The Key Challenges Facing Adult Social Care in Brighton & Hove

Brighton & Hove has an established adult social care market, but meeting demand is not simply a question of increasing the number of services available.

The city faces a more complicated combination of pressures.

People are living with increasingly complex needs. Some specialist services remain difficult to source locally. Adult social care is operating under significant financial pressure. Providers face their own cost and workforce challenges. At the same time, the council is trying to reduce unnecessary dependence on residential care, improve prevention and reablement, and support more people to remain independent.

That creates a market in which more provision is not necessarily the same as the right provision.

For organisations considering starting or expanding a service in Brighton & Hove, understanding these pressures can be as important as understanding headline demand. The companion adult social care market report sets out capacity and demand in more detail.

At a glance

Complex needs

CQC found fewer local options for people with complex or compound needs

Mainstream care

Non-specialist domiciliary and residential care described as relatively accessible

CQC local authority rating

Requires Improvement, December 2025 assessment

Assessing needs

Lowest-scoring area; some waits over three months reported

Annual reviews

45% completed on time in 2025/26, target 55% in 2026/27

Strategic direction

Independence, prevention, reablement and reduced avoidable residential admission

Workforce

Recruitment and retention identified as a major issue in earlier market work

Property

Compact urban authority with limited development space for new care-home capacity

These pressures interact. A headline count of beds or providers rarely captures whether the market can meet the needs that are hardest to place.

1. Increasing complexity of need

One of the clearest themes running through Brighton & Hove's recent adult social care evidence is increasing complexity.

The Care Quality Commission's assessment of the local authority found that people with complex needs had fewer local options and could sometimes need to leave the city to access appropriate care.

Brighton & Hove City Council has also repeatedly identified increasing complexity, particularly among working-age adults, as a significant pressure on both service delivery and cost.

This matters because complexity changes the type of capacity the market requires.

Ten available general residential beds are not equivalent to ten beds capable of supporting somebody with advanced dementia, complex nursing requirements, significant behavioural needs or multiple co-existing conditions.

The same principle applies outside care homes.

A domiciliary care agency may have available care hours but still be unable to accept a package requiring specialist competencies, intensive double-handed support or a combination of physical and behavioural care.

A supported living provider may have accommodation but not the staffing model, environment or expertise required for a particular person.

Capacity therefore needs to be considered in terms of capability, not simply numbers.

For new providers, this is one of the strongest lessons from the Brighton & Hove market.

A service designed around a clearly defined complex need may be addressing a fundamentally different market from a general provider operating in the same CQC registration category.

2. Specialist local capacity remains uneven

Brighton & Hove has historically described its mainstream residential market as relatively strong.

The gaps have been more specific.

The council's Market Sustainability Plan identified shortages in:

1. High-frailty care

   Shortage of provision for people with higher physical dependency.

2. Nursing care

   Insufficient nursing capacity relative to need.

3. Dementia care

   Severe shortage of residential and nursing dementia provision.

4. Planned respite

   Insufficient long-term planned respite.

5. Under-65 specialist care

   Shortages of specialist provision for people under 65.

6. Complex mental health

   Gaps for some people with complex mental health needs.

That document dates from 2023, so those findings should not automatically be treated as a description of the market in 2026.

However, later evidence suggests that the underlying problem has not disappeared.

CQC's assessment, published in December 2025, concluded that people with complex needs could still have limited options locally. The regulator noted that the authority was trying to increase capacity for these groups but considered it too early to determine the full impact.

The council's subsequent 2024/25 annual report also documented the development of additional supported living and specialist accommodation, including services for people with mental health needs, learning disabilities, physical disabilities and acquired brain injury.

Taken together, this suggests an important distinction.

Brighton & Hove does not necessarily need indiscriminate expansion of adult social care provision.

It needs better alignment between provision and the needs that are hardest to meet.

3. Keeping people within Brighton & Hove

The availability of appropriate local services also affects where people receive care.

Out-of-area placements were one of the issues identified during Brighton & Hove's CQC assessment.

Where the correct specialist provision is unavailable locally, people may be placed elsewhere. That can separate them from family, friends, existing professionals and community networks.

The council has subsequently reviewed its use of out-of-area placements and says that these have been reducing. It has also explained that many existing placements are within East or West Sussex and that some relate to people who are already settled and would not appropriately be moved purely to satisfy a geographical target.

This is an important qualification.

An out-of-area placement is not automatically evidence that Brighton & Hove needs a new local provider. People may choose provision elsewhere, specialist services may operate more efficiently across a wider region, and existing placements cannot simply be repatriated.

Nevertheless, repeated difficulty finding suitable local provision can reveal where the market is struggling to match need.

For prospective specialist providers, understanding why particular people are being placed outside the city is therefore considerably more useful than counting out-of-area placements alone.

4. Access and assessment have been under pressure

Not all adult social care challenges are supply-side problems.

Brighton & Hove's recent CQC assessment found significant problems with the time some people were waiting for their needs to be assessed.

The council received an overall Requires Improvement rating, with its lowest score relating to assessing people's needs. That resulted in a Section 50 notification to the Secretary of State.

CQC reported that some people had waited more than three months and also identified delays affecting reviews, occupational therapy and some unpaid carers.

This is important when interpreting local demand.

A waiting list for assessment is not the same as a waiting list for a care provider.

One reflects how quickly the local authority can assess or review somebody's needs. The other reflects whether an appropriate service is available once those needs have been established.

Conflating the two can substantially overstate the commercial opportunity for a new provider.

There has also been material progress since the inspection evidence was collected.

In September 2026, Brighton & Hove reported that its Waiting Safely Framework had been introduced, assessment pathways were being reviewed and new proportional review tools were in use. The council said performance on annual reviews had reached 45% completed on time in 2025/26, with a target of 55% during 2026/27.

45%

Completed on time in 2025/26

with a target of

55%

Target during 2026/27

The position is therefore changing.

Market analysis needs to distinguish between historic service-access problems, current provider-capacity gaps and improvements already underway.

5. The council is trying to reduce reliance on residential care

Another important challenge for the market is that demand does not translate automatically into traditional residential placements.

Brighton & Hove's strategic direction is to help more people remain independent and receive support in their own homes or communities where appropriate.

Its adult social care improvement programme includes an expanded reablement offer, greater use of prevention and work intended to reduce avoidable admissions to residential and nursing care.

That direction is significant for anyone considering developing a care home.

Population ageing can increase underlying need while public policy simultaneously attempts to delay or prevent admission into institutional care.

Both things can be true at once.

Demand for the most complex nursing, dementia and high-frailty provision may rise while demand for some lower-acuity residential models is constrained by successful home-based care, reablement, adaptations, technology and supported housing.

This means that projecting care-home demand from demographic growth alone can be misleading.

The more useful question is:

Which needs are still likely to require accommodation-based care after community alternatives have been considered?

That is where the longer-term requirement for residential and nursing capacity becomes clearer.

6. Workforce remains fundamental to capacity

Physical capacity does not guarantee operational capacity.

Brighton & Hove's market sustainability work identified recruitment and retention as a major issue for both care homes and domiciliary care. Providers reported pressures relating to pay, burnout and the wider availability of care workers.

The labour market has changed since that assessment, including changes to international recruitment and workforce policy. The exact staffing conditions experienced by an individual provider in 2026 therefore need current local testing rather than assuming that the 2023 position remains unchanged.

The underlying commercial principle remains important.

A new service does not create useful market capacity simply because it receives CQC registration.

It needs enough appropriately skilled people to deliver the service reliably.

This becomes harder as complexity increases.

Specialist nursing, dementia care, learning disability support, mental health provision and intensive supported living can require different competencies, management structures and staffing ratios from lower-acuity provision.

A gap in specialist provision can therefore coexist with providers struggling to recruit the very workforce required to fill it.

For new entrants, a credible workforce model should be part of the viability assessment from the beginning, rather than something solved after registration.

7. Financial pressure affects commissioners and providers

Brighton & Hove also operates within a difficult financial environment.

The council has identified adult social care as one of its major demand-led financial pressures. Its September 2026 improvement update links service improvement directly with a wider demand-management and financial transformation programme.

Providers face the other side of the equation.

Care delivery is labour intensive. Accommodation-based services also carry property, utilities, food, insurance, maintenance, regulatory and financing costs.

Brighton & Hove's cost-of-care work previously demonstrated substantial operating costs across residential and nursing provision, while its Market Sustainability Plan described difficulty purchasing some placements at the council's standard fee levels.

CQC's later assessment reported that some providers felt the authority's fee-uplift process lacked transparency and made financial planning more difficult.

Again, this does not establish that a particular care business will or will not be viable.

It does highlight an important distinction between social need and economically sustainable demand.

An area can have a shortage of a particular service while still being commercially difficult to enter if the cost of providing that service exceeds what purchasers can sustainably pay.

8. Brighton & Hove has physical constraints as well as care constraints

Accommodation-based provision faces another local issue: Brighton & Hove is geographically compact, urban and constrained.

The council has previously highlighted limited development space as a barrier to significantly reshaping the care-home market through new-build capacity.

Property suitability also matters.

A building that is technically available may not provide the accessibility, room sizes, communal environment, outdoor space, parking, staff facilities or adaptability required for the intended service.

The challenge becomes greater for provision involving substantial physical disability, advanced dementia or complex nursing needs.

Supported living introduces a different version of the same issue.

Care and housing may be legally and operationally separate, but the availability and suitability of accommodation can still determine whether a support model can operate.

For new services, the property search and the care-market assessment should therefore inform one another.

Choosing premises first and deciding who the service will support afterwards creates unnecessary risk.

9. Homecare has its own geographical and operational pressures

Brighton & Hove is compact, but that does not mean all domiciliary care rounds are equally easy to operate.

The council's earlier homecare commissioning work identified geographical differences across the city, with some areas historically more difficult to service because of recruitment and travel issues. Its redesigned homecare model subsequently organised provision around East, West, North and Central localities.

• East locality
• West locality
• North locality
• Central locality

For an independent provider, route density can materially influence performance.

Travel time between calls is labour that has to be funded somewhere within the operating model. Poorly concentrated packages can increase mileage and non-contact time while reducing the proportion of a worker's shift that can actually generate care revenue.

Brighton & Hove's congestion, parking conditions and urban geography can therefore matter commercially even though the authority covers a relatively small physical area.

This is another reason why "demand in Brighton & Hove" is too broad a measure on its own.

A viable homecare market is built at a much smaller geographical level. See the guide to starting a domiciliary care agency for registration context alongside local testing.

10. Prevention creates opportunity, but it can also change demand

Brighton & Hove is placing increasing emphasis on prevention, reablement and community support.

Its current improvement programme includes expanding reablement and strengthening preventative support, while the council's annual report describes wider work around healthy ageing, adaptations, community services and integrated neighbourhood teams.

• How prevention can reduce demand

  • Successful prevention can reduce or delay demand for some traditional services.

• How it can shift demand

  • Short-term reablement and rehabilitation
  • Homecare and technology-enabled care
  • Supported living and specialist accommodation before permanent residential care

The opportunity shifts rather than simply disappears.

For the care market, this has two effects.

Successful prevention can reduce or delay demand for some traditional services.

But it can also create demand for different forms of support.

Providers increasingly operate within a continuum that can include short-term reablement, rehabilitation, homecare, technology-enabled care, supported living and specialist accommodation before permanent residential care becomes necessary.

The opportunity therefore shifts rather than simply disappears.

Providers that understand how their service interacts with this wider pathway may be better placed than those designed around a single assumption that increasing need must result in increasing volumes of conventional care.

What do these challenges mean for a new provider?

Brighton & Hove has genuine demand for adult social care, and there is evidence of continuing gaps.

But the market does not support a simple conclusion that another generic service is required.

The stronger signals concern:

1. Complex needs

   People with complex or compound needs where local choice can remain limited.

2. Nursing and frailty

   High-frailty and nursing provision identified in council market work and later CQC evidence.

3. Dementia

   Residential and nursing dementia care flagged as a severe shortage in the Market Sustainability Plan.

4. Working-age adults

   Appropriate specialist provision for people under 65, including mental health pathways.

5. Targeted supported living

   Models aligned to identified commissioning need rather than generic capacity.

6. Independence and alternatives

   Services that support independence and reduce unnecessary long-term institutional care where community options exist.

These signals still need testing against current commissioning behaviour, referral volumes, private-pay demand, workforce availability and achievable fees.

The most important challenge facing a prospective provider may therefore be one of precision.

Starting a service because there is a general need for care is not enough.

A sustainable service needs to know whose needs it intends to meet, why existing provision is not meeting them, who will purchase the service, what it will cost to deliver and whether the necessary workforce and infrastructure are actually available.

That is particularly important in Brighton & Hove, where the evidence suggests that the problem is less about the absolute quantity of mainstream care and more about matching the right provision to increasingly complex needs.