In this article we hear from STEPS Rehabilitation co-founders, sisters Jules Leahy and Toria Chan and their father, Ray Boulger, about how STEPS has blossomed from a seedling of an idea, into the ground-breaking facility that it is today. This very personal account explores the challenges they have overcome along the way, what makes the job so rewarding, and their future plans.

Deciding to establish a facility like STEPS must have taken an incredible amount of planning and dedication. What was your motivation, and has your motivation changed in any way?

Ray Boulger, Chairman: “10 years ago Jules and Toria were keen to start a new business together and initially my involvement was limited to discussing the financial viability of their ideas. They didn’t have any savings to put into any new venture but my wife and I and a friend of Jules’ did. There was an obvious motivation to back our daughters but I would not have been very interested in investing in a “me too” business. However, as a Chartered Physiotherapist Toria was acutely aware of the shortcomings of rehabilitation provision not only in Yorkshire, but also many other parts of the UK. This provided the initial kernel of an idea for a new business that had the potential to meet two key criteria: (1) Providing a socially useful service that filled a gap in the market and (2) Sufficient demand at an economic price to be financially viable.”

Toria Chan, Clinical Director: “The motivation came from seeing first-hand the lack of provision for patients being discharged from hospital before they had recovered sufficiently to manage at home, or being discharged to a nursing home (regardless of their age) with minimal rehabilitation.

Our research revealed there was particularly a need for specialist residential rehabilitation from 16 years upward, where everything could be accessed ‘under one roof’, and which could support a wide range of conditions. Creating a facility that would be a temporary home as well as a place that people could receive specialist and intensive rehabilitation was our motivation.

Jules Leahy, Business Development Director: “The basic motivation behind setting up STEPS hasn’t changed; but our motivation has evolved as we’ve identified new opportunities along the way. Where this has meant working with other businesses, it’s been really important to us to work with organisations and people who share our ethos. We were all very motivated to create a place we would choose for our loved ones; one that did not feel clinical, or like a hospital or care home.”

You overcame many significant challenges in order to build and open STEPS.

What do you regard as your biggest challenges in running the facility, and how do you tackle them?

Jules Leahy: “The first significant challenge was to convince someone to fund us to build STEPS. We spoke to many banks who loved the idea but as they couldn’t model our business on anything already out there, we didn’t fit into a regular box so were unable to help us. During the many months of searching for a lender we used the time to continue our research, as well as work with our architects to design the building, and connect with referrers and industry experts. We attended conferences and any event we thought we could meet people who we could learn from, help us to create STEPS.”

Ray Boulger: “Although our project ticked potential lenders’ boxes in terms of the concept, we were the exact opposite to a dream client for a development loan from most lenders. The initial equity we had raised plus a Regional Growth Fund grant were sufficient to enable us to pay for the land, pre commencement professional fees and some initial ground work. As a result the loan to value we required to fund the building was OK, albeit at the top end of the range for a development loan, but a big red line for most lenders was that none of the founding directors had any experience in developing a property.

However, as so often in life, personal contacts can make a big difference and we managed to secure a £3.4m loan, which was 100% of the projected build cost. Funding having been secured we were able to start the build in February 2016, but there were several complications with the site and the build was completed in April 2017. We had many challenges during the build stage that nobody could have predicted which meant we incurred a very significant increase to our build cost. We were lucky that we had a very understanding contractor, NCS, who worked with us through the many, many hurdles.”

Jules Leahy: “We had to keep going and work as though it would all turn out as planned and not give up and that is what we all did, despite some doubting we could make it work and even going so far as to tell us it wouldn’t work. There were times we thought maybe they were right and that was why nobody had done this before. However because of our 4 years of research, we knew that there was a huge need for somewhere like STEPS. Family and friends had trusted in us enough to invest and lend money. Plus the 3 of us had put all we owned against the business, so we HAD to make it work, and would do whatever it took to make that happen!”

Toria Chan: “Over the years we have faced more challenges than we could have ever foreseen, and many a time questioned if we had aimed too high! However, there was always something or someone that spurred us on.

One of the biggest challenges running a 24/7 facility is that switching off is virtually impossible. Therefore developing a strong management team to provide support, and to ensure that when we are not present, we can feel confident that things will still be in safe hands has been vital. Starting a business like STEPS from scratch means that we have had to develop everything needed to operate the business – there was no blueprint which we could copy.

There are multiple policies and procedures required to be in place for a CQC regulated business; these need regular review, particularly as we are evolving at speed! Maintaining the high standards we have set across the business as we have grown has needed a consistent approach, and ensuring all the new members of the team joining STEPS understand the STEPS story, and how important the values are, we believe is the best way to do this.

You’ve now got several years’ experience and expertise under your belt. Do you feel that you’ve now realised your original vision of what you wanted STEPS to be?

Ray Boulger: “I think it has already gone beyond our original vision, which I consider to be one of our successes in just over 4 years of operations. For example, we are now treating clients with a much wider range of rehab requirements than we originally envisaged. There are few things more satisfying than seeing clients who came into STEPS with serious rehab needs leave us after achieving a major life changing improvement in the quality of their life, which of course also improves the quality of life for their partner and family.”

Jules Leahy: “We’re lucky to have built up such a wonderful team whose talent allows us to offer a very unique service. We very carefully designed our building to create a space that would enable a sense of community, a space that didn’t feel clinical and we’re deliberately hands-on to ensure that we develop the culture and atmosphere we wanted for our clients. Despite having no experience in setting up a multi-million-pound rehabilitation facility we are extremely proud to have managed to hold onto that vision.”

Toria Chan: “We have had to learn a lot along the journey and work in all areas of the business, days, nights and weekends, and have many amazing people around us who have supported us every step of that journey. We have realised the original vision of creating a specialist rehabilitation centre and developing a reputation nationally and beyond. However, our vision for STEPS was to continually grow and improve our offering. The range of consultants and specialists is wider than we originally envisaged, which has allowed us to develop more expertise in spinal injuries, offer a unique residential amputee programme, a specialist pain management programme, our STEPS training school, and new ideas yet to be revealed!”

It’s clear from your website that you are constantly looking to innovate and deliver the very latest in rehabilitation therapies. How do you keep abreast with developments to maintain your reputation as a centre of rehabilitation excellence?

Toria Chan: “Being aware of new techniques from emerging research and development, and new products on the market, is key to enable us to keep abreast with developments within our industry. Through our established links with universities and our partnerships with several companies at the forefront of innovation, including Fourier and Mind Maze, we are able to do this. We have also built many strong relationships with different suppliers who are keen to work with us, which has enabled us to trial new equipment, often before it is available on the market.

We have a very experienced team of clinical professionals who all bring knowledge, expertise and passion to drive the innovation at STEPS, which is another vital ingredient required to achieve clinical excellence. This allows us to explore new ideas such as using biozoon technology (instant flavoured air) to improve quality of life and as part of dysphagia management, combining hypnotherapy and acupuncture for pain management and using wearable metronomes in our amputee balance group jointly run with physio and Neurologic Music Therapy. We are always looking for ways to continually improve outcomes for our clients”

Despite the inevitable restrictions and challenges brought about by Covid, in 2021 you’ve been able to deliver on several ambitious projects. Tell us about them.

Jules Leahy: “The more clients we’ve worked with, the more we’ve been able to understand what robotic equipment they could benefit from. Over the past 12 months we’ve spent time researching the robotic and VR rehab market. We’re now the first RehabHub in the UK and 2nd in Europe, and we’re also one of just 3 facilities in the UK to have a MindPod. We’re thrilled that this equipment is now available for clients to use alongside the wide range of other therapies we offer.”

Toria Chan: “Our training school, also new for 2021, was a very natural development for us as we were already working closely with external professionals, appointed care teams and families to make the transition home for a client as smooth as possible. We were frequently being asked to deliver training by NHS commissioners and case managers for the care teams they had recruited, to enable them to meet each individual’s unique complex care needs. With Darren, our Clinical Nurse Educator, alongside Jennie, our Transition of Care Lead, we were in a position to develop this into a more formal offering, and we opened our Training School. We are also excited to get involved with the evaluation testing stage of a newly developed piece of robotic rehabilitation equipment in collaboration with the Advanced Wellbeing Research Centre (AWRC), being the first place to test it on clients as part of the efficacy trials.

The sense of community and positivity is something that strikes everyone who visits STEPS. It’s also a family-run business and you’re helping clients and families face the most difficult and challenging time of their lives. Does being a family-run business help to create the right atmosphere? How do you create that atmosphere, and why is this so important to clients?

Jules Leahy: “As a family business we care about everyone who is a client or a team member. Because we are in STEPS daily, we care very much about the little things as well as the big picture. Some of our own family members work in the business, the youngest being 19 years old and the oldest 76 years old! STEPS’ building is named after Alexander, our brother who tragically died in a road traffic accident, and our baby grand piano in our music room was the piano he used to play growing up. We didn’t set up STEPS to not manage the service ourselves, we have always wanted to make sure the service was the vision we had for a truly client centred rehabilitation facility.”

Toria Chan: “The design, look and feel of the building is deliberately homely and non-clinical. We believe this is very important for clients and families who have typically spent many months in a hospital where they have limited privacy and often can’t even eat together. Creating a team of like-minded people who share the same philosophies and values as us is absolutely crucial for our success, and we believe it is this that enables us to have the amazing atmosphere that we do. Our team go above and beyond to make the client experience at STEPS as amazing as possible. They often burst into song or dance to make someone smile; there is always someone to have a chat or play a game with and many bring their pets in, which engages clients in a very special way; Bailey (one of the Physio’s dogs) is now very much part of the STEPS family! It is most definitely a team effort.”

Ray Boulger: “In any business, staff selection is an important factor for success, but in STEPS it is vital. At STEPS there are no back-room persons; every staff member, clinical and non-clinical, works with our clients (and may also liaise with their family and friends on visits). Therefore, as well as appropriate skills staff must have the necessary soft skills and the STEPS ethos to fit in with the rest of the team.

We are keen to invest in our staff by supporting career development and some are currently on apprenticeship programmes for a related qualification.”

Your expert staff are key to the success of STEPS. Managing such a large team (include in your answer how many staff you have) who have such a wide range of skills/expertise can’t be easy. How do you ensure a coordinated approach between them all to ensure that clients receive the very best combination of rehabilitation care?

Toria Chan: “We now have over 140 people in our team, which has grown very fast across all departments. Our Heads of Department and Leads are the key to making this all work. Selecting the right people for these senior roles in STEPS has been the key to our success. We have always strived for an interdisciplinary team that works in a truly collaborative way and this hasn’t happened easily. It has taken a lot of hard work, trial and error and a huge amount of perseverance and patience for everyone. We are always looking for ways to improve the client experience and so we never stand still!”

What’s the most satisfying part of your job?

Ray Boulger: “Seeing the improvement that STEPS makes to clients’ lives has to be top of the list but it is also lovely to receive so many positive comments from clients, clients’ family, case managers and solicitors. These comments, whether by email, letter or card, are really appreciated by the STEPS team members and help to keep them motivated.”

Jules Leahy: “The most satisfying part of our job is being with our clients and their families, seeing them achieve their goals, hearing a family member say things like I don’t know where we would be without STEPS, you have changed our lives, and seeing them leave to go back to their own home, often over a year after their injury. We have now helped rehabilitate over 200 people and this is something we are immensely proud of.”

Toria Chan: “Like dad and Jules, I love seeing first-hand the impact STEPS has had for clients and their families. Watching clients leave for home, with newfound enthusiasm to continue the next stage of their rehabilitation journey, is really rewarding and it’s lovely when clients come back to visit or send us pictures or videos of their progress once they have left us.

I also love working with the team, and seeing them grow and develop, and progress within the company, or where we have been the launch pad for them to gain a university place to train for their chosen career such as nursing, physiotherapy, occupational therapy or to be accepted for a psychology doctorate and more!”

Has there been any standout moment at STEPS for you over the past few years?

Jules Leahy: “Winning Awards, in particular the Rehabilitation Provider of the Year at the Personal Injury Awards for two years running in 2018 and 2019 when we were still a very young company, was a standout moment. Not for vanity reasons, but mainly because at that stage of our development, peer endorsements and industry recognition were very important as it significantly enhanced awareness of STEPS with case managers and personal injury solicitors.”

Toria Chan: “There are so many standout moments…it is really hard to pick one! Some that I treasure are: seeing one of our clients walk in our hydrotherapy pool holding her baby daughter for the first time; seeing one of our older clients walk out of STEPS and return to her own home in the Lake District after she was told she would need to move to a nursing home. Another was learning that one of our young clients, who had suffered a stroke, had completed his degree after leaving STEPS and gone on to get a fantastic job.

Staff related standout moments include supporting one of our rehabilitation assistants who joined us when we first opened, to develop her skills and be accepted to study a masters in occupational therapy, alongside continuing to work part time with us. She then went on to get her first job as an OT, and we have now just appointed her back to the STEPS team as our first junior OT!

Ray Boulger: “Part of my role has been negotiating the loans STEPS needed initially to build our facility and for working capital. When we opened in May 2017, we had a development loan of £3.4m with interest at 1% per month. Jules, Toria and myself all had to provide the lender with a joint and several personal guarantee (PG) for the whole £3.4m. It was a priority to refinance this loan at a cheaper rate as soon as possible, preferably with less onerous PGs, but unlike tech companies, where long term losses seem to be a badge of honour, to do this we had to demonstrate we had built a sustainable business and it takes time to take a new business to profitability.

The standout moment on the finance side was early October 2020 when we completed the refinancing of our £3.4m mortgage; this reduced our interest costs by 70% and also meant that Jules, Toria and myself were no longer personally on the hook for £3.4m!”

What has building and running STEPS taught you about human nature? Has this impacted your thinking and approach to life in any way?

Jules Leahy: “Building and running STEPS has definitely changed us in many ways. The build and first 2 years were nail biting and very scary but we knew what we were doing was the right thing and never doubted that. There were times we were exhausted from working 7 days a week and then we would see a client walk for the first time or propel their own wheelchair and that’s what would keep us going. Along with the incredible support we had from our family and friends around us. We have made many new friends on this journey too, and these are people who, like us, see the need for this type of rehabilitation and understand why we have built STEPS.”

Toria Chan: “So many of our clients inspire us with their determination and positive attitude despite their serious injuries. Working with clients who have all been through such traumatic experiences can’t fail to change the way you look at life. We know that life can change in the blink of an eye, and you really do never know what is around the corner. Life is very precious, and we are reminded of this every day in our building.”

“The other amazing thing has been the amount of people who have believed in us and supported us in so many ways. From working for us for long periods of time not knowing if they would be paid, but believing in us enough to take that chance, to people offering us support and advice for free. We’ve been guests of others at key industry events when we were not at a stage financially to attend under our own steam. I’ll never forget the many acts of kindness shown to us all.”

What are your plans for the future?

Toria Chan: “We have plans to develop more specialist rehabilitation programmes with the benefit of the new robotic tech we have invested in. The opportunity to engage in leading edge research with both Sheffield Universities and the AWRC is really exciting. Our partnerships with MindMaze and Fourier Intelligence open up opportunities for cross centre research and development nationally and internationally. This should provide an opportunity for some of our clients to be early beneficiaries of new developments in rehabilitation, particularly in robotics, as well as in the longer term providing wider benefits for many others who will need rehabilitation.”

Ray Boulger: “Our next major expansion will be to build on land we own opposite our current building. Based on the experience we have gained since opening in 2017 we are reviewing which of our services would benefit from more capacity and what complementary services we could offer.”

Jules Leahy: “We are really excited about the future and the prospect of further expansion. One thing we know for certain is that after all the challenges that have been thrown at us, we have the resilience and passion to make it happen!”