How To Scale A Healthcare Business When Facing Extreme Change

By Richard Taylor, BGF (

From one day to the next the goalposts change. The unpredictable nature of 2020 has made managing a healthcare business extremely challenging.

Since March, businesses in the care and domiciliary sectors have been fighting on all fronts – whether that’s having to contend with the ongoing lack of government funding, COVID-19 and the plethora of issues that have spawned from the global pandemic – namely managing cost base, testing, PPE, staffing and occupancy – and Brexit, which understandably comes far down the list of concerns in the current climate.

For many, it’s like being caught ‘in a hamster wheel’, with ‘COVID-free’ being tentatively spoken, while touch- ing wood. The issues facing the sector are vast and the pressures immense. But, despite this, the introduction of a vaccine roll-out is leaving some ‘cautiously optimistic’. The prospect of protecting residents and staff from the coronavirus by Spring 2021 will help to build confidence in the sector – one that has proven how vital it is in sup- porting the NHS and delivering safe clinical outcomes. It’s very much a confidence piece. With a vaccine in place, which will lead to renewed visiting plans and operational improvements, the market can finally take stock and focus on future growth – scaling up against a backdrop of extreme change. So, what are the biggest considerations facing healthcare leaders when it comes to growth in an unpredictable world.


Finding and retaining the right people is vital at any stage of growth, but the pressures being placed on healthcare businesses at the moment are significant. With an inability to move staff between services, due to COVID restrictions, fluctuations in staffing levels because of self-isolation, and additional costs associated with filling those temporary vacancies, employment is a key issue. Many see record unemployment in the UK as an opportunity to migrate high quality people from the service sector into healthcare to help plug that gap. However, Brexit will play its part, with concerns over what it will do to the overall talent pool. This has led to calls for the government to provide support to the sector, in terms of recruiting and employing overseas nursing staff.


Controlling costs is vital for any business looking to grow, but doing that during extreme change is incredibly challenging. Businesses are already facing the prospect of significant hikes in areas such as insurance, with operational costs increasing in order to deal with heightened processes. However, the growth in the self- pay private healthcare market, and a robust fee structure is likely to help offset a spike in costs in the short- term. The key lies in creating confidence and reassurance around the care system, which in turn will produce a shift in demand for services – occupancy levels play a vital role in enabling healthcare businesses to grow.


There’s little doubt that the sector will look somewhat different in a post-COVID world. No more so than in the size and type of players that will be left in the market. The appetite for financing small, non-purpose-built care homes is reportedly reducing, leading to questions about whether there will be an exodus in the next 12 months. With every challenge comes an opportunity – opportunity to provide a service in a vacated area and opportunity to achieve growth through acquisition.

There can be little doubt that COVID-19 will continue to pose a very clear challenge to the healthcare sector for many months to come, with the prospect of further change still a distinct possibility. Robust testing, a widespread vaccine roll-out, a reassessment of fee rates, keeping a close eye on cost base, and managing changing staffing levels, will remain firmly on the agenda in 2021. But, alongside that, the opportunity to scale-up in amongst extreme change is still a real possibility for many as we enter a new year.

Richard Taylor heads up BGF in Yorkshire and the North East. To date, BGF – the UK’s most active investor in growing companies – has backed 42 companies in the healthcare sector with a total of £230 million invested and seven exits to date. Portfolio companies include Pharmacy2U, Springfield Healthcare, Dolphin Homes and CHS Healthcare.

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