- Commissioned care services for longer term domiciliary care in 2024/25 is £160.5 million (£105.5 million - older people; £55 million - working age adults). This is supporting 7,465 adults with 128,000 hours of domiciliary care per week.
- Personal care accounts for 90% (115,000 hours) of domiciliary care commissioned, with a further 10% (13,000 hours) commissioned to support Adults with 24-hour live-in support, night awake and night sleeping services.
- Out of the 115,000 of personal care, 69% of this (79,000 hours) is for older adults whereas 31% (36,000 hours) for working age adults.
- Out of the 13,000 hours of 24-hour live-in support, night awake and night sleeping services whereas 15% is commissioned for older adults and 85% for working age adults.
Long Term Domiciliary Care
- The majority of care is commissioned through the Live at Home (2021) framework. This is a two-tier framework with higher quality requirements for inclusion on tier 1 (including a CQC rating of Good and Outstanding overall and for Key Lines of Enquiry Safe and Well Led).
- The framework is set up on a lot basis, with ranked lists for each of the 12 districts in the geographical boundary of ECC. The ranked lists are split by service type (personal care, night awake, night sleeping, 24 hour / live in care and carer support), also by adult cohort (older person and learning disability and autism).
Like most local authorities, the Council faces significant pressures around the funding of social care. This is linked to increasing costs, rising demographic pressures and the increasing complexity of need that is supported. We know that the local care market faces challenges around recruitment and retention, however employment of overseas workers has helped to improve recruitment and capacity. Supply is generally good across the county, however there are still pockets of lower supply linked to rural areas, where there is still a reliance on the spot market.
Whilst there continues to be progress with the closer integration of Health and Social Care, there remains much to be done to improve joining up the approach across the system, particularly to avoid hospital admissions and to support discharge processes.
Services
The Council has a strategy that focuses on keeping adults independent and living at home for as long as possible with their family and friends. Unfortunately there are times where support is required for a number of reasons and we are required to ensure that services are available for these adults.
The Council has a number of contracts/frameworks in place to ensure that there are the appropriate services available for the residents of Essex. These include the Live at Home Framework which is used to commission domiciliary care and support for adults that want to stay independent and living at home. In Essex we refer to this as Live at Home services (LAH).
Next Steps
We will seek to more closely integrate the domiciliary care and other services that support people to live independently and create the strategic approach to the delivery and shaping of these services.
We will review how domiciliary care works with services that support discharge such as Reablement, Short Term Care and Discharge to Assess. We will look to ensure that all services that support an Adult to live at home are working effectively.
We recognise the skills, knowledge and experience that our providers offer. Although we have improved how we engage with our providers, this is an area where we need to further improve. This includes working with framework providers to co-produce solutions to the challenges we face.
We will engage with providers at the right level, including engagement with Elected Members and Senior Officers. Engagement may increasingly be locality-based, possibly on CCG footprints.
With Health Partners and Providers, we will seek to develop a mixed but cohesive workforce which might include Health Care Assistants and Medication Specialists as well as Home Carers.
We want to free up people to do the tasks that people are better at and use technology for other tasks where possible. As well as the 'Technology Enabled Care' project, we want to consider the following:
- We will to publish live demand data on our provider portal so that providers can better understand demand and plan their business accordingly.
- We want to share (in a safe way) information that might help providers build more coherent rounds in localities and broker a transfer of care where appropriate. We believe that this would enable more effective use of resources and offer the Adult a Proactive and transparent management of packages when sourcing.
- We will support providers to ensure that they are able to take a holistic look at the assistive technology available and consider how it could be used to meet the needs of that individual - a personalised approach based on their specific needs.
We will review the activities we have already undertaken (see above) and engage further with providers to ensure to plan our next steps. This is likely to include a training offer as well as promoting the care worker profession more widely.
Direction of Travel
- Joined up health and social care
- Solutions that enable people to gain, regain and maintain independence
- Personalised support, based on individual choice and control
- Flexible support and outcome focused support that can meet both generic and specialist needs
- Increased uptake of Direct Payments
- Consistency of care provision in smaller geographical areas to enable alignment and integration with other community services
- A skilled workforce who feel valued and enabled to deliver good quality support
- Active promotion and use of digital technology
- A better and closer relationship with a smaller number of providers
- Financial sustainability
- Better quality solutions; favouring good and outstanding Providers
- Joint commissioning of services
- In tandem with developing and testing various new delivery models, we will implement an improved framework
- Having a framework in place allows us to maintain a diverse market, supporting choice for Adults and develop localised solutions in a managed way
- Current demand modelling indicates that demand will increase over the longer term
Following engagement with the market through the Essex Care Association and at a series of market wide events, as well as with our Health partners, we have identified a number of potential delivery models that support our direction of travel.
In the short term we plan to trial the following approaches in specific localities:
- Guaranteed hours arrangements in Primary Care Network pockets in both urban and rural areas or a combination, where it's difficult to source and unmet need / spot usage is high, as well areas of good supply
- Digital platform trials to stimulate the creation of individual circles of support around people using self-employed Personal Assistants and an Individual Service Fund (ISF) model
- Community micro provider development using an ISF / Direct Payment model to increase choice and control stimulated by guaranteeing hours in an area where there is a large oversupply
Integrated commissioning with CCGs for Continuing Health Care and / or neighbouring local authorities who have similar sourcing challenges