The current social care debate is well-known within the sector. However, it is in such times of difficulty that innovation and different models can prosper. That is exactly what’s happening with co-operatives, which are becoming more prominent in social care.
To understand the role of co-operatives and any advantage they may have in the provision of care and support, it is important to reflect on the context in which social care is presently perceived, commissioned and provided.
Firstly, social care has become primarily known for its funding issue, which is creating a crisis of supply and demand as well as impacting on the health service through delayed transfers of care, amongst other things. Additionally, the growing costs of care, its non-affordability and the demands of an ageing population also dominate current narratives. The Care Quality Commission in its report The State of Care (2017) talked of the sector being at a ‘tipping point’.
Media portrayal of the sector is focused on these issues as well as reporting that providers are handing back their contracts to commissioners, and also focusing on poor care. Unsurprisingly, it does not report on the Good or Outstanding regulated care that is happening across the country.
The consequence of this is that the public are nervous about the sector. They do not fully understand it, they have concerns about care quality and the demographic challenges of the ageing population, conflating it with the current economic and austerity reality, a shrinking state (through privatisation), and reporting of a rather ‘production line’ approach to personal care services.
With councils having now, in the main, moved away from service provision, it is also important to note that public service trade unions view any externalisation or spin-outs of local authority or NHS care, even to co-operative models, as privatisation.
With all this building to create a negative view of social care, and given that the co-operative sector is increasingly interested in the promotion and growth of the social care economy, those of us who support the co-operative approach need to be clearer about exactly what is on offer in a crowded market.
What are co-operatives?
Now we have a picture of the market in which co-operatives are establishing themselves, it’s important to explore what they are and what they can offer the general public and the social care market.
Recently, the iCare Coops Consortium published a toolkit to support the creation and development of care co-operatives (Foundation Guide 2017). It provides a useful summary.
‘Co-operatives are autonomous associations of persons who voluntarily co-operate for their mutual, social, economic and cultural benefit. They include non-profit community organisations and businesses that are owned and managed by the people who use its services (a consumer co-operative), or by the people who work there (a worker co-operative), or by the people who live there (a housing co-operative).
‘They bring together civil society and local actors to deliver community needs. Co-operatives are typically based on the co-operative values of self-help, self-responsibility, democracy and equality, equity, and solidarity…’ – International Co-operative Alliance, 2015, quote in Foundation Guide, p.4
Supporting this are seven key principles, which underpin all co-operatives, regardless of the model.
- Voluntary and open membership.
- Democratic member control.
- Member economic participation.
- Autonomy and independence.
- Training and education.
- Co-operatives supporting co-operatives.
- Concern for community.
It is important to examine some of these in the context of social care provision – particularly the first four.
Voluntary and open membership
A co-operative service or business must be open to all persons able to use the service, but who are willing to accept responsibility of their membership.
In terms of an employee-owned social care service, the workers, from managers to care and support staff, are equal in their membership.
For those using a service in membership, they become equal to the workers.
In these situations, I would suggest that the very term ‘service users’ should be more appropriately considered as ‘member users’. This also creates a balance between workers and clients, shifting away from ‘them and us’ which can occur between those receiving the service and those directly providing it.
A co-operative model that is gaining traction in the context of membership is that of the multi-stakeholder co-operative which includes member users, workers, families and local communities.
Democratic member control
Under this principle, active members of a co-operative control the organisation. It means that they are not merely co-producers, but co-governors of the business and services, participating in all aspects of policy and decision-making.
In terms of governance, those elected members, be they users, staff, family, or community representatives, all become accountable to the total membership. They also all have equal voting rights: one member, one vote.
Member economic participation
In traditional co-operatives, this principle allows members to contribute equitably and democratically to control the capital of their co-operative.
A care home or homecare service presents some interesting possibilities in this regard. Member users (such as residents or clients) together with the staff, families and local communities fundamentally determine the organisation’s priorities and operational policy, evaluate the care provided and support the wider stakeholders.
Autonomy and independence
Taking principles one to four together, a co-operative is ultimately an autonomous, self-help organisation that is controlled by its members.
However, that doesn’t mean it can’t expand or take on contracts like any other social care business, it just needs to keep the co-operative principles at the heart of the business as it grows.
James Scott in Taking Care: A Co-operative Vision for Social Care in England expands on this by saying that if co-operatives ‘enter into agreements with other organisations, including governments, or raise capital from external sources, they do so on terms that ensure democratic control by their members, and maintain their co-operative autonomy’.
Concern for community
Skipping now to principle seven, concern for the community it focuses on working to develop sustainable communities. If this includes community development, then it has a profound impact when applied to social care provision which has the community at its heart. If co-operative social care is to become revolutionary, then it needs to embrace this crucial principle.
Social care co-operatives
The range of services provided across the social care landscape is broad and they all are open to the co-operative model.
James Scott’s report referred to above concluded that, ‘the application of co-operative values and principles…to the care sector, will result in co-operative growth via a number of pathways’.
These pathways include contracting, externalisation, partnership, social venture and new starts. ‘Applying these [co-operative] values and principles’, Scott went on to state, ‘within these pathways would necessitate the creation of a care sector very different to the one we have today’.
It ‘would mean the growth of non-profit care providers established as multi-stakeholder co-operatives, whose adherence to a high standard of pay and conditions for the workers would be rewarded by a system of collaborative commission’. Change AGEnts, a multi-stakeholder co-operative, coined the term ‘FairCare’ for this approach.
The Cooperative Care Forum (England), which is a forum for co-operative approaches in care ‘believes that mutual self-help, solidarity and fairness in co-operative enterprises, has a lot to offer those working toward such an approach’ (Wright, 2017).
In addition, the Forum argued that when operating in social care, co-operatives:
- Enable citizens and qualified carers to work collaboratively to optimise financial resources and maximise good outcomes.
- Locate mutual community-based care in a wider context, which takes us out of the focus of ‘dependency, deficit and sickness’, to the broader World Health Organisation determinants of health and wellbeing.
- Engage those accessing care by providing it informally and professionally, and also the local community, by owning the responsibility for meeting care needs within that community.
- Address disempowerment and isolation through the organisation’s approach to care.
- Recast the role of care workers, enhance career prospects and improve public perspective and appreciation of care workers.
- Innovate through community-based collaboration, rather than by top-down reorganisation or competition.
Are co-operatives the answer?
Current care provision is based on price, competition and profit: the market is failing and public trust is fragile.
The sector has to face some uncomfortable truths – namely challenging how it thinks of ‘service users’, or even ‘member users’, in the context of deficit, dependency and sickness.
However, co-operative approaches are not a Holy Grail to addressing this situation. There is work for the sector to do and co-operatives, if they are to flourish in social care, also have a role to play in addressing and overcoming the issues.
Above all, however, any growth or development in social care co-operatives must not compromise the values and principles of that co-operation. It must also avoid capture by stakeholders and, most importantly, must ensure all members own, control and benefit from their care experience.
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