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Domiciliary Care - UK - July 2018

“Independent care providers are already well-established in the market and are expected to offer services to those with ‘substantial’ care needs, as well as all other care clients. However, the ever-widening gap between the fees paid by LAs and the actual cost of service provision means some providers could refuse to provide services in certain areas, or leave the market altogether.”
– Lewis Cone, B2B Analyst

This Report looks at the following areas:

  • Green paper delay leading to uncertainty
  • New innovations drive cost efficiency and could increase service provision

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Table of contents

  1. Overview

    • What you need to know
      • Covered in this Report
      • Executive Summary

          • The market
            • Market value reaches five-year high
              • Figure 1: UK market for domiciliary care, 2013/14-2017/18, (£ million)
            • Informal care drives growth
              • Figure 2: Segmentation of the UK domiciliary care market, by type of purchaser, 2013/14-2017/18, (£ million)
            • Old age support ratio to continue to decline
              • Figure 3: Old age support ratio, 2018-43, (ratio)
            • Home care still accounts for majority of delays in the transfer of care from NHS hospitals
              • Market value to rise by 5% to 2022/23
                • Figure 4: Forecast UK domiciliary care market value, 2018/19-2022/23, (£ million at 2018 prices)
              • Companies and brands
                • Many care providers struggle to survive in a high-cost, low-profit climate
                  • The consumer
                    • 68% of people have not thought about how they would fund their long-term care
                      • 40% would prefer a family member or friend to provide them with care over an agency
                        • Choosing when a carer visits and the care time provided are key factors behind agency choice
                          • What we think
                          • Issues and Insights

                            • Green paper delay leading to uncertainty
                              • The facts
                                • The implications
                                  • New innovations drive cost efficiency and could increase service provision
                                    • The facts
                                      • The implications
                                      • The Market – What You Need to Know

                                        • Market value reaches five-year high
                                          • Informal care drives growth
                                            • Market value to rise by 5% to 2022/23
                                            • Market Size

                                              • Market value reaches five-year high
                                                  • Figure 5: UK market for domiciliary care, 2013/14-2017/18, (£ million)
                                                  • Figure 6: UK commercial market for domiciliary care, 2013/14-2017/18, (£ million)
                                              • Market Segmentation

                                                • Informal care drives growth
                                                    • Figure 7: Segmentation of the UK domiciliary care market, by type of purchaser, 2013/14-2017/18, (£ million)
                                                  • Local authority expenditure
                                                      • Figure 8: Segmentation of local authority expenditure on domiciliary care for older people (65+) in the UK, by type, 2012/13-2016/17, (£ million)
                                                      • Figure 9: Segmentation of local authority expenditure on domiciliary care for adults aged 18-64 in the UK, by client type, 2012/13-2016/17, (£ million)
                                                      • Figure 10: Segmentation of UK local authority expenditure on domiciliary care, all adults, by client type, 2012/13-2016/17, (%)
                                                    • Regional LA expenditure
                                                      • Figure 11: Local authority expenditure, all adults, by region, 2012/13-2016/17, (£ million)
                                                      • Figure 12: Local authority expenditure, older people (65+), by region, 2012/13-2016/17, (£ million)
                                                      • Figure 13: Local authority expenditure, adults (18-64), by region, 2012/13-2016/17, (£ million)
                                                    • Number of contact hours
                                                      • Figure 14: Number of contact hours of home care provided in the UK, by sector and country, 2013/14-2017/18, (million hours)
                                                    • NHS expenditure
                                                      • Figure 15: Segmentation of NHS expenditure on social care community services, by country, 2013/14-2017/18, (£ million)
                                                    • Private expenditure
                                                        • Figure 16: Segmentation of private expenditure on domiciliary care in the UK, by type, 2013/14-2017/18, (£ million)
                                                      • Informal care
                                                          • Figure 17: Informal carers by relationship to person receiving care in England, 2012/13-2016/2017, (% of informal carers)
                                                          • Figure 18: The UK market for informal domiciliary care, 2013/14-2017/18, (£ billion and hours)
                                                      • Market Forecast

                                                        • Market value to rise by 5% to 2022/23
                                                            • Figure 19: Forecast UK domiciliary care market value, 2018/19-2022/23, (£ million at 2018 prices)
                                                          • Informal care to remain dominant industry provider, but growth is starting to stagnate in relation to demand
                                                              • Figure 20: Forecast UK domiciliary care market segmentation value, by type, 2018/19-2022/23, (£ million at 2018 prices)
                                                          • Market Trends

                                                            • Old age support ratio to continue to decline
                                                                • Figure 21: UK population projections, by age group, 2018-43, (000 people)
                                                              • Minimum price for home care still not widely met, leading to insufficient delivery of care services
                                                                  • Figure 22: Estimated minimum price for home care, 2018, (£)
                                                                • Care worker and manager turnover rates rise, although average wages have improved
                                                                    • Figure 23: Annual workforce turnover rates in the independent and voluntary domiciliary care sector, England, 2015-17, by employee position, (%)
                                                                    • Figure 24: Average annual pay in the independent and voluntary domiciliary care sector, England, 2015-17, by employee position, (£)
                                                                  • Home care still accounts for majority of delays in transfer of care from NHS hospitals
                                                                  • Market Drivers

                                                                    • Current care service shortages and provider failings will force changes to provision…
                                                                      • …while the increase in the number of elderly people and changes to the pension system will also affect the industry’s operating model
                                                                        • Staff costs continue to rise due to the increased NLW and NMW rate, but U-turn over ‘sleep-in’ back pay has provided temporary relief
                                                                          • Implications of Brexit
                                                                            • Other factors
                                                                              • NICE guidelines
                                                                              • Legislation

                                                                                • Community Care Act
                                                                                  • Care Standards Act
                                                                                    • Regulation and Inspection of Social Care (Wales) Act
                                                                                      • The Carers (Scotland) Act
                                                                                        • The Care Act 2014 and Better Care Fund
                                                                                          • Pensions Act
                                                                                            • Other legislation
                                                                                            • Companies and Brands – What You Need to Know

                                                                                              • Many care providers struggle to survive in a high-cost, low-profit climate
                                                                                                • Providers handing back contracts to councils
                                                                                                • Industry Structure

                                                                                                  • Industry development
                                                                                                    • M&As and other industry movements
                                                                                                      • Market share
                                                                                                          • Figure 25: Independent sector domiciliary care providers’ market share, 2018, (% of total independent sector market)
                                                                                                        • Changes in the structure of the industry
                                                                                                          • Figure 26: Analysis of the changes in the structure of the ‘other human health activities’ industry, 2013-17, (number of local units and businesses)
                                                                                                          • Figure 27: Analysis of the changes in the structure of the ‘social work activities without accommodation for the elderly and disabled’ industry, 2013-17, (number of local units and businesses)
                                                                                                        • Structure by employment
                                                                                                          • Figure 28: Analysis of the employment structure of the ‘other human health activities’ industry, 2016 and 2017, (number of local units and local unit employment size)
                                                                                                          • Figure 29: Analysis of the employment structure of the ‘social work activities without accommodation for the elderly and disabled’ industry, 2016 and 2017, (number of local units and local unit employment size)
                                                                                                        • Structure by turnover
                                                                                                          • Figure 30: Analysis of the financial structure of the ‘other human health activities’ industry, 2016 and 2017, (£ 000 and % of total turnover)
                                                                                                          • Figure 31: Analysis of the financial structure of the ‘social work activities without accommodation for the elderly and disabled’ industry, 2016 and 2017, (£ 000 and % of total turnover)
                                                                                                      • Competitive Strategies

                                                                                                        • Many care providers struggle to survive in a high-cost, low-profit climate
                                                                                                          • Providers hand back contracts to councils
                                                                                                            • New integrated care models tested through vanguards
                                                                                                            • Company Profiles

                                                                                                              • Allied Healthcare (now part of Aurelius Group)
                                                                                                                • Recent company activity
                                                                                                                  • Financial information
                                                                                                                    • Figure 32: Financial analysis of Allied Healthcare Group, 2012-16, (£ million)
                                                                                                                  • Interserve Healthcare (formerly Advantage Healthcare)
                                                                                                                    • Recent company activity
                                                                                                                      • Financial information
                                                                                                                        • Figure 33: Financial analysis of Interserve Healthcare, 2013-17, (£000)
                                                                                                                      • Lifeways Community Care
                                                                                                                        • Recent company activity
                                                                                                                          • Financial information
                                                                                                                            • Figure 34: Financial analysis of Lifeways Community Care, 2012-16, (£000)
                                                                                                                          • Mears Group
                                                                                                                            • Recent company activity
                                                                                                                              • Financial information
                                                                                                                                • Figure 35: Financial analysis of Mears Group, 2013-17, (£ million)
                                                                                                                              • MiHomecare
                                                                                                                                • Recent company activity
                                                                                                                                  • Financial information
                                                                                                                                    • Figure 36: Financial analysis of MiHomecare, 2013-17, (£000)
                                                                                                                                  • Sevacare
                                                                                                                                    • Recent company activity
                                                                                                                                      • Financial information
                                                                                                                                        • Figure 37: Financial analysis of Sevacare, 2013-17, (£ million)
                                                                                                                                    • The Consumer – What You Need to Know

                                                                                                                                      • 68% of people have not thought about how they would fund their long-term care
                                                                                                                                        • 40% would prefer a family member or friend to provide them with care over an agency
                                                                                                                                          • Choosing when a carer visits and the care time provided are key factors behind agency choice
                                                                                                                                          • Care Payment

                                                                                                                                            • 68% of people have not thought about how they would fund their long-term care
                                                                                                                                              • Figure 38: Domiciliary care payment plans, April 2018, (% of respondents)
                                                                                                                                            • Half of women over-65 have considered the financial consequences of care compared to less than a third of men over 65
                                                                                                                                              • Figure 39: Domiciliary care payment plans, by age and gender, April 2018, (% of respondents)
                                                                                                                                            • Personal savings expected to fund long-term care
                                                                                                                                              • Figure 40: Domiciliary care payment method, April 2018, (% of respondents)
                                                                                                                                          • Home Care Provider

                                                                                                                                            • 40% would prefer a family member or friend to provide them with care over an agency
                                                                                                                                              • Figure 41: Domiciliary care provider, April 2018, (% of respondents)
                                                                                                                                            • Lack of care payment plans will drive people towards care from family or friends
                                                                                                                                              • Figure 42: Domiciliary care provider, by care payment plans, April 2018, (% of respondents)
                                                                                                                                          • Care Service Features

                                                                                                                                            • Choosing when a carer visits and care time provided are key factors behind agency choice
                                                                                                                                              • Figure 43: Domiciliary care service features, April 2018, (% of respondents)
                                                                                                                                          • Future Care Concerns

                                                                                                                                            • Rising fees affecting care affordability represent people’s largest concern...
                                                                                                                                              • Figure 44: Future domiciliary care concerns, April 2018, (% of respondents)
                                                                                                                                            • ...with this concern rising with age
                                                                                                                                              • Figure 45: Future domiciliary care concerns, by age and gender, April 2018, (% of respondents)
                                                                                                                                          • Appendix – Data Sources, Abbreviations and Supporting Information

                                                                                                                                              • Abbreviations
                                                                                                                                                • Methodology
                                                                                                                                                • Further Sources and Contacts

                                                                                                                                                  • Trade associations
                                                                                                                                                    • Age UK
                                                                                                                                                      • Care England (formerly English Community Care Association)
                                                                                                                                                        • Carers UK
                                                                                                                                                          • National Care Association
                                                                                                                                                            • National Care Forum
                                                                                                                                                              • United Kingdom Home Care Association (UKHCA)
                                                                                                                                                                • Trade magazines
                                                                                                                                                                  • Care Management Matters
                                                                                                                                                                    • Care Talk
                                                                                                                                                                      • Caring Times
                                                                                                                                                                        • Caring UK
                                                                                                                                                                          • Community Care
                                                                                                                                                                            • Trade events
                                                                                                                                                                              • Care England 2018
                                                                                                                                                                                • Care Show 2018
                                                                                                                                                                                  • Care Roadshow London 2018
                                                                                                                                                                                    • Community Care Live 2018
                                                                                                                                                                                      • Health + Care 2019
                                                                                                                                                                                        • Primary Care and Public Health 2019

                                                                                                                                                                                        Domiciliary Care - UK - July 2018

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