Report to:

People Scrutiny Committee

Date of meeting:

16 September 2021


Director of Adult Social Care


Developing Care Markets – Home care and Care Homes


To provide the Scrutiny Committee with an overview of the market position in relation Older Peoples and specialist bedded care and Home Care


The People Scrutiny Committee is recommended to consider the current market position for the areas of social care provision covered in this report.

1.         Background

1.1       Adult Social Care has the responsibility for assessing the social care needs of adults in East Sussex and providing support to meet those needs. Assessments are undertaken in line with the Care Act 2014 and support is arranged for people who meet Care Act eligibility criteria.

1.2       Adult Social Care commission support and services from a wide range of independent care providers to meet the assessed, eligible needs of individuals.  These services include support in people’s own homes (home care); care provided by residential and nursing care homes; other accommodation-based services such as supported living and Extra Care housing; housing related support; the provision of aids and adaptations for people’s homes; providing information and advice; and providing support for family carers.

1.3       This report focusses on the areas of social care provision with the highest volumes of activity and highest levels of spend, namely Home Care and residential/nursing care or ‘bedded care’ for older people and for adults with complex mental health and learning disabilities. The slides in Appendix 1 contain additional supporting information.

1,4       These services are all regulated by the Care Quality Commission (CQC) and East Sussex compares favourably to other areas in terms of the proportion of regulated services rated ‘Good’.

1.5       Adult Social Care work very closely with independent care providers to arrange packages of care to meet individual needs.  Choice and control for the client and service quality are key considerations which must be balanced against the availability of suitable provision at Local Authority rates.

2.         Supporting information

2.1       The Supply Management Teams within the Adult Social Care Department are the interface between the social work teams and the Social Care Market.  Supply Management work directly with the Home Care and Bedded Care markets to secure suitable placements for clients referred to them by the Adult Social Care social work teams.   Adult Social Care also purchase care home beds and home care capacity on behalf of the NHS, to support patient flow out of hospital.

2.2       Approximately 2,200 people are in receipt of Local Authority funded home care services. East Sussex commissions home care from a range of providers, delivering around 22,000 hours of care per week. The number of clients receiving home care is increasing as more people are being supported to stay living in their own homes.  In recent months, the rate of increase in demand for home care has accelerated.  At the time of writing, the brokerage teams are dealing with the highest ever levels of referrals for home care.

2.3       There are around 300 care homes (residential and nursing) in East Sussex.  Residential and nursing care covers a wide range of care and support needs for both adults and older people.  We are increasingly seeing people presenting with more complex and challenging behaviours, some of which is due to the increasing prevalence of dementia. Within the Adult Social Care Department, the Specialist Bedded Care Brokerage Team source and arrange placements for adults and older people with complex and challenging behaviours.  The Department currently supports over 500 placements in specialist bedded care settings.

2.4       Independent care providers often provide care solely for private clients who fund their own care, often referred to as ‘self-funders’.  Other providers provide care and support for both self-funding clients and individuals who have had their care and support arranged by the Local Authority.  Positive and productive relationships with home care and bedded care providers are therefore essential in ensuring Adult Social Care can secure suitable, good quality provision at Local Authority rates.

2.5       Most people will pay some money towards their care costs and people with more than £23,250 in savings and assets (capital) will pay the full cost for their care and support.  In East Sussex there is a strong self-funding market.  This is particularly the case for residential and nursing care, where the Local Authority accesses a relatively small market share.

2.6       In addition to the mixed economy of funding arrangements for individuals seeking or having been assessed as needing social care, there are a range of well-documented challenges facing the social care sector.  Funding reform for Social Care has been on the national agenda for a number of years and, as set out in the 2020 Spending Review, the government is committed to sustainable improvement of the adult social care system and will bring forward proposals this Autumn. 

2.7       There is no doubt that the provision of care during the Covid19 pandemic has come at a terrible cost for people living in care homes, their families and for care workers across the social care sector. Covid19 also exposed and exacerbated several key challenges facing social care providers.  Prior to the pandemic, the sector already faced significant challenges including longstanding financial pressures and increasing workforce shortages. 

2.8       Amongst the many challenges faced by providers over the last 18 months, services have had to make sure they have enough employees with the right skills to cope with new and increased demands. In the earlier stages of the pandemic, some home care providers were reporting positive outcomes to recruitment campaigns as individuals found themselves without work in sectors such as hospitality.  More recently, all types of care providers, including agency staff providers are reporting significant workforce challenges.

2.9       The combination of (i) staff leaving care work to return to other sectors which have now re-opened as Covid19 restrictions have been lifted and (ii) Brexit, are having a worrying effect on social care workforce resilience locally and nationally.  The impact of the mandated vaccination legislation for care home staff which comes into effect in November, is of further concern to providers.

3.         Conclusions and Recommendations

3.1       The Adult Social Care Supply Management and brokerage teams have long and well-established relationships with providers of Home Care and bedded care in East Sussex.  The recent and significant increase in referrals/demand for home care is however stretching the market to capacity and the increasing workforce challenges are compounding this situation.

3.2       The Adult Social Care Department will continue to work with the market to support recruitment and retention issues and develop new ways of working including the role that technology can potentially play in supporting peoples care needs.  The recommissioning of Home Care provision which is currently in-train is also looking at payment mechanisms and other ways we can improve how we work with providers. 

3.3       The multi-agency East Sussex Care Homes Group, Chaired by Adult Social Care, includes partners from the CCG, NHS Trusts, Public Health, Care Home Managers and Healthwatch.  Through this group we are taking forward the Enhanced Health in Care Homes work at place and the group is responsible for ensuring the system is working together, for example, to ensure care homes are fully supported through changes in guidance and legislation such as the mandated vaccination legislation for care homes.  Adult Social Care, Public Health and our local NHS partners are working together to support the Care Home sector to maximise vaccination levels amongst staff, including targeted support for care homes reporting less than 70% vaccination rates.

3.4       Healthwatch are a key partner in the Care Homes Group and have held eight webinars since the pandemic which carers and families of care home residents have shared their experiences and issues to statutory partners.

3.5       Adult Social Care has reviewed the way we engage with care providers.  Many of the initiatives which started in response to the Covid19 pandemic such as the care home huddle and Provider Bulletin, will continue as providers continue to value these communication channels.      

3.6       Through the ADASS Commissioning and Market Development Network we have commissioned the Institute of Public Care to lead some work with Local Authorities and care providers to agree on key messages about how best to support the market and the outcomes for vulnerable adults, in particular during the challenging times of winter/seasonal pressure. This will serve as a springboard for future market development work.

3.7       Overall, the challenges facing the provision of home care and bedded care in East Sussex are replicated across other types of social care provision and across the Country.  We are confident in our relationships with and understanding of the local care market and will continue to work closely with providers to meet the social care needs of our local adult population.

3.8       It is recommended to consider the current market position for the areas of social care provision covered in this report.


Director of Adult Social Care



Debbie Endersby -Head of Supply Management and Learning Disability Commissioning
Tel: 01273 481125





Appendix 1:  Developing care markets -presentation