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Domiciliary Care (Industrial Report) - UK - October 2014

“Domiciliary care services have always been preferred to other forms of care, especially for elderly people, as remaining in their own home and being able to have as much control over their own lives as possible maintains their independence. Recent high-profile care home scandals, highlighted by Panorama investigations and reinforced by other media outlets, have strengthened the public’s preference of receiving home care and this has seen significant increases in demand for domiciliary care services.”
– Lewis Cone, Research Analyst

This report will answer the following key questions:

  • What are the key determinants driving the domiciliary care industry?
  • Did the market suffer in any way from the financial crisis and how has it recovered since? Have there been any fundamental changes as a consequence?
  • How have UK governments influenced and shaped the development of home care in each respective country?
  • Are there any major regional differences in the UK when it comes to the provision of domiciliary care services?
  • What are the key issues the industry needs to address to be able to fully benefit from any favourable market conditions and future trends?
  • What does the future hold for the UK’s domiciliary care industry?

The market for domiciliary care covers a broad range of healthcare services provided in the home. This ranges from home help services, such as assistance with shopping, ironing and cleaning, through to the provision of meals and assistance with rising and retiring, as well as high-tech healthcare provision. Much of the market involves the supply of such services to the elderly, but receivers of domiciliary care also include people with long-term illnesses and disabilities, as well as those recently dismissed from hospital care.

This report covers the provision of domiciliary care services by a range of organisations including:

  • Local authority provision, including the supply of meal services, day centres, occupational therapy and consumer monitoring, social alarms and telecare. Local authorities purchase domiciliary care services through a range of service providers including direct purchase of LA providers, voluntary services, which are operated by charities and religious organisations registered with the LA, and through private service providers
  • Private purchase of domiciliary care, including informal care, includes the provision of services purchased directly either by, or on behalf of, the customer. Typically, this includes private clients who are either ineligible for LA domiciliary care provision, those who prefer a private provision rather than LA services, and those who are topping up LA packages
  • NHS community health services, including care related to the early hospital discharge and rehabilitation of patients and the provision of high-tech domestic healthcare and healthcare services. This includes community nursing services providing direct nursing services such as control of incontinence, drug administration and some forms of social care; community psychiatric nursing; community learning disability services; specialist nursing such as HIV, terminal care, continence and ostomy care, as well as occupational therapy, physiotherapy and chiropody services. Community health and para-medical services are typically purchased by health authorities or GP fund-holders and are provided by community NHS trusts
  • Informal domiciliary care refers to care normally provided to individuals requiring low intensity care and is frequently used to supplement LA and private domiciliary care. Informal carers often help with daytoday tasks, such as shopping, housework, ironing and gardening. The sector includes individuals who offer services and assistance typically in local newspapers. Friends and family, predominantly women, offering companionship also represent a marginal proportion of the informal domiciliary care market. Reliable, official data on the value of informal care is scarce, thus an evaluation of the market is subject to interpretation, particularly with regard to the hourly value of informal carers’ time.

This report also examines the relatively new telecommunications-based care services offered throughout the UK. The terminology of this sector is still being determined, with telecare, telehealth, and telemedicine often used interchangeably. Indeed, many services offer some overlap between the three. For this report the following definitions are used:

  • Telemedicine has been used for the longest period of time, and is defined by the World Health Organisation as ‘the practice of medical care using interactive audio visual and data communications. This includes the delivery of medical care, diagnosis, consultation and treatment, as well as health education and the transfer of medical data.’
  • Telehealth is the provision of health services at a distance using a variety of technologies, including telephone services, such as NHS 111, and video consultations between patients and clinical professionals.
  • Telecare is the remote delivery of health and social services to people in their own home by means of telecommunications and computerised systems, typically referring to alarms and detectors that provide continuous remote monitoring of emergencies and routine changes, using the information gathered to trigger human or electronic responses, such as initiating an emergency visit from a carer or alerting a nearby family member via pager.
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Table of contents

  1. Executive Summary

      • Market size
        • Figure 1: UK market for domiciliary care, 2009/10-2013/14 (£ million)
        • Figure 2: Segmentation of the UK domiciliary care market, by type of purchaser, 2009/10-2013/14 (£ million)
      • Market trends
        • Figure 3: Segmentation of the UK domiciliary care market, by type of purchaser, 2009/10-2013/14 (£ million): UK population projections, by age group, 2012-2037 (million people)
        • Figure 4: Number of contact hours of home care provided in the UK, by sector, 2009/10-2013/14 (million hours)
        • Figure 5: Local authority domiciliary care expenditure for all adults, by age category, 2009/10-2013/14 (£ million)
      • Regional analysis
        • Figure 6: Number of domiciliary care service users per 10,000 adults, by region, 2009/10 and 2013/14 (no. of clients per 10,000 adults)
      • Market factors
        • Demographic trends will provide constant source of demand for domiciliary care services
          • The rate at which care is provided by relatives of the people, who need care, is declining
            • The Care Act has provided the first overhaul of social care statute in England in more than 60 years
              • State pension reform and increase in the eligible age may change recent domiciliary care trends
                • Companies
                  • Forecast
                    • The value of the domiciliary care market is forecast to increase by over 3% annually until 2018/19
                      • Figure 7: Forecast UK Market for Domiciliary Care, 2014/15-2018/19 (£ million at 2013/14 prices)
                    • Informal care expected to account for a large part of market growth over the next five years
                      • Figure 8: Forecast segmentation of the UK Market for Domiciliary Care, by type, 2014/15-2018/19 (£ million at 2013/14 prices, % of total market)
                    • What we think
                    • Introduction

                      • Introduction
                        • Definitions
                          • Methodology
                            • Abbreviations
                              • Market positioning
                              • UK Economy

                                • Key points
                                  • Overview
                                    • Inflation
                                      • Interest rates
                                      • Market Factors

                                        • Key points
                                        • Market Size and Trends

                                          • Key points
                                            • Market size
                                                • Figure 9: UK market for domiciliary care, 2009/10-2013/14 (£ million)
                                                • Figure 10: UK market for domiciliary care, 2009/10-2013/14, (£ million)
                                                • Figure 11: UK commercial market for domiciliary care, 2009/10-2013/14 (£ million)
                                                • Figure 12: UK commercial market for domiciliary care, 2009/10-2013/14, (£ million)
                                            • Market Segmentation

                                                  • Figure 13: Segmentation of the UK domiciliary care market, by type of purchaser, 2009/102013/14 (£ million)
                                                  • Figure 14: Segmentation of the UK domiciliary care market, by type of purchaser, 2009/10-2013/14, (£ million)
                                                • Local authority expenditure
                                                  • Older people (65+)
                                                    • Figure 15: Segmentation of local authority expenditure on domiciliary care for older people (65+) in the UK, by type, 2009/10-2013/14 (£ million)
                                                    • Figure 16: Segmentation of local authority expenditure on domiciliary care for older people (65+) in the UK, by type, 2009/10-2013/14, (£ million)
                                                  • Adults aged 18-64
                                                    • Figure 17: Segmentation of local authority expenditure on domiciliary care for adults aged 18-64 in the UK, by client type, 2009/10-2013/14 (£ million)
                                                    • Figure 18: Segmentation of local authority expenditure on domiciliary care for adults aged 18-64 in the UK, by client type, 2009/10-2013/14, (£ million)
                                                    • Figure 19: Segmentation of UK local authority expenditure on domiciliary care, all adults, by client type, 2009/10-2013/14 (%)
                                                    • Figure 20: Segmentation of UK local authority expenditure on domiciliary care, all adults, by client type, 2009/10 and 2013/14, (%)
                                                    • Figure 21: Number of contact hours of home care provided in the UK, by Sector and Country, 2009/10-2013/14, (million hours)
                                                    • Figure 22: Number of contact hours of home care provided in the UK, by sector, 2009/10-2013/14, (million hours)
                                                    • Figure 23: Number of domiciliary care service users, by region, 2009/10-2013/14 (thousands)
                                                    • Figure 24: Number of domiciliary care service users per 10,000 adults, by region, 2009/10-2013/14 (no. of clients per 10,000 adults)
                                                    • Figure 25: Number of domiciliary care service users per 10,000 adults, by region, 2009/10 and 2013/14, (no. of clients per 10,000 adults).
                                                    • Figure 26: Local authority expenditure, all adults, by region, 2009/10-2013/14 (£ million)
                                                    • Figure 27: Local authority expenditure, older people (65+), by region, 2009/10-2013/14 (£ million)
                                                    • Figure 28: Local authority expenditure, older people (65+), 2009/10 and 2013/14, (£ million)
                                                    • Figure 29: Local authority expenditure, adults (18-64) with physical or sensory disabilities, by region, 200910-2013/14 (£ million)
                                                    • Figure 30: Local authority expenditure, adults (18-64) with learning disabilities, by region, 2009/10-2013/14 (£ million)
                                                    • Figure 31: Local authority expenditure, adults (18-64) with mental health needs, by region, 2009/10-2013/14 (£ million)
                                                    • Figure 32: Local authority expenditure, all adults (18-64), by region, 2009/10-2013/14, (£ million)
                                                  • NHS expenditure
                                                    • Figure 33: Segmentation of NHS expenditure on social care community services, by country, 2008/09-2012/13 (£ million)
                                                    • Figure 34: Segmentation of NHS expenditure on social care community services, by country, 2008/09 and 2012/13, (% of total)
                                                  • High tech domiciliary care
                                                    • Private expenditure
                                                        • Figure 35: Segmentation of private expenditure on domiciliary care in the UK, by type, 2009/10-2013/14 (£ million)
                                                        • Figure 36: Segmentation of private expenditure on domiciliary care in the UK, by type, 2009/10-2013/14, (£ million)
                                                        • Figure 37: Estimated size of self-funded home care market, by client type, 2010/11
                                                      • Informal care
                                                        • Figure 38: Informal carers by relationship to person receiving care in England, 2012/2013 (% of informal carers)
                                                        • Figure 39: The UK market for informal domiciliary care, 2009/10-2013/14 (£ billion and hours)
                                                        • Figure 40: UK market for informal domiciliary care, 2009/10-2013/14, (£ billion and billion hours)
                                                      • Market trends
                                                        • Figure 41: UK population projections, by age group, 20122037 (million people)
                                                        • Figure 42: Estimated and projected age structure of the United Kingdom population, by sex, mid-2012 and mid-2037, (thousands)
                                                    • Regional Analysis

                                                      • Key points
                                                        • England
                                                          • North East
                                                            • Figure 43: Analysis of households receiving home help and home care in the north East of England, by authority, 2009/10-2013/14 (number of service users per 10,000 adults)
                                                            • Figure 44: Analysis of local authority domiciliary care expenditure on older people in the North East of England, by authority, 2009/10-2013/14 (£000)
                                                            • Figure 45: Analysis of intensity of local authority domiciliary care services in the North East of England, by authority, 2013/14 (% of people receiving home care)
                                                          • North West
                                                            • Figure 46: Analysis of households receiving home help and home care in the North West of England, by authority, 2009/10-2013/14 (number of service users per 10,000 adults)
                                                            • Figure 47: Analysis of local authority domiciliary care expenditure on older people in the North West of England, by authority, 2009/10-2013/14 (£ 000)
                                                            • Figure 48: Analysis of intensity of local authority domiciliary care services in the North West of England, by authority, 2013/14 (% of clients receiving home care)
                                                          • Yorkshire & The Humber
                                                            • Figure 49: Analysis of households receiving home help and home care in Yorkshire & The Humber, by authority, 2009/10-2013/14 (Number of Service Users per 10,000 Adults)
                                                            • Figure 50: Analysis of local authority domiciliary care expenditure on older people in Yorkshire & The Humber, by authority, 2009/10-2013/14 (£000)
                                                            • Figure 51: Analysis of intensity of local authority domiciliary care services in Yorkshire & The Humber, by authority, 2013/14 (% of clients receiving home care)
                                                          • East Midlands
                                                            • Figure 52: Analysis of households receiving home help and home care in the East Midlands, by authority, 2009/10-2013/14 (number of service users per 10,000 adults)
                                                            • Figure 53: Analysis of local authority domiciliary care expenditure on older people in the East Midlands by authority, 2009/10-2013/14 (£000)
                                                            • Figure 54: Analysis of intensity of local authority domiciliary care services in the East Midlands, by authority, 2013/14, (% of clients receiving home care)
                                                          • West Midlands
                                                            • Figure 55: Analysis of households receiving home help and home care in the West Midlands, by authority, 2009/10-2013/14 (number of people receiving care per 10,000 adults)
                                                            • Figure 56: Analysis of local authority domiciliary care expenditure on older people in the West Midlands by authority, 2009/10-2013/14 (£000)
                                                            • Figure 57: Analysis of intensity of local authority domiciliary care services in the West Midlands, by authority, 2013/14 (% of clients receiving home care)
                                                          • South West
                                                            • Figure 58: Analysis of adults receiving home help and home care in the South West of England, by authority, 2009/10-2013/14 (number of people receiving care per 10,000 adults)
                                                            • Figure 59: Analysis of local authority domiciliary care expenditure on older people in South West England, by authority, 2009/10-2013/14 (£000)
                                                            • Figure 60: Analysis of intensity of local authority domiciliary care services in the South West of England, by authority, 2013/14 (% of clients receiving home care)
                                                          • East of England
                                                            • Figure 61: Analysis of households receiving home help and home care in the East of England, by authority, 2009/10-2013/14 (number of people receiving care per 10,000 adults)
                                                            • Figure 62: Analysis of local authority domiciliary care expenditure on older people in East of England, by authority, 2009/10-2013/14 (£000)
                                                            • Figure 63: Analysis of intensity of local authority domiciliary care services in East of England, by authority, 2013/14 (% of clients receiving home care)
                                                          • London
                                                            • Figure 64: Analysis of households receiving home help and home care in London, by authority, 2009/10-2013/14 (number of people receiving care per 10,000 adults)
                                                            • Figure 65: Analysis of local authority domiciliary care expenditure on older people in London, by authority, 2009/10-2013/14 (£000)
                                                            • Figure 66: Analysis of intensity of local authority domiciliary care services in London, by authority, 2013/14, (% of clients receiving home care)
                                                          • South East
                                                            • Figure 67: Analysis of households receiving home help and home care in the South East of England, by authority, 2009/10-2013/14 (number of people receiving care per 10,000 adults)
                                                            • Figure 68: Analysis of local authority domiciliary care expenditure on older people in the South East of England, by authority, 2009/10-2013/14 (£000)
                                                            • Figure 69: Analysis of intensity of local authority domiciliary care services in the South East of England, by authority, 2013/14 (% of clients receiving home care)
                                                            • Figure 70: Analysis of intensity of English regional domiciliary care services, 2013/14, (% of people receiving home care)
                                                          • Scotland
                                                            • Figure 71: Domiciliary care clients in Scotland, by client type and authority, 2013/14 (number of clients)
                                                            • Figure 72: Distribution of home care hours per week in Scotland, 2013/14, by time band and district (% of clients)
                                                          • Wales
                                                            • Figure 73: Number of domiciliary care clients aged 65+, 2009/10-2013/14 by local authority, Wales (number of clients)
                                                            • Figure 74: Number of domiciliary care clients aged 18-64, 2009/10-2013/14 by local authority, Wales (number of clients)
                                                            • Figure 75: Local authority domiciliary care expenditure in Wales, by local authority, 2008/09-2012/13 (£000)
                                                            • Figure 76: Hours of home care provided in Wales, by local authority, 2009/10-2013/14 (thousand hours)
                                                            • Figure 77: Percentage of home care hours contracted to the independent sector, by local authority, 2009/10-2013/14 (% of home care hours)
                                                          • Northern Ireland
                                                            • Figure 78: Number of clients receiving domiciliary care in Northern Ireland, by sector and HSC trust, 2013/14, (number of clients during survey week)
                                                            • Figure 79: Number of home care hours provided per week, by sector and HSC trust, 2013/14 (number of hours provided during survey week)
                                                        • The Consumer – Paying for Future Care

                                                          • Key points
                                                            • Lack of pre-emptive care payment planning
                                                              • Figure 80: Paying for future care, July 2014
                                                              • Figure 81: Paying for future care, % of respondents
                                                            • Personal savings and pensions will pay for care
                                                              • Figure 82: Payment methods for future care, July 2014
                                                              • Figure 83: Payment Methods for Future Care
                                                          • Industry Structure

                                                            • Key points
                                                            • Industry Development

                                                              • Company Profiles

                                                                • Chrysalis Community Care Group (formerly Blue Arrow Care)

                                                                    • Figure 84: Financial analysis of Chrysalis Community Care Group, 2009-13 (£ 000)
                                                                • BUPA Home Healthcare

                                                                      • Figure 85: Financial analysis of BUPA Home Healthcare, 2009-13 (£ million)
                                                                  • Care UK

                                                                        • Figure 86: Financial analysis of Care UK, 2009-13 (£ million)
                                                                    • Mears Group

                                                                          • Figure 87: Financial analysis of Mears Group, 2009-13 (£ million)
                                                                      • MiHomecare

                                                                            • Figure 88: Financial analysis of MiHomecare, 2013-14 (£ 000)
                                                                        • Saga Group (Acromas Holdings)

                                                                              • Figure 89: Financial analysis of Acromas Holdings, 2009-2013 (£ million)
                                                                              • Figure 90: Financial analysis of Nestor Healthcare Group, 2006-10 (£ million)
                                                                              • Figure 91: Financial analysis of Allied Healthcare Group, 2008-13 (£ million)
                                                                          • Housing & Care 21 (formerly Housing 21)

                                                                                • Figure 92: Financial analysis of Housing 21, 2009-13 (£ million)
                                                                            • Forecast

                                                                              • Key points
                                                                                • Market size
                                                                                    • Figure 93: Forecast UK market for domiciliary care, 2014/15-2018/19 (£ million at 2013/14 prices)
                                                                                    • Figure 94: Forecast UK market for domiciliary care, 2014/15-2018/19, (£ million at 2013/14 prices)
                                                                                    • Figure 95: Forecast UK commercial market for domiciliary care, 2014/15-2018/19 (£ million at 2013/14 prices)
                                                                                  • Market Segmentation
                                                                                      • Figure 96: Forecast segmentation of the UK market for domiciliary care, by type, 2014/15-2018/19 (£ million at 2013 prices)
                                                                                      • Figure 97: Forecast segmentation of the UK market for domiciliary care, by type, 2014/15-2018/19 (£ million at 2013 prices, % of total market)
                                                                                    • Difficulties in expanding home care workforce numbers
                                                                                      • The ongoing dominance of the independent sector providing home care
                                                                                      • Further Sources and Contacts

                                                                                        • Trade Associations and Organisations
                                                                                          • Trade magazines
                                                                                            • Trade exhibitions

                                                                                            Companies Covered

                                                                                            • Acromas Holdings
                                                                                            • BUPA

                                                                                            Domiciliary Care (Industrial Report) - UK - October 2014

                                                                                            US $1,935.88 (Excl.Tax)