Tag Archives: Values

Developing effective commissioner–provider relationships

Vic Citarella – a post that first appeared on RiPfA website on the 9th March 2017
As everyone seeks to squeeze more out of the social care system, how can strong and positive relationships lead to improved and more cost-effective working practices?
I have recently authored a Strategic Briefing for RiPfA on effective commissioner-provider relationships and facilitated a workshop on the same topic. I will also be leading their upcoming open access webinar ‘developing effective commissioner-provider relationships’ (28 March, 12-1pm, online). As part of my approach to gather evidence relating to this work, I began by asking some initial questions. I found it helpful to test out some of the underlying assumptions, namely that:

  • there is a problem
  • the relationship that matters is the one between the commissioner and the provider
  • such relationships have character – effective, strong and positive – which can be improved
  • there is an answer to the problem.
Problem – what problem?
Clearly social care is experiencing unprecedented financial pressures which is characterised as a problem or even a ‘crisis’. RiPfA identified this as a key issue back in 2012 in the publication: How to maintain safe, effective and quality services with reducing resources.

The underlying assumption is that integral to the problem are poor relationships between commissioners and providers. Community Care and the Guardian certainly think so. The guidance and toolkits say so. If only commissioners and providers got on better, they could make the money go further and people in need would get what they want. Implicit in this assumption, and reinforced in the Care Act 2014 guidance (Chapter 4), is that it is for the commissioner to do something about this problem. They have the money, the power and are the public authority.

But is this in fact the case? Does the responsibility lie at their door? The forthcoming webinar offers an opportunity to check this out.
A many-faceted relationship
Perhaps a more worrying assumption is that the relationship we are talking about involves just the two parties – commissioner and provider. But social care is patently a more complex system involving lots of people, organisations and stakeholders. Relationships between two people are hard enough. Imagine how much more convoluted relationships are in the multi-agency, multi-professional and multi-faceted world of social care.

The webinar session will try to unpick some of these relationship interactions and dynamics, and look at common purpose, co-production and role clarity. We will look at ideas around stakeholder mapping, user-led approaches and person-centred coordinated care.
The character of a relationship
That a strong relationship is a positive one and leads to more effective services is another assumption we can test. From there we can explore what steps can be made to build strength in relationships. How we turn our social care values into commissioning and service providing practice is the proving ground for the customers.

Clearly trust and communication are at the heart of all kinds of relationship building – but what do you actually do to make these things happen? The webinar will also look at how the behaviours of the participants in the commissioner-provider relationship can be (positively) developed, drawing on examples that have been tried involving individuals, groups and organisations in a variety of settings and formats.
A problem demands a solution
Lastly there is an assumption that there is an answer to the problems of poor commissioner-provider relationships. There is no sure-fire formula for success. Like personal relationships, those in business and between organisations require continuous work (and as with personal relationships there are online quizzes to evaluate the partners’ starting point and where they want to go with a business relationship, for example: http://www.growthink.com/content/finding-business-partner-take-quiz). In fact, the similarities between the advice offered by relationship counsellors and business gurus is quite remarkable. Writ large are trust, open communication and respect.

What we will examine during the webinar is ways for commissioners and providers to work together, how to make the time, and some methods that have been found to work. We will consider approaches to procurement and contracting as procedural processes to cement relationships, to record agreements where the players may change and to cater for endings and failures as well as success.
If you are a commissioner or service provider (of any kind – registered/not registered/large/small/private/voluntary), please do join us at the webinar on 28 March. As we are looking at relationships between commissioners and providers in social care then it would be beneficial if people who have worked together in these roles could participate jointly (although this may of course not be possible). People who use services and/or directly commission for their own needs are very welcome to attend.

If you have any thoughts or questions, please email me in advance at vic.citarella@cpea.co.uk– although I am not offering relationship counselling!

About the author
Vic Citarella is a qualified social worker and a former Director of Social Services. He now works with local authorities, NHS bodies, private and voluntary social care providers, to help them improve standards and quality of services.

Related resources

Cults and Brain Washing

Penny Moon despairs about the process of individual radicalisation and how often apparently intelligent young people can be so easily fooled 

Altered States 

As a psycho/hypnotherapist and meditator for well over 30 years, I have often shown people how to use ‘altered states’ to help them manage, and indeed change, their behaviours. This allows them to become empowered and develop more successful communication skills, thus living their lives more successfully to become the best they can be.

However, these powerful techniques can be used to manipulate. Indeed, since the beginning of time it has been known that there are ways of influencing both individuals and groups, controlling behaviour by institutions like religion, by government, advertising agencies, even cults and families. Civilised society likes to think it can avoid physical violence, but then uses psychological tools to control a more ‘desirable’ compliant and indeed a more ‘civilised’ community.

Religions utilise altered state approaches, appealing to the greater good to get people to follow their rules – for example, missionaries who use various methods of persuasion from kindness and forgiveness to threats of Hell and eternal damnation. The use of fear is the strongest emotional charge of all; with ‘mystery’, singing or chanting, flickering candle light, unusual fragrances and so forth as other means.

Yes, religion can be very comforting, offering a safe structure which defines right and wrong. It’s can be useful to the powers that be, as getting people to march into battle is often supported by a lot emotionally-charged communication and rhetoric. (The very same methods are used by advertising companies with various psychological techniques, chirpy little tunes and repetitive phrases to persuade people to spend money.)

Altered states, then, soften vulnerable or susceptible people, placing them in a heightened state of suggestibility – and when all the other factors are right, there is the perfect storm for recruiting and radicalisation to the ‘cause’. Suggestibility The 3 main ways to achieving an altered state (sometimes called trance or hypnosis) are

1. Canalisation of attention

This is about focusing attention down one particular track; blinded by external factors, all energy is gathered to one end, whatever that may be. (Actually, when anyone has an ‘interest’ in something they tend to do this naturally, passionately looking to research, read, explore whatever is needed to find out about this ‘thing’; for example, a passionate/emotional charged chef will notice food first, a bereaved person will notice those similar to the person they have lost, and so on.)

If an individual’s culture is intertwined with a specific belief system, it is inevitable that their perception of the world will be through that particular lens. All else outside will pale or brighten, depending on how early family culture has been enforced, as well as the developmental age of the individual and their likelihood of adolescent rebellion.

2. Rhythm and repetition Constant repetition of phrases at different times of the day will eventually become automatic. This is basic Behaviourism, as demonstrated by Pavlov and his salivating dogs – but focused on subtler things than food. If repetition is repeated with a chant or musically and affirmed with physical posturing, rocking, specific gestures then responses, it will eventually become almost part of muscle memory, slipping out of the general notice of the conscious mind. In other words, behavioural responses will become automatic and instinctual, familiar and safe, thereby passing any rational thought processes, strengthening the focus of attention, belief systems and increasing suggestibility.

3. Breathing and the emotional charge Breath and emotions are inextricably linked; we can control our emotions by controlling our breathing :

• Hyper/Hypo ventilating can occur when the body is under stress, which means there will not be enough oxygen for the body or mind to function properly
• Fear, use of violent images, screaming and ranting will heighten the emotional charge and therefore make an individual more susceptible to suggestion
• This may be enhanced by the Internet, which can be accessed 24 hours a day and is both a blessing and a plague on society.


Installation of beliefs in a positive form initially canalises the attention from early childhood; learning by rote, chanting, rocking and 5 times a day, etc., may help lock in total obedience.

Add to these beliefs about victimisation and combine with natural teenage rebelliousness and emotional loyalty to older generations will bring confusion, emphasising and distorting the theme even more.

Put all of this in the hands of a mediaeval Islamist cult for example, and you have the perfect storm. 

Whilst the West has tended to put aside older questioning deferential approaches to authority, with the inevitable consequence for the short term, many societies have not – and still rule by fear and violence.

Altered states misused in the name of religion heightens our vulnerability, making us more susceptible to suggestion and the consequent control and abuse by others. Shock (violence), ranting, (authority) screaming (fear) all serve to heighten the emotional charge, causing ‘confusion’ in the mind (‘confusion technique’ is a well-known hypnotic induction), drawing the susceptible individual to powerful propaganda, tightening blinkers and losing sight of a broader, more tolerant, view of the world.

We were like this ourselves a thousand to five hundred years ago, but by myths – stories – like King Arthur and chivalry, we made progress. Perhaps in these troubled days we could consider stories as a value shared beginning – and look to develop new myths.

Honour, respect and tolerance, protection of the weak and innocent, support for the vulnerable… could these be used to help lead troubled youth away into an altered state that would be much better for the world, do you think?

A Rose by Any Other Name

Sue McGuire asks whether values matter 

I don’t know. Maybe I’m being a bit over sensitive here but I suspect anyone who reads this page will agree with me that it is wrong for a care home to change someone’s name. So why – if it’s so obviously wrong do people do it without the flicker of an eyelid?

When my mother in law went into a care home 7 years ago it was only after a couple of weeks that we realised that some of the staff were calling her Renee. Her name was Irene. She had never been called Renee and in fact (I’m not defending her stance just stating it) she would have considered it rather common and would have objected strongly – when she had been capable of making any objections. We asked them to stop and it didn’t happen again.

I had honestly (perhaps naively) thought that care staff training had moved on and that wouldn’t happen now. But a few weeks ago I visited the friend of an aunt in the care home she had just gone into. My aunt and I asked for Pat and staff looked blank. Eventually it clicked and they said ‘Oh Trish, yes her room is just down there’. Pat has never been known as Trish in her 88 years. Pat has the power to object but said that the staff had explained there were too many Pats so to distinguish her they would call her Trish. So she just let them – mind you she thinks she’s going home, which I very much hope she can but it will depend how good the social work is. I feel the urge to put several exclamation marks in here !!!!!! and one WTF.

Why do I think this is so wrong and yet the staff in the home can’t see anything wrong with it at all? Values. That’s the conclusion I come to. I believe I have a strong sense of individual worth, dignity and the respect that is due to someone. How does that get measured when care providers recruit? Pressure to recruit constantly is massive. Vacancy rates and turnover appear to be high everywhere in the country. According to the NMDS data turnover is 25.1% and vacancy rates across the country 6.7%. Pay is poor. Conditions worsening with zero hours’ contracts becoming more widely adopted. Having the right values may very well be going to the bottom of the pile or requirements.

But the aspirations of the Care Act 2014 will never be delivered by people without the right values. That is a big message for the social care workforce across all job roles and sectors. How can you be committed to ensuring someone chooses for themselves, grows in independence and has care personalised to them if you think that it’s OK to change their name – especially when they are already confused and vulnerable?

No answers here – just questions. Where does this casual lack of respect start? How can it be spotted? How can it be changed if this is the workforce we have? Maybe I have to ask as well – is it just me or doesn’t it matter?


Sue McGuire thinks about porridge for breakfast – and vivid pink lipstick

I’ve spent a bit of time thinking about professionalism lately, and have been having some interesting conversations about it. One of the first things to say is that it’s a bit of a difficult term to define – and as to what is professional or unprofessional, well everyone has an opinion on that score, it seems.

In my own case, one of the first times I remember being moved to consider what was ‘professional’ or not was when I got rather exercised about what appeared to be a growing movement in our office for people to eat their breakfast in the office, at their computers.

I put up with it for a while but eventually, as deputy manager of that team, I had to say something in the team meeting. Basically, I wasn’t enamoured about people clocking in then going into the kitchen to make breakfast – after some of them had put their make up on in the toilets, as well.

This wasn’t taken lightly. Why was it any different to eating a sandwich at your desk at lunch time etc.? Well, it’s a fair point and I admit to bringing some of my perhaps puritanical and judgmental nature to bear here. (I think you can tell that from the make-up remark!).

In the end, we agreed that you could have your breakfast at work as long as you didn’t clock on until after it was made. All’s well that ends well, but I still shudder to see a bowl of porridge by a computer; having your breakfast in work seems to me to be evidence of a very disorganised home life, it seems to me.

I’ve seen other examples of similar behaviour, of course. I remember that at one authority I worked in, all PC games, such as solitaire, were removed from all desktops. Later on, in another authority people were often seen playing these games in their lunch times (and sometimes not only lunch times), quite openly. I thought this appalling, and wondered what people visiting our big open plan office might think. The response: it was their break times, they should do what they like.

I don’t know. I guess I’m a kind of ‘you don’t go to work to enjoy it’ person. So the following thoroughly grabbed my attention the other day and I did read it and reflected on it at length. Seven things that brand you unprofessional by Liz Ryan.

Apart from the fact that I had been discussing the experiences above very recently, I was brought up a Catholic – and there is no-one like an ex-Catholic for raking up the past for things to feel guilty about! So I had to read this and put myself through the mill.

Liz’s piece opened my eyes to a few things about this whole set of questions about what is and what isn’t appropriate in the office. It made me feel a bit bad, for example, for picking on trivial reasons for applying the term unprofessional. ‘Professional’, she says, doesn’t make you stiff or staid – and presumably, being stiff or staid doesn’t make you professional. I was very struck by some of the things she says are professional – such as ‘telling the truth’ and ‘being compassionate’. These are much bigger ‘asks’ to maintain than a lot of people give credit for and I’d be willing to bet we can all think of a time when we didn’t maintain our standards to our satisfaction on those items.

I also really like her seven ‘don’ts’ about professional vs unprofessional and if I had to go back to carrying a card around with me to tell me what values I should espouse (as one employer tried to make me do!) I’d be happy to put these on it.

• Don’t drop you commitments – do what you say you’ll do or don’t say it
• Don’t blame others for your mistakes
• Don’t attend events ‘impaired’
• Don’t assault other people’s senses
• Don’t throw your co-workers to the wolves
• Don’t cut corners
• Don’t bad-mouth your employers or their associations

I think really what they are saying is that being unprofessional consists in many small daily acts of unkindness or lack of consideration.

I can think of times when I’ve let both myself and others down on some or all of these.

It’s very good advice. So I think something is emerging here about what started out as being a controversial term, perhaps – about how being professional is about being a person others can trust, someone whose consistency and values are clear and obvious. About being someone who explains why when things aren’t as perfect as you’d like them to be and will keep trying to make them better against momentous odds. And yes, someone who keeps on trying.

The concepts ‘professional’ and being ‘unprofessional’ deserves discussion in teams and among leaders and managers. It’s a good debate and I think it’s worth knowing what people think they look like, both for good team cohesion and for good organisational motivation.

It’s also a discussion about detail and not just broad concepts. Will it sanction the freedom to eat porridge at work and wear the brightest shade of lipstick you can buy? Worth finding out, surely?