Industry report: Development of the Domiciliary Care Market

With the growth in UK population and our increasing lifespans, the UK has an ever increasing number of older people. Caremark Managing Director Kevin Lewis reflects on the sweeping changes that the care services industry has undergone over the last 20 years and the creation of the domiciliary care market

Up to the early 1980s, the availability of care tended to be mainly residential based, either in residential or nursing homes, albeit with some additional provision of state funded home-helps. In fact, 98 per cent of all institutional care was provided by the state.

However, in 1984 compulsory registration of independently owned residential homes was introduced and during the next nine years, there was an enormous upsurge in the numbers of independent operators providing residential care for mainly older people. These were boom times for operators of private rest homes and the vast majority of these homes provided a safe, secure and caring environment for older people who had been struggling to cope for themselves in their own homes.
All this changed with the passing of the NHS and Community Care Act in 1990.

This Act represented the most drastic changes to the way care had ever been provided before. Delayed for two years, in April 1993 the Community Care Act was finally implemented in England and Wales, having initially been introduced to Scotland. The main consequences of this act were that the budgets held by the DSS to fund residential care were to be diverted to local authorities' Social Services departments and anyone who felt that they required care and funding for that care would now need to apply for assessment by their local Social Services.

This system has now been in place for 13 years and the result of the majority of these assessments is that individuals can remain living in their own homes with care workers visiting them and providing appropriate in-home care and support. Of course, this has enormous cost saving benefits to the economy but more importantly, it allows people to retain a great deal more independence living in the familiar surroundings of their own homes.

The other major development in 1993 was the move by Social Services departments to purchase more and more community-based care from the independent sector whose costs were significantly lower, rather than to be providers of care services themselves. Hence, a new market started to develop in 1993 - the domiciliary care market.

The market today is enormous, estimated to be worth £12-£17 billion per annum! There are now around 4,500 independent operators in the UK with Social Services currently purchasing 70 per cent of their community based care from these new independent sector operators.

In 2003 the Care Standards Act was introduced, requiring compulsory registration for all care providers and thereafter regular inspections from an independent organisation, the Commission for Social Care Inspection. This was a move welcomed by professional operators and has resulted in less committed/able operators withdrawing from the market. Domiciliary Care now has the professional status it has sought, and indeed yearned for.

The benefits of franchising this type of business are numerous, but for clients, a franchised care operator such as Caremark can ensure a far greater standard of care delivery than either a large corporate provider or a small independent operator. The owner of a good solid professional care franchise can build a hugely profitable business, but equally, will reap far greater rewards from knowing that often vulnerable clients are receiving the very best care in their own homes as a result of his/her business.