Why co-operatives could be the answer to the UK's social care crisis
Independent, by Hazel Sheffield
Emma Adelaide Back tears up when she talks about her house in Hebden Bridge flooding on Boxing Day 2016. Not because Christmas was ruined for her one-year-old son, or because of the damage to the family home. But because she was so touched by the way the community rallied.
“Our entire ground floor was gone – we didn’t have a kitchen,” she remembers, “but the kindness of strangers was overwhelming. A hoard of volunteers descended on our house to help.”
As Adelaide Back put her home and her life back together, the experience fed into her work with VoiceAbility, an advocacy group that handles legal issues on the behalf of vulnerable patients.
She wondered if there was a way of providing vital services for the UK’s growing elderly population and the need for improved access to mental health services for young people that valued kindness and flexibility above profit.
She came up with CareShare, a social care platform owned by its members. CareShare helps match those in need of care with care-givers, who can choose whether they want to be self employed or pay into employee benefit schemes for the security of employment.
It also fosters peer support, so that those receiving care can offer support or services to others and be rewarded. Adelaide Back is considering a timebanking scheme or a similar alternative currency to give people an incentive to help others.
“As a co-op, CareShare is not owned by a venture capitalist in San Francisco, it’s owned by the people who are getting the care and giving the care,” Adelaide Back says. “I want to stop our public funds for social care flowing into the hands of shareholders and investors that are a far removed from the front-line.”
The idea that social care should be run co-operatively, rather than privately or publicly, is gaining traction in the UK. Labour said in its election manifesto that it would double the size of the co-operative sector while working towards a model of community care for mental and social health services as part of a new National Care Service. Co-operatives UK have outlined how this could be achieved in a report, Owning Your Care.
Since 2015, Mervyn Eastman has led a Co-operative Care Forum to support the urgent need for co-operative approaches to care in the UK. Spending on social care for older people has dropped from £8.1bn in 2005/06 to £5.46bn in 2014/15, with community care services being the hardest hit, according to Age UK. In 2016, the Care Quality Commission said the situation had reached “tipping point”.
Social care is struggling to attract workers because of a reputation of being poorly paid. Just under 60 per cent of care workers said they were paid for travel time between residential visits, according to a survey by Unison, which has serious implications for adult social care in rural areas where travel times are longer.
Brexit is making the situation worse. The jobs website carehome.co.uk said that in the 12 months after the EU referendum, the number of applications from EU nationals dropped by 26 per cent to 2.41 per cent of all applications. In April, just after Theresa May triggered Article 50, the number of applications was as low as 60, compared to 612 in March 2016.
The sector has a bad reputation. Multiple investigations have revealed abuse by care workers in homes. Videos showing care workers neglecting or assaulting those in their care demonstrate how cuts to local authority care funding have badly affected the quality of care on offer and the support offered to care workers.
Eastman says it takes more than a business being owned by its members to stop abuse, but that ownership contributes to a better culture. He says: “I do believe that if you own something and you are engaged in its design or delivery, then you are more likely to be empowered to address the issue of standards.”
Establishing co-operatives as an alternative will take time in the UK, where welfare is traditionally state-owned and run. “If you compare the UK to Spain, Italy and South America, these countries didn’t have a state social care provision, so co-ops started to form,” Eastman says.
He recognises that it will take time to challenge the status quo. “[At present] we warehouse people in need, in residential care; we institutionalise people,” he says. “We create an oppressive bureaucracy that reframes the need in the context of what’s available, rather than looking at what’s innovative or responsive.”
But the number of social care co-operatives is growing. Choices4Doncaster was formed by Martin Walker after eight years working for the local authority. He realised that big organisations like the NHS and local authorities talk about personalising care, but often fail because of a system set up to buy support cheaply and at scale and use contracts to try and keep quality high. “You don’t have to look far to see that this isn’t working,” he says.
Walker is bringing small social care organisations in Doncaster together as part of a Choices4Doncaster co-operative. “The idea is to provide a number of activities and services under one roof that people can access easily, with minimum hassle and as much help and support as they need,” he says.
Fledgling co-operatives in England look to Wales, where the sector is more developed thanks to government support and legislation. The Welsh Government funds a Welsh Co-operative Centre to work with people receiving care through social enterprises, social co-operatives and consortia.
Cartrefi Cymru, a co-op providing support to people with disabilities in rural Wales, has 234 active members, including people receiving care, their support workers and others involved in the community. Each member gets one vote to elect representatives to a council that sits above the board, with the power to appoint and dismiss new members. This puts those receiving care in control of the business caring for them.
But most of its income comes from contracts with local authorities that require a certain number of hours worth of support for the contract price. Adrian Roper, chief executive of Cartrefi Cymru, says a change in the way services are funded is needed. "The current system is based on an arms-length procurement relationship in which people's support is commodified into hourly units that are sold competitively to contractors. The person is fossilised as a static number of 'need-hours' and given no role in the negotiation of their support requirements," he says.
This approach is underpinned by the idea that workers should be monitored to make sure they are being efficient, which creates distrust. Roper says. "The fact that the marketisation of care has stimulated the growth of cynical, for-profit and self-interested care agencies has only encouraged this distrust, like a self-fulfilling prophecy."
Roper says local councils should instead target trustworthy agencies and give them the opportunity to work with patients to define their own care in the most cost-effective way: "We might then be able to pay a proper living wage without a massive price hike."
Adelaide Back agrees: “It’s about defining people not by their conditions but by what they want out of a service.” She recently won a Dragon’s Den-style pitching competition by the Co-operative UK and will use the prize money and business support to develop CareShare, with plans to be up and running in nine months.
Roper says this kind of support and a more open commissioning process is vital if social care co-operatives are going to offer a viable alternative. "It is our hope that the competitive environment around us will either be replaced by a co-productive and collaborative approach or adjusted to include social values in the awarding of contracts," he says. "The attitudes of commissioners will be crucial to whether care cooperatives flourish."
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