The delivery of health and care services in the home is entering an exciting phase: Overall demand is increasing due to an aging population and the prevalence of long-term conditions. The consensus is that care is better and less costly when delivered outside hospitals and nursing homes. At the same time common sense (and now even politicians) is driving towards integrated care and the pooling of health and social resources. So what does this mean for providers of health and care services in the community? We set out our top five predictions:
Convergence of health and domiciliary care
‘Person centred care’ is challenging the traditional split between ‘health’ and ‘social’. Service users or patients have needs on a continuum of care. Effective delivery must be centred on the individual – not arbitrary silos or budgets.
The political consensus is moving relatively fast towards tighter integration. The number of regions with integrated care models with joint health and social funding is increasing noticeably.
Expect an increase in the number of large, ambitious private care organisations moving towards delivering higher acuity care services. In particular, large domiciliary care providers have ‘feet on the ground’, working branch networks, managerial talent and the need to generate return for owners.
Commissioning of outcomes…not yet…but eventually
‘A lot of talk but no willingness to change the funding mechanism – ultimately cost is the only driver’ is a typical response from disillusioned providers.
Defining outcomes in health and care is challenging. But it is the only direction of travel. In order to do more with less, innovation and alignment between funder and provider is essential.
Expect successful outcome based programs to focus on a small number of indicators. Our view is that a combination of hospital avoidance and satisfaction will be key.
Also, expect outcome focused strategies to evolve into the management of defined cohorts of patients/service users. The simplest will be where easily identifiable patient groups with similar needs exist(e.g. HIV) . Most powerful would be regional ‘accountable care organisations’ (..yes, I said it) where comparative performance could be assessed.
New business models, new technologies
The traditional domiciliary care business is a tough game, essentially selling a commodity – ‘hours delivered’. Old-school commissioning has put enormous pressure on cost per hour leading to a race to the bottom in terms of quality.
Going forward, the only way to get more done for less funding is to design new services.
Expect providers to incorporate telecare/telehealth and design escalation-based services using technology to facilitate independence and to use face-to-face contact more sparingly. Finding ways of engaging the patient or service user will become important.
Also, expect traditional call monitoring (e.g. measuring how much time was spent) to be replaced by more sophisticated tracking of care plans and outcome measures.
The falling cost and increasing power of smartphones will allow providers to tap into the trend of BYOD (bring your own device), ensuring cost-effective clinical governance and control of a fluid workforce.
Growing role of the private sector in ‘health’
A number of factors point to significant increase of private providers and the third sector in healthcare delivered in the home. 
Over a period of 15 years, the delivery of domiciliary care in England by private providers has gone from 2 percent to over 80 percent! Significant cost reductions where achieved primarily through better staff utilisation and lower staff pay (and, in some cases, a drop in quality).
In parallel, the Health Bill and the general political current points towards more competition in health. A recent survey of CCGs suggested that over 30 percent thought competition would first be introduced for home and community related services.
Expect a battle in the health & care at home between large domiciliary care providers, traditional outsourcers and private health companies.
Given the historically low priority given to NHS community care provides it is reasonable to expect that only a small number of these organisations will survive – leaving plenty of opportunities for other organisations.
Top-up funding and new insurance products
Ever increasing demand and (most likely) decades of austerity budgets will drive rationing of services one way or the other. Combined with the slow but credible momentum of individual budgets and personalisation, this will eventually lead to extensive private top-up funding by individuals and families who can afford it.
Despite the political sensitivities, many people argue that we are standing on the brink of a large-scale transition to mixed funding.
Traditional private medical insurance has been stagnant in the UK for a while. The focus is now on creating new insurance products that wraps around NHS and social care funding. Large insurers and financial services companies already have new product on the market. Expect that in less than 10 years this will become a multi-billion pound market.