The survey results, supported by other evidence collected as part of this project, suggest very strongly that the relationship between ECC and providers is currently more transactional than collaborative, and is certainly not inclusive. As we have already observed, there is a clear lack of information sharing which has fostered a low level of trust, thereby reducing the capacity to partner effectively. Despite this, vast majority of providers and officers we have worked with on this project have stated a clear desire to work together more closely. Conversely, however, whilst contracts and contractual relationships are necessary these were often seen as an inhibitor to progressing joint working.

Essex has a large and diverse range of providers. Within this range there are very small and very large providers, local and national organisations and private as well as not for profit companies.  This undoubtedly has some benefits, but represents a significant challenge when trying to contract and collaborate with so many different types of providers in a rapidly changing and demanding environment.  The capacity, or indeed the desire to partner (i.e. to move beyond a purely transactional relationship) with all providers, was not considered practical or necessary by most providers and officers involved in this project.  Instead, although there was a clear willingness, need and desire to encourage more collaborative working, it was felt by both sides that any partnering arrangements would need to be proportionate and appropriate for both ECC and providers.

As a result, it is anticipated that most contractual relationships will continue to operate under either a framework or spot contract arrangement. For framework contracts, providers will continue to be grouped by level of spend and importance to business need based on three tiers. Tier One providers would continue to have a named contract manager. Alongside this, there is now an emerging view that it will be increasingly necessary to develop agreements beyond these frameworks to help develop different and closer ways of working based on a higher degree of collaboration and partnering.  This is likely to be with providers that are more 'strategically' important because of: 

• The number of SUs they support;
• Their importance in developing new ways of working related to innovation and integration;
• The role they play in providing specialist services;
• The need to join-up different client groups with single providers; and
• The need to promote more locality/neighbourhood based working.

As yet it has not been specified what this 'partnering' might look like in practice, other than the development of much closer working arrangements based on a higher degree of collaboration and risk sharing.  It must be stressed that developing new partnerships would not be at the expense of commercially disadvantaging other providers, nor would it suggest that other relationships and responsiveness to all providers would become less important.  Indeed this work has shown that, transactionally and operationally, ECC needs to be much more responsive to all providers when required. In this sense the ability to ensure a small provider: is paid on time; knows where to go to discuss a safeguarding issue; and knows who to contact to raise an issue of policy or practice, will be as important as large providers being effectively engaged in a new service model that may require them to operate differently.

The ability to partner effectively is an issue that has arisen consistently during this review.  Some of this is about issues touched upon elsewhere in this report e.g. the desire to work together, trust, clarity of direction and leadership.  Fundamentally, however, for both sides to be able to partner more effectively there is a need to agree and understand what partnering might look like in a complex and highly regulated system.  In reality, partnering between providers and ECC would probably also need to involve other organisations such as CCGs, hospitals and voluntary groups.

The survey questions offer a model of how to improve partnership working by advancing five elements that underpin effective relationships, greater joint working and integration. Figure 10 summaries this model and Appendix H gives a fuller understanding of how this approach works. In essence, as well as being a diagnostic tool, the survey can also be used to help partnering groups to discuss and identify what actions they might take to improve working together to progress integration, and also to help them assess their success.

On the assumption that the recommendations in this paper are taken forward, it is suggested that the survey is repeated annually as an objective measurement of how much relationships have improved.  However, a much larger response rate would be required to ascertain with more certainty whether relationships are improving and what some of the specific issues might be.  A larger response rate will also allow for the better identification of issues by provider type, geographical area, officer seniority and operational teams.