The Key Challenges Facing Adult Social Care in East Sussex

East Sussex has a large and established adult social care market, but the pressures facing it are not simply about finding enough care.

An ageing population, increasing complexity, workforce pressures and mismatches between the type of provision available and the type of provision increasingly required are changing the local care environment.

East Sussex County Council's latest Market Position Statement identifies a number of pressures that are likely to shape adult social care over the coming years. This report looks at eight of the most significant.

At a glance

Ageing population

Nearly one-third of residents projected to be 65+ by 2031

Long-term support

Up 20.6% between 2021/22 and 2024/25

Adult social care workforce

Around 19,000 workers and 1,400 vacancies

Workforce requirement

Projected to increase 28% by 2035

Nursing care

Occupancy above 90%

Nursing capacity

Net loss of 477 older people’s nursing beds since 2014

Home care

Existing capacity currently exceeds council demand

Supported living

General additional capacity not currently being sought in some areas

Reablement

74.6% of people aged 65+ still at home 12 weeks after discharge into reablement or rehabilitation

Unpaid carers

Around 69,241 people, roughly one in ten residents

These figures illustrate one of the central challenges facing East Sussex: overall care demand is increasing, but that demand does not translate evenly across different services, and some demand is being delayed or absorbed elsewhere in the system.

1. An ageing population is increasing the underlying level of need

East Sussex already has a considerably older population than England overall.

Around 26.6% of residents are aged 65 or over, and the proportion is expected to continue increasing. By 2031, almost one-third of the county's population is projected to be aged 65+. The 85+ population is growing particularly quickly.

The number of people receiving long-term support from East Sussex Adult Social Care and Health increased by 20.6% between 2021/22 and 2024/25, reaching 10,925 people. Among people aged 65 and over, growth was higher at 23.7%.

1. 18.7%England today
2. 26.6%East Sussex today
3. Nearly 1 in 3East Sussex by 2031, projected

Rising demand is increasingly concentrated among older people with more complex needs, with sustained pressure on services supporting multiple conditions, dementia, frailty and increasing dependency.

2. The challenge is increasingly complexity, not simply more capacity

East Sussex's strategy is to help people remain independent and living at home or within their communities for as long as possible.

That can reduce or delay the need for institutional care, but it also changes the point at which some people eventually enter residential or nursing provision.

The Council expects people moving into long-term care to increasingly have more complex needs, with growing demand for nursing and dementia provision in particular.

This creates a mismatch within parts of the existing market.

General residential provision has average occupancy of around 80%, while general nursing occupancy is approximately 92% and nursing dementia occupancy approximately 93%.

Residential care, average occupancy

• 80%General residential
• 81%Residential dementia

→More complex needs

People supported at home for longer arrive in long-term care needing more, which moves demand towards nursing and dementia provision.

Nursing care, average occupancy

• 92%General nursing
• 93%Nursing dementia

So East Sussex does not simply face a shortage or surplus of "care-home beds".

The challenge is whether the right type of bed, at the right price and with the right workforce, is available for increasingly complex needs.

3. Nursing and dementia provision is under greater pressure than general residential care

Since 2014, East Sussex has experienced a net loss of 477 older people's nursing beds, and no new nursing beds have opened since 2021. Recent additions to care-home capacity have been more heavily concentrated in residential provision or services aimed at self-funding residents.

The Council specifically identifies continuing demand for affordable nursing and dementia care.

Affordability is important here. A theoretically vacant bed is not necessarily accessible to someone whose placement is being funded within the local authority's fee structure.

1. 01Since 2014A net loss of 477 older people’s nursing beds
2. 02Since 2021No new nursing beds opened
3. 03Spring 2026Nursing occupancy above 90%, with continuing demand for affordable nursing and dementia care

There is also a geographic dimension. Care-home provision is more concentrated in the east of the county and in urban areas, which the Council says can restrict choice for people living in northern and western East Sussex.

High nursing and dementia occupancy, combined with reduced nursing capacity, limits effective supply. The issue is therefore a combination of capacity, specialism, affordability and geography.

4. Recruiting and retaining enough care workers remains a structural challenge

East Sussex had approximately 19,000 people working in adult social care in 2024/25, alongside around 1,400 vacant posts.

The workforce required to meet future demand is projected to grow by 28% between 2023 and 2035.

At the same time, the workforce itself is ageing.

Around 29% of adult social care workers in East Sussex are aged over 55, and approximately 5,000 existing workers are expected to reach retirement age during the next decade.

Turnover also remains significant. East Sussex's reported workforce turnover rate of 26.7% was above both the South East and England averages in 2024/25.

19,000

People working in adult social care, 2024/25

1,400

Vacant posts, 2024/25

26.7%

Turnover, 2024/25

29%

Workers aged over 55

5,000

Workers who may reach retirement age within ten years

+28%

Projected workforce growth by 2035 from 2023

Approximate figures from East Sussex County Council.

Changes to international recruitment add another dimension, particularly for home care. The Council notes that restrictions introduced from July 2025 removed a recruitment route that parts of the sector had previously relied upon.

The local challenge is therefore not merely creating additional care capacity. It is creating capacity that can be reliably staffed.

5. Supply does not always match commissioning demand

One of the clearest lessons from East Sussex is that demographic growth should not automatically be interpreted as a need for more providers of every type.

Home care is the strongest example.

The Council commissions around 37,000 hours of home care each week and supports approximately 2,700–2,800 people through home-care packages. Yet its current assessment is that market capacity exceeds existing Adult Social Care demand.

Around 25% of providers on the approved list have left the market during the current contract period, while there have nevertheless been no home-care waiting lists anywhere in the county during that period.

Supported living provides a similar warning against relying on headline demographic demand.

The Council says it currently has sufficient supported accommodation for adults with higher levels of learning-disability need and is not seeking additional standard supported-living capacity over the immediate period. Instead, it identifies more specific requirements around respite, emergency provision and targeted future commissioning.

• What is growing

  • An ageing population, with the 85+ group growing fastest
  • 20.6% more people receiving long-term support than in 2021/22
  • More complex needs on entry to long-term care

• What the Council is commissioning

  • Home-care capacity already exceeds its current demand
  • No home-care waiting lists during the contract period
  • No additional standard supported living in the immediate period
  • Specific needs: respite, emergency provision and targeted gaps

More demand does not necessarily mean more general capacity.

This creates an increasingly important distinction between overall need and commissionable market opportunity.

6. Affordability and financial sustainability are becoming harder to reconcile

Providers are facing higher employment, utility and operating costs at the same time as councils remain under significant financial pressure.

East Sussex highlights rising National Living Wage costs, employer National Insurance changes, utility costs and wider inflationary pressures as factors affecting provider sustainability. The Council itself expects significant future budget deficits.

This is particularly important in services where local-authority-funded placements represent a substantial part of the market.

A service may be clinically or operationally capable of meeting demand while still struggling to provide that care at a sustainable price.

East Sussex explicitly identifies demand for nursing and dementia provision that can operate within or close to the Council's fee structures.

Provider costs rising

• National Living Wage
• Employer National Insurance
• Utilities
• Wider inflation

→Where demand sits

Nursing and dementia care that can operate within or close to the Council’s fee structures.

Public funding constrained

• Councils under significant financial pressure
• Significant future budget deficits expected by East Sussex

This makes financial sustainability one of the defining challenges for both commissioners and providers.

7. Prevention, reablement and unpaid care can hide pressure as well as reduce it

East Sussex is deliberately trying to prevent, reduce or delay the need for formal care.

That is an important success measure, but it also changes how providers should interpret demand.

In 2024/25, 74.6% of people aged 65 and over who entered reablement or rehabilitation following hospital discharge were still at home 12 weeks later, significantly above the England figure of 60.7%.

Strong reablement can reduce or delay long-term packages and residential admissions. It can therefore make simple demographic growth a poor predictor of immediate service demand.

At the same time, around 69,241 people in East Sussex provide unpaid care, roughly one in ten residents.

Unpaid carers are a major part of the county's effective care capacity. When that support is sustainable, it can help people remain at home for longer. When it breaks down, demand can emerge quickly for respite, home care, emergency support or longer-term provision.

This creates a difficult planning problem for the market: some pressure is visible in formal service use, while some is being absorbed by families, carers, reablement and community services.

For providers, the implication is that future demand should be assessed through pathways and client groups rather than population growth alone.

8. Market resilience and consolidation affect how much capacity is genuinely usable

The number of registered providers is not the same as a resilient market.

East Sussex reports increasing corporate acquisition and consolidation in residential and nursing care. Consolidation can bring investment and scale, but it can also reduce diversity and local responsiveness if ownership becomes concentrated.

The Council therefore monitors provider quality, financial sustainability, safeguarding information, placement activity and continuity risk alongside simple capacity measures.

Quality remains broadly strong, but there is variation. In the Spring 2026 market information, 80% of older people's residential services and 78% of older people's nursing services were rated Good or Outstanding, compared with 92% of working-age residential and nursing provision.

The home-care market illustrates the same point in a different way. Around a quarter of providers on the approved list have left during the current contract period, yet there have been no waiting lists because remaining capacity has continued to exceed Council demand.

So provider exits, acquisitions or spare capacity cannot be interpreted in isolation.

A resilient market needs the right services, in the right places, at sustainable prices, with enough staff and sufficient quality. That is a more demanding test than simply counting providers.

Health inequalities add another layer

East Sussex is not a uniform market.

Life expectancy, deprivation and health outcomes vary significantly between different parts of the county.

For example, life expectancy is substantially higher in Wealden than in Hastings. The Council expects these inequalities to continue influencing the timing and type of health and social care support required in different communities.

That means county-wide averages can conceal significant differences in local need.

• Lewes
• WealdenLife expectancy substantially higher than in Hastings
• Rother
• Eastbourne
• HastingsLife expectancy substantially lower than in Wealden

English Channel

Districts are shown in their rough positions, not to scale.

This is one reason local market analysis becomes more useful when it moves below the county headline and considers the specific geography and population being served.

What are the biggest challenges for East Sussex adult social care?

The evidence points towards a market undergoing structural change rather than facing one simple capacity problem. These are the central challenges.

1. 01

   Meeting rising demand

   Long-term support up 20.6% since 2021/22; nearly one-third of residents projected 65+ by 2031.

2. 02

   Supporting more complex needs

   More complex needs on entry to long-term care, with growing nursing and dementia demand.

3. 03

   Keeping nursing and dementia capacity

   477 nursing beds lost since 2014; nursing occupancy above 90%.

4. 04

   Recruiting and retaining staff

   1,400 vacancies, 26.7% turnover, 28% workforce growth needed by 2035.

5. 05

   Matching supply to commissioning

   Home-care capacity exceeds council demand; no additional standard supported living sought.

6. 06

   Staying affordable

   Rising provider costs against constrained council budgets and fee levels.

7. 07

   Reading hidden demand correctly

   Reablement and around 69,241 unpaid carers absorb or delay some formal demand, while creating pressure for respite and emergency support when those arrangements fail.

8. 08

   Maintaining a resilient market

   Consolidation, provider exits, quality and financial sustainability all affect whether nominal capacity is genuinely usable.

East Sussex County Council's stated commissioning direction reflects these pressures. Its immediate focus is less on indiscriminate expansion and more on market stability, quality, prevention, independence and targeted provision where specific gaps remain.

For existing and prospective care providers, that makes understanding the detail of the local market increasingly important.