22nd March 2017 Dr Simon Willson Right Time…Right Place…Right Conversation: Improving the Relationship between Essex Care Providers and Essex County Council 22nd March 2017 Dr Simon Willson

Structure for Today Background to Essex Why and How We Did the Review Findings Reflections 2

Part 1: Brief Background to Essex

The market in numbers… Residential: 464 services registered as care homes in Essex (excluding Southend and Thurrock) providing 12,977 beds 15 homes (12%) on the framework are not honouring their prices 390 providers of domiciliary care to ECC 60% of current placements are made using spot arrangements. 400+ placements in the last year have taken considerable time to source via the Unmet needs process. 40% of unmet needs packages are as a result of capacity issues within the market 32% of unmet needs packages are as a result of location 1 in 4 vacancies/79 registered manager vacancies  

The market in numbers… 17,000 service users In ten years the OP population is expected to grow by 24.67%, while the whole population is only expected to grow by 8.9% 2016/17 £45m gap. £60m gap in 2017/18 (£400m spend overall) 79% providers rated good or above by CQC (regional leaders/2nd in nearest and dearest) National Patient Strategy Award winner for Prosper  

The market in words ECC adopts a traditional approach to the market, this includes standard framework and spot contracts Commercially led An agreed quality and improvement strategy to raise standards in the market An emerging workforce strategy - Essex Skills Board Undertaken a cost of care exercise with the market to understand true costs Integration is slow Market does not represent itself well

Part 2: The Why and How

Why A Perception that Relationships Were Getting Worse The Care Act and Shaping the Market  Pressures Quality Improvement Work

Project Aims Understand why relationships had worsened Understand how both parties perceived each other Assess the appetite for working together in the future Clarify what people thought must change to make them feel the project had been successful (what became known as the ‘Must Haves’) Identify areas for improvement Suggest how these improvements might be made.

Methodology A written questionnaire completed by officers and care providers 7 workshops sessions (5 with officers and 2 with providers) A benchmarking survey completed by 6 local authorities in the East of England Telephone discussions with some of ECC’s larger care providers Discussions with other local authorities Discussions with national provider organisations UK Home Care Association (UKHCA) and Registered Nursing Home Association (RNHA) and with local authority based care provider organisations in Devon, Hertfordshire, Norfolk and Surrey.

Methodology Published report for feedback (not consultation) whole market Agreed with directors and briefed lead cabinet and published and then into ‘governance’ CEO interest Importance of independence - me and Colin and Ian Some big providers missing Kept away from ECC project and governance

Part 3: Findings

Headlines 4 ‘Themes’ 7 AFIs 29 individual recommendations (suggested solutions for many)

4 ‘Themes’ Areas Trust and Partnering Leadership Engagement Operational

7 AFIs

Current Progress ECA created (considering funding) 29 Nov and 26 April ‘strategic’ event Shadow strategic group to support market shaping strategy work Clarifying roles as part of restructuring Proposed ‘market relations team’ within in a full commissioning function in Adults

Part 3: Reflections

Leadership Who leads – from both sides? Do they have the: Will/appetite? Skills? Time? It takes time Providers value organ grinders not monkeys Keep a high profile as officer lead Leadership of ‘hope’

Engagement – who, what and how? What is meant by this – the ladder of participation? Roles and responsibilities – who does what and do they have the right skills? Who do you need to talk to, what about and how often?

Partnering What is meant by this? Who needs to partner with whom and why? How does partnering actually work and how is it assessed? The importance of trust and honesty Understanding - different perspectives and needs Dialogue Valuing each other

Last Thoughts Its not rocket science, but…. Hard environment to build positive relationships - what is the alternative? Requires effort – appetite, ambition, desire Needs to give both sides what they need, as well as the mutual gains? Different motivations from the market: some just commercial others more vocational – needs sophistication. But, there are businesses Providers want to be valued - frightening world out there: CQC, money reducing, attracting staff. They are human. Respected as an equal partner not a ‘poor relation’ …. And one more thing

If nothing else….stick to the knitting!