Engagement has been a key theme arising from all the research work undertaken. The 2015 project led by Georgia Dedman made significant recommendations in this area. Both providers and officers have agreed that this is still an area that is not working as well as it needs to. We think this is for several reasons:

• A lack of understanding as to what engagement actually means;
• A lack of a clear approach and structure that enables ECC to engage with care providers at the right level (who), the right time (when) and the right place (where);
• When providers and officers do engage, these activities are less effective because:
• There is often a lack of clarity about the purpose of engagement events, their anticipated outcomes and who they are aimed at
• The skills to run engagement events  need strengthening e.g. event design, facilitation and evaluation
• There is an inability on both sides to talk and listen constructively
• There is confusion as to who is best place to lead and facilitate individual engagement events with providers;
• There is a reluctance to identify and commit resources to engagement work
• There is a jadedness about the usefulness of these events, hence attendance is often variable.

Engagement is a term that is applied to a variety of situations when two parties need to share or exchange information and ideas.  However, a lack of understanding as to what kind of engagement is most appropriate, why and with whom is significantly undermining current engagement activities with providers.

In particular, officers need to distinguish more clearly between the need to:

• Just inform care providers;
• Consult providers to seek their views, normally on a range of options or possible solutions/ways forward;
• Participate with providers to maximise shared input into problem solving; and
• Collaborate to identify issues and then co-produce and design solutions together.

Depending on which 'mode of engagement'  is most appropriate, this will determine what mechanism should be used to engage providers e.g. if it is just to inform then it would generally be more appropriate to use emails, newsletters, letters.  If there is a need to be more exploratory (i.e. the precise issue or problem was not clear or the solution unknown) it would probably be necessary to design a one-off workshop that maximised the input of all participants in an open ended way. See also Appendix I.

Once the mode of engagement (inform/consult/participate/collaborate) has been determined, there is also a greater need to understand who needs to be involved, when and where. Too often officers are taking the wrong issues to the wrong provider groups at the wrong time.

Officers (and to a lesser extent providers) need to stop thinking about the care market as a homogeneous whole.  Residential and nursing care, domiciliary care and other types of providers (e.g. for Learning Disabilities, Independent Living) often have differing needs and, therefore, require different types of engagement to find solutions that suit them best.  To aid thinking about 'whom do I need to talk to?' we have already introduced the concept of thinking about providers operating at three levels: owners and directors/care managers/care workers. This recognises that, for example, not much will be gained by discussing commissioning strategies or complex resourcing issues with care workers, but that much will be learnt by accessing their expertise and knowledge to determine, for example, how best to operationalise a new medicine management scheme. Similarly, care owners will want to use their pressurised time on engaging and influencing decisions about pricing and contracting issues, rather than focusing too much of their effort on operational details which are more appropriately dealt with by their care managers.

When to talk to providers has also become an issue.  The research has shown ECC is incredibly poor at planning ahead.  As a result, engagement activities are often arranged at short notice and are not co-ordinated, even when the need to engage with the market is known well in advance.  Similarly, too many engagement events run simultaneously.  For example, at the same time last on the basis that issues related to quality and safeguarding could be progressed through the Tie One Provider groups - see paragraphs 17.14-17.15.

One of the issues that has arisen from this project is the recognition by providers that they are not as well organised to represent themselves as they need to be.  At the moment there are three provider 'associations' in Essex (EICA, CPN and SECHA). In total these have a membership of about 200 providers, although the CPN is more of a networking group so doesn't have members as such.  In advance of this report, and stimulated by this project, there is a proposal for EICA and CPN to merge and for the resulting new organisation to increase its membership to become more of a single body representing the care market in Essex.  This is a welcome development and one ECC needs to support actively.

Over time, if this new organisation becomes suitably representative of the care market, it may become the strategic group ECC works with and can replace the four strategic groups being proposed above. For this new organisation to become representative of the market, ECC would need its Tier One providers to be amongst its members. Until this is achieved, we think there is a need for ECC to meet more regularly and formally with Tier One providers as it is crucial for ECC to improve and foster its relationship with this group.

We also suggest that the provider forums should continue but have noted that these are still not as effective as they need to be. We think the forums will be greatly improved by:

• Being focused more on the implementation and operationalisation of key issues and initiatives, as well as seeking feedback and ideas on what needs to improve;
• Being more directly targeted at care mangers and care staff;
• The Adult Operations Local Delivery Directors having full responsibility for them;
• The compulsory attendance of officers from Commisioning, Quality Improvement, Contracts, Safeguarding and the Service Placement Team;
• Insisting partner organisations (e.g. CCGs and Acute Sectors) attend;
• Being split between residential and nursing, and domiciliary care providers with perhaps a networking overlap session;
• Meeting a minimum of three times a year with the dates being set in diaries 12 months in advance;
• Having a forward plan of items to which providers should be asked to contribute; and
• The notes and actions being properly recorded and distributed, and each event being properly evaluated. 

Appendix J sets out a visual representation of the proposed provider engagement structure for Essex.  On the basis that the arrangements and structures set out above were agreed we would suggest that ECC should limit or stop all other ad hoc engagement events with providers.  Where separate engagement events were considered necessary e.g. those related to procurement activity, these would need to managed and delivered on the basis of the principles set out in this paper.

We have already stated that more thought needs to be given to the who, when and where of officer engagement with providers.  We think another reason why engagement activities are not as good as they need to be is because how these events are designed and run also needs strengthening. We believe there is a need for officers to think harder about 'event design' i.e. content, appropriateness, outcomes, and questions to be asked, and who is best to lead and facilitate the event.  Furthermore, all engagement events should be properly evaluated and any feedback acted upon. We think, therefore, there is a clear and critical need for officers to be upskilled in this area.

Similarly, we think both providers and officers would benefit from developing their listening, talking and questioning skills.  It is suggested that consideration is given to senior officers and key provider representatives undertaking some joint training in this area.

All of the above depends upon sufficient resourcing.  However, as we have noted, there is a reluctance to identify and commit resources to engagement work. A failure to do this is a false economy because ECC is already spending money in this area but it is largely being wasted on badly organised and ineffective engagement work and events.  A clear structure, with properly identified and committed resources, will:

• Create efficiencies and save money i.e. fewer engagement events;
• Improve effectiveness i.e. better quality events, better decision making, etc., and
• Increase attendance i.e. many events are poorly attended due to provider jadedness about their value and usefulness. 

The Provider Engagement and Adult Social Care project recommended establishing a new role of a Provider Engagement Manager to help join up and create a more consistent approach to ECC's engagement work with providers. If resources were found for such a role (and we believe this review has provided further evidence for justification for such a role), it could also be assigned the responsibility for leading on the implementation of this review.