Debt, policy shifts and private equity reshape Britain’s care home sector
“You can’t, in this business, just make profits. You’ve got to take into account something more important: people’s lives.”
On a spring morning in 1987, Robert Kilgour, then 30, arrived in Kirkcaldy on Scotland’s east coast to inspect a derelict Victorian property he had recently purchased. The four-storey sandstone building, Station Court, had been intended as a residential development project.
That plan faltered when a Scottish government grant scheme for developers was withdrawn, leaving Kilgour with a largely unusable asset and depleted personal savings.Facing financial pressure, Kilgour pivoted. Drawing on his experience in hospitality, he concluded that care homes shared operational similarities with hotels.
In June 1989, after securing bank financing, he converted the property into a care facility and launched Four Seasons Health Care, naming it after a restaurant he had visited in New York.The timing proved advantageous.
In 1990, the UK government began transferring responsibility for social care provision to local authorities, which increasingly outsourced services previously delivered by the National Health Service. This policy shift created a growing market for private operators. Kilgour expanded rapidly, opening additional homes across Fife and nearby regions.
By 1997, he owned seven care homes and had begun to build a regional presence.Kilgour’s business growth coincided with broader structural changes in the care sector. Local councils became key purchasers of care home beds, and demand rose steadily.
Alongside his business activities, Kilgour engaged in charitable work and explored political ambitions, although he was unsuccessful in attempts to enter Parliament.
In the late 1990s, Kilgour sought to scale the business beyond Scotland. He partnered with accountant Hamilton Anstead, who joined Four Seasons as joint chief executive. Over approximately two years, the company expanded to 43 care homes across Britain.Despite the growth, tensions emerged between the two executives.
Anstead later indicated that differences in management style contributed to the strain, with Kilgour focusing on strategy and external engagement while Anstead concentrated on operational detail. In 1999, the founders agreed to sell the company to private equity firm Alchemy Partners, intending to remain involved post-acquisition.
Shortly after the deal was completed, Anstead informed Kilgour that neither he nor the new owners wanted Kilgour to continue in an executive role. Kilgour later said he was exhausted at the time and prepared to leave, though the departure marked a sharp break from the company he had founded.
Alchemy sold Four Seasons in 2004, beginning a series of ownership changes that would define the company’s subsequent trajectory. The business passed to Allianz Capital Partners and later to a Qatari investment fund. Over this period, debt levels increased significantly, reaching an estimated £1.56 billion by the time of the 2008 financial crisis.
When refinancing options narrowed, control shifted to creditors led by the Royal Bank of Scotland.The company’s ownership structure grew increasingly complex. By 2016, forensic accountants at the University of Manchester reported that Four Seasons consisted of 185 companies arranged across 15 layers, describing the organisation as opaque and difficult to analyse.
The report argued that such structures reflected broader changes in corporate financing practices.Ros Altmann, a Conservative peer who has studied the care sector, said investors had introduced financial models that prioritised debt over equity.
She described the process as “financial pass-the-parcel,” adding that there were limited constraints on leverage despite the essential nature of the services provided.In 2012, private equity firm Terra Firma acquired Four Seasons for £825 million, funding the purchase with £325 million in equity and the remainder through borrowing.
The firm’s strategy was to position the company as a reliable, large-scale provider of care services to local authorities. However, the business continued to carry substantial debt, with annual interest payments of around £50 million.The financial model relied in part on stable or increasing public funding.
In 2015, the UK government announced plans to reduce public spending by £55 billion, a policy that translated into tighter budgets for local authorities. These constraints limited the fees councils could pay for care home placements, placing additional pressure on operators.Guy Hands, founder of Terra Firma, later said the firm had misjudged government policy.
He stated that the expectation had been for increased support for the care sector, particularly given demographic trends and political considerations, but that funding instead declined.As financial pressures intensified, concerns about care standards emerged.
Advocacy groups reported recurring issues in some facilities, including inadequate staffing and failures in basic care provision. One case cited by a coroner concluded that a resident had died “for want of care.”Eileen Chubb, who runs a charity supporting whistleblowers in the care sector, said her organisation was assisting hundreds of employees at any given time who had raised concerns about conditions in care homes, many operated by private equity-backed firms.
She reported frequent accounts of residents not receiving adequate food, hydration or hygiene support.Regulatory oversight also faced constraints. The Care Quality Commission, the statutory regulator in England, experienced budget and staffing reductions between 2016 and 2020. Over the six years to 2024, in-person inspections of care homes declined by approximately two-thirds, according to available data.
At the same time, costs for privately funded care rose sharply. Weekly fees in some homes exceeded £1,700, limiting access for individuals without significant financial resources or property assets.
Kilgour, who later returned to the sector with new ventures, said he had declined approaches from private equity investors despite offers of substantial funding. He cited the experience of Four Seasons as a reason for avoiding similar partnerships in future.
