Gill Weatherill, partner at DAC Beachcroft, looks at how structural reform can be practically delivered through transforming mental healthcare assets and the estate
Headlines around mental health and the Transforming Care Agenda are now unequivocal about the need to create more capacity in the system and move it towards community-based care. Yet, there are challenges in doing so, due to gaps in community service provision and a lack of specialist training.
DAC Beachcroft’s mental health report, published in August 2019, emphasised the drive towards community care, increasing choice for service users and improving collaboration. The pressure on services to adapt and reform, however, has increased since its publication.
Bridging the gap
A key part of the Transforming Care Agenda is to move care back into the community and away from the more isolated hospital or institutional setting. The current state of reform,
however, has faced criticism: with the number and availability of mental health beds considerably outstripped by demand, and a dearth in community services. At the same time CQC enforcement activity, including the closure of some wards and services, has created additional pressure in the system.
Matt Hancock, secretary of state for health and social care, has also announced new mandatory training on autism and learning disabilities for health and social care workers in an effort to mitigate the effects of these gaps in care.
Although, it is clear that the direction of travel in 2020 will be influenced by the newly elected government, there are opportunities for investors in three key areas: the sector’s estate, technology and partnership working with charities who are increasingly delivering community services.
Estates play a key role in creating efficiencies in the provision of care, with many ripe for investment to either upgrade existing premises or invest in new purpose-built facilities that bridge the gap for community care provision.
Both developers and REITs are shifting the focus of new developments towards supported living accommodation as a result of a central government pledge to continue to fund welfare benefits for supported living, where housing benefit will otherwise see annual reductions going forward. Registered Providers are taking long leases (20-30 years) on these properties, which do not have to be separately CQC registered as care is independently provided.
Colleague and real estate expert at DAC Beachcroft, Stan Campbell, comments that ‘with minimal adaptations required for these supported living units and a long-term return on investment, this is an area that could provide a solution to certain aspects of the mental health community care challenge’.
Of course, it is important to note that developers and investors must consider regulatory scrutiny around certain care settings: the CQC is taking an increasingly forensic approach
with regulated services, including enforcement activity which can have a significant impact on bed occupancy and hence commercial success. This may affect the willingness of investors to develop services which fall within the ambit of the CQC regulatory remit. This, in turn, will influence the extent to which commissioners are able to access safe, quality community services in the areas needed, allowing people to stay in their home area.
Alongside the bricks and mortar of healthcare, sit technological solutions that have the potential to support the system change that is needed, through creating both efficiencies in current service delivery and space (and investment) to modernise care pathways.
Mental health apps for digitally enabled therapy assessments include remote face-to-face video consultations: one such example is the Improving Access to Psychological Therapies
(IAPT) programme, developed by NHS England and NICE; whereby digital therapy products, such as talking therapies for anxiety disorders and depression, can be accessed on the IAPT platform remotely. It’s a way of providing support in the community and offering mental health interventions which rely on verbal communication rather than physical contact.
Digital healthcare also offers the opportunity to create efficiencies in home care and care homes through homecare monitoring services. These models offer nurses and care workers additional support to maintain safe care and better access to services (such as emergency consultations) on-site or at home, without the need for admission into more acute care services.
The technological revolution also promises to improve information sharing, which can help to ensure that the plethora of different health and social care providers that can be involved in the provision of services to a complex individual, with multiple physical and mental health needs, can communicate effectively. Effective information-sharing platforms are essential to ensure safe services, reducing the risk of safety or quality failures resulting from a lack of ownership or accountability.
Charities in the community
It is widely accepted that charities can create myriad and specialised solutions for supporting individuals in the community, and many are becoming the provider of choice for mental health services in some areas of the country. Investors may, therefore, benefit from close working relationships with the dominant charitable organisations in the relevant geographical patch, to facilitate the sharing of resources, ideas and solutions.
In summary, the pressure for community solutions at a governmental and policy level is growing, and is unlikely to change, even with a change in government. While national policy may influence delivery models and funding streams, it is likely that significant opportunities for investment will continue in the planning, building, and management
of new community services. The delivery models will, however, need careful thought, given the operational challenges in delivery of safe, quality mental health services and the scrutiny of the CQC in regulated services. The market can only grow with an ageing
population and soaring mental health demand, but the challenge will be working with local commissioners and stakeholders to identify the investment opportunities which can thrive in a complex sector.