Adult Social Care in Medway: Capacity, Demand and the Market Outlook

Medway is a substantial adult social care market with a clearer distinction between mainstream capacity and specialist shortages than headline population figures alone would suggest.

The area already has a developed residential, nursing, homecare and supported-living sector. In April 2026, Care Quality Commission data cited by Medway Council showed 67 residential and nursing homes with 1,756 registered beds. The council was commissioning 872 residential and nursing placements, while its homecare and extra-care arrangements supported around 1,250 people and delivered approximately 495,000 hours of care and support each year.

That is not a market starting from low supply.

At the same time, Medway Council is explicit that some needs remain difficult to meet locally. Its current Market Position Statement identifies shortages in high-frailty and nursing care, dementia residential and nursing care, planned nursing respite, specialist provision for people under 65 and care for people with functional mental-health or multiple complex needs.

The council is responding by trying to expand specialist provision, reviewing commissioning models and progressing a new council-owned care development.

For anyone considering starting or expanding a care service in Medway, the useful question is therefore not simply whether demand is growing.

It is where existing capacity fails to match the needs of the people requiring care, and whether a new provider can meet those needs at a sustainable cost.

The companion key challenges report and starting a care service report go further on pressures and pre-registration testing.

Medway at a glance

292,655

Estimated residents, 2024

279,730

Residents at the 2021 Census

17%

Residents aged 65 and over, 2021 Census

9,265

New requests for support, 2024/25

67

Residential and nursing homes, April 2026

1,756

Registered care-home beds, April 2026

384

People receiving supported living, April 2026

Requires Improvement

CQC Care Act rating, January 2025

Demand for adult social care is increasing

Medway Council reports that requests for adult social care support have increased for both working-age adults and older people and are now above the England and South East averages.

In 2024/25, the council received 9,265 requests for support from new clients.

Of these, 6,275 came from people aged 65 and over. That compares with 4,846 requests from the same age group in 2022/23.

Requests from working-age adults also increased, from 2,777 in 2022/23 to 2,980 in 2024/25.

That means the strongest recent numerical growth has come from older people, but the working-age market has not stood still.

1. Age 18 to 64, 2022/23

   2,777

2. Age 18 to 64, 2024/25

   2,980

3. Age 65+, 2022/23

   4,846

4. Age 65+, 2024/25

   6,275

Medway Council adult social care activity, 2024/25.

The figures need interpreting carefully.

A request for support is not the same as a funded long-term care package.

In 2024/25, 46% of new requests resulted in information, advice, signposting or no subsequent service. Only 6% resulted in a long-term service such as homecare or residential care.

That distinction is commercially important.

A provider should not take 9,265 requests and treat them as 9,265 potential customers. The figure is evidence of pressure and activity across the system, not an addressable market size.

The more useful analysis is what happens after assessment, which types of support are commissioned, where people wait, and which needs existing providers struggle to accept.

Medway is ageing, but not uniformly

Medway had a population of 279,730 at the 2021 Census. The council's newer JSNA summary estimates that the population had reached 292,655 in 2024.

CQC's local-authority assessment records that around 17% of residents were aged 65 and over at the 2021 Census. Between 2011 and 2021, the number of people in that age group increased by 24%.

292,655

Estimated population, 2024 JSNA summary

with

17%

Residents aged 65 and over, 2021 Census

Medway Council's longer-term planning material records 46,054 older people aged 65 and over in its 2021 population base and projects the overall population to reach approximately 299,734 by 2040. These figures use a different reference period from the newer 2024 JSNA estimate, so they should not be read as a single current-year population series.

The important change is within the age profile.

The proportion of residents aged 65 and over is expected to continue increasing, and local planning evidence points to particularly strong growth among the oldest age groups.

That matters because adult social care demand does not rise evenly with age.

People in their late 60s may require little or no formal care. Demand becomes more concentrated as frailty, dementia, mobility limitations and multiple long-term conditions become more common at older ages.

An ageing population therefore tells us that the underlying demand base is strengthening.

It does not tell us which service to open.

Residential and nursing care is already a large market

Medway had 67 residential and nursing homes with a combined 1,756 registered beds in April 2026.

The council's breakdown shows the scale of provision for older people:

43

Homes registered for older people

1,521

Beds within that older-person service-user band

725

Residential beds across 29 homes

796

Nursing beds across 14 homes

Medway Council, citing Care Quality Commission data.

There is also a substantial working-age residential market. Medway records 36 homes capable of supporting working-age adults across mental health, physical disability and learning disability service-user groups.

Some homes and beds have dual registrations, so the category totals cannot simply be added together. They do, however, demonstrate that Medway already has a diverse accommodation-based care sector.

The council was commissioning 872 residential and nursing placements in April 2026, including placements both within and outside Medway.

Of the older-person placements, 428 were residential and 240 were nursing. Dementia accounted for 277 of the residential placements and 106 of the nursing placements.

The council also commissioned 160 residential placements for working-age adults, including 101 for people with learning disabilities, 28 for people with physical disabilities and 31 for people with mental-health needs.

• 101Learning disabilities
• 31Mental-health needs
• 28Physical disabilities

428

Older-person residential placements

240

Older-person nursing placements

277

Residential dementia placements

106

Nursing dementia placements

These numbers show a sizeable purchasing market.

They do not show that every part of that market has spare demand for another general provider.

General residential capacity is not the main gap

Medway Council describes its overall residential provision as robust.

That is one of the most important facts for a prospective care-home operator.

The market signal is not a blanket shortage of beds.

Instead, the council identifies specific deficiencies:

• inadequate capacity for people with high frailty and nursing needs

• shortages of residential and nursing dementia beds

• shortages for people with dementia alongside functional mental-health needs

• insufficient long-term planned nursing respite

• limited specialist care for people under 65

• fewer services in more rural wards

• workforce shortages across residential and nursing care

Some people have consequently been placed outside Medway.

This is a much stronger market signal than population ageing alone.

Out-of-area placements can indicate that local supply does not match assessed need, although they should still be interpreted carefully. Some placements are made outside an authority for reasons such as family location, personal preference or highly specialist requirements.

But when the commissioning authority itself repeatedly identifies particular service gaps, a prospective provider has something more concrete to investigate.

The commercial question becomes:

Can a service be designed around the people who are currently difficult to place?

Complexity changes what useful capacity looks like

A registered care-home bed is not a standard unit.

A vacant general residential bed may be irrelevant to somebody requiring complex dementia nursing, significant physical support, behavioural support or a combination of mental and physical-health care.

This is why headline bed numbers can be misleading.

The useful capacity is the capacity that can safely accept the person.

For higher-acuity services, that may require:

• Registered nursing staff
• Higher staffing ratios
• Stronger clinical governance
• Specialist dementia capability
• Moving and handling equipment
• Suitable room and communal-space design
• Enhanced medication management
• Stronger links with community health services
• More experienced leadership
• Higher fee levels

CQC's assessment of Medway reinforces this issue.

It found that workforce, recruitment and retention were significant challenges to provider-market stability. Four nursing homes had handed back packages during the preceding 12 months because people's needs had increased. Residential, supported-living and homecare packages had also been handed back, while 12 locations had left the market.

That suggests a market where some existing capacity becomes less useful as people's needs intensify.

For a new provider, specialism may therefore create a stronger demand proposition, but it also creates a more demanding operating model.

Dementia is one of the clearest areas to investigate

Dementia appears repeatedly in Medway's commissioning evidence.

The council identifies shortages in both residential and nursing dementia capacity, and a substantial share of its existing older-person placements already involves dementia.

Of the 428 older-person residential placements recorded in April 2026, 277 were categorised as residential dementia placements. Of 240 nursing placements, 106 were dementia nursing.

The council is also planning additional specialist capacity.

Its proposed Medway Care Home and Older People Unit includes an 80-bed care home. Current plans allocate 40 beds to specialist nursing residential dementia care and 40 beds to a discharge-to-assess facility.

40

Specialist nursing residential dementia care

and

40

Discharge-to-assess facility

A full planning application was submitted in July 2026.

This is important for two reasons.

First, it confirms that dementia and complex nursing capacity are not abstract future concerns. The council considers the gap significant enough to invest directly in new provision.

Second, it means a private provider assessing the market must account for planned capacity as well as current shortages.

A feasibility study that measures today's gap but ignores tomorrow's supply pipeline can overstate the opportunity.

Council fee levels provide a useful reference point

Medway published its 2026/27 weekly residential and nursing band rates in March 2026:

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

These rates provide a useful benchmark for council-funded placements.

They are not a complete pricing model.

Actual income can vary according to assessed need, additional support, individual negotiations, NHS contributions, contractual arrangements and whether the resident is privately funded.

The important commercial exercise is to build the service from realistic revenue backwards.

For a proposed dementia nursing home, for example, the provider needs to test whether achievable weekly fees can support the staffing and property model required to deliver the service safely.

Demand does not rescue an uneconomic operating model.

Commissioning is becoming more deliberate

Medway's commissioning intentions for 2026 to 2028 show an authority trying to shape the market rather than simply purchase whatever capacity becomes available.

For residential and nursing care, the council intends to:

• recommission contracts for older people and working-age adults

• develop new framework arrangements

• consider increasing block contracting

• encourage more providers into specialist care

• encourage existing homes to diversify

• increase provision particularly in dementia nursing, physical-disability nursing, working-age mental health, working-age dementia and multiple complex needs

The council says spot purchasing works for many long-stay placements but that it faces increasing pressure sourcing some types of care at a sustainable cost.

It is therefore considering greater use of block contracts where supply and cost are difficult to manage.

For providers, this matters.

A block contract can provide occupancy certainty and improve financial planning, but it also changes the commercial relationship with the commissioner. Providers considering specialist capacity should monitor procurement activity rather than assuming future council demand will continue to be purchased entirely through spot placements.

Homecare is substantial, but competition is also substantial

Medway's homecare market is large.

Homecare and extra care are commissioned through the Support to Live at Home Service. Together they 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 delivered each year

12

Homecare providers on the current framework

2

Extra-care providers on the framework

The current framework began on 1 April 2024 and runs until 31 March 2028.

Twelve providers were appointed for homecare and two for extra care.

But the wider market is much larger.

More than 100 care providers expressed interest during the recommissioning exercise. Medway also reported 104 organisations registered with CQC to provide community-based adult social care locally when describing the market, while its April 2026 ratings data covered 121 community-based locations.

1. Appointed to the homecare framework

   12

2. Registered with CQC for community-based adult social care

   104

3. Community-based locations in the April 2026 ratings data

   121

This is a strong warning against equating a large number of care hours with an easy market-entry opportunity.

The demand exists.

So does competition.

A newly registered homecare agency that intends to rely on council-funded work needs to understand the commissioning route, framework access and package-allocation process.

A provider targeting private-pay customers faces a different challenge: customer acquisition, local reputation, pricing and the ability to build geographically dense rounds.

Quality is another differentiator in homecare

Medway's April 2026 CQC ratings snapshot adds another layer.

Among the 12 providers appointed to the Support to Live at Home framework:

1. Requires Improvement

   5

2. Good

   3

3. Not yet rated

   4

4. Outstanding

   None

5. Inadequate

   None

Across all community-based locations in Medway, a large proportion were not yet rated.

This should not be used to imply that the local homecare market is poor.

Many newly registered services remain unrated until inspected, and ratings are only one measure of market quality.

It does, however, mean that a provider able to demonstrate reliable delivery, continuity, good governance and strong outcomes may have a more meaningful proposition than one competing only on being newly registered.

Registration creates permission to operate.

It does not create differentiation.

Extra care is established and aligned with independence

Medway has five extra-care schemes.

These provide self-contained accommodation with on-site care and support for people generally aged over 55, offering an alternative between ordinary housing and conventional residential care.

The five schemes include provision in Rochester, Wainscott, Gillingham and St Mary's Island.

Medway expects to begin market discussions about renewing extra-care arrangements in spring 2027.

The strategic direction is significant.

Like many authorities, Medway wants more people to remain independent for longer rather than move unnecessarily into higher-cost residential care.

That means population ageing will not translate mechanically into residential-care demand.

Some of the growth will instead be absorbed through homecare, extra care, equipment, adaptations, reablement, community services and unpaid care.

A care-home operator assessing demographic demand should account for that substitution effect.

Supported living is a sizeable working-age market

Supported living is another significant part of Medway's adult social care system.

As of April 2026, the council reported 384 people receiving supported-living services.

The service supports adults with needs including learning disability, autism, physical disability and mental-health conditions.

Provision is purchased through a Dynamic Purchasing System and divided according to level of need, including lower-needs, higher-needs and specialist support.

The existing commissioning arrangements are approaching a transition point, with the current DPS due to expire in February 2027 and recommissioning activity taking place during 2026.

This creates a market-development opportunity, but not a generic invitation to open supported living.

The stronger opportunity is likely to sit where accommodation, staffing and expertise align with identified higher or specialist needs.

Supported living also needs to be structured correctly.

Housing and care should remain genuinely distinct, and CQC registration depends on the regulated activity being delivered rather than the label attached to the service.

Prevention will shape future demand

Medway's Market Position Statement emphasises preventing escalation and helping people live independently.

That direction is visible in the scale of community equipment.

The council issued 32,884 items of community equipment to 6,424 clients between April 2024 and March 2025. Between April 2025 and March 2026, 5,927 clients received 37,623 items.

Medway Council prevention activity.

The authority is also looking to develop more community activities and smaller providers capable of helping people maintain independence and delay more intensive support.

This matters to market analysis.

Rising need does not necessarily produce the same rate of growth in long-term commissioned care.

If prevention, reablement, equipment and community support work effectively, some people will require formal care later, for fewer hours or at a lower intensity.

At the same time, the people who do enter long-term care may be more complex.

That combination can create a market with slower growth in generic provision but stronger demand for high-acuity services.

Workforce capacity is part of market capacity

A service does not create useful capacity merely because it has a CQC registration and available rooms or care hours.

It needs staff.

CQC's assessment of Medway identified recruitment and retention as significant risks to provider stability. Residential and nursing providers reported workforce reductions, and package hand-backs showed what can happen when needs rise beyond a provider's staffing capability.

For a new entrant, workforce analysis should be treated as part of market research.

That means testing:

• Local pay expectations
• Registered nurse availability where required
• Travel patterns for domiciliary care
• Recruitment lead times
• Turnover assumptions
• Training requirements
• Management capacity
• Agency exposure
• Sponsorship strategy where relevant
• Competition from the NHS and other care employers

A business plan that proves customer demand but assumes an unrealistic workforce is not a viable plan.

Geography matters

Medway is more compact than the surrounding Kent County Council area, but it is not one uniform care market.

The main urban areas around Chatham, Gillingham, Rochester and Strood offer different operating conditions from the more rural Hoo Peninsula and outlying communities.

• Chatham, Gillingham, Rochester and Strood
• Hoo Peninsula and more rural wards
• Fewer residential and nursing services in rural wards
• Homecare rounds sensitive to travel and parking

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

For homecare, geography directly affects productive capacity.

Travel time, parking, route density and the location of workers can determine whether an hourly fee produces an acceptable margin.

For accommodation-based services, location affects access to families, hospitals, primary care, public transport and the available workforce.

A Medway-wide demand figure should therefore be treated as the beginning of analysis, not the end.

CQC's assessment shows a system under pressure

CQC published its assessment of Medway Council's Care Act responsibilities in January 2025 and rated the authority Requires Improvement.

The assessment does not rate individual providers and should not be presented as a judgement on the quality of Medway's care sector as a whole.

It does provide useful system context.

CQC scored Medway more strongly for supporting people to lead healthier lives and partnership working, but identified shortfalls in areas including assessing needs, equity, care provision and continuity, safeguarding, governance and sustainability.

The provider-market evidence was particularly relevant.

CQC recorded workforce pressures, package hand-backs and providers leaving the market. It also recognised the authority's awareness of shortages in complex nursing provision.

For prospective providers, this reinforces the need to understand the operational system around the service, not just the number of potential customers.

Assessment, brokerage, hospital discharge, commissioning, workforce and provider capacity all influence whether underlying need becomes deliverable care.

What does the Medway market actually show?

Medway has clear underlying growth in adult social care demand.

New requests have increased. The older population is growing. Dementia and frailty will become more important. The council is already purchasing hundreds of residential and nursing placements and nearly half a million hours of homecare and extra-care support each year.

But the market is not short of everything.

1. General residential care

   Medway describes overall residential provision as robust. A generic new care home therefore needs a stronger case than population ageing alone.

2. Nursing, dementia and high-frailty care

   This is one of the clearest areas of identified shortage. The council wants more specialist capacity and is developing some itself.

3. Homecare

   Demand is substantial, but so is provider interest. A new agency needs a credible route to commissioned or private-pay customers and a workforce model capable of delivering efficiently.

4. Supported living

   There is a sizeable existing market and commissioning transition is under way. The strongest signal concerns provision matched to higher and specialist needs rather than undifferentiated supply.

5. Respite and working-age specialist care

   Planned nursing respite and specialist provision for adults under 65 remain identified gaps.

6. Prevention and independence

   Medway is actively trying to reduce or delay the need for more intensive formal care. Future market growth is therefore likely to change the mix of services required, not simply increase every category at the same rate.