There is capacity in the market, but the capacity needs to be brought in line with Essex’s future vision. Going forward the placements will predominantly be for very complex needs, and work needs to be done with the market to move to this position. We have a wide and varied market, and rationalisation will be needed in the future to streamline the market to align with the vision of residential care.
Market Context
Working Aged Residential Care is a service that supports an adult with learning disabilities and/or autism and physical and sensory impairments on a long-term basis. Going forwards, the Council's strategy is to reduce the number of residential placements, instead supporting people to be more independent within their own homes.
The services are currently delivered by a very diverse range of providers within Essex with more than 900 people currently placed within residential services. All services are currently procured on a spot basis by Essex County Council, and we purchase three different types of service from this market:
- Permanent residential placements
- Temporary residential placements
- Short term or respite services
In the future, the intention of the Council is to work with the market to better meet our requirement for the most complex adults we support, and to do this we will procure a new framework specifically for the placement of adults with complex needs and to seek to stimulate the market to develop more services for these adults.
It is expected that some services which do not meet the direction of the residential market may need to consider transition to other services such as supported living or to take more complex adults.
Market Rating
Market quality is good within Essex, as evidenced by the CQC ratings awarded to residential homes. Workforce remains a significant challenge for providers and the ability to recruit and retain staff remains very difficult in the current markets. Demand is relatively stable but the majority of demand in the future will be for complex needs which poses a threat to some homes in our market that are not suited to delivering care to these adults. As such, the ambition is to decrease supply in the market and focus on complex needs services to align with our direction of travel.
| Market Quality | Market Supply | ECC Demand |
|---|---|---|
| Good | Low | Stable |
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| ECC Ambition | Market Workforce | Market Maturity |
| Decrease Supply | Very Low | Mature |
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ECC rating of the market, assessed on the 31st March 2023
- ECC has previously commissioned all LD residential services on a spot contract basis with prices negotiated individually with providers at the time of placement by SPT. ECC use Care Cubed as a benchmarking tool to ensure placements are made at rates achieving value for money.
- Each placement is made under the terms of the AWD Residential Contract 2020 with a smaller number on the older 2016 version.
- Going forwards the intention is to utilise the recently procured Complex Residential Framework which matches our strategic direction in respect of adults that are to be placed through it.
| Essex Market | |
| No. Homes | 158 |
| No. Beds | 1,394 |
| % Homes CQC rated Good or Outstanding | 87% |
| Total Occupied Beds (including ECC funded) | 1,257 |
| Occupancy % | 90% |
| Occupancy % for ECC Funded Adults | 56% |
| Market Entrants since 1.April 2023 | 0 |
| Market Exits since 1.April 2023 | 4 |
The market has been segmented based on the main specialism supported by the home
| Essex ASC Market (ECC Funded) | |
| 2022-23 Forecasted Spend | £97 Million |
| No. Adults funded by ECC receiving care in a residential setting | 927 |
| Average Cost per week | £2,005 |
| % ECC funded placements in a residential setting CQC rated Good or Outstanding | 85% |
| Average Length of Stay (Years) | 3 Years 10 Months |
| Essex ASC Market - Sourcing | |
| Average Rate per week | £942.56 |
| No. Placements per month | 21 |
| % Admissions CQC rated Good or Outstanding | 80% |
| Average Placements ended per month | 14 |
The information shown in the table(s) above is correct as of 30th September 2023 and some data updated as per January 2024.
Information in the above table for sourcing is based on activity between 1st April 2023 and 30th September 2023.
Moving towards the vision although gaps do remain, there is a lot of ongoing work with providers developing new services and models to match ECC vision and requirements. With the new framework procured we are developing plans for how to bring forward new services matching our needs within Essex.
Work is going on within the Ageing Well programme looking at adults aged 55+ and where they might have their needs best met in the future to allow for market shaping in the residential market.
There are lots of existing placements and stock where we are unlikely to make placements into. We have completed an exercise to RAG rate all homes within Essex based on strategic alignment and our response to supporting them to continue operation. In some cases homes may not be able to meet future needs and will be supported to exit the market or develop to meet the needs we do have.
The current COVID impact highlighted is:
- Lower impact than seen in OP residential; there were cases, but the market reacted well with infection control and staff availability.
- Staffing - we are starting to see that it is as difficult or more difficult to recruit into as other industries open up.
- Long Covid will potentially have an impact on PSI
- Providers had to increase hours of support where individuals could not access day opportunities, placing pressure on the workforce.
Current market risks:
- Staffing remains a risk and the use of agency staff is widespread and costly to providers which compromises their viability and increases costs of new placements for Essex County Council.
- High inflation is a key risk and residential provision is more affected by cost increases to food, consumables, building maintenance and mortgages.
- Squeeze on development - less likely to develop if money is tighter and homes can’t be staffed.
- Potential closure of homes in future as placements slow to ‘traditional’ homes and they become unviable.
Our current area of focus is:
- To stabilise and maintain the markets so that moving forward we can work in partnership and innovate with the market
- Innovate - move from a category approach to a local community partnership approach – market shaping by community and locally expressed need
- Value – sustainable rates which are efficient whilst also supporting the required service development
- Continue to promote choice and control for individuals and their families, with personalised, inclusive approaches driving outcomes and progression
- Drive the progression of individuals, meeting and sustaining their outcomes to live a more meaningful life
- Improve the quality of provision inclusive of quality of care and accommodation.
- Develop the provision of more specialist complex care accommodation to meet the needs of people with complex needs, including PSI.