Millbrook Healthcare is a serious force in the disability equipment market. Managing director Phillip Campling and director of wheelchair services Annette Cairns explain how the firm is working to support its new contracts while targeting new spheres with an innovative approach based on clinical governance, home-grown staff and in-house expertise.
Millbrook Healthcare is one of the largest care contractors in the country, providing more than 30 wheelchair, community equipment, assistive technology and home improvement agency services to the NHS and local authorities (LA).
As such a large company funded in effect by the tax payer in the form of multi-million pound NHS and LA contracts, it is often exposed to scrutiny from critics. The last 18 months in particular have seen the company scolded in the press for what some have branded as ‘unacceptable’ wheelchair waiting times and ‘struggling wheelchair services’.
The backlash generated by the negative press has been a hindrance for Millbrook but its management is determined to shake off the comments and explain the challenges and frustrations expressed in media reports.
For Millbrook’s managing director, Phillip Campling, it is a shame that some claims have been taken at face value. While he notes one or two of the firm’s wheelchair services are dealing with lengthy waiting lists, Campling insists that many of the difficulties were inherited from the previous provider.
He says that the reason some contracts come out to tender in the first place is usually because they are failing and that Millbrook is a company often appointed to take on a struggling service and revive it.
“We take on failing services, that’s what we do. [Authorities] come to us when the in-house provider either collapses or is unable or unwilling to continue delivering its services. We’ve won tenders and inherited, in some cases, a two year waiting list,” Campling says.
“Some of the reports are a completely unfair assessment because they’re not looking at the bigger picture. We’ve been brought in to turn failing services around and ensure that we are delivering care pathways in a much better way.
“Absolutely there have been struggles from the outset, not only because we’re bringing in quite a complex service and trying to turn it around, but there are also a number of undeclared waiting lists, coupled with higher levels of demand.”
Aside from the complexity of clearing inherited waiting lists, it is an expensive task. For example, one wheelchair service Millbrook took on faced a significantly higher demand than was being funded at the time.
While the firm managed to secure additional funding from commissioners to clear the backlog, the incoming demand can in some contracts sit as high as 20% more than available funded, making it difficult to tackle build-ups.
Data and knowledge of demographics is also a vital component of any given tender. One of the issues Millbrook faced when taking on certain contracts was the quality of the data collected by previous providers.
Consequently, on winning the tender the contractor sometimes faced a different scenario to what it had initially expected based on the data provided. One of the challenges has been to ensure the data it collects when it takes on a tender is far more accurate than what it found when it arrived.
Campling says that a combination of factors has meant in certain cases, Millbrook has held a uniquely challenging position but is confident in its ability to complete the job of turning each service around. He adds: “When you’re an outsourced contractor you naturally attract more attention but have the same goals and ambitions to deliver the best care.”
Embracing the challenges
Millbrook’s strategy for reviving some of the wheelchair services it has taken on has followed a multi-pronged approach. At its heart has been heavy investment, driving efficiencies and boosting clinical capabilities.
In 2017/2018, Millbrook ploughed millions into supporting its contracts, with £2.5m being driven into staff, IT systems and facilities. Annette Cairns, director of wheelchair services at Millbrook Healthcare, confirms that the company has been making some serious investments in-house, with a particular leaning towards clinical governance.
“We’ve done lots of things,” Cairns says. “There is a national shortage of occupational therapists and rehab engineers. At Millbrook we are investing in ‘growing our own’. We take staff through the lower ranks and train them up.
“We’ve currently got some staff going through a university course who will either qualify as an OT or with a Masters qualification and they will continue to work in our wheelchair service. We’ve really made some quite radical changes to our clinical model.”
We take staff through the lower ranks and train them up. We’ve currently got some staff going through a university course who will either qualify as an OT or with a Masters qualification and they will continue to work in our wheelchair service. We’ve really made some quite radical changes to our clinical model.”
Campling is quick to reinforce Cairns’ point: “We shouldn’t undersell the fact that part of our investment has been in the clinical leadership. Under Annette’s leadership, we’ve assembled the most experienced clinical wheelchair therapists in the UK.
“For example, we have a clinical scientist and two very high-level OTs who provide clinical leadership across the depots. That enables us to offer support to the clinical teams and grow our own therapists. Clinical governance is absolutely key.”
We know what the challenges are and we’ve got our eyes very much open in terms of what is needed to turn those services around because we go in specifically to turn them around, that’s what we do”
The impact of some of the changes has been clear and rapid. For example, changing working practises has more than tripled capacity in some contracts, according to Campling.
Investment in IT has helped to develop Millbrook’s current systems, which provide clinical commissioning groups (CCGs) with a highly transparent view of what is happening within services. Campling says commissioners are given “granular-level detail around the demand, the complexities and the demographics of services”.
From the data supported by its IT systems, Cairns says that Millbrook has been able to develop its demand and capacity models. From that, it has been able to better predict its resourcing and funding requirements.
Knowing its funding requirements inside out is becoming increasingly important as more and more service-users necessitate more complex solutions. All providers are experiencing a greater demand for more sophisticated and expensive equipment, which has to be accounted for.
Cairns explains: “I think if you spoke to any commissioner they would admit that there can be a lack of real credible data at the beginning of a tender. We work very closely with them and have an open door policy so they come in and meet our staff and have a much better understanding of our wheelchair contracts.
“It is a huge learning curve and we have supported a number of commissioners who have gone out of their way to really understand what a wheelchair service contract entails, the complexity of it and the importance of the data.”
‘Integration is the future’
In addition to a focus on accurate data and close relationships with commissioners, key to Millbrook’s tendering strategy is its integrated approach to the care pathway. Most traditional NHS services are separated and some might have three different providers working on the same wheelchair service.
Campling outlines how his company was the lead innovator for integrated wheelchair services in 2011 and has since developed this vertical care model. The final piece of the integration jigsaw, he says, was developing its specialist seating division, which it completed when it purchased manufacturer Consolor last year.
“It’s changed the way conversations are held with the service-user and professionals. Technicians can talk to a clinician and converse about delivering care for an individual. That supports training, better outcomes, efficient services, and it’s the way forward.
“Eventually, wheelchair services may themselves get consumed by other services. Because those in receipt of wheelchairs are also often in receipt of community equipment, telecare and incontinence services.”
Campling says he is a “firm believer” that integration is the future and is aligning Millbrook with this view. Referring to the NHS’s recently published 10-year plan, Campling stresses a need for efficient and sustainable models to support an ever increasing demand and keeping people at home for longer. M
illbrook wants to be able to provide multiple care elements with a view to providing a better experience for users and a more affordable solution for commissioners. The company is therefore immersing itself in more spheres such as telecare and home improvements.
Campling comments: “That genuinely does set us apart from the others. We initially started in wheelchairs services in 1995 as an approved repairer, entered community equipment services (CES) in 2000 and grew from there.
“We entered the home improvement agency (HIA) space in 2015. We’re in the telecare space, we do minor adaptations, specialist seating, we manufacture our own products with Ultimate Healthcare and now we have Consolor.
“We are continually looking at how we can develop our services and if we’re sub-contracting something we look at how we can do it ourselves. We’re always looking at what other services commissioners are contracting and how we can make it a better experience for service-users by having one point of contact. We’re aiming towards a single service-user record throughout our IT system. It’s the only system that can work across all services.”
The single point of contact idea is one that has cropped up time and again with service-users, according to Cairns. In its service-user engagement process, Millbrook has found that people often struggle to navigate the care pathway and can get frustrated by having to phone various organisations to explain the same thing over and over.
Millbrook is clearly on the path to greater integration. Naturally therefore, we might assume it is targeting more acquisitions. But for Campling, growth does not necessarily go hand-in-hand with takeovers. Millbrook’s expansion has come from tendering and bringing in expertise, he notes.
“We got into HIA by bringing in the leaders of that space. We entered into the wheelchair space because we had that knowledge and it was the same in telecare. Our history shows we’re not a company that necessarily acquires.
“It’s planned in a way that when we want to enter a field, we bring in the expertise and then tender. What we’re very good at is working with commissioners to develop the services we have. The commissioner might say they want to develop telecare within a service we already provide so we work with them on that.”
Campling explains that Millbrook recently launched its own stairlift division which is growing quickly as a result of its HIA work. Its existing HIA team meant it already had good knowledge of ceiling track systems and so stairlifts were a natural extension of in-house technical expertise.
Campling says it is about leveraging the contracts it has to see how it can improve services and offer better value in a controlled way that ensures quality. Increasingly, commissioners are seeing the value of recycling equipment like stairlifts and so Campling identifies this division as a significant opportunity for Millbrook and its customers.
In another development, Millbrook exited the mobility retail space over a year ago after finding the model did not quite sit with its current set-up. Campling describes how the company put a conscious effort into creating some top-end retail facilities in the form of its MiLife concept.
It became clear, however, that the MiLife sites, based at its service depots, were not going to attract the footfall required for a viable retail model. Online retail is still very much regarded as an opportunity by Campling’s team and could become a new venture if the appropriate expertise can be brought in.
Driving sustainable growth
Millbrook Healthcare appears to be evolving quickly and has bold expansion plans which could see it enter more markets as it continues its strategy of integrating services.
Such a model will certainly appeal to commissioners in the near future as the pressure on NHS budgets continues. But considering the job it has on its hands to turn around the various contracts it holds, how sustainable are its growth plans?
According to Campling, the company’s structure has been set-up to deliver the contracts it has while looking forward and developing. He concludes: “We know what the challenges are and we’ve got our eyes very much open in terms of what is needed to turn those services around.
“Many of our services have had to go through a turnaround process so we know what’s required to support them. It’s a challenge we fully appreciate and we don’t underestimate it.
“In terms of the future for Millbrook Healthcare, we’ve grown considerably over the last 10 years. In 2008 we were turning over around £15m and this year we’ll reach c£120m.
“I don’t see our growth stopping. In a few years’ time I’d expect that to probably be around £200m, there’s no reason why not. We will continue to build our infrastructure to support the contracts.”
The tendering market will continue to gather momentum in the coming years as more services are outsourced to private contractors. The fact Millbrook is approaching this trend with a diverse mind-set to cover as many areas as possible places it in a strong position for sustainable growth.
Its management is under no illusions about the challenges it faces turning around the contracts it involves itself with. If it can overcome the various hurdles we could well see it increase its stature not only on the CES and wheelchair services stage, but other areas such as assistive tech, stairlifts and perhaps in time, even retail.