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Market Context

Intermediate Care is a service provided to adults for a short period of time after leaving hospital or for adults that are at risk at home or in the community and is often used to avoid admission to hospital. This service is jointly supported by Adult Social Care and our NHS partners. This service has a focus on providing care and support for adults either within the home or within a residential setting to maximise a return to levels of autonomy and independence, through the relearning of the personal and domestic activities of daily life.

Essex County Council currently commission five types of services:

  • Reablement-at-Home Service (RaH): A therapy-led Intermediate Care service at the adult's home for up to 6 weeks.
  • Additional Reablement Capacity (ARC): As a therapy-supported reablement service to support the capacity demands of the reablement service, with an identical 6-week limit.
  • Home-to-Assess Service: As an opportunity for adults to return home in a non-reablement setting, for up to 2-4 weeks, to allow care assessments to take place once the adult is settled at home.
  • Bridging: Short-term rapid intervention support for hospital, community, and admission avoidance referrals, to support transit to appropriate longer-term solutions.
  • Spot placement of short-term domiciliary care when capacity within the reablement services (RaH and ARC) is not available, or a referral has no potential for development in a reablement environment.

There are additional contracted services to provide therapy support to elements of the Intermediate Care service.

Essex currently holds numerous contracts with multiple providers to support these services. These are:

  • Reablement-at-Home Contract: A countywide service for reablement, contracted with Essex Cares Limited (ECL), a wholly owned Local Authority Trading Company of Essex County Council.
  • Additional Reablement Capacity (ARC) Contracts: Five separate contracts with four providers, placed in each of the five localities across Essex to support demand pressures for out of hospital and to support community referrals. 
  • Home-to-Assess (H2A) contract: A single contract addressing homecare and assessment needs in North Essex only, with a pending tender to extend the service across the county to replace current bridging provisions.
  • Bridging Contracts: A single contract, in West Essex, for rapid response services for to 5 days to aid our reablement and domiciliary providers for a short period to support quicker discharges from hospital and admission avoidance, and a contract (between MSE FT and the local CCG) to provide bridging support in Mid and South Essex. 

Market Rating

The current overall Market Quality is very good, and past issues with market capacity and workforce no longer exist. Tender activities from 2024 and 2025 have demonstrated a strong and motivated market, with a clear understanding of reablement services.

Market Quality Market Supply ECC Demand
Good Good High/Very High
ECC Ambition Market Workforce Market Maturity
Manage Supply Good Mature/Established

ECC rating of the market, assessed on the 31st March 2025

The reablement service, including both RaH and ARC, has been increasing in provision since September 2022 and is currently contracted to deliver 13,700 hours of reablement care at home each week. However, the RaH contract has now moved to a ‘finishers’ model without a contracted number of hours, but the average weekly hours (since November) in the RaH service is 8,015. These figures (hours and finishers) can be adjusted if required, and increases to the contracted hours have been actioned, based on the availability of additional winter funding.

There are two bridging services across the county, one is contracted directly by ECC in the West, with a further service, covering Mid and South Essex, contracted by our NHS partner for this area. This service is vital to improve and maintain service discharge speeds in accordance with NHS guidelines.

We have encountered past recruitment issues, but the workforce market is now far more stable with many providers indicating an improved recruitment and retention position, especially with many now utilising the UK Visa Sponsorship programme to encourage recruitment from aboard. Currently, three of the Intermediate Care providers are utilising care workforce from Kenya, Nigeria and Zimbabwe.

Short-term care to maximise independence (reablement services), Essex’s gross expenditure per 100,000 adults is the 4th highest in the CIPFA region for 18 to 64 and 5th highest in the region for 65+ (out of 16 LAs in that region).

Essex ASC Market (ECC Funded)  
Spend £33.6 Million per annum
ECL Capacity (Finishers Per Week) 108
ARC Capacity (Hours per week) 5,250
No. Providers (inc. bridging) 4
Good/Outstanding Providers 75%
No. of Spot IC Beds 0
No. Good/Outstanding Spot Providers N/A
Essex ASC Market - Utilisation  
Reablement-at-Home Utilisation 100%
Reablement-at-Home % Self Caring 74.5%
Reablement-at-Home - Average Length of Stay 27 Days
Reablement-at-Home - Standard Hourly Rate Not applicable
Additional Reablement Capacity Utilisation 112.1%
Additional Reablement Capacity % Self Caring 52.1%
Additional Reablement Capacity Average Rate £22.71
Additional Reablement Capacity - Average Length Stay 38 Days

The information shown in the table(s) above is correct as of 31st March 2025

Our Intermediate Care offer is subject to a transformation process, following the positive work completed by the, now complete, Connect Programme during 2022 to 2024, to improve the service offer and flow for adults in the community or hospital.

The outcomes are demonstrating that we are able to speed up the adult flow and place adults on the most appropriate pathway, thereby increasing the number of people using the service and reducing the ongoing needs for the adult into long-term care.

We are aiming to minimise the use of bridging services in the future, with a replacement Home-to-Assess service to support flow and improve the understanding of service user requirements.

The future of Intermediate Care will focus on collaboration with elements of the referral process to pursue common goals and closer working relationship. This route will ensure an improved customer journey and value-for-money for the taxpayers of Essex.

There are now no COVID risks and impacts, with the availability of staff within the reablement services no longer affected.

Current and future ARC service provisions specifically include procedural and insurance provisions to mitigate risks for future pandemic situations.

  • Current information is indicating that past pressure on the Domiciliary market to pick up packages of care for long-term provision is no longer relevant.
  • Increased costs, for fuel and daily living, together with repeated increases to the National Living Wage, are putting pressure on wages in the market and the potential for increased costs to be passed to ECC to support market providers.
  • The legislative changes associated with visa support and the recruitment of workers from overseas have resulted in a reduction in applications, and the release of a number of foreign workers into the market who came to the UK for potential care providers who are no longer able to provide work to these individuals.
  • Due to change in legislation, the NHS is accountable for discharging adults from hospital and culturally this causes pressure as the NHS focus is to discharge quickly and safely. This can result in adults going into residential beds when reablement at home would be most appropriate or receiving reablement without needing this service.
  • Reducing failed starts, and otherwise lost hours, across all reablement's services
  • Improve throughput of adults in their reablement journey, reducing length of stay and improvements to challenging and proportionate objectives for users.
  • Better insight on system wide data, intelligence, and insight, with the use of current business tools to replace fragile and inconsistent data management tools. This includes the development of a comprehensive Intermediate Care dashboard focused on a range of audiences and stakeholder.
  • Ensuring robust and flexible contract arrangements for the on-going delivery of reablement and bridging services are established and maintained.
Last updated: 01/04/2025
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