Medway Council: Adult Social Care Market Intelligence

Medway Council is a unitary authority serving approximately 280,000 people across the five towns of Chatham, Gillingham, Rochester, Rainham and Strood. The council has responsibility for all local government functions including adult social care, making it a single point of accountability for commissioning and provider engagement.

The adult social care market in Medway is smaller and more concentrated than in neighbouring Kent County Council. A limited number of providers dominate the domiciliary care market, and the authority faces distinct challenges including above-average deprivation in parts of its area and significant health inequality.

This report draws on systematic review of Medway's published Market Position Statement, commissioning strategies and Joint Strategic Needs Assessment; analysis of CQC registration and inspection data; ONS population projections and Skills for Care workforce estimates; and direct engagement with CQC-registered providers operating within the authority.

Medway is a unitary authority in the South East of England, formed in 1998 from the merger of Rochester-upon-Medway City Council and Gillingham Borough Council with part of Kent County Council. As a unitary authority, Medway Council is responsible for all local government services within its boundaries, including adult social care, children's services, housing, highways, education, public health and environmental services.

The council's adult social care budget exceeds £90 million annually. The population aged 65 and over is projected to grow 22% by 2030, and approximately 180 CQC-registered adult social care locations operate within the authority. Medway has higher-than-average levels of deprivation compared to the South East region as a whole, with several wards falling within the most deprived quintile nationally.

The council's Health and Wellbeing Board provides strategic oversight of health and social care integration, and the authority is part of the Kent and Medway Integrated Care System.

Medway Council's commissioning priorities centre on increasing domiciliary care capacity — particularly for complex packages that support people with higher acuity needs to remain at home rather than entering residential care. The authority is actively seeking to increase the number of providers capable of delivering culturally competent services that reflect Medway's diverse communities, including significant South Asian and Eastern European populations.

Developing supported living pathways for adults with learning disabilities and autism is a stated priority, with the council seeking to reduce reliance on out-of-area residential placements. The authority is also prioritising integrated discharge pathways to reduce delayed transfers of care from Medway NHS Foundation Trust — a persistent challenge given pressures on both the acute hospital and the community care system.

Embedding a strengths-based, outcome-focused approach across all commissioned services is a cross-cutting theme in the council's commissioning strategies, aligned with the Care Act 2014 wellbeing principle.

The Medway provider market is concentrated — domiciliary care is dominated by a small number of providers, with the largest five accounting for a significant share of commissioned hours. While this concentration creates administrative efficiency for the council, it also introduces market fragility: if a major provider were to exit the market, replacement capacity would be difficult to secure at short notice.

CQC ratings in Medway are 79% Good or Outstanding — slightly below the national average of 83%. Several providers report difficulty maintaining viable margins at current fee levels, particularly for short visit slots of 30 minutes or less. Provider turnover in domiciliary care is a concern, with several providers citing workforce challenges and fee levels as the primary reasons for market exit.

The supported living market is growing but remains fragmented, with a mix of local and regional providers. The council has indicated interest in expanding framework agreements for domiciliary care and supported living to encourage provider participation.

Medway Council operates a centralised commissioning function for adult social care, led by the Director of Adult Social Services with support from the Assistant Director for Commissioning and the Head of Integrated Commissioning. The council uses a mix of spot purchasing, framework agreements and block contracts for care services.

The authority is increasing its use of framework agreements for domiciliary care and supported living, with new frameworks being developed to reflect the council's commissioning priorities. Framework inclusion is managed through the council's procurement and contracts team, with an open-door policy for providers to register interest throughout the year rather than only during formal tendering windows.

Medway participates in the Kent and Medway Integrated Care System, and the Integrated Commissioning Board oversees pooled budget arrangements between the council and the NHS for services including continuing healthcare, learning disability services and mental health.

The concentration of the domiciliary care market among a small number of providers represents the most significant structural risk to Medway's adult social care market. The failure or withdrawal of a major provider would create immediate and severe capacity pressure that the remaining market could not easily absorb.

Rising demand for complex care packages is another significant challenge. Medway's population aged 65 and over is projected to grow 22% by 2030, and the proportion of people presenting with multiple long-term conditions is increasing. The current provider base has limited capacity for complex dementia care at home and for packages requiring culturally competent staff.

Workforce recruitment and retention is a persistent concern, with providers in Medway competing for staff with better-funded authorities nearby (including Kent County Council area) and with the London market. Fee levels for home care are a frequent point of tension between providers and the council. The authority's upper-tier local authority status means it must also manage financial pressures across multiple service areas simultaneously, with adult social care competing for resources with children's services, housing and other statutory functions.

Culturally competent domiciliary care is the most clearly identified opportunity in Medway. Providers who can demonstrate genuine cultural competence — particularly in serving South Asian and Eastern European communities — and who can recruit multilingual care workers will find a receptive commissioning environment.

Supported living for adults with learning disabilities and autism is a growth area, driven by the council's commitment to reducing out-of-area residential placements. Providers with experience in supported living and the ability to develop new schemes within Medway should engage early with the council's commissioning team.

Reablement and intermediate care linked to hospital discharge pathways is a third opportunity area. Medway NHS Foundation Trust is under significant pressure to reduce delayed transfers of care, and providers who can deliver short-term, intensive reablement services in people's homes will find willing partners in both the council and the NHS.

Complex dementia care at home — while challenging to deliver — addresses a stated council priority and would help reduce reliance on residential placements. Providers with a track record in dementia care and the ability to evidence staff training and support should consider Medway as a target market.

Medway represents an instructive case study in the challenges facing compact unitary authorities. The council has significant commissioning responsibilities but a smaller provider base to draw upon than county-level neighbours. This creates a structural tension: the council needs provider diversity for market resilience, but its market size may not be sufficient to sustain the number of providers required for genuine competition.

The cultural competence dimension is particularly noteworthy. Medway's diverse population creates service needs that generic domiciliary care provision does not always meet. Providers who invest in cultural competence — not just as a policy statement but as a demonstrable operational capability — are likely to differentiate themselves in this market.

The concentration risk in domiciliary care suggests that the council would benefit from a structured provider development programme that supports new market entrants and helps existing smaller providers scale their operations. PDA for Social Care is one methodology that could support this objective.

The Director of Adult Social Services (DASS) leads strategic commissioning for adult social care. The Assistant Director for Commissioning oversees operational commissioning and provider engagement. The Head of Integrated Commissioning leads on pooled budget arrangements between the council and the NHS.

Adult Social Care Commissioning — responsible for strategic commissioning of care services across all service categories. Brokerage — manages day-to-day placement of care packages and maintains provider relationships for spot purchasing. Market Development — responsible for provider engagement, market shaping and framework development. Quality Assurance and Contracts — monitors provider performance, manages contract compliance and oversees the quality assurance function. The Procurement and Contracts Team — manages formal tendering, framework agreements and contract awards.

The Health and Wellbeing Board provides strategic oversight of health and social care integration, and the Integrated Commissioning Board oversees pooled budget arrangements between the council and the NHS.

Medway Council, Market Position Statement (most recent published version).

Medway Council, Joint Strategic Needs Assessment.

Medway Council, Published Accounts, 2024/25.

Medway Council, Commissioning Strategies (adult social care).

Medway Health and Wellbeing Board, Strategies and meeting papers.

Kent and Medway Integrated Care System, Plans and strategies.

CQC, Active locations data, January 2026.

ONS, Mid-year population estimates, 2024.

ONS, Subnational population projections, 2022-based.

MHCLG, English Indices of Deprivation, 2019.

Skills for Care, The state of the adult social care sector and workforce in England, 2025.

NHS England, Adult Social Care Activity and Finance Report, 2025.

Odelia Group, Direct provider engagement and cross-authority MPS analysis, 2025–2026.

This report is part of the Odelia Local Authority Intelligence Series — a growing collection of evidence-led council-level research into adult social care provider markets across England.

Each report in the series follows a consistent, rigorous methodology: systematic review of published Market Position Statements and commissioning strategies; analysis of CQC registration and inspection data, ONS population projections and Skills for Care workforce estimates; direct engagement with CQC-registered providers operating within the authority; and structured review of Health and Wellbeing Board strategies and Joint Strategic Needs Assessments.

The series is designed for commissioning teams, provider development leads, sector analysts and care providers seeking to understand local authority priorities, provider market dynamics and opportunities for provider development.

More information about the methodology and approach is available at the Odelia Local Authority Intelligence Hub and the Our Approach page.