Policy Process 2021

Our social care system has pushed to breaking point – certainly by the Covid crisis, but also before Covid hit. The market in social care services incentivise a race to the bottom on quality and workforce conditions, a lack of accountability, and de-personalisation of services.

Our social care system is in urgent need of reform. Private companies profiteer, whilst older people, those who rely on social care and the staff that deliver it, pay the price. Large chains of residential care are backed by private equity with opaque ownership and decision-making, while social care budgets in councils are stretched to breaking point. Companies that provide home care are forcing workers to make shorter and shorter visits – which benefit the bottom line at the expense of overworked staff and those who rely on them.

Shrinking budgets and increasing demand has meant tighter eligibility criteria. Hundreds of thousands fewer people are getting help, and there is a financial imperative for local authorities to commission services at the lowest price regardless of quality. All the while the numbers providing care informally to family and friends is growing.

Councils have supported the start-up of co-operative and participatory models, to deliver services that put people before profit and, from Leading Lives in the South East, to Colne Valley Care or Equal Care Co-op in West Yorkshire, these models are demonstrating in practice that there are alternatives to private, for-profit models. These existing social care co-operatives show that a co-operative approach can innovate, empower service users and care workers, remove the profit incentive and leakage, and create a sector that reflects the needs, wants, demographics and challenges of those who rely on it and work in it. In Wales, the value of co-operative approaches has been recognised by the Government, who have created a duty on local authorities to promote co-operative organisations to deliver care in their area, as part of the Social Services and Well-Being (Wales) Act in 2014.

• 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 care recipients, their families, care workers and the wider community having a role in decision-making and social care service delivery. It means passengers and employees involved in the governance and decision-making on local transport, and housing tenants involved in policies and decisions to do with their housing estates.

  The Co-operative Party believes that local councils should ensure services have transparent, participatory governance structures, which give service users, workers and the wider community a say in how they are run. This is not about who provides the service – the Party supports insourcing – but in the way it is run so that voices outside the town hall can be heard.

• Our public services must be high quality, responsive and accountable. The level of funding cuts to services our communities rely on, from local government and social care to the NHS and policing, make this an increasingly challenging task. For our public services to remain effective, they must be properly financed by central government in a way that ensures funding is linked to need.
• However, increasing funds from the top down without fixing the broken system itself won’t improve services alone. The shift to private provision of services has reduced the quality of care, undermined labour market conditions and reduced cost efficiency within the sector. Private companies profiteer, whilst those who rely on social care and the staff that deliver it pay the price. That health and social care services should be delivered by the market is an idea whose time is up – it’s time to end the race to the bottom on quality and workforce conditions, the lack of accountability and the de-personalisation of services.

  The Co-operative Party proposes 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. It is care recipients, their families and care workers who know how to create a care system that will deliver consistently high-quality care - they should be allowed to lead the care sector. Co-operation that is hard-wired into the system as well as that which emerges from the bottom up within this sector can provide a powerful tonic with the ability to radically benefit those in need.

• People who receive, rely on and provide care (care recipients, their families, and care workers) have the most sophisticated understanding of what good quality care looks like. This knowledge should be respected, and given equal weight within the governance of private care providers. To hardwire the interests and knowledge of frontline staff and care recipients, workers, care recipients and community representatives should be offered positions on corporate boards.
• In England, 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. Currently all non-state providers are categorised as ‘independent’, undermining the ability of service users and their families, as well as commissioning authorities, to distinguish 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.
• The Co-operative Party believes in health and social care systems that are properly integrated, providing services that are joined up from home to hospital. This alternative vision needs to be brave - built around the whole person, and meeting their physical, mental and social care needs. This vision can only occur under local systems that truly integrate the different players in the system, delivering co-operation not competition and putting people before profit.

  There is also an urgent need for reform of the ‘market’ in social care – reducing profit leakage, improving the quality and accountability of care, preventing the continual downward pressure on terms and conditions for the workforce, and better aligning the values of social care with those of the NHS to support the transition to an integrated system.

• The Co-operative Party believes that wherever possible public services like health and social care should be truly public – delivered in-house.

  However, when services are delivered by private organisations, better protections are needed. When private organisations face financial difficulties, they are often sold on to another private organisation or simply closed down.

  Under such circumstances, there should be a ‘right to own’ in the private sector. 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’.

  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.

• 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. To support this, guidance must be given to social care procuring authorities to ensure that the special features and sometimes sizes of cooperative and social enterprise delivery models are taken account of and included in procurement exercises.

Take a look at the Co-operative Party’s existing social care policy. What do you think should remain part of our platform and what do you believe needs changing?

What lessons can we learn from this crisis to ensure our social care services are better prepared for future challenges?

What values and principles should underpin our approach to social care?

Coronavirus has shown yet again the unacceptable inequalities in accessing health care and outcomes. How can we ensure our social care system offers fair access, promotes equality and tackles the wider determinants of ill health?

At the Co-operative Party, we believe that co-operative approaches to social care empower people to have a say over the services they rely on. How can we further empower people who use social care services and their families?

How can we ensure that social care workers are properly valued and safe, with a stake and a say in their workplace?

Mental health services are chronically underfunded – but more funding alone will not fix the system. How should mental health services be shaped and delivered?

Social care is often seen as a service for older people, when in fact younger adults’ care accounts for half of councils’ social care spending. Despite this, young people cannot vote and are often excluded from decision-making – even on the services that impact their lives. How can we ensure the social care system meets the needs of everyone, regardless of age, and give young people a voice in decisions which affect them?

(Filtered based on whether you live in England, Scotland, NI or Wales)

• England and Scotland: How can local councils be supported and encouraged to promote co-operative approaches to social care?
• Wales: Councils in Wales have a duty to promote co-operative social care models, but despite this, the co-operative social care sector hasn’t grown as fast as hoped. What further support, incentives or other drivers are necessary to help the sector grow?
• NI: What role can health and social care trusts play in encouraging and enabling the development of co-operative approaches to social care in Northern Ireland?