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UK Domiciliary Care market report

Everything you need to make the right decisions

Providing the most comprehensive and up-to-date information and analysis of the Domiciliary Care market, and the behaviours, preferences and habits of the consumer.

Mintel has the answers you’re looking for

What are the key challenges facing the industry and how fast are its rates of growth? Who is the consumer and what do they want? Where are the opportunities, where are the risks and what lies ahead?

Covered in this Report

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 services to the elderly, but domiciliary care is also provided to people with long-term illnesses and disabilities, as well as those recently dismissed from hospital care.

Adult social care is estimated to contribute nearly £42 billion to the economy. It employs around 1.45 million people, with the majority of jobs split between residential and domiciliary care employers (just over 40% each). Adult social care can help individuals, and the families of people who need care and support, to carry on working.

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 providers, including the direct purchase of LA providers; voluntary services, which are operated by charities and religious organisations registered with the LA; and 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 day-to-day 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 so an evaluation of the market is subject to interpretation, particularly 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.

What you need to know

The UK market for domiciliary care rose in value between 2013/14 and 2017/18 by a cumulative 3% - despite total market value falling by £1.2 billion in the first two years of the review period.

While the market is believed to have remained at a fairly consistent value over the last five years, the commercial sector is expected to represent just over a fifth of total market value. This also comprises the direct private sector supply and voluntary informal sectors, which meet the needs of the vast majority of low intensity contacts.

Expert analysis from a specialist in the field

Written by Lewis Cone , a leading analyst in the Healthcare sector, his extensive knowledge delivers in-depth commentary and analysis to highlight current trends and add expert context to the numbers.

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
Healthcare Analyst

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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