- Essex County Council expects to spend £136.4 million in 2017/18 (£44.7 million - Older People; £91.7 million - Working Age Adults) supporting 7,465 Adults with 183,000 hours of domiciliary care per week.
- Personal Care accounts for 79% (144,000 hours) of domiciliary care commissioned, with a further 12% (22,000 hours) commissioned to support Adults with Night Sitting and Night Sleeping services.
- Essex County Council commissions 47% (68,000 hours) of personal care for Older Adults whereas 89% (14,000 hours) of 24 hour Live in Support is commissioned for Working Age Adults.
Long Term Domiciliary Care
- The majority of care is commissioned through the Live at Home (2021) framework
- The framework is set up on a lot basis with ranked lists of providers split by service type
Like most Local Authorities, Essex faces significant pressures around the funding of Social Care. This is linked to increasing costs and 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, linked to the availability of alternative employment in the retail sector, and we expect situation to worsen as Brexit progresses.
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 support discharge.
Quality is generally good, as rated by CQC and considering issues such as safeguards. However, we are concerned as to whether this is sustainable when providers face rising costs and limited uplifts of funding.
Supply of domiciliary care has improved, with reductions in available packages and fewer placements into 'Provider of Last Resort'. However, we continue to experience supply issues in some areas of the county, such as Mid Essex. Often this is in rural areas, but some urban areas (including parts of Colchester) are under-supplied.
Services
Essex County 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 Essex is required to ensure that services are available for these Adults.
Essex has a number of contracts/frameworks in place to ensure that we have the appropriate services for the residents of Essex. These include:
- Short Term Support Enablement ("The Service") is for adults who have been assessed as requiring a period of intermediate care whilst determining their longer term support needs. The service is designed to provide a high quality locality based intermediate care service and will combine the current Reablement at Home and Short Term Support in the Community services into a single offer. This service is available both on discharge from hospital or from the community and is the default offer for all adults, whether new to social care or at review. The support is provided for as long as an adult requires it, but no longer than 6 weeks.
- Long Term Domiciliary Care - for Adults that require long term domiciliary care to support them to stay independent and at home. In Essex we refer to this as Live at Home services (LAH).
- Provider of Last Resort (POLR) - Under the Care Act, Essex has a duty of care to ensure that all vulnerable adults are given the support they require when they need it. This service ensures that support is available at very short notice or where there is no capacity in the market at the current time and the Adult is at risk if a service is not provided. This service is currently under review and Essex is looking at a number of different options to ensure they meet their statutory obligations under the Care Act.
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 speak further to providers to ensure our next steps are effective. This is likely to include a mix of training, promoting the care profession and seeking to draw in additional funding.
Direction of Travel in 2021 and Beyond
- 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
- Over time we envisage that volumes procured through the framework will reduce as the successful ‘Test and Learn' solutions are rolled out
- Current demand modelling indicates that, post-Covid, demand will increase over the longer term
Following engagement with the market through the Essex Care Association, and at the market wide event in October 2019, as well as with our Health colleagues, we have identified a number of potential delivery models that align with 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
- Dengie Neighbourhood Team (integrated health and social care team using a guaranteed hours arrangement)
- 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