Vic Citarella, Director CPEA Ltd, looks at the economics of social care and suggests marketing is more than immediate sales but is integral to every provider’s longer-term business strategy.
Describing a market portrays how buyers and sellers do business. There are many kinds of market and several types of player. Social care is a market with changing characteristics and an evolving cast of participants. Knowing and understanding how it works is central to successful transactions – now and into the future – between customers and service provider. In this respect, social care is like any other business.
In economics, it is usual to identify five types of market:
- Perfect Competition
- Monopolistic Competition
Applying the associated features of each to the social care market, it appears that not to be perfect competition because there are not an infinite number of buyers and sellers. There is one buyer who can alter the prevailing price in the market and that is the local authority. Nether buyers nor sellers have infinite alternatives and choice is a chimera.
Patently nor is there a monopoly with just a single supplier of social care and no reasonable substitute. If there were the supplier would be able to charge whatever they wanted and their income would only be limited by whether the customer was prepared or able to pay.
Neither is there an oligopoly in social care where there are just a few dominant providers. If there were they would be able to collude to set prices and to the customer it would seem just like a monopoly.
If the social care market were monopolistic competition there would be numerous competitors but the differences between each would allow them to charge different prices. Whilst each provider may be different there are usually substitutes available.
Lastly the monopsony market in social care would just have a single buyer. If this were the case they could dictate the price.
So, what types of market are there is social care? On a national level, there are two markets. Firstly, the public market – about 40% – which is a monopsony. Here the purchasing local authority can keep the price to the lowest level feasible. The only controls are if there is intervention from a regulator or there are unlawful actions. Both forms of intervention are currently being tested.
Secondly the private market which displays aspects of all the other types excepting monopsony. Several providers are seeking to differentiate their social care offer. For example, this is the case at the luxury end of the market and in terms of specialism or niche. There are signs of an oligopoly-like cluster emerging as smaller businesses are squeezed and consolidation takes places through mergers and acquisitions. If this trend continues there will need to be a strong regulator to prevent price fixing between providers and the eventual emergence of a monopoly. There are further signs in some parts of the private market that there is genuine competition (if not perfect) which offers the customer some choices at affordable prices.
Questions and Challenges
Selling to the monopsony provider – the local authority – is becoming untenable. Home care providers are handing back contracts and residential care homes are closing or ceasing to operate for the public-sector customer. The return on investment is insufficient to sustain a business even for a not-for-profit provider. There is little scope to attract and retain a skilled workforce. Much vaunted innovation will not take root in a climate of survival of the fittest. Social care is not a business field where rebuilding or paradigm shift can come out of chaos because of the lives at stake. Such change is much needed but careful incubation is a safer approach.
Residential home providers are either shifting to the private market and/or charging in a way that means private customers are subsiding the shortfall on income from the public customers. The former leads inextricably to a two-tier service with characteristics akin to the airline industry where actual customer service is increasingly for the first class only. Whereas the latter seems duplicitous under consumer legislation.
Inevitably providers are cutting costs – some say ‘corners’ – and seeking ways to raise income from extras – some say from ‘basics’. There are too many services not reaching the minimum standards required by the regulator. The regulator is not well enough resourced to enforce standards. And policing a service that cannot comply brings the system into disrepute with a fall-back position that colludes to allow the standards to lapse.
Knowledge and Expertise
In short – two markets, two tiers of service, falling standards for the have-nots and a get what you pay for service for the haves. The scenarios are last business standing takes the chaotic market into a monopolistic new order or the state intervenes to prop up a failing market and a centralised monopsony is (re)institutionalised with a choice and/or means tested opt out. Not a pretty picture for providers or genuine investors. Not encouraging for the social care entrepreneur unless jeopardising quality and safety are an acceptable risk for permitting the entry of a cohort of more ‘disruptive’ investors.
Markets and marketing are vital areas of knowledge and expertise for social care providers. In social care, both involve individuals with needs, transactions between organisations and purchasers as well as a strategic understanding of the local and national (and indeed international) business environment.
- How well do you know your market – where are the gaps?
- Who are the key players in your market – the service users, families, the workforce, the commissioners, brokers, agents or regulators – how well do you know them and do you need support in mapping and understanding your stakeholders?
- What are the emerging opportunities – do you need assistance in developing them?
- Who are the customers and why should they buy from you? What’s your plan?
Lynden Consulting has a proven track record in implementing successful strategies to achieve excellence and tangible results for providers in health and adult social care. Get in touch to find out how we can help.