Co-operative Social Care
It is hardly worth asking whether the adult social care system is in crisis. A better question would be ‘Why might co-operation offer a better way?’ The answer to that lies in the main features of the current crisis:
- An ageing population and fuller recognition of the rights of vulnerable people to decent care have exponentially driven demand.
- Inadequate public funding, especially since 2010 and the shift to austerity. The Dilnot Report (2011) recognised that the sector was in crisis and a more stable system of funding was needed.
- At the same time changes in benefit and social care funding systems with the Care Act (2014) aimed to put care recipients and carers in control of buying services. However, the amount of support available for those who could not contribute themselves has not matched that paid in by individuals who can, with about a 25% (and growing) gap. Put bluntly, there is increasing inequality between those who have enough money and those who don’t.
- Meanwhile private sector market share rose from 5% in 1993 to 87% by 2012, driven by price as Local Authorities sought ever cheaper care creating a ‘race to the bottom’ effect. This has led to the insolvency of some private social care companies such Southern Cross. The number of insolvencies is growing as the financial situation of councils becomes more desperate. • To maintain profitability private providers have inevitably sought to cut labour costs. This in turn has led to exploitation, very high staff turnover, low pay, lack of loyalty, limited training and career progression opportunities and low morale.
- Predictably in such a person-centred sector, declining staff pay and conditions have led to issues with the quality of the service as measured by the Care Quality Commission (CQC). In some cases, such as at Winterbourne View in Bristol (2011) criminal cases of abuse have surfaced.
It's tempting to say that more money will fix the problem - and it is certainly needed! But this is unlikely to be forthcoming in the near future and would not address all the issues in any case. As important is the way care is delivered and by whom.
The purpose of this brief ideas paper was to successfully argue that a shift of policy by Kirklees Council towards Social Care Cooperative provision would make a real difference. At the core of the argument lies some simple and well-tested principles concerning the value of cooperation and the nature of cooperative organisations. In particular, it argues for the roll out of the Multi-Stakeholder Cooperative model, as developed in countries like Italy, Japan, Canada and France. However, it is likely to require some adaptation to fit with current UK realities. In the context of the social care sector the key stakeholders are:
- Service users and their families
- Volunteers from the wider community
- Kirklees council and other commissioning/grant giving bodies
It follows that if a cooperative approach has any validity it must meet the needs of these stakeholders better than the existing, privately dominated one. There are solid grounds for optimism. In Italy the social care cooperative sector now has over 14,000 individual social care coops delivering a wide range of services, a workforce of over 400,000, a turnover of 9 billion euros and is serving over 5 million people. The outstanding feature of the co-ops is that they are small, with most employing less than 30 workers and having 100 stakeholder members. They link together within consortia to pool back office functions, share costs, engage in joint-tendering to bulk purchase goods and services. Each new co-op is committed to upholding the ‘strawberry patch principle’ and send out at least one ‘runner’ to create a new coop in its vicinity, ensuring growth and vibrancy in the sector. So ‘small’ is not only beautiful, but also mighty.
Finally, this paper looks only at adult social care in the knowledge that Children’s Services require deliverers to operate in a completely different and rightly more demanding legal and regulatory framework. It has also been written particularly with elderly citizens in mind – 2/3rds of adults receiving social care are aged 65 or over.