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Essex County Council - Provider Hub
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Market Context

The Council provides social care support and services for adults who are aged 18 - 65, with a learning disability and or autism (LDA) on a long-term basis. In most instances these adults would be known to Social Care from birth. To support families and carers short term respite services can be provided to support unpaid carers due to the long-term nature of the adults needs. 

The Council commissions  a range of services to enable adults to be as independent as possible within a community setting including accommodation-based services such as supported living and residential care, and community-based services like domiciliary care and day opportunities.  We will also seek to support people into employment opportunities wherever possible and we commission contracts for this purpose.  For more information refer to the following services/contracts:

As with all other market cohorts a financial assessment may be undertaken on adults who are in receipt of certain services and they may be required to contribute to their care. This is comparatively less likely to be the case than for other cohorts however. The adult can choose to have a managed service via a Council contract, or directly manage their own support by taking a direct payment.

The conditions in social care markets remain challenging for operators. Funding for providers within LDA services is primarily from Local Authority contracts in contrast to older people services, and this means prices paid are heavily reliant on perennially tight Local Authority budgets.

At the same time, inflation and National Living Wage (NLW) have continued to grow at accelerated rates. Most care providers pay their frontline support staff at close to the NLW and this means the impact of increases is felt more keenly than in other sectors.

This can affect the ability of care providers to recruit effectively with high levels of competition within their own industry (across different types of service and cohorts) and externally from retail and hospitality sectors often pulling from the same pool of candidates. Recruitment continues to be a challenge cited by most care providers we engage with, and the resultant cost of agency staff required to meet commissioned hours increases the pressure on provider budgets as these are typically high-cost when compared to directly employed staff.

Barriers to entry for some types of social care contract are relatively low which makes these markets competitive. Current demand for services such as supported living and domiciliary care remains strong but has resulted in placements being made with a vast number of providers.

Other markets do not have as many entrants or active providers and in these cases we can find it difficult to meet demand. Complex services are frequently challenging to commission due to specialist requirements which has the effect of escalating costs for those services that are available.

  • The provider market is varied dependent on the specific category but has a higher proportion of small and medium sized enterprises
  • The Essex vision is that adults have access to services that will maximise their independence and promote the achievement of the outcomes they desire.
  • Recording of specific outcomes and progression for adults is not systemised and is difficult to monitor at present. Work needs to be done to ensure ISPs are reflective of outcomes and that support plans from providers are tracking and updating the progress against the outcomes.
  • There remains a lack of high-quality complex provision to meet the needs of ECC and further development will be required. This is especially acute in the Transforming Care cohort of adults which causes hospital discharge delay and increased costs across the system.
  • There are still high numbers of adults placed into residential settings and people who have been in residential care for a long period of time.
  • The prevalence of direct payments in AWD can make it difficult to have a clear picture of all categories, and some, like Day Opportunities, are likely to have significant spend with some providers under direct payment over which we have limited oversight or control. This presents a challenge with market shaping.
  • Lack of general needs housing and joined up approach to securing a move on from accommodation services for AWD adults.

The COVID impact highlighted is:

  • Infection control remains high on the agenda for the CQC but operation of services and the ability for people to visit without restriction has returned to pre-pandemic levels.
  • Staffing remains a challenge in many areas but this is less prone to the variability seen during the pandemic because all industries have returned to operation at full capacity. Competition is driven by wages.

Current market risks:

  • Staffing – specifically recruiting and retaining staff of a high enough quality to deliver the services at the rates that are being paid.
  • Funding – lack of funding to local authorities prevents any substantial increases to providers which could assist with recruiting/retaining, delivering high quality services, or developing new services. At the same time there are large increases in National Living Wage which has a big impact on providers as support workers are often paid at or around the prevailing NLW.
  • Viability – due to a combination of the two previous risks as well as the needs of the Council there are some providers that could reach a threshold where they are no longer viable and exit the market.
  • Social care resource – there is a lack of resource in Adult Social Care to support reviews and the provider market.
  • Accommodation – for providers of accommodation based services Essex presents a challenge due to the value of land and buildings in the county, and the general availability of services suitable for adults with complex needs.

Our current area of focus is:

  • Development of new and existing services to align with ECC’s strategic direction. This is focussed increasingly on complex needs services and those that can meet needs of Transforming Care cohorts.
  • Market resilience activity to support providers to continue to deliver services or to exit markets in the most planned way possible.
  • Outcomes and progression for adults and rethinking contracts and frameworks to capture and reward this behaviour.
  • Development of relationships with providers through robust contract management and looking at development opportunities with providers seeking to grow or innovate.
  • Review of Day Opportunities and the role it plays for adults being supported, with a longer-term procurement plan for this category to assure best value.
  • Benchmarking against other Local Authorities to assure best value is being achieved in Essex.
Last updated: 31/03/2024