Adult Specialist Care UK Market Report 6ed

1.1 Definition, scope and data sources
1.1.1 Definition and scope
1.1.2 Data sources
1.2 Impact of Covid-19 on operators
1.2.1 Financial impact
1.2.2 Other impacts of Covid-19
1.3 Market size
1.3.1 Care in residential settings
1.3.2 Service users
1.4 Market segmentation (market value, settings and service users)
1.4.1 Segmentation by primary client type
1.4.1.1 Overlapping client types
1.4.1.2 Limited data on further segmentation into client sub-groups
1.4.1.3 Segmentation by support setting
1.4.1.4 Balance between residential and non-residential settings
1.4.2 Segmentation by primary client type ? learning disabilities
1.4.2.1 Care in residential settings - learning disabilities
1.4.2.2 Balance between residential and non-residential settings - learning disabilities
1.4.2.3 Service users - learning disabilities
1.4.3 Segmentation by primary client type ? mental health needs
1.4.3.1 Care in residential settings - mental health needs
1.4.3.2 Care in residential settings - mental health needs
1.4.3.3 Service users - mental health needs
1.4.4 Segmentation by client type ? physical disabilities and sensory impairments
1.4.4.1 Care in residential settings - physical disabilities and sensory impairments
1.4.4.2 Balance between residential and non-residential settings ? physical disabilities
1.4.4.3 Service users - physical disabilities and sensory impairments
1.4.5 Segmentation by client type ? memory and cognition needs
1.4.6 Segmentation by client type ? Acquired brain injury (ABI) aka neuro-rehabilitation
1.4.7 Segmentation by client type ? substance misuse
1.5 Funding profile - by payor type
1.5.1 Commissioner or consumer driven market?
1.5.2 Reasons for low level of private pay, and exceptions
1.5.3 Trends over time
1.6 Customer profiles
1.6.1 Demographic profile
1.6.2 Non-commodity like
1.6.3 Provider polarisation
1.6.4 Longevity and stickiness
1.7 Growth
1.7.1 Market value growth (historic)
1.7.1.1 Recent growth trends - by market segment
1.7.1.2 Recent growth trends - by provider sector
1.7.2 Market volume growth (historic)
1.7.2.1 Residential settings
1.7.2.2 Residential care vs. supported living - recent trends
1.7.2.3 Non-residential settings
1.7.3 Prospects for future growth
1.7.3.1 Public spending constraints
1.7.3.2 Non-residential care
1.8 Demand drivers
1.8.1 Demography
1.8.2 Public attitudes
1.8.3 Consumer choice
1.8.4 Public funding
1.8.5 Outsourcing by statutory agencies
1.8.6 Supported living demand drivers
1.9 Demand and supply
1.9.1 Demand for adult specialist care in residential settings - historical perspective
1.9.1.1 Occupancy rates in adult specialist care homes
1.10 Further segmental information by broad client type
1.10.1 Learning disabilities
1.10.1.1 Underlying demand for learning disability services
1.10.1.2 Autism spectrum disorders
1.10.1.3 Future projections of change in underlying demand for learning disability services
1.10.1.4 Market value trends - learning disabilities
1.10.1.5 Market value trends by funding source - learning disabilities
1.10.1.6 Market value trends by provider sector - learning disabilities
1.10.1.7 Market volume trends - learning disabilities
1.10.1.8 Prospects for future growth - learning disabilities
1.10.2 Mental health needs
1.10.2.1 Underlying demand
1.10.2.2 Future projections of change in underlying demand
1.10.2.3 Market value trends - mental health needs
1.10.2.4 Market value trends by funding source - mental health needs
1.10.2.5 Market value trends by provider sector - mental health needs
1.10.2.6 Market volume trends - mental health needs
1.10.2.7 Prospects for future growth - mental health needs
1.10.3 Physical disabilities and sensory impairments
1.10.3.1 Underlying demand
1.10.3.2 Future projections of change in underlying demand
1.10.3.3 Market value trends - physical disabilities and sensory impairments
1.10.3.4 Market value trends by funding source - physical disabilities and sensory impairments
1.10.3.5 Market value trends by provider sector - physical disabilities and sensory impairments
1.10.3.6 Market volume trends - physical disabilities and sensory impairments
1.10.3.7 Prospects for future growth - physical disabilities and sensory impairments
1.10.4 Acquired Brain Injury
1.10.4.1 Causes of ABI and underlying demand
1.10.4.2 Patient pathway
1.10.4.3 Occupancy rates - acquired brain injury
1.10.4.4 Market value trends - acquired brain injury
1.10.4.5 Market volume trends - acquired brain injury
1.10.4.6 Sources of funding ? acquired brain injury
1.10.5 Substance misuse
1.10.5.1 Underlying demand for substance misuse services
1.10.5.2 Market value trends - substance misuse
1.10.5.3 Market volume trends - substance misuse
1.11 Key operational metrics
1.11.1 Prices
1.11.1.1 Care home fees
1.11.1.2 Supported living fees
1.11.1.3 Cost differentials between outsourced and local authority in-house services
1.11.2 Occupancy rates
1.11.3 Payroll
1.12 Operating models
1.12.1 Care homes
1.12.2 Supported living and homecare
1.12.2.1 Supported living in clustered settings and synergies with care homes
1.12.2.2 Risk of exposure to rental voids
1.12.2.3 Supported accommodation business model
1.13 Investment models
1.14 Performance measures
1.14.1 Financial
1.14.1.1 Adult specialist care homes
1.14.1.2 Supported living
1.14.2 Quality performance
1.14.2.1 CQC ratings
1.14.2.2 Incentives to perform well on CQC Fundamental Standards
1.14.2.3 Does size matter?
1.15 Supported accommodation - a parallel market
1.15.1 Market size
1.15.2 Market growth
1.15.3 Appetite for investment in supported accommodation
1.15.3.1 Civitas Social Housing plc
1.15.3.2 Triple Point Social Housing REIT
1.15.3.3 Other investors in supported housing freeholds
1.15.3.4 Housing associations/RSLs acting as counterparties to supported housing REITS

2.1 Impact of government policy on the adult specialist care sector
2.2 Funding of publicly paid services
2.2.1 General economic management
2.2.1.1 Immigration policy, Brexit and the social care staffing crisis
2.2.2 Funding of social care
2.2.2.1 A decade of austerity - not over yet
2.2.2.2 Social care charging reforms
2.2.2.3 People at the Heart of Care - the adult social care reform white paper
2.2.2.4 Expansion of supported housing and supported living - an exception to austerity
2.2.3 Other government policies - high degree of cross-party consensus on non-funding issues
2.2.3.1 Personalisation and self-directed care, Direct Payments and Personal Budgets
2.2.3.2 Integration of health and social care - The Health and Care Act 2022
2.2.3.3 Removal of legal barriers to health and social care integration in 1999
2.2.3.4 Integration of health and social care in Scotland
2.3 Regulation of adult social care provision
2.3.1 Underpinning legislation in England - Health and Social Care Act 2008
2.3.2 Fundamental Standards in England
2.3.3 Scotland, Wales and Northern Ireland
2.3.4 Scope of regulation - services covered not covered
2.3.4.1 In England
2.3.4.2 In Scotland and Wales
2.3.5 History of last two decades ? deregulation accompanied by tougher enforcement
2.3.5.1 Replacement of National Minimum Standards with less prescriptive Essential Standards
2.3.5.2 Fundamental Standards of Quality and Safety 2014?
2.3.5.3 Risks to providers from breaches of regulations and Fundamental Standards
2.3.5.4 Stronger enforcement powers
2.3.5.5 CQC market oversight regime - to ensure financial stability of hard to replace providers
2.3.5.6 CQC’s next phase of regulation consultation
2.3.5.7 CQC’s new strategy for regulation ? 2021
2.3.5.8 Providers’ views of regulation
2.3.6 Scotland - rejection of simple rating system
2.3.7 Regulatory distinction between care homes and supported living
2.3.8 CQC’s six bed maximum guidance for homes for learning disabled people
2.3.9 Market shaping - councils’ duty to promote diversity and quality and to ensure market sustainability
2.4 Regulations affecting payroll
2.4.1 National Living Wage (NLW)
2.4.2 Stakeholder pensions
2.4.3 Apprenticeship levy
2.4.4 VAT staff hire concession
2.4.5 Sleep-in pay
2.4.6 Employers National Insurance Levy of 1.5% from April 2022

3.1 Local authorities
3.1.1 Local authority funding environment
3.1.1.1 Current social care funding situation and outlook for 2023/24
3.1.1.2 Expansion of supported housing - an exception to austerity
3.1.2 Local authority market environment
3.1.2.1 Commissioning is viewed by providers as sub-scale, understaffed and excessively focused on price
3.1.2.2 Reliance on ‘care calculator’ tools
3.1.2.3 Balance of market power between commissioners and providers
3.1.2.4 Personalisation and self-directed care
3.1.2.5 SWOT analysis
3.1.3 Supported living ? threats and opportunities for adult specialist care providers
3.1.3.1 Definition of supported living
3.2.3.2 Balance of services between residential and non-residential settings
3.1.3.3 Commissioners’ more ‘nuanced’ views on the merits of supported living
3.1.3.4 Variability of provision across the country
3.1.3.5 Relative cost of care homes and supported living
3.2 NHS
3.2.1 NHS funding environment
3.3 Private funding

4.1 Recruitment and retention - workforce statistics
4.2 Will labour availability constrain future expansion of supply

5.1 Market concentration and leading providers’ shares
5.1.1 All adult specialist care (residential and non-residential services combined)
5.1.2 Adult specialist care in residential settings
5.1.2.1 Learning disability care homes ? market concentration and leading providers
5.1.2.2 Mental health care homes - market concentration and leading providers’ shares
5.1.2.3 Physical disabilities and sensory impairments care homes - market concentration and leading providers’ shares
5.1.2.4 Acquired brain injury (neuro-rehabilitation) ? market concentration and leading providers’ shares
5.1.2.5 Substance misuse - market concentration and leading providers’ shares
5.1.2.6 Market concentration and leading providers’ shares ? care homes and hospital units combined
5.2 Consolidation
5.3 Market structure by provider sector ? for-profit/not-for-profit supply
5.4 Capacity turnover ? openings and closures
5.5 Profile of adult specialist care homes
5.5.1 Scale of care homes
5.5.2 Age distribution of adult specialist care home stock
5.5.3 Purpose-built and conversions/adaptations
5.6 Entries and exits
5.6.1 Company level entries and exits
5.6.2 At service level
5.6.3 Business failures and recapitalisations
5.6.3.1 Business failures among small housing association counterparties to major supported housing investors
5.7 Economies of scale and scope
5.7.1 At individual service level
5.7.2 At group/portfolio level
5.7.3 Brands
5.7.4 Absence of intermediation
5.8 Barriers to entry
5.9 Sources of capital
5.9.1 Sources of capital for care homes
5.9.1.1 Traditional bank debt funding, to supplement business owners’ equity
5.9.1.2 Private equity
5.9.1.3 Sales and leaseback
5.9.1.4 High yield bond issues
5.9.1.5 Stock exchange listing, giving access to public funds
5.9.1.6 Islamic funding
5.9.2 Capital for supported accommodation
5.10 Developers

6.1 Private equity
6.1 Other financial institutions
6.2 Enterprise values and exit multiples

7.1 Strong fundamentals
7.2 Recognition of adult specialist care as an investment opportunity
7.3 Contiguous market segments
7.4 Digital technologies
7.5 Artificial intelligence and robotisation
7.6 Absence of any transnational dimension

APPENDIX 1. GLOSSARY
APPENDIX 2. KEY LEGISLATION
APPENDIX 3. REGULATORS
APPENDIX 4. TRADE BODIES AND ASSOCIATIONS
APPENDIX 5. HISTORY ? PRIVATISATION OF SOCIAL CARE FROM THE 1970s
APPENDIX 6. PROFILES OF MAJOR ADULT SPECIALIST CARE PROVIDERS
APPENDIX 7. FINANCIAL APPENDIX