Intermediate Care Service | Provider Hub

Market Context

Intermediate Care is a service 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, through the relearning of the personal and domestic activities of daily life.

Essex County Council currently commission five types of services:

Reablement-at-Home Service (RaH): A therapy-led Intermediate Care service at the adult's home for up to 6 weeks.
Additional Reablement Capacity (ARC): As a therapy-supported reablement service to support the capacity demands of the reablement service, with an identical 6-week limit.
Home-to-Assess Service: As an opportunity for adults to return home in a non-reablement setting, for up to 4 weeks, to allow care assessments to take place once the adult is settled at home.
Bridging: Short-term rapid intervention support for hospital, community, and admission avoidance referrals, to support transit to appropriate longer-term solutions.
Spot placement of short-term domiciliary care when capacity within the reablement services (RaH and ARC) is not available, or a referral has no potential for development in a reablement environment.

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

Reablement-at-Home Contract: A countywide service for reablement, contracted with Essex Cares Limited (ECL), a wholly owned Local Authority Trading Company of Essex County Council.
Additional Reablement Capacity (ARC) Contracts: Five separate contracts with four providers, placed in each of the five localities across Essex to support demand pressures for out of hospital and to support community referrals.
Home-to-Assess (H2A) contract: A single contract addressing homecare and assessment needs in North Essex only, but with plans for future expansion.
Bridging Contracts: A single contract, in West Essex, for rapid response services for to 5 days to aid our reablement and domiciliary providers for a short period to support quicker discharges from hospital and admission avoidance, with a further NHS contracted bridging service in Mid and South Essex.

Market Rating

The current overall Market Quality is very good, and past issues with market capacity and workforce no longer exist. Recent tender activity has demonstrated a strong and motivated market, with a keen understand of reablement services. Essex continues to see an increase in demand, but it is unclear if this correlates with the speed of market development.

Market Quality	Market Supply	ECC Demand
Good	Good	High/Very High

ECC Ambition	Market Workforce	Market Maturity
Manage Supply	Good	Mature/Established

ECC rating of the market, assessed on the 31st March 2024

The reablement service, including both RaH and ARC, has been increasing in provision since September 2022 and is currently contracted to deliver 14,600 hours of reablement care at home each week. These figures can be adjusted if required, and increases to the contracted hours have been actioned, based on the availability of additional winter funding.

There are two bridging services across the County, one is contracted directly by ECC in the 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 encountered past recruitment issues, but the workforce market is now far more stable with many providers indicating an improved recruitment and retention position, especially with many now utilising the UK Visa Sponsorship programme to encourage recruitment from aboard. Currently, three of the Intermediate Care providers are utilising care workforce from Kenya, Nigeria and Zimbabwe.

Short-term care to maximise independence (reablement services), Essex’s gross expenditure per 100,000 adults is the 4^th highest in the CIPFA region for 18 to 64 and 5^th highest in the region for 65+ (out of 16 LAs in that region).

Essex ASC Market (ECC Funded)
Spend	£23.4 Million per annum
ECL Capacity (Hours per week)	9,350
ARC Capacity (Hours per week)	5,250
No. Providers (inc. bridging)	5
Good/Outstanding Providers	89%
No. of Spot IC Beds	0
No. Good/Outstanding Spot Providers	N/A

Essex ASC Market - Utilisation
Reablement-at-Home Utilisation	92.2%
Reablement-at-Home % Self Caring	38.6%
Reablement-at-Home - Average Length of Stay	39 days
Reablement-at-Home - Standard Hourly Rate	£37.70
Additional Reablement Capacity Utilisation	92.8%
Additional Reablement Capacity % Self Caring	38.7%
Additional Reablement Capacity Average Rate	£23.89
Additional Reablement Capacity - Average Length Stay	37 days

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

Our Intermediate Care offer is subject to a transformation process, following the positive work completed by the Connect Programme over the last 2-3 year, to improve the service offer and flow for adults in the community or hospital.

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.

We are aiming to minimise the use of bridging services in the future, with 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.

We are still working to establish a new contractual arrangement with ECL, with a positive change in service and management dynamics, together with mobilisation of the new ARC and H2A contracts, which commenced in September 2024.

There are now no COVID risks and impacts, with the availability of staff within the reablement services no longer affected.

Current and future ARC service provisions specifically include procedural and insurance provisions to mitigate risks for future pandemic situations.

Current information is indicating that past pressure on the Domiciliary market to pick up packages of care for long-term provision is no longer relevant.
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.
The legislative changes associated with visa support and the recruitment of workers from overseas have resulted in a reduction in applications, and the release of a number of foreign workers into the market who came to the UK for potential care providers who are no longer able to provide work to these individuals.
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.

Reducing failed starts, and otherwise lost hours, across all reablement's services
Improve throughput of adults in their reablement journey, reducing length of stay and improvements to challenging and proportionate objectives for users.
Better insight on system wide data, intelligence, and insight, with the use of current business tools to replace fragile and inconsistent data management tools.
Improved alliance working and collaboration across the market, and with health partners, as part of a greater Intermediate Care offer across Essex, with initial meetings yielding positive results.
Ensuring robust and flexible contract arrangements for the on-going delivery of reablement and bridging services are established and maintained.

Last updated: 30/09/2024

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