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Domiciliary care – the growing movement from public to private fee paying care

A recently published survey by the United Kingdom Home Care Association highlights the growing concern of providers about the stability of the domiciliary care market in the UK.

The survey focuses upon data that confirms the decline in local authority take up of domiciliary care. The survey found that between 2009 and 2015 the number of people receiving local authority funded domiciliary care in the UK decreased by 20%. Over the same period the hours delivered decreased by 6.8%. There is evidence that not only are fewer people receiving care funded by the local authority but they are also receiving less hours of care and support at home. It would seem then that there is a local authority funding strategy to restrict access to domiciliary care to those with the greatest levels of care and support needs.


Confirmation of this approach to funding can be seen in local authority funding for domiciliary care. Gross expenditure by local authorities on domiciliary care continues to decrease. In 2014/15 gross expenditure on domiciliary care by local authorities was £3.9 billion. Gross total local authority expenditure in 2013/14 was £4.05 billion. This is a 3.7% decrease.

There does however seem to be somewhat of a contradiction in the domiciliary care market trends. On the one hand, we have seen a marked decline in local authority funding but on the other there is evidence of growing numbers of domiciliary care providers. In March 2016, there were 10,176 regulated providers of domiciliary care operating in the UK. This is a 3.6% increase compared to March 2015. There was also an increase in the workforce. In 2014/15 it increased by 8.2% to 631,000 people.

The survey of providers shows that 93% of those trading with councils had faced a real-terms decrease in the price paid for their service over the last 12 months, and 20% reported a decrease in the actual fees paid.

There is strong evidence that the funding strategy of local authorities of domiciliary care is leading to a major shift towards private fee paying domiciliary care. Many providers are now considering handing back care packages to commissioners, because they are financially unsustainable.

The survey found that 74% of those providers who responded said they would reduce the amount of publically funded care they delivered, and this is estimated to affect 50% of all people for whom they provide care and support.

Albert Cook Albert Cook BA, MA & Fellow Charted Quality Institute Managing Director Bettal Quality Consultancy

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