Adult social care in Surrey

Surrey is one of the largest and most commercially distinctive adult social care markets in the South East.

Its population is now estimated at more than 1.25 million people. The county has a large and growing older population, high levels of private wealth in many areas, a substantial self-funder market and an established network of residential, nursing, homecare and supported-living services.

That combination creates real demand.

It also makes Surrey a poor example of a market where population growth can be treated as proof that another general care service will succeed.

Surrey County Council's current market-shaping material is unusually explicit about this. More than 65% of care-home capacity is either used by older self-funders or is vacant but not available to the council. The authority says there is insufficient affordable extra-care housing, while its homecare market position statement describes an overprovision of homecare and warns that the number of new agencies has grown faster than council-funded demand.

At the same time, the council continues to identify gaps in specialist accommodation, complex care and affordable capacity.

For a prospective provider, Surrey therefore needs to be read as several overlapping markets rather than one.

The most useful question is not whether Surrey needs care.

It is which people are difficult to support, which capacity is genuinely available to the relevant purchaser, and whether a new provider can deliver that care at a sustainable price.

Surrey at a glance

1,255,255

Estimated residents in mid-2025

1,203,108

Residents at the 2021 Census

19.1%

Of residents aged 65 and over in the 2022 projection base

25.1%

Projected to be aged 65 and over by 2047

686

CQC-regulated adult social care services in 2024/25

368

Residential services and 318 non-residential services in 2024/25

37,000

Adult social care posts in 2024/25

3,000

Vacant adult social care posts in 2024/25

8.4%

Estimated adult social care vacancy rate

4,000

Council-purchased homecare packages in the February 2024 market snapshot

57,352

Council-purchased homecare hours each week in that snapshot

65%+

Of care-home capacity either occupied by older self-funders or vacant and unavailable to the council

850

Projected deficit in affordable extra-care housing by 2030 in Surrey's specialist-housing planning evidence

These figures come from different datasets and reference periods. They should not be treated as one live operational snapshot. Together, however, they describe the structure of the market clearly: very large demand, very large supply and important mismatches between the two.

Surrey's population is growing and ageing

Surrey's latest published population estimate puts the county at 1,255,255 residents in mid-2025.

That is around 52,000 more people than were counted at the 2021 Census.

1. 2021 Census

   1,203,108

2. Mid-2025 estimate

   1,255,255

Population growth matters to care providers, but the more important change is the age profile.

Surrey's current population projections estimate that people aged 65 and over represented 19.1% of residents in 2022. By 2047, that proportion is projected to reach 25.1%.

1. 2022 projection base

   19.1%

2. 2047 projection

   25.1%

The absolute number of older people is therefore expected to rise substantially even though total population growth is comparatively modest.

The oldest age groups are especially relevant.

Surrey's JSNA has previously estimated that the number of residents aged over 80 will rise sharply over the longer term. This matters because formal social care demand becomes much more concentrated at older ages, when frailty, dementia, mobility limitations and multiple long-term conditions become more common.

An ageing population strengthens the long-term demand base for:

• Homecare
• Residential care
• Nursing care
• Dementia care
• Extra care
• Reablement
• Community support
• Equipment and technology-enabled care
• Unpaid-carer support

But it does not determine which of those models will grow fastest.

Surrey's strategy is explicitly designed to help people remain independent for longer. Some future demand that might once have flowed directly into residential care is therefore expected to be met through home-based care, extra care, supported housing, reablement, direct payments and community support.

Population ageing increases need.

It does not remove the need to understand how that need will be met.

Surrey already has a very large regulated care market

Skills for Care estimated that Surrey had 686 CQC-regulated adult social care services in 2024/25.

Of these:

• 368Residential services
• 318Non-residential services

That immediately distinguishes Surrey from a thin or immature market.

A new provider is entering an area with extensive existing capacity, recognised brands, experienced operators, established referral relationships and a substantial private-pay sector.

The existence of hundreds of registered services does not mean the market is saturated in every category.

It does mean that a business case based only on population size is weak.

The provider needs to know what type of capacity already exists, how much of it is accessible to the intended customer group, how competitors are positioned and where commissioners or families are struggling to find an appropriate service.

The private-pay market changes the care-home economics

Surrey County Council says that more than 65% of care-home capacity is either used by older self-funders or is vacant but unavailable to the council.

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

That is one of the most important facts in the Surrey market.

It means nominal bed capacity and council-accessible bed capacity are not the same thing.

A care home may have vacancies but still choose not to accept a council-funded placement at the authority's guide price. A home may also target self-funders because the private market can support higher fees.

This creates a two-sided market.

For private-pay providers

Affluence in parts of Surrey can support premium fees, higher-specification accommodation and a consumer-led proposition.

But the same attractiveness has encouraged substantial supply.

A private-pay care home still needs to compete on:

• location
• reputation
• property quality
• clinical capability
• dementia provision
• customer experience
• family confidence
• price
• lead generation

For council-funded providers

The issue can be the opposite.

The council may know there is capacity in the county but be unable to secure it at an affordable rate or for a person with more complex needs.

This creates opportunities for providers willing and able to work within council commissioning arrangements.

But those opportunities need to be tested against realistic staffing and property costs.

Surrey's current 2026/27 guide prices for new older-person residential and nursing placements are:

1. £830.64Residential, per week
2. £893.81Enhanced residential
3. £958.16Nursing, excluding funded nursing care
4. £1,021.33Enhanced nursing, excluding funded nursing care

These are useful reference points for the council-funded market.

They are not a guarantee that every placement will be made at those exact rates, and they should not be compared directly with private self-funder pricing without recognising the different market dynamics.

For a new home, the key exercise is to build the cost model from achievable income backwards.

Affordable care-home capacity is more important than total capacity

Surrey's market-shaping documents repeatedly distinguish between overall supply and supply the council can actually use.

This is especially relevant for more complex placements.

The authority has said that it faces difficulty purchasing good-quality care-home placements at prices it can afford, particularly where people have higher needs.

That creates an important market signal.

The gap may not be another standard residential bed.

It may be a bed that combines:

• Appropriate staffing levels
• Dementia capability
• Nursing support
• Behavioural support
• Suitable physical environments
• Robust clinical governance
• Willingness to accept the relevant funding route

The commercial opportunity can therefore sit in making existing capacity usable, not simply increasing the raw number of beds.

Extra care is one of Surrey's clearest structural gaps

Surrey has a longstanding strategy to reduce unnecessary reliance on conventional residential care by expanding extra-care housing.

Its Right Homes, Right Support market position statement estimated a deficit of around 850 affordable extra-care units by 2030.

The council has separately committed to delivering an additional 725 social-rent extra-care units by 2030.

850

Projected deficit in affordable extra-care units

725

Additional social-rent extra-care units the council has committed to deliver

That is a strong strategic signal.

Extra care gives residents self-contained accommodation with care and support available around them. It can allow people to remain more independent than they might in a traditional care home while still receiving substantial support.

For providers and developers, however, the opportunity is more complex than opening a care home.

It depends on:

• housing development

• land and planning

• tenure

• capital funding

• nomination arrangements

• care commissioning

• staffing

• integration with local health and community services.

The scale of the projected deficit makes extra care strategically important.

It does not make every proposed scheme viable.

Homecare demand is large, but Surrey has warned about overprovision

Surrey's 2024 Care within the Home Market Position Statement gives a particularly clear warning to prospective domiciliary-care providers.

At the time of the snapshot, the council was purchasing around 4,000 homecare packages, including approximately 165 live-in-care packages.

The breakdown included around:

2,650

Older adults

740

People with a physical disability

260

People with a learning disability and/or autism

190

People with a mental-health condition

The council was purchasing approximately 57,352 hours of homecare each week, with an average of around 15 hours per person.

57,352

Hours each week

at

15

Average hours per person

Those are substantial volumes.

But the same market position statement said there was an overprovision of homecare in Surrey.

That distinction is critical.

High demand and oversupply can exist at the same time.

Surrey attracts new homecare agencies because the county is large, affluent and has a strong self-funder market. The council's own funded demand, however, does not automatically expand at the same rate as the number of registered providers.

A newly registered domiciliary-care agency should therefore not assume that there is a shortage simply because thousands of packages are purchased each week.

The homecare market is also changing structurally

The commissioning route has evolved since the 2024 market-position snapshot.

For 2026/27, Surrey refers to an Approved Provider List Dynamic Purchasing System for care within the home. Providers accepted onto the relevant purchasing arrangements can receive council-funded packages under the applicable terms.

The practical implication is straightforward.

A provider relying on council-funded work needs to understand:

• whether the purchasing system is open

• the qualification requirements

• current package-allocation rules

• expected rates

• geography

• service-user groups

• continuity requirements

• quality thresholds

Registration with CQC does not itself create access to council packages.

For private homecare, the problem is different.

The business needs a reliable customer-acquisition route and enough geographic density to prevent travel time from eroding productivity.

A county of Surrey's size should never be treated as one homecare catchment.

Geography creates several different local markets

Surrey contains densely populated urban and suburban areas, commuter towns and substantial rural territory.

Population, affluence, age profile and transport differ significantly between districts.

The 2021 Census, for example, showed the proportion of people aged 65 and over ranging from 16.6% in Woking to 23.8% in Mole Valley.

1. Woking16.6%
2. Mole Valley23.8%

1526

The market around Guildford, Woking or Epsom can therefore behave differently from parts of Waverley, Mole Valley or Tandridge.

This matters most for services delivered in people's homes.

Travel time, worker availability and package density can determine whether a homecare round is financially viable.

It also matters for accommodation-based services.

Families may want somebody to remain near a spouse, children, familiar community, GP or hospital. A vacancy on the other side of the county can be operationally available but practically unsuitable.

Surrey-wide demand should therefore be treated as the first layer of analysis, not the final one.

Supported independent living is a major strategic market

Surrey also has substantial demand among working-age adults.

The council's specialist-housing strategy identifies deficits in supported independent living for people with learning disabilities, autistic people and people with mental-health needs.

Its earlier modelling estimated that, without expanded community alternatives, the number of people with learning disabilities or autism living in residential care could rise from 1,082 in 2019 to around 1,600 by 2030.

The strategic ambition was to reduce reliance on residential care substantially, creating a requirement in the region of 600 supported-independent-living units.

For people with mental-health needs, the same strategy projected a supported-independent-living deficit of approximately 185 to 210 units by 2030.

600

Units in the strategic requirement, to reduce reliance on residential care

185–210

Projected mental-health deficit by 2030

These figures are planning estimates rather than live vacancy counts.

Their importance lies in the direction of policy.

Surrey wants more people to live in community settings with appropriate support rather than defaulting to conventional residential care.

The purchasing route has also moved on. Surrey says a new Care and Support with Community Accommodation Dynamic Purchasing System for supported independent living went live on 1 April 2025.

For a provider, this makes supported living a serious market to investigate.

But it should not be approached as generic low-support accommodation.

The stronger opportunities are likely to be where housing, staffing and specialist capability align with the needs commissioners are trying to move away from institutional or out-of-area provision.

Mental health demand increasingly favours community support

Surrey's mental-health market position work also points toward greater use of community-based support.

The council has reported that the volume of people supported through care-within-the-home packages for mental-health needs increased by 262% between October 2019 and the 2023/24 period.

By July 2024, 37 CQC-registered care agencies were approved for the additional-needs element of the homecare arrangements, with 32 accepted to support people with mental-health needs.

37

CQC-registered care agencies approved

32

Accepted to support people with mental-health needs

The council said that sourcing suitable providers had become considerably easier than it had been before 2020.

This is another example of why historic shortage should not be assumed to persist unchanged.

A market can develop.

Capacity can improve.

The opportunity can move from basic availability toward more specialised community outreach, discharge support, tenancy sustainment and complex accommodation-based care.

Direct payments create another route into the market

Surrey describes direct payments as its preferred approach where appropriate for people who want to arrange their own support.

For providers, this matters because the council is not always the direct purchaser.

People may use a personal budget to buy support themselves, creating a different commercial relationship from a framework or spot placement.

Direct payments can be used for a wide range of community services, including home-based care, respite, outreach, supported accommodation and other forms of support, subject to the applicable rules.

A provider targeting this market needs to communicate directly with individuals and families rather than treating the local authority as the only customer.

It also needs to understand that direct-payment recipients are still price-sensitive and may have tightly defined budgets.

Unpaid carers are a major part of Surrey's care capacity

Surrey's updated JSNA reports 90,497 residents providing unpaid care at the 2021 Census.

Around 23,469 were providing 50 or more hours of unpaid care each week.

90,497

Residents providing unpaid care

of whom

23,469

Providing 50 or more hours each week

That matters for two reasons.

First, unpaid care absorbs a significant amount of need that would otherwise fall on formal services.

Second, the sustainability of that unpaid care affects future formal demand.

As the population ages, more families will be balancing employment, their own health and increasingly complex caring responsibilities.

Respite, replacement care, information, community support and flexible home-based services can all become more important when unpaid-care arrangements are under pressure.

A provider should not treat family care as separate from the market.

It is one of the factors shaping when and how people enter formal care.

Workforce remains one of the main constraints

Skills for Care estimated that Surrey had around 37,000 adult social care posts in 2024/25.

Approximately 34,000 were filled and 3,000 were vacant.

1. Filled

   34,000

2. Vacant

   3,000

Skills for Care.

The estimated vacancy rate was 8.4%, above the South East average of 7.0% and the England rate of 6.8% in the same dataset.

1. England6.8%
2. South East7.0%
3. Surrey8.4%

69

Turnover was estimated at 23.9%.

Surrey's care workforce is also internationally dependent. Skills for Care estimated that around 53% of the workforce identified as British, 35% as a non-EU nationality and 11% as an EU nationality.

• 53%British
• 35%Non-EU nationality
• 11%EU nationality

Skills for Care. The published shares do not add to 100.

That is commercially significant.

The more specialised the service, the more difficult it may be to recruit enough people with the required skills.

A gap in provision can therefore be real but difficult to convert into a sustainable business because the staffing model is the limiting factor.

For a homecare provider, workforce availability also interacts directly with geography. A service can have clients and still fail operationally if it cannot build workable rounds around where staff live.

For a nursing home, registered-nurse availability can shape usable bed capacity more than the physical number of bedrooms.

Workforce capacity is part of market capacity.

Quality and experience matter in a mature market

A market with hundreds of regulated services creates another challenge for new entrants.

Registration is not a differentiator.

Families, commissioners and professionals can compare providers based on:

• CQC history
• Leadership
• Continuity
• Staff experience
• Safeguarding
• Responsiveness
• Specialist expertise
• Outcomes
• Local reputation

Surrey's mature market makes it especially important that a new service has a proposition beyond being newly registered.

A provider entering a crowded category with no specialist positioning may find that the hardest problem is not CQC registration.

It is winning trust and referrals after registration.

Financial sustainability will remain a central issue

Surrey County Council increased its care-provider fees again from April 2026, with uplifts varying by service type.

Older-person residential and nursing guide prices increased by 3%. Care within the home, reablement, extra care, supported independent living, community outreach and several other services received 3.3% uplifts under the council's stated approach.

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

2.54

These increases need to be considered alongside staffing, property, insurance, utilities, financing and compliance costs.

Surrey's self-funder market can support higher prices in some segments.

Council-funded services have tighter affordability constraints.

This makes the payer mix particularly important.

A business model heavily dependent on premium private fees is different from one built around council purchasing, even when the regulated service looks similar.

What does the Surrey market actually show?

Surrey has one of the strongest underlying demand bases for adult social care in the South East.

It combines population scale, ageing, wealth and a very large existing care economy.

But the evidence does not support a simple conclusion that Surrey needs more of every type of care.

1. Care homes

   There is extensive existing capacity and a powerful self-funder market. The council's difficulty is partly access to affordable and suitable capacity, especially for more complex needs.

2. Homecare

   Demand is substantial, but the council has explicitly described overprovision in the market. New agencies need a defined geography, customer-acquisition route and clear reason why they will win work.

3. Extra care

   This is one of the clearest strategic gaps. Surrey has projected a significant deficit in affordable extra-care housing and is actively expanding supply.

4. Supported independent living

   The strategic direction is strongly toward greater community-based accommodation for learning disability, autism and mental-health needs. The opportunity is specialist and commissioning-led rather than generic.

5. Complex and specialist support

   A recurring theme across Surrey's market statements is that useful capacity depends on whether providers can safely meet higher or more specialised needs at an affordable price.

6. Workforce

   Recruitment remains a material constraint. A credible market opportunity needs a credible staffing model.

The result is a market where specialism, payer, geography and commissioning route matter more than headline population growth.

Questions to answer before starting a care service in Surrey

Before committing significantly to registration, property or recruitment, a prospective provider should be able to answer:

Those questions should be answered before treating registration as the next step.