Starting a Domiciliary Care Business: Q&A with Chris Williams from Tiggo Care

In this blog post, we ask Chris Williams, the founder of Tiggo Care, a series of questions that we think you should consider if you want to start a domiciliary care business in the UK. Chris first reached out to Delphi Care in 2021 looking for support to start his domiciliary care start-up. Since then Chris has successfully launched Tiggo Care, which is a multi-award-winning domiciliary care business based in southwest London.

What is a domiciliary care business?

Firstly, it’s important to clarify what a domiciliary care business is. Domiciliary care businesses, also known as home care or home healthcare agencies, are businesses that provide various types of non-medical and medical care services to individuals living in their own homes. These services are typically provided to people who have difficulties with daily activities due to age, illness, or disability. The important distinction is that the service users want to remain in the comfort of their own homes rather than relocate to a residential facility, such as a care home, nursing home, or assisted living complex.

What services should I offer?

All domiciliary care companies provide the following services to their clients:

• Personal Care
• Companionship
• Meal Preparation
• Medication Management
• Light Housekeeping

However, the way these services are delivered can vary quite significantly. For example, some companies will coordinate daily visits from care assistants to deliver these services and others will organise for a full-time live-in care assistant. Some companies, like Tiggo Care, provide both daily home care visits and 24/7 live-in care services.

Care companies can also choose to offer specialised services that fall under these two categories. For example, some care companies focus on providing a reablement service. This type of service aims to help restore the independence of patients after they are discharged from hospital. This type of service might last anywhere between 1 and 8 weeks depending on the the patient’s needs. Others might choose to specialise in complex care, where the clients require assistance from a carer or nurse 24 hours per day, 7 days per week. Finally, other domiciliary care companies might specialise in respite care, where a carer gives the client’s primary caregiver a break. The breaks might be for 2 hours every day or for a whole week while the primary caregiver goes on holiday.

The services you choose to provide will depend on your local market, your experience in the care sector, and your personal preferences. However, it’s important to think about which of these services you want to offer before you start recruiting or marketing for your business.

How do I find clients?

Before starting your domiciliary care business it’s important to consider how you will acquire clients. There are three types of payers in the sector: local authority-funded clients, NHS-funded clients, and private clients.

If you want to acquire clients via your local authority or via the NHS you will need to register your company with adult social services or with the NHS Continuing Healthcare team. It’s important to note most local authorities and NHS Integrated Care Boards will require you to have a Good CQC rating before they are willing to refer you clients. Once you have a Good CQC rating it will be possible for you to do ‘spot work’, where you contract to support an individual. Local authorities and Integrated Care Boards also give domiciliary care providers the opportunity to tender for larger contracts every 2 to 5 years. Successful tenders will result in the local authority or NHS supplying you with clients on a regular basis.

Private clients can be acquired via several channels. The most popular marketing channels are online and include registering your company on lead generation websites, such as homecare.co.uk and Lottie. You may also want to consider paid advertising on Google and social media websites. Organic search can be an effective method too but it usually takes a long time before you see an ROI on your efforts. Lastly, you should consider offline marketing such as advertising in local newspapers and magazines.

What is the CQC and how do I get CQC approval?

The Care Quality Commission, known as the CQC, is the independent regular of health and social care services in England. This organisation is responsible for ensuring health and social care providers, including hospitals, care homes, home care agencies, dental practices and other healthcare service providers, meet essential standards of quality and safety. If you are starting a home care agency you will need to register with the CQC to legally provide personal care.

Applying to the CQC can seem daunting at first but in reality, it isn’t that complicated. You will make the application online and you will need to have selected a Registered Manager before submitting the application. To work as a Registered Manager you need an NVQ Level 5 in Health & Social Care. If you don’t have this qualification you will need to hire someone to fill this role. You will also need to select a Nominated Individual. For most startups, the Nominated Individual is the business owner. Both the Registered Manager and Business Owner will need a recent DBS check. The Registered Manager will need a CQC countersigned DBS check but the business owner will only need a Enhanced DBS check.

You’ll also need to clearly understand what services you are going to offer to complete the New Provider Application Form. For example, are you only going to support people over the age of 65 with personal care or are you also going to support people between the ages of 18 and 65? The other form you need to complete is your Statement of Purpose. You will use the template Statement of Purpose available on the CQC website. It’s worth taking a look at the New Provider Application Form and the Statement of Purpose template now because these documents will help you to think about how your business will operate.

Besides the two documents I’ve already mentioned, you’ll need to submit the following:

• Home Care Business Plan
• Financial Viability Statement (my accountant provided me with this)
• Specific Policies, such as your Infection Control Policy
• Public and Employer Liability Business Insurance Quote or Certificate
• Sample Care Contract
• Sample Care Plan
• Staffing Structure
• Staff Training Matrix
• Organisation Strucutre

More information on supporting documentation can be found on the CQC website here.

Once your application has been processed you will be asked to attend an interview before the CQC make their final decision. This will either take place in your office or online.

What happens during a CQC inspection?

You are usually given prior notice of a CQC inspection to ensure key employees are available at the time of the inspection. During the inspection, a CQC Inspector will visit your office and assess your business against the Key Lines of Enquiry, which include:

• Safe: Assessing whether service users are protected from harm, abuse, or neglect.
• Effective: Evaluating whether care and support achieve good outcomes and promote health and well-being.
• Caring: Assessing whether staff treat service users with compassion, respect, and dignity.
• Responsive: Evaluating whether services are person-centered and responsive to individual needs and preferences.
• Well-led: Assessing the leadership, governance, and management of the home care agency.

You will be asked to provide evidence to support each of the key lines of enquiry. Evidence might include key policies and procedures, care plans and risk assessments, and staff training matrixes. You will also be asked to provide contact details for customers and staff members so that the inspector can ask them questions directly.

Is a domiciliary care business profitable? 

Domiciliary care companies can be profitable businesses but they aren’t profitable from day one because they have relatively high start-up operating costs. For example, it’s hard to run this type of business from home and so you will need to pay for an office with a training/meeting room. If you don’t have an NVQ Level 5 you will also need to account for the salary of your Registered Manager. 

To operate smoothly you’ll also likely need to pay for some care-specific software, HR legal support, policies & procedures, and accounting. The other big operating costs are advertising costs, both for staff and clients. Hence, it’s unlikely your business will turn a profit quickly but once you have enough clients to cover these operating costs your domiciliary care business will be profitable.

How much will it cost to start a domiciliary care business?

It’s hard to give a specific figure but in order to have sufficient cash flow I would say you need somewhere between £50,000 and £150,000. You will need less money if you have an NVQ Level 5 because you won’t need to hire a Registered Manager. It might cost more to start a domiciliary care business if you’re looking to purchase a home care franchise because franchises charge a setup fee.

What staff do I need to get started?

To get started you will need a Registered Manager and some Care Assistants. As you grow you will need to hire a Field Care Supervisor, Care Coordinator, and more Care Assistants. Some larger care companies might have a deputy manager and an in-house trainer.

How do I recruit domiciliary care workers?

At the moment it can be challenging to recruit care workers due to the national shortage of professional carers. However, the best place to find care workers is online. Job sites such as Indeed and Total Jobs are popular places for carers to look for work. You can also advertise via your local job centre or recruit directly from colleges that offer health and social care qualifications.