Is the care home market heading for a crash?

Nick Triggle
Health correspondent
@nicktriggleon Twitter

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There are over 500,000 care and nursing homes places in the UK - that is more than the entire population of Liverpool.

The people living in them are among the oldest, most vulnerable people in society. One in six of all people over the age of 85 are housed in them.

I make these points to illustrate the size of the market. Why? Because something isn't right.

The sector is haunted by the collapse of Southern Cross four years ago, which left more than 30,000 people at risk of losing their "homes". Other providers stepped in then.

But now storm clouds appear to be gathering over many of those. Four Seasons, the biggest provider with nearly 500 homes, has debts that are costing £50m a year to service, while rumours have circulated that Bupa is preparing to sell a number of homes, although this has been dismissed by the firm.

I have also been told about internal market research carried out by consultants PwC (but not published publicly) which shows among the big five firms as many as half their homes may not be viable in the long-term.

The care home market

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  • There are 465,000 care home beds in England, rising to 500,000 when the rest of the UK is taken into account
  • The big five firms - Four Seasons, Bupa, Care UK, Barchester and HC-1 - control about a fifth of the market
  • About six in 10 residents get council funding. This means the council will pay the care home, although they will assess the individual to see what contribution they can make towards that
  • The average amount paid for those places is £512 a week, but the average cost to providers is £542
  • The rest - known as self-funders - pay for the full cost of the care home themselves. Fees for self-funders are nearly always set above what the council rate is

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But they are not alone, according to Mike Parish, the chief executive of Care UK.

The big five, of which his firm is one, account for just a fifth of the market. Most of the rest are small providers. He believes the smaller providers are most at risk, adding: "The market has been pretty resilient until now, but that could soon change."

Top of his thoughts is the introduction of the National Living Wage next year.

Research by the Resolution Foundation think tank predicts up to a million of the 1.4m workers across the whole care sector could end up getting rises over the coming years.

Another concern is the squeeze on fees paid by councils. About six in 10 people in care homes get their care arranged and paid for by councils - the rest pay for themselves.

But as local government has seen its funding cut in recent years so it has passed this on.

Research by LaingBuisson consultants found the cost of running a care home is £554 per week, but the average fee paid by English councils is just £512.

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It was a combination of these factors which led the think tank Respublica to warn that as many as 37,000 beds could close in the coming years.

Since the report was published in early November, the government has set out its spending plans.

Chancellor George Osborne spoke about the importance of the sector and claimed to be putting forward measures that would see funding for care increase, mainly because councils will be allowed to raise council tax by 2% to invest in care.

However, councils have since disputed this, leaving the sector once again worried what the future holds.

But is it really as bad as people are saying? After all, if you look at the figures the number of care home beds has been pretty much increasing year on year since 2010 - up from just over 460,000 in 2010 to nearly 465,500 this year, according to figures from the Care Quality Commission, the sector's regulator.

However, even the CQC itself admits that doesn't tell the full story.

Firstly, despite the rise in beds, the number of homes has actually fallen by 5% over the same period, suggesting the more vulnerable smaller operators are being swallowed up.

Chief inspector for social care Andrea Sutcliffe acknowledges this.

She says a "tipping point" seems to have been reached, particularly when inspectors demand changes be made.

Whereas in the past homes would respond quickly to requests, now, she says, they're simply talking about "throwing in the towel".

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