The COVID pandemic resulted in an increased level of unoccupied care home beds across Essex. Since the end of the pandemic, we have seen an increase in the number of residential placements across Essex.
Market Context
Older People Residential 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 residential setting are:
- Short or long term residential care
- Short or long term specialist care, i.e. dementia, complex behaviours
- Respite residential care
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 good. There is currently an oversupply of residential care homes in the market. There is a need to work with the market to ensure care home provision meets future demand and need, including an increase in nursing care provision. Covid has impacted the speed of which we can develop and shape this market.
| Market Quality | Market Supply | ECC Demand |
|---|---|---|
| Good | Good | Stable |
 |
|
 |
| ECC Ambition | Market Workforce | Market Maturity |
| Decrease Supply | Low | Mature |
 |
 |
 |
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 | 191 |
| No. Beds | 9,379 |
| % Homes CQC rated Good or Outstanding | 77% |
| Total Occupied Beds (including ECC funded) | 7,720 |
| Occupancy % | 82% |
| Occupancy % for ECC funded Adults | 35% |
| Market Entrants since 1.April 2022 | 1 |
| Market Exits since 1.April 2022 | 1 |
(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 | £116 million |
| No. Contracted Homes | 149 |
| % Contracted Homes CQC rated Good or Outstanding | 71% |
| No. Adults funded by ECC receiving residential care | 3,050 |
| % ECC funded residential care placements CQC rated Good or Outstanding | 76% |
| Contract Utilisation | 77% |
| Average Length of Stay (Years) | 1 year 9 months |
(Note: this includes homes that are also registered as residential with Nursing)
| Essex Adult Social Care Market - Sourcing | |
|---|---|
| Average Contracted Rate per week | £648.45 |
| Average Spot Rate per week | £974.91 |
| Contracted Placements per month | 175 |
| Spot Placements per month | 39 |
| % Admissions into residential care CQC rated Good or Outstanding | 64% |
| Average placements ended per month | 104 |
(Note: this includes homes that are also registered as residential with Nursing)
The information shown in the table(s) above is correct as of 31st March 2023
Information in the above table for sourcing is based on activity between 1st April 2022 and 31st March 2023
Overall, prior to COVID 19 there was a gradual decrease in the number of placements made by ECC into residential care homes across Essex which has maintained into 2023. This is in alignment with our strategic direction to keep adults at home with their families in their community for as long as possible.
The length of stay in domiciliary care is increasing, and there is pressure to secure additional nursing provision across Essex. Our expectation is that when adults require a residential placement it is likely the adult’s needs will be more complex and for a shorter period of time. There is an ambition that whenever someone is placed in a care home, it is in a home that has a good or outstanding CQC rating.
The current COVID impact highlighted is:
Prior to COVID our average occupancy levels were approximately 92%. This decreased down to 80% in some residential homes during COVID and has now started to increase in 2023 and is currently at 82% Without financial support there is an assumption that some areas of the market will struggle to remain open. Interim measures in place include:
- Block provision has been secured for a period of time with some providers that are on the IRN Framework and have a good or outstanding CQC rating.
- Providers are joining the IRN framework to receive ECC benefits i.e. mini competitions and other opportunities as they arise.
- Residential placements are increasingly being used for intermediate care placements for short term provision.
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 due to an increase in costs.
- The NHS may increase demand for residential placements from hospital driving up longer term costs for Adult Social Care.
- Long COVID could bring people into Social Care a lot earlier for 55 plus.
- ECC does not currently pay Cost of Care Rates (30% for Residential Care)
Our current area of focus is:
- A review of residential homes is required to ascertain future provision requirements. ECC will need to play an active role in shaping our future residential provision.
- There is a possibility of shaping some residential homes into nursing homes or providing intermediate care provision moving forward, potentially using either block contract mechanisms or other incentives.
- A more integrated approach with the NHS for residential placements may help keep costs down for placements that have come from hospital.
- A review of our financial pricing matrixes for the IRN Framework.