Priory boss expands rehab services as ‘long Covid’ cases rise

For André Schmidt, the new boss of the Priory, the coronavirus pandemic has created an opportunity to expand the group’s rehabilitation services.

The chief executive of Germany’s Median, responsible for running Britain’s biggest chain of mental healthcare clinics, plans to extend its rehabilitation services to “long Covid” — long-term effects from coronavirus infections — and other physical conditions such as strokes and hip operations on top of its mental health and addiction programmes.

His plans come after Median’s private equity owner Waterland bought the Priory for £1.08bn in December. The buyout group, which will own 570 clinics in Germany and the UK, has ambitious plans to become the largest provider of mental health and rehabilitation services in Europe.

Schmidt argues that a greater focus on rehabilitation and early intervention prevents illnesses from becoming chronic and saves costs in the long run.

“In the UK, people are transferred home from hospital within days of a heart transplant,” Schmidt said. “This would never happen in Germany where the patient would have a four-week stay in hospital followed by psychiatric treatment.”

Any UK expansion requires support from the NHS, which provides 90 per cent of the Priory’s revenues, he added.

With long Covid cases climbing above 1m in the UK, according to the Office for National Statistics, Schmidt says there is a need for additional capacity for people suffering from the condition.

In Germany, Median opened a long Covid clinic just over a year ago and has treated 600 patients, including a number of young people who originally suffered only mild symptoms and then began experiencing neurological problems months later.

Median’s toolkit of therapies for long Covid includes techniques used to treat dementia patients such as memory games, simple maths puzzles as well as origami and pottery that improve hand-to-eye co-ordination.

Demand for mental health treatment is also rising sharply. Schmidt expects it to increase further over the next two years, comparable to the rise seen in the aftermath of the 2007-08 financial crash, when a struggling economy caused a surge in depression and addiction.

The Royal College of Psychiatrists is already warning the country is in the grip of a mental health crisis related to the pandemic that is “likely to get a lot worse before it gets better”, with a surge in the numbers needing psychological emergency care.

The number of children and young people in need of psychological emergency care jumped 18 per cent to 18,269 between April and December last year, while the number of adults needing such treatment reached a record high of 159,347, according to the RCP.

To deal with the unfolding crisis, Schmidt proposes the Priory provide remote services including apps and a 24-hour telephone help line that could enable nurses to provide ongoing care to patients returning home from hospital.

“People often find that once they return home, the depression rises again, but if you can continue providing care, that subsides,” he said, adding that this would not replace inpatient beds, which remain a crucial part of treatment.

The Priory’s purchase was almost entirely financed through the sale and leaseback of 40 of the group’s hospitals to a US property fund, the Medical Properties Trust.

The agreement burdens the Priory, which already leased about 20 per cent of its properties, with significant rental costs of about £50m a year, and a minimum annual increase of 2 per cent. 

Health commissioners are concerned that the rental costs will put pressure on the business and force it to raise the fees it charges the NHS, which uses it for about 10 per cent of its mental health patients. In 2012, the care home chain Southern Cross collapsed after failing to pay rent.

According to LaingBuisson, the healthcare statisticians, profitability among providers in the sector has declined even though NHS fee rates appear to have remained stable, though there is little transparency.

But Schmidt argues that its landlord is also a minority shareholder, so has a vested interest in the success of the business. A shortage of beds for mental healthcare patients in NHS hospitals should also prevent any sudden drop in demand, he said.

The biggest inflationary pressure across the sector is staffing, where there is a nationwide shortage of doctors and nurses, and medics have been quitting to take on temporary work through agencies, which requires fewer responsibilities, Schmidt said.

Recruitment from China and the Philippines is one solution to the staffing shortage, but the government should also intervene to stop all hospitals relying on agency workers, he added.

“This money goes from taxpayers’ pockets direct to agencies and it’s not coming to services. Someone has to take this on politically as this is where the inflation [rising costs for staff] is coming from.”

An increase in permanent staff would also help improve care quality, he argued. In March, a facility at a Priory hospital in Sussex was told to show improvement after staff were found to have used “disproportionate” levels of restraint, including “unauthorised techniques”, such as when a patient was pushed to the floor, according to the Care Quality Commission.

Schmidt would not be drawn on this case or any others, which predates the takeover — to be completed later this year — but Priory Healthcare said it had “taken immediate action to deliver improvements”.

In Germany, he said, there were fewer but larger hospitals and they employed permanent staff. This enabled lower patient-to-staff ratios, while the quality of care was maintained.