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| Opportunities for providers as awareness grows |
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Caring Times, February 2010
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On 8th December 2009 Management Guru, Gerry Robinson, begins a much trumpeted two part series on BBC television focusing on the state of care provision for those suffering with dementia. Coming just nine months after the Government launched the first ever national strategy for dementia it appears an opportune moment to focus on this key segment of the social care market.
Laing and Buisson's 'Dementia Care Services UK Market Briefing 2009' sets out the significance of this market. Focusing on what it calls the 'most useful' measure of the size of the market it estimates there are some 142,000 people in residential care for whom dementia is a known cause of admission. It values this part of the dementia market at �4.7billion annually.
There are a further 90,000 people in the UK (Laing and Buisson add) whose principal need is dementia, who are estimated to be receiving non-residential care services which includes home care, day-care and other community care. The value of this non-residential element of the market was estimated to be worth �700m pa in 2008.
*Government prioritises dementia*
Over the past eight years there have been several important reports focusing, directly and indirectly, on the huge impact the incidence of dementia has on people's lives and the resources of health and social provision.
A slew of reports since 2007 from the National Audit Office, The Alzheimer's Society as well as the National Institute for Health and Clinical Excellence culminated in the Government's February 2009 launch of 'Living well with Dementia- A national dementia strategy'.
The Government announced a �150m investment over the next two years to focus on the objectives set out in the Living Well document.
The report sets out the sheer scale of the prevalence of dementia:
o There are currently 700,000 people in the UK with dementia
o Dementia costs the UK economy an estimated �17billion a year
o Over the next 30 years the number of people with dementia is expected to double to reach 1.4million with costs trebling to over �50billion a year.
Given the above it is easy to see why Alan Johnson, Secretary of State for Health at the time of the launch of the national strategy, stated that: 'Dementia is not an illness we can ignore' The National Strategy highlighted three key areas where 'significant improvements' need to be made: 'Improved awareness, earlier diagnosis and intervention and a higher quality of care'.
The strategy sets out 17 key objectives to realise the above improvements and these include those dealing with residential care settings (objective 11), community care settings (objective 6) and also the need for a joint commissioning of dementia care across health and social care departments (objective 14).
*Large providers dominate service delivery*
The Laing and Buisson 2009 report referred to above provides valuable insights into the current and likely future structure of the dementia care sector.
In terms of residential care settings the independent sector 'dominates' the supply of 'dedicated dementia care capacity' constituting some 92% of overall capacity, the private sector accounting for 81% and the voluntary sector some 11%. According to Laing and Buisson's 2008 survey, care for those with dementia offers a premium in terms of fees for care home operators:
1. The average fee for nursing care for those with dementia was �618 per week- a premium of �43per week on frail elderly nursing care
2. The average fee for residential care for those with dementia was �469 per week- a premium of �47 per week The sector is relatively fragmented with the top 10 providers accounting for some 30.5% of 'dedicated dementia care capacity'. These include Southern Cross, Four Seasons, Bupa, Care UK and also Barchester Healthcare. MHA Care Group and Anchor Trust are amongst the top 10 that are from the voluntary sector.
All five of the for-profit providers mentioned above have at least 25% of their total capacity (within their portfolio of care homes) that are dedicated to dementia care provision.
Notwithstanding this, it should be highlighted however that according to Laing and Buisson:
'..only about 57% of residents for whom dementia is a known cause of admission are receiving care in settings which are dedicated to dementia care'.
It would seem likely that, as awareness grows driven perhaps by the Government's national strategy, providers will need to focus more resources on having dedicated facilities and that dementia will become an ever more significant and distinct segment of residential care delivery.
Part of this is likely to centre on the need to develop specialised training for care workers dealing with dementia; this is in accordance with the aspirations of Objective 13 of the national strategy.
Community based care delivery of crucial importance The Laing and Buisson report also makes it clear that: 'Though residential care is a vital setting for care of those with dementia, the majority with the disease are living in the community.'
Many of these people receive care from spouses, relatives or friends. There is however also a 'significant proportion' that receives care via paid homecare services.
The Government's Living Well National Strategy highlights homecare as a 'priority' for service development for those with dementia. The Laing and Buisson report goes further and predicts:
'There is little doubt that non-residential care services will expand in the future, driven by demograghy, government policy and the roll out of individual budgets by local authorities.'
There is of course a strong thrust within Government policy across the social care arena which clearly promotes the centrality of homecare/community based care delivery. This will add lustre to the Liang and Buisson prediction.
In addition the advocates and experts within the sector back homecare provision for dementia sufferers. The Alzheimer's Society Dementia UK Report (2007) includes a key recommendation that the number and extent of home care packages for dementia must be increased.
Indeed the Laing and Buisson Market Report finds it 'surprising' that no major operator has yet positioned itself as a 'full services' specialist provider of the entire range of personalised dementia care spanning the residential and non-residential spectrum.
One suspects that as the national strategy promotes awareness and assuming that direct payments and personal budgets are taken up in significant numbers, the economic case for such a specialist service will become more compelling. It will be intriguing to see how the major providers jostle for pole position.
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