Care UK is the UK's largest independent provider of health and social care, with more than 110 care homes across the UK, caring for approximately 7,600 people. Measured by bed numbers, Care UK is one of the five largest operators of care homes. In healthcare the company’s services include treatment centres, GP practices, walk-in centres, out-of-hours GP support and diagnostics facilities. Care UK also provides healthcare at a number of prisons. In 2015 Care UK sold its businesses in mental health, learning disabilities support and care at home.
Care UK has grown through a process of acquisition and organic growth to become one of the five leading residential home companies in the UK and the leading independent sector provider to the NHS in England of elective surgical procedures, NHS 111 non-emergency service and out of hours primary care, and healthcare in prisons. It has two business divisions: residential care and healthcare. Until very recently, revenue for the healthcare division has been derived entirely from contracts with the NHS and public bodies.
For many years Care UK's strategy has been to bid for contracts with the NHS in the area of primary and urgent care, it was a major player in the walk-in centres developed in the previous decade, and prison healthcare, as well as contracts to run treatment centres performing a range of elective surgery. By late 2017, its NHS contracts focused on NHS 111 services, prison healthcare, primary care and out-of hours care, and elective treatment centres.
In 2017, Care UK reported that it is the largest provider of healthcare services in prisons and secure facilities, with services at 42 different sites. It also provides over 60 NHS primary care services, including GP and walk-in services, 11 NHS out of hours services, providing health advice and support for over 10 million people, and 13 NHS 111 services handling on average 240,000 calls a month covering a population of over 11.0 million people.
However, in 2017 the company's strategy took a slightly different direction; for the first time the company began to offer "self-pay" services. In its September 2017 report to bondholders the company notes that the profitability of the primary care (including 111 service, OOH and primary care) is marginal and there are also concerns over the continuing profitability of the elective surgery contracts the company has with the NHS.
The company notes that financial pressures in the NHS are leading commissioners to defer patients needing a range of elective procedures. As a result there will be an increase in the number of patients waiting for treatment. Care UK believes that this increase in waiting list numbers is "unsustainable" and is an opportunity for the company. For the first time Care UK is moving into the self-pay market, offering patients on waiting lists the possibility of paying for their operations at the treatment centres where Care UK carries out the NHS work. Care UK notes it is "exploring partnership structures with NHS Acute Trusts alongside developing the opportunity to give patients choice and control over their treatment through a self-funding alternative currently being trialled."
The first "self-pay" trial began in late 2017 in the West country, where Care UK has two treatment centres one in Bristol and the other in Devises. Care UK wrote to local GPs, who would normally have referred patients to Care UK for NHS work, marketing its self-pay option as a quicker alternative. The mail shot included a list of treatments and prices, ranging from ear wax removal to complete knee replacement. This approach received considerable criticism from GPs and local anti-privatisation campaigners. A report in the Bristol Post noted that the letter to GPs says: “we understand the pressure of growing waiting lists is leading to greater restrictions on NHS access.” and goes on to tell GPs they “will have greater options to discuss with patients” thanks to the self-pay scheme.
The company's strategy to explore partnerships with the NHS bore fruit in late 2018 when the company entered a partnership with the University Hospitals Plymouth Trust to carry out all the trust's elective orthopaedic surgery for 18 months. Surgeons and anaesthetists at the NHS trust will move to Care UK's Peninsula Treatment Centre to operate on around 200 patients per month. The staff will remain trust employees but be managed jointly by Care UK. This agreement has been termed a 'partnership' by the trust and was not awarded via a tender process.
Care UK (as Anglia Secure Homes) specialised in retirement homes and sheltered housing, then added nursing homes and homecare support. Then in 1994 after being renamed Care UK, the company began acquiring learning disability support, community care and mental health services. In 2003, Care UK began providing secondary healthcare services after winning contracts to run a number of independent sector NHS treatment centres. Later Care UK entered the primary care market with its first GP out-of-hours contract. In recent years Care UK has won contracts to provide GP practices, walk-in centres, and clinical assessment and treatment services (CATS).
A notable move in November 2012 was the acquisition of Harmoni for £48 million, significantly expanding Care UK’s OOH business, including 12 NHS 111 contracts, and prison healthcare business. Following the deal Care UK is reported to provide unscheduled care to approximately 15 million people across England.
Harmoni has been active in the development of telehealth; in May 2012, Harmoni, the Qatar Science & Technology Park (QSTP), and Corinium Technologies signed an agreement to use RASAD, an ICT telehealth platform developed and owned by Qatar Science & Technology Park (QSTP) and ASPETAR (the Gulf region’s first orthopaedic and sports medicine hospital in Doha), as part of the UK’s long term health care management programme. Harmoni will use RASAD to remotely monitor patients with conditions that require regular medical observation, such as pulmonary vascular disease.
In June 2015, Care UK's mental health services were sold to Partnerships in Care for an undisclosed sum, its learning disability group was sold to Lifeways, and its homecare division was sold to Mears Group for £11.3 million. Following these divestments, Care UK is fully focused on primary and secondary NHS health services and residential and nursing homes.
Co-founder of Care UK John Nash and his wife have reportedly donated over £300,000 to the Conservative party including £21,000 to the personal office of the former Health Secretary Andrew Lansley. John Nash has gained considerable power within government although unelected. In 2010 he was appointed by the UK chancellor, George Osborne to plan the drive for austerity, then in December 2010 he was appointed non-executive director of the Department of Education board. In January 2013, John Nash, received a peerage, becoming Baron Nash of Ewelwe, and became a schools minister in the Conservative government. responsible for among other things, academies and free schools and school capital (including playing fields). He continued in this role after the Conservatives won the May 2015 UK general elections, but has now left this position. He sits in the House of Lords.
In October 2012 Jim Easton resigned from the NHS Commissioning Board to become Managing Director of Care UK. Jim Easton was responsible for the procurement process for the NHS 111 services, 12 of which were won by Harmoni. Care UK acquired Harmoni a few weeks after Jim Easton joined Care UK. Jim Easton is now Care UK's managing director for healthcare.
For the financial year to the end of September 2017 Care UK reported total revenue of £658 million, up 10.3% on FY2016, and a loss on continuing operations of £16.5 million (£31.2 million loss in FY 2016). The residential care business reported revenue of £300.7 million, up 10.6% on FY 2016, and the healthcare sector reported £357 million in revenue, up £32.8 million on FY 2016.
Revenue for the Health Care division is wholly derived from CCGs, NHS England or the Department of Health for services provided entirely to NHS patients. New contracts begun in 2016 and 2017 for healthcare at 28 prison and offender facilities added revenue of £42.6 million year-on-year (approximately £85 million pre year). The company's NHS 111 services revenue grew by £9.5 million in the year as a result of the West Midlands contract begun in 2016, but there were also contract extensions and improved funding in some areas.
Overall Primary Care Revenue increased by £40.6 million in the year ended 30 September 2017 compared with the same period in 2016. The company notes that out-of-hours is a difficult market; the company left contracts in Luton and Rotherham in 2017, but began a contract in Gloucestershire in June 2017. Revenue from the NHS 111 service line increased £9.5 million during the year as a result of the West Midlands contract. Care UK notes that the overall profitability of these service contracts remains marginal.
Revenue from Secondary Care, the ISTC elective surgery services and CATS and Diagnostics contracts, decreased by £8.6 million in the year ended 30 September 2017 compared to FY2016.
In the year ending 30 September 2017, over 80% of revenue from continuing operations was derived from contracts with publicly funded entities, with the remainder derived from self-funding individuals in Care UK’s residential care business.
Data collected by the NHS Support Federation estimated that Care UK was awarded £187.4 million in contract awards from 2010 to April 2016, then from April 2016 to April 2017, the company was awarded a further £596.3 million in contracts. However this is certainly a significant underestimate of the amount of income Care UK derives each year from work for the NHS.
In March 2010 Care UK was acquired by Bridgepoint in a deal worth £432 million and Care UK was removed from the public markets.
As of September 2017 Care UK Limited is 100% owned by Care UK Health & Social Care Plc, which is 100% owned by Care UK Health & Social Care Investments Limited. Care UK Health & Social Care Investments Limited is 100% owned by Care UK Health & Social Care Finance Limited, which is 100% owned by Care UK Health & Social Care Holdings Limited.
Bridgepoint Europe IV (Nominees) Limited holds 77.9% share of the issued ordinary share capital of Care UK Health & Social Care Holdings Limited. The remaining 22.1% of the issued ordinary share capital of Care UK Health & Social Care Holdings Limited is held by Mike Parish, other members of Care UK’s senior management and a number of Care UK’s employees including the group’s Employee Benefit Trust, who together hold 21.2% of the issued ordinary share capital of Care UK Health & Social Care Holdings Limited, as well as the group’s former Chairman, whose trustees hold 0.9% of the issued ordinary share capital.
In February 2018, Reuters reported that Bridgepoint plans to sell Care UK and in April 2018 the first bids were reported to have been made for the company. However, in September 2018 Care UK is still listed as an investment on Bridgepoint's website.
Care UK has a large number of contracts with CCGs and local councils.
Data collected by the NHS Support Federation estimated that Care UK was awarded £187.4 million in contract awards from 2010 to April 2016, then from April 2016 to April 2018, the company was awarded a further £709.8 million in contracts. However this is certainly a significant underestimate of the amount of income Care UK derives each year from work for the NHS.
According to the company’s accounts in the year to the end of September 2017 income from NHS work received from CCGs, NHS England and the Department of Health was £357 million.
Care UK terminated a contract for an out-of-hours service in April 2015. The contract was to provide OOH care in conjunction with Portsmouth Health Limited (a group of local GPs), however the contract, which began in 2012, proved to be loss-making and so Care UK terminated its involvement before the end of the contract.
Care UK has a large number of contracts that cover the following areas:
- Care homes (112 homes with approximately 7,600 beds), plus 12 day care centres
Health Care Services
- 9 specialist hospitals (ISTCs)
- 50 primary care centres, including GP practices and walk-in centres
- Health services in 42 prisons and detention centres
- NHS 111 service provides services to 46 CCGs and handle on average 225,000 calls a month covering a population of over 11.6 million people
Prison Healthcare Contracts
In the 2016/17 year Care UK won a contract worth £135.6 million to provide healthcare at prisons and detention centres across the Thames Valley, Bristol, South Gloucestershire, Wiltshire and Gloucestershire. In the same year, Care UK was also awarded contracts for prisons in Devon and Dorset, worth £79.8 million, and Sudbury and Foston Hall, worth over £18.5 million.
In the 2017/18 year Care UK was awarded a £23 million contract for "Healthcare Provision for Women in Prisons across Yorkshire & Humber". It also received a £4.6 million contract for healthcare services at HMPYOI Feltham.
Orthopaedic Surgery in Devon
In October 2018, the HSJ reported that the University Hospitals Plymouth Trust had entered an agreement with Care UK for the company to take over all elective orthopaedic surgery for 18 months. Surgeons and anaesthetists at the NHS trust will move to Care UK's Peninsula Treatment Centre to operate on around 200 patients per month. The staff will remain trust employees but be managed jointly by Care UK. The trust is hoping that this will free up space over the coming winter.
This agreement has been termed a 'partnership' by the trust and was not awarded via a tender process.
Shepton Mallet Health and Wellbeing Centre
The contract for the Shepton Mallet Health and Wellbeing centre is worth £120 million over eight years. Under the contract, which began in January 2017, Care UK will work with the Somerset Partnership NHS Foundation Trust, which currently runs the community hospital and the minor injuries unit (MIU) on the site. However, as this is a prime-provider contract, Care UK is able to subcontract work to other firms and organisations. At the moment, Care UK runs the Shepton Mallet NHS Treatment Centre on the same site delivering a range of NHS services for people living in the Shepton Mallet area. Care UK and the trust will develop the Shepton Mallet Health and Wellbeing centre to encompass: a treatment centre; the community hospital and services that go beyond being a hospital, providing a base for the community, including voluntary and third sector organisations; diagnostics; and the minor injury unit (MIU).
Urgent Care and OOH in the Midlands
Another large contract won partially by Care UK is for an integrated out-of-hours GP service and NHS 111 service for 16 CCGs in the midlands. Care UK shares this six year contract with other private companies, but Care UK receives the lion’s share with almost £140 million; almost £24 million goes to Nestor Primecare Services Ltd; £6 million goes to Badger Healthcare Limited, a social enterprise; and £690,000 goes to Coventry and Warwickshire Partnership NHS Trust. These new contracts will begin in November 2016, to be integrated with the existing contracts through the alliance agreement.
Urgent Care and OOH in Suffolk and north-east Essex
In June 2018, Care UK was awarded a five year contract to run the NHS 111 helpline and out-of-hour services across Suffolk and north-east Essex. From 1 November 2018, the private company will take on the “enhanced integrated urgent care service”. These services will be delivered to the 950,000 population across the STP area.
Primary Care Out of Hours Services in Gloucestershire
In August 2017 Care UK was awarded an interim contract to run primary care out of hours services in Gloucester.
111 services in London
Care UK was comissioned in April 2017 to run a 111 service in the London Buroughs of Hounslow, Ealing and Harrow.
North East London Elective Care Services
Barking and Dagenham, Havering, Redbridge and Waltham Forest CCGs awarded a £70 million contract to Care UK to provide elective care services.
Since 2009, there have been a number of high profile cases in the national media in which very poor standards of practice by Care UK have been exposed. This included a BBC Panorama investigation which uncovered instances of gross negligence in care homes operated by Care UK. Other incidents include in 2011 the 84 year old woman who was not visited by carers for four days as Care UK thought she was in hospital and in 2012 the lack of processing of 6,000 X-rays at a Care UK-run urgent care centre.
In Suffolk Harmoni’s OOH service was heavily criticised in 2011 then again in 2012, for excessive waiting times and cuts to the service. In 2012 Harmoni reorganised its Suffolk OOH service, including the closure of several bases, including in Newmarket and Aldeburgh. The closure of the bases was reported to be without any consultation with local people.
At the end of 2012, it became evident that things were going badly wrong in Harmoni's out-of-hours business in London. In December 2012, The Guardian exposed a catalogue of failings, noting that senior doctors have complained that the service is so short-staffed that it is routinely unsafe. Harmoni is also reported to have manipulated its performance data to cover up for delays in seeing patients and missed targets.
One of the most high profile cases was that of a seven-week-old baby boy who died while in the care of Harmoni's out-of-hours GP service. Harmoni's service was described as "wholly inadequate" by a coroner in February 2013. The coroner noted that Dr Muttu Shantikumar assessed the newborn baby, Axel Peanberg King, in a telephone call lasting just one minute a few hours before he collapsed in his mother's arms, and later made "wholly inadequate entries on the records that were clearly at odds with the evidence". When the baby's mother attended the Harmoni clinic three and a half hours later, she was made to wait with her baby in a queue with six patients ahead of her. The baby died shortly afterwards in the NHS A&E department next door to the clinic.
In May 2013, the Care Quality Commission produced a report on Harmoni noting that cost-cutting at the company may be harming patient care. The routine inspection by the CQC, which was carried out in March 2013, found that Harmoni did not respond quickly enough to calls from patients in north central London because it did not have enough doctors, putting patients “at risk”. The CQC report was highlighted by The Independent, which in its article noted that Harmoni won the contract to provide the out-of-hours service against rival bidder LCWUCC, a non-profit GP organisation in west London, by beating it on price despite scoring worse on quality.
In October 2014 concerns were raised about the quality of care at two care homes run by Care UK in Suffolk, and admissions were suspended by Suffolk County Council after an inspection by the CQC. In November, the CQC again criticised the Mildenhall Lodge home in Suffolk in a second care quality report, which highlighted concerns over how 'low staffing numbers and the use of agency staff who were not familiar with people's needs placed them at potential risk'.
In September 2016, Veritas produced a critical report on Care UK's urgent care contract in Ealing. The contract awarded by Ealing Primary Care Trust in 2011 was worth £3.9 million to run an urgent care centre in Ealing Hospital. The independent report by Veritas was triggered following complaints of poor care made to ITV reporters. The report noted that there was a gap in the assurance process carried out by the CCG as well as problems with the staffing model used by Care UK, which “took no account of predictable peaks in demand”.
The contract ran at a loss for Care UK, but when the company requested more funding from Ealing CCG in May 2013 it was refused. Furthermore, Ealing CCG would not allow Care UK to terminate the contract. The contract finally ended in April 2016, when Greenbrook Healthcare took over.
A BBC Radio Four investigation on the programme Outsourced in January 2013 reported that at three residential care homes in Croydon, Surrey, outsourced by local council to Care UK in 2011, many staff accepted new lower employment terms in exchange for a lump sum of money. Basic pay changed from £11.15 per hour to £6.50 per hour, holiday entitlement was reduced and sick pay changed. Care UK entered agreements with individual employees to buy them out of their terms and conditions. Employees that did not agree were served notice. Those who were dismissed were offered re-employment under the new terms and conditions.
In March 2015, Care UK was listed in an investigation by Richard Murphy a chartered accountant at Tax Research UK, published in The Guardian that highlighted the use of tax havens by private companies with NHS contracts.
In July 2015, Care UK complained to Monitor about the loss of its contract to run the North East London Treatment Centre; Care UK had run it for three years since 2011. In 2015 the new £55 million five year contract for the centre was awarded to Barking, Havering and Redbridge Hospital Trust. Care UK has questioned the procurement process and Monitor investigated. At the end of January 2016 Monitor found in favour of Care UK in the first part of the competition case; Monitor reported that it had identified “potential issues” with the procurement process. As a result, the CCGs extended Care UK’s contract by 15 months, then retendered the contract. Eventually, in September 2017, Care UK won the contract.
In December 2017 local press in the Bristol area reported that Care UK was sending hundreds of letters to local GPs outlining the costs of operations at Care UK's treatment centres in a marketing exercise for its self-pay services. Care UK, which runs nine centres offering treatment on the NHS, said it intended to use spare theatre time to provide self-pay procedures.
The company is trialling the scheme at two treatment centres in the west of England, the Emersons Green treatment centre near Bristol and a second centre in Devizes in Wiltshire. The list of treatments on offer ranges from earwax removal (£160) to hip replacements at just under £9,000. Other procedures being offered include cataract surgery, tonsillectomies and vasectomies.
There is currently a six to 20-week wait for NHS patients seeking operations at Emersons Green treatment centre – the NHS says this wait time “under-performs against national and/or local standards”.