1. 1 Department of Health’s Care Markets Work Programme Tabitha Brufal, Deputy Director Stephen Airey, Head of Care Markets Policy Social Care Policy and Legislation 23.03.2016

2. 2 A challenging current context… DH Care Markets Work Programme ASC Market SR settlement National Living Wage Fees Fragmented market QualityWorkforceDevolution

3. 3 Context: Provision and Funding DH Care Markets Work Programme Around 7,000 independent residential homes and 5,000 with nursing; 10 largest providers cover 25% of the market; 395,000 older people are state-funded for support in the community and 330,000 are self- funded Around 7,000 independent residential homes and 5,000 with nursing; 10 largest providers cover 25% of the market; 395,000 older people are state-funded for support in the community and 330,000 are self- funded Spend on care and support is split between state and individual LA £15.5bn £8.4bn working age £7.1bn older adults Individual £9.5bn NHS £2.5bn £7bn self- funders £2.5bn user charges £2bn CHC £0.5bn FNC FNC = NHS-Funded Nursing Care CHC = NHS Continuing Health Care Private sector Older people’s care home market is dominated by private providers Voluntary sector 380,000 beds 70,000 LA and NHS 38,000 Working age share is higher than in 2010 (was 47%, now 54%)

4. 4 Context: The supply side consists of many small providers and a few brand names DH Care Markets Work Programme -CQC record 5,800 different providers of care homes for older people and people with dementia (counting the brands as single providers) -Laing and Buisson (2015) report that: -The top 10 for-profit providers have a market share of 25% by value -For-profit sector has 86% of beds, not for-profit 14% of beds The 5,300 providers with fewer than 100 beds account for 42% of total beds Top 10 providers Next 915 providers (50-99 beds each) Final 2,186 providers (24 beds or fewer each) Biggest provider: BUPA Group, 4.4% of beds. Then Four Seasons, 4.1% Next 90 providers Next 391 providers (375-100 beds each) Next 2,220 providers (25 to 49 beds each)

5. 5 Context: First round of ASC CQC inspections will be complete by September 2016 DH Care Markets Work Programme Community social care is performing best overall with 68% ratings outstanding or good, nursing homes perform worst with 46% outstanding or good. March 2015

6. 6 DH Care Markets Work Programme Context: a larger workforce than the NHS…

7. 7 Markets - roles and responsibilities DH Care Markets Work Programme Care Act (2014) sets out duties and responsibilities for market related issues: DH: Lead government department for adult social care market and system steward, and provides national leadership and co-ordination of national level contingencies CQC: Quality regulator and market oversight scheme LAs: Commissioners, care planning, DPs, local contingency planning, working with providers on market shaping, universal preventative services.

8. 8 Aims and objectives of the DH markets work programme DH Care Markets Work Programme Primary aim is to mitigate risks to the availability of affordable, high quality adult social care and to ensure markets are sustainable and able to meet the needs of the population over the short, medium and longer term Deepen understanding of the market, including current trends and risks Provide appropriate support to market actors – on the commissioning and supply side Ensure appropriate contingency plans are in place to handle significant provider failure(s) Proactively assess, review and develop markets policy Support Ministers in their duty to be accountable for care markets to parliament and the public

9. 9 Delivery of the programme will be managed through 6 workstreams DH Care Markets Work Programme Data, intelligence and AnalysisContingency planning and CQC market oversight interfaceSupport for commissionersSupport for the supply side National Market Position Statement New approaches to care

10. 10 Highlights of work underway DH Care Markets Work Programme Commissioning for Better Outcomes Peer challenges and other sector- led improvement Getting the price right Guidance to support informed fee negotiations Best practice in market shaping (Market ShaRe) IPC guidance for local authorities- focus on market positions statements Build on DCMQC and MaST

11. 11 Discussion DH Care Markets Work Programme What do you think are the priorities for the DH care markets programme? What role could the NMDF play to support these priorities? What would you like the forum to achieve in partnership with the markets work programme over the next 12 months?