Nationwide, providers and commissioners in the care, health and support marketplace face a number of risks, issues and challenges, most of which are also present within Torbay. Whilst the list below is not meant to be exhaustive, it gives a flavour of the potential challenges facing both providers and commissioners.

This should be seen within the wider context of the potential impacts of the UK leaving the EU, which could have implications for the health and social care market. Economic and political uncertainty at a time when the system is facing major operational and financial pressures could provide challenges to commissioners and providers alike.

Costs and fees

  • The impact of cost savings that commissioners have to make (as a result of reductions in central government funding), on the level of fees paid to providers;
  • General inflation pressures;
  • Specific increases in core costs, such as national insurance, the National Living Wage and pension contributions;
  • Servicing debt associated with properties and other financial commitments; and
  • The costs of moving from out-of-date services (including premises that are no longer ‘fit for purpose’ or investment in new technology) to new ways of working. This is particularly an issue for the many small providers in the marketplace.

This potentially leads to reducing profit margins and falling returns on investment for service providers, possibly resulting in existing businesses being unable to develop or exit the market and potentially discouraging new entrants. Providers may also seek to concentrate more on the self-funder market to support their business models.


  • Recruiting and retaining a trained and well paid workforce (particularly with regard to Registered Care Managers);
  • Issues relating to staff turnover, ageing workforce, competitive labour market (e.g. attraction of permanent and seasonal retail and service sector employment opportunities), image and career prospects for carers, ‘bureaucracy’ and costs with recruitment (e.g. DBS checks), costs of training, etc;
  • Increased demand; and
  • Increases in the number of clients requiring care, particularly those with more complex needs e.g. co-morbidities and long-term conditions.

Quality and choice

  • Increasing demand from service users and their families in terms of the quality of service they expect and being able to exercise choice in meeting their needs (e.g. the personalisation agenda); and
  • Higher regulatory standards e.g. impact of CQC requiring providers to raise quality standards within services provided and impact of having to meet the widened scope of Deprivation of Liberty Safeguards (DoLS), etc.