Homecare and Supported Living UK Market Report 5ed

1.1 Market definition
1.2 Further context on market definitions
1.2.1 Adult social care services
1.2.2 Non-residential adult social care services
1.2.3 Complex care
1.2.4 Clinical homecare
1.2.5 Virtual wards
1.2.6 NHS community health services
1.2.7 Informal care
1.2.7.1 Changes in families’ willingness to provide informal care
1.3 Market size
1.3.1 Market value of homecare and supported living
1.3.2 Market value of ‘other’ non-residential social care services
1.3.3 Market value of clinical homecare
1.3.4 Market value of ‘Technology Enabled Care’ and telehealth
1.3.4.1 Technology Enabled Care (TEC) market value
1.3.4.2 Telehealth market value
1.3.4.3 Virtual wards
1.4 Segmentation
1.4.1 Segmentation of homecare and supported living
1.4.2 Segmentation of other non-residential care services
1.5 Market trends - historical
1.5.1 Austerity 2010/11?
1.5.2 Activity trends
1.5.2.1 Homecare activity trends - service users and contact hours
1.5.2.2 Supported living activity trends ? service users and contact hours
1.5.3 Market value historic trends
1.5.3.1 Homecare market value trends
1.5.3.2 Supported living market value trends
1.5.3.3 Clinical homecare market value trends
1.5.3.4 Telecare market value trends
1.5.3.5 Virtual wards
1.6 Funding
1.6.1 Funding of homecare and supported living
1.6.2 Funding of ‘other’ non-residential social care services
1.6.3 Funding of clinical homecare
1.6.4 Funding of telecare (Technology Enabled Care)
1.7 Supply and demand
1.7.1 Homecare and supported living volume of demand
1.7.1.1 Impact of Covid-19 on volume of demand for homecare
1.7.2 Supported living volume of demand
1.7.2.1 Impact of Covid-19 on volume of demand for supported living
1.7.3 Regional variations in demand and supply
1.7.4 Workforce - will labour shortages continue to constrain supply?
1.7.4.1 Recruitment & retention - workforce statistics from Skills for Care and the ONS Labour Force Survey
1.7.4.2 Will labour availability be a hard constraint on future expansion of supply
1.7.5 Inadequate rewards for enterprise as a constraint on expansion of supply
1.7.6 Constraints on demand
1.8 Drivers of demand - future growth prospects
1.8.1 Homecare drivers of demand
1.8.1.1 Demography
1.8.1.2 Recognition of the need to invest in social care in order to support the NHS
1.8.1.3 Technological counter drivers of demand for homecare
1.8.1.4 Ability and willingness to pay
1.8.1.5 Conclusions on drivers of homecare demand
1.8.2 Supported living drivers of demand
1.8.2.1 Learning disabilities demand drivers
1.8.2.2 Projections of supported living services for all younger adults
1.8.3 Clinical homecare drivers of demand
1.8.4 Telecare and telehealth drivers of demand
1.8.4.1 Telecare
1.8.4.2 Telehealth
1.9 Homecare and supported living in Scotland and Wales
1.9.1 Scotland
1.9.2 Wales
1.10 Business models - homecare and supported living
1.10.1 Common features of all homecare and supported living business models
1.10.1.1 Asset-light business model
1.10.1.2 Providers as intermediaries between care workers andcustomers
1.10.1.3 Low pay
1.10.2 Full service (employed carers) or introduction only agencies (self-employed carers)
1.10.3 Mainstream ‘time and task’ dispersed homecare (short duration visits)
1.10.4 Live-in homecare
1.10.5 Supported living and homecare delivered to clustered settings
1.10.5.1 Housing with care developments
1.10.5.2 Supported living in clustered settings
1.10.6 Tech-enabled homecare providers
1.10.7 Complex care
1.10.8 Hospital discharge and reablement
1.10.9 Franchises
1.10.10 Outcome-based commissioning
1.10.11 Clinical homecare
1.10.12 Telecare
1.10.13 Telehealth
1.11 Key operational statistics
1.11.1 Hourly charge-out rates
1.11.2 Cost of providing domiciliary care
1.11.3 Domiciliary care rates actually paid by different local authorities
1.11.4 Operating margins
1.12 Performance measures
1.12.1 EBITDA as a percentage of revenue
1.12.1.1 Profitability - EBITDA as a percentage of revenue
1.12.1.2 Supported living EBITDA as a percentage of revenue
1.12.2 CQC ratings in England
1.12.3 Service user satisfaction in England

2.1 History: emergence of the independent sector as the dominant supplier of adult social care services from the late-1970s
2.1.1 Emergence of a large scale, publicly financed homecare sector from 1993
2.1.2 Benign financial environment 2003?2009
2.1.3 Austerity 2011/12-
2.1.4 Why did outsourcing of social care become mainstream so rapidly?
2.2 Policy context - much cross-party consensus, though not on funding
2.3 Main policy areas impacting on homecare and supported living
2.3.1 Funding of publicly paid services
2.3.2 Regulation
2.3.3 Strategic planning and commissioning framework for health and social care
2.3.3.1 Health and social care integration in Scotland
2.3.4 Delayed discharges ? inadequate integration at the health and social care interface
2.4 Regulation of social services
2.4.1 Underpinning legislation in England - Health and Social Care Act 2008
2.4.1.1 Fundamental standards
2.4.2 Scotland, Wales and Northern Ireland
2.4.3 Scope of regulation - services covered and not covered in England
2.4.4 Scope of regulation in Wales and Scotland
2.4.5 Registrable entities
2.4.6 History of last two decades ? deregulation accompanied by tougher  enforcement
2.4.6.1 Replacement of National Minimum Standards with less prescriptive  Essential Standards
2.4.6.2 Fundamental Standards of Quality and Safety 2014?
2.4.6.3 Risks to providers from breaches of regulations and Fundamental Standards
2.4.6.4 Stronger enforcement powers
2.4.6.5 CQC market oversight regime
2.4.6.6 CQC’s next phase of regulation consultation
2.4.6.7 CQC’s new strategy for regulation ? 2021
2.4.6.8 Providers’ views of regulation
2.4.7 Scotland’s rating system
2.5 Regulation of payroll costs
2.5.1 National Minimum Wage and National Living Wage
2.5.2 Pension legislation
2.6 Other government policies relating to adult social care
2.6.1 Personalisation and self-directed care: Direct Payments and personal  budgets
2.6.2 Council charges for homecare
2.6.3 National eligibility criteria
2.6.4 Other aspects of The Care Act 2014
2.6.4.1 General responsibilities of local authorities
2.6.4.2 Market shaping - duty to promote diversity and quality and to  ensure market sustainability
2.6.4.3 Assessment of need and eligibility criteria
2.6.4.4 Duty of local authorities to meet needs for care and support
2.6.4.5 Contracting out of core local authority functions
2.6.5 National Service Framework for older people and the single assessment  process
2.6.6 Consumer information to support choice
2.6.7 Long-term care costs - a fair balance between the state and property owners

3.1 Payor profile overview
3.1.1 Supported living payor profile
3.2 Financial environment by payor type
3.2.1 Public funding - austerity not yet over for social care
3.2.1.1 Sources of public funding
3.2.1.2 Adequacy of public funding
3.2.2 Current social care funding situation and outlook for 2023/24
3.2.2.1 Impact of public funding constraints of homecare and supported living providers
3.2.3 Social care charging reforms
3.2.4 Expansion of supported housing - an exception to austerity
3.2.5 Private funding
3.3 Market dynamics by payor type - balance of market power
3.3.1 Publicly funded services - exercise of monopsony purchasing power
3.3.2 Private and quasi-private consumers - market power balanced
3.3.3 Insurance and other intermediaries

4.1 Market structure ? homecare and supported living
4.1.1 Provider sector and service type
4.1.2 Spectrum of providers
4.1.3 Absence of diversification among major homecare groups
4.1.4 Market concentration and market leaders by revenue
4.1.5 Scale of individual services
4.1.6 Exits and entries
4.1.6.1 Exits
4.1.6.2 Entries
4.1.7 Business failures and recapitalisations
4.1.8 Sources of capital
4.1.8.1 Private equity
4.1.8.2 Publicly traded companies
4.1.8.3 Other sources of capital
4.1.9 Segmentation by provider sector
4.1.10 Economies of scale and scope
4.1.11 Value of brands
4.1.12 Diversification
4.2 Market structure - clinical homecare
4.2.1 Market concentration and market leaders by revenue
4.2.2 Consolidation
4.2.3 Exits and entries
4.2.4 Business failures and recapitalisations
4.2.5 Sources of capital
4.2.6 Segmentation by provider type
4.2.7 Economies of scale and scope

5.1 Major transactions in the homecare and supported living space
5.2 Current investors in homecare and supported living and their portfolios
5.2.1 Amp Capital
5.2.2 Apposite Capital
5.2.3 Business Growth Fund (BGF)
5.2.4 Bridges Fund Management
5.2.5 Charterhouse Capital Partners
5.2.6 Elysian Capital
5.2.7 G Square
5.2.8 iCON Infrastructure
5.2.9 Limerston Capital
5.2.10 Livingbridge
5.2.11 Montreux Capital Management
5.2.12 OMERS Private Equity
5.2.13 Passion Capital
5.2.14 Sovereign Capital Partners
5.2.15 Spring Ventures
5.2.16 Summit Partners
5.2.17 Vitruvian Partners
5.2.18 Weight Partners Capital
5.2.19 Wellspring Capital Management
5.2.20 Westbridge Capital
5.2.21 Wren House Infrastructure

6.1 Opportunities for diversifying and expanding into adjacent segments
6.2 Alternative models of social care
6.2.1 Local Area Coordination model
6.2.2 The Buurtzorg model
6.2.3 Scope for applying alternative models in the UK
APPENDIX 1. GLOSSARY
APPENDIX 2. REGULATORS
APPENDIX 3. TRADE BODIES AND ASSOCIATIONS
APPENDIX 4. MAJOR PROVIDERS OF HOMECARE AND SUPPORTED LIVING SERVICES
APPENDIX 5. FINANCIAL APPENDIX