Thought Leadership
Scale where it must, autonomy where it can
Why strategic collaboration and scale-up are essential now for the future of the VVT sector
The VVTsector faces a stark choice: grow with demand and technology, or get bogged down in staff shortages, ICTfailures and real estate pressures. JBR's analysis shows that below €80-100 million turnover, independence quickly becomes vulnerable, while smart alliances unlock agility, investment power and better care.
The care gap is growing: more demand, less capacity
Demographic pressures are inescapable. The number of over-70s will rise from 2.68 million in 2025 to 3.37 million in 20351 with an expected aging peak in 2040. Older people are living at home longer, which increases the demand for extramural care and innovative reablement, yet care needs are increasing, especially due to more people with multimorbidity and dementia.
In addition, the shortage of care staff in the VVT sector is only expected to increase further by more than ~130% to ~52,600 care workers in the VVT sector in 20302. As a result, the ratio between the number of care workers and the elderly will deteriorate and VVT organizations will have to find other solutions to meet the demand for care and workload such as technological innovations and ambulantization.
Digital backbone under stress: costs, links and compliance
The digital backbone of VVT organizations is creaking: fragmented ECD links, outdated infrastructure, rising cloud OPEX and stricter cybersecurity requirements (e.g. NEN 7510, NIS2) are squeezing operations and investment space. The growth of extramural care requires reliable mobile tooling, planning and telehealth, but without scale, proper data integration and solid identity & access, downtime risks and compliance issues arise, slowing innovation and increasing costs.
Real estate and investments: the bottleneck of the future
Over the next 25 years, about €117 billion is needed for new construction and another €13 billion for sustainability of healthcare real estate3. The investment capacity of healthcare organizations and housing corporations falls short, making external investors increasingly important. At the same time, organizations are focusing their investments on crucial locations, while aging real estate offers opportunities to investors. The need for cooperation, both public and private, is increasing to meet this investment challenge.
Autonomy under pressure: scale as a prerequisite
The combination of a growing care gap, scarcity of personnel, ICT and increasing real estate investments makes it increasingly difficult for many VVT organizations to operate fully independently. Under current market conditions, 'independence' requires sufficient financial and organizational clout: access to capital, professional support functions (IT, HR, real estate), risk diversification and execution power for sustainability and innovation. JBR sees that the limit for sustainable independent operation is around €80-100 million in turnover; below that level, vulnerabilities rapidly increase and strategic cooperation or scaling up becomes a logical route to safeguard continuity, quality and investment capacity.
From fragmentation to resilience: from vision to action with the right alliances
The playing field is fragmented: transactions in long-term care rose sharply in 2024, but large chains remain out and investors are reluctant due to tight margins and rising costs. This is precisely why collaboration is now a prerequisite. Economies of scale, shared platforms and streamlined processes create room to address the rising demand for care, staff shortages, ICTcomplexity and real estate challenges simultaneously.
Organizations that are independently vulnerable must therefore choose a route that best fits their profile and region in a timely manner:
- Strategic alliance: shared IT platforms, data integration, procurement and back office for immediate efficiency gains.
- Joint venture (care/telecare or real estate): bundle expertise and capital to accelerate innovation and investment.
- Merger: maximize synergy in care process, support functions and balance sheet position.
Work consistently according to the principle "scale where you must, autonomy where you can": standardize where it adds value (IT, procurement, planning, data lines, real estate), and maintain local agility in the primary care process and district anchoring. A Quick Scan provides quick insight into your current strengths, vulnerabilities and the most promising collaboration path.
At JBR, we combine in-depth knowledge of strategy, corporate finance and interim search with sector expertise to guide organizations through these choices - from market exploration and partner selection to transaction and integration - so that the VVT sector can move forward with resilience.
Read more about our approach here: Strategic transformation in elderly care
Sources: CBS, AZW, CBRE
Contact us personally for more information
Caspar van der Geest
Partner
Tijs van der Wielen
Associate Partner Interim & Governance
Bobby Cornelisse
Senior Strategy Consultant
Alexander Rutten
Business Analyst