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Critical Care

Our Market 

Our Critical Care business, Bush & Co, provides vital services supporting individuals who have suffered severe and life changing injuries whilst they pursue a compensation claim. Bush & Co holds a leading position in the medical reporting and rehabilitation market, itself a subset of the catastrophic injury 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.

Catastrophic injuries are usually complex resulting in long case life cycles and the majority of clients will require the services of an expert witness and around half will use a case management service to support their rehabilitation. These long life cycles makes the market more resilient and predictable.

Case management services usually begin when a client’s solicitor instructs Bush & Co to conduct an Initial Needs Assessment. Assessments are typically carried out three to four months after an injury occurs. The outcomes are documented in a report and this may lead to ongoing case management support for the client’s rehabilitation, which has an average life cycle 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. This timeframe extends significantly when working with children and young people; an area of specialism that grew at Bush & Co in 2022 with an expansion of the number of case managers taking on this case load to over 30.

Expert witness instructions typically happen much later in the process, on average around three years from the date of the accident. Established over 35 years ago, our expert witness service is made up of over 70 clinical professionals across the UK. Due to the time taken to instruct from the date of accident, it was previously unclear whether the full impact of the pandemic had been fully realised in relation to expert witness instructions. Our analysis shows that we have gained market share in recent years and instruction volumes are ahead of those periods before the pandemic so we do not expect a lasting impact on expert witness volumes.

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;  
  2. A wide range of competencies and specialisms creating revenue realisation opportunities throughout the multi-year rehabilitation process;  
  3. 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.  

We continue to invest in technology to drive efficiencies through updating back-office systems and we continue to explore the opportunities offered by adjacent markets. Our Care Quality Commission regulated Bush Care Solutions service continues to grow following its launch in H2 2021. This service provides a support and management service for directly employing support workers and nurses within the home. This compliments our case management service allowing us to offer clients a fully managed solution and also attracts standalone work.