Adult Specialist Care UK Market Report

Best Price Guarantee	Length	Publisher	Published Date	SKU
from $4,465	430 Pages	LaingBuisson Ltd.	January, 2022	LBU17058107

Best Price Guarantee
Price	from $4,465
Length	430 Pages
Publisher	LaingBuisson Ltd.
Published Date	January, 2022
SKU	LBU17058107

Adult Specialist Care UK Market Report

The fifth edition of LaingBuisson’s Adult Specialist Care UK Market Report is vital reading for anyone involved in adult social care for adults under 65, be they a provider, a commissioner, an investor, an advisor or a policy maker. Written and researched by leading market commentator, William Laing, this industry standard report provides unique insight into all areas of the market, including funding, operating models, future prospects and supply and demand.

EXECUTIVE SUMMARY AND HIGHLIGHTS
1. MARKET: 1.1 Definition, scope and data sources; 1.1.1 Definition and scope; 1.1.2 Data sources; 1.2 Impact of Covid-19 on operators; 1.2.1 Financial impact; 1.2.2 Other impacts of Covid; 1.3 Market size; 1.3.1 Care in residential settings; 1.3.2 Service users; 1.4 Market segmentation (market value, settings and service users); 1.4.1 Segmentation by primary client type; 1.4.1.1 Overlapping client types; 1.4.1.2 Limited data on further segmentation into client sub-groups; 1.4.2 Segmentation by support setting; 1.4.2.1 Balance between residential and non-residential settings; 1.4.3 Segmentation by client type ‒ learning disabilities; 1.4.3.1 Care in residential settings – learning disabilities; 1.4.3.2 Balance between residential and non-residential settings – learning disabilities; 1.4.3.3 Service users – learning disabilities; 1.4.4 Segmentation by client type ‒ mental health needs; 1.4.4.1 Care in residential settings – mental health needs; 1.4.4.2 Balance between residential and non-residential settings – mental health needs; 1.4.4.3 Service users – mental health needs; 1.4.5 Segmentation by client type ‒ physical disabilities and sensory impairments; 1.4.5.1 Care in residential settings – physical disabilities and sensory impairments; 1.4.5.2 Balance between residential and non-residential settings – physical disabilities and sensory impairments; 1.4.5.3 Service users – physical disabilities and sensory impairments; 1.4.6 Segmentation by client type ‒ memory and cognition needs; 1.4.7 Segmentation by client type ‒ Acquired brain injury (ABI) rehabilitation; 1.4.8 Segmentation by client type ‒ substance misuse; 1.5 Funding profile – by payor type; 1.5.1 Commissioner or consumer driven market; 1.5.2 Reasons for low level of private pay, and exceptions; 1.5.3 Trends over time; 1.6 Customer profiles; 1.6.1 Demographic profile; 1.6.2 Non-commodity like; 1.6.3 Provider polarisation; 1.6.4 Longevity and stickiness; 1.7 Growth; 1.7.1 Market value growth (historic); 1.7.1.1 Segmental analysis of recent growth trends; 1.7.1.2 Segmental analysis of recent growth trends – by provider sector; 1.7.2 Market volume growth (historic); 1.7.2.1 Residential settings; 1.7.2.2 Residential care vs supported living – recent trends; 1.7.2.3 Non-residential settings in general; 1.7.3 Prospects for future growth; 1.7.3.1 Public spending constraints; 1.7.3.2 Residential care; 1.7.3.2 Non-residential care; 1.8 Demand drivers; 1.8.1 Demography; 1.8.2 Public attitudes; 1.8.3 Consumer choice; 1.8.4 Public funding; 1.8.5 Outsourcing by statutory agencies; 1.8.6 Supported living demand drivers; 1.9 Demand and supply; 1.9.1 Demand for adult specialist care in residential settings – historical perspective; 1.9.2 Occupancy rates in adult specialist care homes; 1.10 Further segmental information by broad client type; 1.10.1 Learning disabilities; 1.10.1.1 Underlying demand for learning disability services; 1.10.1.2 Autistic spectrum disorders; 1.10.1.3 Future projections of change in underlying demand; 1.10.1.4 Market value trends – learning disabilities; 1.10.1.5 Market value trends by funding source – learning disabilities; 1.10.1.6 Market value trends by provider sector – learning disabilities; 1.10.1.7 Market volume trends – learning disabilities; 1.10.1.8 Prospects for future growth – learning disabilities; 1.10.2 Mental health needs; 1.10.2.1 Underlying demand; 1.10.2.2 Future projections of change in underlying demand; 1.10.2.3 Market value trends – mental health needs; 1.10.2.4 Market value trends by funding source – mental health needs; 1.10.2.5 Market value trends by provider sector – mental health needs; 1.10.2.6 Market volume trends – mental health needs; 1.10.2.7 Prospects for future growth – mental health needs; 1.10.3 Physical disabilities and sensory impairments; 1.10.3.1 Underlying demand; 1.10.3.2 Future projections of change in underlying demand; 1.10.3.3 Market value trends – physical disabilities and sensory impairments; 1.10.3.4 Market value trends by funding source – physical disabilities and sensory impairments; 1.10.3.5 Market value trends by provider sector – physical disabilities and sensory impairments; 1.10.3.6 Market volume trends – physical disabilities and sensory impairments; 1.10.3.7 Prospects for future growth – physical disabilities and sensory impairments; 1.10.4 Acquired brain injury; 1.10.4.1 Causes of ABI and underlying demand; 1.10.4.2 Patient pathway; 1.10.4.3 Occupancy rates – acquired brain injury; 1.10.4.4 Market value trends – acquired brain injury; 1.10.4.5 Market volume trends – acquired brain injury; 1.10.4.6 Sources of funding ‒ acquired brain injury; 1.10.5 Substance misuse; 1.10.5.1 Underlying demand for substance misuse services; 1.10.5.2 Market value trends – substance misuse; 1.10.5.3 Market volume trends – substance misuse; 1.11 Key operational metrics; 1.11.1 Prices; 1.11.1.1 Care home fees; 1.11.1.2 Fees for supported living; 1.11.1.3 Price differentials between outsourced and local authority in-house services; 1.11.2 Occupancy rates in registered care homes; 1.11.3 Costs; 1.11.3.1 Payroll; 1.12 Operating models; 1.12.1 Care homes; 1.12.2 Supported living and homecare; 1.12.2.1 Supported living in clustered settings and synergies with care homes; 1.12.2.2 Risk of exposure to rental voids; 1.12.2.3 Supported accommodation business model; 1.13 Investment models; 1.14 Performance measures; 1.14.1 Financial; 1.14.1.1 Adult specialist care homes; 1.14.1.2 Supported living; 1.14.2 Quality performance; 1.14.2.1 CQC ratings; 1.14.2.2 Incentives to perform well on CQC Fundamental Standards; 1.14.2.3 Does size matter?; 1.15 Supported accommodation – a parallel market; 1.15.1 Market size; 1.15.2 Market growth; 1.15.3 Appetite for investment in supported accommodation; 1.15.3.1 Civitas Social Housing plc; 1.15.3.2 Triple Point Social Housing REIT; 1.15.3.3 Other investors in supported housing freeholds; 1.15.3.4 Housing associations/RSLs acting as counterparties to supported housing REITS
2. POLITICS AND REGULATION: 2.1 Impact of government policy on the adult specialist care sector; 2.2 Funding of publicly paid services; 2.2.1 General economic management; 2.2.1.1 Brexit and the social care staffing crisis; 2.2.2 Funding of social care; 2.2.2.1 A decade of austerity – not over yet; 2.2.2.2 The NHS and social care funding announcement in September 2021; 2.2.2.3 People at the Heart of Care – the adult social care reform white paper; 2.2.2.4 Expansion of supported housing and supported living – an exception to austerity; 2.2.3 Other government policies – high degree of cross-party consensus on non-funding issues; 2.2.3.1 Personalisation and self-directed care, Direct Payments and Personal Budgets; 2.2.3.2 Integration of health and social care; 2.2.3.3 Removal of legal barriers to health and social care integration in 1999; 2.3 Regulation of adult social care provision; 2.3.1 Underpinning legislation in England – Health and Social Care Act 2008; 2.3.2 Fundamental Standards in England; 2.3.3 Scotland, Wales and Northern Ireland; 2.3.4 Scope of regulation – services covered not covered; 2.3.4.1 In England; 2.3.4.2 In Scotland and Wales; 2.3.5 History of last two decades ‒ deregulation accompanied by tougher enforcement; 2.3.5.1 Replacement of National Minimum Standards with less prescriptive Essential Standards; 2.3.5.2 Fundamental Standards of Quality and Safety 2014-; 2.3.5.3 Risks to providers from breaches of regulations and Fundamental Standards; 2.3.5.4 Stronger enforcement powers; 2.3.5.5 CQC market oversight regime – to ensure financial stability of hard to replace providers; 2.3.6 CQC’s new strategy for regulation in England – fewer inspections and more focus on data; 2.3.7 Scotland – rejection of simple rating system; 2.3.8 Regulatory distinction between care homes and supported living; 2.3.9 CQC’s six bed maximum guidance for homes for learning disabled people; 2.3.10 Market shaping – councils’ duty to promote diversity and quality and to ensure market sustainability; 2.4 Regulations affecting payroll; 2.4.1 National Living Wage (NLW); 2.4.2 Stakeholder pensions; 2.4.3 Apprenticeship levy; 2.4.4 VAT staff hire concession; 2.4.5 Sleep-in pay; 2.4.6 Employers National Insurance Levy of 1.5% from April 2022
3. PAYORS: 3.1 Local authorities; 3.1.1 Local authority funding environment; 3.1.2 Local authority market environment; 3.1.2.1 SWOT analysis; 3.1.3 Supported living - threats and opportunities for adult specialist care providers; 3.1.3.1 Definition of supported living; 3.1.3.2 Balance of services between residential and non-residential settings; 3.1.3.3 Commissioners’ more ‘nuanced’ views on the merits of supported living; 3.1.4 Variability of provision across the country; 3.1.5 Relative cost of care homes and supported living; 3.2 NHS; 3.2.1 NHS funding environment; 3.2.2 NHS market environment; 3.3 Private funding
4. MARKET STRUCTURE: 4.1 Market concentration and leading providers’ shares; 4.1.1 All adult specialist care (residential and non-residential services combined); 4.1.2 Adult specialist care in residential settings; 4.1.2.1 Market concentration and leading providers: learning disability care homes; 4.1.2.2 Market concentration and leading providers’ shares ‒ mental health care homes; 4.1.2.3 Market concentration and leading providers’ shares ‒ physical disabilities and sensory impairments care homes; 4.1.2.4 Market concentration and leading providers’ shares ‒ acquired brain injury; 4.1.2.5 Market concentration and leading providers’ shares ‒ substance misuse; 4.1.2.6 Market concentration and leading providers’ shares ‒ care homes and hospital units combined; 4.2 Consolidation; 4.3 Market structure by provider sector ‒ for-profit/not-for-profit supply; 4.4 Capacity turnover ‒ openings and closures; 4.5 Profile of adult specialist care homes; 4.5.1 Scale of care homes; 4.5.2 Age distribution of adult specialist care home stock; 4.5.3 Purpose-built and conversions/adaptations; 4.6 Exits and entries; 4.6.1 Company level exits and entries; 4.6.2 At service level; 4.7 Business failures and recapitalisations; 4.7.1 Business failures among small housing association counterparties to major listed supported housing investors; 4.8 Economies of scale and scope; 4.8.1 At individual service level; 4.8.2 At group/portfolio level; 4.8.3 Brands; 4.8.4 Absence of intermediation; 4.9 Barriers to entry; 4.10 Sources of capital; 4.10.1 Sources of capital for care homes; 4.10.1.1 Traditional bank debt funding, to supplement business owners’ equity; 4.10.1.2 Private equity; 4.10.1.3 Sales and leaseback; 4.10.1.4 High yield bond issues; 4.10.1.5 Stock exchange listing, giving access to public funds; 4.10.1.6 Islamic funding; 4.10.2 Capital for supported accommodation; 4.11 Developers
5. INVESTORS: 5.1 Private equity; 5.2 Other financial institutions; 5.3 Enterprise values and exit multiples
6. MARKET POTENTIAL: 6.1 Wider recognition of adult specialist care as an investment opportunity; 6.2 Digital technologies; 6.3 Artificial intelligence and robotisation; 6.4 Absence of any transnational dimension; APPENDIX 1. GLOSSARY; APPENDIX 2. KEY LEGISLATION; APPENDIX 3. REGULATORS; APPENDIX 4. TRADE BODIES AND ASSOCIATIONS; APPENDIX 5. HISTORY - PRIVATISATION OF SOCIAL CARE FROM THE 1970s; APPENDIX 6. PROFILES OF MAJOR ADULT SPECIALIST CARE PROVIDERS; APPENDIX 7. FINANCIAL APPENDIX
LIST OF TABLES: Table ES1 Number of recipients of long-term social care support; Table 1.1 Adult specialist care ‒ Market by support setting and provider sector, all younger adult client types, England, 2020/21 and UK projection; Table 1.2 Adult specialist care ‒ Volume and annualised value of services in residential settings, all younger adult client types1 England (by provider sector) and UK (summary), 2020/21; Table 1.3 All younger adult client groups ‒ Illustrative calculation of number of recipients of publicly funded long-term social care support and expenditure per recipient, all provider sectors, England, 2020/21; Table 1.4 Learning disabilities ‒ Market size by service type and provider sector (18 to 64-years-olds), England, 2020/2024 and UK projection; Table 1.5 Learning disabilities ‒ Volume and annualised value of social care services in residential settings, (18 to 64-years-olds), by provider sector, England , 2020/21 and UK projection; Table 1.6 Learning disabilities ‒ Illustrative calculation of number of recipients of long-term social care support and expenditure per recipient (18 to 64-years-old), all provider sectors, England, 2020/21; Table 1.7 Mental health needs ‒ Adult specialist care market size by service type and provider sector, England, 2020/21 and UK projection; Table 1.8 Mental health needs ‒ Volume and annualised value of social care services in residential settings (18 to 64-years-olds), by provider sector, England, 2020/21 and UK projection; Table 1.9 Mental health needs ‒ Illustrative calculation of number of recipients of long-term social care support and expenditure per recipient (18 to 64-years-olds). England, 2020/21; Table 1.10 Physical disabilities and sensory impairments ‒ Adult specialist care market size by service type and provider sector (18 to 64-years-olds), England 2020/21 and UK projection; Table 1.11 Physical disabilities and sensory impairments ‒ Volume and annualised value of services in care homes, England (by provider sector) and UK (summary) at 31 March 2021; Table 1.12 Physical disabilities and sensory impairments ‒ Illustrative calculation of number of recipients of long-term social care support and expenditure per recipient (18 to 64-years-olds), England, 2020/21; Table 1.13 Memory and cognition needs ‒ Social care market size by service type and provider sector (18 to 64-years-olds), England, 2020/21 and UK projection; Table 1.14 Acquired brain injury ‒ Volume and annualised value of social care services in residential settings (18 to 64-years-olds), plus UK value of neuro-rehabilitation in NHS and independent sector by provider sector, England, 2020/21 and UK projection; Table 1.15 Substance misuse ‒ Market size by service type and provider sector, England, 2020/21 and UK projection; Table 1.16 All adult specialist care client groups ‒ Addressable market value by service line for adult specialist care services (all provider sectors and all funding sources), England, 2014/15‒2020/21; Table 1.17 All adult specialist care clients ‒ Service users in residential settings (occupied beds), all provider sectors and all funding sources, England, 1990–2021; Table 1.18 Learning disabilities ‒ Segmental analysis of addressable market value by service line at current prices for social care of adults (18 to 64-years-old), all provider sectors and all funding sources), England, 2014/15‒2020/21; Table 1.19 Learning disabilities ‒ Service users in residential settings (occupied beds), all provider sectors and all funding sources, England, 1990–2021; Table 1.20 Mental health needs ‒ Segmental analysis of addressable market value by service line at current prices for social care of adults (18 to 64-year-olds), all provider sectors and all funding sources, England, 2014/15‒2020/21; Table 1.21 Mental health needs ‒ Service users in residential settings (occupied beds), all provider sectors and all funding sources, England, 1990–2021; Table 1.22 Physical disabilities and sensory impairments ‒ Segmental analysis of addressable market value by service line at current prices for social care of adults (18 to 64-years-old) (all provider sectors and all funding sources), England, 2014/15‒2020/21; Table 1.23 Physical disabilities and sensory impairments ‒ Service users in residential settings (occupied beds), all provider sectors and all funding sources, England, 1990–2021; Table 1.24 Key operating statistics (capacity, occupancy and prices) for leading adult specialist care providers: Voyage and CareTech (Adult Services), 2020‒2021; Table 1.25 Selected unit cost differentials: outsourced versus local authority in-house provision of social care services, gross of SSMSS council overheads, England, 2020/21; Table 1.26 Payroll costs as a percentage of revenue, major adult specialist care home groups, accounting periods ending 2020‒21; Table 1.27 Summary of CQC Fundamental Standards overall ratings by provider type for adult specialist care homes, primary client type: learning disabilities, mental health (including eating disorders), physical disabilities, brain injury rehabilitation and substance misuse, England, snapshot at June 2021; Table 1.28 Adult specialist care home providers ‒ League table, listed in order of share of homes rated Good or Outstanding, England, June 2021; Table 1.29 Projected units of supported housing by client group, England, 2015‒2030 (Base case, in thousand units); Table 1.30 Specialist, listed supported housing REITS, key statistics, 2017‒2021; Table 2.1 National Minimum Wage and National Living Wage rates, 1999‒2022 and projections to 2024; Table 2.2 Minimum employers stakeholder pension contributions, 2017‒2019; Table 3.1 Penetration of self-directed care among council funded non-residential service users by age and client group, England, 2020/21; Table 3.2 SWOT analysis of the adult specialist care market, from the provider perspective; Table 3.3 Local authority commissioners' views on supported living and residential care for working age adults with high social care needs; Table 4.1 Adult specialist care ‒ Market shares of leading providers, UK, c.2020/21; Table 4.2 Market concentration (share controlled by the four largest providers) in different segments of the UK independent health and social care services sector; Table 4.3 Adult specialist care ‒ Numbers of service users supported by leading providers and revenue per service user, 2020/21; Table 4.4 Adult specialist care ‒ League table of leading 20 independent sector (for-profit and not-for-profit) groups by adult specialist bed capacity, all 18 to 64-year-old client types, UK, November 2021; Table 4.5 Learning disabilities ‒ League table of leading 20 independent sector (for-profit and not-for-profit) care home groups by bed capacity, UK, November 2021; Table 4.6 Mental health ‒ League table of leading 20 independent sector (for-profit and not-for-profit) care home groups by bed capacity, UK, November 2021; Table 4.7 Physical disabilities and sensory impairments‒ League table of leading 20 independent sector (for-profit and not-for-profit) care home groups by bed capacity, UK, November 2021; Table 4.8 Acquired brain injury ‒ League table of leading 20 independent sector (for-profit and not-for-profit) care home groups by bed capacity, UK, November 2021; Table 4.9 Substance abuse ‒ League table of leading 20 independent sector (for-profit and not-for-profit) care home groups by bed capacity, UK, November 2021; Table 4.10 Mental health hospital and adult specialist care homes ‒ League table of leading 20 independent sector (for-profit and not-for-profit) providers of bed capacity, UK, November 2021; Table 4.11 Adult specialist care - Share of capacity in each size band, independent (for-profit and not-for-profit) care homes by client type, UK, 2021; Table 4.12 Adult specialist care ‒ Purpose-built status of independent (for-profit and not-for-profit) sector care homes, by client type, UK, 2021; Table 5.1 Private equity holdings of adult specialist care companies, UK, November 2021; Table 5.2 Health and care service transactions since the global credit crisis which are either markers of exit value for the health and care sector in general or for the specialist care sector specifically
LIST OF FIGURES: Figure ES1 Adult specialist care ‒ Value of the market by client type, UK, 2020/21; Figure ES2 Adult specialist care ‒ Funding sources; Figure ES3 Projected increases in volume of demand for care for adults aged 18 to 64-years-old in England, 2018–2038; Figure ES4 Estimated service users in residential settings (occupied beds) and supported living settings, England, 2015‒2021; Figure ES5 EBITDAR as % of revenue posted by companies whose principal business is the operation of adult specialist care homes; Figure 1.1 Illustration of broad market segments and client groups covered by this report, UK all funding sources; Figure 1.2 Adult specialist care ‒ Value of market by client type (18 to 64-years-old), England, 2020/2021; Figure 1.3 Adult specialist care ‒ Value of market by support setting, all client groups, England, 2020/21; Figure 1.4 Adult specialist care ‒ Share of spending absorbed by residential settings, by client type, England, 2007/08‒2020/21; Figure 1.5 Learning disabilities ‒ Value of market by service type, England, 2020/21; Figure 1.6 Learning disabilities ‒ Share of councils’ adult specialist care spending allocated to residential services (18 to 64-years-olds), England 2007/08‒2020/21; Figure 1.7 Mental health needs ‒ Value of adult specialist care market by client type (18 to 64-years-olds), England, 2020/2021; Figure 1.8 Mental health needs ‒ Share of councils’ adult specialist care spending allocated to residential services (18 to 64-years-olds), England, 2007/08‒2020/21; Figure 1.9 Physical disabilities and sensory impairments ‒ Value of adult specialist care market by client type (18 to 64-years-olds), England, 2020/21; Figure 1.10 Physical disabilities and sensory impairments ‒ Share of adult specialist care spending allocated to residential services (18 to 64-years-olds), England, 2007/08‒2020/21; Figure 1.11 Adult specialist care ‒ Sources of funding by value, England, 2020/21; Figure 1.12 Adult specialist care ‒ Sources of funding by number of service users, England, 2020/21; Figure 1.13 All adult specialist care client groups ‒ Gross spending envelope (including local authority overheads), England, years ending March 31 2008‒2021; Figure 1.14 All adult specialist care client groups ‒ Gross spending envelope at current (nominal) prices, by sector of provision (local authority overheads included and allocated pro rata), England, years ending 31 March 2012‒2021; Figure 1.15 All adult specialist care client groups ‒ Share of services supplied by the independent sector by value, England, 2008‒2021; Figure 1.16 All adult specialist care client groups ‒ Service users in residential settings (occupied beds), all provider sectors and all funding sources, England, 1990–2021; Figure 1.16a Estimated service users in residential settings (occupied beds) and supported living settings, England, 2015‒2021; Figure 1.17 All adult specialist care client groups ‒ Council funded users (age 18 to 64-years-old) of long-term non-residential social care services, all provider sectors, England ,2006–2021; Figure 1.18 Projected increases in demand for care for adults aged 18 to 64-years-old, in England, 2018–2038; Figure 1.19 Adult specialist care homes ‒ Occupancy rates, UK, years ending March 2000‒2021; Figure 1.20 Adult specialist care homes ‒ Occupancy rates by region, England, 2021; Figure 1.21 Learning disabilities ‒ Gross spending envelope for social care services (including local authority overheads), England, years ending 31 March 2008 to 2021; Figure 1.22 Learning disabilities ‒ Gross spending envelope by sector of provision, England, years ending March 31 2008‒2021; Figure 1.23 Learning disabilities ‒ Share of adult specialist care services outsourced to the independent sector by value, England, years ending March 31 2008‒2021; Figure 1.24 Learning disabilities ‒ Service users (18 to 64-years-old) in residential settings (occupied beds), England, 1990–2021; Figure 1.25 Learning disabilities ‒ Service users (18 to 64-years-old) of council funded non-residential social care, all provider sectors, England, 2006–2021; Figure 1.26 Learning disabilities ‒ NHS occupied hospital beds for people with learning disabilities, England 2001‒2021; Figure 1.27 Mental health needs ‒ Gross spending envelope for social care services (including local authority overheads), England, years ending March 31 2008‒2021; Figure 1.28 Mental health needs ‒ Gross spending envelope, by sector of provision, England, years ending March 31 2008‒2021; Figure 1.29 Mental health needs ‒ Share of adult specialist care services outsourced to the independent sector by value, England, years ending March 31 2008–2021; Figure 1.30 Mental health needs ‒ Service users in residential settings (occupied beds) (18 to 64-year-olds), England 1990–2021; Figure 1.31 Mental health needs ‒ Service users (18 to 64-year-olds) of council funded non-residential social care, all provider sectors, England, 2006–2021; Figure 1.32 Physical disabilities and sensory impairments ‒ Gross spending envelope for social care services (including local authority SSMSS overheads), England, years ending March 31 2008‒2021; Figure 1.33 Physical disabilities and sensory impairments ‒ Gross spending envelope by sector of provision (local authority overheads allocated pro rata), England, years ending March 31 2008‒2021; Figure 1.34 Physical disabilities and sensory impairments ‒ Share of adult specialist care services outsourced to the independent sector by value, England, 2008‒2021; Figure 1.35 Physical disabilities and sensory impairments ‒ Service users in residential settings (occupied beds) (18 to 64-years-old), England, 1990–2021; Figure 1.36 Physical disabilities and sensory impairments ‒ Service users (18 to 64-years-old) of council funded non-residential social care, all provider sectors, England, 2006–2021; Figure 1.37 Acquired brain injury ‒ Neuro-rehabilitation in hospitals and care homes by sector of supply, UK 2020/21; Figure 1.38 Acquired brain injury ‒ Value of independent sector (for-profit and not-for-profit) provision in care homes, UK, 2008‒21; Figure 1.39 Acquired brain injury ‒ Estimated number of patients/residents in NHS rehabilitation units, independent sector hospitals and care homes, England, 2011/2021; Figure 1.40 Substance misuse ‒ Percentage of 16 to 59-year-old population in England and Wales who reported using any drug in the last month, years ending March 31 1997‒2019; Figure 1.41 Substance misuse ‒ Age-standardised alcohol-related mortality rates per 100,000 population, UK, 1994‒2020; Figure 1.42 Substance misuse ‒ Service expenditure by sector of supply, England, 2020/21, and UK projection; Figure 1.43 Substance misuse ‒ Expenditure under the ring-fenced Public Health England budget, England, 2013/14‒2019/20; Figure 1.44 Substance misuse ‒ Adults and young people in treatment in Public Health England funded drug and alcohol misuse programmes, 2006‒19; Figure 1.45 Average weekly fees paid by English local authorities to independent sector providers for selected adult specialist care client types; Figure 1.46 Distribution of average fees (£ per hour) for supported living services purchased by councils from independent sector providers , Great Britain, 2020/21; Figure 1.47 EBITDAR as % revenue posted by companies whose principal business is the operation of adult specialist care homes, 2006‒2019; Figure 1.48 EBITDA as % of revenue posted by providers whose principal business is supported living services, 2006‒2020; Figure 1.49 Relationship between occupancy rates and CQC ratings in adult specialist care homes, England, June 2021; Figure 1.50 Percentage of adult specialist care homes rated Good or Outstanding by size of home (number of registered beds), England, all provider sectors, latest CQC ratings at June 2021; Figure 1.51 Supported housing stock (younger adults) held by housing associations and other private registered (non-statutory) providers of social housing, England, 2010‒2020; Figure 2.1 Adult social care ‒ Change in gross current expenditure by local authorities, in cash and real terms, England, 2006/07‒2020/21; Figure 2.2 National Living/Minimum Wage rates, 2000–2022 and projections to 2024; Figure 2.3 Index of hourly paid care home staff pay, UK for-profit homes, years ending March 2008‒2024 (projection), INDEX: October 2008 = 1.00; Figure 3.1 Adult specialist care - Illustrative segmentation by degree of defensibility; Figure 3.2 Demand for alternative accommodation for adult specialist care service users (aged 18 to 64-years-old) and the role of property investors in creating new supported accommodation, England, 2020/21; Figure 3.3 Supported living expenditure as a proportion of total social care expenditure on working age adult (18 to 64-years-old) service users, distribution of 149 individual English local authorities, 2020/21; Figure 4.1 Adult specialist care ‒ Independent sector (for-profit and not-for-profit) bed capacity in residential settings1 by broad primary client type (18 to 64-years-old), UK, 2021; Figure 4.2a Adult specialist care ‒ Consolidation trends, share of independent sector market value held by the largest providers, UK, 2008–2021; Figure 4.2b Adult specialist care ‒ Consolidation trends, share of independent sector market bed capacity operated by the largest providers, UK, 2008–2021; Figure 4.3 Adult specialist care ‒ For-profit and not-for-profit shares of independent care home capacity, all client groups (18 to 64-years-old), UK, 1990‒2021; Figure 4.4 Adult specialist care ‒ Care home capacity gained and lost through new registrations and home closures, all client groups, all sectors, UK, 1995‒2021; Figure 4.5 Learning disabilities ‒ Care home capacity gained and lost through new registrations and home closures, all sectors, UK, 1995‒2021; Figure 4.6 Learning disabilities and all other adult specialist care types ‒ Distribution of care home capacity by size of home, independent sector, UK, 2021; Figure 4.7 Adult specialist care ‒ Age distribution of home stock, UK, 2021; Figure 4.8 Adult specialist care ‒ Purpose-built penetration among independent (for-profit and not-for-profit) care homes, by client type, UK, 2021