Starting an Adult Social Care Service in Medway: What the Market Evidence Shows

Starting a care service in Medway can look attractive from the headline numbers.

Demand is rising. Medway Council received 9,265 new requests for adult social care support in 2024/25. The older population is growing. The council is already buying hundreds of residential and nursing placements, around 495,000 hours of homecare and extra-care support a year, and supported-living services for hundreds of working-age adults.

But those figures do not mean that Medway simply needs more of every type of care.

The local evidence is much more selective.

Medway already has a substantial residential, nursing, homecare and supported-living market. The council describes general residential provision as robust, while repeatedly identifying more specific shortages in dementia, high-frailty nursing, specialist working-age care, planned nursing respite, functional mental-health provision and services for people with multiple complex needs.

That distinction should shape a new provider's business model before it shapes the CQC application.

The strongest question is not:

Is there demand for care in Medway?

There clearly is.

The stronger question is:

Is there accessible, sustainable demand for the specific service you intend to build?

This report focuses on that decision.

See the adult social care market report and key challenges report for the wider local picture.

Start with the people you intend to support

The first decision should be the client group, not the registration category.

Descriptions such as "older people", "domiciliary care", "supported living" or "complex care" are too broad to establish whether a viable gap exists.

A useful service definition needs to answer questions such as:

This matters because Medway's clearest shortages concern capability rather than generic capacity.

A general residential bed is not equivalent to a dementia nursing bed.

A conventional homecare agency is not equivalent to a provider able to accept double-handed packages, high frailty, neurological needs or more clinically complex work.

A supported-living service for someone with relatively low support needs operates very differently from a service designed around autism, significant mental-health needs, physical disability or behaviours that challenge.

The commercial model should therefore be built around the intended cohort before the provider chooses premises, recruits staff or submits a registration application.

Read the Medway demand signal correctly

Medway received 9,265 requests for adult social care support from new clients in 2024/25.

Of those, 6,275 were from people aged 65 and over and 2,980 from adults aged 18 to 64.

• 6,275Aged 65 and over
• 2,980Aged 18 to 64

That is useful evidence of pressure.

It is not an addressable market of 9,265 customers.

Medway reports that 46% of requests resulted in information, advice, signposting or no subsequent service. Only 6% resulted in a long-term service such as homecare or residential care.

1. Advice, signposting or no subsequent service

   46%

2. Long-term service such as homecare or residential care

   6%

A prospective provider therefore needs to understand what happens after people enter the adult social care system.

Need can be met through:

• information and advice
• community equipment
• reablement
• unpaid care
• voluntary and community support
• direct payments
• short-term services
• homecare
• supported living
• residential or nursing care

Medway's current adult social care strategy places strong emphasis on early help, independence, prevention and getting the right support at the right time.

That means rising demand does not translate mechanically into equivalent growth in long-term commissioned care.

The people who eventually require formal services may also have higher levels of complexity.

For a provider, the opportunity is often in the part of demand that existing pathways cannot absorb easily.

Homecare is a large market, but it is not an empty market

Homecare is one of the obvious service models for a new provider in Medway.

The strategic direction supports it.

Medway wants more people to remain independent at home for longer, and the Support to Live at Home arrangements cover substantial activity. Homecare and extra care together support approximately 1,250 people and deliver around 495,000 hours of care and support each year.

1,250

People supported through homecare and extra care

495,000

Hours of care and support each year

But the provider market is already significant.

Twelve providers were appointed to the current Support to Live at Home framework, which began in April 2024 and is due to run until March 2028.

More than 100 providers expressed interest during the recommissioning exercise.

Medway has also cited more than 100 organisations registered with CQC to provide community-based adult social care locally.

The demand case is therefore not enough.

A new homecare agency should establish its route to customers before assuming that registration will produce work.

For commissioned care, that means understanding:

For private-pay care, the questions are different:

A homecare business can fail with plenty of underlying demand if the provider cannot convert that demand into efficient, chargeable care hours.

Specialist homecare may be more defensible than generic entry

Medway's evidence suggests that the stronger homecare proposition may sit in capability rather than volume.

As the system tries to keep people at home for longer, providers may increasingly encounter people with higher levels of frailty, dementia, physical disability, neurological conditions, end-of-life needs or more complex combinations of health and social care requirements.

That can create space for a provider able to demonstrate:

• reliable double-handed care
• experienced dementia support
• strong medication governance
• more intensive packages
• neurological or physical-disability capability
• robust clinical escalation arrangements
• strong continuity of care
• experienced registered management

The trade-off is cost.

Specialist homecare can require more training, supervision, longer calls, higher pay, additional management time and stronger clinical oversight.

A higher hourly rate does not automatically mean a higher margin.

The model needs to be costed around the real package, not around a generic domiciliary-care hourly rate with a specialist label added afterwards.

A new care home needs a specialist case

Medway already has a large accommodation-based care market.

In April 2026, the council reported 67 residential and nursing homes with 1,756 registered beds.

67

Residential and nursing homes

1,756

Registered beds

Medway Council.

The council describes overall residential provision as robust.

That should immediately challenge a business plan for another undifferentiated residential home.

The clearer local gaps concern:

• high-frailty nursing
• dementia residential care
• dementia nursing
• people with dementia alongside functional mental-health needs
• specialist care for people under 65
• people with multiple complex needs
• planned nursing respite

Those gaps are more commercially meaningful than simply pointing to population ageing.

A prospective care-home operator should therefore test whether the intended service can actually accept the people who are difficult to place.

That may require:

• registered nurses
• higher staffing ratios
• specialist dementia design
• suitable moving and handling equipment
• enhanced clinical governance
• experienced management
• stronger links with health services
• more robust night staffing
• higher weekly fees.

The stronger need can make the service more valuable.

It can also make it substantially harder and more expensive to operate.

Account for Medway's planned capacity before investing

Current shortages should never be assessed in isolation from future supply.

Medway Council is itself progressing additional specialist capacity.

Plans submitted in 2026 for a new 80-bed council-owned development included 40 specialist nursing residential dementia beds and 40 beds associated with discharge-to-assess provision.

1. 0140 bedsSpecialist nursing residential dementia care
2. 0240 bedsDischarge-to-assess provision

That is a powerful market signal.

It confirms that commissioners consider specialist dementia and discharge capacity important.

But it also means that a private provider cannot assume today's shortage will remain unchanged.

A feasibility study should include:

• council-owned developments
• independent planning applications
• care homes under construction
• framework changes
• block contracts
• service closures
• conversions of existing homes
• hospital-discharge pathway changes

The relevant question is not simply today's gap.

It is the likely gap when the proposed service is finally registered and operational.

Supported living can work, but "supported living" is not a market segment

Medway reported 384 people receiving supported-living services in April 2026.

That represents a meaningful existing market.

The commissioning model has also been changing, with the existing Dynamic Purchasing System approaching the end of its term and recommissioning activity taking place through 2026.

For a new provider, that can create interest.

But supported living should not be treated as one generic opportunity.

The commercial case depends on:

• client group
• hours of support
• staffing ratio
• waking-night or sleep-in requirements
• property model
• void exposure
• referral pathway
• commissioner relationship
• achievable fee.

A lower-needs model based on several hours of weekly support is fundamentally different from a 24-hour staffed service supporting people with complex autism, significant mental-health needs or behaviours that challenge.

The stronger gaps can also be the most expensive to deliver.

A provider should therefore establish commissioning interest before taking on expensive property commitments.

Supported living also has to be structured correctly

The phrase "supported living" describes more than a marketing position.

The legal and regulatory structure matters.

CQC's current scope guidance distinguishes between personal care delivered in someone's own home and accommodation supplied together with care as a single package.

Where people have a genuine separation between their housing and care arrangements, and can exercise meaningful choice about care, the regulated activity of Personal care may apply.

Where accommodation and personal or nursing care are supplied together as a single package, the model may instead fall within Accommodation for persons who require nursing or personal care.

The business should therefore design the housing and care relationship correctly from the beginning.

Trying to retrofit the legal structure after a lease has been signed or after referral discussions have started can create significant problems.

Respite is a genuine need with a difficult utilisation model

Medway identifies long-term planned nursing respite as an area of shortage.

On the surface, that appears to be a straightforward opportunity.

Operationally, respite can be difficult.

A provider may need to keep appropriately staffed capacity available even when it is not occupied.

Demand can be irregular.

People may arrive with high or changing needs.

Admissions can require quick assessment and coordination with families, community teams and commissioners.

For a new provider, the key question is not only whether people need respite.

It is how the service will be paid for when capacity is reserved but unused.

Possible models could include block-funded capacity, mixed respite and long-stay beds or a wider specialist service in which respite is one component.

The demand signal is real, but the utilisation model needs proving.

Decide who will pay before deciding how large to become

A recurring weakness in care start-ups is treating "demand" as if it automatically produces revenue.

Medway's care market includes several funding routes. Each behaves differently.

• Local-authority commissioned care
• NHS-funded care
• Direct payments
• Private-pay customers
• Mixed funding

Council-funded work can provide an organised referral route, but access may depend on frameworks, procurement and commissioner confidence.

Private-pay work gives the provider more control over pricing, but usually requires stronger local marketing, reputation and enquiry conversion.

NHS-funded work can involve different clinical, contracting and governance expectations.

A credible business plan should state clearly what percentage of expected revenue is intended to come from each source and what evidence supports that assumption.

"Medway needs care" is not a funding strategy.

Use council fee levels as a constraint, not a promise

Medway published 2026/27 residential and nursing band rates of:

1. Standard residential£824
2. Dementia residential£875
3. Standard nursing£1,030
4. Dementia nursing£1,081.50

8001100

These are useful commissioning benchmarks.

They are not guaranteed revenue for every placement.

Individual arrangements can differ according to need, additional support, NHS funding, negotiations and contractual structure.

A provider should model the service using conservative assumptions.

For example, a dementia nursing service should test whether realistic weekly income supports:

• nursing cover
• care staffing
• management
• training
• agency contingency
• utilities
• food
• insurance
• property finance
• maintenance
• central overhead
• void periods.

A need can be clinically obvious and still be commercially unsustainable at the fee a provider can actually secure.

Geography affects viability more than a Medway-wide average suggests

Medway is relatively compact compared with Kent as a whole, but it still contains very different operating environments.

Chatham, Gillingham, Rochester and Strood create relatively dense urban catchments.

The Hoo Peninsula and more outlying communities behave differently.

Medway itself identifies fewer residential and nursing services in rural wards.

• Dense urban catchments: Chatham, Gillingham, Rochester, Strood
• Hoo Peninsula and outlying communities
• Homecare sensitive to travel, mileage and parking
• Care homes sensitive to workforce catchment and family access

A branch covering "all of Medway" can therefore be less commercially attractive than a tightly defined catchment with high package density.

The geographic model should be deliberate.

Workforce planning should happen before registration

CQC's assessment of Medway identified workforce recruitment and retention as risks to provider-market sustainability.

That matters because the strongest market gaps often require the hardest workforce.

A provider considering dementia nursing may need registered nurses plus care workers comfortable with high frailty and complex dementia.

A specialist supported-living service may require autism, learning-disability, mental-health or positive-behaviour-support experience.

A homecare agency may need enough workers living close to the intended service area to create efficient rounds.

The workforce model should include:

• local pay expectations
• employer National Insurance
• pension
• holiday
• sickness
• training
• supervision
• travel and mileage
• recruitment cost
• agency exposure
• management time
• sponsorship dependency where relevant.

It is easy to create a spreadsheet that shows profit if only chargeable care hours are counted.

It is much harder to build a service that remains profitable once the full cost of employing and retaining people is included.

The property should follow the service model

Property commitments can lock a provider into the wrong service before the evidence has been tested.

For a care home, the property needs to support the intended acuity and client group.

For supported living, the housing needs to work for the people expected to live there and preserve the correct separation between accommodation and care.

For homecare, the registered location still matters even though care is delivered elsewhere. CQC expects applicants to have their location arrangements in place and ready.

Property analysis can include:

• accessibility
• fire safety
• planning use
• room configuration
• communal space
• equipment
• infection-control requirements
• staff facilities
• parking
• transport
• proximity to workforce and referral networks.

The cheapest available premises are not necessarily the cheapest service to operate.

Get the CQC scope right before the application is built

CQC registration follows the regulated activity being provided.

It should not be used to define the business model.

For domiciliary care and many supported-living services, Personal care is commonly the relevant regulated activity.

Where accommodation and personal or nursing care are provided as a single package, Accommodation for persons who require nursing or personal care may apply.

Other regulated activities can also become relevant depending on the service, including Treatment of disease, disorder or injury.

CQC's scope guidance was updated in 2026 and should be checked against the actual service design.

Getting scope wrong can affect:

• forms
• supporting documents
• registered manager requirements
• locations
• statement of purpose
• staffing
• assessment.

The service should therefore be designed first and mapped to the correct registration second.

CQC now expects a service that is genuinely ready

CQC's current provider-registration guidance is explicit that applicants should submit only when everything is in place to start providing the service, including the necessary locations and staff.

That changes the sequencing for a new provider.

Registration is not the point at which the business should still be deciding:

• who it supports
• where it operates
• how it recruits
• what the premises are
• how the service is financed
• what policies are needed.

For homecare agencies, CQC currently requires additional documents including a business plan and financial forecast, evidence of legal occupancy, service-user guides and a staff training plan, alongside the core provider evidence.

The business plan itself is expected to include market research.

That makes local-market analysis directly relevant to registration readiness, not simply to commercial planning.

Registration does not create referrals

This point deserves to be explicit.

A successful CQC registration does not create customers.

For commissioned services, a provider still needs access to the commissioning route and enough confidence from commissioners to receive work.

For private-pay services, the provider still needs enquiries and a process capable of converting them.

For supported living, the provider still needs appropriate referrals and housing arrangements.

For a care home, the provider still needs occupancy.

A start-up should therefore build a pre-registration demand plan that identifies:

• intended referral sources
• commissioner conversations
• local brokers
• discharge teams
• community health links
• direct-payment routes
• private-pay marketing channels
• expected enquiry volume
• expected conversion rate.

The route to occupancy or care hours should be as well researched as the registration process itself.

Build a realistic utilisation curve

New care services rarely move from zero to full utilisation immediately.

Homecare requires recruitment, package allocation and route density.

Care homes require enquiries, assessments, admissions and reputation.

Supported living can carry significant void risk if referrals develop slowly.

A financial model should therefore include a realistic ramp rather than an assumption of immediate scale.

Useful scenarios include:

1. 01ScenarioSlow case
2. 02ScenarioExpected case
3. 03ScenarioStrong case

Each should test:

• occupancy or care hours
• staffing cost
• management overhead
• marketing
• property costs
• delayed referrals
• voids
• payment timing.

This is especially important where the model has large fixed costs.

A care home or high-support supported-living service can consume substantial cash before utilisation reaches break-even.

Test the market before committing heavily

The strongest evidence comes from combining published data with direct market testing.

Before making a large commitment, a prospective provider can speak with:

• Medway commissioning teams
• brokerage
• hospital-discharge teams
• local health partners
• social workers
• housing partners
• existing providers
• families or representative groups
• local recruitment agencies.

The purpose is not to ask whether "there is demand".

It is to test the precise proposition.

For example:

• Are commissioners struggling to source this exact type of placement?
• How many such referrals arise?
• What currently happens when no local provider can accept?
• What fee range is realistic?
• What outcomes are commissioners expecting?
• Are new providers able to access the purchasing route?
• Is planned capacity likely to change the answer?

This is the difference between market research and market evidence.

What does the Medway evidence suggest by service type?

1. 01

   General residential care

   The evidence does not support a simple case for another generic residential home. Medway describes overall residential provision as robust.

2. 02

   Dementia and nursing care

   This is a stronger signal. The council identifies shortages in dementia residential and nursing care, high-frailty nursing and more complex needs. Planned council capacity must, however, be included in the feasibility assessment.

3. 03

   Homecare

   Demand is substantial and aligned with the strategic direction toward independence at home. Competition is also substantial. A new entrant needs a clear commissioning or private-pay route and efficient geography.

4. 04

   Specialist homecare

   Potentially stronger where the provider can safely accept more complex packages that generic providers may struggle to deliver. Workforce and pricing must support the higher-acuity model.

5. 05

   Supported living

   A sizeable existing market with changing commissioning arrangements. The proposition needs to be defined by client group and support intensity rather than simply by the phrase "supported living".

6. 06

   Specialist working-age provision

   Medway identifies continuing need around mental health, physical disability, dementia in younger adults and multiple complex needs. These can be stronger opportunities but require more specialist delivery.

7. 07

   Respite

   Planned nursing respite remains an identified gap. The challenge is the commercial model for maintaining flexible capacity.

A practical pre-investment checklist

Before committing significant money to a Medway care service, the provider should be able to answer:

A provider that cannot answer those questions is not yet ready to make registration the next major step.