The Growing Gap in Local Nursing Home Provision - a perspective by Preyen Dewani

There’s a growing and under-reported crisis in the UK’s social-care infrastructure: in many areas, there simply aren’t enough nursing-home beds for the elderly and those who need ongoing care. As recent reporting has highlighted, the shortage is so severe in some places that families are being forced to look outside their home county, uprooting lives at a difficult time.

The problem - a shrinking supply of beds despite growing need

Demand for nursing-home care in the UK is rising. The over-65 population continues to grow steadily, and the proportion of people aged 85+ - those most likely to need residential or nursing care is also increasing.

Yet the expansion of care-home and nursing-home capacity has failed to keep pace. One recent analysis estimated that as of 2025, the number of UK care-home beds per 100 people aged 85+ remains marginal, far short of what demographic change suggests is required.

In practice, this mismatch means that local authorities, care providers and families are simply running out of options when someone needs care locally.

The human impact - moving out of county

When a local care home has no available beds, families are left with no choice but to look further afield, often outside of their county. That means older people may end up dozens of miles from their community, away from familiar streets, friends, local GPs, and most painfully, family support.

For relatives, this creates logistical and emotional burdens - longer travel times, reduced opportunities for visits, greater difficulty in coordinating care. For the person moving into the home, it can mean dislocation and loss of familiar surroundings, factors that can worsen mental and emotional well-being.

From a systemic perspective, this is deeply inefficient and socially costly. It signals failure to provide local access to care as close to home as possible, a principle long regarded as fundamental to equitable, dignified social care.

Yet there are situations where moving out of county can offer meaningful benefits. If no provider within the local area is able to deliver the right level of care, particularly for individuals with complex needs, looking farther afield becomes not a compromise but a necessity. In these circumstances, out-of-county placements can lead to better outcomes, placing people in environments specifically equipped to support their condition. Families will travel to ensure their loved one receives the right expertise, and success stories do exist when the receiving home has the specialist capacity that the home county simply cannot provide.

What this reveals about the current care-home ecosystem

The phenomenon of out-of-county placements underlines several structural weaknesses in Britain’s care model:

• Underinvestment / under-capacity: The growth in care demand has not been matched by investment in new beds. As a result, even where need is documented and referrals made, there’s nowhere nearby for people to go.

• Geographic inequality: Access to care becomes a lottery, if there are no beds locally, individuals are penalised simply by where they live. This creates a postcode-based inequality in care access.

• Strain on families and social ties: When people are forced to relocate, it fractures the informal support networks (family, neighbours, community) that often supplement formal care, especially important for mental and emotional wellbeing.

Implications for policy, providers and investors

For policymakers this is a signal that the current trajectory isn’t sustainable. As we age as a society, absence of local care capacity will erode community cohesion, increase pressure on hospitals (as people unable to find care degrade), and exacerbate inequalities.

For care-home providers and investors there is a clear, and growing, market deficiency. Building more capacity in high-demand areas isn’t simply an opportunity; it is a social imperative. Investors and operators who can develop ethically managed, quality nursing-home beds close to communities will meet both a strong business need and a social need.

For local authorities and regulators there is a need to forecast demand better, plan capacity expansion proactively, and consider strategies such as publicly funded care-home bed creation, incentivising private investment, or expanding alternatives like high-quality home care - all to reduce reliance on out-of-county placements.

A call to action - anchored in responsibility not activism

As someone who works at the intersection of investment and social infrastructure, I believe the current shortage is not simply a “care-sector problem”, it is a societal challenge.

We need to treat access to dignified, local care for older and vulnerable people as a basic community infrastructure, on par with transport, housing, education. That requires collaboration between investors, operators, local authorities, regulators and communities.

If we succeed in doing that, we preserve more than beds. We preserve dignity, social bonds, local identity and deliver care in a way that reflects both compassion and strategic foresight.

For more insights and perspectives by Preyen Dewani, please click here.

Thoughts and Perspectives by Preyen Dewani