Key challenges for adult social care in Surrey

Surrey has one of the largest and most developed adult social care markets in the South East.

That scale can make the county look comparatively well supplied. Skills for Care estimated 686 CQC-regulated adult social care services in Surrey in 2024/25, including 368 residential and 318 non-residential services. The county also has a large private-pay market, substantial council purchasing and a workforce of around 37,000 adult social care posts.

But a large market does not mean an uncomplicated one.

Surrey's challenge is increasingly about matching the right capacity to the right people at a price that commissioners, families and providers can sustain.

The county combines high property and employment costs with pockets of deprivation, urban and rural geography, a rapidly ageing population and strong private purchasing power. That creates tensions that are different from those seen in authorities where the council is the dominant buyer.

The Care Quality Commission rated Surrey County Council's Care Act responsibilities Good in its assessment published in November 2024. CQC found strengths in prevention, market shaping, integration and partnership working, but it also identified shortfalls in areas including assessment and safeguarding.

For prospective providers, the most useful way to read Surrey is therefore not as a county with a single "care shortage".

It is a market with a series of distinct operational and commissioning problems.

Some create opportunities.

Others are reasons to be cautious.

At a glance

Regulated services

686 CQC-regulated adult social care services in 2024/25, including 368 residential and 318 non-residential

Care homes

More than 65% of capacity used by older self-funders, or vacant and unavailable to the council

Workforce

Around 37,000 adult social care posts

Council assessment

CQC rated Surrey Good in November 2024, with shortfalls in assessment and safeguarding

Homecare

Large commissioned volume, alongside a council warning of overprovision

Extra care

A deficit of around 850 affordable units projected by 2030

These figures show how demand, supply and commissioning pressures interact in Surrey. County-wide averages rarely show whether the market can support people whose needs are hardest to place locally.

1. Population ageing will increase need, but not evenly

Surrey's older population is growing faster than the population as a whole.

The county's latest population estimate is above 1.25 million people, and current projections show the proportion aged 65 and over increasing substantially over the next two decades.

That strengthens the long-term demand base for adult social care.

But demographic growth does not translate evenly into service demand.

A person aged 67 living independently is not equivalent, from a care-market perspective, to somebody aged 88 with dementia, frailty and multiple long-term conditions.

The growth that matters most to providers is therefore concentrated among people whose needs become sufficiently complex to require formal support.

That creates demand for:

• Homecare
• Dementia care
• Nursing care
• Extra care
• Reablement
• Community support
• Supported housing
• Respite
• Technology-enabled care

At the same time, Surrey's strategy is to help people remain independent for longer.

That means the county is actively trying to prevent demographic ageing from producing a one-for-one increase in traditional residential-care demand.

The challenge for providers is to distinguish between underlying need and the service model through which that need will actually be met.

2. Surrey is already a crowded market

Skills for Care estimated 686 regulated adult social care services in Surrey in 2024/25.

That is a substantial existing market.

For a new provider, this matters because registration does not place the business into an empty field.

It places it alongside hundreds of existing services, many of which already have:

It places it alongside hundreds of existing services, many of which already have: local reputation, established referral routes, experienced managers, and existing council relationships.

Private-pay marketing, repeat family referrals, and established staff teams.

A new service therefore needs more than evidence that people in Surrey require care.

It needs a reason why those people, commissioners or families would choose it.

That reason might be:

That reason might be: specialist clinical capability, a poorly covered locality, complex dementia support, culturally specific care, and difficult-to-source hours.

A new accommodation model, stronger continuity, and a distinct private-pay proposition.

Without that differentiation, a new entrant can be commercially weak even in a county with growing demand.

3. Care-home capacity and usable capacity are not the same thing

One of Surrey's most important market-shaping issues is the difference between physical care-home capacity and capacity that the council can actually purchase.

Surrey County Council has said that more than 65% of care-home capacity is either occupied by older self-funders or is vacant but unavailable to the authority.

• 65%+Occupied by older self-funders, or vacant and unavailable to the authority

This creates an unusual market dynamic.

There may be beds in the county.

Those beds may not be available at the council's price, for the relevant client group or with the capability required for a complex placement.

That means the council can experience placement difficulty without Surrey being short of care homes in a simple numerical sense.

For prospective providers, this distinction is critical.

The opportunity may be to create capacity that is:

The opportunity may be to create capacity that is: affordable to the intended purchaser, capable of accepting higher levels of need, appropriately staffed, and willing to work within the relevant commissioning route.

Another conventional residential home aimed at the same part of the market may add capacity without solving the actual problem.

4. The self-funder market pulls capacity in a different direction

Surrey has a powerful private-pay care market.

That can be commercially attractive.

Affluence in many parts of the county means some families can pay substantially more than public-sector guide rates. Providers may therefore design services, accommodation and marketing around self-funders.

The difficulty for the wider system is that this can pull capacity away from publicly funded placements.

A provider with strong private demand may have little reason to accept lower council rates unless there is another commercial benefit.

This creates a structural tension between:

This creates a structural tension between: what the market can charge privately, what the local authority can afford, and what complex care actually costs to deliver.

For new providers, payer strategy therefore matters from the start.

A care home designed around premium self-funding economics is not the same business as one built around council-funded complex care.

Trying to serve both without understanding the pricing gap can produce an unstable model.

5. Complex care is harder to source than general care

A recurring challenge in adult social care is that more complex needs make nominal capacity less useful.

Surrey is no exception.

As people live longer and are supported in the community for longer, those who eventually need accommodation-based care can arrive with higher acuity.

They may have combinations of:

They may have combinations of: dementia, frailty, mobility limitations, neurological conditions, behaviours that challenge, and mental-health needs.

Sensory impairment, multiple long-term conditions, and end-of-life needs.

A general residential vacancy may not be appropriate.

For the provider, supporting complexity can require:

For the provider, supporting complexity can require: more staff, more experienced staff, nursing capability, specialist training, stronger management, and more robust clinical governance.

Specialist equipment, suitable physical environments, and enhanced liaison with health services.

This is why an apparent shortage in complex care cannot be solved merely by registering another service.

The operating model must be capable of accepting the people who are actually difficult to place.

6. Extra care remains a major structural gap

Surrey has identified a substantial need for additional affordable extra-care housing.

Its specialist housing planning work estimated a deficit of around 850 affordable extra-care units by 2030, while the council has been progressing a programme intended to increase social-rent extra-care capacity.

This is one of the clearer strategic gaps in the county.

It also illustrates the complexity of market entry.

Extra care sits across several systems:

Extra care sits across several systems: housing, planning, property development, adult social care, and care commissioning.

Support services, health, and community infrastructure.

A care provider cannot simply treat extra care as a care-home variant.

The accommodation and care models need to work together while remaining appropriately structured.

For developers, providers and investors, the size of the identified gap is attractive.

But development timescales, capital requirements and commissioning arrangements make this a very different proposition from opening a domiciliary-care agency.

7. Homecare has demand and overprovision at the same time

Surrey's homecare market is a strong example of why headline demand can mislead.

The council's detailed market snapshot showed around 4,000 purchased homecare packages and more than 57,000 hours of care purchased each week.

4,000

Purchased packages

57,000+

Hours of care purchased each week

That is a large commissioned market.

Yet Surrey County Council has also described an overprovision of homecare and warned that growth in the number of agencies had exceeded growth in council-funded demand.

Both statements can be true.

There can be thousands of people receiving homecare while too many providers compete for the available work.

This matters especially for newly registered agencies.

The common assumption is:

Surrey is large + Surrey is affluent + Surrey is ageing = Surrey needs another homecare agency.

That conclusion is not supported by the commissioning evidence on its own.

A new provider needs to identify:

A new provider needs to identify: the exact geography it will cover, the client group, whether it wants council or private work, whether the council purchasing route is accessible, how customers will be acquired, how staffing density will be built, and what will make the service distinctive.

Without those answers, market size can create false confidence.

8. Geography makes homecare economics difficult

Surrey is not one operational market.

The county includes dense urban and suburban areas, commuter towns and significant rural communities.

That matters enormously for homecare.

A care worker delivering visits in a compact area may spend a high proportion of a shift providing paid care.

A worker covering rural or dispersed areas may spend substantially more time travelling between clients.

The effect appears in:

The effect appears in: labour productivity, mileage, scheduling, and punctuality.

Continuity, worker satisfaction, and package profitability.

A county-wide opportunity assessment can therefore be almost useless for a homecare start-up.

The viable market needs to be understood at a much smaller geographic level.

Providers should know where clients are likely to cluster, where staff live and how the two can be matched efficiently.

9. Workforce remains one of the strongest constraints

Skills for Care estimated around 37,000 adult social care posts in Surrey in 2024/25.

Approximately 3,000 were vacant.

1. Adult social care posts

   37,000

2. Vacant posts

   3,000

Skills for Care.

The estimated vacancy rate was 8.4%, above both the South East and England rates in the same dataset.

Turnover was estimated at 23.9%.

37,000

Adult social care posts

3,000

Vacant posts

8.4%

Vacancy rate

23.9%

Turnover

Skills for Care.

Those figures show improvement from the extreme labour shortages seen nationally after the pandemic, but recruitment remains a major operating constraint.

Surrey also has a high-cost labour market.

Care providers compete not only with other care providers but with:

Mental-health capability, senior care workers, and staff able to work waking nights.

A genuine demand gap can therefore exist without being easy to serve.

10. International recruitment has changed the workforce model

Surrey's care workforce includes a significant proportion of workers of non-UK nationality.

International recruitment contributed heavily to workforce growth across adult social care in the years after the pandemic.

But immigration policy and sponsorship requirements have become less predictable as a workforce strategy.

For providers, the lesson is not that international recruitment is unavailable.

It is that a business should not assume it can solve every local staffing problem through overseas recruitment.

A resilient workforce strategy should consider:

A resilient workforce strategy should consider: domestic recruitment, retention, career progression, training, pay, and shift design.

Travel, sponsorship compliance where relevant, and management capacity.

A model that depends on a constant inflow of new workers is vulnerable to policy change.

11. Affordable fees and high costs remain in tension

Surrey's costs are high.

Property is expensive in many areas. Wages face upward pressure. Insurance, utilities, food, compliance and financing costs have also increased.

The council has continued to uplift provider fees, including for 2026/27.

But fee increases do not eliminate the underlying tension between affordability for commissioners and cost sustainability for providers.

This is particularly difficult where people have complex needs.

More complex support may require:

More complex support may require: higher staffing ratios, more senior oversight, specialist training, clinical input, enhanced premises, and more equipment.

If the achievable fee does not cover those inputs, an identified need may still be commercially unattractive.

Providers should therefore test unit economics before treating an unmet need as a business opportunity.

12. Supported independent living needs more specialist capacity

Surrey's strategic direction for working-age adults is strongly toward greater independence.

The county has previously modelled a substantial requirement for additional supported independent living for people with learning disabilities and autistic people.

It has also identified future need for community accommodation for people with mental-health needs.

The aim is to reduce unnecessary use of traditional residential care and support more people to live in ordinary or specialist housing with appropriate care.

This creates opportunity.

It also creates several challenges.

A supported-living service needs:

A supported-living service needs: suitable housing, clear separation of housing and care arrangements, appropriate tenancy structures, staffing matched to need, cqc registration where regulated personal care is provided, commissioners willing to purchase the support, robust safeguarding, and community integration.

The label "supported living" is not enough.

The strongest market is likely to be in services capable of supporting people whose needs have historically led to residential or out-of-area placements.

13. Mental-health support is moving further into the community

Surrey has seen substantial growth in home-based support for people with mental-health needs.

The council has reported significant growth in care-within-the-home packages for this group compared with the pre-pandemic period.

The market has also matured, with more approved providers available to support people with additional needs.

That is positive for commissioners.

For new entrants, it means that older assumptions about an obvious shortage may no longer hold.

The opportunity is more likely to sit in:

The opportunity is more likely to sit in: higher-complexity community support, hospital discharge, tenancy sustainment, rehabilitation, outreach, integrated accommodation and support, and people whose needs span mental health and other conditions.

This is a more demanding market than generic homecare.

14. Assessment shortfalls can delay access to care

CQC's assessment of Surrey County Council gave the quality statement for assessing needs a score of 2, indicating some shortfalls.

This matters for the care market because formal care demand often becomes visible only after assessment.

Delays or inconsistency in assessment can affect:

Delays or inconsistency in assessment can affect: when packages begin, whether needs escalate before support starts, pressure on unpaid carers, hospital discharge, and provider planning.

For providers, this can create volatility.

The underlying need may be strong while the flow of commissioned packages is affected by processes elsewhere in the system.

It is therefore risky to equate population need directly with immediate purchasable demand.

15. Safeguarding remains an operational pressure

CQC also scored Surrey's safeguarding quality statement at 2.

Safeguarding is not merely a local-authority issue.

Providers sit inside the safeguarding system.

A new service needs robust processes for:

A new service needs robust processes for: recognising abuse and neglect, escalating concerns, mental capacity, deprivation of liberty where relevant, medication, and financial abuse.

Self-neglect, staff conduct, whistleblowing, and partnership working.

As services become more complex, safeguarding risk often becomes more complex too.

This creates a strong argument for experienced management rather than rapid expansion without governance capacity.

16. Hospital discharge creates pressure for responsive capacity

Adult social care and the NHS are increasingly interdependent.

When people are medically ready to leave hospital but do not have appropriate support available, pressure builds across the whole health and care system.

Surrey has invested in prevention, reablement and integrated working to reduce those delays.

For providers, discharge pathways can create demand for:

For providers, discharge pathways can create demand for: rapid-start homecare, reablement, short-term beds, step-down care, nursing, and complex home support.

But hospital-discharge demand can be operationally difficult.

Providers may need to mobilise quickly and support people whose needs are still changing.

The service has to be designed for responsiveness rather than assuming predictable long-term packages.

17. Unpaid carers are carrying substantial demand

The 2021 Census recorded more than 90,000 Surrey residents providing unpaid care, including more than 23,000 providing at least 50 hours each week.

90,000+

Residents providing unpaid care

including

23,000+

Providing at least 50 hours each week

That represents a huge amount of informal care capacity.

It also creates vulnerability.

If an unpaid carer becomes ill, exhausted or unable to continue, formal demand can rise suddenly.

This is why respite and flexible replacement care matter.

The challenge is that respite does not always fit neatly into a conventional high-occupancy commercial model.

Demand can be intermittent, urgent or highly individual.

Providers need to understand how respite is purchased and whether enough utilisation can be generated to sustain the service.

18. Prevention changes what future demand looks like

CQC found strong prevention and partnership work in Surrey.

The county's strategic direction includes:

The county's strategic direction includes: reablement, community support, technology, equipment, and direct payments.

Extra care, supported accommodation, and strength-based approaches.

These interventions aim to delay or reduce long-term dependence on formal care.

For providers, prevention is not simply a threat to traditional demand.

It changes the composition of demand.

People may enter long-term services later.

When they do enter, their needs may be more complex.

That can mean:

That can mean: fewer low-intensity packages, more specialist support, more home-based complexity, later moves into residential care, and higher acuity in care homes.

Providers that build only around historic patterns can therefore misread future demand.

19. Direct payments create opportunity but fragment purchasing

Surrey supports the use of direct payments where appropriate.

This gives people more control over how their care budget is spent.

For providers, it creates another route to customers.

The local authority is not always the direct purchaser.

But direct payments also fragment the market.

Providers may need to market to:

Providers may need to market to: individuals, families, brokers, social workers, and community networks.

The sales process can look more like private consumer acquisition than traditional council procurement.

A service that expects work simply to arrive after CQC registration may struggle.

20. Quality matters more in a mature market

Surrey's care market is large enough that people often have some choice.

That raises the importance of quality and reputation.

A new provider begins without:

A new provider begins without: inspection history, established reviews, known outcomes, long-term commissioner confidence, and local word of mouth.

That creates a trust deficit.

Strong governance, continuity and leadership therefore matter commercially as well as regulatorily.

Registration is only the starting point.

The provider then has to prove that it is safe, reliable and worth choosing.

What do these challenges mean for a new provider?

Surrey can support successful care businesses.

But the evidence points away from undifferentiated market entry.

Stronger propositions

A new service is more likely to have a credible market case where it is built around:

A new service is more likely to have a credible market case where it is built around: complex or specialist need, a clearly underserved locality, affordable extra-care development, supported independent living, and difficult-to-source community support.

Hospital-discharge capacity, respite, and a well-defined private-pay proposition.

Weaker propositions

The case is weaker where the plan is simply:

1. 01

   "Surrey has lots of older people"

2. 02

   "homecare demand is growing"

3. 03

   "there are care-home waiting lists"

4. 04

   "CQC registration will create referrals."

Those statements do not establish a viable service.

The provider needs evidence for the exact client group, geography, payer, price and route to demand.

Questions to answer before entering the Surrey care market

A prospective provider should be able to answer:

If those questions cannot yet be answered, the business is not ready to treat CQC registration as the main problem.