Employee Assistance Programme

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 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 31st March 2024

Although demand for domiciliary care has been increasing year on year, in recent months demand has been relatively stable. 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 - 88% of packages commissioned overall are with providers who are rated Good or Outstanding by the CQC.

New providers considering entering into domiciliary care will need to be aware that, on the whole, current supply outstrips demand and is being met by existing strategic or framework providers on our Live at Home framework. You may wish to consider investigating specific areas of hard of source locations or specialist types of care, such as complex behavioural needs.

ECC anticipates that some providers may exit the market due to lack of supply.

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) 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. 

Essex Market (This is whole market)  
No. Providers 366
Total No. Adults Receiving Domiciliary Care 14,564
% Providers CQC rated Good or Outstanding 75%
No.Providers onboarded to work with the Council since 1st April 2023 26
No. Providers exiting the market since 1st April 2023 24
Essex Adult Social Care Market - funded  
2023-24 Forecasted Spend £147 Million
No. Providers on the Live at Home Framework 105
% Providers on the Live at Home Framework CQC rated Good or Outstanding 88%
No. Adults funded by ECC  6,476
Commissioned Hours per week funded by ECC 123,282.00
% ECC funded placements CQC rated Good or Outstanding 84%
Framework Utilisation 62%

The information shown in the table(s) above is correct as of 31st March 2024.

Information in the above table for sourcing is based on activity between 1st April 2023 and 31st March 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 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: 31/03/2024