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Critical Care

Our Market 

Our Critical Care business, Bush & Co (Bush), holds a leading position providing legal support services in the Catastrophic Injury market, itself a subset of the Medical Reporting & Rehabilitation market. The Catastrophic Injury market is defined as those cases involving the most severe and life-changing injuries, with settlement values of £500,000 and above. We calculate that prior to the COVID-19 pandemic, our target market was worth £107m, with around 6,500 catastrophic personal injury claims made in a typical year. Whilst not all of these claims are subject to the full suite of services provided by the sector, most require the services of an Expert Witness and around half will use a Case Management service as part of their rehabilitation. 

The market had grown steadily over the five years prior to the COVID-19 pandemic, with a compound annual growth rate of 2%. Case numbers had remained broadly flat, with a slight decline in the number of serious road traffic accidents offset by modest growth in medical negligence and workplace injuries. COVID-19 saw the number of serious accidents contract due to a reduction in vehicles on the road, people in work and a delay in non-urgent medical procedures.  

The complexity of catastrophic injuries results in long case lifecycles, which makes the market more resilient and predictable. Within Case Management, instructions for Initial Needs Assessments are typically made 3–4 months after an injuryd. Ongoing case management support for rehabilitation has an average lifecycle of over two years, meaning that in any given year more than half of the cases under management relate to accidents suffered in previous years. Expert Witness instructions are typically received once a case is well under way, which is often more than three years from the dates of the accident.

Our investment case and business model 

Bush’s business model is built on three pillars: 

  1. strong and diverse customer relationships with over 400 clients across the legal, insurance, clinical and charity sectors;  

  1. a wide range of competencies and specialisms creating revenue realisation opportunities throughout the multi-year rehabilitation process;  

  1. focused investment in technological innovation and expansion into adjacent segments of the market, steered by our Innovate – Optimise – Grow strategic framework 

Consequently, Bush delivers robust and predictable financial performance with a mix of new and recurring revenues providing high visibility on cash flow over the multi-year life of a case. Bush provides vital services to support individuals who have suffered severe and life-changing injuries whilst they pursue a compensation claim. Typically appointed early in the case lifecycle by a claimant’s representative (e.g. a law firm, or insurer), we manage catastrophic injury cases for claimants from injury to rehabilitation with an average lifecycle of 26 months through our network of Case Manager and Expert Witness Associates, who are exclusive to Bush in this sector. We are also engaged later in a case lifecycle (an average of 36 months post-injury) by lawyers on either the claimant or defendant side to provide expert assessments and reports used by the court to determine both liability and claim size.  

Through the deep and long-term relationships that we have built with our clients we command a prominent and market-leading position in case management and have grown to become one of three leading players in the expert witness sector. Through the combination of our core competencies in case management and expert witness, and the coverage this affords of the case lifecycle, our business model provides a mix of immediate and recurring revenue which in turn provides predictable, highly visible cash flows.  

Investments in marketing, technology and capability through the Innovate – Optimise – Grow framework have given the business a track record of strong top line growth, consistent market share gains, and operating margin expansion. We have also identified significant growth opportunities in expert witness and are seeking to develop our capabilities in key specialisms. 

In 2021, our investment in technology included the successful launch of our proprietary report writing tool for expert witness reports, in April 2021. This tool helps to streamline the production of reports and enhances quality, whilst delivering savings as demand grows.  

2021 also saw the launch of our differentiated case management proposition for serious injury claims valued at between £100,000 and £500,000. This service utilises employed case managers and technology solutions to deliver outcome-driven solutions for our larger customers. 

We also entered the adjacent care market with the launch of Bush Care Solutions in September 2021. Having achieved accreditation for TDDI (Treatment of Disease, Disorder or Injury) from the Care Quality Commission, Bush Care Solutions is able to offer nurse-led care management services to support rehabilitation in a client’s home. The introduction of this service complements Bush & Co’s existing case management offering and enables us to offer clients a fully managed solution.