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Market Context

Domiciliary care is a range of services that are put in place to support an adult to remain in their home. The professional, known as a carer, will provide support and complete tasks that aid an adult to remain independent and safe. The type of tasks can vary from personal care, administering medications, or supporting the adult with activities. Their primary role is to maintain the adult's quality of life and support them to meet their outcomes.

Domiciliary care can be provided on a short-term or long-term basis. It is commissioned mainly from the Live at Home framework. Where care cannot be sourced from framework providers, a spot purchase contractual arrangement is used.

Market Rating

The current overall Market Quality is good, and past issues with market capacity and workforce have been addressed. 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 Good Stable/High
ECC Ambition Market Workforce Market Maturity
Manage Supply Stable/High Evolving

ECC rating of the market, assessed on the 30th September 2024

Demand for domiciliary care has been increasing year on year, with an overall growth of 9% in domiciliary care hours commissioned in the 12 months up to August 2024. Market supply has increased significantly, partially due to a number of care providers obtaining overseas workers sponsorship licencing. This has enabled providers to recruit care workers from overseas and build their capacity. On the whole, demand is being met by providers on our Live at Home framework, with currently 90% of provision being commissioned with framework providers. Whilst market capacity across the county is currently good overall, there are pockets where there is less framework provision and work is commissioned through spot purchasing arrangements. This is typically linked to areas where there is more travel time between care visits, often in rural areas. Areas where an increase in framework provision is needed are: Colchester (Mersea & Pyefleet, Marks Tey & Layer, Rural North); Tendring (Arlseford & Elmstead); and Maldon (Southminster).

Overall, quality in the home care market is good - 87% of packages commissioned overall are with providers who are rated Good or Outstanding by the CQC.

The current Live at Home framework commenced in August 2021 and has a four year term. The framework covers a number of service types including personal care, carer’s support, carer’s break, night awake, night sleep and 24-hour live-in care.  It is structured as a two-tier framework, with a specific set of quality criteria that providers must satisfy in order to be eligible for inclusion on tier 1 (this includes holding a Care Quality Commission rating of at least Good overall and for the key lines of enquiry of ‘Safe’ and ‘Well Led’). Care packages are offered in order of the highest ranked tier 1 provider, then if no tier 1 provider will accept the package it is offered to tier 2, and then to the spot market. Providers on the framework have the opportunity to select rates from a price matrix, with rates for new packages being refreshed on an annual basis. For spot purchased care, providers select their own prices.

The majority of commissioned providers are using digital technology to manage care provision. However, the extent to which this is used varies - some providers are using technology to manage all aspects of their business including the management of staff as well to support care planning and delivery (using electronic rostering, electronic homecare monitoring (EHM), digital social care records (DSCR) and electronic medications administration records). Framework providers are contractually required to use an EHM system (if they deliver care to 10 or more  adults). The Council is currently developing a proof-of-concept system to collate Electronic Home Care data from framework providers to improve the oversight and risk management of commissioned care delivery.

Essex Market (This is whole market)  
No. Providers 388
Total No. Adults Receiving Domiciliary Care 15,240
% Providers CQC rated Good or Outstanding 68%
No.Providers onboarded to work with the Council since 1st April 2023 10
No. Providers exiting the market since 1st April 2023 5
Essex Adult Social Care Market - funded  
Spend £157.9 Million
No. Providers on the Live at Home Framework 105
% Providers on the Live at Home Framework CQC rated Good or Outstanding 86%
No. Adults funded by ECC  6,826
Commissioned Hours per week funded by ECC 128,100.75
% ECC funded placements CQC rated Good or Outstanding 84%
Framework Utilisation 66%

The information shown in the table(s) above is correct as of 30th September 2024.

Information in the above table for sourcing is based on activity between 30th June 2024 and 30th September 2024

The Council has a strategic ambition to drive up quality in the market and to work more closely and collaboratively with fewer suppliers. The intention is to develop a partnership approach with key strategic providers, to align with future alliance working. To achieve this, the Council is working to increase the proportion of work placed with framework providers, in particular with tier 1 providers, and reduce the volume of placements made with the spot market.

Pilots are underway to investigate new ways of working with contracted domiciliary providers to explore approaches such as outcome-based commissioning and embedding a reablement ethos as part of care delivery, as well as increasing supply in hard to source areas. In addition to this, the Council is investigating technical solutions to automate sourcing and flow for this market.

The market has recovered from some of the effects of COVID-19, with workforce recruitment and retention being good.

Key risks that will need to be managed over the next two years include:

  • An increase in care packages being handed back/supplier failures in both the spot provider market and from framework providers positioned lower down the ranked lists, as a greater proportion of work is picked up by framework providers, particularly those positioned higher up on ranked lists
  • Inflationary pressures
  • Social Care Reform and the impact of this on the market

Our current area of focus is:

  • The design of the future Live at Home contractual model and arrangements
  • Pilot to explore Trusted Reviewer
  • The workforce, training and retention strategy - critical to ensure the increased capacity is sustained
Last updated: 30/09/2024
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