Barclays Head of Healthcare Paul Birley talks kitchens, gardens, linen cupboards, robots and Four Seasons with Care Home Professional
Care Home Professional: Can you tell me about your background?
PB: I joined Barclays in 1981. We started the healthcare team in 2001 although I had a portfolio of healthcare clients prior to that. We have won Health Investor of the Year six times in the last nine years and I was a Capital Provider in the Health Investor Power 50 last year.
CHP: Could you tell me about your healthcare portfolio?
PB: We have a portfolio of several billion in five key areas in the healthcare space: high street healthcare, including pharmacies, dentists and day nurseries; healthcare services, including anything that is centrally funded such a domiciliary care, foster care and technology companies; the NHS, including PFIs and ISTCs; asset backed healthcare, including specialist and elderly care homes and acute care hospitals; and life sciences, including pharma, mid-tech and biotech.
CHP: Can you tell me more about your care home investments?
PB: We have relationships with about 13 out of the top 25 providers. We invest in all sizes. We look to support the growth aspirations of operators and cover everything from single home operators to the large groups.
CHP: Is your investment in the sector on the rise?
PB: We have always had a very consistent approach to the sector. The sort of things we look for when we are looking to do a deal are a real focus on care and a motivated staff and inspirational leadership. We want to see staff who are really engaged with residents and looking like they are enjoying being there. The care home manager is a very important person. The last thing you want to see is a care home manager stuck in their office or someone who doesn’t know the residents names as they walk around.
The third thing we look for is location, including transport links because you have to get staff to the care home and you also have to have people visiting. Bus stops and the bus timetable are important because if they don’t tie in with staff rotas that can be a challenge.
The fourth thing is attention to detail; care homes have to be really focused on how they do the whole operation such as what sort of system of care they deliver. It could be the Gold Standard for end of life care, it could be Butterfly Care. If they have some methodology around the kind of care they are delivering that does tend to differentiate them.
We look at how the kitchen has become an integral part of the care home. I was talking to one chef who weighs the food when it goes out to residents and when it comes back to see how much has been eaten and then takes appropriate action about whether he should help residents graze during the course of the day or try using appetite enhancers to help people eat more during meal time.
The garden is also key. There are a number of examples of providers who are taking the principles of dementia care within the care home and adding them to the garden. Abbeyfield’s garden at Winnersh is a great example.
The other area I like to look at is the linen cupboard. If the linen cupboard is pristine it’s probably not being used enough. If it is a complete mess it probably means the care home is a mess. Nicely ruffled is the way I like to see it. If you get all of that right, the money looks after it itself.
CHP: Would you look favourably on a home with a typical care specialism?
PB: That’s the way the market is moving. We have seen operators reconfigure their dementia care offering but you can’t just switch from nursing care to dementia care because it does need a certain level of training. We have had Training 2 CARE come in and offer some dementia simulation sessions for our staff. If we are starting to see more people with dementia this helps us to understand how the care homes will support people with dementia. It gives you an understanding of the challenges that people looking after people with dementia go through. We are delighted to sponsor a Training 2 CARE van this year. We have also used ageing suits to give us an idea of the challenges elderly people encounter.
CHP: Is there a cut-off point for you in terms of CQC ratings?
PB: Let us say if you have got an Inadequate rating you are probably going to find it quite difficult to get funding. Everyone would like to bank Outstanding care homes. We have started to try and recognise our clients when they get an Outstanding rating. When you get down to Requires Improvement you take every case on its merit. You need to go through the CQC report and find exactly why. It may well be that they just didn’t have a manager at the time.
I like to describe ourselves as privileged observers of the sector. You get a feel when you go around what the owner’s motivation is and speak to the care home manager. We also encourage our staff to do an ‘understand your business’ day. This involves going into a care home and helping out. It’s a great way of getting to understand what really goes on in a care home. I have done basket making and other sorts of entertainment, I’ve had coffee chats with the residents and helped at meal times. Some of the team have been in the kitchen and helped out to get a feel for how the operations works and the challenges they have.
CHP: Are you concerned that some of the larger providers are getting too big?
PB: Clearly, if we are looking to invest in a 100-home group we are never going to get round all the homes. What I will do is go and look at the care home that is furthest away from head office. If there’s going to be an issue, that’s typically where it is. I do worry that some care home groups do get too big. Southern Cross clearly had its challenges. Four Seasons is in the press at the moment and HC-One is now a huge enterprise. I hope that HC-One is the exception that proves the rule and I do believe that there are some factors that are coming to play that mean it may be possible to manage a larger group. That revolves around technology. I have been talking to one of the operators who now operate a paperless care home. They have implemented an e-medication system and it has taken two to three hours off the medicine round every day. That means that staff can spend more time delivering care.
CHP: So technology is another key factor when you are looking at places to invest?
PB: Technology has to be a way of helping people get better care. Instead of being reactive, they can be proactive. We can be looking at providing earlier support for people. If you have the data and the information that has created it, you can then potentially predict what is going to happen. You have robots now. Why can’t you have a robot going into a room each night to check whether the person is asleep?
You can have much more focused interventions through technology which monitors when people have left their beds for longer than they should have done, for example. You have Virtual Reality where you can actually take somebody back to a time they think they are in. The great care homes get to the essence of the individual. They find out what makes them tick and they’re the care homes we would like to bank.
CHP: What is your view of the current situation at Four Seasons?
PB: My hope is that Four Seasons work their issues out because don’t think that any provider getting into difficulties is good for the sector. I hope they can work it out in a way that ensures that the people they look after get the continued care and the staff continue their employment to continue to look after their residents.
Operators tend to get into challenging positions when they stretch their resources. That can happen in a number of ways over a period of time, for example, if they stretch their staff or their finances or the real estate by not spending the capital they need to. Wherever you find businesses stretched you find they become susceptible to changes in the overall climate.
As a society we need to change some of our language when we describe how the sector operates. People don’t talk about the good stuff that goes on. There’s so much good stuff about people making the difference and making that moment for the resident.