Although demand for domiciliary care has been increasing year on year, in recent months there has been a downturn. Market supply has increased significantly in the last nine months, 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. Whilst market capacity across the county is currently overall good, there are pockets where there is less provision. This is typically linked to areas where there is more travel time between care visits, often in rural areas. Overall, quality in the home care market is good - 89% of packages commissioned overall are with providers who are rated good or outstanding by the CQC.
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
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 | Good | Stable/High |
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| ECC Ambition | Market Workforce | Market Maturity |
| Manage Supply | Stable/High | Evolving |
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ECC rating of the market, assessed on the 31st March 2023
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 more than 10 adults) and 60% of care providers who responded to a recent survey use DSCR. 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.
The council is 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.
| Essex Market (This is whole market) | |
|---|---|
| No. Providers | 332 (165 Active) |
| Total No. Adults Receiving Domiciliary Care | 6465 |
| % Providers CQC rated Good or Outstanding | 89% |
| No.Providers onboarded to work with the Council since 1st April 2022 | 2 |
| No. Providers exiting the market since 1st April 2022 | 10 |
| Essex Adult Social Care Market - funded | |
|---|---|
| 2023-24 Forecasted Spend | £116 Million |
| No. Providers on the Live at Home Framework | 115 |
| % Providers on the Live at Home Framework CQC rated Good or Outstanding | 85% |
| No. Adults funded by ECC | 6,465 |
| Commissioned Hours per week funded by ECC | 121,439.7 |
| % ECC funded placements CQC rated Good or Outstanding | 98% |
| Framework Utilisation | 59% |
The information shown in the table(s) above is correct as of 31st March 2023
Information in the above table for sourcing is based on activity between 1st April 2022 and 31st March 2023
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 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 with the spot market. As the capacity of the framework providers grows, the council will move care packages away from the spot market focussing initially on the lower quality spot provision.
Pilots are underway to investigate new ways in 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 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.
Key risks that will need to be managed over the next two years include:
- Social Care Reform and the impact of this on the market
- An increase in care packages being handed back / supplier failures in the spot provider market, as a greater proportion of work is picked up by framework providers
- Inflationary pressures
Our current area of focus is:
- Impact of the Social Care Reforms
- Pilot to explore Trusted Reviewer
- The workforce, training and retention strategy - critical to ensure the increase capacity is sustained