Cost of Living Support

Essex County Council - Provider Hub
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Market Context

Intermediate Care is defined as a service that is 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. Essex County Council currently commission four types of services:

  • Reablement-at-Home: A therapy-led Intermediate Care service at the adult's home for up to 6 weeks
  • ARC (Additional Reablement Capacity): 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.

Essex currently holds numerous contracts with multiple providers to support these services. These are:

  • Reablement Contract: This is a countywide service for reablement and is contracted with Essex Cares Limited (ECL).
  • ARC (Additional Reablement Capacity) Contracts: Five separate contracts, placed by localityacross Essex to support demand pressures out of hospital and 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.  
  • Spot Contracts: Occasionally the Council will spot purchase an Intermediate Care, to support local shortfalls and demand fluctuations 

Market Rating

The current overall Market Quality is good, however due to existing demand we are struggling at times with capacity and our market workforce. Essex have an unprecedented increase of demand over the last 12 months which is impacting the speed of which we can develop and shape this market.

Market Quality Market Supply ECC Demand
Good Moderate/Good High
Market Quality = Good Market Supply = Moderate/Good
ECC Ambition Market Workforce Market Maturity
Manage Supply Good Mature
Market Maturity = Mature

ECC rating of the market, assessed on the 19th January 2022

The reablement service, including both RaH and ARC, has been increasing in provision since December July 2022 and is contracted to deliver a minimum of 13,650 hours of reablement care at home each week. There is continued increased pressure to provide short-term reablement in the home countywide.

There are 3 bridging services across the County, 2 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 experienced recruitment issues countywide over the last year in respect to reablement services, but the workforce market is now far more stable with many providers indicating an improve recruitment and retention position.

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

Spend

£25.5m

ECL Capacity (Hour)

9,350

ILOR Capacity (Hour)

4,300

No of Providers

9

Good/outstanding

77.7%

No IC Beds

0

Good/outstanding

N/A

 

Essex ASC Market - Utilisation

ECL Utilisation

98.7%

ECL % Self Caring

56%

ECL Average Length of Stay

24 days

ECL Average Rate

£37.70

ARC Utilisation

88.6%

ARC % Self Caring

54%

ARC Average Rate

£22.00

ILOR Length Stay

24.2 days

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

Our intermediate care offer is in the middle of a transformation 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.

It is still hoped that we can minimise the use of bridging services in the future and there are 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.

The current COVID impact highlighted is:

Issues with staff absence due to COVID sickness or associated self-isolation is now significantly lower than this time last year and providers are not reporting an ongoing impact of COVID-19 to the availability in all areas of Intermediate Care.

Current market risks:

  • 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.
  • Ongoing service availability issues in Uttlesford, due to lack of available workforce and geographical challenges
  • 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.
  • Alternative employment opportunities and attractive wages in the retail and hospitality sectors or limiting the recruitment market in some areas.

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: 27/05/2022