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Commissioning relationship-centred care in Essex: An evaluation

How can local authority commissioners work with the care home sector to ensure older people consistently receive high-quality, relationship-centred care?

Care homes are under scrutiny as never before and a series of failures have tarnished the reputation of the sector as a whole. Financial pressures affecting local authorities are influencing commissioning decisions, as well as relationships between commissioners and providers. In spite of these difficulties, there are some positive signs of change.

Essex County Council (referred to here as ‘Essex’) has developed its own distinctive, quality improvement programme based on the social movement My Home Life (MHL), which aims to improve quality of life in care homes. The Joseph Rowntree Foundation commissioned NDTi to evaluate the approach and early signs of progress in Essex. This evaluation focused on the implementation and outcomes of the ‘My Home Life Essex’ programme, a framework that was introduced to improve the relationship between commissioners and care home providers, and enable care home managers to focus on providing relationship-centred care in the face of increasing financial pressure and changing demands.

You can view or download a summary of the JRF report Commissioning relationship-centred care in Essex: an evaluation or the full final report by selecting your option from the download report tab on the right hand side of this page.

The study found that:
• the support networks put in place for care home managers through My Home Life Essex resulted in better quality commissioning and an increase in managers’ ability to motivate staff to provide relationship-centred care to residents;
• positive changes in the relationship between Essex County Council and the county’s care home sector were driven by the council’s corporate ownership of the new approach, investment in the care sector, a focus on quality improvement rather than monitoring compliance, effective leadership and a support network for managers;
• specific issues that need to be addressed in order to bring about required changes in the county’s care home sector include the impact of financial pressures and local organisational change, and ensuring that staff have the necessary skills and aptitude for delivering personalised, relationship-centred care and support to older people with increasingly complex needs.

Key points

• The ‘Essex approach’ is based on the social movement My Home Life, which aims to improve quality of life in care homes. A relationship-centred approach focuses on building positive relationships and connections between and among older residents, care home staff and managers, and with commissioners.

• This approach has been embedded in commissioning and procurement of care through a self-assessment process using indicators based on the relational aspects of living in a care home.

• Care home managers are in a pivotal place to model relationship-centred care; where this occurs there are signs of staff empowerment and a change in emphasis from task-orientated care to relationship focused care and support.

• A Leadership Development Programme and facilitated network for care home managers was introduced in Essex, reducing the isolation of care home managers, enabling problem solving with peers and improving the recruitment of care staff.

• Adopting an appreciative enquiry approach that relies on a ‘no-blame’ culture has enabled staff to build on successes rather than dwell on negatives, and to see everything as a learning opportunity.

• In some homes, adopting a relationship-centred approach and shared decision making with residents has led to care home staff describing a more balanced, creative approach to risk. There are signs that through modelling relationship-centred care, managers have begun to shift the power dynamics between staff and older residents. In some homes, there is a concerted effort to move away from too much focus on physical tasks towards more positive relationships and individual outcomes for older residents.

• Discussions are underway between commissioners, providers and local groups of older people and other interested parties about a broader range of models of care and support, with older people’s voices and preferences central to these developments.


About the project
This evaluation forms part of a wider JRF programme of work on risk and relationships in the care sector. A theory of change framework was used to deliver the evaluation and the main data collection was through nine case studies in a sample of Essex care homes.

We are mindful of the Panorama programme broadcast in May 2014 that exposed abuse and neglect in care homes in Essex. This evaluation did not include any of the homes involved in; it's focus was on the changes made to commissioning relationships and practices with regard to a sample of care homes who had adopted the My Home Life Essex framework to guide their provision and support to older people.