The UK market for independent mental health hospitals as a whole grew by 4.1% in calendar 2018. The market remains highly consolidated, with 65% in the hands of the top four providers. In a market where margins have been squeezed during the years of austerity, it stands to reason that those with the greater bargaining power in the face of monopsony NHS purchasers and also national market knowledge and relationships have fared better. The ability to spread the cost of service development has also enabled larger groups to develop leading-edge specialist programmes.
While the NHS has put an end to the four-decade trend to reducing its in-house capacity, specialism continues to offer the independent sector a way to differentiate itself. NHS Mental Health Trusts still seem reluctant to invest in specialised services, which would require them to attract patients from beyond their boarders, preferring instead to provide a broad service range to meet the overall needs of their local population.
However, this means that there is an unequal distribution of specialist facilities throughout the country, meaning that some patients have to travel long distances to receive appropriate treatment. The report considers how the independent sector may be affected by NHS England's plans to eliminate out of area placements by 2020/21.
The prevalence and greater recognition of mental illness are not market drivers in of themselves. However, the greater priority being given to mental health in line with the objective of 'parity of esteem' and the funding that follows from this is. Limits on NHS capital budgets make it unlikely that the NHS will be able to provide significant growth in in-patient care, though it dominates community-based services and these are likely to be the recipients of any additional targeted spending. Independent providers seeking to grow through diversification would be well advised to consider the larger adults specialist care home space.
Key findings include:
- The main payor remains the NHS, which accounts for 90% of the market, with private payors only accounting for 10%. A third of the NHS's share is central commissioning by NHS England, meaning providers have a significant monopsony purchaser to negotiate with.
- Specialisation remains the independent sector's main strength and its main way to counter any risk that the NHS increases its in-patient mental health capacity. Local NHS trusts still appear to prefer to set up services that serve the broad needs of their local populations rather than invest in specialised services.
- Profitability in the sector is satisfactory, though it is far lower than before the global credit crisis and, with the public sector being the dominant payor, has suffered from the UK government's austerity policy. It is hoped that profitability will grow as financial pressures on the NHS ease.
- Demand in the independent sector remains subject to longer-term ebb and flow in NHS commissioning as commissioners prefer in-house NHS provision. However, so long as independent hospitals are perceived as offering value for money, there remains scope for them to increase their share of the mental health in-patient market.
- Those providers looking to expand their offering in mental health would be advised to consider the adult specialist care home market.
Key Topics Covered:
1.1 Market definition
1.2 Market size
1.3 Market size trends
1.4 Funding - by payor type
1.5 Segmentation by security level and patient type
1.6 Demand drivers
1.7 Demand and supply
1.8 Key operational statistics
1.9 Business models - strengths and weaknesses
1.10 Performance measures
1.11 Community mental health services
2. POLITICS AND REGULATION
2.1 History of independent mental health services in the UK
2.2 National policies
2.4 Regulation of the independent mental health sector in England
3.1 Payor breakdown and trends
3.2 Public sector commissioners (the NHS)
3.3 PMI and company paid medical expenses schemes
3.4 Self pay
4. MAJOR PROVIDERS
4.1 Market concentration and group penetration
4.3 Exits and entries
4.4 Business failures and recapitalisations
4.5 Age and quality of stock
4.6 Segmentation by provider type
4.7 Sources of capital
4.8 Economies of scale and scope
4.9 Barriers to entry
4.11 Major provider profiles
5.1 Major investors and their UK mental health holdings
5.2 Mergers and acquisitions, deal values and enterprise value multiples
6. MARKET POTENTIAL
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