Starting an Adult Social Care Service in Brighton & Hove: What the Market Evidence Shows

Starting a care service in Brighton & Hove can look attractive for obvious reasons.

There is established demand for adult social care, the city's older population is expected to grow substantially over the coming decades, and the local authority has identified areas where existing provision does not fully meet need.

But those facts are not, on their own, a business case.

Brighton & Hove already has a developed care market. Mainstream residential care and ordinary domiciliary care are comparatively well supplied, while the clearest pressures are more concentrated around complex needs, specialist nursing and dementia provision, respite and some forms of supported living.

That means the starting point should not be "there is demand for care".

It should be:

What specific service is needed, who will buy it, and why is the existing market not already meeting that need?

For anyone considering launching a care service in Brighton & Hove, answering those questions before starting the CQC registration process can significantly reduce risk. See the adult social care market report and key challenges report for the wider local picture.

Understand the market before choosing the service

Brighton & Hove City Council publishes Market Position Statements specifically to help providers understand what support exists, what is missing, what commissioners expect to need in future and how the local market may develop.

That is useful, but it should be treated as one source of evidence rather than a guarantee of business.

The council's position is nuanced.

Historic market-sustainability work described a strong general residential care offer alongside shortages in high-frailty care, nursing, residential and nursing dementia provision, planned respite and specialist care for people under 65.

CQC's later assessment of Brighton & Hove reached a similar conclusion at a broader level: mainstream residential and domiciliary care were comparatively accessible, while people with complex or compound needs could have fewer local options.

The practical implication is important.

A new provider entering Brighton & Hove with a broad, undifferentiated offer may be competing in an established market. A provider designed around a clearly evidenced gap may be entering a much narrower market with different referral pathways, staffing requirements and economics.

The service model should therefore follow the evidence, not the other way around.

Define exactly who the service is for

One of the most common weaknesses in early care-business planning is trying to serve too many client groups.

A proposal may describe support for older people, dementia, learning disabilities, autism, mental health, physical disabilities and complex care within the same model.

On paper, that creates a larger addressable market.

Operationally, it can make the service less credible.

Different groups can require different staff competencies, training, management experience, risk controls, environments and commissioning relationships. The CQC application also needs to demonstrate that the provider and registered manager understand the needs of the people they intend to support.

In Brighton & Hove, this is particularly important because the stronger market signals concern complexity.

If the business case depends on meeting a specialist gap, the service should be specific enough to explain what specialist capability actually means.

For example, "supported living" is not itself a client group. A supported living service for adults with acquired brain injury is a different proposition from one designed for people with learning disabilities, complex mental health needs or high levels of physical support.

The same applies to homecare and care homes.

The more precisely the intended population is defined, the easier it becomes to test demand, build the workforce model and understand the regulatory requirements.

Decide who is going to pay

Demand and purchasing are not the same thing.

A service may meet a genuine social need without having a viable route to revenue.

Before registration, a prospective provider should understand whether it expects to rely primarily on:

• Local authority commissioned placements or packages
• NHS-funded care
• Direct payments or personal budgets
• Private-pay customers
• A mixture of these

Each route behaves differently.

Commissioned care can provide access to significant volumes of demand but may involve framework requirements, fixed rates, brokerage systems and procurement processes. Private-pay care can support different pricing but requires a credible route to customer acquisition and may expose the provider to a different competitive set.

Brighton & Hove's own evidence shows why this matters. The council has previously highlighted financial pressure in both the residential and homecare markets, alongside workforce and fee pressures.

An identified shortage therefore does not automatically mean that the available fee will support a new entrant's cost base.

The business model needs to work at the price the market will actually pay.

Test demand at the right level

"Brighton & Hove" is still too broad a market definition for many care businesses.

For homecare, demand needs to be understood at route level. Travel time, parking, worker availability and the density of care packages can materially alter the economics of a branch.

For care homes, the relevant market varies by care type. General residential care, dementia residential care, nursing, dementia nursing and complex working-age provision should not be treated as interchangeable capacity.

For supported living, the relevant question may be even narrower: whether there is demand for a particular client group, support intensity and accommodation model.

CQC's assessment found that mainstream care could generally be accessed more readily while local options were more restricted for some people with complex needs.

That does not prove there is a viable vacancy for a new provider.

It tells you where further investigation is warranted.

Good market testing goes beyond population statistics. It looks for evidence from commissioning plans, placement patterns, local authority responses, provider capacity, waiting times, out-of-area placements and the practical experience of referral teams.

Understand whether CQC registration is required

Once the service model is clear, the next question is regulatory scope.

CQC registration is based on the regulated activities being carried on, not simply the label attached to the business. CQC's current guidance states that providers carrying on regulated activities in England need to register and that the nature of the activity determines which registration requirements apply.

For example, a homecare agency providing personal care will generally need to register for the regulated activity Personal care. Supported living can also require registration for Personal care where the provider is actually delivering regulated personal care to people in their own homes.

A care home operates differently.

Where accommodation is provided together with nursing or personal care as a single package, the relevant regulated activity is normally Accommodation for persons who require nursing or personal care.

The distinction matters.

Supported living, domiciliary care and residential care can look similar from a distance, but the underlying legal and operational structures are different.

CQC's scope-of-registration guidance makes clear that it is the nature of the activity being delivered that determines whether registration is required and which regulated activity applies.

Registration should therefore follow the service design.

Trying to design the service around an assumed registration category can create problems later, particularly where housing and care arrangements have not been properly separated.

Be realistic about the CQC application

Registration is not simply an administrative stage before trading.

CQC states that applicants should submit an application only when the service is ready, including having the necessary locations and staff in place. Applicants must demonstrate how the proposed service will meet regulatory requirements and provide safe, effective, caring, responsive and well-led care.

For homecare applications, CQC currently requires additional evidence including a business plan and financial forecast, evidence of legal occupancy, service-user information and a staff training plan alongside the broader application requirements.

Supported living and other service types can require additional documents depending on what is being proposed.

The regulator also expects providers and registered managers to understand relevant legislation, the needs of the intended client group and how the fundamental standards will be met.

For someone starting from scratch, this means registration should not be the first major piece of work.

The commercial and operational model should already make sense before the application is submitted. The step-by-step CQC registration guide sets out the process; this report is about whether the local market supports the service you intend to register.

Property can determine whether the model works

For accommodation-based services, Brighton & Hove's property market deserves particular attention.

The city is geographically compact and development space is constrained. Brighton & Hove's market-sustainability work has previously identified limited opportunities to create significant new care-home capacity through development.

The suitability of an individual building is equally important.

A property may be available but unsuitable for the intended service because of accessibility, room configuration, communal space, outdoor space, parking, fire-safety requirements or the adaptations needed for people with complex physical or cognitive needs.

This is especially relevant where the opportunity being pursued is specialist rather than generic.

A service designed for people with significant mobility needs, advanced dementia or complex nursing requirements cannot assume that an ordinary residential property can simply be adapted later.

For supported living, the property question is different but no less important.

The housing and care arrangements need to reflect the actual supported-living model. CQC's registration guidance requires a genuine separation between the provision of accommodation and personal care for a service to operate as supported living rather than accommodation with care supplied as a single package.

Property decisions should therefore be made alongside regulatory and market analysis, not before them.

Build the workforce model before the marketing plan

A new care service can generate enquiries and still fail if it cannot staff the work.

Brighton & Hove has previously identified recruitment and retention as a material pressure in its care market. Its homecare commissioning model was redesigned partly to improve workforce sustainability and move away from arrangements that made stable pay and hours difficult.

For a start-up provider, workforce planning needs to be specific.

Specialist provision adds another layer.

If the market opportunity is based on supporting more complex people, the service may need a more experienced workforce, additional clinical input, enhanced training or higher staffing ratios.

The very feature that makes the service more valuable can also make it more expensive to deliver.

Model the economics before assuming occupancy

Revenue forecasts in care can look attractive because they multiply a weekly fee or hourly rate by a theoretical level of utilisation.

That is not the same as cash flow.

A homecare agency may need supervisors, recruitment, training, software, insurance, an office and management capacity before enough chargeable hours exist to cover those costs.

A care home carries substantial fixed costs even when beds are empty.

Supported living can involve a long development and referral cycle before a service reaches intended occupancy.

Specialist services may command higher fees but can also require materially higher staffing and property costs.

The financial model should therefore include a realistic ramp-up period, not an assumption that registration is followed immediately by full utilisation.

It should also distinguish between gross demand and demand available to a new entrant.

Brighton & Hove already has established providers. A new service has to win work from somewhere.

Understand commissioning before relying on it

Local authority demand is often central to the business case for a new care provider.

But a council identifying a need does not necessarily mean it will immediately contract with any provider capable of meeting it.

Brighton & Hove's Market Position Statements are explicitly intended to tell providers what support the authority believes is needed, what is currently available, what may be needed in future and how commissioners want to shape the market.

That is valuable intelligence.

It is not a contract.

Prospective providers should understand how the relevant service is actually purchased: whether through a framework, dynamic purchasing arrangement, block contract, individual placement, brokerage process or another route.

They should also understand what evidence commissioners expect from a new provider and whether there are barriers to receiving referrals immediately after registration.

This is particularly important where the entire financial forecast depends on local-authority placements.

A stronger model identifies more than one realistic source of demand.

What does the Brighton & Hove evidence suggest by service type?

The local evidence does not point equally strongly in every direction.

1. General domiciliary care

   Established demand and an established provider market. CQC did not identify ordinary homecare as one of the clearest specialist-capacity gaps. A new agency needs a sharper proposition than reliable personal care alone.

2. General residential care

   Historically a comparatively strong offer. A conventional residential model should not assume population ageing alone creates an immediate gap.

3. Nursing, dementia and high frailty

   Stronger historic signals around high frailty, nursing, dementia and respite. Still check current commissioning and capacity before investment.

4. Supported living

   An active area of local development. Strongest where the service targets a defined client group, support intensity and accommodation model.

5. Working-age adult services

   Commissioning direction includes learning disability, mental health and other specialist community-based provision deserving specific attention.

None of these observations replaces direct validation.

They help determine where that validation should begin.

Do not confuse registration readiness with business readiness

It is possible to prepare a technically strong CQC application for a commercially weak service.

It is also possible to identify a genuine market opportunity and underestimate what is required to register and operate safely.

Both sides have to work.

Before committing heavily to a Brighton & Hove start-up, a provider should be able to answer four questions with evidence:

1. 01

   Who exactly will the service support?

   Define the client group precisely enough to test workforce, property and regulatory scope.

2. 02

   Where will referrals or customers come from?

   Identify commissioning routes, private-pay channels or both, with evidence beyond population statistics.

3. 03

   Can the service operate safely?

   Confirm workforce, management and infrastructure can meet the intended need before the first placement.

4. 04

   Does the model make money?

   Model realistic fees, utilisation and ramp-up, not full occupancy from day one.

If any of those answers depend mainly on assumption, more work is needed before registration.

The strongest starting point in Brighton & Hove

Brighton & Hove is not a market where the available evidence supports indiscriminate new supply.

It is more selective than that.

The city has existing capacity, established providers and a strategic direction that increasingly favours independence, prevention and community-based support where appropriate. At the same time, there are continuing signs of pressure around complex needs and specialist provision.

That creates an opportunity for providers that are precise about what they are building.

A credible new service should start with an identifiable unmet need, define the people it is designed for, validate how that demand is purchased, establish that the workforce and property model are realistic, and only then move into registration.

That order matters.

CQC registration can give a provider permission to carry on regulated activity. It does not create demand, referrals or a viable business.