Starting a care service in Surrey

Surrey can look like an attractive place to start a care business.

The county has more than 1.25 million residents, a growing older population, a large private-pay market and one of the biggest established adult social care sectors in the South East.

But Surrey is also a market where broad demand statistics can be misleading.

The county already had an estimated 686 CQC-regulated adult social care services in 2024/25. Surrey County Council has explicitly described homecare as overprovided overall, while its care-home market is heavily influenced by self-funders and by the difference between nominal capacity and capacity the council can actually purchase.

At the same time, Surrey continues to identify gaps in affordable extra care, supported independent living and services for people with more complex needs.

That means the starting point for a new provider should not be:

"Surrey has an ageing population, so there must be demand."

The better question is:

Which part of Surrey's care market has a clear enough need, purchasing route and operating model to justify starting a service?

This report turns the local evidence into a practical market-entry test.

Start with the service, not the CQC application

The most common mistake in starting a regulated care service is to treat CQC registration as the first major task.

It should not be.

Before deciding how to register, the provider should know:

• who the service is for

• where it will operate

• who will pay

• how customers or placements will be acquired

• what the likely fee level is

• which competitors already operate locally

• what workforce is required

• what makes the service meaningfully different

Surrey's market evidence makes this particularly important because the county is large, mature and commercially segmented.

A service aimed at privately paying older people in Elmbridge is not the same market as a council-funded supported-living service for autistic adults in another part of the county.

Both may require CQC registration.

They are still fundamentally different businesses.

Decide which Surrey market you are actually entering

"Adult social care in Surrey" is too broad to be useful as a business category.

At minimum, a new provider should decide whether it is entering:

• domiciliary care

• live-in care

• residential care

• nursing care

• dementia care

• extra care

• supported independent living

• mental-health support

• learning-disability support

• respite

• community outreach

• reablement

• another specialist service

It should then identify the intended payer.

That might be:

• Surrey County Council

• the NHS

• a direct-payment recipient

• a privately paying individual or family

• a mixture of these

The payer affects almost every part of the business.

It changes pricing, procurement, referral routes, marketing and cash flow.

A provider that cannot say clearly who the customer is has not yet completed the market-entry work.

Surrey is large enough to hide weak local markets

County-wide data is useful for understanding the direction of demand.

It is not enough to decide where to launch.

Surrey includes very different local economies and population profiles.

Districts and boroughs vary in:

A viable Surrey service usually needs a defined locality strategy rather than a plan to cover the whole county from day one.

If you are considering homecare, be cautious

Surrey has a large homecare market.

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

4,000

Purchased packages

57,000+

Hours of care each week

That sounds attractive.

But the same market-position evidence described overprovision.

Surrey has attracted large numbers of homecare businesses, partly because the county is affluent and partly because domiciliary care has historically had lower capital barriers than accommodation-based care.

This creates a crowded market.

A new agency should not proceed simply because:

• the population is ageing

• there are thousands of homecare hours

• people want to stay at home

Those are demand indicators, not proof of a gap.

A stronger homecare case would show one or more of the following:

• a locality where packages are persistently difficult to cover

• specialist care that existing providers struggle to deliver

• a strong private-pay acquisition route

• an existing referral partnership

• a clear live-in-care proposition

• capability around complex discharge support

• a workforce base already available in the target area.

Without that, the provider risks becoming another agency competing for the same clients and staff.

Work out whether you want council-funded or private homecare

This is one of the most important decisions.

Council-funded homecare is commissioning-led.

The provider needs to understand Surrey's current approved-provider and purchasing arrangements, eligibility requirements and package-allocation process.

CQC registration by itself does not guarantee council work.

Private homecare is different.

The business needs to generate leads from individuals and families.

That requires:

• local visibility

• referrals

• reviews

• marketing

• fast response

• clear pricing

• reputation

• customer service

Private customers may pay higher rates, but acquiring them can be expensive.

A start-up that expects council work and private customers to arrive automatically is unlikely to have a robust commercial plan.

Homecare needs a workforce-density model

A Surrey domiciliary-care plan should include a map before it includes a growth target.

The provider should identify:

• where carers are likely to live

• where prospective clients are concentrated

• typical travel times

• parking constraints

• public-transport limitations

• rural areas that are difficult to cover

• whether rounds can be built efficiently

The unit economics of homecare are highly sensitive to unproductive travel.

Ten clients spread across a wide area may be less valuable than six clients clustered tightly together.

This is one reason why a county-wide marketing strategy can be inefficient.

The early objective should be density, not reach.

If you are considering a care home, separate private demand from council demand

Surrey's care-home market is unusual because private funding has such a strong influence.

The council says more than 65% of care-home capacity is either occupied by older self-funders or vacant but unavailable to the authority.

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

That means there may be physical beds in the county that do not solve the council's purchasing problem.

A new care home therefore needs a clear payer strategy.

Private-pay model

A private-pay care home may compete on:

• location

• accommodation

• amenities

• family experience

• clinical reputation

• dementia expertise

• hospitality

• brand

• premium positioning

But premium demand attracts premium competition.

Property and development costs in Surrey can also be high.

Council-funded model

A service targeting council placements needs to understand:

• guide prices

• enhanced rates

• individual negotiation

• complexity

• occupancy assumptions

• procurement routes

The central question is whether the achievable fee can support the staffing and property model.

Demand cannot compensate for structurally weak unit economics.

Complex care creates stronger evidence of need

The more compelling Surrey opportunities are often not in generic capacity.

They are in care that is difficult to source.

Complexity may involve combinations of:

• dementia

• nursing needs

• mental-health conditions

• autism

• learning disability

• physical disability

• behaviours that challenge

• neurological conditions

• high dependency

A provider that can safely support complex needs may solve a more valuable problem.

But complexity also increases the operating burden.

The business may require:

• more experienced leadership

• higher staffing ratios

• additional training

• clinical governance

• specialist equipment

• waking-night support

• stronger multidisciplinary links

The provider should never choose a complex niche simply because commissioners say it is difficult to source.

It needs the capability to deliver it.

Extra care is one of Surrey's clearest strategic opportunities

Surrey County Council says there is not enough extra-care housing, with a particular shortage of affordable extra care.

The council has committed to increasing affordable provision by 725 units by 2030.

This is a much stronger market signal than a generic claim that "older people need care".

It is tied to an explicit commissioning and housing strategy.

For a provider, however, entering extra care requires more than care-registration expertise.

The model may involve:

• property development

• housing partners

• landlords

• planning

• nomination rights

• care contracts

• 24-hour staffing

• community facilities

• long-term commissioning

This makes it better suited to providers or partnerships with development and commissioning capability.

A small start-up should not treat extra care as the easiest route into Surrey simply because the strategic need is clear.

Supported independent living also has a strong strategic case

Surrey's Right Homes, Right Support strategy has committed to major growth in supported independent living for people with learning disabilities and autistic people.

The council has also been increasing community accommodation for people with mental-health needs.

This reflects a clear direction away from unnecessary residential care and toward greater independence.

By late 2025, Surrey reported new supported independent living developments in Horley, Byfleet and Cobham, with further capacity planned.

The opportunity is therefore real but already being actively developed.

A new provider should identify:

• which client groups remain underserved

• whether self-contained or shared accommodation is needed

• whether the housing already exists

• who controls the tenancy

• which care and support purchasing route applies

• whether the provider has appropriate specialist capability.

Supported living should never be built backwards from an available property.

The need and commissioning route should come first.

Mental-health services require a specific proposition

Surrey has expanded community support for adults with mental-health needs.

That is strategically positive but it also means the market has matured.

A new mental-health care provider needs a clearer proposition than "there is demand".

Potential areas to investigate include:

• hospital discharge

• rehabilitation

• supported accommodation

• tenancy sustainment

• complex community outreach

• dual diagnosis

• people with combined physical and mental-health needs.

The provider should map existing NHS, council and voluntary-sector pathways before assuming that unmet need will become purchasable demand.

Direct payments create another possible route to customers

Not all publicly funded care in Surrey is purchased directly by the council.

Some people use direct payments to arrange their own support.

For providers, this can create a hybrid market between public funding and private consumer choice.

The customer may have an allocated budget but still choose the provider personally.

That means the service has to be discoverable and understandable to individuals and families.

A provider may need:

• clear pricing

• transparent terms

• local marketing

• flexible support

• easy onboarding

• strong reputation

Direct payments can broaden the addressable market.

They do not remove price sensitivity.

Check the purchasing route before committing

A strong market need is not enough if the provider cannot access the purchasing route.

Surrey uses a range of commissioning mechanisms, including dynamic purchasing systems and approved-provider arrangements.

These differ by service type.

Before investing heavily, a prospective provider should confirm:

• what the current mechanism is

• whether it is open to new entrants

• minimum requirements

• insurance levels

• quality thresholds

• experience requirements

• pricing rules

• geographic lots

• mobilisation requirements

This should happen early.

A provider can obtain CQC registration and still discover that the commissioning route it expected to use is closed, highly competitive or commercially unattractive.

Model fees before registration

Surrey's 2026/27 adult social care fee uplifts vary by service.

Older-person residential and nursing care received a 3% uplift. Care within the home, extra care, supported independent living and several other community services received 3.3%.

1. Older-person residential and nursing3%
2. Care within the home and several other services3.3%

2.54

These uplifts provide useful context.

But the critical number for a start-up is not the percentage uplift.

It is the actual achievable income per unit of service.

For homecare, that means the realistic hourly rate after considering travel.

For a care home, it means the realistic weekly fee after considering occupancy.

For supported living, it means the funded staffing model.

The provider should build:

• pessimistic case

• realistic case

• stronger case

If the model only works in the strongest case, it is fragile.

Stress-test workforce before launch

Skills for Care estimated around 37,000 adult social care posts in Surrey in 2024/25, with around 3,000 vacancies and an 8.4% vacancy rate.

37,000

Adult social care posts

3,000

Vacancies

8.4%

Vacancy rate

Skills for Care.

Recruitment has improved nationally since then, but Surrey remains a competitive labour market.

A start-up should know:

• required roles

• required skills

• hourly pay

• recruitment sources

• manager availability

• training costs

• travel requirements

• shift patterns

• retention plan

For a regulated service, the registered manager is especially important.

The provider should not treat manager recruitment as something to solve after the business model is built.

A weak management plan can delay registration and undermine the service after launch.

Do not assume overseas recruitment will solve staffing

International recruitment has been important across social care.

But it should not be the only workforce strategy.

Immigration rules, sponsorship requirements and recruitment conditions can change.

A Surrey provider should have a labour model that remains viable even if overseas recruitment becomes slower or more constrained.

Retention matters just as much as recruitment.

A business that constantly replaces staff will struggle with:

• continuity

• quality

• training costs

• morale

• customer confidence

Understand the difference between demand and referrals

A county can have significant unmet need without a new provider receiving referrals.

This distinction is fundamental.

Demand becomes business only when there is a mechanism that connects the person to the provider.

That mechanism may be:

• council brokerage

• NHS referral

• hospital discharge

• social worker referral

• direct-payment choice

• family search

• GP or community referral

• digital marketing

• professional recommendation

A new provider should be able to describe that route in detail.

"People need care" is not a route to market.

Build the proposition around evidence, not registration categories

CQC regulated activities define the legal scope of the service.

They should not define the commercial proposition.

Two providers can both be registered for Personal care while serving entirely different markets.

One may provide private dementia homecare.

Another may support adults with autism in supported living.

The same regulated activity can sit behind very different services.

The provider should therefore design:

• Client group

• Care model

• Payer

• Geography

• Workforce

• Referral route

• Economics

before finalising the registration scope.

Check whether the service is actually regulated

Not every form of support requires CQC registration.

This matters especially in supported living, community support and non-personal-care models.

CQC registration depends on whether the provider carries on a regulated activity, not the marketing label used.

A business should therefore establish regulatory scope early.

But it should not use registration as a substitute for market validation.

Registration answers: "Can this provider legally carry on this regulated activity?"

It does not answer: "Will this business succeed in Surrey?"

A practical Surrey market-entry test

Before progressing, score the proposed service against six areas.

1. Need

Is there clear evidence that the specific client group is difficult to support?

Strong evidence:

2. Competition

How many comparable providers already operate in the target locality?

Strong position:

3. Route to demand

How will clients arrive?

Strong position:

• accessible commissioning route

• existing referral source

• proven private lead generation

Weak position:

• assumption that CQC registration generates work.

4. Economics

Does realistic income exceed realistic operating cost?

Strong position:

• viable at conservative occupancy or utilisation.

Weak position:

• only viable at full capacity or unusually high fees.

5. Workforce

Can the required staff actually be recruited?

Strong position:

• defined recruitment pool

• manager identified

• competitive pay

• workable geography

Weak position:

• dependent on large-scale recruitment after launch.

6. Regulation

Is the service model compatible with CQC requirements?

Strong position:

• regulated activities clear
• manager and governance model ready

Weak position:

• service still changing during the application.

If several areas are weak, registration should wait.

Which Surrey service types deserve the closest look?

The local evidence suggests different levels of caution.

1. 01

   General domiciliary care

   High caution. Demand is large, but Surrey has described overprovision. A strong local or specialist proposition is needed.

2. 02

   Private-pay homecare or live-in care

   Potentially viable where there is a strong acquisition strategy and a credible premium proposition. Competition remains substantial.

3. 03

   General residential care

   Moderate to high caution. There is already extensive supply. Payer strategy and location are critical.

4. 04

   Complex residential or nursing care

   Stronger market signal, but much harder operationally.

5. 05

   Extra care

   Strong strategic need, high capital and partnership complexity.

6. 06

   Supported independent living

   Strong strategic direction, but housing and commissioning must align with the intended client group.

7. 07

   Specialist mental-health or learning-disability support

   Potentially attractive where the service addresses clearly evidenced gaps and can demonstrate genuine specialist capability.

When should you move to CQC registration?

Move forward when the provider can evidence:

• target client group

• target locality

• expected payer mix

• referral route

• realistic pricing

• staffing plan

1. 01

   registered manager strategy

2. 02

   premises or housing model where relevant

3. 03

   correct regulated activities

4. 04

   12-month cash-flow resilience

At that point, the CQC application becomes part of executing the business plan.

Before that point, it can become an expensive distraction.