Workstream 2: Market analysis and system management - Current Projects

1. Market dynamics in regional social care markets

Project lead:Stephen Allan

Context and problem statement

Work in ESHCRU to date has examined market dynamics of care homes markets nationally, looking at the effects of competition on prices and quality and competition on market exit rates. We have also examined substitution effects between care homes markets and domiciliary care providers. Nonetheless, there is significant scope to improve the understandings of social care markets in England, particularly at a more local level.

Reductions in social care expenditure by local authorities have impacted the care homes market through reduced prices for publicly-supported residents (or non-inflationary increases). This has put providers under increasing pressure and our previous work (Forder and Allan, 2014) showed that the power of local authority commissioners in the market to reduce prices causes quality to decrease through competition.


Social care expenditure reductions are likely to differ in how they affect local social care markets. Even local markets that appear strong may be seeing an increased polarisation in services between basic and high quality providers.

Project aims

The overall aim of this project is to improve our understanding of factors that affect changes in the supply in local social care markets.

  1.  Building on the assessment of the national care homes market, we will descriptively analyse differences in local authority care home markets (levels of competition, quality, entry and exit).
  2. We will analyse local social care markets in general, particularly concentrating on describing the different forms of social care available in two LA markets, examining the economic factors that act as enablers or barriers to different forms of social care provision.

To quantitatively assess whether differences in local authority expenditure cause provider entry and exit in local care homes markets, and to what extent.


2. Workforce stability and labour supply in social care markets

Project lead:Florin Vadean (Kent), Raphael Wittenberg (LSE)

Context and problem statement

In general, high vacancy and turnover rates are heavily influenced by low pay, low job satisfaction and lack of opportunities for career advancement. Yet little is known about the determinants of the current substantial turnover and vacancy rates in the social care sector. Factors that can help explain and inform the development of solutions to workforce stability issues in social care are of great interest, given the current shortage of social care workers in England. Reduced turnover and vacancy rates would promote care home and home care quality and create efficiencies in the costs of staffing.

Social care is a low-pay sector, with wages of care staff at or just above minimum wage rates. Earlier work in ESHCRU showed that the introduction of the National Living Wage in April 2016 created an increased compression of wages around the minimum. However, a significant minority of workers were paid above the minimum wage. Non-pay factors might explain the quite important wage dispersion between social care establishments. Understanding the impact of higher wages and better conditions of employment can promote social care as a vibrant and rewarding sector.

Project aims

The main research aims are:

  1. To assess the main factors affecting staff turnover and vacancy rates in the social care sector, in particular those that can be addressed by social care providers and policies.
  2.  To examine the relationship between pay and conditions of home care staff and the quality of care provided by their employing home care agencies as rated by the Care Quality Commission (CQC).
  3. To give an overview of the social care labour market, including the distribution of wages and non-pay compensation by geography and service type, and provide comparisons with other sectors (e.g. retail trade and hospitality) competing in local labour markets.

3. Organisation, size, and outcomes in general practice: GP hubs, federations & chains

Project lead:Hugh Gravelle, Rita Santos

Context and problem statement

NHS England has announced that practices are to be encouraged to work together in hubs or networks or Federations with a combined list size of 30 to 40,000 patients (Five Year Forward View – Next Steps).  The rationale is that this scale will allow practices to share facilities and resources and hence improve outcomes.  But there is little robust evidence.  The limited quantitative evidence reports mixed findings and used cross section comparisons.

Project aims


(i) What are the effects of larger general practices on clinical quality and patient reported outcomes such as satisfaction.
(ii) What are the effects of Federations and similar organisations of practices on clinical quality and patient reported outcomes.