ECC is a large local authority and represents a very diverse community with differing educational, health, housing and economic needs. There are 16,700 older people (OP) services users and 3,700 adults with a learning disability in Essex.

Essex has a higher proportion of over 65s than England (20% vs 18%). In ten years the OP population in Essex is expected to grow by 24.67%, while the whole population of the county is only expected to grow by 8.9%. Currently the OP population accounts for 55.4% of all population growth in Essex (2015-2025) and 67% by 2035.

There are 464 services registered as care homes in Essex (excluding Southend and Thurrock) providing 12,977 beds and 450 providers of domiciliary care to ECC. The domiciliary care market is under the greatest pressure with insufficient capacity in the market to meet demand.

The care market and ECC's approach remains largely traditional and risk averse and operates in a challenged health economy that is complex due to its size and the way it is organised.

The Methodology

A mixed methodology was devised to identify current issues and find solutions to improving relationships between providers and ECC. The methodology also looked to test the perceptions and feelings both parties had about each other, as well as bringing a focus on learning from best practice. 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 officer and 2 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 Suffolk and Surrey.

Recognising the importance of involving providers in the project, a core group of providers was established on a voluntary basis to 'guide' the project and to give detailed input into issues as they arose. Appendix B shows those providers who volunteered for that group. This group met four times throughout the life of the project culminating in a joint workshop with senior officers on 10 October 2016.

The project was underpinned by standard project management practices and an impact model - see Appendix C. Specifically, the project 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.

The project did not look at issues such as the cost of care, payment of invoices and safeguarding practices i.e. issues that can greatly affect the quality of relationships although these were raised as issues by providers as examples of things that undermine trust and mutual respect.

Concepts

Each of the workshops held with providers and officers looked to establish some conceptual understanding of what might be required to improve relationships. In particular, addressing the need to attend to both infrastructure changes as well as changing the 'mood' around relationships - culture change. Both sides were encouraged to realise that one could not be achieved without the other and that the culture change required was likely to prove harder to deliver. This was represented as follows:

Similarly, the need to examine, and distinguish between strategic and operational relationships, was also introduced early on as a concept.