LOCATED: LOcal care market Composition Assessment – Trends and gEographical Disparities

Background: Shifting care from hospitals to community settings is a key priority in England’s 10-Year Health Plan, with home care playing a central role in promoting independence and personalised support. However, the balance between home care and residential settings varies widely across the country, influenced by local socio-economic, demographic, and health factors.

 

Approach:This study examines the composition of home care and care home provision and use across England in 2024 and explores how local contexts shape these differences. It adopts a retrospective observational design using secondary data to analyse variations in adult social care market composition. Published Care Quality Commission registration tracker data from 2022 to 2025 were used to assess the distribution of care home and home care providers and locations, while unpublished Department of Health and Social Care Capacity Tracker data from the same period captured service use and occupancy.

 

The research involved three analytical approaches. First, longitudinal descriptive analyses identified trends in the composition of home care and care home provision and use by region, deprivation, rural or urban classification, and coastal status from 2022 to 2025. Second, cross-sectional analyses examined geographical variation in 2024 using comparative statistics and mapping to assess differences by local authorities.

 

Third, multilevel regression models will explore how local characteristics such as deprivation, urban or rural classification, demographics, and health metrics influence service composition and distribution. The work was developed collaboratively with Department of Health and Social Care analysts to ensure policy relevance.

 

Results: Preliminary findings show persistent and widening inequalities in the balance between home care and residential care provision and use across England. London consistently shows the highest and fastest growth in home care locations and users, while the North East and South West record the lowest proportions. Less deprived areas maintain higher home care composition than more deprived areas, and this gap has widened since 2022. Urban areas display higher proportions of home care provision and use, although mainly rural areas have experienced gradual increases since 2022, narrowing the difference slightly. Non-coastal areas maintain higher home care composition than coastal areas, with divergence increasing after 2022. In 2024, the highest home care composition was concentrated in London boroughs such as Tower Hamlets, Hackney, and Barking and Dagenham, while rural and coastal areas such as North Lincolnshire, East Sussex, and North Yorkshire recorded the lowest. These results suggest that the transition toward home-based care is progressing unevenly across regions and contexts.

 

Implications: Local care markets in England are evolving at different pace. Urban and less deprived areas appear better placed to expand home care and support independent living, while rural, coastal, and more deprived areas continue to face challenges providing home care. These disparities have important implications for planning, commissioning, and the pursuit of equitable community-based care. For international delegates, this study offers a transferable approach to monitoring social care markets using administrative data. It shows how linking provider, user, and contextual datasets can inform evidence-based policy and practice that promote independence and inclusion while reducing geographical inequalities.