We suggest that both providers and ECC give consideration to agreeing and implementing the following recommendations.

• On the basis that providers and ECC have agreed in principle to work more closely together in the future, it is recommended that they make a formal agreement to do this and agree a set of principles to help underpin how future working.
• If this way forward is agreed, it is recommended that both providers and ECC explore how they can ensure the majority of providers and all relevant officers sign up to these principles and ensure they are fully enacted.

• It is recommended that providers and ECC develop strategies and approaches that will help rebuild trust.  We have suggested a model to help build trust (see Appendix G) but we would encourage providers and ECC to explore other ways of rebuilding trust over and above what is being recommended in this report.

• Providers and ECC have agreed there is a need to develop more strategic partnerships.  However, we have observed that there is a lack of understanding as to what this might mean and how these might be achieved.  We have suggested a model and process for developing strategic partnerships (see Figure 10, page 19 and Appendix H). It is therefore recommended that in the first instance, ECC decides where it wants to develop strategic partnerships with the providers, and to put forward how this might be done, noting we have cited a lack of knowledge and skill from providers and ECC in this area.  To this end, we are also recommending that thought should be given to establishing a small number of 'pilot' strategic partnerships to help test and evaluate new models of partnership working so that the lessons learnt may be applied to other partnership arrangements in the future.
• It is recommended that the establishment and development of any strategic partnering arrangements should be done openly, paying due regard to procurement rules and not implemented at the expense of maintaining and improving other more purely transactional relationships with providers which need to improve.
• It is recommended that providers should increase their ability and skills to partner more effectively with ECC and other organisations in the care system and ECC should enable providers to do this.
• In order to measure the health and development of relationships between providers and ECC, it is recommended that the survey is repeated annually but noting there is a need for a greater response rate from providers to make it more reliable. Providers should take more responsibility for ensuring a greater number of responses are returned.

• It is recommended that the formal structure for engaging with providers as set out in paragraphs 17.7-17.17 and Appendix J, including the creation of two new strategic groups as outlined and is adopted and implemented with immediate effect.
• As part of implementing, it is recommended that ECC supports the reenergising of the EESB Care Sector Group and ESAB Safeguarding Group.
• It is recommended that ECC supports the proposed creation of a new care provider association in Essex subject to further discussions that should be concluded by the end of  December 2016.
• It is recommended that until the new association becomes the key representative group of providers in Essex, ECC should consider meeting its Tier One  providers on a more formal and regular basis every three months.
• It is recommended that the provider forums should continue but in the way suggested.
• It is recommended that a forward plan is developed and maintained for all provider engagement activities.
• On the basis that recommendations are agreed, it is recommended that ECC should limit or stop all other ad hoc engagement events with providers.
• It is recommended that ECC gives consideration to offering training to officers that are regularly involved in engaging with care providers and, as part of this, identifies and develops a number of 'super facilitators' that can be deployed to advise and lead engagement events with providers.  It is also recommended that consideration should also be given to offering this training to a number of provider representatives as well.
• It is recommended that consideration is given to senior officers and key provider representatives undertaking some joint training in the areas of, listening, talking and questioning.
• It is recommended that ECC develops a proper resourcing plan for care provider engagement work, knowing that such a plan is likely to save money and as well support the achievement of a more mature and overall stable care market. This resourcing plan should give consideration to establishing a new role of provider engagement manager.

• It is recommended that a list of 'who's who' is published and kept up to date to support operational working; to clarify the roles and responsibilities for managing relationships with the market; and to set out the key people and organisations that providers think that ECC should be in regular contact with.
• It is recommended that an owner is assigned to keeping the 'who's who' list up to date and circulated to all providers on a regular basis. This first list should be published by January 2017.
• It is recommended that ECC needs to determine who has the key responsibility for leading and managing the overall relationship with the market.

• It is recommended that ECC, working with providers, needs to think and agree as to what would be the most appropriate leadership style to lead and develop the market and to ensure the designate care market leader(s) have the necessary skills to do this. 
• It is recommended that that care providers focus more of their leadership effort on organising and representing themselves better to engage with ECC and to work better with the whole health and care system.
• It is recommended that providers need to create more leadership capability to develop stronger peer influence in order to help improve relationships, standards and practice.
• It is recommended that that ECC needs to increase its leadership capability in order to be able to lead the large and diverse market that exists in Essex more effectively, taking into account the current dynamic and challenging environment. We have suggested that this is something about leading change, managing complexity and ambiguity and being able to lead across organisational boundaries.

• It is recommended that ECC needs to provide much greater clarity about the direction and future shape of the care market and needs to actively involve providers in these discussions. This direction needs to clarify its commissioning intentions; articulate how this will impact upon providers; and set out what the commercial opportunities might be available for providers.
• It is recommended that there is a need for providers and ECC to examine more closely their performance expectations and to bring a greater level of understanding and sharpness to what is considered achievable in the current environment.
• It is recommended that ECC needs to clarify and help providers understand how fee levels and pricing mechanisms are determined, and to give assurances that they are being applied equitably. 

• It is recommended that Adult Operations Local Delivery Directors give full consideration to the findings and recommendations in this report and work with their providers and service teams to agree what actions need to be taken forward to improve relationships on the basis of the issues.