Critical Care
Our Market
Our Critical Care business, Bush & Co., provides vital support services for 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 lifecycles 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 lifecycles make the market more resilient and predictable. The key to growth is in attracting experts and case managers with the right level of expertise, and geographical coverage to deliver our services. Bush & Co. has had success in growing our capacity in recent years, aided by offering additional training, mentoring and Continuing Professional Development (CPD) to attract new associates as well as directly employing case managers.
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, which may lead to ongoing case management support for the client’s rehabilitation. This typically 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 more complex cases and children and young people (CYP).
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 90 clinical professionals across the UK. In 2023, expert witness services continued its impressive growth, with new instructions growing by 9% compared to the previous year and achieving its highest ever number of new enquiries (+13% compared to 2022). This resulted from the quality of our recruitment and our focus on experience and key specialisms, such as midwifery and speech and language therapy. We continue to receive excellent feedback from solicitors on the standard of our expert witness reports, the credibility and knowledge amongst our associate network and the reliability of our service.
We launched Bush & Co. Care Solutions in 2021, as a care management service for the direct employment of support workers and nurses in the home. Since then, it has grown rapidly with solicitor and deputy customers attracted by the high levels of governance and clinical care demonstrated by the service.
Our investment case and business model
Bush’s business model is built on three pillars:
- Strong and diverse customer relationships with over 400 clients across the legal, insurance, clinical and charity sectors;
- A wide range of competencies and specialisms creating revenue realisation opportunities throughout the multi-year rehabilitation process;
- 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.