A case study of a council and place that scores higher in this aspect
Our relationships have taken a lot of work to get where they are today. We had a legacy among lead members and senior NHS executives of some highly volatile and difficult individuals, failed attempts to engage with and form a coalition of the voluntary and community sector, tough provider negotiations, and a tradition of commissioners who were very good technically and delivered mostly good processes, but didn’t engage much with individuals outside of the formal processes. There was a feeling that everyone was trying to pass on costs to everyone else, and trust was low.
Things started to change with a new political leadership which coincided with several senior leaders moving on. This offered an opportunity to address and reset some of the resentments that still simmered. We started to build a new outcomes-focused plan as we entered into ICS planning and held a facilitated session which encouraged us – in a safe way – to air all those old opinions about each other. Although that was not comfortable, we found it was safe, and important, to do, and set a new tone.
The real breakthrough was joint locality visits – we went jointly (social care, health, and political leaders) to engage with staff and citizens in various places, and to hear people’s experience of our care system first-hand. That was very powerful and led to things like people with experience on our decision-making boards and regular back-to-the floor and mystery shopping exercises which have helped to keep us all focused on the big picture. That does not mean there have not been some really strong disagreements, but those have more often been useful than destructive. We are really focused on broadening beyond the ICS plans to include coproduction, providers, community groups, and other parts of the council and public services who can help.
We eventually learned that all the credit we gained with providers with really good up-front engagement was lost with a very stiff and formal procurement process – which presented providers with a fait accompli after all our talk of partnering and coproduction – and then weak contract management, even when they were coming to us with innovative ideas. We are working on that now, and that involves building a much better partnership with procurement and commercial colleagues.
A case study of a council and place that scores lower in this aspect
We thought our relationships were good, but now I don’t think that’s true. We have a place-based plan, part of our local strategic partnership, which is based on place-based data, but while everyone comes to the partnership board meetings, we have realised that agreement in that meeting does not mean that partner services change in line with this and that people working on the ground do not know about the plan at all.
A recent resident door-knocking exercise (following on from our experience during Covid) suggested that our understanding of vulnerability and care needs in our strategic documents might not be that accurate. We created a provider forum, but that got bogged down in price discussions and attendance is really low now. We also tried to do community engagement with ward-based ‘town hall’ meetings but they became a miserable experience that officers try to get out of attending, dealing with complaints and negativity.
We have realised now that we do need to do something about this, and that commissioners are quite well-placed to have an influence, so we are working to connect – through listening to suppliers, citizen groups and frontline care workers, at first. And the Mayor has set up informal networking before the strategic partnering meetings. We know there is a lot of work to do on this!
Equality and equity considerations with this aspect
Good quality relationships allow the challenging of issues to be done safely. They need to be built for the long-term and embedded, for inequality to be challenged and overcome. Relationship-building must consciously include formerly-excluded groups, if it is to be valuable. Commissioners and systems need to be aware of the risk that a focus on building relationships can reduce the willingness to challenge norms and problematic issues.