I will be speaking to a joint meeting of the Cooperative Party across the East and West Midlands on afternoon of 6th February. The topic will be social care, and it will form part of the consultation process that will in turn lead to the development of a refreshed and renewed Policy on Social Care from the Coop Party.
The focus of my talk will be about the social care system itself, describing the experiences that I hear about on a daily basis from those who are living with the services, and whether there are cooperative solutions that might offer a better way forward. I hope to hear as part of the Q&A session what solutions our membership may have heard about or experienced.
As a Party it is our firm belief that those who provide, receive, and rely on services are best placed to know how to ensure they are run cost effectively and to a high quality. That means those who receive care, their families and friends, those who work in care services and the wider community must have a key role in decision-making and in social care service delivery.
It also means that service commissioners must ensure that services have transparent and inclusive governance structures. It is so important that service users, the workforce and the wider community have a real say in how they are run. This is not simply about who provides the service, but also the way that services are run so that peoples voices can be heard.
Our public services need to be high quality, responsive and accountable, they must be properly financed by central government in a way that ensures funding is linked to need if they are to be effective.
However, I am clear that simply increasing funds from the top down without fixing the system itself will not necessarily improve services. The shift to almost exclusively private provision of services has in some cases compromised the quality of care, undermined labour market conditions, and reduced cost efficiency.
Private providers quite understandably exist to be profitable, but it is those who rely on social care and the staff who deliver it that can feel the pinch as margins are squeezed, particularly during this pandemic.
Perhaps it is time to state clearly that the notion of health and social care services being delivered by the market is an idea whose time is up. Perhaps it is time to say that the erosion of quality and workforce conditions, the lack of accountability, the de-personalisation of services, and the unacceptable inequalities in accessing health care and outcomes, outweighs the perceived benefits.
To be absolutely clear we believe that wherever possible public services like health and social care should be truly public, delivered in-house. We propose a new model of care, one that uses the principles of co-operation to build on the first-hand knowledge of those who rely on, receive and provide care.
Putting care recipients, their families and care workers in the driving seat, allow them to create a care system that will deliver consistently high-quality care. Hardwiring the interests and knowledge of frontline staff and care recipients, workers, care recipients and community representatives, perhaps by offering them positions on corporate boards for example.
National policymakers should learn from Social Services and Well-being (Wales) Act 2014, which goes further than the Social Care Act 2014 by putting a duty on local authorities to promote co-operative organisations to deliver care in their area.
The Care Quality Commission should level the playing field between co-operative and private care providers by modifying its inspection methodology to capture the ownership model of its registered providers. Move away from the blanket categorisation of all non-state providers as ‘independent’. Draw distinctions between for-profit and not-for profit providers. This would also allow users and commissioners to analyse the relative performance of different ownership models within care.
There is an urgent need for reform of the ‘market’ in social care. We must look for a model of provision and commissioning services that reduces profit leakage, improves the quality and accountability of care, prevents the continual downward pressure on terms and conditions for the workforce, and better aligns the values of social care with those of the NHS to support the transition to an integrated system.
The social care workforce should have a ‘right to own’ in the private sector where a provider is facing financial difficulties or closure. Much like public sector employees have a ‘right to request’ the option to turn the service they work for into an employee-owned enterprise, so should those carers working for privately owned organisations as a ‘Right to own’.
We would also argue that not-for-profit social care providers should be ‘asset locked’ to ensure that assets of all types (including any surpluses) are locked within the organisation or transferred to another asset locked organisation on winding up.
So there is much to debate, and many ideas to be developed, at our Conference on 6th February and beyond. The Policy consultation will run through to the Coop Party’s Annual Conference in October. I look forward to hearing your ideas.
Chris Bain
PS The thoughts and ideas expressed in this article are entirely my own and personal to me.
Chris Bain 