

AwardsHM

CONTACT US [email protected]

EDITOR Maria [email protected]+44 (0)20 7923 5390

PUBLIC POLICY REPORTER Ann McGauran

RESEARCH AND DATA [email protected] +44 (0)20 7923 5395

PUBLISHING DIRECTOR [email protected]

SUBSCRIPTION SERVICES Janet [email protected]

DISPLAY [email protected]+44 (0)20 7841 0045

Healthcare MarketsHMDECEMBER 2017/JANUARY 2018 Vol. 21 Iss. 10

ISSN 2399-7044

HM is published ten times a year by LaingBuisson Ltd, 29 Angel Gate, City Road, EC1V 2PT. +44 (0)20 7923 5390 Printed by Rapidity, Citybridge House, 235-245 Goswell Road, London, EC1V 7JD ©LaingBuisson Limited 2017. No responsibility can be taken by the publisher or contributors for action taken as a result of information provided in this publication. All rights reserved; no part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise without either the prior written permission of the publisher or a licence permitting restricted copying issued in the UK by the Copyright Licensing Agency Ltd and in the USA by the Copyright Clearance Center Inc.

Annual subscription (10 issues) Print & Online £499Print, Online & Digital £749+44 (0)20 7923 5390

SUBSCRIBE NOW

REGISTER NOW 020 7841 0045 [email protected] laingbuissonevents.com

Features 16 Inconversation Healthcare at Home CEO Natalie Douglas talks to Maria Davies about complex home healthcare

20 Infocus An app a day... LaingBuisson research shows a growing market for GP apps as consumers seek appointments at the touch of a button

24 Infocus The new face of urgent care Integrated urgent care models are providing new opportunities but are they worth it? asks Ann McGauran 26 Indepth The new GP Dr Druin Burch from Candesic explores the changing face of general practice

Chosen provider of independent sector healthcare market data to the ONS

The voice of professional publishers

Incoming BMI Healthcare CEO Karen Prins has her work cut out as

it reports its 2017 results, p36Is it the end of general practice as we know it? p26


News

One Healthcare has opened its second hospital in three years and plans to accelerate the roll-out of its national network, with

six more sites secured around the M25.Following the launch of its first facility,

One Ashford, in Kent in April 2016, the new hospital in Hatfield, Hertfordshire, will be one of the only hospitals in the UK to provide a predominantly MSK-centric service, including spinal surgery. The development comprises six operating theatres, three of which incorporate the latest laminar flow equipment alongside integrated technology enabling surgeons to review scans and x-rays on high-defini-tion screens, 20 overnight beds, con-sulting suites and a 14-bed ambulatory surgery centre.

One Healthcare chief executive Adrian Stevensen said: ‘By focusing our clini-cal services predominantly on the MSK market we are able to offer exceptionally high-quality services supported by robust clinical support from consultation and diagnosis right through to enhanced post-operative recovery. The MSK market has grown consistently over recent years yet private healthcare facilities have been slow to adapt. We believe that One Healthcare offers a new model of MSK-centric services which are attractive to consultants, patients and insurers. On the latter point, the UK private medical insurers have been really supportive of our plans to change the dynamics of MSK delivery in what is the major sector of the

UK market.’Established in 2014 with backing from

Octopus Healthcare, One Healthcare’s vision is to create a national network of purpose-built hospitals designed to replicate the ambulatory surgery centres common in Australia and the US.

Although One Healthcare’s hospitals also provide some complex care (the new Hatfield site has critical care facilities) they are heavily skewed towards provision of routine elective surgery away from ma-jor tertiary centres and closer to patients’ homes.

The idea is that by applying rapid recovery programmes, outcomes will be improved and lengths of stay minimised, with average lengths of one and a half to two days for some major surgery. Ultimate-ly, this reduces costs and, according to Stevensen, could help stimulate the UK PMI market.

‘We build new and really efficient hos-pitals to improve the quality of care and at less cost to the payor so that should stimulate medical insurance to grow,’ he said. ‘We set out to change how private healthcare is delivered and to design modern, welcoming hospitals putting our clinical teams, patients and other cus-tomers (including medical insurers) at the heart of our plans.’

One Healthcare expects to develop 12 centres over the next five to six years at a cost of around £40m/£45m per site. The first phase will concentrate on sites around the M25; the second will be around other major commuter centres

in the UK. The overarching philosophy is ‘localism’ – seeing and treating patients near their homes and reducing the need for referral into London or other major centres except for complex, specialist treatment.

‘This development pipeline represents the most significant expansion in private healthcare facilities in the UK in the past 30 years. Our plans are supported by the major private medical insurers who share our vision of modern, safe and efficient private healthcare within the highest qual-ity surroundings,’ said Stevensen.

In addition, each hospital is operated as a separate local entity rather than ad-hering to a standard corporate template. This means that the Hospital Manage-ment Board, which includes consultant and GP representation, makes local decisions to meet local needs.

Rajeev Sharma, One Hatfield director of consultant development, said: ‘From a consultant perspective, One Hatfield hospital is unique in the UK regarding the way they prioritise the patient-physician relationship. As director of consultant development at One Hatfield I was respon-sible for setting up the medical society there. This incorporates both consultants and GPs and introduces a formal govern-ance structure which places the views of physicians at the top of the management tree at the hospital. No other hospital in the public or private sectors involves such an integral dedication to improving patient outcomes at all levels of operation.’

One Healthcare opens second hospital and plans further roll out

One Healthcare has opened its second hospital in Hatfield, Hertfordshire

Adrian Stevensen, CEO, One Healthcare


Steep rises in IPT are forc-ing thousands of people to abandon private medical insurance, according to a study by the Centre for Economics and Business Research (Cebr).

The study, commissioned by Bupa ahead of the autumn budget, analysed the insurer’s monthly customer data from 2003 to 2017 and extrapolated the findings to the whole market. It concluded that 21,000 customers have left PMI for every 1% rise in IPT.

IPT has doubled in the last two years and increased to 12% in June. Some industry commentators expect further rises as the Treasury looks to boost its coffers. It is estimated that the latest 2% increase will raise an additional £4.06bn for the

Treasury over the next five years – making IPT the second largest revenue raiser in the 2016 autumn Budget.

Bupa has been a vocal opponent of the increases. In October, Bupa Insurance CEO Alex Perry told HM that the government’s focus on IPT meant short term gains in times of austerity but could prove self-destructive in the longer term.

‘In 1997, tax relief on personal contributions to health insurance was removed and since then the personal market has shrunk by a third, that’s half a million people who have left the market. It has declined from one and a half million to one million and that’s half a million more people who are now dependent on the NHS

for their care,’ he said.The Cebr report warned

that more people would cancel their policies or reduce their level of cover if IPT was raised again.

A spokesperson for Bupa said that the money collected from the tax was not ring-fenced for the NHS. The insurer added that IPT hits people in most need the hardest because older people or other groups perceived as higher risk pay higher premiums and therefore more tax.

Oliver Hogan, chief economist at Cebr said: ‘The impact of the tax has not been considered by the government and we hope this research will make for interesting reading for the industry, the government and the public.’

IPT hikes forcing individuals out of PMI

Bupa de-recognises last NI NHS trustBupa customers living in Northern Ireland could have to travel elsewhere in the UK for treatment after it emerged that the insurer no longer recognises any of its NHS hospitals.

Bupa de-recognised Belfast Health Trust in April because it does not have medical negligence cover. It had already stopped referring patients to Northern Ireland’s other four trusts. Although the private hospitals on its network in the country all have critical care transfer arrangements with NHS hospitals in case of emergency, this means that high risk patients will either have to travel for treatment or be treated as an NHS patient.

A spokesperson for Bupa told HM that very few patients would be affected by the decision but that the wellbeing of its customers had to take ‘top priority’.

‘We temporarily suspended recognition of the NHS Belfast Trust in April 2017 as it does not have the medical negligence insurance necessary to treat private patients at its hospitals. This is important as it gives our customers security if something goes wrong and they need to claim against the hospital, as well as being a requirement of Bupa recognition.

‘If a patient requires ICU facilities they can have their Bupa funded treatment elsewhere in the UK. If they decide to do so we’ll help cover their travel and accommodation expenses and those of a family member,’ she said.

Other major insurers are still recognising the trust.

Dr Keith Klintworth, deputy CEO at VitalityHealth, said: ‘We have carefully considered our position and we do not

presently feel it is necessary to suspend our recognition of the Belfast Health and Social Care Trust. We will re-evaluate our position on an ongoing basis as we receive further information and we will support our customers to have options to seek care at other facilities whenever requested.’

Bupa said it was in regular contact with the trust and was working with them to arrange the appropriate medical negligence insurance. ‘Once this has been arranged we would like the trust’s hospitals to continue to be included on our recognised hospital lists,’ said the insurer.

Over 80% of PMI providers now include an option to cover mental health treatment, according to research by comparison site ActiveQuote. It said two out of its 11-strong PMI panel provided cover as standard while seven offered it as an add-on.

Mental health cover

Bupa suspends relationship with Belfast HSC Trust

Out Of Hospitals Services

Northern Ireland £0.3bn

Scotland £0.8bn

England £9.5bn

Wales £0.5bn

UK total £11bn

3% of GP consultations are privately funded

UK expenditure on NHS general practice, 2015/16(including GP dispensing costs)

Home Healthcare

Delivery of specialised pharmacological treatment at home, or delivery of ‘complex care’ for patients with multiple disabilities who would otherwise be placed in care homes.

£2.6 billion estimated market size for 2016

Telecare & Telehealth

These services refer to portable devices for people with long term health conditions that are measuring and transmitting vital signs for monitor by healthcare staff and feeding back information to users.

£250 million estimated market size for 2016

Occupational Health

Occupational health services help keep employees safe and healthy by managing risks in the workplace.

£800 million estimated market size in 2016

Prison Healthcare

Healthcare services offered to prisoners and people in other secure institutions include specialist support.

£500 million estimated market size in 2016

General Practice

Other Services

SOURCE Out of Hospital Services -third edition, LaingBuisson

0

2

4

6

8

10

20162015201420132012

Expenditure on NHS general practice, England 2012-2016(£bn)

Providers of private general practice services (by number of locations)

BUPANuffield HealthBMI HealthcareHCASpireCircle

Total multi practiceOtherTotal

5.1%2.8%1.8%1.4%0.7%0.2%

12%88%

100%

Market share (%)Group


Inpictures


News

A Budget for healthcare?

Philip Hammond’s first autumn Budget is as interesting for what it didn’t say as much as for what it did. Historically, Chancellors have used the Budget to address the major challenges in both health and care. However, November’s statement in the House of Commons focused on only one – the NHS.

The Chancellor echoed the comments of the Prime Minister at the infamous Conservative party conference in October by praising the NHS as a source of pride, epitomising the values of the British people. Committing the government to back the NHS, he said that staff are tackling the additional demands with skill and commitment.

Highlighting the ever-increasing numbers of patients being seen by the service as ‘higher than ever,’ (c.4% increase in annual demand) he stated that patient satisfaction is at its highest in 20 years.

Despite a series of hints and promises from ministers to local government audiences over the last few months, there was not a single mention of social care in the Budget. It was, however, good news for the NHS, with a £10bn additional package of capital investment announced for the course of this Parliament to support frontline services and Sustainability and Transformation Partnerships (STPs).

The Chancellor emphasised his desire to make the NHS fit for the future. Recognising that the NHS is currently under vast amounts of pressure, a further £2.8bn of resource

funding is to be delivered for England, with £350m to be made immediately available for trusts this winter. In addition, the extra resource for next year will be £3.75bn. Therefore, the NHS will see a total increase in its resource budget of £7.5bn this year and next.

In other 2017 Budget health announcements, the Chancellor also suggested that R&D investment would grow to 2.4% of GDP, benefitting a range of life-science industries in the UK, as well as outlining a series of investment opportunities for new health, care, life science and bio-tech companies to expand across the UK.

The government will also deliver £1.7bn of transforming city funds, partly to be shared with devolved mayors, the remainder for competition with other cities. A second devolution deal was also agreed with West Midlands and 100% business rates retention is to be piloted in London. Alongside this, there will be £100m of discount lending for local government infrastructure.

Lastly, and probably most importantly given the workforce challenges in the NHS, nurses were shown the light at the end of the tunnel in terms of wages. Highlighting that the nation’s nurses deliver valuable support to those in need, the Chancellor announced that if an independent body recommends a rise in wages, the government will fund it with new monies from outside the existing NHS budget.

Most commentators suggest that the government must

find a way to announce an increase in nurses’ pay while holding pay levels for doctors and auxiliary workers for this to be affordable. However, there are those in the Cabinet who have mooted a wage increase at the expense of an expanding workforce, putting the NHS on a direct collision course with both the DWP and Home Office.

So, why did the Chancellor omit social care from the Budget? Is it fall-out from the General Election or are they waiting for the Social Care Green Paper to be published next year. Everyone knows that the NHS problem cannot be solved without a funding solution and reform to social care. Everyone knows that hospital beds are at maximum capacity (underestimated) due to pressures in social care. This omission has caused many in the social care sector to ask why there was no announcement, despite the unambiguous promises by Ministers to solve the problem.

Looking to the next Budget, it is time for the social care sector to demand more from the Treasury. They must do what the NHS did very successfully this year and lobby hard to ensure their needs are addressed going forward.

Ben Howlett, director, Public Policy Projects

Scottish spendingThe amount the NHS in Scotland spends on inde-pendent sector healthcare has fallen to a five-year low. Health boards’ spend-ing on private healthcare fell to £72m in 2016/17 - down from £78.5m the previous year. However, some boards increased their spending on private provision, including the biggest spender, Great-er Glasgow and Clyde, which spent over £20m in 2016/17 - an increase of £3m on the previous year. Borders, Tayside and Lothian also recorded increases, with the latter two reporting spending of £8.8m and over £9m respectively.

New partnershipJohnson & Johnson Managed Services, part of Johnson & Johnson Fi-nance Limited, and Guy’s and St Thomas’ NHS Foundation Trust have announced a 15-year partnership to deliver an Orthopaedics Centre of Excellence at Guy’s Hos-pital. Under the deal, the orthopaedics centre at Guy’s Hospital will be ex-panded and redeveloped to include an additional operating theatre in year one and eight new state-of-the-art theatres by the end of year three.

Virgin settlementSix CCGs in Surrey have settled their legal dispute with Virgin Care for an undisclosed sum. Virgin Care started proceed-ings against CCGs and NHS England last year after losing out on an £82m contract to provide children’s health services. It claimed there were ‘se-rious flaws’ in the way the contract was awarded.

Inbrief

Public Policy Projects director Ben Howlett takes a closer look at the

Chancellor’s focus on the NHS

News


Consultants working in pri-vate practice can now review their entire clinical data on the Private Healthcare Information Network’s (PHIN) secure online portal.

This is first time consultants have been able to review data across both their NHS and private practice and it is hoped the move will assist in appraisal and revalidation as well as help drive improvements in patient safety.

From next May, patients visiting PHIN’s site will be able to search for information on individual consultants as well as hospitals, including numbers of patients treated for common conditions, average lengths of stay and profile information.

PHIN’s clinical informatics director Dr VJ Joshi said: ‘The view of private and NHS practice together is unique – most consultants will not have had this available before. A number of

leading doctors have already seen their data and given us suggestions, which we are working to incorporate. Others are already using our data to inform appraisal and revalidation. The accuracy of the information will improve as doctors check and use it. We’re grateful to the doctors who engage early, as that helps us to improve the service for all.’

Starting early next year, individual consultants will be asked to formally validate the completeness and accuracy of the data held about them in preparation for publication. PHIN said it is keen to ensure information is only published when consultants are confident it is complete, accurate and presents a fair view of their practice. The sector’s information body has developed tools and materials to help support consultants, who will be invited to participate under a phased roll-out.

President of the Royal College of Surgeons Professor Derek Alderson said: ‘There have been a large number of initiatives in the NHS to improve patient safety. Yet the same focus from government and healthcare leaders has not happened in the private sector. The recent abhorrent case of Ian Paterson served as a reminder that this sector needs as much focus on safety as the NHS. The Private Healthcare Information Network is taking steps to improve data publication, and is now inviting consultants to play their role to help improve the outcomes and safety data about their private practice. We encourage surgeons to support this initiative and work to improve it as it matures.’

Private hospitals and NHS facilities offering private healthcare services are legally obliged to supply detailed data to PHIN. However, the organisation has highlighted

ongoing concerns with data quality, and a number of hospitals that have failed to provide any data are subject to enforcement action by the Competition and Markets Authority.

PHIN chair Dr Andrew Vallance-Owen said: ‘For information to be useful to and trusted by patients, it must first be trusted by the doctors it describes. PHIN’s portal gives consultants a unique view of their whole practice, private and NHS, and allows them to check data well ahead of any information being published. Inevitably, stark variations in the quality of the data provided by hospitals will be exposed. We are asking consultants to engage with their data to identify any issues or gaps, and to work with PHIN and the hospitals at which they practice to get the data and its interpretation right.’

Virtual GP provider babylon Health has entered into partnership with NHS GPs in London to provide a 24/7 appointment service.

The ‘GP at Hand’ service, which was trialled in Fulham, can be accessed by patients across the capital, with plans for a national roll-out.

Patients can see a GP via video consultation within two hours or use the service to book a face-to-face appointment at locations close to major transport hubs, including Canary Wharf, Victoria, Liverpool Street and Euston. The service can also be used to check symptoms and arrange for prescriptions to be delivered to a pharmacy. In addition, the video can

be played back following consultation.

Mobasher Butt, GP at Hand partner, said: ‘We do everything from grocery shopping to our banking online yet when it comes to our health, it can still take weeks to see a doctor and often means taking time off work for an appointment.

‘With the NHS making use of this technology, we can put patients in front of a GP within minutes on their phone, so the days of ringing frantically at 8am for an appointment should be long gone. This new NHS service makes it easier for patients to see a doctor quickly at anytime and from anywhere and doesn’t cost the NHS a penny more. It’s a win-win.’

babylon partners GPs

Consultants able to review data on PHIN portal

Bupa has launched a com-prehensive self-referral can-cer service - Cancer Direct Access.

The service offers custom-ers fast access to diagnosis for a wide range of cancers, including stomach, lung, testicular and bladder, via the Cancer Direct Access team. Delivered by specialist advisers using the latest NICE guidelines, the service builds on Bupa’s Direct Access service for breast and bowel cancer.

According to the insurer, the majority of custom-ers who are referred to a specialist consultant will be seen within a week, and if diagnosed with cancer will

begin their treatment within a month.

Dr Steve Iley, medical director at Bupa UK, said: ‘Early cancer detection can have a significant impact on an individual’s chance of sur-vival and reduces their need for complex and invasive treatment.

‘However we know that diagnosis and treatment are often delayed as people can’t find the time to book a GP appointment or worry about wasting the doctor’s time. Cancer Direct Access removes the need for a GP referral and allows customers to access specialist diagnosis services in a way that is easy and convenient for them.’

Bupa launches self-referral for cancer services


Intelligence tables

Organisation Sector MH hospitals

MH beds Year end Revenue

£mEBITDAR

£mEBITDAR margin %

Priory For-profit 63 2,598 2016 823.8 £202.8 24.6%

Cygnet Health Care For-profit 47 1,718 2016 178.0 - -

Elysium Healthcare (end of year figures not yet released) For-profit 27 1,127 - - - -

St Andrew's Healthcare Not-for-profit 9 879 2017 205.1 29.3 14.3%

Huntercombe For-profit 12 387 2016 113.6 20.0 2 15.7%

Royal Hospital for Neuro-disability Not-for-profit 1 220 2016 35.6 1.6 4.6%

Barchester Healthcare For-profit 7 179 2016 563.9 162.7 28.9%

Inmind Healthcare For-profit 5 159 2015 11.3 2.9 25.9%

Danshell For-profit 10 134 2016 29.5 (1.8) (6.0)%

Alternative Futures Not-for-profit 7 128 2017 58.9 0.9 1.5%

Riverside Healthcare For-profit 1 110 2016 16.6 5.2 31.3%

Ludlow Street Healthcare For-profit 3 99 2016 37.2 7.1 19.1%

St George Healthcare For-profit 3 99 2016 19.0 3.9 20.5%

Bramley Health For-profit 2 96 2015 7.0 (1.4) (19.4)%

The Retreat York Not-for-profit 3 93 2016 11.2 (1.9) (17.3)%

Florence Nightingale Hospitals For-profit 1 73 2015 15.6 2.5 16.3%

Livewell Southwest Not-for-profit 4 73 2016 111.6 6.6 5.9%

Tracscare Group For-profit 1 72 2017 57.3 11.5 20.1%

Mental Health Care (UK) For-profit 3 69 2016 31.2 1.4 4.6%

St Matthews Healthcare For-profit 3 69 2016 15.7 4.4 28.3%

The Disabilities Trust Not-for-profit 2 67 2016 56.1 3.1 5.5%

John Munroe For-profit 2 58 2016 10.3 1.6 15.9%

Jeesal Group For-profit 1 54 - - -

Raphael Hospital (acquired by Raphael in Sept 2017) For-profit 1 50 2016 13.8 1.3 9.7%

The Whitepost Health Care Group For-profit 1 50 - - -

Nouvita For-profit 1 49 2016 6.9 0.7 9.7%

Sanctuary Care Not-for-profit 1 45 2016 90.0 9.8 10.9%

NAViGO Health & Social Care CIC Not-for-profit 3 44 2017 28.5 0.6 1.9%

Glenside Care For-profit 1 42 2017 13.7 1.6 11.6%

The Congregation of the Daughters of the Cross of Liege Not-for-profit 1 40 2016 25.9 (6.6) (25.5)%

Shaw healthcare For-profit 2 39 2017 93.0 12.4 13.3%

Equilibrium Healthcare For-profit 1 37 2016 7.5 1.8 23.9%

Christchurch For-profit 2 37 2016 4.8 1.1 23.6%

Turning Point Not-for-profit 4 36 2016 111.8 2.9 2.6%

Options for Care For-profit 2 34 - - - -

Making Space Not-for-profit 2 30 2017 24.7 1.5 6.0%

CareTech Community Services For-profit 1 30 2016 149.0 44.9 30.1%

Ellern Mede For-profit 1 26 - - - -

KR Health & Social Care For-profit 1 24 - - - -

Sequence Care For-profit 2 23 2017 10.9 (0.8) (7.3)%

Rushcliffe Care For-profit 1 16 2015 18.1 4.0 22.4%

NOTES 1 NUMBER OF REGISTERED MENTAL HEALTH HOSPITALS OWNED/LEASED BY INDEPENDENT OPERATORS, RANKED BY BEDS 2 EBITDAR(M) PRE-EXCEPTIONAL EARNINGS BEFORE INTEREST, TAX, DEPRECIATION, AMORTISATION, RENT (AND CENTRAL COSTS)SOURCE LAINGBUISSON DATA. NUMBERS CORRECT AS OF 1 DECEMBER 2017

Major providers of mental health hospitals1


Inpartnership

confidence in and which, as expressed recently in The Economist, builds on the ‘imperfect market-based reforms of the last 30 years [that] have helped to cut waiting times, give patients more choice and instil financial discipline?’

For the independent sector, as for many other organisations, these are important questions and the answers will determine the shape and quality of the NHS for years to come. NHS Partners Network has said consistently that there is a very strong case for reforming the way that health and care services are constructed to ensure they are more responsive to the needs of real people rather than reflect historical organisational partitions; and that there is clear international evidence that accountable care style systems, using the latest technology platforms, can achieve this, particularly in supporting people with more complex, long-term conditions. But we have also argued that ‘integration’ is not a silver bullet and that any moves in this direction must not lead to inflexible monopoly provision that locks out new ideas and innovations.

The legal challenge coming from ‘999 for our NHS’ will work its way through the courts and undoubtedly the results will be followed with interest. But the fact that a legal challenge has been brought at all brings into sharp focus the potentially extra-legal way in which the NHS is now functioning and the need to avoid the risk, as the King’s Fund recently put it, of ‘finding ourselves back in the 1970s’ with ‘unaccountable local monopolies’.

What is more surprising is where the challenge has come from. ‘999 for the NHS’, supported by law firm Leigh Day, is a campaign group seeking to ‘fight for the complete removal of corporate control from the NHS.’ The irony of an ‘anti-privatisation’ campaign group using the 2012 Health and Social Care Act, perceived (wrongly as it happens) by some as opening the door to greater contestability in the NHS, to push back on NHS England’s attempts to ‘integrate’ care will not be lost on HM readers. It will also not be lost on readers that the arguments being deployed for the ACO contract’s illegality suggest support for a system where money follows the patient and where patient decision-making, particularly for acute elective services, is the organising principle of the NHS as opposed to organisational integration.

It is clearly too early to know whether the Judicial Review will succeed or fail although it is clear that NHS England intends to fight the challenge strongly.

Searching for clarityHowever, what the challenge does

highlight is the urgent need for clarity on some of the key questions driving implementation of the Five Year Forward View. For instance, whilst patient choice remains a key part of the Forward View, there is a gradual erosion of the payment mechanism, underpinned by law, which supports choice and ensures that money is not locked up with providers that cannot deliver. How does this get reconciled? Also, what is the future for tendering and procurement and how will patients be reassured that the providers delivering their NHS services – whether public, private or voluntary – are the best placed operators for the job, rather than those who just happen to be there?

In short, how does the current reform agenda build a stable operating model which all participants can have

For those organisations working in the NHS, in recent years it has become increasingly clear that many of the key tenets of the

NHS Five Year Forward View buttress up quite sharply with some of the legal principles laid down in successive Acts of Parliament and indeed from European law, particularly on procurement. Views on whether this direction of travel is right or wrong, and whether it is being safely and successfully implemented, do vary, although there is a widespread view in many parts of the health community that deviating from the law does bring considerable risk, so it therefore cannot be a major surprise when that direction of travel is challenged in the courts.

This is what has now happened with a Judicial Review submitted in late October arguing that NHS England’s ‘Accountable Care Contract’, designed to govern relationships between commissioners and the operators of new care models, including Multi-specialty Community Services and Accountable Care Organisations (ACO), was ‘unlawful’. The statement submitted to the court and reported first in the Health Service Journal said: ‘The new ACO contract does not link payment to the number of patients treated and/or the complexity of the medical treatment provided, as required by the Health and Social Care Act 2012, but is based on a fixed budget for an area’s population.

‘[We are] deeply concerned that the contract, if implemented, would threaten patient safety and force hospitals and doctors to restrict treatment, making decision based on money not clinical judgement.

‘This is because a fixed capitated budget would fail to ensure that there would be enough money to meet the cost of delivering NHS services to the required quality standard.’

The fact that this challenge has been brought is perhaps unsurprising.

NHS on trialA judicial review brought by an anti-privatisation

campaign group is questioning the payment mechanisms of ACO contracts

David Hare, CEO, NHS Partners Network


TRANSFORM CAREIMPLEMENTING NEW MODELS TO IMPROVE CARE AND VALUE

To build sustainable solutions that are patient/

customer focused, health and social care

systems need to optimise outcomes and

experience, while delivering on value.

We help clients transform care through

the development and implementation

of innovative, proactive, patient-centred

models that address gaps and

inefficiencies in our current

delivery system.

www.oliverwyman.com/transform-care

Insider


means that the independent healthcare sector will need to be particularly vigilant in their safeguarding of the information that they hold about the health and treatment of individuals. Processing of this data must be justified based on one of ten justifications, including the need for a higher level of informed consent referred to as explicit consent. As such, providers need to be aware of the new regulations that they need to follow. For instance, many members will hold and process information about children. Privacy notices given to children need to be written in a clear, plain way that a child will understand.

Where to start? In practical terms, independent

hospitals should start by analysing the data about individuals that they have obtained. This analysis should then be reviewed for compliance with the data protection principles and permitted reasons for processing. The results from this undertaking should then be documented so that when inspected, it is evident that proper practices and procedures have been followed.

As the 25 May 2018 and the implementation of the GDPR draw nearer, AIHO will continue to support its members towards complying with the new regulations. This is a working document and will be updated and amended as required.

and procedures and take steps to ensure timely compliance.

The guide covers the scope of organisations covered, the obligations they must observe and the penalties that can result from a breach. The document also provides key information on the six new core principles that need to be followed and a range of other requirements that will impact different organisations. It will also help AIHO members analyse their policies and procedures and take steps to ensure timely compliance.

The document addresses the following areas: the main principles and requirements of the GDPR, the permitted grounds for processing personal data, the rights of data subjects, the implication of the GDPR for the independent healthcare sector and the practical work that AIHO members need to undertake to comply, what GDPR compliance will look like and the repercussions of breaching the GDPR.

GDPR means real changeAlthough most providers are aware of

the new GDPR reform, there is a section on dispelling common myths about GDPR. For example, many providers think that ‘they already comply with data protection law and nothing much is changing’. However, even though the core principles of data protection will remain, there are important changes being made by GDPR and every organisation should understand what this means.

The implementation of the GDPR

The General Data Protection Regu-lation (GDPR) comes into force in May and organisations that fail to comply will face heavy fines.

The Association of Healthcare Organisations (AIHO) has provided its members with a document, developed with legal input and support from Mills and Reeve LLP, to prompt and support them in considering the key issues that this reform of data protection brings about. It also highlights the areas where compliance may be challenging when implementing changes for the GDPR.

The key issuesThe document summarises the key

legal and regulatory issues that arise in relation to data protection, particularly in the context of the reforms being introduced on 28 May 2018 under the GDPR. AIHO members are encouraged to carry out audits of their own activities and develop policies and procedures to address the principles in this document.

Most organisations have become familiar with the obligations of the existing law, enacted in the UK as the Data Protection Act 1998. They will recognise many of the same principles and procedures in the new GDPR. But while evolutionary, rather than revolutionary, the extent of the change is significant. This means that any organisation involved in the collection, use and storage of data about individuals, be they service users, existing or potential clients or employees, must analyse their policies

Preparing for the new data regulationsWith GDPR now less than six months away, AIHO has developed a new guide to help ensure its members understand the changes to existing data protection law - and ensure that they are compliant

Fiona Booth, chief executive, AIHO

INFOCUS


Rapidly advancing technology is driving a revolution in healthcare, where more treatment and services can be delivered outside of hospitals and even away from GP

premises. But will the technology be unleashed or will the revolutionaries remain shackled?

BEYOND BRICKS AND MORTAR

DECEMBER 2017/JANUARY 2018


Inconversation

Complex home healthcare provid-ers have long believed they can be part of the solution to the seemingly intractable problem of

delayed transfers of care (DTOC). As the NHS gears up for another long, cold win-ter, DTOCs are on the agenda and in the news once again but despite the almost continual focus, the problem is getting worse rather than better. The annual direct cost of DTOCs is es-timated at around £170m for 2016/17 but the National Audit Office has sug-gested the real figure could be in excess of £820m while a parliamentary briefing published in the summer stated there were 2.3 million delayed transfer days in England in 2016/17 – up 25% on the previous year.

Complex home healthcare is no panacea for the health service’s ills but according to Healthcare at Home (HAH) CEO Natalie Douglas, it could help alleviate much of the pressure in a creaking system - if only it was adopted more extensively.

‘The opportunity to outsource at the moment and to get those beds unblocked is tremendous,’ she tells HM. ‘Some of these services we have offered for many years are solutions to the problems we are seeing at the moment but I don’t see the uptake to the extent that’s possible from the NHS during a time when you would expect them to be seizing this opportunity.’

Since Douglas took over as CEO in 2014, HAH has gathered vast amounts of support and evidence to help make the case for home healthcare. In 2015,

it convened a market enquiry to examine the value of the type of services that could be delivered in patients’ homes. Chaired by Christine Outram, its initial report concluded there were likely to be compelling benefits for both patients and the health service. And its follow up report in 2016 estimated that the NHS could save £120m a year by using virtual ward models alone. Just last month, the 2,000 Days Project, which looks at care in the first and last 1,000 days of life, produced by a coalition of clinicians and managers from both the NHS and independent sector, called for an informed debate on the costs and benefits of developing healthcare in the home.

Yet, despite the growing mountain of support and evidence, the market has failed to gain significant traction over the last few years.

‘We have really spoken out to encourage the NHS to outsource to the independent sector and it’s a massive

frustration what’s going on at the moment because we are building up to winter and there are these issues with winter pressures but for some reason the NHS are just not making decisions,’ says Douglas. ‘There is resource out there but they are keeping it all in house. It’s not the bigger thinking the system needs and it will be interesting to see what happens over the winter period. You would think that now they would really be ensuring they have the capacity to cope with what might happen.’

Short-sightedIn common with other providers

working in partnership with the NHS, HAH has reported a marked decline in outsourcing over the past 18 months as the NHS grapples with how best to deploy its limited financial envelope.

‘It has definitely got worse,’ says Douglas. ‘It started to get worse 18 months ago but in last six to 12 months it’s become really bad. I think there is absolutely a strategy to keep these services within the NHS as opposed to operating in partnership with other providers, especially those considered independent sector.’

Major independent hospital providers, including Spire and Ramsay, have reported a tailing off in NHS demand since waiting times targets and penalties were removed last year. With pressure on the NHS to retain all of its limited financial resources, Douglas believes independent providers are being placed in the same ‘bucket’ regardless of the

Complex home healthcare offers huge benefits for patients and potentially

significant savings for payors yet it was absent from the NHS Five Year Forward

View. Healthcare at Home CEO Natalie Douglas talks to Maria Davies about

why the NHS needs to take a closer look at how care can be delivered at home

HM meets...Natalie Douglas

I THINK THERE IS ABSOLUTELY A

STRATEGY TO KEEP THESE SERVICES WITHIN THE NHS


HM meets... Natalie DouglasCEO, Healthcare at Home

Career Chief Executive Officer, Healthcare at Home (June 2014 – Present) Board Member, Evofem Inc (Dec 2015- Present)Board Member, Global Genes (2013- Present)Co-Founder, Executive Chairman,

Partner, Rocket Science Consultancy (2014 - 2015)CEO, Idis (1999-2013)

Currently reading Wuthering Heights by Emily Brontewww.linkedin.com/in/natalie-douglas-70b2b11/

services and benefits they offer. ‘I think that because we have a lot

of clinicians on staff, the NHS could consider we are employing staff that would be in an NHS hospital, so it’s a resourcing issue. There is also a view that NHS community services should be managing patients in the home. There is some confusion because it’s a very nascent market in many respects and it’s very difficult at the moment to have sensible conversations. However, I do believe it’s a strategy to keep more [clinical care] inside hospitals than out at a time when the mantra appears to be that we should be delivering care closer to home,’ she says. ‘We’ve seen examples recently where we have anticipated being awarded services and all of a sudden not being awarded those services, so things have become particularly problematic in last few months because of short-term thinking around budgets.’

According to Douglas, the slowdown is largely being driven by finances rather than ideology but the short-term focus on savings means the NHS is often overlooking the greater gains of working with an independent sector partner.

Making gainsIn home healthcare, some of the

gains are self-evident. On the dispense and delivery side, for instance, the NHS makes a 20% VAT saving on the cost of drugs dispensed in the home. However, the number of trusts and CCGs using the service has not increased significantly in recent years. ‘It’s an obvious saving,’ says Douglas, ‘which I don’t see the NHS tapping into at all.’

Other financial gains are more complex to demonstrate. Based on pilot studies, research by HAH indicates that ‘virtual wards’ could save the NHS more than £120m a year. But Douglas says the real figure is probably much higher when you take into consideration bed nights saved, readmission avoidance, ward staffing and clinician time.

‘If you’ve been in the industry a long time as I have, you see the peaks and the troughs but I think it is pretty bad right now,’ she says. ‘I think it’s unprecedented what we are seeing and what we are faced with. We are delivering great services for the NHS but it’s the fact that



Inconversation

HM


Inconversation

HM

more could be done that’s the issue.’It is not all bad news, however, and

Douglas says HAH has developed innovative partnerships with the local NHS in many areas, in particular, the population dense Midlands, London and the South East.

‘There are some great exemplars in some parts of the country where we work hand in glove with the local trust or CCG. And I think that’s the only way that these services can work - when we are working collectively and together, especially in difficult times for the NHS,’ she says.

Specialist careClinical home healthcare may still

be maturing as a market but in recent years HAH has expanded both its clinical competencies and its offering, with services ranging from post-surgical care packages, occupational therapy and physiotherapy to cancer nurses providing chemotherapy in patients’ homes. It looks after the largest proportion of rheumatoid arthritis patients in the UK and has specialist paediatric nurses providing daily interventions for children with rare conditions.

‘We do amazing work,’ Douglas explains. ‘We have clinical service design teams that go into wards and design out pathways. There is a very specific clinically-led methodology and pathway that we go in and develop and it is specific to the type of ward and hospital we are working with so it’s actually very bespoke.’

Part of the problem, according to Douglas, is that people don’t always understand this complexity or the expertise involved in delivering home healthcare services.

‘We are a partner to the NHS. We are not taking jobs away. We are creating more opportunity for those clinicians within the hospitals to spend time doing the things they really need to do while getting out some of the patients who don’t necessarily need to stay in a hospital.

‘This isn’t handing over care of people to perfect strangers or people with a spare bed in their homes. This is real clinical expertise – we’ve been doing it for years and we’re really good at it,’ she says.

HAH remains a strong business which, according to Douglas, has plenty of new opportunities to expand – whether that be in its work with pharmaceutical, private or NHS clients. Clearly, however, she is frustrated by the pace of change in the latter.

Making the case‘The issue for us is that the system

still isn’t as receptive as it should be in thinking through some of the challenges it faces and how simply solvable some of those are today. It’s just not happening to the extent it should be. We’ve got 12,000 interactions in people’s homes every day of the week so that’s a very sizable number but it should be much more than that when you consider the size of the population and the extent of bed blocking in the UK. I think there should be a much more determined effort to get people home much quicker and maybe avoid people having to go into hospital in the first place,’ she says.

Over the last decade, there has been much talk about transferring more services out of expensive secondary care settings and into the community. However, despite the rhetoric, progress has been slow. The Five Year Forward View places considerable emphasis on strengthening primary care and community services, but to the surprise of Douglas and her colleagues, clinical home healthcare received no mention.

‘I’ve been at HAH for three years and I’ve not seen a determined push to get

patients or care into the community,’ she says.

‘There are some very good examples but I think some of the things we’ve read about recently are utterly crazy. I think there should be a much more determined effort to get people home much quicker and maybe avoid people having to go into hospital in the first place. People don’t always need to go into hospital and sometimes it’s a pain for them because they are not all that agile or mobile. Just think if the government really did push to get patients out, we would see a different picture emerging. I think there is a push in the wrong direction to keep them in hospital.’

According to the 2,000 Days Project, the home should be the starting place for care. It maximises independence, prevents time being wasted, gives people control over their environment, reduces infection risks and removes the stress and anxiety of going to hospital. For the NHS, it reduces pressure on hospital facilities and beds and means staff are treating patients who are less anxious and better able to cope. It sounds like a ‘no-brainer’, but the coalition behind the research also recognise it would mean ‘a profound change’ for the NHS. That is unlikely to happen overnight but, it adds, the costs and benefits need to at least be debated.

Frustration aside, Douglas remains patiently optimistic about the future.

‘I think the market will definitely grow but there is a very short-term focus on finance at the moment,’ she says. ‘It’s typically cyclical in the NHS and if you’ve been in healthcare a long time you do see these cycles - its either a thrive or bust situation. I think it will turn around again.

‘We are in this for the long term and we do see these peaks and troughs in the NHS. Our job is to continue to provide the evidence and convince the NHS we are a service they should be using and that’s an ongoing challenge but also a great opportunity. Services are slowly won and we are in it for the long haul. We are in one of those troughs at the moment but it will peak fairly soon and then it will be all hands to the pump.’

THE MARKET WILL DEFINITELY GROW

BUT THERE IS A VERY SHORT-TERM FOCUS ON FINANCE

AT THE MOMENT

ab

Looking for a new direction? At UBS, we have built our business around you, our clients.

Whether you’re looking for advisory or capital raising services, we want to help you achieve your goals and deliver results beyond your expectations.

And that means always striving to provide the advice, ideas and excellent execution you need to succeed.

ubs.com/investmentbank

© UBS 2017. All rights reserved.

To speak to our team of specialists, please contact Martin Henrichs. [email protected]+44 207 567 0796

Infocus


WHEN NHS PRIMARY CARE IS FACING ONE

OF THE BIGGEST CHALLENGES IN ITS HISTORY, THE

USE OF APP BASED HEALTHCARE COULD HELP TAKE SOME OF

THE WEIGHT OFF

An app a day...New research by LaingBuisson

suggests the value of the UK private general practice market was £800m in 2017.

Private primary care providers have responded to the increasing difficulties in accessing NHS GP services by expanding their offering. However, the market is also being stimulated by the new breed of digital private primary care providers, which have been making inroads into the market since babylon launched the UK’s first ‘virtual GP app’ in 2013.

The value of this nascent UK market is still unclear. However, according to market intelligence firm Tractica, the global market is growing rapidly, with the number of ‘tele health video consultation sessions’ set to increase from 19.7 million in 2014 to 158.4 million per year by 2020’.

Rising waiting timesSharp rises in GP waiting times

have created increased demand for private consultations in the UK, particularly among working age adults in metropolitan areas. With very low price points and added convenience, digital private primary care providers are meeting this surge in demand and are likely stimulate rapid growth in the market over the next few years.

In addition to recent deals between babylon Health and NHS GPs in Essex and London, eConsult claims to have gained traction with over 2.2 million patients using its on-line symptom checker, self-management and signposting offering for 100 common General Practice conditions – though without a video link.

Private medical insurers have been quick to see the benefits. In the space of just a few years, most have developed a ‘virtual GP’ offering. Vitality was one of the earliest adopters and launched its own private GP app, facilitated by 250 GPs, at the end of 2014. Both Bupa and Aviva have deals with babylon Health to provide remote consultations while

AXA PPP Healthcare has partnered with Doctor Care Anywhere and Cigna has engaged with Now GP.

Remote GP consultations are now an integral part of private medical and health cash plan cover, particularly in the corporate sector. Digital private primary care providers are also working directly with corporates to provide remote GP consultations as part of wider employee wellness and benefits packages. For example, babylon has partnered with Collinson Group, the insurance and assistance firm behind leading brands such as Columbus Direct and Intana Global, to provide unlimited free GP video consultations initially to Columbus Direct customers, with a view to offering it as an additional service to the rest of Collinson Group’s client base. In addition, the market has attracted growing numbers of self-pay patients, attracted by the low price point.

AffordabilityIndeed, pricing has been key to the

rapid development of the market in such a short space of time. The deliberate

strategy of babylon and others has been to target the perceived high price of private medical care by offering the convenience of a private consultation at a low-cost fixed price.

The average cost of a 15-minute face-to-face GP consultation in the UK is £75. However, with far fewer overheads, digital private primary care providers have been able to offer significantly lower prices for subscriptions and one-off consultations. babylon Health, for example, offers subscriptions as low as £5 a month for unlimited consultations and £25 for a one-off consultation.

Another reason babylon and others have been able to develop such low price business models is the way they engage with GPs. In general, they work with practicing GPs in either the NHS or private sector who can carry out video consultations from their home or workplace during leisure time. GPs can choose when and how many hours they work, and with most companies paying £50-£60 an hour, this can prove an attractive way of supplementing income. Since an average consultation lasts less than ten minutes, as many as six consultations can be made per hour each priced at around £25-£30.

Disruptive innovationAs well as GP consultations, digital

private primary care providers can also make onward referrals and arrange prescription delivery. Some also offer face-to-face follow up appointments if needed and are increasingly employing artificial intelligence algorithms to analyse, interpret and diagnose conditions.

To date, the NHS has been slow to embrace the potential benefits of digital primary care. Some doctors are concerned that remote consultations could lead to an increase in misdiagnosis while the Royal College of GPs has warned that use of the technology in the NHS could take doctors away from frontline services. Some industry

Long waits and inconvenient appointment times are fuelling increased demand for private primary care services. Nowhere is this more apparent than in the rise of the ‘virtual GP app’, which is tapping into a new, young and technically savvy market with enhanced accessibility and a very low price point.


HM

y

commentators are also sceptical about the use of artificial intelligence for the diagnosis and triaging the symptoms. However, although data on the use of video consultation remains sparse, a study published in the BMJ suggests new technologies that support alternatives to face-to-face consulting are seen by policymakers as potentially improving the financial efficiency as well as the clinical effectiveness of services.

LaingBuisson founder William Laing said: ‘With an ever increasing gap between the supply and demand of NHS primary care, the emergence of technology based video consultation and artificial intelligence based triage and diagnosis of symptoms is steering private primary care into a new era of business. The leading mobile based companies understand how to enhance the customer experience and are targeting a new breed of healthcare consumer who expect high quality services at their fingertips.

‘Companies such as babylon aim to disrupt the traditional doctor-patient healthcare model through their range of services including health advice chatbot, GP video chat function, prescription delivery service and health tracker. At a time when NHS primary care is facing one of the biggest challenges in its history, the use of app based healthcare services could help take some of the weight off of over-burdened GP services.

‘NHS England has recently committed £45m to NHS GP practices to enable them to set up digital ways of working. This is a classic move by an established market leader (the NHS) to up its game to match the disruptors. It remains to seen whether NHS England will push the initiative through with sufficient vigour.’

Established by former Circle Health founder and CEO Ali Parsa in 2013, babylon was the first virtual GP provider to register with the CQC. The company offers both personal and corporate subscriptions and is increasingly working with NHS GPs. It also delivers prescriptions and arranges referrals. Users can choose to subscribe to a monthly fee (£5), a yearly plan (£50), or opt for the pay-as-you-go model (£25 per appointment).

Founded in 2008, Anytime Doctor provides a pay-as-you-go doctor and prescription service as well as STD clinic and DNA paternity testing. Patients must register prior to consultation. The price of medication includes the consultation, issuing of the prescription and dispensing. Prescription prices are not displayed until after the consultation but the patient is under no obligation to purchase and the consultation itself is free.

Established in 2003 by Dr Brian McGirr, DoctorNow offers a range of primary care services, including home visits. Individual and family memberships subscriptions are on offer and plans include free administration services, a free annual flu vaccination and discounts on medicals and health screenings. It also offers corporate clients an ‘on-premises’ service. Monthly membership fees start at £55 for an individual plus a £150 joining fee.

Founded by Dr Farzad Entikabi and Dr Bayju Thakar in 2013, Doctor Care Anywhere offers two subscription plans at £12 and £20 per month, and charges £60 for a one-off pay-as-you-go consul-tation. Subscriptions include unlimited online appointments, health tracking, NHS repeat prescriptions and two free international appointments. The compa-ny also provides nutritional coaching and mental health support.

Founded in 2013 by obstetrician and gynaecologist Dr Karen Morton, the company offers primary care services and gynaecological advice to female patients via email and phone. It does not offer vid-eo consultations but a phone consultation with a GP costs £35 whilst email is £25. Registration on the website is free and GP services are available from 7am to 11pm, 365 days a year. It also offers fixed price prescriptions for many minor illness.

Founded by Eren Ozagir, Push Doctor uses a digital platform app that allows patients to access GPs from anywhere around the clock. It has a network of more than 7,000 doctors and is reported to provide around 100,000 consultations a month. Subscrip-tion plans start at £20 a month. The com-pany also offers a pay-as-you-go service for £20 per consultation. In addition, it provides mental and sexual health as well as support for pregnancy related conditions.

Founded by Dr Noorpoori and Dr A Dhil-lon, i-GP offers online primary care ser-vices and provides online assessment for over 25 minor illnesses for a one-off price of £10. Assessment involves a two step process: symptoms are initially self-assessed using a clinical algorithm and then reviewed by a GP if considered appropriate. Prescriptions are then sent electronically to the patient’s pharmacy of choice.

Founded by Dr Julian Eden who set up the website in 2000. In addition to GP services, the company offers travel health advice, low dose Naltrexone prescriptions for multiple sclerosis patients, blood testing and hyperbaric medicine. The company offers Skype video GP consultation for £15 per consultation for members. Membership costs £20 per year for both individual and corporate patients.

LaingBuisson is currently working on two reports which will cover this emerging digital market. A revision to Out of Hospital Ser-vices (third edition) and a new Digital Healthcare report are scheduled for publication in the first quarter of 2018. Further details will appear in future editions of Healthcare Markets.


Infocus

Childcare Report launch and seminarLondon, 13th February 2018

Lead Sponsor Sponsor

Care

Media Partner

Investing in our future

£100 + VAT � 020 7841 0045 [email protected] � laingbuissonevents.com

REGISTER TODAY

Themes include:

Dominic Barrett Evans LaingBuisson

Courteney DonaldsonChristie + Co

Jean-Emmanuel RodonachiLPCR

Kush PurewalKPMG

Government policy

Eco-nurseries: the 30 hour solution

Ofsted ratings

Models of care in UK and Europe

Managing childcare settings

Child development and parental support

Investment opportunities and valuations

Thoughtful discussion and networking with peers

Speakers include:

HM

Making timeWith so much money being

raised recently by companies angling for traction in the digital-artificial intelligence

space, you would think the world of vir-tual GP apps is maturing from a nascent technology to mainstream. So, who are these companies, what is the technology and benefit that they will be bringing to the NHS and what are the alternatives?

With demand for primary care appointments rising 23% in the last five years at a time when more GPs are thinking of leaving the profession than our entrance-capped medical schools can replenish, the hope is pinned on technologies that can help manage this rising demand. These are digital tools, apps, software that can identify patients who should be seen by an alternative healthcare professional such as a nurse and/or signpost them to a relevant support service as opposed to booking a GP appointment. With up to 27% of GP appointments being deemed as ‘inappropriate’ in the Making Time in General Practice Report, that means nearly 9,100 GPs are, numerically at least, being used ineffectively. The technologies trying to address this fall into four broad areas; the private GP services, the in-NHS switchers, the symptom checkers, and the sign-posters.

Private GP servicesThe private GP services are the

services you see advertised in free Metro magazines and on public transport, offering immediate access via a video interface to an NHS approved doctor for a fee of £20-50 depending on the provider. The patient chooses the appointment time but, generally, the service is ‘disconnected’ from their NHS medical record and history. As far as regulators and the Royal Colleges are concerned, the jury is still out on the effectiveness of these services. Professor Steve Field, chief inspector of general practice at the Care Quality Commission, said this year that although ‘these websites can present

convenient ways for people to access advice, treatment and medication...some services may be putting patients at risk’. However, this hasn’t prevented leading organisations such as PushDoctor, one of the main providers, from being able to raise $37.5m to invest in these services.

NHS switchersThe second group of providers, in-

NHS switchers, are those that allow patients, free-of-charge, to access video consultations which are powered by NHS GPs. The ‘GP at Hand’ service, run by NHS doctors from NHS practices has been offering to provide AI backed triage courtesy of babylon Health (raised $85m from a mix of US, Egyptian and Nordic investors), for certain patient groups. The service is both convenient and free to NHS patients but does involve the patient switching their registration to the ‘GP at Hand’ practice. The website ‘advises’ patients in the following groups not to register for the service; women who are or may be pregnant, adults with a safeguarding need, people living with complex mental health conditions and/or complex physical, psychological and social needs, people living with dementia and older people with conditions related to frailty, to name but a few.

Symptom checkersThe symptom checkers are probably

the most advanced group commercially and organisations such as the German ADA Health, is now selling into the UK, having raised nearly $67m to support their pre-appointment triaging software. The concept is that by asking questions about your symptoms, can you be prevented from getting an ‘unnecessary’ GP appointment, cutting off the problem of supply versus demand early in the process? The issue with these systems is that they require a large font of clinical knowledge which needs to be continually maintained and kept up-to-date. Furthermore, there is limited scope to see whether they are effective in

reducing cost, providing efficiencies, as well as their accuracy. The hope is that with more AI-backed triage being applied, these symptom checkers become more accurate, but at a recent conference at Lambeth CCG, a main provider volunteered a concern that it may take five years before they are fully functional.

SignpostingThe final group of technologies, like

iPLATO Intelligent Care Navigation, are around signposting of care and care alternatives. This is a more customised approach to gathering information about local services, for example, pharmacy, mental health help lines, practice nurses, cervical smear tests and flu clinics. Patients can book their GP appointment on their smartphone on the myGP® app, and then are asked questions by a Chat-Bot relevant to their condition. They can be offered earlier appointments with practice or prescribing nurses, access telephone call backs or receive information on medications from practice pharmacists. In recent studies for NHSE, nearly 11% of patients were offered and accepted alternatives to seeing the GP and then decided they no longer needed their original GP appointment and cancelled it themselves. Simple technology was able to show potential savings of around £20,000 per practice per year without clinical knowledge, regulatory risks or changing patients from one practice to another. With future developments based on machine learning algorithms, the iPlato system learns what to offer as alternatives based on the patient’s past history of transactions.

The future will probably involve a combination of all of the available solutions - we wouldn’t expect the GP Forward View budget of £45m to be spent on a single service. However, we do expect that all of these services should offer a risk-based pricing, that rewards the effective and efficiencies gained, rather than charging a flat fee irrespective of whether the solution works.

Mike Lewis, chairman of health technology company iPlato asks how the NHS can harness new technology to effectively deliver virtual consultations


HM

Childcare Report launch and seminarLondon, 13th February 2018

Lead Sponsor Sponsor

Care

Media Partner

Investing in our future


REGISTER TODAY

Themes include:

Dominic Barrett Evans LaingBuisson

Courteney DonaldsonChristie + Co

Jean-Emmanuel RodonachiLPCR

Kush PurewalKPMG

Government policy

Eco-nurseries: the 30 hour solution

Ofsted ratings

Models of care in UK and Europe

Managing childcare settings

Child development and parental support

Investment opportunities and valuations


Speakers include:

Infocus


The new face of urgent care

A new model for more integrated urgent care services is offering the opportunity for the independent sector to work in partnership for service delivery. But are these highly complex, multi-agency contracts worth the effort? Ann McGauran reports

England has a new integrated urgent care service specification aimed at streamlining and redesigning demands at the NHS

‘front door’. What role are independent providers playing in this and what’s been achieved so far?

The national service specification emerged in the summer. It requires a functionally integrated 24/7 urgent care access, clinical advice and treatment service incorporating the free 24/7 non-emergency number NHS 111 and out-of-hours (OOH) services. This is referred to as an Integrated Urgent Care (IUC) Clinical Assessment Service (CAS).

It‘s expected more than half of all calls to NHS 111 will involve a clinical consultation over the phone by the end of 2017/18. The delivery target is for the whole of England’s population to have access to IUC by April 2019. Patients will receive a complete episode of care concluding with either advice, a prescription, or an appointment for further assessment or treatment (see box).

The IUC CAS will be made up of a multidisciplinary clinical team with at least one senior responsible GP available 24/7. Working alongside GPs will be specialist clinicians such as palliative care nurses, advanced nurse practitioners, dental nurses, mental health nurses and pharmacists.

Future-proofingUrgent care is already delivered to a

large extent by the independent sector through general practice, out-of-hours GP services, walk-in centres and urgent treatment centres. NHS 111 services are currently provided by organisations such as ambulance trusts, co-operatives, and companies including Vocare and Care UK.

The move to IUC is seen by some independent sector insiders as representing a ‘future-proofed’ NHS 111 underpinned by more clinicians who can ‘bolster up’ the service.

This approach is viewed by them as a more challenging, costly and difficult proposition. Yet the shift to integration is attracting interest from both large players such as Care UK and smaller healthcare providers such as Medvivo.

Medvivo has been awarded a five-year contract to provide integrated urgent care services across Bath and North East Somerset (BaNES), Swindon and Wiltshire from 1 May 2018. The business, rated as ‘outstanding’ by the Care Quality Commission, will be the lead provider - working in collaboration with Vocare and BaNES Enhanced Medical Services (BEMs+).

Dr Jamie Brosch is medical director of Medvivo. He told HM that ‘unlike others who quite reasonably expanded geographically, we chose to expand vertically and stay broadly based in a single geography that we know, but to

offer other services including telecare and digital health’. He says this local focus has been ‘a very strong selling point’ to commissioners.

According to Brosch, the downside of being a smaller local provider is that ‘we’re not actually big enough to be a credible NHS 111 provider to meet the criteria’. It has partnered with Vocare as a sub-contractor, and Vocare will run a part of the NHS 111 service locally from Medvivo’s call centre in Chippenham in Wiltshire.

‘We’ll have overspill into their bigger network and into one large call centre specifically. The commissioners get as much local control as they can but they get the national resilience of having a big player with the infrastructure of that,’ he says.

Medvivo will develop the model to include a new locally managed clinical assessment service.

While acknowledging there is always a risk that more complicated contracting arrangements could result in lead contract holders spending too much time on ‘managing and driving sub-contractors’, Brosch stresses that Medvivo feels confident about contract performance overall.

The clinical hub will have nurse practitioners and GPs ‘all the time - but we’ll need to have easy access to higher levels of expertise in care of the elderly, mental health, paediatrics and palliative care and probably some social care and probably some dental,’ he adds. Those will be in the form of ‘relationships, hotlines and shared pathways rather than actually having those people sitting in our hub twiddling their thumbs much of the time’.

However, he says the big challenge ‘as ever’ is the cost. ‘Whether you are the owner, directors, have investors or even if you are a social enterprise you’ve got to


Dr Jamie Brosch, medical director, Medvivo


run at a surplus, particularly if you want to run a high quality service,’ he says.

Chief executive of the NHS Partners Network David Hare says businesses will have to make individual commercial decisions on whether contracts are worthwhile. However, he believes the urgent care services component of NHS delivery lends itself quite naturally to an independent sector solution, adding: ‘Many of the services need investment. Many of the services are operating on quite a large geographical footprint which requires quite sophisticated supply chain management capability.’

Complex modelsThe introduction of the integrated

support and assurance process (ISAP) following the 2015 collapse of the contract with UnitingCare Partnership provides some reassurance that the national NHS bodies will have a degree of oversight ‘without being overly restrictive on the development of contracts such that they ought not to be collapsing and providers ought not to be walking away’.

Dr Marjorie Gillespie is primary care medical director for Care UK – the provider chosen to deliver NHS 111 and ‘clinical hub’ services as part of a new integrated urgent care service across 16 CCGs in the West Midlands.

An overarching alliance contract links the NHS 111 service to OOH. Tender documents showed the deal was worth between £86.4m and £172.1m, from July 2016 to July 2022. Led by NHS Sandwell and West Birmingham CCG, the contract went live in November 2016.

Dr Gillespie describes the contract as ‘remarkably complex across the 16 CCGs in terms of process.’ She adds: ‘ We are the provider of the OOH in some areas. We have the NHS 111 telephony and have to link with all the OOH providers. They have their own contracts but part of their contracts oblige them to put workforce into the clinical hub. It’s complicated but I’d say yes we are the lead (provider).’

The great advantage, she says, is being able to build on the telephone end of NHS 111, so that when, for example, patients need advice about medication ‘we can now send them straight to a pharmacist’.

That pharmacist might be a person on the telephone working in Care UK’s call centre. ‘It might even be a booked appointment at a local pharmacy on their high street. That’s what integrated urgent care gives us that we couldn’t do before.’

The ‘great thing about integrated urgent care is it can be tailored to that population and that patch’, she adds. ‘What do they have? What facilities, what

district nurses, what emergency dental service do they have and how do we bring all that together so that the patient only has to make one phone call?’

Care UK has contracts to provide 12 NHS 111 services across a range of areas of England. Working at scale in the way that Care UK does is a significant advantage, she adds. ‘We run a number of call centres so we have a huge national capability to provide different types of staff groups.’

She emphasises that commercial boundaries and conflicts have to be set aside by everybody. ‘It takes a lot of building of relationships and trust. We’ve got together and said let’s talk about how the patients’ flow. If a patient comes into me from that postcode with this problem, is that the kind of patient I hand to you and how? More importantly (we discuss) the governance and the safety,’ she says.

Sometimes, the problems identified are not something anybody in the collaborative group can fix, and they need to be brought to the commissioner. ‘We’re able to highlight to them the gaps that we see and hopefully they can commission better,’ she adds.

But each population and each geography is going to need something slightly different, she concludes. ‘One cookie cutter style approach across the whole of England wouldn’t be right.’

The IUC CAS modelThe model for an Integrated Urgent Care Clinical Assessment Service (IUC CAS) requires the following offer for patients:

• Access to urgent care via NHS 111, either a free-to-call telephone number or online• Triage by a health advisor• Consultation with a clinician using a Clinical Decision Support System (CDSS) or an agreed clinical protocol to complete

the episode on the telephone where possible• Direct booking post clinical assessment into a face-to-face service where necessary• Electronic prescription; and• Self-help information delivered to the patient

SOURCE NHS ENGLAND INTEGRATED URGENT CARE SERVICE SPECIFICATION, AUGUST 2017


Indepth

The new GPWidespread access to primary

healthcare, regardless of income, started in the UK with the 1911 National

Insurance Act. Established by a Liberal Prime Minister, it did for Britain what the conservative Chancellor Otto von Bismarck had done for Germany. The benevolent intention of providing healthcare for all workers was driven by the desire to support the country by making sure workers were healthy. With the establishment of the NHS by a Labour government in 1948, universal access to primary healthcare came into being. Again, the aim was two-fold: to support the health of the population and, by doing so, support the health of the nation. The NHS foundation was backed by the Labour, Liberal and Conservative parties combined. This is not ancient history; the political consensus in favour of the NHS in Britain is long-standing and likely to

continue. Internal market reforms were continued by the most recent Labour administrations just as the overall delivery of socialised medicine has been supported by the current Conservative

one. Britain knows clearly what it wants and it wants the NHS. It’s just not clear what sort of NHS that is.

From the foundation of the NHS until the late twentieth century, the fundamentals of General Practice remained largely unchanged. Doctors ran practices and provided primary care services to a core group of patients, in and out of hours.

Continuity of care was the norm, and generations grew up knowing who their GP was, having kept the same one most of their life.

From the late twentieth century, the relationship began to change. Out-of-hours cover began to be provided not by each practice individually but by small groups of them, then larger groups operating at county or near-county level. The 111 service was introduced as the first port of call.

Today, GPs in Britain provide a more varied and fragmented service. Much care previously provided by doctors now

The traditional model of a family GP caring for multiple generations from birth to death is long gone but as yet no clear paradigm has come forward to replace it. Dr Druin Burch, a consultant at Oxford University Hospital and senior advisor to health and social care strategy consultancy Candesic explores the new models of general practice emerging in the 21st century and asks whether they can prove attractive enough to boost the supply of GPs in England

INDIVIDUAL GPS THEMSELVES ARE NOW FREQUENTLY OPTING TO AVOID

PARTNERSHIPS AND PURSUE A SERIES OF INDEPENDENT

TEMPORARY CONTRACTS


falls to nurses, pharmacists and other allied health professionals. Existing practices currently struggle to recruit and many newly qualified GPs have no wish to settle permanently, as older ones have done. The notion of the ‘portfolio GP’, with a mixed bag of experiences, jobs and special expertise, would once have been viewed with suspicion – now it is the norm.

The picture todayFigure One highlights that there is only

a single CCG in England (Hambleton, Richmondshire and Whitby CCG) with the recommended balance in supply and demand in terms of number of GPs per population. The rest of the country shows ‘the heat is on’ for GPs to care for more registered patients on their books than recommended.

Despite rises in numbers of places at medical schools and in GP training schemes, these stresses are likely to increase. Not only is demand rising inexorably, year-on-year, but the supply of GPs is showing strain. The proportion of

doctors choosing to specialise in general practice has fallen and the number of GPs choosing to work in a salaried role (more often part-time) has risen by a factor of ten.

The classic model of general practice is the ‘partner model’, where experienced general practitioners join and invest money into opening their own practice to serve a local community. They can also employ salaried general practitioners.

Unlike salaried GPs, partners are not on a fixed salary, and are paid from the profits that the practice makes; historically practices were owned by GP partners and few wished ever to be salaried doctors working for others.

A general practice can choose whether to operate independently or as part of a network of general practices, known as a ‘federation’. This is a group of general practices that join together with the aim of improving the delivery of care for the local population and increasing efficiency savings via economies of scale, resource sharing and potentially increased specialisation.

Over 50% of general practices now find themselves as members of federations. 2016/17 NHS Digital data showed that just eight new GP surgeries opened, while 202 GP surgeries closed or merged.

There is the start of a trend of large private corporations taking over local practices. Individual GPs themselves are now frequently opting to avoid partnerships and pursue a series of independent temporary contracts; others are moving away entirely from their traditional environments and going to work in hospital A&E or ambulatory care departments.

General practices are now frequently owned by non-doctors and have the majority of care delivered by allied healthcare professionals and doctors who are not partners in their own business.

From being professionals working long hours with 24/7 responsibility for patients they know well, primary care doctors are increasingly expecting and opting for jobs where they clock in and clock out, with defined responsibilities

2,500-3,000<1,500 1,500-2,000 2,000-2,500 >3,000

The majority of CCGs exceed the ‘less than 1,500-2,000 patients per full time equivalent GP’ recommended by the Royal College of General Practitioners

Hambleton, Richmondshireand Whitby CCG

FIGURE ONE UNDER-SUPPLY OF GENERAL PRACTITIONERS IN ENGLAND NUMBER OF PATIENTS PER FTE, 2016

SOURCE NHS DIGITAL; THE KING’S FUND; ROYAL COLLEGE OF GPS; CANDESIC ANALYSIS



Indepth

and payments made by the hour. Much of this reflects societal changes that are common also to secondary care and beyond the borders of medicine. These changes are partly behind the movement of GPs out of their community surgeries and into the emergency and ambulatory departments of nearby hospitals. Having lost continuity of care they are open to new roles that don’t include it.

An uncertain futureThe future of primary care inside

and outside the NHS has never been more uncertain. The most effective way to deliver it, and the way in which that can be made attractive to providers, is unclear. Along with an increase in private provision, such as drop-in centres, online services are growing rapidly.

Babylon is positioning itself as a provider of NHS primary care services. The automated service will compete with NHS 111, and is reputed to be equivalent when it comes to triggering hospital referrals but superior in terms of how many face-to-face primary care appointments it provokes. With ‘GP At Hand’, Babylon is attempting to add something new, with direct access to NHS GP consultations both online and in person.

Doctors themselves have raised concerns. Trained to expect that new interventions are based on good evidence, they will need persuading. Their opinions matter, not only in swaying the tastes of patients-as-consumers.

The unintended consequences of good

ideas are not a new part of primary care; the 111 service, designed to reduce workloads, did the opposite.

Babylon, Doctor Care Anywhere, Push Doctor, eConsult and similar services need to find ways of interfacing with the NHS Emergency Care Data Set and with the electronic patient records of primary and secondary care. Doing so will allow them to demonstrate safety and value, thus ensuring that those who plan and deliver primary care come to trust them. It will also open rich new avenues for future development.

Being able to link artificial intelligence and decision-making tools with real-life outcomes will not simply prove a means of demonstrating safety and efficiency, it will allow systems to mine the masses of data produced by the NHS in order to learn and improve.

Evidence and innovationInvestors are dipping their toes into

the primary care market just as owner-operating GP partners are withdrawing.

GPs have traditionally been driven by the satisfaction of providing lifelong care for patients they know well. What will their role be, relative to other health professionals and relative to services from hospitals and other providers, with that continuity gone? To what extent can it be preserved, and might online systems support it?

Chasing targets and tariffs may result in new models of care with attractive efficiencies, but such models also have to be attractive to the doctors needed

to deliver them. The projected shortage of GPs, despite explicit efforts by the government to increase their numbers, suggests the attraction is not currently there.

Part of the appeal of Babylon is that it doesn’t only seem fresh and attractive to younger, healthier patients wanting quick advice and quick prescriptions, it seems fresh and attractive to some doctors. To last, and to win over those who are suspicious, that appeal needs to be backed up by evidence that innovation is driving clinical quality. Gaining that evidence, through linking patient consultations with individual outcomes, would have profound benefits.

What next?It would be untrue to say that primary

care in Britain is at a crossroads: untrue because none of the roads leading forward are clear. Proven clinical effectiveness is needed to support the design of regulations and tariffs, as well as to attract and motivate the required workforce.

There is no going back to the family doctor of the past, but the quality they provided was tightly bound up with what gave them job satisfaction. Innovations and new models of care should look to provide both those attributes if they are to survive and flourish.

Primary care in 2015/16, England

£10.395bn budget

7,435 General Practices across 207 CCGs

34,242 full-time equivalent General Practitioners

58.5 million registered patients and an emerging trend of practices closing their lists to new patients to focus on ‘safer care’

HM

Investing in Healthcare ConferenceLondon, 8th February 2018

Sponsors Media Partner


REGISTER TODAY EARLY BIRD

Themes include:

Rt Hon Nicky Morgan MP Treasury Select Committee

Stephen Dorrell NHS Confederation

Neil ParkerRBS

Ali Parsa babylon

Brexit - opportunity or threat

How technology is transforming care

The manager-private equity relationship

Clinic based models


Speakers include:


Investing in Healthcare ConferenceLondon, 8th February 2018

Sponsors Media Partner



Themes include:

Rt Hon Nicky Morgan MP Treasury Select Committee

Stephen Dorrell NHS Confederation

Neil ParkerRBS

Ali Parsa babylon

Brexit - opportunity or threat

How technology is transforming care

The manager-private equity relationship

Clinic based models


Speakers include:


Inlaw

In a sector that is contingent on people to deliver its services across the whole UK population, it is not surprising that around a third of the UK’s working pop-

ulation are employed in the provision of health and social care. However, despite this heavy reliance upon workforce, both NHS and independent sector providers are faced with critical shortages in their workforce which may be worsening in the wake of Brexit. Nursing is a good exam-ple, where healthcare organisations have previously sourced their workforce from the EU, but are now seeing significantly reduced and declining levels of EU nurses registering to work in the UK.

A recent Freedom of Information request by the Health Foundation to the Nursing and Midwifery Council (NMC) revealed a 96% drop in nurses from the EU registering to practice in the UK since July last year. And, following a sharp decline from a high of 1,304 in July 2016 to 344 in September 2016, numbers have continued to fall. There were just 46 registrations in April 2017.

Stop gap measures The UK health sector has repeatedly

used international recruitment as a stop-gap measure to fill staffing shortages, both from inside and outside of the EU. However, since 2008, the majority of international nurses registering in the UK have come from the EU; the Health Foundation’s Anita Charlesworth says the recent fall in EU nursing registrants suggests that ‘a more sustainable, long-term approach to workforce planning is urgently needed’.

Recent ONS migration statistics echo the data seen from the NMC: in the year after Brexit, immigration fell by 80,000 and three quarters of this was down to fewer EU citizens coming to the UK. It is, therefore, the ability of the healthcare industry to recruit

internationally, outside of the EU, that is crucial to maintaining delivery of care in the immediate future – this applies to both clinical and non-clinical employees. And, whilst figures are not available for independent health providers, the percentage of EU nationals working within the NHS is approximately 5.7% of the total workforce (rising to more than 10% in London) - it is reasonable to assume private healthcare providers have similar levels of exposure.

Earn, learn, return

There are solutions in progress, particularly in the NHS. For instance, Health Education England (HEE) has been in talks with Apollo Hospitals to source nurses for the NHS on a fixed, two-year ‘earn, learn and return’ basis. HEE describes ‘earn, learn and return’ as an innovative educational programme for healthcare workers wanting to spend three years in the UK gaining formal qualification, while practising on wards.

Anita Charlesworth said: ‘Each recruit will have a bespoke educational plan, which will include a baseline development programme and mentorship, but with options to study for higher degrees.’

Although this is a public sector scheme, there is no reason why similar projects cannot be implemented within the independent sector as well.

All recruits will meet NMC registration requirements – which include English-language skills to A-level standard – and will receive salaries equal to similarly qualified staff. NHS trusts involved in the Apollo scheme will also pay any education costs.

Apollo is optimistic about the scheme. On signing a memorandum of understanding with HEE, its chief executive Sangita Reddy said: ‘The collaboration will include clinical

rotation of doctors, nurses, midwives, other health professionals and undergraduate healthcare students through mutual exchange. It will explore the possibility of establishing a global healthcare school, to ensure that opportunities for global learning are available to the healthcare workforces in both countries.’

A cautious welcome

Any attempts to address recruitment shortages are to be welcomed but it remains to be seen whether the HEE-Apollo arrangement will, for example, provide nurses in sufficient numbers to have a significant impact. Especially as applicants will still be required to comply with immigration requirements, which include passing the stringent Objective Structured Clinical Examination and International English Language Test. These have so far proven to be a very real obstacle to non-EU recruitment.

What’s clear is that however successful fixes of this kind are, they must run alongside longer-term strategies to bring more people into the healthcare professions.

Greater collaboration between providers within the independent sector on training and developing workers together could result in a bigger pool of skilled workers from which all could draw (rather than relying on traditional sources of recruitment such as the NHS). The advent of the Apprenticeship Levy means there may be a way for these employers to recoup some of their levy payment (a not inconsiderable 0.5% of the wage bill) to support such efforts. Employers should not think the vouchers available to pay for training for apprentices under the Apprenticeship Levy are only available to new or low skilled staff – a well structured scheme could be made to work for a wide variety of workers.

Alarming statistics show that the UK’s withdrawal from the EU is already having a significant impact on nurse recruitment. DAC Beachcroft’s Udara Ranasinghe looks at the potential solutions to the growing staffing problems

Tackling workforce issues After Brexit

laingbuissonnews.com | DECEMBER 2017/JANUARY 2018 | 31laingbuissonnews.com | DECEMBER 2017/JANUARY 2018 | 31

Chosen provider of independent sector healthcare market data to the ONS

“This is a time of immense change and opportunity in healthcare driven by substantial market,

economic and policy challenges”

• Market Intelligence• Consulting• Data Solutions

Health and social care

Stephen Dorrell Chairman, LaingBuisson

LaingBuisson LaingBuisson.com @LaingBuisson


Inawards

Best in show out in force

For a twelfth year the LaingBuisson Awards 2017 gave the health and social care sectors a chance to recognise the outstanding quality and innovation among independent providers.

More than 850 people were present at the annual event which celebrates the best in health and social care. Held in the spectacular ballroom at the Park Plaza Westminster Bridge, the event was again hosted by broadcaster, writ-er and former MP Gyles Brandreth who entertained the guests before handing out the Awards with LaingBuisson Chairman, Stephen Dorrell.

LaingBuisson’s biggest event yet, the finalists were chosen by an independent panel of judges from over 350 nominations.

Henry Elphick, CEO of LaingBuisson, said: ‘The LaingBuisson Awards have become a fixture in the health and social care calendar. They offer providers and advisors the opportunity to recognise and celebrate the most inspiring and innovative work in the sector - they are the ‘Oscars’ of our sector. The nominations were hugely impressive and included many deserving projects, organisations and professionals who are dedicated to tremendous health and care causes, and I know that the judges’ decisions were not easy ones. We are delighted with the Awards’ continued success and congratulate all our finalists and winners.

‘We would also like to take the opportunity to thank the judges for their time and for sharing their expertise with us, our charity partner, Cancer Research UK, our lead sponsor, Genesis Care, and all our other sponsors, nominators and everyone else who contributed to the success of this event.’

Awards sponsors

Sponsors

Investors & FinanceInvestor Octopus Healthcare

Lender Citi

Financial Advisor Grant Thornton

AdvisorsManagement Consultancy GE Healthcare Finnamore

Recruiter Nurse Plus

Legal Advisor - Public DAC Beachcroft

Legal Advisor - Private Trowers & Hamlins

Property Consultant Christie & Co

Clinical Services

Private Hospital The Royal Marsden Private Care

Private Hospital Group Nuffield Health

Mental Health Hospital Jeesal Cawston Park

Primary Care & Diagnostics

The William Quarrier Scottish Epilepsy Centre

Healthcare Outcomes Spirit

Nursing Practice Four Seasons Health Care

Rehabilitation Ascot Rehabilitation

Innovators & LeadersPublic Private Partnership Eden Futures

Management Excellence The London Clinic

Innovation in Care Loretto

Innovation in Technology West Lancashire Clinical Commissioning Group

Excellence in Training Anchor

Rising Star Amy Childs, Danshell

Outstanding Contribution Stephen Collier

Social CareResidential Care - Larger Care UK

Residential Care - Smaller The Royal Alfred Seafarers' Society

Dementia Care Cera

Specialist Care Horizon Care & Education

Supported Living Supporting you in the Midlands, Priory Adult Care

Homecare The Good Care Group

Extra Care Audley

Personalisation Caring Homes

Children's Services ROC Northwest


Care Monitor, England

CQC ratings of acute hospital providers

Rank Provider No. of hospitals % good or outstanding % not yet inspected

1 Aspen Healthcare 5 100% 0%

1 Circle Health 3 100% 0%

1 Horder Healthcare 2 100% 0%

4 Nuffield Health 29 93% 0%

5 Care UK 9 86% 22%

6 HCA Healthcare 7 83% 14%

7 Spire Healthcare 35 67% 14%

8 Ramsay Health Care 29 64% 3%

9 BMI Healthcare 49 46% 2%

10 Optegra 7 0% 71%

CQC ratings of mental health hospital providers

Rank Provider No. of hospitals % good or outstanding % not yet inspected

1 Alternative Futures 7 100% 14%

2 Cygnet Health Care 45 88% 7%

3 Priory 55 81% 4%

4 Elysium Healthcare 24 78% 25%

5 Danshell 9 78% 0%

6 St Andrew's Healthcare 9 71% 22%

7 Huntercoombe 11 60% 9%

8 Inmind Healthcare 5 60% 0%

9 Barchester Healthcare 7 57% 0%

10 Livewell Southwest 4 0% 100%

SOURCE LAINGBUISSON’S CAREMONITOR DATA CORRECT AS OF 1 DECEMBER 2017

Intelligence tables

MonitorComing soonA major refresh of LaingBuisson’s care quality portal tool...

INBUSINESS


DECEMBER 2017/JANUARY 2018

INDEX

Acadia 42

Alliance Medical Group 46

Alliance Surgical 43

Apax 36

Aspire 42

Assura 40

BMI Healthcare 36

Broadham Care 46

Calea 43

Elysium Healthcare 46

General Healthcare Group 36

Hirslanden 40

Horder Healthcare 43

Life Healthcare 46

Mediclinic 40

MedicX 43

Netcare 36

PHP 46

Priory Group 42

Spire Healthcare 40

Telemedicine Clinic 46

The Retreat York 43

Totally 44

Unilabs 46

United Medical Enterprises 43

Vocare 44

INBUSINESS


Netcare chief executive Dr Richard Friedland said the group had faced an ‘extraor-dinarily challenging year’ in 2017 as BMI Healthcare re-ported an operating loss of £20.6m for the year ended 30 September.

Revenue at the UK private hospital business was down 0.9% to £887.1m as NHS demand softened and a ‘significant shift’ in the patient mix impacted on revenue per case. NHS revenue, which represents 43% of BMI’s activity, grew by 4.9% during the year but slowed considerably in the second half. And while self-pay was up 9.6%, PMI caseload fell by 5.5% with no sign of recovery in sight.

Overall, the UK caseload increased by 0.5%, but revenue was hit by the shifting case mix as inpatient activity dropped by 4.5% and day cases increased by a marginal 2%.

Friedland said the company had been unable to flex its costs to deal with the ‘radical change’ in casemix resulting in a 14.7% fall in EBITDAR to £191.6m. Meanwhile, EBITDA before exceptional items nosedived 60.7% to £25.1m while EBITDA margins reduced from 7.1% to 2.8%.

As a result of the difficult market conditions, weaker trading results and contractual rental commitments, the company

was also required to undertake impairment testing, which resulted in a non-cash write down of £316.3m.

Given the poor performance in the UK, Friedland said that incoming CEO Karen Prins, had been mandated to drive a ‘very focused change management and restructuring agenda’ to address areas of underperformance and reduce its operating cost base. The company also expects to enter into renewed negotiations with its major external landlord regarding a reduction in rentals on 35 hospital properties.

‘It is very important to bear in mind the fact that at EBITDAR level this is a business that still produces a margin of 21.6%, which demonstrates the underlying strength of these operations aside from the very hefty rental costs and one-off charges,’ he added.

Despite the slow-down in NHS electives, which Friedland said was impacting referrals into NHS as well as private facilities, the company maintained that

the UK market remains underpinned by strong long-term drivers.

‘Demand management is in fact demand deferral because these patients are not being treated in the NHS either,’ said Friedland. ‘There is a subtle difference in managing demand and deferring demand and this indicates that the problem isn’t going away from the NHS and waiting lists will probably rise as a result.’

However, Netcare warned that the challenges prevalent in the second half of 2017 were ‘unlikely to abate in the first half of 2018’.

‘Our view is that long-term demographic demands support private healthcare in the future, particularly given the NHS’s inability to meet this demand and some of the constraints within the British economy,’ Friedland added. ‘We do think there will be some short-term pain in 2018 and we will continue to see some of the demand-led strategies to dampen down on elective surgery but we see that recovering towards the end of 2018.’

In addition, although the company expects PMI demand to ‘remain challenging’, it said growth in NHS waiting lists was likely to drive further increases in self-pay volumes, which represented 12% of activity in 2017.

In September 2017, Netcare announced it had reached an agreement with Apax and other minority shareholders to buy all the remaining shares in BMI Healthcare’s parent company General

Healthcare Group. The deal is subject to specific conditions, but Netcare said it would pave the way for the business to benefit from the operational efficiencies that have been achieved across its South African business platform.

Netcare chief financial officer Keith Gibson added: ‘What it gives to Netcare is the ability to immediately implement and take control of this business and address the turnaround. In the event that this is not able to take place it does give Netcare full ability to determine what it’s going to do with this asset in future without being encumbered by other shareholders’ agendas.’

As well as poor performance in the UK, Netcare’s overall results were impacted by a strong Rand, which Gibson said took R3.65bn off its revenue line. Despite a 1.2% rise in South African revenues, group revenue decreased by 9.6% to R34bn and EBITDA before exceptional items fell by 22.7% to R4.3bn.

Change in case mix and slower NHS growth lead to losses at BMI

South African Netcare says ‘short-term pain’ will continue in

the start of 2018

BMI Healthcare’s incoming CEO Karen Prins will focus on turning

the business around

“Demand management is in fact demand deferral because these patients are not being treated in the NHS either”

HM


D E C E M B E R 2 0 1 7 / J A N U A R Y 2 0 1 8

BMI Healthcare is the latest private hospital group to feel the NHS pinch

Netcare Limited Financial profile

BPI Capital Africa

Bank of America Merrill Lynch

Citi Bank

Deutsche Bank

Goldman Sachs Int.

Ingham Analytics

Investec

JP Morgan

Macquarie First South Securities

Renaissance BJM Securities

Arqaam

RMB Morgan Stanley

Banks covering Netcare stocks

NETCARE LIMITED (NCT:JSE) NUMBER OF ANALYST RECOMMENDATIONS

SOURCE JOHANNESBURG STOCK EXCHANGE

NETCARE LIMITED (NCT:JSE) CLOSING SHARE PRICES RAND

SOURCE REUTERS

22.15

18

20

22

24

26

28

30

32

34

Jan 03, 2017 Feb 14, 2017 Mar 29, 2017 May 16, 2017 Jun 28, 2017 Aug 10, 2017 Sep 21, 2017 Nov 03, 2017

Price

in Ra

nds

0

1

2

3

4

5

6

7

8

9

(1) BUY (2) OUTPERFORM (3) HOLD (4) UNDERPERFORM (5) SELL No Opinion

Num

ber

of a

naly

st

Current 1 Month Ago 2 Month Ago 3 Month Ago


HealthcareMarkets Index

Intelligence tables

Com

pany

Sub

Sect

orTi

cker

Stoc

kEx

ch.

Loca

l Cur

renc

yTe

chni

cal

TTM

Fun

dam

enta

ls (G

BP

m)

Valu

atio

n

Shar

e pr

ice

Mar

ket

Cap

(m)

% o

f 52-

wk

high

YTD

(%)

Mar

ket

Cap

Net

D

ebt

EVSa

les

EBIT

DAEB

ITDA

mar

gin

Net

Debt

/ EB

ITDA

EV/

Sale

sEV

/ EB

ITDA

PE

Ratio

Capi

oH

ospi

tals

CAPI

O.ST

STO

44.3

kr

6,25

3 kr

84.4

%-7

.9%

580

336

9

16

1,36

310

27.

5%3.

3x0.

7x9.

0x17

.8x

Cran

ewar

eH

CIT

CRW

.LLS

E£1

,430

p£3

8595

.9%

7.3%

385

Cash

345

44

1329

.8%

Cash

7.8x

34.5

x37

.2x

Ded

icar

e AB

Staf

fing

DED

I.ST

STO

90.3

kr

636

kr59

.4%

23.2

%59

Cash

54

709

12.4

%Ca

sh0.

8x6.

2x9.

7x

EMIS

HCI

TEM

IS.L

LSE

£943

p£5

9795

.0%

-1.6

%59

7Ca

sh 5

86

159

4226

.1%

Cash

3.7x

14.1

x33

.2x

Feel

good

Sve

nska

AB

Occ

upat

iona

l Hea

lthFE

EL.S

TST

O3.

2 kr

328

kr68

.3%

49.1

%30

031

603

5.3%

0.0x

0.5x

9.5x

1.3x

Fres

eniu

s M

edic

al C

are

Ambu

lato

ry C

linic

sFM

E.D

EG

ER€

83.9

€ 25

,773

.694

.4%

2.3%

23,1

03 5

,681

2

8,78

4 16

,582

3,04

418

.4%

1.9x

1.7x

9.5x

19.9

x

Fres

eniu

s SE

& C

oH

ospi

tals

FRE.

DE

GER

€ 60

.9€

33,6

91.5

76.6

%-1

8.6%

30,2

01 1

5,29

2 4

5,49

2 28

,659

5,34

618

.7%

2.9x

1.6x

8.5x

19.3

x

Geo

rgia

Hea

lthca

re G

roup

Hos

pita

lsG

HG

.LLS

E£3

52p

£464

87.2

%0.

5%46

4 7

1 5

35

200

3015

.0%

2.4x

2.7x

17.8

x52

.3x

GH

P Sp

ecia

lty C

are

ABH

ospi

tals

GH

P.ST

STO

8.8

kr60

0.9

kr60

.3%

-17.

8%56

12

68

904

4.4%

3.1x

0.8x

17.3

x78

.9x

Inte

grat

ed D

iagn

ostic

s H

oldi

ngs

Dia

gnos

tics

IDH

C.L

LSE

$4.6

$687

.097

.9%

35.5

%52

4Ca

sh 5

14

123

22.8

%Ca

sh43

.9x

192.

3x59

.2x

Luz

Saúd

eH

ospi

tals

LUZ.

LSLI

S€

3.1

€ 29

1.4

89.7

%84

.8%

261

234

4

96

412

4511

.0%

5.2x

1.2x

11.0

x18

.0x

Med

ica

Gro

upD

iagn

ostic

sM

GP.

LLS

E£2

19p

£243

92.8

%21

.6%

243

9

252

30

930

.7%

0.9x

8.4x

27.4

x11

0.6x

Med

iclin

ic In

tern

atio

nal

Hos

pita

lsM

DC.

LLS

E£5

66p

£4,1

6963

.8%

-26.

4%4,

169

1,6

62

5,8

31

2,74

949

918

.2%

3.3x

2.1x

11.7

x18

.2x

Med

icov

er A

BH

ospi

tals

MCO

V-B.

STST

O64

.8 k

r3,

333

kr90

.2%

-1.1

%30

9 6

3

16

470

388.

1%0.

2x0.

7x8.

3x53

.9x

NM

C H

ealth

Hos

pita

lsN

MC.

LLS

E£2

849p

£5,8

2089

.1%

83.3

%5,

820

622

6

,442

1,

080

229

21.2

%2.

7x6.

0x28

.2x

48.3

x

Pihl

ajal

inna

Oyj

Hos

pita

lsPI

HLI

S.H

EH

EL€

14.6

€ 30

0.1

79.6

%-2

0.4%

269

32

301

37

128

7.4%

1.1x

0.8x

10.9

x32

.6x

Ram

say

Hea

lth C

are

Hos

pita

lsRH

C.AX

ASX

$69.

8$1

4,10

1.2

92.1

%1.

5%8,

354

1,7

89

10,

143

5,15

772

914

.1%

2.5x

2.0x

13.9

x29

.6x

Rhoe

n-Kl

inik

umH

ospi

tals

RHK.

SGST

U€

29.0

€ 1,

941.

994

.6%

11.8

%1,

741

Cash

1,4

92

1,18

693

7.9%

Cash

1.3x

16.0

x45

1.6x

Spire

Hea

lthca

re G

roup

Hos

pita

lsSP

I.LLS

E£2

47p

£989

68.3

%-2

7.4%

989

436

1

,426

93

815

916

.9%

2.7x

1.5x

9.0x

36.6

x

UD

G H

ealth

care

Phar

ma

Serv

ices

UD

G.L

LSE

£840

p£2

,086

87.6

%24

.1%

2,08

6Ca

sh 2

,022

94

112

012

.8%

Cash

2.1x

16.8

x34

.2x

MED

IAN

88.3

%1.

9%55

2 2

85

560

441

4314

.6%

0.4x

1.7x

12.8

x33

.7x

MEA

N

83.4

%11

.2%

4,01

2 1

,870

5,

302

3,02

952

715

.4%

2.3x

4.5x

23.6

x58

.1x

OTH

ER

Assu

raPr

imar

y Ca

re R

eal E

stat

eAG

R.L

LSE

£59p

£978

88.3

%5.

0%97

8 4

96

1,47

471

6186

.0%

8.1x

20.7

x24

.1x

10.3

x

CVS

Gro

upVe

tCV

SG.L

LSE

£101

0p£6

4567

.8%

-6.2

%64

5 1

00

745

272

3914

.4%

2.6x

2.7x

19.0

x55

.6x

Dig

nity

Fu

nera

l Ser

vice

sD

TY.L

LSE

£173

2p£8

6562

.4%

-29.

2%86

5 5

21

1,38

532

511

836

.4%

4.4x

4.3x

11.7

x14

.2x

Hea

lth It

alia

Fina

ncia

l Ser

vice

sH

I.MI

MIL

€ 4.

6€

258.

881

.5%

23.0

%23

2Ca

sh23

219

421

.0%

Cash

12.1

x57

.5x

117.

6x

Prim

ary

Hea

lth P

rope

rtie

sPr

imar

y Ca

re R

eal E

stat

ePH

P.L

LSE

£115

p£6

8792

.9%

3.8%

687

706

1

,392

70

6287

.7%

11.5

x19

.8x

22.6

x11

.0x

MED

IAN

81.5

%3.

8%68

7 5

08

1,38

571

6136

.4%

6.2x

12.1

x22

.6x

14.2

x

MEA

N

78.6

%-0

.7%

681

455

1,

046

152

5749

.1%

6.6x

11.9

x27

.0x

41.7

x

MA

RK

ET IN

DEX

FTSE

250

^FTm

cFG

I19

,952

.997

%10

.0%

NO

TES

TTM

TR

AILI

NG

TW

ELVE

MO

NTH

S

EB

ITD

A E

ARN

ING

S BE

FORE

INTE

REST

, DEP

RECI

ATIO

N A

ND

AM

ORT

ISAT

ION

YTD

YIE

LD T

O D

ATE

PE C

URR

ENT

SHAR

E PR

ICE

DIV

IDED

BY

ITS

PER-

SHAR

E EA

RNIN

GS

P

EG P

RICE

/EAR

NIN

GS

TO

GRO

WTH

RAT

IO

D

ATA

CO

RR

ECT

AS

OF

2 D

ECEM

BER

201

7FT

SE 1

00^F

TSE

FGI

7,32

6.7

97%

2.1%

laingbuissonnews.com | OCTOBER | 39

CM CareMarkets ACADIA HEALTHCARE, AMBEA, ATTENDO, CAMBIAN GROUP, CAPITA, CARETECH HOLDINGS, KORIAN, LE NOBEL AGE, MEARS GROUP, ORPEA, SERCO, UNIVERSAL HEALTH SERVICES, MCCARTHY & STONE, HUMANA AB, MATERNUS-KLINIKENHM HealthcareMarkets CAPIO, CRANEWARE, EMIS, GEORGIA HEALTHCARE GROUP, INTEGRATED DIAGNOSTICS HOLDINGS, MEDICA GROUP, MEDICLINIC INTERNATIONAL, MEDICOVER AB, NMC HEALTH, RAMSAY HEALTH CARE, RHOEN-KLINIKUM, SPIRE HEALTHCARE GROUP, UDG HEALTHCARE, DEDICARE AB, GHP SPECIALTY CARE AB, PIHLAJALINNA OYJ, LUZ SAÚDE, FEELGOOD SVENSKA AB (EXCLUDING FRESENIUS MEDICAL CARE, FRESENIUS SE & CO)OTHER ASSURA, CIVITAS SOCIAL HOUSING, CVS GROUP, DIGNITY, HEALTH ITALIA, IMPACT HEALTHCARE REIT, PRIMARY HEALTH PROPERTIES, TARGET HEALTHCARE REITDATA CORRECT AS OF 2 NOVEMBER 2017

Health and Care returns against FTSE

%CM, 7.5%

%HM,17.5%

%Other, -3.1%

%FTSE100, 2.1%

%FTSE250, 10.0%

-5%

0%

5%

10%

15%

20%

25%

%CM %HM %Other %FTSE100 %FTSE250

CM: Acadia Healthcare, Ambea, Attendo, Cambian, Capita, Caretech Holdings, Korian, Le Nobel Age, Mears Group, Orpea, Serco, Universal Health Services, Mccarthy & Stone, Humana AB, Maternus-KlinikenHM: , Capio, Craneware, EMIS, Georgia Healthcare Group, Integrated Diagnostics Holdings, Medica Group, Mediclinic International, Medicover AB, NMC Health, Ramsay Health Care, Rhoen-Klinikum, Spire Healthcare Group, UDG Healthcare, Dedicare AB, GHP Specialty Care AB, Pihlajalinna Oyj, Luz Saúde, Feelgood Svenska AB (excluding Fresenius Medical Care, Fresenius SE & Co,)Other: Assura, Civitas Social Housing, CVS Group, Dignity, Health Italia, Impact Healthcare REIT, Primary Health Properties, Target Healthcare REIT

You know what’s best for your business, such as a bank that understands your sector inside out. As a Barclays client, we can offer your business a dedicated, sector-specific Relationship Director with in-depth knowledge of your market.

Contact Paul Birley, Head of Healthcare, on 07775 546 435* or [email protected],or visit barclayscorporate.com.

To think outside the boundaries, we operate inside the healthcare sector

*Please note: this is a mobile phone number and calls will be charged in accordance with your usual tariff.Barclays is a trading name of Barclays Bank PLC and its subsidiaries. Barclays Bank PLC is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority (Financial Services Register No. 122702). Registered in England. Registered number is 1026167 with registered office at 1 Churchill Place, London E14 5HP.

(3.1)%

INBUSINESS


Mediclinic abandons Spire bidMediclinic has abandoned its takeover bid for Spire Healthcare after a revised offer was rejected by the UK private hospital group.

The revised offer con-sisted of 165 pence per share in cash and 0.271 new Mediclinic shares per Spire share, representing around 315 pence per share. The offer valued Spire at approximately £1.3bn – an improvement on the £1.2bn valuation from Mediclinic’s original offer but not enough to convince Spire’s Board, which said it undervalued the group and its prospects.

Spire chairman Garry Watts said: ‘The Board care-fully considered Mediclinic’s approach but determined that it did not reflect the true value of the company and was not in the best interests

of shareholders as a whole.’Mediclinic said it was

‘disappointed’ an agreement could not be reached, adding that it had every intention of ‘remaining a supportive shareholder of Spire’.

It has been a turbulent year for Spire, which has continued to face the fallout from the case of disgraced surgeon Ian Paterson and, in common with other UK pri-vate providers, a slowdown in NHS demand. However, the Board said it had ‘strong confidence’ that new CEO Justin Ash was fully focused on delivering the company’s strategy and realising medi-um-term growth opportuni-ties. Despite warnings that the dip in NHS demand will impact on full year margins, the Board said the company was on track to meet exist-ing guidance.

Watts added: ‘The Board is highly confident in the future of Spire as an inde-pendent company under the leadership of Justin Ash and the potential to drive shareholder value over the medium term. We welcome Mediclinic’s intention of remaining a supportive shareholder of Spire.’

Mediclinic, which ac-quired its 29.9% stake in Spire for £434m in 2015, recently reported an 11% drop in underlying earnings to £84m following a fall in EBITDA across both its Hirslanden and Middle East operations and a decline in contribution from Spire. The company also attributed losses of £50m to an impair-ment charge on the equity investment in Spire and other exceptional items.

It said it would continue

to take a disciplined ap-proach to capital allocation to ensure investments are in the best interests of its shareholders.

UK takeover rules mean that Mediclinic is now prohibited from making another offer for Spire for six months unless there is a change in circumstances.

Spire is planning a capital markets day in the first quarter of 2018 to set out its operational and strategic goals.

Assura has announced plans to raise up to £330m in its second share issue in 12 months.

The specialist healthcare REIT, which raised £98m in a share placing in June, said it intends to use the proceeds to make further investments in primary care properties and reposition the group’s balance sheet.

Under the plans, the company will raise up to £300m though the issue of 526,315,789 new ordinary shares by way of a Firm Placing, Placing and Open Offer. Additional gross proceeds of up to £30m will be raised through the issue of up to 52,631,578 new ordinary shares through an Offer for Subscription. The offer price will be set at 57 pence per share, representing a discount of 2.7% on the closing price of 58.6 pence on 15 November.

Assura reported a 76% leap in pre-tax profits for the six months ended 30 September 2017 as the value of its property portfolio hit £1.6bn (March 2017: £1.3bn), with a passing

rent roll of £83.1m.CEO Jonathan Murphy said the

group’s ‘unique business model and strong, diversified funding structure’ had allowed it to accelerate investment, while growing its portfolio and delivering strong financial performance.

The group completed £174.1m worth of acquisitions in the period and has a near-term pipeline of approximately £209m, including £126m of new acquisitions which the group anticipates will be under contract by the end of March 2018. The remaining £83m are new developments which are either on-site or are expected to be underway over the next 12 months.

The Board said this pipeline was the strongest it has been in five years and that it will continue to target acquisitions and fund developments to secure new investments at above-market yields in what could be its ‘busiest year’ to date.

Subject to completion of the share

issue, the group also intends to refinance its Aviva senior secured term loans, which had a balance of £211.7m as at 30 September 2017. It said it would use the proceeds to fund the break costs, estimated at around £55m, and deploy £36m to further reduce its LTV.

Murphy added: ‘Primary care remains at the heart of the NHS agenda...the anticipated proceeds of this fund raising will allow us to continue investing in the primary healthcare estate of the future and positions us at the forefront of this opportunity.’

‘Strong’ Assura plans share issue

Assura says strong development pipeline will mean its busiest year yet

Spire board confident new CEO Justin Ash can drive the business

forward

Major transactions in UK healthcare

Major Transactions (£100m+)

Date Target Sub Sector Acquirer EV (£M) Valuation Comments

EV/Revenue

EV/EBITDAR EV/EBITDA

Sept 17 BMI Healthcare Acute Care Netcare - - - - Apax will sell their remaining shares to Netcare. No cash will be exchanged and the deal is thought to be valued around $125m.

Dec 16 Cambian adult services business

Mental Health

UHS (Cygnet Health Care) 377.0 2.9x - 15.6x 81 behavioural facilities with 1,193 beds. Price per bed £316,010.

Nov 16 Oasis Dental Care Dentistry Bupa 835.0 3.0x - - 380 practices with over 1,800 dentists. Bupa Dental UK will comprise around 420 Oasis and Bupa dental practices, serving over 2 million patients.

Nov 16 Alliance Medical Hospital Life Healthcare 760.0 - 800.0

3.3x-3.4x - 11.8x -

12.4xInitial cash consideration of approximately £553m and deferred cash consideration of £40m.

Oct 16 Elysium (22 Priory hospitals) Hospital BC Partners 320.0 2.4x - -

Approximately 1,000 beds. US firm Acadia Healthcare Company is selling the sites in order to satisfy concerns raised by the Competition and Markets Authority (CMA) following its £1.3bn deal to buy Priory Group and its 322 facilities in January 2016.

Other Transactions

Oct 17 Focused Healthcare

Adult & Children’s services

Voyage Care - - - -The two companies provide complementary specialist care and support services, with FHL focusing on providing specialist care to children and Voyage Care predominantly supporting adults.

Jun 17 Sussex Travel Clinic Primary Care Vaccination UK - - - -

One-stop shop for all travel vaccinations and health needs. The undisclosed deal brings the number of clinics in the DVDS group to more than 40, seven of which are in the UK, making it one of the largest specialists in Europe.

Jun 17 Expert-24 MedTech Medvivo - - - - Develops and provides clinical decision support applications. The acquisition will support Expert 24’s growth throughout the US, UK & Europe.

Jun 17Capita healthcare recruitment (Affinity Workforce)

Flexible staffing

Endless Private Equity 25.0 0.2x - - Brands within Affinity Workforce: 4FRONT; Team24 & Medicare First. Affinity has

healthcare, education and social care divisions in 19 locations across the UK.

May 17 Newbridge Care Systems

Children’s services Schön Klinik - - - -

28 beds. Newbridge is said to be the second largest facility in the English healthcare system for the acute care treatment of eating disorders in children and adolescents.

May 17 Ergon Medical MedTech InnovaDerma 1.0 - - - Consideration was £1m, met by the issue of ordinary shares in Innovaderm. Ergon is the owner of intellectual property rights to a medical device named Prolong.

May 17 Kirton Healthcare MedTech Direct Healthcare - - - - Supplier of specialist seating solutions. Based in Caerphilly, DHG has 190

employees and a turnover of £21m.

Apr 17 Amberleigh Care Children’s services

Amberleigh Management - - - - Management buy out. The company was owned by Pat Pritz & Christine Smith, who

held 66% of the company between them.

Apr 17 Medisoft MedTech Heidelberg Engineering - - - -

Provider of electronic medical record (EMR) software solutions. While ophthalmic IT solutions will play an increasingly growing role in Heidelberg Engineering’s portfolio, the company will continue focusing on its core business of state-of-the-art diagnostic imaging platforms for eye-care professionals.

Apr 17 Ultrasound Direct Fertility Clinics

The Fertility Partnership - - - - 80-plus clinics across the UK. The deal brings together the largest providers in the

UK of fertility conception and pregnancy monitoring services.

Apr 17 Southern Dental Dentistry Jacobs Holding - - - -80 dental practices. Southern is said to have had around £65m-£70m of debt, meaning that the estate which in 2014 was valued at £150m, is today probably worth around £70m - £80m.

Apr 17 The Badby Group Mental Health

Elysium Healthcare - - - - Four facilities across the country (316 beds). This move takes Elysium to 26

operational sites in England & Wales.

Apr 17 Nuada Medical (MRI Business) Private Acute Medical Imaging

Partnership - - - - MRI business and the transfer of staff. MIP will operate the services as Medical Imaging London.

Mar 17 Circle Holdings Hospital

Penta Capital Partners; Toscafund Asset Management

74.3 0.56x N/A N/ACircle is the parent company of Circle Health, which runs three hospitals. Toscafund already owned a 26.75% stake in Circle & offered 30p for each additional share, valuing the company at £75.2m.

Feb 17 Working On Wellbeing

Occupational Health OH Assist - - - - Working on Wellbeing had £21.4m turnover for year end 2016. It trades as Optima

Health and supplies more than 300 companies in the public and private sector.

Feb 17 RSL Steeper Group MedTech RSL Steeper

management - - - - Management buy out. Two members of Steeper's existing executive board acquired the business from the UK mid-market private equity firm Dunedin.

Feb 17 MMO International MedTech Medstrom - - - -

Medstrom is now the UK’s only independent hospital bed maker. 2017 will see it operating directly in four countries, including Ireland, generating annual revenues of over £35m and employing around 280 people.

Jan 17 Rayner Surgical Group MedTech Phoenix Equity

Partners - - - - Rayner exports to more than 80 countries. It is a leading developer and manufacturer of ophthalmic implants and pharmaceuticals.

Jan 17 Carden Medical Investments

Healthcare Real Estate

Primary Health Properties 7.2 - - -

Serves nearly 20,000 patients. This acquisition increases PHP's portfolio to a total of 298 assets, including one property in the Republic of Ireland, with a gross value of over £1.2bn.

Jan 17 Nitritex MedTech Ansell 57.0 - - -Total consideration of £57m includes £12m cash. The net purchase price of £45m is equivalent to a multiple of approximately seven times adjusted EBITDA on a trailing 12 month basis.

NOTES EV ENTERPRISE VALUE EBITDA EARNINGS BEFORE INTEREST, DEPRECIATION AND AMORTISATION EBITDAR EARNINGS BEFORE INTEREST, DEPRECIATION, AMORTISATION AND RENTSOURCE LAINGBUISSON DATABASE

Intelligence tables


INBUSINESS


Acadia says Priory not for sale but offers would be ‘entertained’

Acadia has indicated that it would entertain offers for the Priory Group after the UK business reported results ‘significantly below expectations’.

The US healthcare giant saw its share price plummet following its Q3 announcement after being forced to revise its full year guidance for 2017 in light of lower occupancy and higher operating costs in the UK.

It said the seasonal rebound in occupancy rates in September had been ‘significantly weaker than anticipated’ at 87% as NHS trusts reined in outsourcing to the private sector. In addition, shortages of nursing and clinical staff meant its agency staffing bill had been higher than expected.

Same facility revenue increased by a 3.8% to $236.3m in the third quarter against the same period 2016 on the back of a 2.5% increase in patient days and a 1.2% increase in revenue per patient day. Same facility EBITDA margin was 21.4% for the quarter compared with 22.6% for the third quarter of last year and total facility EBITDA margin declined 170 basis points to 19.3%.

In an earnings call with analysts, chairman and CEO Joey Jacobs said: ‘So am I glad we’re in the UK? Absolutely. Do I think it’s going to be a great business? It is a great business, but will it be greater? Yes. But that doesn’t mean that if somebody came by and wanted to make an unsolicited offer for it, we wouldn’t entertain it.’

Acadia’s full-year guidance now includes revenue in a range of $2.82bn to $2.83bn and adjusted EBITDA in a range of $600m to $605m – against earlier guidance of $628m to $635m.

Jacobs said growth in the US had also been lower than expected but that the revised guidance was primarily due to underperformance in the UK.

Acadia has faced a number of setbacks since its 2016 acquisition of Priory for £1.5bn. It was forced

to sell 22 facilities to BC Partners last year following an investigation by the CMA, limiting the efficiency gains anticipated from the merger with its original UK investment Partnerships in Care.

However, Jacobs said that despite the CMA and Brexit, Priory remained a fundamentally solid business.

‘I’m not advocating selling it at all,’ he added ‘Actually, I’m advocating that it’s going to be positioned correctly; that three years from now, everybody will go, wow, what a great deal they did. They had some rough times in the beginning, but they did a good job with it.’

The Priory Group has agreed to acquire spe-cialist children’s care and education provider Aspire Scotland for an undisclosed sum.

Under the deal, North Ayrshire-based Aspire will become part of Priory’s Education and Children’s Services division, which currently operates 45 day and residential schools and 95 children’s homes.

Priory CEO Trevor Tor-rington said the acquisi-tion would create a strong partnership that would contribute to the division’s success.

‘Our combined strengths will enable us to offer our young people and their families access to a wider range of specialists, whilst also improving the continuity and co-ordination of care we are able to offer. Our management teams are committed to ensuring that high quality service provision remains the top priority and we are committed to continuing the excellent work of the Aspire Scotland team and building on their success,’ he said.

Simon Coles, CEO of Priory Education and Chil-dren’s Services added: ‘Aspire has an excellent reputation for providing high quality, safe care: all of their sites are rated Grade 5 - Good or above by the Scottish regulator, the Care Inspectorate. With seven children’s homes and a day school, we will be able to build on these successes to help more young people than ever before.’

Priory buys Aspire

“I’m not advocating selling it at all. Actually I am advocating that it’s going to be positioned correctly"

Priory Group’s future looks a little less certain after poor performance in Q3 forces Acadia to revise its guidance

HM


D E C E M B E R 2 0 1 7 / J A N U A R Y 2 0 1 8

Fallout from NHS austerity spreads all the way to Tennessee

Orthopaedic charity Horder Healthcare has described 2016/17 as a year of con-solidation following the mo-bilisation of its SMSKP joint venture and its acquisition of the McIndoe Surgical Centre in July 2015.

The charity, which was for-mally known as the Horder Centre, reported a 6.8% rise in revenue to £31.6m driven by the introduction of new orthopaedic care pathways and the expansion of MSK services outreach locations. However, costs associated with extended services and supporting the expanding business pushed up expenses.

Total expenditure increased by 12%, following a 40% leap in the previous year, to £32.2m, resulting in a net deficit of £320,000 against net

income of £919,000 the previ-ous year and £5m in 2015.

Capital expenditure totalled £6.4m during the year, the majority (£6.7m) of which was spent on the refurbish-ment of the McIndoe Centre. A further £5.3m of capital expenditure is planned for the

current financial year, which the charity said would help deliver increased capacity and improvements in service provision.

At the year-end, the or-ganisation had total funds of £71m (2016: £71.3m).

Horder Healthcare consolidates

Deficits have deepened at Quaker-owned mental health charity The Retreat York as it continued to face internal and external challenges.

Income edged up 8% to £12.7m in the year ended 31 December 2016 despite financial pressure in the NHS. However, expenditure climbed by 15% to £13.6m, leaving a deficit of £910,700 against a deficit of £105,300 in 2015. After taking into account total investment gains of £803,300 (2015: loss £17,000) and an actuarial loss on the defined pension benefit scheme of £1.3m (2015: gain £2.2m), the charity reported a net deficit of £1.4m against a surplus of £2.1m the previous year.

The charity said the reversal in its financial position over such a short period of time was a ‘considerable concern’ and was the result of significant

organisational change along with more stringent demands on NHS resources.

Looking ahead, it said the challenges were likely to continue over the next few years as financial pressure on the NHS continued. It is currently reviewing its strategic direction, including options for widening its outpatient services and addressing low occupancy. However, it added that it did not expect to see a major recovery until at least 2018.

The charity suffered a major setback in June 2017 when its York facility was rated ‘inadequate’ by the CQC. Amongst other areas of concern, the regulator said the Allis unit was ‘dirty, damp and cold’ while both the Allis and George Jepson units were inadequately staffed. The Retreat has since put in place an action programme to address the problems.

Deficit deepens at Retreat

Alliance SurgicalAlliance Surgical has reported a 19% jump in turnover to £17.8m for the year ended 31 March 2017. The consultant-led healthcare group said the increase was due to ongoing growth in its cus-tomer base. Cost of sales increased from £10.7m to £12.8m, while admin-istrative expenses edged up 23% to £3.7m, leaving operating profit of £1.1m against £1m in 2016.

Calea UKCalea UK, the pharmaceu-tical and home healthcare business owned by Frese-nius, reported a 26.5% rise in turnover to £43.5m in the year ended 31 December 2016 on the back of a 16% increase in patients treated through its homecare business.Cost of sales climbed from £25.7m to £31.2m. How-ever, the company kept tight control of distribution costs and administrative expenses, resulting in an operating profit of £7.6m compared to £4.8m in 2015 and an operating margin of 17.5% - up 3.5% on the prior year.

UMEDiagnostics and imaging company United Medical Enterprises (UME) has reported a 6.5% drop in revenue to £13m for the year ended 31 Decem-ber 2016. Tough market conditions resulted in a fall in sales while an impairment charge of £4.9m pushed operating losses to £5.1m (2015: loss £1.9m).

Inbrief

MedicX disposals

MedicX has sold five properties for a total of £5.6m. It said it would use the proceeds to further pursue its investment objectives. The company also announced the acquisition, by way of forward funding, of a new primary healthcare centre in the Vale of Neath, South Wales.

Horder Healthcare has expanded following its acquisition of the McIndoe Surgical Centre in 2015


Organisation Year end Revenue £m %Δ EBITDA(R)

£000s Δ EBITDAR Margin

PBT £000s Δ Net Debt 1

£000s

Alliance Surgical 31-Mar-17 17.6 19.2% 1,197 5.6% 7% 1,159 12.2% (5,099)

Ashley House 30-Apr-17 18.6 (10.5)% 713 (68.4)% 4% 67 (72.2)% (89)

Calea UK 31-Dec-16 43.5 26.5% 9,541 67.7% 22% 7,652 59.3% (1)

Community Health Partnerships 31-Mar-17 348.7 0.3% 190,824 2.2% 55% 1,896 30.3% 109,759

First Community Health & Care 31-Mar-17 22.0 2.6% 1,568 2,258.3% 7% 182 117.0% (1,051)

Horder Healthcare 30-Jun-17 30.0 6.1% (268) (136.0)% (1)% (320) (134.8)% (3,056)

Making Space 31-Mar-17 24.7 5.1% 1,481 258.8% 6% 1,421 575.2% (4,384)

Navigo Health & Social Care CIC 31-Mar-17 28.5 6.3% 554 412.7% 2% 33 155.6% (1,136)

Partnerships in Care UK (Priory) 31-Dec-16 823.8 N/C 202,778 N/C 25% (175,158) N/C 1,117,086

Raphael Medical Centre 31-Dec-16 13.8 7.2% 1,334 1,631.1% 10% 1,268 12,278% (43)

TBS G.B. Telematic & Biomedical Services 31-Dec-16 22.4 4.7% 3,007 (11.8)% 13% 745 (67.1)% 23

The Retreat York 31-Dec-16 11.2 5.9% (1,940) (87.5)% (17)% (107) 12.2% (3,030)

UME Group 31-Dec-16 13.1 (6.3)% 4,140 31.7% 32% (7,747) (68.0)% 57,875

NOTES 1 NET DEBT (INTEREST BEARING DEBT + FINANCIAL LEASES) - CASH % IN ( ) DENOTES DECREASE NET DEBT IN () DENOTES CASH Δ CHANGE FROM PREVIOUS YEARSOURCE LAINGBUISSON DATABASE

Company results round upA summary of the latest results available in the healthcare sector, revenues over £1m

Intelligence tables

Vocare acquisition a key step in Totally’s ‘buy and build’ plans

AIM-listed healthcare provid-er Totally Plc has completed its acquisition of out-of-hos-pital services provider Vocare for £11m.

Vocare is one of the UK’s leading providers of integrat-ed urgent care services to the NHS, including GP out-of-hours services, the NHS 111 service and urgent care cen-tres working in conjunction with NHS A&E departments. It provides services to CCGs covering around 9.2 million patients.

Totally said the acquisition marked a ‘transformational step’ in its stated buy and build strategy, under which it plans to become a leader in the growing out-of-hospital care market. It said there

were significant opportunities to build and develop a high quality diversified out-of-hos-pital UK healthcare services group.

The deal, which was approved by shareholders at the end of October, follows the acquisitions of Premier, About Health and Optimum Sports Performance in 2016 and gives Totally a foothold in the urgent care sector.

Totally CEO Wendy Lawrence said: ‘We are extremely pleased that our shareholders have recognised the strategic and financial benefits that the acquisition of Vocare will bring to the Enlarged Group. The services offered by Vocare fit perfectly with our existing business

model and will complement the services already offered across our other subsidiary businesses. The transaction is another important milestone for Totally as we continue to execute our buy and build strategy, working towards becoming the leading out-of-hospital care provider in the UK.’

In November, Vocare was awarded a two-year contract extension worth £6m to pro-vide GP out-of-hours services to NHS Vale of York.

Lawrence added: ‘This key contract extension emphasis-es the continued confidence of the CCG in Vocare’s abil-ity to consistently deliver GP out-of-hours services.

‘GP out-of-hours services

are a vital part of a broad-er integrated urgent care offering and I am pleased that the NHS recognises the importance of a collabora-tive approach to address the rising pressure on emergency care services.’

Wendy Lawrence, CEO, Totally


I n t u n e w i t h y o u r w o r l d

LEGAL EXPERTISETHAT’S IN TUNEWITH YOUR WORLD.

A HEALTHY APPROACH TO LEGAL EXPERTISE.

At Gowling WLG, we have a team of experts in health and care issues advising clients on matters from new care models to real estate transactions, from procurement law to competition law advice, from employment law support to investigations/inquests. Whatever your requirements, we have a specialist who can help. For more information, please contact:

Robert Breedon T +44 (0)370 730 2862 [email protected]

Gowling WLG (UK) LLP is a member of Gowling WLG, an international law firm which consists of independent and autonomous entities providing services around the world. Our structure is explained in more detail at www.gowlingwlg.com/legal.

INBUSINESS


PHP has acquired Wincan-ton Healthcare Limited, which runs Wincanton Medical Centre in Som-erset for an undisclosed sum.

Completed in 2011, the 983sqm medical centre is fully let to the partners and includes a pharmacy unit, let to Boots UK Limited, with an unexpired term of 19.5 years.

The acquisition takes PHP’s portfolio to a total of 306 assets with a gross value of more than £1.3bn and a contracted rent roll of just over £72m.

PHP managing director

Harry Hyman said: ‘Win-canton Medical Centre is a positive addition to the portfolio being located within a growing catchment area with ongoing nearby residential development in progress. The unexpired term is accretive to the overall portfolio and the building represents a mod-ern purpose built dedicated healthcare facility with the benefit of secure onsite car parking. We have a strong pipeline of acquisitions in the UK and Ireland and are well positioned to continue growing the portfolio.’

PHP boosts portfolio

Unilabs has acquired Euro-pean teleradiology and tele-pathology services provider Telemedicine Clinic (TMC) for an undisclosed sum.

TMC has a network of radiologists and pathologists across Europe as well as an office in Sydney. It is also a leading player in elective tel-eradiology in the Nordics and one of the top four company’s in the UK on-call and elective markets.

According to Unilabs, the deal marks a step forward in the teleradiology markets and will accelerate the develop-ment of digital processes to enable more sub-specialist reporting.’

Unilabs chief operating officer Michiel Boehmer said: ‘Operating in a market where the demand for pathology and radiology services is increasing rapidly when, at the same time, the number of available radiologists and pathologists is decreasing, TMC offers a unique net-work to foster international

collaboration... Together, TMC and Unilabs will op-erate a network of over 500 specialists collaborating in the digital diagnostics network to provide best-in-class service and innovation to the pathol-ogy and radiology markets. We are thrilled to move on now and raise the bar for medical diagnostics in terms of quality, innovation and turnaround times.’

Alexander Böhmcker, CEO of TMC, added: ‘I am delighted that TMC is becoming part of the Unilabs family. This agreement is in line with TMC’s core purpose to make quality healthcare accessible to all, independent of the location of patients and experts. Together with Unilabs, we want to accelerate the cre-ation of truly integrated and digitalised diagnostic services and deliver better results and outcomes for our clients and patients. We are genuinely excited at what this transac-tion and partnership offers our customers and our people.’

Unilabs expands after acquisition of TMC

Elysium Healthcare remains on the acquisition trail after buying boutique residential care provider Broadham Care for an undisclosed sum.

The company, which was launched last year when BC Partners acquired 22 former Priory/Partnerships in Care sites from US healthcare giant Acadia, now has more than 40 sites.

Based in the south east, Broadham Care has eight facilities providing specialist epilepsy, autism and learn-ing disability services. The

acquisition complements service lines offered by Lighthouse Healthcare, which Elysium acquired earlier in the year.

Elysium CEO Joy Chamberlain said: ‘We are delighted to bring Broadham Care into the Elysium fold. Each of the eight homes have been specially designed to provide the best environment for clients. The standard of care delivered by the team is exceptional which is evidenced by the Good and Outstanding CQC ratings across the board.’

Elysium buys Broadham

Unilabs has acquired Euro-pean teleradiology and tele-pathology services provider Telemedicine Clinic (TMC) for an undisclosed sum.

TMC has a network of radiologists and pathologists across Europe as well as an office in Sydney. It is also a leading player in elective tel-eradiology in the Nordics and one of the top four company’s in the UK on-call and elective markets.

According to Unilabs, the deal marks a step forward in the teleradiology markets and will accelerate the develop-ment of digital processes to enable more sub-specialist reporting.’

Unilabs chief operating officer Michiel Boehmer said: ‘Operating in a market where the demand for pathology and radiology services is increasing rapidly when, at the same time, the number of available radiologists and pathologists is decreasing, TMC offers a unique net-work to foster international

collaboration... Together, TMC and Unilabs will op-erate a network of over 500 specialists collaborating in the digital diagnostics network to provide best-in-class service and innovation to the pathol-ogy and radiology markets. We are thrilled to move on now and raise the bar for medical diagnostics in terms of quality, innovation and turnaround times.’

Alexander Böhmcker, CEO of TMC, added: ‘I am delighted that TMC is becoming part of the Unilabs family. This agreement is in line with TMC’s core purpose to make quality healthcare accessible to all, independent of the location of patients and experts. Together with Unilabs, we want to accelerate the cre-ation of truly integrated and digitalised diagnostic services and deliver better results and outcomes for our clients and patients. We are genuinely excited at what this transac-tion and partnership offers our customers and our people.’

Alliance Medical Group (AMG) owners Life Healthcare said the UK-based diagnostic provider produced a ‘good set of results’ in the year ended 30 September 2017 based on solid underlying growth in all its territories and business areas.

The South African health-care provider acquired AMG, which has operations in the UK, Italy, Ireland, Germany and Poland, for R13.9bn in November 2016 as part of a bid to increase its European footprint.

Revenue was up 12% to £261m, while EBITDA increased by 11.3% to £69m. Roughly 50% of the company’s revenues are de-rived from the UK business, which was awarded a ten-year PET scanning contract by NHS England in 2015.

Life Healthcare said the business had experienced good volume growth under the contract as well as good performance from its static diagnostic imaging units. However, increased

competition in the mobile business has led to pricing pressure, holding EBITDA margins back to 26.4% (2016: 26.6%).

Group strategy and inves-tor relations executive Adam Pyle said that to date the company had not felt any significant fall-out from the tightening of NHS elective procedures.

‘We haven’t been impact-ed like other players have been but we are aware that if the NHS cuts back [on electives], at some point there is going to be some impact on us,’ he said.

Life Healthcare also an-nounced the appointment of new CEO Dr Shrey Viranna, who will take up the post in February.

AMG reports growth for Life

Dr Shrey Viranna will take up the post of Life Healthcare CEO in

February


Themes include:

Updated LaingBuissonHealthcare Real Estate

Report

Primary Care & Care HomesHousing with Care

Secondary Care

Healthcare Real Estate ConferenceLondon, 24th April 2018




Media Partners

Highlights include:

Sponsor


Major UK acute hospitals providers1 sponsored by

Operator Hospitals Beds Operating theatres Year End Revenue

£m

BMI Healthcare2 56 2,609 190 2017 887.1

Spire Healthcare 39 1,869 134 2016 926.4

Nuffield Health3 32 1,205 97 2016 839.5

Ramsay Health Care UK 29 885 78 2017 449.2

HCA Healthcare UK4 10 668 58 2016 891

Aspen Healthcare 6 204 17 2016 133.0

Trustees of the London Clinic 1 190 10 2016 144.4

Care UK 9 178 32 2016 597.2

Medical Services International 1 116 5 2016 102.2

Imperial Private Healthcare 5 107 29 2015 43.1

Hospital of St John & St Elizabeth 1 80 5 2016 57.5

KIMS Hospital Holdings 1 79 5 2015 8.8

Circle Health 3 76 17 2016 133.5

Horder Healthcare 2 75 6 2017 31.9

Ulster Independent Clinic 1 70 7 2016 26.3

Royal Marsden Private Care 6 54 23 2017 91.9

Frimley Health NHS Foundation Trust 2 53 20 2017 9.8

Royal Free London NHS Foundation Trust 2 52 3 2017 21.6

University College London Hospitals NHS Foundation Trust 3 52 18 2017 19.9

The Healthcare Management Trust 2 49 4 2016 33.7

Great Ormond Street Hospital for Children NHS Foundation Trust 1 43 12 2017 55.1

One Healthcare 2 41 10

King Edward VII's Hospital Sister Agnes 1 40 3 2016 23.0

Royal Brompton & Harefield Hospitals Specialist Care5 2 40 11 2017 39.9

The Victoria Foundation 1 37 3 2011 13.8

The Christie NHS Foundation Trust 1 34 5

Guy Pilkington Memorial Home 1 32 2 2016 12.8

Chelsea & Westminster Hospital NHS Foundation Trust 1 30 20 2017 18.0

Maidstone & Tunbridge Wells NHS Trust 1 26 10 2017 4.8

Spencer Private Hospitals 2 26 16 2016 10.3

Vale Healthcare 2 25 4

Western Sussex Hospitals NHS Foundation Trust 2 25 19 2017 6.6

Hampshire Hospitals NHS Foundation Trust 1 22 2016 4.8

NOTES 1 MAJOR ACUTE/SURGICAL HOSPITAL OPERATORS RANKED BY BED NUMBER 2 REVENUES STATED NET OF CONSULTANTS’ FEES 3 COMBINED REVENUE FOR HOSPITAL AND WELLNESS BUSINESSES 4 HCA INC. REPORTED FIGURES FOR UK BUSINESS CONVERTED USING FEDERAL GOVERNMENT RESERVE AVERAGE EXCHANGE RATE FOR 2016. 5 NINE MONTH PERIODNHS PPU OPERATING THEATRES LISTED ARE FOR WHOLE TRUST AND ARE NOT RESERVED SPECIFICALLY FOR PRIVATE PATIENTSSOURCE LAINGBUISSON DATABASE

Intelligence tables


Serious about health. Passionate about care.

PRIVATE HOSPITAL CARE

25 MILLION PATIENTS.* ALL TREATED EXACTLY THE SAME WAY – UNIQUELY.

At BMI Healthcare we are focussed on delivering high quality individual care to all of our patients across the country, from Aberdeen to Eastbourne.

We live our brand promise, ‘Serious about Health. Passionate about Care’, every day, and are delighted to be the first private provider to win the Nursing Times Nurse of the Year Award1, and the first to be awarded VTE Exemplar status across our network of hospitals and clinics2.

*BMI internal data August 2015 1Nursing Times Award 2013 2http://www.vteprevention-nhsengland.org.uk/vte-exemplar-centre6049 0011 CORP ADV / 11.2016

6049_0011 CORP ADV/11.2016_LangBuisson Advert.indd 1 10/11/2016 10:52

Aetna International has appointed David Healy as CEO of its newly created EMEA region, following a strategic decision to merge its European and Middle East & Africa divisions.

Healy, who joined Aetna in 2012, will lead the expansion of international business across EMEA, which includes internation-al health benefits and health management solutions.

With over 30 years of experience in International Insurance and Employee Benefits Industries, Healy brings a wealth of knowl-edge and expertise to the role.

Before joining Aetna, he worked for AEGON Ireland, the cross-border arm of AEGON, where he served as managing director for life, invest-ment and variable annuity

products in Europe. His insurance career began in 1987 with operational roles in Ireland. He joined J Rothschild International in 1993 to help launch its international operations from Dublin. In 1995, he joined the cross-border life assurance company Scottish Equitable International in Luxembourg at its start-up, becoming managing direc-tor in 1997.

Commenting on his ap-pointment, Healy said: ‘In order to support our strate-gy to scale-up our capabil-ities, work with stakehold-ers on further developing healthcare infrastructure and create greater access to the right healthcare solu-tions, we have implemented a new structure by creating an EMEA region.

‘Not only will this allow us to leverage our strengths

and give our people the best environment to contribute and develop, it will also allow faster decision-making, more regional empowerment and accountability and put our customer groups at the heart of everything we do – including brokers.’

Aetna appoints CEO of new EMEA region

Bupa appoints Gates

Professor Sir Mike Richards joins PwC


Former national cancer director and chief inspector of hospitals, Professor Sir Mike Richards has joined the Health Industries team at PwC as senior advisor.

As well as working with the wider PwC health industries leadership team on its evolving healthcare strategy, Sir Mike will play a significant role in supporting the company’s clients on assignments both in the UK and internationally. In

particular, he will focus on supporting clients to drive sustainable improvement in quality of care; supporting new investment in innovation and technology; and supporting clients as they move towards implementing new models of care.

He will work alongside Alan Milburn, Mike Farrar and the PwC senior health leadership team.

Health Industries Leader at PwC Quentin Cole said: ‘I am delighted that Sir Mike will be joining the firm’s team of health experts. He will be a significant addition, providing unparalleled insight and experience into the NHS which will undoubtedly expand our support to clients.’

Bupa has appointed Steve Gates to the newly-created role of director of dental insurance and cash plans. Previously managing director of Denplan, Gates will lead on the development of Bupa’s dental insurance and cash plan businesses and will also work with its dental practice business.

David Healy will head up Aetna’s newly created EMEA region

Inpost

Professor Sir Mike Richards joins PwC

HSBC has appointed Jeremy Huband as head of healthcare to lead its relationship teams across the UK.

Huband has over 20 years’ experience in the healthcare sector and joins the company from Royal Bank of Scotland where he worked for 31 years in a number of roles, most recently as head of healthcare.

His expertise includes working with care homes, GPs, dental practices, com-munity pharmacies, private hospitals, day care nurseries and veterinary practices.

Commenting on his ap-pointment, Huband said: ‘I was drawn to HSBC because I could see a real enthusiasm

to develop the bank’s knowl-edge and market presence in the healthcare sector, which is changing on an almost daily basis as the UK nego-tiates its way out of Europe. How healthcare services are funded and staffed is a problem many operators are faced with, whether they are residential care homes, GP surgeries or dentists, and we want to help them overcome some of these barriers.

New head of healthcare for HSBC

Jeremy Huband moves to HSBC


PRECISON INTEGRITY PASSIONOur key sectors of expertise are Health, Social

Care, and Life Sciences. With our comprehensive

and extensive local and global networks, in-depth

market sector knowledge and our outstanding

team of highly experienced professional

consultants, we can make the process of finding

your next CXO, board member or senior

appointment simple.

WWW.GILBERTMEHER.COM

Health and Social Care Recruitment

READY.Our strength is we provide a first class service to an outstanding healthcare base. The team are poised to rise to every challenge on behalf of our healthcare clients.

Advising on healthcare assets of over £8BN a year, we are ideally placed to help clients understand the market as it stands now and importantly how it will look in the future.

CONTACTJulian Evans FRICST: +44 20 7861 1147E: [email protected]

Knightfrank.co.uk

CT1530 Healthcare_generic_advert_FINAL.indd 3 28/09/2016 17:31

DECEMBER 2017/JANUARY 2018 | Volume 21 | Issue 10 … · 2017. 12. 8. · DECEMBER 2017/JANUARY...

Documents

Transcript of DECEMBER 2017/JANUARY 2018 | Volume 21 | Issue 10 … · 2017. 12. 8. · DECEMBER 2017/JANUARY...