There are several factors that continue to have an impact on the delivery of care in the older people’s residential care market in Brighton & Hove. Some factors are in line with national and regional comparison, others are specific to Brighton & Hove. Together they pose significant difficulties for providers and commissioners.
The current care home market in Brighton & Hove is explained as:
- a strong residential care offer, but with gaps in specific areas
- a shortage of high frailty and nursing care
- a severe shortage of residential and nursing dementia beds, alongside functional mental health, which has resulted in large numbers of people being placed out of the city
- a shortage of long-term planned respite care
- a shortage of specialist care for people under 65
- severe financial pressures for both Brighton & Hove City Council and independent providers
- a care workforce shortage
Care home beds in Brighton & Hove in March 2023
There were a total of 2005 care home beds available in March 2023.
Care home type |
Beds |
Percentage of total beds |
---|---|---|
Independent Care Home with Nursing |
668 |
33% |
Independent Care Home with Dementia Nursing |
350 |
17% |
Independent Care Home with Mental Health Nursing |
17 |
1% |
Independent Care Home without Nursing |
347 |
17% |
Independent Care Home Older People Dementia and Mental Health |
174 |
9% |
Independent Care Home Working Age Mental Health |
112 |
6% |
Independent Care Home Sensory Loss |
44 |
2% |
Independent Care Home Acquired Brain Injury/Physical disabilities |
31 |
2% |
BHCC Care Home (CSTS) |
89 |
4% |
Independent Care Home Learning Disabilities |
139 |
7% |
BHCC Care Home Learning Disabilities |
34 |
2% |

Ownership of city based care homes
The majority of residential care settings for older people (defined as those aged 65 and over) in the city are in the private or not-for-profit sector. The council has a very small number of homes that focus on rehabilitation and move-on support services and there is also a lack of nursing care and in particular those services that support more complex people, including dementia.
Recently we have been made aware of an increasing number of city based care homes that are focussing on the self-funder market which reduces the number of available beds to Local Authorities. Historically this has been a small number of city based care homes and could present new challenges going forward.
With limited development space in a small urban city there are limited opportunities to develop new provision and shape the how the market meets the needs of residents. The focus for Brighton & Hove City Council is working with the existing market, enabling adaptations to meet needs.
Demand for care
Prior to COVID-19 we saw small reductions in referrals, particularly in non-specialist residential care. This coincided with the city’s long established intention to support people in their community for longer and to place fewer people in registered care homes.
Long-term support needs of older adults (65 and over) met by admission to residential and nursing care homes, per 100,00 population
Year | Council score | Region score | England score |
---|---|---|---|
2017 to 2018 | 748.8 | 561.5 | 585.6 |
2018 to 2019 | 794.7 | 517.7 | 577.6 |
2019 to 2020 | 733.8 | 526.5 | 584.0 |
2020 to 2021 | 656.1 | 489.0 | 498.2 |
2021 to 2022 | 438.3 | 524.3 | 538.5 |

Since 2022 the number of placements has risen above pre COVID levels. As we have focussed support on winter pressures to expedite the numbers of patients waiting for care in acute hospital beds, hospital discharge pathways have focused on step down residential/nursing care placements, which has inevitably increased the number of new residential admissions.
Increasing prevalence of high frailty, dementia and complex comorbidity
Demand has increased particularly for services that can support extremely vulnerable people with multiple conditions. This has been driven by hospital discharges, but also demographics changes.
Whilst life expectancy has been increasing, healthy life expectancy has fallen in recent years. People are living longer in ill health, with frailty and multiple long-term conditions increasingly common amongst older people in residential care.
This has been evidenced within the last Joint Strategic Needs Assessment undertaken on adults with multiple long-term conditions in Brighton and Hove highlighting the percentage of people living with long-term conditions increases with age.
Percentage of people with specified number of long term conditions, by age group, Brighton & Hove, March 2017

For those living with dementia, the recorded prevalence rates amongst people aged 65 and over in Brighton & Hove is higher than both England and the South East, (4.2% of over 65 year olds with a diagnosis of dementia, with an England average of 4.0% (2020)) with rates predicted to rise significantly in the next decade.
Workforce, capacity, and resilience challenges
Endemic structural workforce issues in adult social care have been made worse in recent years by the effects of COVID-19, Brexit, people exiting the labour market and the cost of living crisis. Recruitment and retention, pay and reward, support, training, and career progression are issues that continue to challenge the whole sector. This has increased the risk to services and require resilience planning at all levels to safeguard people in receipt of care.
Workforce capacity pressures have been growing significantly over the last two years, notably impacting on the home care sector as many more people are choosing to have care in their own home rather than within a care home. This has been exacerbated by home care and care home staff leaving the care sector due to low salaries and burnout after the pandemic.
Funding provided by the government to support recruitment and retention while welcomed, is of a short-term nature. It is now more difficult to recruit staff from the European Union due to post Brexit government requirements, although Social Care carers are now on the government’s Shortage Occupancy List.
Through engagement with Care Homes, we know that workforce remains a key challenge having lost access to overseas staff, without immediate replacements and young people who want a career in care.
Care reform impact on fees and self-funder arrangements
Charging Reform legislation was scheduled for introduction in October 2023, this has since been delayed until October 2025. As part of that preparation Brighton & Hove studied the self-funder market and predicted the impact of legislation change on the demand for services.
We are conscious that although the legislation changes had additional government funding, the expected increase in demand and costs for self-funders moving to Local Authority rates would have been beyond the additional funding. This is explained further in section 2 below.
The cost of living crisis
The unprecedented escalation in costs, particularly energy bills, has shaken the sector. Brighton & Hove City Council faces a shortfall of £14.3 million in 2023/2024 due to demand for our services, increase inflation, the impact of the pandemic and the cost of living crisis. The Council’s budget position remains challenging over the next 4 years.
The accommodation based care sector, Care Homes and Supported Living, have also faced rising fuel costs. Central heating is commonly in use for the majority of the year in most care homes and environments where people are relatively immobile. Similarly, food costs have increased substantially in 2022 and providers are seeking to pass these costs on.
A further ongoing cost that providers face is the Real Living Wage increasing by 10% from £9.90 to £10.90 (a contractual requirement for Home Care providers) and the National Living Wage, currently £9.50, which has been announced to increase by just under 10% to reach £10.42 in 2023.
Quality of city based care homes and home care providers
Brighton & Hove City Council Quality Monitoring Team (QMT) supports contracted and in-house services. The team gather information about providers through various means e.g., complaints, compliments, plaudits, S42 enquiries (safeguarding), and one-off information from a variety of sources.
QMT also works closely with other professionals including NHS SUSSEX Integrated Care Board (ICB), and Care Quality Commission colleagues, to share information to build up a picture of the quality of care services. The QMT and ICB (quality lead/s) use a jointly developed quality assurance audit tool during all quality monitoring assurance audits.
Over 1 January 2023 to 31 March 2023 QMT has closely monitored and provided enhanced support to 19 individual services, comprising three nursing homes, seven supported living learning disability, three care homes, one learning disability community service, one learning disability care home, two nursing home and three home care providers. Although some providers are out of scope for the Market Sustainability Plan this does show an increase of six compared to the number of providers receiving enhanced support over third quarter of the year.
The total number for year 2022/2023
A total of 22 providers were on the main Service Improvement Panel and received significant monitoring and support from QMT.
Compared to 2021/2022 QMT provided enhanced support to 14 providers, 2022/2023 has seen an increase of 8 providers requiring enhanced monitoring and support from QMT and others. The figure is slightly skewed due to Achieve Together having six services registered under one registration which was CQC (Care Quality Commission) rated overall Inadequate February 2023.
Annual fees and price uplift
Annual fees paid for commissioned services are reviewed in line with Local Authority budget setting process, which starts in Autumn and is finalised in February each year.
When setting annual fees, the Council considers inflationary pressures, the living wage and other cost pressures affecting Adult Social Care providers, but this must be balanced with managing the overall budget of Adult Social Care services and the wider Council.
For residential settings we have published set rates which cover both residential and nursing homes and for our homecare provision we have a set hourly rate. The table below set out these rates as at 2022/2023. Additional Funding provided through the cost of care exercise has been applied to these rates for 2022/2023.
Fee Rates Table 2022 to 2023
Service |
Current set fee per week 2022 to 2023 |
---|---|
In city care homes for people aged 65 and over |
£624 |
In city care homes for people aged 65 or over with nursing |
£833.19 (inclusive of FNC £209.19) |
It is important to recognise that for our residential provision and due to market pressures, we are currently only able to purchase a limited number of beds at these published rates with variable rates above this depending on market conditions.
It is increasingly difficult to place clients at the Council’s set rates and as of October 2022 only 15% of council funded people are in care homes at set rates. Although the Set Rate is now £624 the average cost the Council paid for a care home placement in October 2022 was £816 for a Care Home providing physical care and £918 for a Dementia Care Home which is more than 33% above the Set Rate.
We will be reviewing our published set rates alongside our commissioning of residential provision over the next few years and consideration to the Cost of Care exercise outputs will be part of this process. This will be one of many areas of consideration when reviewing fee rates going forward and other factors such as current rates being paid, and affordability will also need to be considered.