William Laing - International and UK healthcare and medical travel … · William Laing Data...

LaingBuissonUK Healthcare Market Review

William Laing

Data Director and Founder

LaingBuisson

OLDER PEOPLE


Age specific usage rates for care in residential settings, UK age 65+

65-74 75-84 85+

% OF POPULATION

WHO LIVE IN

RESIDENTIAL SETTINGS 0.57% 3.6% 14.7%

THESE RATES HAVE BEEN DECLINING SINCE 1993 – WHY?


0.90

1.10

1.30

1.50

1.70

1.90

2.10

2.30

2.50

2.70

2.90IN

DEX

19

81

= 1

00

INDEX of population ageing* INDEX of occupied beds INDEX of deaths, persons aged 80+

Population at risk vs proximity to death as predictor of demand

BROOKINGS INSTITUTE HYPOTHESIS – DEMAND FOR CARE HOMES IS A FUNCTION OF THE NUMBER OF OLD PEOPLE AT THE END OF LIFE, NOT THE NUMBER OF OLD PEOPLE LIVING

*Expected number in care in year N divided by actual number in care in base year of 1981, where Expected number is the sum of % people in care in 1981 in each age group 65-74, 75-84 and 85+ times the population at those ages in year N


Volume of demand for care in residential settings – actual

and projected, UK 65+

0

100,000

200,000

300,000

400,000

500,000

600,000

Independent Sector actuals Public Sector actuals

Independent Sector projections Public Sector projections

Additional demand of 18,000 in 5 yearsand 66,000 in 10 years


Occupancy rates (occupied divided by registered beds) UK

care homes for older people and dementia 65+

86.3%

82.2%

91% 91%94% 92% 92% 92% 90%

87% 87% 87% 89%91% 91% 92% 92% 91% 91% 90% 90% 89% 89% 89% 89% 89% 90% 91% 90% 90% 90%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Year ending March 31

CQC inspection reports (England only) LaingBuison surveys

CQC occupancy from about 1/3 of all homes is significantly lower than from LB survey and other sources. Raw CQC data may be skewed towards 'at risk' homes subject to more frequent inspection. Further research needed.


Capacity change from openings & closures, UK care homes 65+

-30,000

-10,000

10,000

30,000

50,000

BED

S

NEW REGISTRATIONS - Public Sector FROM 2000 OTHER NET CAPACITY CHANGE**

NEW REGISTRATIONS - Independent Sector CLOSURES - Public Sector FROM 2000

CLOSURES - Independent Sector TOTAL NET CAPACITY CHANGE

Capacity shakeout following Blair/Brown public Austerity1993 Community Care Reforms expenditure boom


Council paid fees for residential care of older people and

people with dementia 65+, England

0

100

200

300

400

500

600

700

800

2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18

Council paid fees (Fredom of Information requests) £pw Council paid fees (NHS Digital Unit Costs, exc. SSMSS) £pw

'Care Cost Benchmark' CEILING* £pw 'Care Cost Benchmark' FLOOR* £pw

CAGR 2010/11 - 2016/17 2.6%


Private pay premium

43% higher than council pay (LaingBuisson research on behalf of the County Councils Network, 2015)

41% higher than council pay

(Competition and Markets Authority, 2016 research)


34,700 33,600 31,200 29,700 28,400 27,200 23,300 21,100 20,500 19,000 16,300 15,400

73,500 68,600 63,300 61,200 59,900 60,000 59,300 59,800 58,600 59,000 58,000 57,400

129,700 126,800 127,800 127,700 125,700 128,700 127,200 128,500 128,700 127,300 124,900 124,000

10,100 13,300 15,700 19,800 23,300 26,200 28,700 30,400 31,700 34,200 34,100 34,800

144,700 152,300 155,400 150,400 152,400 158,000 168,700 170,000 176,200 172,000 173,700 176,400

0

50,000

100,000

150,000

200,000

250,000

300,000

350,000

400,000

450,000

Council in-house Council outsourced (with top-up) Council outsourced ( no top-up)

NHS in-house NHS outsourced Private pay

Payor profile trends – care homes for older people, UK


Profitability of old people’s care homes portfolios EBITDAR

as % revenue

10%

15%

20%

25%

30%

35%

40%Barchester (y/e Dec)

Care UK (Residential Care

Division) y/e Sept

Bupa (y/e Dec)

Four Seasons Care Homes

Division (y/e Dec)*

HC-One (y/e Sept)

Caring Homes (y/e March)

Avery Healthcare (y/e

March)

AGGREGATE


ADULT SPECIALIST

CARE


Demand for adult specialist residential and nursing care,

UK occupied beds 1990-2018

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

100,000

Adjustment for data discontinuity* NHS residential settings

Local authority staffed homes Independent residential

Independent nursing Shared Lives

No data on supported living capacity


Occupancy rates (occupied divided by registered beds) UK

younger adult specialist care homes

87% 85%

91% 91% 92% 90%94%

91% 91% 92% 91% 89% 89% 89% 87% 86% 88% 86% 86% 86% 85%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

CQC inspection reports LaingBuisson surveys, UK


Council fees paid to independent sector homes for residential

care of younger adults with learning disabilities, England

£0

£200

£400

£600

£800

£1,000

£1,200

£1,400

£ p

e w

eek

Year ending 31 March

CAGR 2001/2 to 2010/11 8.2%

CAGR 2010/11 to 2016/17 2.3%


Profitability of adult specialist care EBITDAR as % revenue

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Priory Specialist Division (y/e Dec) Voyage (y/e March)CareTech (y/e Nov) Care Management Group (y/e Feb)Prime Life (y/e March) Regard (y/e March)AGGREGATE


Virtuous circle

Focus on quality

Good CQC rating

Higher occupancy

Less chance of high agency

cost

More profitable


Virtuous circle – CQC ratings and occupancy rates

92%

86%80%

77%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Outstanding Good Requires improvement Inadequate

Occ

up

ancy

rat

es


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