Market position statement - Summer 2024
1. Introduction
The summer 2024 market position statement provides an overview of the key issues, challenges and market opportunities for adult social care and health in East Sussex. This statement identifies areas where the need for different types of support is emerging and how we want services and support to develop in the future.
The statement is based on our understanding of demand for care in our county. We work closely with local care providers and the East Sussex voluntary, community and social enterprise (VCSE) sector to understand supply, demand and need.
The last three years have been the most difficult in recent history. Providing social care through the COVID-19 pandemic and the cost-of-living crisis, against a backdrop of significant workforce, recruitment and retention challenges, has tested the resilience of staff and providers to the limit.
During this time, we aimed to pass on available funding to the sector, from personal protective equipment (PPE) provision in the early days of the pandemic, to financial support for recruitment and retention activity.
The financial pressures continue for the social care sector. We are acutely aware of the impact that increased utility costs continue to have on providers. Also, whilst we welcome increases in the national living wage, this generates a further pressure on staffing costs.
Over the last two years, we have achieved higher annual fee percentage uplifts than pre-pandemic levels. However, looking forward, we estimate significant budget deficits in the medium-term, with a £55m budget gap in 2025/26 and a £72m gap in 2026/27. We will continue to lobby regarding future funding settlements but may also have to revisit the adult social care offer in future years.
Over the last two years we have undertaken a range of recommissioning activity. We have recently concluded the recommissioning of community based mental health services on behalf of Adult Social Care and Health. In addition, we have also recently recommissioned home care and the Integrated Community Equipment Service. We have also extended our existing arrangements for carers services and mental health advocacy support.
Given the above, market opportunities in terms of recommissioning activity in the near future are limited. However, this statement gives details of future development to the digital agenda, information and advice, and specialist community-based accommodation and support.
Going forward, we will be publishing our strategic commissioning framework and we will aim to update online market information more often. This will make the position statement more relevant and useful to the local care market.
Mark Stainton
Director of Adult Social Care & Health
2. Our priorities
The 2023 East Sussex adult social care strategy, ‘What Matters To You’, sets out the future direction of adult social care for adults who have, or will have, care and support needs, their carers and families, and those who work within or alongside Adult Social Care and Health.
Our six priorities are:
- Right support, right place, right time
- Information and communication about care and support
- Cost of living and cost of care, now and in the future
- A suitable home
- Personal connections with others
- Group activities, hobbies and volunteering
Messages for the market
- We are working to improve waiting times for both social care assessments and financial assessments.
- We have reviewed our approach to supporting care home providers to claim for unpaid client contributions.
We will be piloting gross payments for residential and nursing care in the independent care sector in autumn 2024.The Council Plan 2024/25 provides further information on the Council’s achievements and its plans for the four priority areas:
- Driving sustainable economic growth
- Keeping vulnerable people safe
- Helping people help themselves
- Making best use of resources now and for the future
3. Quality
Every person accessing adult social care services and support deserves the highest quality care, and the maximum opportunity to influence how that support is arranged and managed. Effective commissioning plays a central role in driving up quality, enabling people to meaningfully direct their own care, facilitating integrated service delivery, and making the most effective use of the available resources.
We purposefully adopt a supportive and collaborative approach to working with the provider market and this is evidenced through feedback:
- ‘We had CQC visit, final report came today all GOOD. I thought I should let you know, you supported us lots’
- ‘I just wanted to thank you for your support. Our CQC rating has improved, and we are over all good’
- ‘I have been talking to…. the CQC today who was singing your praises from the roof tops. She said every service in ESCC that she is in contact with gives you 100% positive feedback and how your knowledge and support is such a huge and invaluable asset’
The Market Support team supported 156 providers and services via over 600 visits or virtual support calls and meetings during 2023 (excluding ad-hoc meetings). The team maintain an excellent knowledge of the provider market and risks through a number of different information sources including:
- CQC ratings
- Meetings with local CQC inspectors
- Working closely with local social care providers – supporting delivery of CQC improvement plans; providing advice and support to managers and their staff; signposting providers to specialist support e.g. Infection, Prevention and Control teams
- Running the two weekly multi-agency Market Oversight Panel (MOP)
The Market Oversight Panel is a multi-agency, two-weekly forum chaired by ASCH, that shares information about the independent care sector in order to:
- Identify potential risks to adults who draw on care and support
- Understand risks and impacts on the wider market
- Provide and coordinate support to the market
Members are drawn from our Market Support Team, Supply Development Managers, the Safeguarding Development Team, Operational Teams and the ICS Clinical Quality Nurses. The MOP work proactively with providers to address concerns in terms of quality and overall service delivery. The MOP can make recommendations to suspend a service, which will then be ratified by Departmental Management Team. Other decisions such as the provider agreeing to a voluntary embargo are also considered.
ASCH have contingency measures in place to support providers in exceptional circumstances. We have supported services in business continuity situations including: illness, fire, flood and reduced staffing. We initially focus on providing expert advice and helping to develop an action plan. In exceptional cases, where the issue cannot be resolved and continuity of care and safety of residents must be ensured, time-limited additional help can be provided.
4. Working with providers
Adult Social Care and Health value our relationships with providers across the independent and VCSE sector.
We meet with East Sussex Partners in Care (ESPiC - formerly the local Registered Care Association) on a regular basis. Our support for ESPiC engagement activity includes £25,000 funding for 2023/24.
We provide a range of support to providers including:
- A specific market support function which works very closely with providers and takes a purposefully supportive approach to provider issues to promote and ensure an honest and constructive relationship.
- Employing three dedicated posts to work in the community to attract new staff into the care sector, through promotion at careers fairs, colleges and universities and work with partners such as:
- Department for Work and Pensions (DWP),
- the Armed Forces Network,
- Rest Less over 50s project,
- Princes Trust and
- Refugee Reed in Partnership project.
Candidates are supported with free training, interview preparation and coaching.
- Funding a post within the ASC Training team that works with providers to break down barriers to accessing training. The postholder attends events and forums to engage with providers and works with commissioners and market support to offer bespoke training where appropriate.
- Grant funding towards the costs of recruitment, settlement and integration of overseas workers. In 2023/24 we offered Lead Providers grants of between £1,850 and £3,750 which is 25% to 50% of their overseas recruitment costs.
- Weekly Provider Bulletin which has over 4,500 subscribers, mainly care home, home care, PAs, extra care and supported housing. It also reaches staff from neighbouring local authorities, VCSE organisations, unpaid carers, higher education institutes, housing associations, parish and district councils.
- A range of sector specific groups and forums such as the East Sussex Care Homes Group and Registered Managers Network, Mental Health Action Group and Community of Practice and micro provider engagement group.
- In 2025 we will be introducing a provider forum open to all adult social care providers in the county to connect and engage with ASC and hear important updates and developments from across the sector.
- A free comprehensive programme of training for all East Sussex independent care providers. Delivered by the ASCH training team, the offer includes all mandatory training and covers leadership and management courses, staff wellbeing and specialist training. Bespoke training is also delivered on request.
- Our approach to the market is one of partnership and support. In the event of a business continuity incident (e.g. fire, flood) ASCH have provided advice and support to providers to ensure continuity of care and the safety of residents.
5. Voluntary Community and Social Enterprise (VCSE) sector
The local authority recognises the unique contribution of the voluntary, community and social enterprise sector in the provision of care and support and actively works with the sector as an equal partner.
Aa a local authority, we commission a range of services and support across the local VCSE sector. Adult Social Care is also the lead commissioner for a range of jointly commissioned VCSE services, on behalf of the local health and care system. Joint commissioning teams have been in place for many years and our partnership approach to commissioning has resulted in strong outcomes across the system; this was praised by the February 2024 Local Government Association Peer Review.
We have worked with the local VCSE sector to develop strategic partnering models of service delivery and are testing new ways of working such as the East Sussex VCSE Alliance executive group and Public Health stewardship approach to loneliness.
VCSE Commissioning Excellence Programme 2023-25
We are working with partners in the VCSE sector and the Integrated Care System (ICS) as part of a two-year programme. We aim to develop East Sussex as a centre of excellence for VCSE commissioning. The programme has agreed a collective vision statement to define and guide our work:
“Prioritising collaboration and trust to drive innovation and improve outcomes”
The programme includes:
- Building trusting relationships as peers, sharing different skills and expertise.
- Exploring and testing different ways of challenging the status quo. We aim to find creative alternatives including funding, contract and delivery models.
- Supporting VCSE involvement and building capacity.
- Developing an improved understanding of co-production and how we can ensure it’s carried out effectively with all stakeholders to benefit service delivery and outcomes
We are in the final year of the programme and have had some positive feedback from participants:
- “It’s been helpful to reflect on commissioning competencies and to hear views from NHS, ESCC and VCSE colleagues during the programme and put my learning/insight into practice.”
- “The ‘transparent bravery’ concept has informed some real-life commissioning activity.”
- “[the programme] has strengthened cross sector communication, insight and understanding into how each other’s organisations work, providing an opportunity to see things differently.”
6. About East Sussex
Our 2024 State of the County – Focus on East Sussex report explores in detail the data available both nationally and locally, combined with ESCCs own projections. Alongside our Joint Strategic Needs Assessment (JSNA), and East Sussex in Figures (ESiF) site, these datasets enable us to look ahead and acknowledge emerging and future needs. The below data points are what we consider to be of most interest to the adult social care market to help guide and influence service development.
Age
Compared to England and the South East, East Sussex has a much older age profile, with Rother having the highest rate of people over the age of 85 in the country at 4.9%, just ahead of North Norfolk and New Forest, both 4.8%. 26% of the East Sussex population is comprised of people aged 65 or over, compared to 20% for the South East and 19% for England. 3.9% of people in East Sussex were aged 85+ in 2022, higher than nationally, 2.5%, and the South East, 2.8%.
Disability
In the 2021 Census, the proportion of the East Sussex population that identified as disabled was 20.3% (110,550). This is the same as the proportion that identified as disabled in the 2011 Census (20.3%, 107,150). The percentage of people identifying themselves as disabled varied slightly across the district and boroughs, but rates across the county were higher than the South East average.
Population change
Around 558,400 people live in East Sussex currently, with the population expected to increase 3.9% to around 580,400 by 2028. We expect the increase in population to be driven by people moving into the county from elsewhere in the UK. Many of the people who choose to come to East Sussex are older adults, as a result the over 65 age group is growing faster than younger age groups. In 2028 we expect that just over half of our population will be aged 18-64 (53%), with over a quarter (29%) aged 65 and over.
Between 2024 and 2028 we are expecting that there will be around 19,200 births in the county and around 26,500 deaths. This reflects the fact that we have a larger population of older adults in East Sussex. Over the same period, we are expecting around 141,600 people to move into the county, offset by around 112,500 people moving out of the county.
Overall, these changes mean that compared to 2024, we estimate that by 2028 there will be:
- An increase of 0.9% (930) in the number of children and young people
- An increase of 1.6% (4,960) in the working age population
- 9% more people aged 65-84 (12,760)
- 2% more people aged 85+ (3,230)
We expect that how our population changes will be different in different parts of the county. By 2028 our projections suggest:
- An increase of 19% (1,200) more people aged 85+ in Wealden; the smallest increase will be in Eastbourne at 11% (500)
- 11% (4,500) more people aged 65-84 in Wealden, 10% (2,300) more people in Eastbourne, and 8% (2,000) more in Lewes
- Only Wealden is projected to see a significant increase of 5% (4,200) in the working age population (18-64)
- Eastbourne (down 0.7%, 400 people) is projected to see a fall in the working age population over this period
Life expectancy
East Sussex has consistently had a higher life expectancy for both men (79.8 years) and women (83.4 years) than the national average.
Wealden has the highest levels of life expectancy at birth for men in the county (81.5 years), whilst the highest levels for women are in Lewes (84.8 years). The lowest levels are in Hastings for both men (76.7 years) and women (80.9 years).
Long term illness
It is estimated that in 2023 there were 69,650 older people (age 65+) in East Sussex living with a long-term illness that limits their day-to-day activities. 39,450 of these people are ‘limited a little’ in their day-to-day activities, while the other 30,200 are ‘limited a lot’.
These figures are projected to rise to an estimated 80,360 older people living with a long-term illness which limits their day-to-day activities in 2030, an increase of 15.4% compared to 2023. 45,410 of these people are projected to be ‘limited a little’ (up 15.1% compared to 2023), and the other 34,950 are projected to be ‘limited a lot’ (up 15.8% compared to 2023).
Dementia
13,960 older people (age 65+) are projected to have dementia by 2030, an increase of 18.4% from 2023 (11,790). In 2022, dementia was the leading cause of death for women in the county and had risen to the second leading cause for men. It is important that we build dementia-friendly communities and services, where people are aware of and understand dementia and where people with dementia can live in the way they want to.
People receiving long term support
The total number of Adult Social Care clients receiving long term support increased by 8.8% in 2023/24 to 10,195. Most clients receiving long term support are older adults (those aged 65 and over).
People receive long-term support for a variety of different needs. The percentage of people receiving long term support due to Learning Disability Support and Mental Health Support reduces as you move up the age ranges, whilst the percentage of people needing support for Physical Support, Sensory Support and Support with Memory and Cognition increases.
Permanent admissions of older people aged 65 and over to residential and nursing homes per 100,000 population aged 65 and over slightly decreased in East Sussex in 2022/23 to 488.8 from 494.2 in 2021/22. The national average for 2022/23 was 560.8.
Permanent admissions of working age people (18-64) to long term residential care increased in East Sussex in 2022/23 (13.9 per 100,000 population) and is now similar to the national rate (14.6 per 100,000 population).
The proportion of older people (aged 65+) still at home 91 days after discharge from hospital into reablement/rehabilitation services increased in 2022/23 to 91.2% and remains significantly above the national figure of 82.3%.
Deprivation and multi-morbidity
Much of the demand for health and social care in the future will be driven by the increasingly complex management of people with multiple long term conditions and those who are becoming progressively more frail. Multi-morbidity is often thought of as a condition that affects only older people.
However, the risk of exposure to unhealthy lifestyle factors in early life is relatively high in more deprived areas and multi-morbidity is known to develop at least 10-15 years earlier. By 2028 it is estimated that there will be an additional 22,000 people with two or more conditions in East Sussex. As a county, East Sussex is ranked 93 out of 151 Upper Tier Local Authorities on the Index of Multiple Deprivation rank. This is a similar level of deprivation as Lincolnshire, Somerset and Kent. However, deprivation varies across the county, with Baird Ward in Hastings in the most deprived 1% of Lower Super Output Areas (LSOA) in the country, while an LSOA in Uckfield is in the least deprived 3%. The Government has identified 4 out of 5 district and borough council areas in East Sussex as having specific locations with priority need for ‘levelling up’ funding. This funding will be used on projects that address economic recovery and growth, improved transport connectivity, and the need for regeneration.
The adult social care workforce
As the demand for support in adult social care increases it is important that we have a sufficient supply of highly skilled workers for the sector. The adult social care workforce includes all staff working in adult social care settings, in both the independent sector and for the Council.
There were 17,000 staff in post in the adult social care workforce in East Sussex in 2022/23, with 1,500 posts vacant. Projections show that between 2023 and 2035 the workforce required in the county will grow by 28%.
The vacancy rate in the adult social care workforce in East Sussex (7.7%) was lower than both the South East (10.3%) and England (9.9%) averages in 2022/23. However, the rate of staff turnover (32.3%) was higher than the South East (31.9%) and England (28.3%) averages.
Only 9% of people working in the adult social care sector in East Sussex in 2022/23 were under 25, while 29% were over 55. It is expected that 5,000 workers in the sector will reach retirement age in the next 10 years.
7. The care and health system in East Sussex
Improving Lives Together is the Sussex Health and Care Assembly’s strategy. This sets out the ambition across health and care in Sussex over the next five years to improve the lives of local people. The strategy identifies three pan-Sussex ambitions:
- A new joined-up community approach to health and care, maximising the power of partnership working. This will allow services and organisations to work together to better meet the needs of each local community.
- Growing and developing our workforce to attract more people to work in health and care. We will also support and develop the skills and careers of our existing staff.
- Improving the use of digital technology and information to help join-up our services and enable people to access advice or care more easily.
A joint five-year shared delivery plan contains actions that support the delivery of:
- The pan-Sussex assembly priorities in Improving Lives Together
- Our East Sussex Health and Wellbeing Strategy
- Pan-Sussex delivery of NHS Operational Plans covering access to primary care; recovery of elective and urgent and emergency care; hospital discharge, mental health, learning disabilities, autism and health inequalities, clinical leadership and making the best use of financial resources.
8. Information and advice
The East Sussex adult social care strategy, ‘What Matters To You’, identifies what is most important to local people. It describes six priorities for adult social care based on what local people told us.
One of the priority areas is “having accessible and available information about care and support. Communicating information in a variety of formats that are clear, succinct, and readily available.”
Messages for the market
- We want to work with providers to make it easier for people to access and share information about the care and support they are receiving in a timely way.
- We will continue to seek opportunities to work with providers to expand the use of technology and digital solutions. This will include the roll out of the digital social care record (sometimes referred to as an electronic care plan).
- We want to work with providers to ensure we are all using clear and inclusive language and alternative formats to explain to residents and partners what Adult Social Care and Health offers.
- We will find new ways to provide updates to people about the services they are getting or have applied for. This includes using digital tools and automatically generated information.
Accessible information and advice is available online covering all aspects of preventative and wellbeing services such as cost-of-living support and welfare benefits. We provide online directories to help people (and practitioners) access local help and support, including:
- 1Space online directory which brings together groups that offer care, support and wellbeing services and has a dedicated section for Information and Advice.
- ESCIS (East Sussex Community Information Service) which is a broader directory and includes community information and events.
9. Residential and nursing care
We fund approximately 750 older people in long term nursing homes and 1,050 older people living in residential care. We also fund approximately 90 adults of working age in nursing homes and 700 in residential care. Adult Social Care funded clients are estimated to account for 22-30% of residents in older people’s care homes across East Sussex. They also account for 46% in care homes specialising in supporting people with mental health problems and people with learning disabilities. In 2023 to 2024 ASCH supported 3,500 clients to access long-term support in residential and nursing care.
- There are 122 providers of older people’s residential and nursing care in East Sussex with 167 services.
- There are a further 53 providers with 110 establishments for specialist residential and nursing care.
- Most care homes are independent operators and small groups, who make up around 87% of beds. This contrasts strongly with national (56%) and regional (60%) averages.
- The older adult care home market relevant to population in East Sussex (in terms of beds per head of population aged 75+) is 12.2% larger than England as a whole, and 7.6% larger than the average for the southeast region (of which East Sussex is a part).
The occupancy levels of care homes currently average 80%. While there has been a recovery after a significant drop in occupancy during the COVID-19 pandemic, occupancy rates have yet to reach pre-pandemic levels.
Financial viability of residential care is an increasing concern. The impact of the increased cost of living and increasing workforce costs is particularly challenging for small independent providers.
Through the East Sussex Care Homes Group, we support and promote workforce initiatives including the MILE pathway (Managers Investing in Leadership Excellence). This is a management and leadership CPD project for registered managers in Sussex. Adult Social Care and Health continue to offer a comprehensive range of free training and development opportunities and facilitate the local Registered Manager Forum.
Adult Social Care and Health purchase ‘discharge to assess’ beds on behalf of the local health and care system to support timely discharge from hospital. The number of beds purchased is determined by the Integrated Care System, available funding and number of beds available. The current level of discharge to assess beds in East Sussex have been agreed until 30 September 2024.
Quality
We have a risk assessment tool for both working age and older people’s residential and nursing care homes. The risk assessment tool draws on a range of data and intelligence sources and provides an appropriately weighted score for each service. The data covers a wide range of variables including CQC ratings; capacity and occupancy; placement activity; pricing; safeguarding or other concerns etc. This profile is used to inform the work and priorities of the Market Support Team and provides service level information impacts should a service move into a business continuity situation.
At the end of June 2024 there were no residential, nursing or community services in East Sussex rated as inadequate and the percentage of services with a CQC rating of good or outstanding was higher than the national and South East averages (with the exception of nursing homes which was slightly lower than the South East average):
| Residential, nursing or community services in East Sussex | East Sussex | South East | England |
|---|---|---|---|
| Residential care homes for older people | 84% | 80% | 80% |
| Nursing homes for older people | 81% | 83% | 78% |
| Care homes for adults with learning disabilities and/or autism | 87% | 83% | 83% |
We believe our approach to market support is one of the critical success factors in this. CQC ratings for services in East Sussex, as at June 2024:
| CQC ratings as at June 2024 | Outstanding | Good | Requires improvement |
|---|---|---|---|
| Residential care homes for older people | 1% | 83% | 16% |
| Nursing homes for older people | 5% | 76% | 19% |
| Care homes for adults with learning disabilities and/or autism | 3% | 84% | 13% |
Note the data in the tables and charts relates to the independent sector and not ESCC directly provided services.
Challenges in service provision
Since 2015 there has been a reduction of 1,829 beds in the independent care market in East Sussex due to service closures. In 2023, the market experienced the first net increase in bed numbers since 2015, with a gain of 35 beds.
While a number of nursing homes have closed in the past ten years, the majority of new homes opening in the county offer residential care. Therefore, a key element of pressure in the care home market going forward will be the provision of affordable nursing care.
There is a high concentration of services in the east of the county, which may impact on the number of options or ease of access for people living in the north or west of the county when considering a move to a care home. This may be linked to the prices of land and property in these locations, and the availability of care and support staff.
Messages for the market
- Currently, the supply of care home beds in the market is meeting the demand for services for most service types. However, there is greater supply of care home beds in Hastings, Bexhill and Eastbourne, and this is not the case in the north and west areas of the county.
- We will continue to purchase services within the local authority fee structure for people funded by ESCC.
- There is an increase in demand for people living with complex dementia or who need complex nursing care, and for older age adults with alcohol or substance misuse issues. We recognise the need to explore how we can increase capacity to meet individuals support needs, within our local authority fee structure.
- Please talk with us if you are considering developing, expanding or changing your services, as early as possible in your process.
- We have an approved list of providers who deliver residential and nursing care services for older people. We revised the terms and conditions for this approved list in July 2022 and it remains open to new applications.
- We will continue to maximise opportunities to support recruitment and retention. We have secured continued funding during 2024 to 2025 for two project officers focusing solely on recruitment, who work with providers rated ‘good’ by the CQC. These officers attend community events, job fairs, colleges and offer interview support to candidates.
- We will continue to seek opportunities to work with providers to expand the use of technology and digital solutions. This will include the roll out of the digital social care record.
10. Home care
Over recent years the local authority home care market has been under some pressure – notably around the ability to recruit and retain staff. This year has been unusual because capacity exceeded demand during 2023/24. This trend is reflected in neighbouring and regional areas. There are 2,557 people in receipt of a home care package and we commission around £36m of home care packages per annum. The average length of a home care package is 37 weeks. In East Sussex, our international recruitment scheme (now closed) brought in 250 recruits and approximately 10,000 new home care hours into the market.
At the end of June 2024 there were no home care services in East Sussex rated as inadequate and the percentage of services with a CQC rating of good or outstanding was higher than the national and South East averages.
| Service | East Sussex | South East | England |
|---|---|---|---|
| Home care | 88% | 86% | 85% |
| Service | Outstanding | Good | Requires improvement |
|---|---|---|---|
| Home care | 4% | 84% | 12% |
Messages for the market
- In January 2023, a new home care contract was issued on a ten-year (six years with an option to extend by up to 48 months) basis to give security and assurance to the market and to encourage investment and development. We now operate a model with two lead providers for:
- Hastings and Rother
- Eastbourne and Polegate
- Seaford and Havens
- Each of the remaining six home care areas have one lead provider. This model supports greater resilience as well as supporting choice.
- Home care provision includes a specific contract for home care in HMP Lewes.
- We are committed to working with providers to improve the quality of care.
- Due to market conditions of capacity outweighing demand, there is no requirement to appoint additional providers to the approved list at this time. We therefore took the decision to suspend the re-opening of the approved list to applications for new members during 2024.
- We continue to offer a comprehensive range of free training and development opportunities for home care providers and their staff.
- We will explore options around trusted assessor models of home care, ranging from a traditional model to one enabling providers to reduce, but not cancel, call times.
11. Carers
There are an estimated 69,241 unpaid carers in East Sussex. One in 10 people in East Sussex are unpaid carers.
Caring takes many forms, and many carers do not see themselves as carers. They can remain hidden for a variety of reasons, such as not wanting to be labelled a carer, not recognising themselves as a carer, and not knowing there is support available to them. Unpaid carers make a huge contribution to promoting and maintaining the wellbeing of people in East Sussex.
We work with social care providers to identify carers and recognise them as expert partners in care. We are committed to ensuring care and support for carers is continually developed to meet carers’ needs. Anyone who is looking after someone who can’t manage without their help has the right to a carer’s assessment.
When planning or commissioning services, we undertake an equalities impact assessment (EqIA). This involves looking at how services may affect groups who share protected characteristics. We include carers in our equality impact assessments to make sure any changes that may affect carers are considered.
Messages for the market
- We have a strategic partner arrangement with Care for the Carers who offer information, advice, support, peer support groups, engagement opportunities, counselling, Carers Card (emergency plan, discounts), respite funding for healthcare appointments and training.
- The value of the main contract is £627,766 per annum and we have recently extended the current contract term by two years, to 31 March 2027.
- Our strategic partner has taken on extra support for carers of people with severe mental illness. They also undertake carers’ reviews on behalf of Adult Social Care.
- Small grants funding is now managed through the strategic partner. It delivers a range of carer services provided by other organisations including:
- dementia training
- cookery and arts activities
- support for carers from ethnic minorities
- carer support in hospices
- digital support and
- lunch and supper clubs
- From October 2023, they also took over the commissioning of the volunteer respite service delivered by the Association of Carers, from Adult Social Care.
- NHS funding (currently agreed for one year) has also been added to the contract to provide carer identification and support through primary care in Hastings and the Havens.
12. Technology Enabled Care (TEC)
Nationally there is an increased emphasis on the use of digital technology, including TEC services, to support and improve existing service provision. The adult social care reform white paper ‘People at the Heart of Care’ makes multiple references to the use of technology and using its full potential to support people’s lives and aspirations.
A good quality TEC service is one that provides a reliable, responsive, person-centred service. It should enable its users to live independently and with confidence, while providing peace of mind to their family, friends and carers.
By 31 January 2027 all telecoms are switching from analogue to digital. In East Sussex, we started making changes early in 2023 and they will be completed by the end of 2024.
The East Sussex commissioned service has good uptake with around 8,000 people with care and support needs using the service with monitored alarms. There is little fluctuation in these figures.
The number of new people using TEC stayed the same during the pandemic, but slightly increased in 2022/23. There are currently the same number of people leaving the service as new people joining.
TEC is currently only available to people who meet the Care Act eligibility criteria. The maximum client contribution for new clients increased to £3.85 from 1 September 2023, due to increasing costs.
A series of proof-of-concept pilots have been undertaken throughout 2023/24 to inform future service developments. These include:
- The use of systems that monitor client activity and ability to support social care assessments
- Apps that support people who need help remembering things, making decisions, planning, or managing anxiety
- The use of virtual assistants such as Amazon Alexa
- The use of robotic pets to assist adults with dementia to reduce anxiety
Messages for the market
- The new contract commenced on 1 September 2023. It will run for a period of five years with an option to extend by up to 60 months.
- The annual contract value is £1.705m, with a £900,000 management fee.
- The intention of the contract is to align the current service with the requirements of health partners to maximise benefits to the whole system.
- This includes areas such as links with Telehealth, equipment to monitor activities of daily living and implementing a mobile response service.
- We will implement a new short-term provision service model to provide extra support at the point of hospital discharge. The existing long-term provision service model will continue.
- Greater importance will be placed on using the information from the equipment used in people’s homes. This will improve service delivery and help to explore the use of artificial intelligence and machine learning.
13. Community equipment
Community equipment provides an essential part of health and social care support. It helps people to remain independent in the community. Community equipment helps by preventing, reducing or delaying conditions from getting worse. For example assisting with mobility and balance, preventing pressure sores and preventing falls. Community equipment also helps to prevent admissions to hospital and supports earlier discharge.
The Integrated Community Equipment Service (ICES) covers the process of purchasing community equipment. Including:
- logistics
- delivery
- collections and warehousing services
- electronic and stock management systems
- decontamination
- recycling and
- maintenance
Equipment is provided to assist with daily living needs and can be categorised as follows:
- beds and accessories
- hoists and slings
- bathing
- mobility
- moving and handling
- pressure care
- seating
- toileting
Equipment for children and young people under 18 years of age is commissioned and provided as part of the Children’s Integrated Therapy Service.
The service is available to those who have an ICES eligible need, are over the age of 18 and is:
- an East Sussex resident, or
- living outside of East Sussex but registered with an East Sussex GP.
Messages for the market
- A new contract started on 1 April 2023. It was sourced via a further competition under a Kent Commercial Services (KCS) framework. The KCS framework is a free to access, national framework for the provision of a full range of daily living health and social care equipment.
- The contract value is circa £2m per annum excluding equipment. The equipment budget for 2023 to 2024 was circa £ The service is jointly funded by the NHS and Adult Social Care.
- The contract is for five years with an option to extend by up to 24 months.
- The service provider is responsible for the procurement, delivery, collection, repair, maintenance, decontamination and disposal of community equipment including pressure relief.
- A range of new service developments were included in the new contracts such as developing a trusted assessor model. Trained delivery technicians will complete lower-level assessments for items such as bed and chair raises enabling local prescribers to dedicate more time to complex cases.
14. Housing with care and support
Housing with care and support is purpose built or adapted housing with the availability of up to 24/7 care and support services.
This includes:
- Providing the housing and support older people need to maintain their independence.
- Providing emergency refuge and support for victims of domestic abuse, helping to stabilise their family life and engage with other services.
- Working with homeless people, some with complex and multiple needs, to secure longer-term accommodation or a permanent home, education, training or employment.
- Supporting people with mental health needs when necessary to stabilise, recover and live more independently.
Supporting people with learning disabilities to maximise their independence and exercise choice and control over their lives.
Extra care
We commission six extra care schemes in Bexhill, Eastbourne, Hailsham, Peacehaven, St Leonards and Uckfield. This comprises 228 rental flats. Most schemes have additional shared equity flats, which are purchased from the landlord, making a total of 285.
The extra care schemes enable adults to live independently through assured tenancies and some shared equity flats, where 24/7 on-site care and support can meet changing needs. Four out of the six have Care Quality Commission ‘good’ ratings. Most people with increasing needs stay in extra care.
Care and support is based on the adults individual assessed support needs and in addition, 65 day and 63 night-time background hours are commissioned per week for each scheme to support needs falling outside of the agreed care package.
In exceptional circumstances, the age criteria can be relaxed to accommodate people under 55. Positive behavioural support and other training opportunities have increased in response to the greater number of people with more complex needs.
Messages for the market
- The 285 units provide enough capacity and there are no plans to develop any additional sites. We will continue to monitor supply and demand to ensure services are developed in line with changes in our population and demographic projections
- Services were tendered in 2023 for six years with an option to extend by up to 48 months.
Refuge and support for victims of domestic abuse
We have a legal duty to support victims of domestic abuse and their children living in refuges and other safe accommodation.
Within East Sussex refuges, 80% of people said they had a mental health condition. This is much higher than within the wider population and the rate amongst refuge residents nationally
We are committed to improving the availability of safe accommodation in East Sussex. We recognise there are areas for development and are working on these:
- Working with our current provider, we have sourced four new units of self-contained safe accommodation which are now taking referrals. As the units are self-contained flats, this has increased the options of safe accommodation in East Sussex for those with protected characteristics. Three of these new units are occupied by male victims, for whom there was previously no refuge provision.
- There is currently no specialist safe accommodation in Sussex for women from black or ethnic minorities, although we jointly commission a specialist legal advice service, Hersana, for black femme survivors of abuse.
- The council has introduced a small grants fund during 2024/25 to further increase our support to smaller providers, including ‘by and for’ organisations which support those with protected characteristics who may not find it as easy to access services as others.
- There are two refuge places which are suitable for wheelchair users; one is a self-contained flat. There is a dedicated budget for specialist equipment if needed by deaf people and those with sensory impairments within refuge and safe accommodation.
- Provision for larger families is limited. The largest number of refuge rooms have two beds; eight rooms in Sussex refuges have four beds and there are no rooms in Sussex with five or more beds.
- Our refuge provider can accept women with no recourse to public funds. The authority will meet temporary bridging costs for refuge while Destitute Domestic Violence Concession (DDVC)is claimed, or alternative funding is secured (for example from Children’s Services).
Messages for the market
- Refuge services were recommissioned in 2021 for five years with an option to extend by up to 60 months, from 1 November 2021.
- There will be funding opportunities in 2024-25 for delivery of the Pan-Sussex Domestic Abuse Accommodation and Support Strategy 2021-2024. This includes 24-hour safe accommodation and support for domestic abuse victims with multiple compound needs, and those with protected characteristics. There are localised East Sussex action plans for delivery of the strategy.
- Ring-fenced funding from Government will enable us to increase the number of refuge beds and diversify the refuge services available in East Sussex.
Supported accommodation for homeless people or people at risk of becoming homeless
Supported accommodation supports vulnerable adults and young people who are at risk of homelessness to develop independent living skills. It offers access to keywork support and other services that promote greater independence. Current provision provides support for the following groups:
- Vulnerable adults
- Adults with a mental health need
- Young parents aged 16-25 (pregnant, or with children under five years old)
- Young people aged 16-25 (including care leavers)
- The current contract values total £1.68m
Demand for homelessness services is expected to continue to rise. This is demonstrated by the growing number of people, particularly single, working-aged adults living in emergency accommodation across East Sussex.
While homelessness prevention in relation to housing provision is not an East Sussex County Council statutory responsibility, improving health and reducing health inequalities is. The cohort of individuals supported by this contract have some of the poorest health and wellbeing within the county.
District and Borough Council partners, who have the statutory duty of housing and homelessness, use and value these services, as it assists them in preventing and alleviating homelessness for the vulnerable people in their areas.
Messages for the market
- Services were tendered in 2020 for six years with an option to extend by up to48 months.
- We commission 18 services which provide 238 units of supported accommodation, each catering for a different type of support need.
- There are currently no plans to expand these services however we continue to explore ways to work with our District and Borough colleagues to support work in this area including the development of a shared approved provider framework.
- We will continue to work in partnership with Public Health and the local housing authorities through our Housing Partnership Board.
Supporting people with mental health needs when it is needed, to stabilise, recover and live more independently
During 2022 to 2023 we reviewed provision for people with mental health support needs. We concluded that mental health services would benefit from expanding the supply of unregistered, approved supported accommodation providers for people with moderate to complex mental health needs in rural areas of Wealden, as well as in Lewes, Eastbourne and Rother. Leading into 2024-25 we still require ongoing expansion, particularly for complex and specialist support and would like to discuss this with providers who are interested in joining our Supported Living Approved Provider Framework.
Supported living has had the highest increase in mental health referrals. We aim to increase the current provision by a minimum of 10% in the next year.
Over the last 12 months we have welcomed new providers into the Supported Living Approved Provider Framework and added 35 new placements with a target of 98 by end of 2024.
Messages for the market
- We would like to talk to providers who are interested in developing a 24/7 provision, as well as floating ‘step-down’ mental health and housing related support as part of their service delivery.
- For more complex cases, we want to explore new interventions or service models to support people with autism, young people, and people with drug and alcohol issues.
- Key areas of growth:
- Supporting people with mental health needs to stay in their own homes
- Increasing support for complex mental health needs
Reducing the number of out of area placements by increasing Supported Living provision in some areas, such as Wealden, Lewes, Eastbourne and Bexhill.
- Developing the VCSE market and linking with primary care networks.
- Developing services that can move with individuals as floating support
Learning Disability and Autism Programme
The Learning Disability and Autism (LDA) Programme (previously known as Transforming Care) supports individuals with a learning disability or autism and complex needs who are in a secure hospital setting, or those at risk of being admitted to a secure hospital setting, to transfer into community-based support and accommodation.
The aim of the programme is to enable more people to receive personalised care in the community, closer to home, and reduce preventable admissions to inpatient services.
Messages for the market
- There is a gap in provision in the County for people with particularly complex and challenging conditions. Increasingly we are seeing requests for single-person, bespoke accommodation and packages of care. We are working with our NHS Sussex colleagues on how we can address this gap.
- Largely speaking, specialist mental health forensic provision will need to be secured to meet the needs of individuals who fall within the LDA programme.
- The packages of care required need to meet behavioural and mental health needs. This is likely to include Positive Behaviour Support (PBS), occupational therapy, speech and language therapy, community mental health nursing and medication management.
Supported Living – learning disability
There are 42 providers of Supported Living accommodation in East Sussex, delivering 139 services with 715 beds. In 2023 to 2024 ASCH supported 735 people to access these services. ESCC are currently developing 24 units of supported living accommodation across the county, with the aim of increasing provision for people with learning disabilities with a range of support needs. These are expected to come on stream in summer 2025.
The Council is committed to increasing high quality supported living provision for adults with a learning disability in East Sussex. We believe that local people should have access to high quality support and accommodation within their communities with access to a range of amenities and good transport systems to enable people to be as independent as possible.
Messages for the market
- We would welcome discussions with care providers who are able to increase opportunities to meet the needs of younger adults with learning disabilities and additional needs in East Sussex.
- We would be seeking opportunities to increase supported living provision for people with complex needs and behaviour that require specialist support, including Positive Behaviour Support (PBS) or interventions to maintain people’s wellbeing in the least restrictive way. This includes accommodation that provides a capable environment specific to peoples assessed needs.
- We would like to engage with care providers who offer flexible, person centred and outcome focused care and support. This includes meeting identified needs, offering the individual control in how and when their support is provided, whilst retaining good value for money and within the ESCC benchmark and framework rates.
- Our priority is to engage with care providers who are registered with the Care Quality Commission, have existing expertise in supported living, and who have existing access to accommodation or have partnered with a housing provider.
- We will engage with providers who can clearly evidence that the care and support provision and the housing provision are managed separately in line with the service model.
- Supported living services must ensure that rents are affordable for prospective tenants and that housing benefit can be secured at a rate that makes the accommodation financially viable and therefore provides security to the tenants (under a tenancy).
- We strongly encourage care and support providers to engage with commissioners prior to developing services. Providers that develop services do so at their own risk, however, commissioners will be able to support early discussions to ensure that the proposed model is in line with ASC expectations and commissioning priorities. Developing or building services does not guarantee that the council will use these facilities/services or fund care at levels that do not align with our fee structures.
Housing-related floating support service
The service provides short-term housing-related floating support across East Sussex. It provides vulnerable people, aged 16 and over, with support to live independently. This can prevent homelessness by enabling people to stay in their current home or support them to find new accommodation and start a tenancy.
Referrals are made by ASCH, Children’s Services and the local housing authorities. People aged 60 and over can self-refer to the service. Referrals are prioritised to ensure a needs-led approach and to maintain capacity within the service to respond to any changes in need or demand.
Messages for the market
- We have a Strategic Partner arrangement with BHT Sussex for the floating support service across the county. The contract was let in November 2021 for 5 years with an option to extendby up to 60 months.
- This follows a comprehensive re-design of our housing-related floating support services bringing the previous services for working age adults and older people into a single pathway.
- The value of the main contract is £4,372,615 per annum
- Our strategic partner has taken on extra support through Home for Ukraine funding, offering host and tenancy support and sustainment for Ukrainian guests in East Sussex
15. Advocacy
Advocates in social care are independent from the local authority and the NHS. They are trained to support individuals to understand their rights, express their views and wishes, and help make sure their voice is heard.
The Care Act states that we must provide independent advocacy to those who would have 'substantial difficulty' in being involved in care and support processes and have no appropriate individual who can support their involvement.
Independent Mental Capacity Advocacy (IMCA) and Relevant Paid Persons Representative (RPPR)
IMCAs support individuals who are facing a decision about a long-term care move, serious medical treatment, a care review or adult protection procedures. They cover the role of the relevant person’s representative when there is a gap between appointments and support the person, or their relevant person’s representative, when a standard authorisation is in place.
Messages for the market
- The IMCA service is provided for any person aged 18 years or older who has no one able to support and represent them.
- Most individuals who access this support are people in residential accommodation with learning disabilities, older people with dementia, people who have an acquired brain injury or people with mental health needs.
- We discharge our IMCA and RPPR statutory duty through a pan-Sussex contractual arrangement covering East Sussex, West Sussex and Brighton & Hove. Brighton & Hove City Council act as the Lead Commissioner for the contract.
- The contract has recently been extended until 30 June 2025.
Independent Mental Health Advocacy (IMHA)
The Council has a statutory duty to commission independent mental health advocacy provision under the Mental Health Act 1983 and independent Care Act advocacy under the Care Act 2014.
Messages for the market
- The contract has been extended to 31 March 2025.
- Independent Care Act activity is reliant on referrals from the Council of those people identified as having a substantial difficulty so is outside the provider’s direct influence.
16. Direct payments
There are currently 1,493 adults with care and support needs receiving a direct payment. This is around 28% of the people receiving long-term support in the county. The value of these payments is approximately £8.06 million each year.
We commission three direct payment support services, which support around 800 people. Independent Lives are our Strategic Partner and sole provider of Direct Payment support.
Independent Lives, PeoplePlus and Purple are approved providers to deliver direct payment payroll and managed account services.
The Strategic Partner works collaboratively with the council on ongoing service development, including engaging with people that have lived experience and supporting partnership working with payroll providers, managed account providers and local stakeholders to ensure a holistic service for clients.
Messages for the market
- Our direct payment support services contracts commenced in April 2024 , delivering direct payment support services until March 2029.
- We are aiming to expand the use of direct payments and are exploring the use of Individual Service Funds. This would be a new approach in East Sussex which aims to diversify the way we deliver care and support in the community and people’s homes, increasing choice and enabling greater flexibility in how people receive care and support.
17. Micro-provider development
Micro-providers are individuals, sole traders or organisations that employ less than five people. We believe that micro-providers can play a key role in enabling ASC to fulfil our ‘What Matters To You’ strategy and complement our existing commissioned markets.
The focus on development of this non-regulated care and support market will increase the range of activities and services delivered in community settings that prevent and delay people entering the social care system or into higher levels of support, such as residential care.
Micro providers can offer personalised support, enabling improved outcomes for individuals, deliver financial benefits. They offer value for money with increased opportunity to be innovative to support emerging and future needs. They can be instrumental in building social connectedness, supporting community infrastructure, and growing creativity, resilience, and diversity within the care sector. Importantly they can also address both geographic and service gaps within the care market as well as supporting recruitment and retention in social care.
Our offer to micro-providers includes detailed on-line tools and resources to support the work they do, plus we facilitate engagement events and provide access to a comprehensive free training offer, covering:
- moving and handling, safeguarding and first aid
- specialisms in areas such as mental health, dementia, autism and self-neglect.
- We are also developing an ‘introduction to care’ programme for people new to care who are unable to get this training from an employer. This will cover specific elements such as professional boundaries and lone working.
We are also developing ‘drop in’ events which will be held twice yearly to give micro-providers in East Sussex an opportunity to engage with the council and partner organisations, find out about the support available and network with other providers.
We offer a range of resources to help residents find micro provider support in East Sussex, including:
- The online East Sussex 1Space directory – micro-providers are able to advertise their services free of charge
- The East Sussex Care Services Directory | Care Choices is a comprehensive guide to care, featuring detailed listings of all registered care providers available online and can be posted to people who don’t have access to the internet.
- East Sussex Community Information Service (ESCIS) is a database of community information and events developed and managed by the ESCC Library and Information Service, in association with Brighton and Hove Library Service.
- Independent Lives have a recruitment and training platform, called PA Pages, where Personal Assistants can advertise their availability for work and individuals wanting to employ a PA can advertise their jobs.
18. Day services
Between 1 April 2023 and 31 March 2024, 350 older people used day services. Of these, 180 had primary support needs with memory and cognition.
Demand for day services for older people with a physical disability has seen a slight increase (by an additional 21 people using the services than during 2022/23), however, this is still significantly lower than pre-COVID levels.
Older people’s day opportunities include:
- Day time respite for unpaid carers, people with additional needs, and those with dementia
- Services for older adults
- Enabling people to stay in the community and prevent or delay them moving to residential care
There are currently 297 active contracts for individuals who use learning disability day care or day opportunities. We directly provide three day services – Beeching Park in Bexhill, Linden Court in Eastbourne and St Nicholas Centre in Lewes.
Learning disability services and day opportunities include:
- Building based services
- Community based services
- Social opportunities to maintain independence
- Day time respite for carers
- Support to build and maintain independent living skills
- Work skills and access to employment (supported employment)
Messages for the market
- There are a range of independent and voluntary sector providers of day care services and day opportunities across the county. Services are currently spot purchased based on individual need, eligibility, and choice.
- We are aware that some providers of learning disability day services and opportunities have seen a decline in attendance as a result of the pandemic, whilst others have been able to rebuild occupancy to pre pandemic levels.
19. Working with East Sussex County Council
Commissioning
We have a responsibility to commission care that is sustainable, for the people drawing on care and support services, and for care providers. We are committed to designing and developing services alongside people with lived experience, recognising the improved quality, relevance and efficacy of services where the voice of local people has been central to the design and commissioning process.
Our Strategic Commissioning Framework sets out the East Sussex County Council (ESCC) approach to commissioning social care services and support for adults.
Procurement
ASC have a dedicated team who are responsible for managing health and social care procurement activity. Further information about working with the Council is available at our Doing business with us page, including:
- The Proactis Supplier Network portal where all competitive processes for contracts over £25,000 will be advertised. These include contracts currently under the Public Contracts Regulations 2015, and will be under the Procurement Act 2023. It is also where all competitive processes for contracts under the Provider Selection Regime will be advertised.
- Information on tender thresholds and procurement regulations
- Finance and insurance requirements
You can also find the Annual Procurement Forward Plan (which is finalised annually in March) on the Council’s Portfolio plans page. Please note that these only include contracts over £1m.
More information
Also available are our ASC Providers and professionals pages, including information on:
- Training and qualifications available to people providing care and support
- Safeguarding resources
- Developing support services
- ASC specific information on contracts and purchasing
You can sign up for our ASC provider email bulletin which has articles about workforce, wellbeing, service news, training and development, events and opportunities to ‘have your say’.
For any queries or feedback on the market position statement, email: ASCHcommissioning@eastsussex.gov.uk