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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 activities of daily life.

Essex County Council currently commission four 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.
  • 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.

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, owned by Essex County Council.
  • Additional Reablement Capacity (ARC) Contracts: Five separate contracts, placed in each of the five localities across Essex to support demand pressures for out of hospital and to support community referrals. 
  • Bridging Contracts: Three separate contracts with three providers for rapid response services for to 5 days to aid our reablement providers for a short period to support quicker discharges from hospital for Adults ready for discharge.  

Market Rating

The current overall Market Quality is good, and past issues with market capacity and workforce have now been resolved. Essex continues to see an increase in demand which has had some impact on the speed of market development.

Market Quality Market Supply ECC Demand
Good Moderate/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 2023

The reablement service, including both RaH and ARC, has been increasing in provision since May 2021 and is currently contracted to deliver 13,650 hours of reablement care at home each week. These figures can be adjusted if required, and increases to the contracted hours have been actioned, based on the availability of additional winter funding.

There are three bridging services across the County, two are contracted directly by ECC in the North and 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 no utilising the UK Visa Sponsorship programme to encourage recruitment from aboard.

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 £39 Million
ECL Capacity (Hour) 9,350
ILOR Capacity (Hour) 4,825
No. Providers 6
Good/Outstanding 100%
No. IC Beds 0
Good/Outstanding N/A
Essex ASC Market - Utilisation  
Reablement-at-Home Utilisation 99.90%
Reablement-at-Home % Self Caring 50%
Reablement-at-Home - Average Length of Stay 21 days
Reablement-at-Home - Standard Hourly Rate £37.70
Additional Reablement Capacity Utilisation 99.34%
Additional Reablement Capacity % Self Caring 42.99%
Additional Reablement Capacity Average Rate £22.63
Additional Reablement Capacity - Average Length Stay 34 days

The information shown in the table(s) above is correct as of 30th September 2023

Our intermediate care offer is in the middle of a transformation process, known as the Connect programme, with health to improve the service offer and flow for adults in the community or hospital requiring short term reablement support. This work is complete with ECL and is nearing completing with the current ARC contracts that were rolled-out during September and October 2022.

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 aspirations for the improved use of technologies to support the service offer or enable the services and system to work collaboratively.

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 very limited COVID risks and impacts, with the availability of staff within the reablement services no longer affected.

The sourcing of the new ARC service up to September specifically included procedural and insurance provisions to mitigate risks for future pandemic situations.

  • Current information is indicating an increased pressure on the Domiciliary market to pick up packages of care for long-term provision.
  • Concerns that an increase to Intermediate Care capacity will negatively affect the capacity for domiciliary care
  • Increased costs, for fuel and daily living, are putting pressure on wages in the market and the potential for increased costs to be passed to ECC to support market providers.
  • 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.

Our current area of focus is:

  • Reducing failed starts across all reablement's services
  • Improve throughput of adults in their reablement journey
  • Better insight on system wide data, intelligence and insight
  • Improve the effectiveness of the services to reduce the quantity for ongoing care
  • Improved alliance working and collaboration across the market, and with health partners.
  • Connect Programme to support flow, culture and practice changes across the NHS & Social Care, with focus on continued deployment into the ARC service
  • Integration between NHS and care services to support the needs of adults
Last updated: 30/09/2023
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