Nursing placements are and have always been relatively hard to source within Essex. There is an expected increase in demand for nursing placements in alignment with our strategic direction to keep adults at home with their families in their community for as long as possible. Adults that do require a nursing care home placement are likely to have more complex needs, including dementia care, and require a shorter term placement.
Market Context
Nursing Care is a service that supports an adult who requires short or long term care in a specific setting outside of the adult's home. The type of services that can be provided in a nursing setting are:
- Short or long term nursing care
- Short or long term specialist care, i.e. dementia, complex behaviours
Essex County Council have several different contracts with our providers in Essex. Our core contract is the Integrated Residential and Nursing Care Framework known as the IRN Framework. Essex County Council will work with our IRN Framework providers to block purchase beds when required to support specific capacity and demand needs for Adult Social Care
Market Rating
The current overall Market Quality is moderate. There is a need to increase the number of nursing care homes across Essex, including increasing the capacity of the nursing workforce within care homes. Covid has impacted the speed of which we can develop and shape this market.
| Market Quality | Market Supply | ECC Demand |
|---|---|---|
| Low/Moderate | Low | High |
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| ECC Ambition | Market Workforce | Market Maturity |
| Increase Supply | Low | Mature |
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ECC rating of the market, assessed on the 31st March 2023
- Since COVID there has been a 9% reduction in ECC funded care home placements in older people residential and nursing care homes.
- 60 residential and nursing care homes have less than 80% occupancy
- ECC has committed to review placement prices on an annual basis. Please see the Older People Residential and Nursing uplift page
| Essex Market | |
| No. Homes | 42 |
| No. Beds | 7,347 |
| % Homes CQC rated Good or Outstanding | 79% |
| Total occupied Beds (including ECC funded) | 6,434 |
| Occupancy % | 88% |
| Occupancy % for ECC Funded Adults | 37% |
| Market Entrants since 1st April 2023 | 0 |
| Market Exits since 1st April 2023 | 2 |
(Note: The above data set covers both Older People Residential and Nursing care. The market has been segmented based on the main specialism supported by the home)
| Essex Adult Social Care Market (ECC Funded) | |
| Spend | £34 Million |
| No. Contracted Homes | 155 |
| % Contracted Homes CQC rated Good or Outstanding | 70% |
| No. Adults funded by ECC receiving residential care | 718 |
| % ECC funded residential care placements CQC rated Good or Outstanding | 75% |
| Contract Utilisation % | 40% |
| Average Length of Stay (Years) | 1 Year 8 Months |
| Essex Adult Social Care Market - Sourcing | |
| Average Contracted Rates per week | £893.99 |
| Average Spot Rate per week | £1,287.25 |
| Contract Placements per month | 28 |
| Spot Placements per month | 32 |
| % Admissions into residential care CQC rated Good or Outstanding | 72% |
| Average placements ended per month | 31 |
The information shown in the table(s) above is correct as of 30th September 2023
Information in the above table for sourcing is based on activity between 1st April 2023 and 30th September 2023
The appropriate discussions with the NHS have started regarding the different options and approaches needed to tackle the lack of provision of nursing care workers. However further investigation is required to ascertain the number of future placements, homes and beds required to meet today’s need and our future project of needs. There is an assumption that this needs to be a two-pronged approach with the NHS to improve this market.
There is also a need to investigate other complex provision such as end of life, CHC, complex behaviours and dementia to ensure we secure the right provision to provide the best outcomes for our adults alongside the NHS.
Work is also required to support providers that could offer dual services (residential and nursing). There is currently some CQC restrictions that make it harder for providers to provide nursing care, i.e. unable to share nurses across homes which need investigating further.
Our ambition is that all our placements in nursing care are in good or outstanding CQC rated provision.
The current COVID impact highlighted is:
There is no specific evidence to show that nursing placements have been impacted like our residential market, however it is expected that they have the same carer workforce pressures to the residential providers.
Current market risks:
There are several risks that will need to be managed over the next 18 months. These include:
- It is to be expected that there could be an increase in homes exiting the market if unable to increase occupancy and retain financial security with less demand in the market for residential placements. This could impact our nursing homes if the residential home is a dual home.
- Health may increase pressure for nursing placements from hospital driving up longer term costs for Adult Social Care. Particularly if they are on a CHC pathway and then re-assessed into Non CHC pathways.
- ECC does not currently pay Cost of Care Rates (20% for Nursing Care) but is implementing a 20% increase to nursing rates from April 2023. Please see the Older People Residential and Nursing uplift page
Our current area of focus is:
- A review of nursing provision is required to ascertain if there are any opportunities to shape our residential market to provide support.
- A nursing workforce, training and retention scheme is critical to increase capacity in Essex.
- Review of complex needs or pathways to ensure the service is appropriate, is funded correctly and has the best outcome for the adult and their family.
- Continue to improve the quality of outcomes for adults in this cohort.
- A review of pricing matrixes for future nursing provision.