The way forward for a system in crisis
Having returned recently from Cooperative UK’s Congress held in Wakefield, I have reflected much on the discussion and focus now on the assertion that cooperative models offer a ‘solution’ and a ‘good way forward’ in addressing a social care system in crisis. Indeed, the Congress launched its National Cooperative Development Strategy ‘do it ourselves’ exploring how to support innovation in three future sectors, social care being one of them!
There is no dispute that our social care system needs both reforming and investment, which does not solely relate to cash, work force conditions, demand and supply, and eligibility criteria. The marketisation of social care has, since the early 1990s fragmented provision, whereby the private, voluntary and independent sectors (profit or not) were encouraged to enter and expand their role as providers of care. As Ed Mayo has rightly pointed out in a recent newspaper article, care is now organised around price, competition and profits; he advocated a cooperative approach that ensures care provision is about users of services, families, staff and communities. All of whom, via cooperative models of member autonomy, have control and provide community benefit. The ethos underpinning cooperative models means care provision ‘has to be about people, relationships and communities’. This is what I have personally bought into after 40 years in the public and voluntary sector and am convinced of its potential to reform and re cast social care with those using care services are in control.
The principles of cooperation
Cooperatives come in all shapes and sizes and the various cooperative models inevitably have both pros and cons. One size does not fit all. But the International Values and Principles of Cooperation bind them together, which can and does, in my view, align with the current personalisation agenda based on self-help, empowerment and choice. It is, however, all very well singing the cooperative values anthem, and stating in annual reports and business plans that services are open to all persons with members actively participating in organisational policies and decision making, with democratic control, being ethical; but these can become meaningless terms when there is no significant shift in the relational power between those that use the service, those that provide the service, or those that commission the service.
In 2016, the Cooperative Party published ‘Taking Care: Cooperative Vision for Social Care in England’, which rightly stated that any new cooperative pathways “would necessitate the creation of a care sector very different to the one we have today. It would mean the growth of not-for-profit providers established as multi-stakeholder cooperatives, whose adherence to a high ethical standard of pay and conditions for workers would be rewarded by a system of collaborative commissioning”
The cooperative sector has been slow in promoting its response while civic society thrashes around in the waters, searching for a boat that will save us all from drowning in the lack of social care. The cooperative increasingly sees itself as that boat, or perhaps an important vessel in a broader rescue flotilla. It has failed, in the UK context to decide what type of vessel it is, and exactly what it is rescuing. Looking across this fragmented landscape, which, to be honest, largely remains based on 19th century attitudes to need (deserving and undeserving), benevolence, othering, paternalistic and patronising predispositions abound; and there is little evidence that power has indeed been redistributed in our ongoing obsession around price, competition and profits. So, the challenge remains, what exactly is the Cooperative seeking to address?
What can a cooperative approach to care achieve?
The preamble to the Cooperative Care forum (England, 2015), in its’ Terms of Reference, asserted that ‘care is increasingly seen as a commodity: something to be provided on a commercial basis as a way of generating an economic return’. The terms of reference goes on to state that, historically, cooperatives came about to ‘provide access to food and basic provision, where the market was failing and it developed a highly effective organisational approach’. The same is needed now for care, as the cooperative ceases to be understood – not just in terms of carrots and coffins, but in terms of health, care and wellbeing.
The State of Adult Social Care Services, 2014-171, published recently by CQC, raises some important challenges for the cooperative sector. This has been articulated very well in a report from Cooperatives UK, which was presented to the Care Forum. Regulated social care cooperatives would need to satisfy the areas of safety, leadership (including culture), effectiveness (outcomes and wellbeing), and responsiveness). In addition, CQC reported that smaller providers were statistically better performers overall in those areas. James Wright pointed out that when addressing the negative end of the scale, care worker-owned models have a particularly strong and straightforward offer. Multi-stakeholder models could also have a significant impact on all areas being inspected. Additionally, the Report went on to say that “Cooperatives require less hierarchy and commodification of activities. They can combine the benefits of large corporate groups with small-scale responsive provision. The Segmentation and Secondary approaches in particular offer a great deal. This could apply both to micro provider cooperatives and clustered multi-stakeholder models."
There is, however, one further issue to address when exploring this Holy Grail. Whilst the values and principles of cooperation are indeed powerful, a cooperative approach and model needs to be clear if one accepts into the cooperative commonwealth a whole range of providers, whose governance structures do not allow for member ownership, member control and community benefit, or driven by the very factors that have caused social care market failure – namely price, competition and profits.
- 1 CQC
The views expressed in this blog are those of the blog’s author alone and do not necessarily represent those of Independent Age. Independent Age is not responsible for the accuracy of the information supplied in blogs by external contributors.