As part of managing the outcomes for the project, at each workshop session three 'Must Haves' were requested from each participant. These were described as being the three outcomes each individual wanted from the Relationship Management project. Attendees were asked to come up with their 'Must Haves' at the end of each session after discussions had taken place. The 'Must Haves' helped to identify those issues people were most concerned about individually, by inviting them to focus and prioritise those issues they wanted to see progressed. They also highlighted what needed to change for people to judge the project to have been successful.

To aid analysis, the 'Must Haves' were written up and categorised, and the results from providers and officers placed next to each other. See Appendix E. The categories were only defined after a large enough response had been received and clear trends identified. It was noted that some responses could have been put into more than one category but, for the purposes of this activity, each one was placed within the 'best fit' following a short moderation process. Some 'Must Haves' were not directly related to improving relationships but could be said to have a bearing on relationships, if not resolved e.g. not paying providers on time. Also, it was rightly observed that the way in which the issues are addressed e.g. good communication and involving providers to improve and develop systems to make the payment process better, could have a direct bearing on improving relationships. It should be noted that fewer individuals from providers attended the workshops, compared to officers, and so there are fewer responses from providers.

From the list of 83 'Must Haves', the three overall areas that were of particular interest to providers and that we would argue would therefore need careful consideration and improving the most were: ? Better cooperation and collaboration;

• More effective meetings, events and communication; and
• Increased market/business understanding.

Officer responses also showed these to be the main areas of importance to them particularly the first two. 

Providers seemed to think there was a knowledge gap amongst officers concerning the care market. We have already seen that there is a perception that officers do not understand the issues some providers face. Similarly, officers didn't think providers understood the difficulties of working for a local authority. One suggestion for the cause of officer knowledge gaps is staff turnover and restructures. It was noted that a lot of knowledge was lost after the last major restructure in 2014.

Providers and officers highlighted 'inconsistent approaches' across ECC, especially in its communication and management of the provider forums. It was noted that the forums are not always very well attended and often ECC 'decision makers' (i.e. senior officers) are not present and that the attendees from the providers ranged from front line staff to owners, meaning some discussion points were not always relevant. It was also noted that very few 'big providers' attended the forums.

The discussions and resultant 'Must Haves' also showed an inconsistent approach to communicating ECC's strategies. This included confusion amongst officers about what the council's approach was to some issues e.g. the use of framework and spot contracts, top-ups and pricing.

Communication between those on the frontline was identified as another issue. Providers are frustrated by response times, particularly from social workers, with it sometimes taking weeks to get a response. The result of which was poor relationships and negative conversations, in addition to it having an impact on service users. Officers felt that, at times, some providers were very defensive and not sufficiently open about when things were going wrong particularly with regard to safeguarding and quality issues.

Other issues raised were providers wanting to be more part of the care 'system' - an equal partner along with Health and ECC. Officers felt this may not always be necessary for all providers but that the focus might be better placed on a few 'strategic partnerships' where these were key to delivering major outcomes or more complex objectives. Where ECC was procuring small volumes of care, or less complex packages of care, it might be better to ensure the transactional relationship was effective and this was key to positive relationships.

A lack of trust and honesty was mentioned, with ECC's 'culture' being partially to blame. Providers felt that officers were sometimes too scared to open up and be honest about issues and stuck with being too rigid when communicating with providers.

Of particular interest from officers was the lack of a clear provider voice. Often at events/meetings officers are subject to numerous provider issues and complaints. With such meetings being held across each area of the county the creation of a 'provider voice' which collates all provider issues and discusses them with appropriate ECC officers on a regular basis was seen as a beneficial 'Must Have'.

It's clear that there is work that needs to be done to improve certain aspects of the relationship. It should be pointed out that there were positives, with some providers saying they had no issues with their relationship with ECC. From this work it appears that resolving a number of 'issues' would be enough to improve the 'relationship' in the short term. Some appear to be easily resolvable so there would be no reason why they could not be actioned. For example, the creation of a contact list / structure charts, including the decision makers. Summary

In summary, focusing on Communication, Collaboration and a Mutual Understanding of each other would cover the majority of 'Must Haves'. These are continuous and long term and if done correctly, the smaller issues would be managed well as a matter of course. We also need to remember that the issues of now will not be the issues of tomorrow and an effective relationship will help ensure we have the ability to manage future challenges more easily.

On a final note, a few discussions highlighted that all sides needed to keep front of centre the purpose of the work we do - to help those in need of care and support. This, it was suggested, was the opportunity to refocus everyone on a common goal to help people move on productively. 

In addition to holding the workshops a survey was also sent to all providers and about 50 officers to complete.  The survey was based upon the 'Catalyst for Change' Workbook devised by the Department of Health/Warwick Insights in 2003. Both providers and ECC officers were asked the same eight questions (see paragraph 10.3) with the provider questionnaire differing slightly as it asked them to score ECC not only as one organisation, but by individual departments.

Each question had a scoring range from 1(low) to 4 (high) with two contrasting statements at either end to define what was 'bad' and what was 'good'. '0' meant the provider/officer had no contact.

Survey - Questions asked:

Providers were asked about the following departments:

Due to a low response from providers, which for some geographical areas was as low as two, the results of the survey cannot be considered wholly reliable when broken down although some of the results are supportive of the finding of other parts of the research carried out.  Overall providers scored ECC 2.23 out of 4.  

A more detailed analysis seems to suggest the following, bearing in mind the low scoring overall and the size of response.  Some of the responses also contradict what had been said in the workshops with providers and ECC officers.

1. Overall the scores were low to mid for each of the questions suggesting providers feel ECC is more transactional, with some inclusion, in its approach to its relationship with providers.
2. Overall, Responsiveness, Managing Conflicts and Understanding Roles and Responsibilities were the areas with the highest scores.
3. Sharing of Information with providers, and Inclusion and Involvement in planning and key decisions had the lowest scoring out of the 8 questions.
4. The Safeguarding Team had the highest overall score, with understanding of roles and responsibilities being their best score.
5. Finance, overall, had the lowest score.
6. Providers based in the North of the county gave the highest scores, scoring particularly high for Responsiveness and Roles and Responsibilities, and clarity of strategic direction.
7. County Wide providers also scored ECC high compared to those providers operating in specific quadrant areas.
8. Providers based in the West were least happy, closely followed by those based in the Mid. Sharing of Information was the lowest score for the West area. The South's score was also low, with inclusion and involvement in planning being the biggest issue.
9. Homecare providers scored ECC marginally higher than Residential providers.
10. Overall small providers scored ECC the highest with Responsiveness, and Roles and Responsibilities being the two best areas for ECC.
11. Directors/Senior managers overall gave higher scores to ECC than both owners and care managers.
12. Providers, whose service user base is between 0-25% ECC sourced, gave the highest scores. Scores were particularly high for Responsiveness, Understanding Roles and Responsibilities and Managing Conflicts.
13. Those with between 25-50% ECC service users gave the lowest scores, scoring particularly low on Sharing Information, and Inclusion in Planning and Decisions.
14. Procurement and Community Agents had the highest number of 'No Contact' responses from providers (an average of 12 per question). Commissioning Officers had an average of 11 'No Contact' responses and Adult Operations Senior Managers 10.
15. AO Service Teams, SPT and Safeguarding had the fewest 'No Contact' responses with an average of 2 per question.
16. Trust, Inclusion in Planning, and How Integrated our Working were questions with the highest 'No Contact' responses.

The officers' responses seem to suggest the following:

1. On average the higher the position an officer held in ECC the lower the score they were likely to give to a question.
2. Overall, having a clear strategic direction was the single biggest issue for officers.
3. Trust was the biggest issue for heads of service and managers
4. Heads of service also saw roles / responsibilities and being responsive as the major issues for ECC.
5. Taking all the scores into account, the Commercial Team scored relationships as the most positive, followed by Adult Operations, and then Commissioning.
6. Overall trust, involvement in decisions and clarity of strategic direction were issues scored the lowest by officers.

We also looked to compare the results given by providers and officers Comparing overall scores, some responses were very similar e.g. Involvement in Planning, Integrated working, Managing conflicts and Understanding Roles.   However, providers were less convinced than ECC officers that the Council shared information well. Officers thought there was less trust between the two parties and also felt that clarity of strategic direction and responsiveness was more of an issue than providers did.

Although the low response causes some issues when comparing across quadrants, some of the results are interesting if inconclusive:

• Providers from the North gave the highest scores for ECC. ECC officers covering the north gave the lowest scores - citing inclusion and involvement in planning as the worst area for ECC;
• Although officers in the South gave the highest scores, with Mid closely following they only account for 2 responses so this can be discounted; and
• Aside from the North, most ECC responses were from officers who covered county wide. For them trust was the biggest issue.