Market Engagement presentation from Norfolk County Council's Market Engagement session on 7th October 2016.

1. Working together in the changing
landscape of social care in Norfolk:
An invitation to join the conversation
Facilitator: Hannah Miller
September / October 2016
1

2. Welcome and introduction to the workshop
What would be a good outcome for NCC from the
three engagement workshops?
Catherine Underwood
Acting Executive Director, Adult Services
2

3. Meet your facilitator – Hannah Miller
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4. Individual private exercise:
 What would be a good individual
outcome for you from the 3
engagement workshops?
 Are you personally prepared to help
make this an achievable outcome?
4

5. Table Exercise 1
 List the positive ways that NCC and
providers currently work together
 List the issues that are seen to be getting in
the way of improving relationships between
NCC and providers
 Feedback one point from each list
5

6. Headline views from a range of
providers on current issues
effecting relations with NCC
Hannah Miller
6

7. Positive views on joint working (1)
 Past history of good relations to build on
 NCC top management well respected and
responsive
 Understanding of NCC budget position
 Good will despite current problems
 Commitment to good quality care
7

8. Positive views on joint working (2)
 Council’s administration of development
fund
 Extension of consultation period on pricing
 Appreciation of NIC’s past achievements
 Care Awards/Annual Conference
8

9. Issues effecting joint relations (1)
(NCC)
 Relations have become increasingly fractious
 Culture in Council (private – bad, public – good)
 Lack of trust
 Inconsistency in messages leads to disagreements
 Lack of follow through on agreed actions
 Ditto from operational/locality fora
 Commitment to co-production v consultation?
9

10. Issues effecting joint relations (2)
(NCC)
 Poor communication
 Lack of level playing field (Norse
Care/Independence Matters)
 Not happy with pricing uplift
 Not happy with procurement processes
 Small providers being squeezed out
 NCC doesn’t listen and doesn’t learn from mistakes
10

11. Issues effecting joint relations
(Providers)
 Too many provider representative organisations
 Key provider associations do not work together
 No fora for everyone (including arms length
companies)
 Health & Social Care Consultative Forum not
sufficiently strategic
 NIC – concerns re: governance, transparency,
scrutiny and representation
11

12. Table Exercise 2
 Choose a contentious issue which you all
agree is effecting relations between NCC and
providers
 List the actions required from NCC to
improve this issue
 List the actions required from providers to
improve this same issue
 Feedback one action point from each list
12

13. BREAK
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14. What does ‘good’ engagement
between a local authority and their
providers look like?
Facilitator: Hannah Miller
14

15.  What do we mean by engagement?
 ‘In practice, engagement can be considered
as a spectrum ranging from communication
between providers and local authorities, to
working co-productively to improve
services and provision for local people’
Market Shaping Toolkit (IPC 2015)
15

16. A key duty of local authorities under the Care
Act 2014 is ‘market shaping’ which has three
main functions:
• To promote well being of the whole local
population not just those whose care they fund
• To move from being an influencer on the care
market solely through their own purchasing to
one where, with providers, ‘it seeks to shape,
facilitate and support the care market’
• To ensure that continuity of care is maintained
for people in case of provider failure
16

17.  Engagement with providers can no longer be a ‘nice to
have’ or ‘a tick in the box’
 Good mutual engagement is a pre-requisite of ensuring
a sufficient supply of good quality care for those that
need it
 Local authority has to be clear what providers need
from it in order to be able to innovate and provide high
quality, locally appropriate service
 Engagement has to be much more than providers
receiving information from the local authority
 Providers should be alerted to future trading
opportunities
17

18.  Providers can give input and expertise on a range
of issues from unmet service user needs to
improving quality
 Mutual sharing of information and experience on
new guidance or regulations and developing a
common understanding around how these work
 Local authorities should share information about
cost assumptions and the rationale for fee and
contract decisions
 Providers should share information about costs,
profit margins and the terms and conditions of staff
18

19.  The key driver for delivery of the Care Act
‘market shaping’ duty is the Market Position
Statement
 Best practice is co-production of the MPS
with service users/carers and providers
 Case example is the Manchester Area
Partnership (Manchester/Trafford/Stockport)
which is seen to demonstrate genuine co-
production between commissioners,
providers and local people
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20. Market shaping can be seen to have three
stages – all of which require engagement with
stakeholders
• Market Intelligence (understanding supply
and demand)
• Market structuring (planning for change)
• Market intervention (taking any necessary
action)
20

21.  Real gap in the rhetoric of engagement in many
areas
 Reduced capacity of both local authorities and
providers due to austerity measures
 New challenges to relationships emerge as others
are sorted out
 Foundation of good engagement is building mutual
trust and understanding with relationships between
commissioners and providers seen as open,
honest and respectful
21

22.  Three core perspectives need to come together
(People/Providers/Commissioners) for co-
production
 Easier said than done!
 Stronger partnerships for better outcomes: a
protocol for market relationships (TLAP 2012)
provides ‘a set of principles and behaviours
that will enhance the environment in which
good adult social care and support is
developed and sustained’
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23.  Relationships require nurturing
 Good starting place for rebalancing relationships
prone to conflict is to recognise and build on what
each do well
 Principles of good engagement underpinning the
protocol are:
 Sharing risk
 Reducing bureaucracy
 Building capacity
 Understanding success
23

24. Key behaviours for commissioners (1)
 Understand the market for self and state funders
and develop an MPS with service users and
providers
 Understand financial pressures on providers and
facilitate honest conversations on cost and spend
 Ensure mechanisms in place to embed co-
production
 Create conditions for positive engagement with
providers of all sizes
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25. Key behaviours for commissioners (2)
 Ensure there is joint understanding of quality and
how it is measured and assured
 Develop a shared understanding of outcomes and
how these relate to commissioning and contracting
 Incentivise innovation and support market diversity
 Develop the workforce and enable stakeholders to
understand each others roles, responsibilities,
drivers and risks
 Work together with providers to find positive
solutions to problems
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26. Key behaviours for providers (1)
 Understand key pressures commissioners are
under and be prepared for honest conversations
about costs and value for money
 Be an active partner in developing an MPS and say
what works in providing support
 Ensure mechanisms to embed co-production in
service development
 Take up opportunities to engage with
commissioners and other stakeholders
 Engage in local planning and respond to market
needs and changes
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27. Key behaviours for providers (2)
 Understand what quality means and how it is
measured and assured
 Develop a shared understanding of outcomes with
commissioners
 Take opportunities to collaborate with other
providers in tendering processes
 Develop the workforce and market social care as a
vibrant and diverse sector to work in
 Work together with commissioners to find positive
solutions to problems
27

28.  Market Shaping Toolkit (Institute of Public Care
2015) provides top tips on how local authorities
and providers should positively engage
 It contains a self assessment exercise for local
authorities to gauge how well they are doing in
provider engagement and to help develop an action
plan for improvement
 Additional tips include the local authority providing
free training across the sectors and additional
support for micro providers seeking to become
sustainable
28

29. What might joint agendas look like where
there is real engagement? (1)
 How can providers input into policy?
 How does the MPS take provider views into account?
 What sector specific information would be useful for
new/expanding providers?
 What financial information, advice and guidance is
available to service users and their families?
 Can providers/local authority share training delivery?
 How can standards improve at a time of cost pressure?
29

30. What might joint agendas look like
where there is real engagement? (2)
 Do staff have skills needed for now and in the
future?
 What workforce planning is needed across the
sector?
 How can we share best practice innovation?
 How do we measure and assure quality?
 What information is needed on-line and via social
media?
30

31. Resource List (1)
 Building constructive market relations Oct. 2010
http://www.ipc.brookes.ac.uk
 Commissioning for better outcomes 2015
https://www.adass.org.uk
 Market shaping toolkit June 2015
http://www.ipc.brookes.ac.uk
 Market shaping review: what is market shaping July 2016
http://www.ipc.brookes.ac.uk
 People not process – co-production in commissioning and
market shaping http://www.thinklocalactpersonal.org.uk
 Promoting good provider forums July 2011
http://www.ipc.brookes.ac.uk
 Stronger partnerships for better outcomes: a protocol for market
relations 2012 http://www.thinklocalactpersonal.org.uk
31

32. Table Exercise 3
 What kind of formal strategic engagement
structures would you like to see going forward
to enable NCC to have the widest possible
dialogue with all providers?
 What kind of operational fora would you like to
see going forward to deal with day to day and
more practical levels of engagement?
 What other key stakeholders would you like to
see involved in any revised arrangements and
why?
 Feedback a key point on each
32

33. Headline views from a range of
providers on changes they
would like to see made in order
to maximize provider
engagement with NCC
Hannah Miller
33

34. Foundations for improved relations
 Clear, trustworthy leadership (NCC +
Providers)
 Clear commitment to work together
strategically
 NCC to commit to real co-production
(engaging providers, NHS, voluntary sector
and service users/carers)
 Provider organisations to work together in
harmony
34

35. Suggestions for change (1)
 NCC to differentiate between the business models
of small providers v large companies
 NCC to review their tendering and financial models
 NCC to use the market with less protection of arms
length companies
 More transparency about business expansion
plans of the arms length companies
 Investment in training across the sectors
35

36. Suggestions for change (2)
 Improved and consistent communication with
providers
 More information about new ways of working in
social work (strength based, outcome focused)
 More clarity about specifications of projects before
inviting bids
 Continue locality/operational meetings but with a
clear remit, senior staff in attendance and timely
follow up on agreed actions
36

37. Improved structures for engagement
 Engagement needs to be simplified
 Engagement should be more proactively led by
NCC
 New model required for real inclusive
representation with full buy-in from the
independent sector
 One umbrella provider association with transparent
governance and accountability
 Provider representatives to be all elected
 Agenda to be set together
37

38. Invitation to participants from the
floor for comments/offers to
actively engage in further
conversations
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39. Next steps: how will NCC take the
ideas and views of workshop
participants forward?
Catherine Underwood
Acting Executive Director, Adult Services
39

40. Summary and close
Thank you and safe journey
home or back to work
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