Introduction With the UK population growing older, living longer and suffering from an ever increasing range of conditions, the need for good quality care has never been higher. Investors have recognised the opportunities in the UK’s private health & social care sectors and signi cant progress has been made to develop new state of the art care homes and hospitals. The last three years have heralded the arrival of many new, well-funded investors to the sector. These investors, many of whom Christie + Co has guided through a number of high-pro le deals and strategic restructurings, have actively targeted the private sector and were responsible for a number of major transactions. Coming from an environment that has been dominated by distress, we now see that the market has gained considerable con dence again. This con dence drives investors to transform the market towards a higher level of quality, particularly in real estate. From an operational perspective, however, the sector has signi cant challenges to overcome. Staf ng remains the most important factor in the delivery of high-quality care and has been a key area of focus for operators and regulators in recent years. Frequent reference has been made to a shortage of nurses in both the NHS and adult social care. Similarly, operators have reported a dramatic increase in the use of agency staff and rising staff costs. Christie + Co now looks to give an answer to the true extent of the problem. Using our network and relationships with the major UK care home operators, we have conducted a survey of the largest nursing home operators on their use of agency staff and the effects on overall staff costs. Supported by a substantial amount of published data, we establish the true extent of the shortage and the key issues. To provide solutions to the issues, we have invited three industry leaders to share their insight with us. We are grateful for the comments from our main contributors Dr Pete Calveley, CEO of Barchester Healthcare, Kevin Groombridge, Executive Chairman of Health Care Management Solutions, and Dr Chai Patel, CEO & Chairman of HC-One.