Adult social care in Southampton

Southampton is a compact, densely populated adult social care market with a younger population than many neighbouring authorities, but a rapidly growing older population and significant levels of deprivation, frailty and complex need.

The city had an estimated resident population of 264,957 in 2023 in the Care Quality Commission's 2026 local-authority assessment. Southampton's Data Observatory gives a 2024 estimate of 259,424, reflecting different publication cycles and population datasets.

The most important demographic trend is not the precise headline population.

It is ageing.

Between 2023 and 2030, Southampton expects the number of residents aged 65 and over to increase by 18.2%. The population aged 80 and over is forecast to increase by 28.9%.

That will increase demand for adult social care.

But Southampton's latest evidence does not support a simple "more of everything" conclusion.

The city already has a large regulated provider market. Skills for Care estimated 139 CQC-regulated adult social care services in 2024/25, including 52 residential and 87 non-residential services.

The stronger pressure is in specialist capacity.

In June 2026, CQC rated Southampton City Council Requires Improvement in its delivery of Care Act responsibilities. It found that people with advanced dementia, mental-health needs and complex physical or nursing needs were more likely to be placed outside the city because local specialist provision was limited.

Southampton's own data also shows 309 long-term adult social care users supported outside the city, including 100 people whose primary support reason was learning disability.

For a prospective provider, the central question is therefore not whether Southampton needs care.

It is which forms of care the city cannot reliably provide locally.

Southampton at a glance

These figures come from different datasets and reference periods. They should not be treated as a single live operational snapshot. Together, however, they show a large provider market under particular pressure at the complex end of care.

260–265,000

Residents in recent published population estimates

38,472

Residents aged 65 and over in 2023

18.2%

Projected growth in the 65-plus population between 2023 and 2030

28.9%

Projected growth in the 80-plus population by 2030

139

CQC-regulated adult social care services in 2024/25

52 / 87

Residential and non-residential regulated services

6,600

Adult social care posts in 2024/25

425

Vacant adult social care posts

6.8%

Estimated vacancy rate

22.7%

Estimated staff turnover rate

2,548

Long-term adult social care users in February 2025

309

Long-term users supported outside the city

100

Out-of-city users with learning disability as their primary support reason

55.5%

Of long-term service users receiving physical-support services

20.3%

Receiving learning-disability support

13.7%

Receiving mental-health support

Requires Improvement

CQC rating for Southampton City Council, published June 2026

Southampton is younger than many care markets, but ageing quickly

Southampton has a substantial working-age and student population.

Only around 14.5% of residents were aged 65 and over in 2023, lower than many neighbouring counties.

That can make the city look less exposed to older-person care demand.

The forward trend is very different.

The 65-plus population is forecast to rise by 18.2% between 2023 and 2030.

18.2%

Aged 65 and over

and

28.9%

Aged 80 and over

The 80-plus population is forecast to increase by 28.9%.

Over the longer term, the 85-plus population is projected to increase even faster.

This matters because formal social care demand is concentrated in the oldest age groups.

Southampton already estimates that around 27% of residents aged 65 and over have moderate or severe frailty, with approximately 2,600 people experiencing severe frailty.

As the older population expands, more residents are likely to need help with dementia, frailty, impaired mobility or several long-term conditions. Some will require nursing care, end-of-life support or respite for their families. That is a more precise forecast than assuming every category of residential provision will expand at the same rate.

The city already has a large regulated provider market

Skills for Care estimated 139 regulated adult social care services in Southampton in 2024/25.

Of the 139 regulated adult social care services recorded in 2024/25, 52 were residential and 87 non-residential. For a compact city, this is a substantial established provider base, so new entrants need a clear understanding of competition as well as local demand.

52

Residential services

and

87

Non-residential services

For a geographically small city, that is a substantial provider base.

It means a new provider is not entering an empty market.

Prospective providers will be entering a market already served by care homes, domiciliary-care agencies, supported-living organisations, specialist services and council-run provision. Simply offering another generic service is unlikely to address the harder gaps identified in the evidence.

The key commercial task is therefore to identify where existing capacity does not match current need.

CQC's 2026 assessment is the strongest current market signal

CQC rated Southampton City Council Requires Improvement in June 2026, with an overall score of 42%.

Care provision, integration and continuity scored 2, meaning CQC found some shortfalls.

The most important market-shaping finding was that specialist provision for people with complex needs was limited.

Residents with advanced dementia, mental-health needs, complex physical conditions or nursing requirements were more likely to need care outside the city. These are distinct and often overlapping needs, and suitable local provision may require a more intensive clinical and staffing model than general care.

CQC said delays in plans to increase specialist capacity had increased reliance on out-of-city provision.

That is more commercially useful than a broad claim that Southampton is short of care.

Out-of-city care is already significant

Southampton's own data shows 309 long-term social care users supported outside the city.

That is 12.1% of long-term service users.

309

People supported outside Southampton

and

12.1%

Of all long-term users

Among the 309 people receiving long-term care outside Southampton, 100 had learning disability recorded as their primary support reason. That makes this a material part of the out-of-city placement picture, although it does not in itself explain why each placement was made.

Out-of-city placement does not automatically mean the local market has failed.

Some people may choose to live elsewhere or require a specialist service not realistically replicated in every city.

But where CQC directly links out-of-city care to limited local specialist capacity, the signal is stronger.

A provider able to support an identifiable cohort locally may solve a real market problem.

Physical support is the largest part of the funded market

In February 2025, physical-support services accounted for 55.5% of long-term users, compared with 20.3% receiving learning-disability support and 13.7% receiving mental-health support. This indicates the scale of physical-support commissioning but does not distinguish all the different types of care purchased within it.

1. Physical support

   55.5%

2. Learning disability

   20.3%

3. Mental health

   13.7%

But physical support covers a wide range of need.

The category encompasses everything from relatively low-intensity homecare and reablement to high-dependency homecare, residential or nursing services, equipment and adaptations. For a provider, the market opportunity depends on the complexity and delivery model, not simply the broad reporting category.

The commercial opportunity therefore depends on service intensity, not the category label alone.

Home First is changing where demand is met

Southampton's strategy places strong emphasis on Home First.

The objective is to help people leave hospital and recover at home wherever possible rather than moving prematurely into long-term residential care.

CQC highlighted reablement as a relative strength.

More than half of people using the service regained independence.

The Home First approach has been supported by the Transfer of Care Hub, Bridging Care, community navigation and assistive technology. These mechanisms aim to help people leave hospital safely and regain or maintain independence where possible.

This changes the care market.

Demand does not disappear.

Rather than disappearing, some demand is being redirected toward short-term support at home, rehabilitation, responsive domiciliary care and community services. This changes which business models are most aligned with the city's direction of travel.

General residential care is not the clearest growth opportunity

Southampton's 2023–28 older-person Market Position Statement concluded that general residential capacity was sufficient to meet expected need until at least 2030.

That is now an older planning assessment and should not be treated as a live capacity count.

Its direction remains consistent with current policy.

Southampton is trying to reduce long-term institutional care where people can safely remain at home.

A provider considering a standard residential home therefore needs stronger evidence than population ageing.

Nursing capacity has been the more persistent care-home gap

The same Market Position Statement identified a materially stronger need for nursing beds than general residential beds.

An earlier planning model estimated demand for approximately 95 additional nursing beds by 2025 and a further 118 by 2030. These are historic planning projections rather than confirmed current shortages, so any investment case should test them against the latest commissioning and bed-capacity evidence.

These figures are historic planning estimates and need current verification before investment.

The underlying issue remains visible in CQC's 2026 findings.

People with complex physical and nursing needs were still more likely to be placed outside the city.

That suggests specialist nursing capacity remains a more credible market area than generic residential care.

Advanced dementia is another pressure point

CQC specifically identified advanced dementia as a reason people may need out-of-city care.

This matters because dementia capacity is not simply about having a dementia label.

Appropriate provision for advanced dementia can require a specialist environment, higher staffing intensity, behavioural expertise and strong clinical oversight. End-of-life capability and experienced management may also be necessary. A home cannot solve this gap merely by describing some of its existing rooms as dementia beds.

A care home that cannot safely support advanced need does not solve this gap.

Older care-home stock creates a structural issue

Southampton's older-person Market Position Statement noted that many city care homes are small and converted from ordinary housing.

Only around one third were purpose built in that evidence base.

Older buildings can face limitations around accessibility, en-suite facilities, wet rooms, space for specialist equipment and the staffing patterns required for high-acuity nursing. A home may be providing acceptable care today while its physical environment becomes less suited to the needs commissioners anticipate.

Quality may be acceptable while the physical building becomes less suitable for future acuity.

This creates a potential redevelopment and modernisation issue, not merely a bed-number issue.

Homecare is a large and competitive market

Southampton has substantially more non-residential than residential regulated services.

Skills for Care counted 87 non-residential services in 2024/25.

The city has also historically expanded its homecare framework and provider diversity.

That means a new domiciliary-care agency should not assume registration creates a ready flow of packages.

A more persuasive offer may involve complex homecare, hospital-discharge support, higher-acuity physical care, specialist mental-health provision, culturally responsive services or a clearly differentiated private-pay proposition. Each requires validation against the local referral and purchasing routes.

Diversity matters more in Southampton than in many neighbouring markets

Southampton is ethnically and culturally diverse.

CQC noted that approximately one in seven people did not speak English as a first language.

Southampton's own adult social care data shows the service-user population is less ethnically diverse than the city population.

Among records with stated ethnicity, 16.8% of long-term service users were recorded as non-white British, compared with 31.9% of the wider city population. The categories are broad and the comparison does not on its own establish unequal access, but it does raise questions worth examining.

1. Long-term service users

   16.8%

2. City population

   31.9%

These categories are broad and should not be overinterpreted.

Potential barriers include awareness of services, accessibility, cultural appropriateness, language, trust and the use of direct payments. Providers able to understand and engage particular communities may be better placed to design responsive care than those relying on a one-size-fits-all model.

A provider that understands specific communities may have a stronger proposition than one offering generic city-wide care.

Deprivation is a major part of the demand picture

Southampton has significant deprivation.

Around 27.6% of residents live in neighbourhoods within England's most deprived 20%.

Among long-term adult social care users who live in the city, the proportion is higher at 32.5%.

1. All residents

   27.6%

2. Long-term care users in the city

   32.5%

Deprivation can be associated with poorer health, earlier disability, difficult housing conditions, reduced capacity to purchase care privately and digital exclusion. This affects both the nature of need and the commercial assumptions suitable for different Southampton neighbourhoods.

This makes Southampton commercially different from more affluent neighbouring areas.

Private-pay opportunity exists, but it should not be assumed uniformly across the city.

Neighbourhood differences are substantial

Southampton has developed six neighbourhood profiles to support integrated health and care planning.

These areas contain populations of roughly 30,000 to 50,000.

The West neighbourhood, covering Coxford, Millbrook and Redbridge, is particularly deprived.

Nearly half of residents there live in the most deprived national quintile.

Coxford also has some of the highest levels of new adult social care requests in the city.

This demonstrates why a city-wide market analysis can be too broad.

Need varies significantly between neighbourhoods.

Learning-disability demand remains substantial

Southampton estimates around 4,988 adults have a learning disability in 2025.

That number is projected to increase modestly to around 5,278 by 2040.

4,988

Estimated adults in 2025

and

5,278

Projected adults in 2040

The increase in numbers is not dramatic.

Complexity and longevity are more important.

An increasing number of people with learning disabilities are living into later life and may also develop dementia, physical disability, frailty or mental-health conditions. Services will need to respond to combinations of needs rather than rely on a single client-group label.

Southampton already has a substantial number of long-term service users receiving learning-disability support.

Out-of-city learning-disability provision deserves investigation

One hundred long-term users supported outside Southampton have learning disability as their primary support reason.

That is a significant proportion of all out-of-city long-term care.

For providers, this does not mean "open a learning-disability service".

A provider needs to establish which individual needs are not met locally, whether the barrier is specialist staffing or accommodation, whether residential care or supported living is appropriate and what level of support would be required. The headline out-of-city count is only the starting point for a viable service proposal.

The market signal becomes useful only when the cohort is understood.

Mental-health care is another specialist pressure

Mental-health support accounts for 13.7% of Southampton's long-term adult social care users.

CQC also identified mental-health needs among the groups more likely to require out-of-city support.

The city has experienced weaker integration between health and social care in mental health after previous joint arrangements ended.

Potential gaps concern suitable supported accommodation, hospital discharge, complex community support, dual diagnosis and recovery pathways. Any new provision would need to work with NHS mental-health services as well as local-authority commissioning, rather than assuming a single purchaser or referral mechanism.

A new provider needs to understand the NHS pathway as well as local-authority demand.

Respite is difficult to access

CQC's 2026 assessment identified respite as a particular problem.

Unpaid carers said services were often difficult to access, especially for people with complex needs.

Some described availability as first-come, first-served.

Southampton also recommissioned residential respite for adults with learning disabilities and complex or specialist needs during 2025.

This makes respite a meaningful market area.

But it is not a simple high-occupancy model.

Demand can be planned, episodic or urgent.

Unpaid carers are part of the city's effective care capacity

When respite is insufficient, unpaid carers absorb more of the burden.

CQC heard reports of burnout.

This matters for the wider market.

When unpaid care breaks down, people can need emergency support, hospital admission, a permanent residential placement or more intensive homecare. Respite and contingency arrangements therefore have value beyond the individual short break: they may help sustain care at home for longer.

Direct payments remain underused

Southampton performs poorly on the proportion of social care users receiving direct payments.

The city's own SALT analysis ranked this among its weakest metrics.

CQC heard that people could experience delays, restrictive processes, limited understanding or insufficient funding when arranging direct payments. The option may offer independence and help meet cultural preferences, but it is not a frictionless route to customers for a new provider.

Direct payments may represent a customer-acquisition route, but it remains underdeveloped and requires careful testing.

Workforce capacity is relatively stable by regional standards

Skills for Care estimated around 6,600 adult social care posts in 2024/25, of which roughly 6,100 were filled and 425 vacant. The estimated vacancy rate of 6.8% was close to regional and national comparisons, although vacancies still represent a meaningful workforce challenge.

6,100

Filled posts

and

425

Vacant posts

Turnover was 22.7%, below the South East average and close to England.

These are not extreme workforce indicators.

But 425 vacancies still matter in a compact market.

Specialist workforce is the bigger question

The issue is whether employers can attract registered nurses, experienced complex-care workers, registered managers, mental-health specialists and dementia-trained staff. These skills are most relevant to the shortages identified in CQC's assessment and cannot be inferred from the headline care-worker vacancy rate.

The clearest demand gaps require precisely those higher-level skills.

A generic care-worker recruitment plan may therefore be insufficient.

Assessment delays affect the flow of commissioned demand

CQC scored Southampton's assessing-needs function at 1.

People experienced long waits for assessments and reviews.

This matters to providers because population need does not convert instantly into funded packages.

Referrals may be slowed by assessments, care reviews, financial assessment or allocation decisions. A person can have clear support needs without an immediately available funded package, so new providers should not equate unmet need with instant commercial demand.

This creates volatility in package flow.

Safeguarding and governance remain system risks

CQC scored both safeguarding and governance, management and sustainability at 1. That points to problems in the council's systems and decision-making which providers need to understand when coordinating care and managing escalation, rather than treating regulatory oversight as only a provider-level issue.

Safeguarding triage and Section 42 enquiries could be delayed.

There was also a significant deprivation-of-liberty backlog.

For providers, this raises the importance of strong internal governance.

A new service cannot rely on the wider system to compensate for weak safeguarding practice.

The 2026–35 Health and Wellbeing Strategy reinforces independence

Southampton's new Health and Wellbeing Strategy 2026–35 includes an ambition to increase the proportion of people able to live independently and decrease the proportion living in residential or nursing homes.

The strategy emphasises integrated neighbourhood working, prevention, frailty support, cardiovascular and respiratory health and mental-health improvement. Together these priorities favour better coordinated, community-based care while recognising the continuing need for specialised services.

This is another signal that future care growth will be more community-based and specialist.

What does the Southampton market actually show?

Southampton has a large and diverse adult social care market.

The strongest local need is not evenly distributed.

General homecare

A competitive market with many providers. New entrants need a specialist, neighbourhood or private-pay proposition.

Complex homecare

A stronger opportunity where services can support high-acuity physical, dementia or mental-health needs.

General residential care

A weaker growth case under the city's Home First strategy.

Nursing and advanced dementia

Stronger evidence of local capacity pressure, including out-of-city placements.

Learning disability and autism

A substantial funded market with significant out-of-city use that deserves cohort-level investigation.

Mental health

A clear specialist pressure area requiring integration with NHS pathways.

Respite

A documented gap, particularly for unpaid carers supporting people with complex needs.

Workforce

Reasonably stable overall, but specialist skills remain a likely constraint.

The key commercial opportunity is therefore to solve a specific specialist or neighbourhood problem rather than add generic capacity.

If you are still deciding whether the opportunity is strong enough for the service you have in mind, the Should I Start? Market Report can apply the same local evidence to your planned service in Southampton, including your service type, stage and intended customer group.

Questions to answer before starting a care service in Southampton

A prospective provider should be able to answer:

1. Which client group will the service support?
2. Which Southampton neighbourhood will it serve?
3. Is the local gap general or specialist?
4. Does the service reduce out-of-city care?
5. Who will pay?
6. Which commissioning route applies?
7. What comparable providers already operate locally?
8. Does the service require specialist property?
9. What fee is realistically achievable?
10. Can specialist staff be recruited?
11. How will the service support Home First and independence?
12. How will it meet the needs of Southampton's diverse population?
13. How will safeguarding and governance be managed?
14. What evidence would cause the provider not to proceed?

Those questions should come before significant investment in CQC registration.

If the local market case already looks strong and you are moving towards CQC registration, you can get a proposal comparing specially selected and verified CQC registration specialists for the service you plan to register.