Clarifying roles and responsibilities has been identified as a key 'Must Have' and is generally felt to be a quick win that will help to improve relationships and operational delivery. The recommendation is to provide a list of 'who's who' to support operational working; to clarify the roles and responsibilities for managing relationships with the market; and for providers to map out the key people and organisations it thinks that ECC should be in regular contact with.  It has been observed that providers feel relationships have been negatively affected as a result of ECC becoming too distant, and due to a lack of continuity amongst officers. Whilst it was noted that there is always likely to be a degree of staff turnover, clarifying roles and responsibilities and keeping names of key contacts up to date will help mitigate against the loss of continuity if key members of staff leave the county council. It will be important, therefore, to task someone with ensuring that the contact list is kept up to date and circulated to all providers on a regular basis.

As observed, the single strongest message from other LAs we have spoken to is the need for senior officers to have regular contact with providers.  As part of this, it needs to be acknowledged that this will take time but it is necessary to ensure that the market operates and develops as smoothly as possible.  We think that, currently, there is a lack of clarity with regard to which director(s) have the prime responsibility for managing relationships with providers.  This may be too big a job for one director given the size of the care market in Essex and the fact that relationships need to be attended to at both the strategic and operational level.  As part of the current restructuring of the county council, ECC needs to be absolutely clear which senior managers are responsible for leading the development of positive relationships with the care market; to put these arrangements in place as a priority; and to communicate them to care providers.

The lack of clarity as to who is responsible for leading the relationship with the market has also affected the quality of leadership for setting the overall direction for the market in terms of 'shape' and strategy.  This is a complex area as it encompasses a number of strands related to market shaping that cross over organisational functions i.e. commissioning intent, commissioning delivery, commercial activities (including procurement and contract management).  Increasingly commissioning strategies are multiple, affecting different client groups, and require integration with health strategies, all of which adds a further layer of complexity.

There is currently a lack of a strong, united and visible leadership of the care market.  This needs to come from care providers and ECC working separately and together. ECC needs to show stronger leadership in setting out a clearer direction for the care market and also to suggest how this might be done.  ECC needs to involve care providers and other partners in articulating this vision and, therefore, needs to think about the most appropriate leadership style to do this.  This will require a degree of 'systems leadership' to enable all partners to work together to lead the care system in Essex. 

For their part, providers need to show more leadership in organising and representing themselves better to engage and work with the whole care system. This will help create workable solutions to meet everyone's needs and, in particular, the needs of SUs.  They also need to create more leadership capability to develop stronger peer influence in order to help improve standards and practice. Together ECC and care provider leaders need to be able to drive the whole system, collectively and the parts of it which are their individual responsibility, and to do this with one voice.

It is our view that the lack of leadership of the care market is not just down to role confusion but is also about capability and capacity.  All the relevant senior leaders at ECC need to focus more on the care market working in the ways described above.  In addition, their capability also needs to increase in terms of how best to lead a large and diverse market in the current dynamic and challenging environment. We are inclined to suggest that this capability relates to the ability to lead change better, manage complexity and ambiguity and lead across organisational boundaries.