In 2016 ECC produced a report on its relationship with Adult Social Care providers. The content of this report is below and we have added a section about the actions ECC has taken to date. We are committed to building relationships with our providers and welcome any feedback - ContractManagementAdults@essex.gov.uk

A project was undertaken between May and October 2016 looking at the relationship between Essex adult social care providers and the county council. It arose out of a previous project looking at the quality of the care market. The project specifically set out to:

• Understand why relationships had worsened;
• Understand how both parties now perceived each other;
• Assess the appetite for working together in the future;
• Clarify what people thought must change to make them feel the project had been successful (what became known as the 'Must Haves');
• Identify areas for improvement; and
• Suggest how these improvements might be made.

A mix of qualitative and quantitative research methods were used, drawing data from several different sources:

• A written questionnaire completed by officers and care providers;
• 7 workshops sessions (5 with officers and 2 with providers);
• A benchmarking survey completed by 6 local authorities in the East of England;
• Telephone discussions with some of ECC's larger care providers;
• Discussions with other local authorities; and
• Discussions with national provider organisations UK Home Care Association (UKHCA) and Registered Nursing Home Association (RNHA) and with local authority based care provider organisations in Devon, Hertfordshire, Norfolk and Surrey.

Recognising the importance of involving providers in the project, a core group of providers was established to 'guide' the project and to give detailed input into issues as they arose. This group met 4 times throughout the life of the project, culminating in a joint workshop with senior officers on 10 October 2016. 

There were four factors that led to this work being undertaken.

A Perception That Relationships Were Getting Worse

There has been a general sense that some relationships with providers have deteriorated in the last two years due to the current financial climate; the retendering of major contracts; the cost of care exercise; the lack of clarity around the future shape of the care market in Essex; and the extent to which the current ECC structure has displaced care providers from Adult Operations.

The Care Act and Shaping the Market

The Care Act requires local authorities to help develop a market that delivers a wide range of sustainable and appropriate high-quality care and support services for users in their communities to choose from. This will not be achieved without providers and ECC working in partnership based on more integration and mutual collaboration. These new ways of working cannot be achieved without good communication, mutual trust and greater openness.

Pressures

There has been a steady increase in the pressures being placed on the whole care system due to increased demand, acuity and the overall reduction in resources. This has manifested itself in a reduction in capacity and concerns about quality and the overall ability to maintain and sustain a vibrant care market in Essex. There is also growing evidence that providers are starting to withdraw from local authority work because it is not financially viable.

Quality Improvement Work

Issues affecting relationships between care providers and ECC emerged as a significant issue when work was undertaken to look at care provider quality during 2015-16.1 As part of developing the strategy for improving quality, relationship management became one of the four building blocks to improve quality and drive transformation and integration:

A wide ranging set of issues were uncovered that were seen to be inhibiting effective relationships between care providers and ECC. These were explored in some detail with care providers and officers as they emerged and led to a consensus view as to what needed addressing and why.

Trust and Partnering

Rebuilding trust was a seen as an important issue that needed tackling in order for care providers and ECC to be able to build stronger relationships and to develop new ways of partnering. Better partnering was seen as crucial to driving integration and responding to the Care Act as well the current financial challenges. Both sides acknowledged that they lacked a shared understanding as to what this partnering might look like and questioned whether they had the necessary skills to make it happen.

Leadership

Leadership was identified as an issue for both care providers and ECC. For care providers this centred on their ability to be able to organise themselves better, be more representative in their engagement with ECC and create sufficient leadership skill and capacity to lead their sector in order to be able to respond to the challenges that lie ahead.

For ECC the leadership challenges were identified as being:

• The need to shape the care market more effectively;
• Clarifying which director(s) had the responsibility for leading the market given it requires a cross-organisational (i.e. adult operations commercial, commissioning, skills and economic development) and a systems wide (i.e. Health, housing, voluntary and community sector) approach; and
• Developing sufficient leadership capability to lead the market i.e. an understanding of what type of leadership style is required; do the leaders have the right leadership skills to lead the market; and are they given sufficient permission and capacity to work with the care market in the way that is required.

Engagement

The review showed quite clearly that ECC has an insufficiently developed infrastructure to support effective engagement with its care market. The elements that needed developing were identified as:

• A robust structure to support engagement work with the market;
• Creating a greater understanding as to what engagement actually means; and 
• The skills (on both sides) to be able to talk and listen to each other more constructively.

Operational

The review highlighted that day-to-day relationships have also become strained and there was a need for operational teams to respond to the findings of the review and consider how they could develop stronger relationships, particularly with care managers and care workers in order to support better operational working. 

Out of the main findings of the review, 7 areas for improvement (AFIs) were identified:

Subsequent discussions of these areas lead to the development of 29 specific recommendations (see Part 4) and a number of suggestions on how some of them might be taken forward.

Although the review has highlighted that there are a large number of areas that need improving on, the comparative work suggests that Essex is not untypical in this area. Nor should the outcomes of this review detract from the fact there is already a considerable amount of effective working going on between care providers and ECC. 

However, we think the window of opportunity to make the changes required is limited because of three reasons. Firstly, hope and expectations have been raised by this review and some good will has returned to relationships between providers and ECC. This needs to be built upon quickly to re-energise and give further hope that both sides do want to find better ways of working together; secondly, the recent merger of EICA and CPN is a welcome development but must be seized upon to make it a success and to support the development of a single provider voice in Essex. This will greatly enhance engagement work and provide a stronger platform for driving change and integration; and, thirdly, if through improved relationships life is not made easier for providers, they will increasingly walk away from LA work and this will reduce capacity further, drive up costs and push down standards of care.

We believe the majority of providers and officers do wish to move forward from the current situation. However, we are quite clear that this will require drive, focus and effort from all parties. This will need to come from the leaders of both sides, building on those providers and officers that have already been instrumental so far in bringing this project to fruition. Initially, we would encourage incremental steps in order to rebuild trust and ensure whatever joint actions are agreed to take forward first, are delivered successfully in order to build more confidence and energy to make Essex the model others want to follow.

Responses to this consultation are very much welcomed. They can be sent via email ContractManagementAdults@essex.gov.uk or in writing to:

Contract Management Adults
Essex County Council
E1 County Hall
Chelmsford
CM1 1QH

The authors of this report would like to thank all those providers and officers that contributed to the review. We would particularly like to acknowledge the honesty and openness shown by all parties. We would like to specifically acknowledge the support given by the 'core group' of providers that gave up a lot of their time to support this review as well as Colin Angel and Ian Turner who helped to provide an invaluable national perspective to this work.