Cost of Living Support

Essex County Council - Provider Hub
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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 household tasks, to personal care or supporting the adult with activities. Their primary role is to maintain the adults quality of life and dignity in their own home. 

Domiciliary Care can be provided on a short term or long term basis. However Essex will utilise reablement services if an adult is likely to return to being independent or will improve with the use of reablement services. Long term Domiciliary Care is commissioned under the Live at Home Framework. This is a county wide service across Essex. 

Market Rating

Demand for domiciliary care has increased significantly in the last year with more adults requiring support in their own homes, the council is working to improve levels of supply across the county to meet this demand by working with its existing higher quality suppliers to improve market capacity. Over the last year the council has introduced a number of measures to support the market to recruit to meet these demands. Overall quality in the home care market is good - 83% of packages commissioned are with providers who are rated good or outstanding by the CQC.

Market Quality Market Supply ECC Demand
Good Low/Moderate High
Market Quality = Good Market Supply = Low/Moderate ECC Demand = High
ECC Ambition Market Workforce Market Maturity
Increase Supply Moderate Evolving
ECC Ambition = Increase Supply Market Workforce = Moderate Market Maturity = Evolving

ECC rating of the market, assessed on the 26th January 2022

Demand for Domiciliary care has increased significantly since January 2020. This is primarily linked to the increase in the number of adults receiving a service and an increase in the average size of the adults care package.  The new Live at Home Framework went live in August 2021, and we are working on the first price refresh, to be effective from  April 2022.

We are currently developing a proof-of-concept system to collate Electronic Home Care data from our providers to improve the oversight of the care provided by our Domiciliary providers. 

Providers on the LAH Framework have the opportunity to select rates from a price matrix and also for SPOT placement providers select their own prices, and this is the reflection of a price driven market.

Essex Market (This is whole market)
No. Providers 327
Total No. Adults Receiving Domiciliary Care 12,878
% Providers CQC rated Good or Outstanding 79%
No.Providers entering the market since 1.April 2022 11
No. Providers exiting the market since 1.April 2022 7
Essex Adult Social Care Market
2022-23 Forecasted Spend £116 Million
No. Providers on the Live at Home Framework 123
% Providers on the Live at Home Framework CQC rated Good or Outstanding 86%
No. Adults funded by ECC receiving domiciliary care 6,434
Commissioned Hours per week of domiciliary care funded by ECC 121,752,50
% ECC funded domiciliary care placements CQC rated Good or Outstanding 87%
Framework Utilisation 56%
Essex Adult Social Care Market - Sourcing
Average Framework Rate (per hour) £20.90
Average Spot Rate (per hour) £22.61
Contract Placements per month 312
Spot Placements per month 234
No. Adults on Unsourced Packages List on 31.July 2022 133
No. Hours on Unsourced Packages List on 31.July 2022 1,140.50
Number of placements ended per month 1037
Number of placements increased per month 745
Number of placements decreased per month 566
Provider of Last Resort Capacity (Number of Carers) 41

The information shown in the table(s) above is correct as of 31.July 2022

Information in the above table for sourcing is based on activity between 1. April 2022 and 31. July 2022 

The primary objectives for the next 4 years are to reduce the numbers and shape our providers on the framework. The intention is to drive up quality in the market with key suppliers to develop a partnership approach with our providers to align with future alliance working. There are 2 tiers; tier 1 providers picking up the majority of packages (up to 80%) and tier 2 providers providing more specialist support. As Adult Social Care is moving towards locality-based commissioning, it is expected that this framework will cater for this as it is developed.  

Strategically we are looking to implement Electronic Homecare Monitoring to ensure adults are receiving their care, it will also aid full oversight of capacity and risk of our adults. Smaller pilots are underway to investigate new ways in working with our Domiciliary providers to understand areas like outcome-based commissioning or reablement ethos as part of the care, as well as increasing supply in hard to source areas. ECC are investigating technical solutions to automate sourcing and flow for this market.

The current COVID impact highlighted is:

  • Capacity largely unimpacted during wave 1 and wave 2 however providers are advising that retention is becoming more difficult, as other sectors are offering higher salaries. 
  • We also have a workforce that is exhausted and burnt out and therefore we are less able to rely on overtime to deliver capacity.  
  • The Live at Home market has also provided additional support for reablement and Provider of Last Resort to support pressures in the system. This ultimately takes out capacity in our domiciliary market for long term provision. 

There are several risks that will need to be managed over the next 18 months. These include:

  • Wave 3 of COVID Pandemic could impact our carer workforce providing care. 
  • Health may increase pressure for nursing placements from hospital driving up longer term costs for Adult Social Care.  Particularly if they are on CHC pathway and then re-assessed into Non CHC pathways. 

Our current area of focus is:

  • A Nursing workforce, training and retention strategy is critical to increase capacity in Essex. 
  • Review of complex needs or pathways to ensure the service is appropriate, is funded correctly and has the best outcome for the adult and their family. 
  • Continue to improve the quality of outcomes for adults in this cohort. 
Last updated: 27/05/2022