“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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