Health and social care

Our health and social care system is in urgent need of reform.

Across the country, services are at breaking point thanks to chronic underfunding. To deliver the high-quality health and social care services that communities need, the system needs to be properly funded. However, services won’t improve if the funding is put into a broken system.

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 patients, older people, those who rely on social care and the staff that deliver it pay the price. The markets in health and social care services are broken – incentivising a race to the bottom on quality and workforce conditions, a lack of accountability and 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 hardwired in to 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.

Britain’s National Health Service is Labour’s greatest achievement. It provides high quality healthcare that is free at the point of need. However, the focus on our NHS is too often about management and too little about the public who rely on it and the staff who keep it going. The Co-operative Party is pushing for reform of our NHS to bring health services closer to their stakeholders; mindful of the huge diversity in this sector, from hospitals and specialist care, to GPs, dentists and pharmacies.

Integration of health and social 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.

Market reform

There is 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.

Right to own

Public sector employees in health and social care currently have the ‘right to request’, allowing them to mutualise the service they run and turn it into an employee-owned enterprise. The Co-operative Party wants to see this right extended to those carers working for privately owned organisations as
a ‘right to own’.

When private organisations face financial difficulties, they are often sold on to another private organisation or simply closed down. Under such circumstances a ‘right to own’ in the private sector would give employees a right of first refusal to take on part or all of their organisation, supported by patient capital investment.

Where social care services are mutualised and moved outside the local authority they 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. This is critical to preventing asset stripping or demutualisation as occurred with the building societies in the 1980s and 1990s.

Right to run

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, a ‘right to run’ would require workers, care recipients and community representatives to be offered positions on corporate boards.

Regulation

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.

Social Care procurement

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 co-operative and social enterprise delivery models are taken account of and included in procurement exercises.

There should also be support for the development of new mutuals within social care procurement processes – this should include the financial, legal, technical and HR support necessary to successfully identify an appropriate model and then go through the process of ‘spinning out’, which can be challenging and expensive. Collectively procured support and more mentoring by other organisations that have been through the process can help reduce these costs and burdens.

Foundation Hospital Trusts

The values and vision behind the creation of Foundation Trust Hospitals in England remain the right ones. However, the rapid growth in the number of Foundation Trusts has seen a widening rather than a deepening of community engagement and in some areas the lack of commitment to the model is evident from the hospital management. NHS Improvement should toughen the regulatory framework on NHS Foundation Trust hospitals to ensure service users are more engaged in decisions taken by local hospitals.

Meaningful engagement must become a properly measured feature of their operation, in conjunction with the local Healthwatch and local communities, to avoid this being a paper exercise. The trusts’ regulatory framework should be toughened, with trusts forced to explain how they are engaging members in decision-making and ensuring that governor elections are vibrant.

Police, crime and justice

A co-operative community is a safe community. The more that people share values and a sense of belonging, the stronger and safer their community will be. In increasingly diverse communities, co-operative values are common to many backgrounds, religions and cultures and can provide the common thread that binds people together in common endeavours.

Since 2011, elected Police and Crime Commissioners have worked in
co-operation with local government, the police and other bodies to cut crime. The Co-operative Party is proud of the approach taken by Labour & Co-operative Police and Crime Commissioners who have spearheaded a co-operative approach to policy making – working with communities and stakeholder groups to co-produce crime prevention strategies.

Successful approaches to policing and crime reduction puts citizens at the heart of the fight against crime. Public participation in police work has always been vital, but as resources become tighter it is becoming ever more vital. The government should do more to unlock the hidden wealth of voluntary activity and social networks to contain and prevent crime.

Involving local residents and businesses

The whole community should play a role in ensuring their neighbourhood is safe, and there should be good partnerships between local police, residents and businesses. Street Watch is currently the only fully regulated UK model for civilian street patrols that involves the whole community. The scheme encourages residents to adopt a new working partnership with police in patrolling their own communities. The government should provide funding for the establishment of a street watch scheme in every lower-tier local authority in the UK.

Facewatch is a business-led initiative to tackle crime that enables local firms to file reports with witness statements and CCTV footage directly to the police. The government should ensure that all local police forces work with Facewatch to introduce a scheme in their area.

Neighbourhood policing, participatory budgeting and co-production

There should be greater involvement of local communities in allocating police resources and setting local priorities. Police forces should establish ‘participatory budgeting units’ and the success of the Crime and Disorder Act 1998 should be built upon in order to improve local accountability by ensuring that local government is involved in the appointment of local police commanders.

The relevant tier of local authorities should be given additional powers to set priorities for neighbourhood policing, local policing of volume crime and anti-social behaviour, and should retain a proportion of the police precept ring fenced for the commissioning of police and crime priorities.

Since 2011, elected Police and Crime Commissioners have worked in
co-operation with local government, the police, communities and other bodies to cut crime. In Wales, the Future Generations Act has built on this to encourage an even more collaborative approach, with new public service boards. New strategies should learn from this best practice.

Youth Offending Teams

The success of Youth Offending Teams – a co-operative initiative in the justice system – has shown that many people who were drawn into crime in the past didn’t need to become career criminals had they been offered better alternatives at an early stage. The Co-operative Party recommends a similar integrated approach to those in the 18-25 age group who are going through the transition to independence and adult life, as is being trialled successfully in South Wales.

Education

Co-operation in education is not limited to governance models in primary and secondary schools in England. There is rich heritage and leadership shown within school and community collaboration, early years’ provision and a potential for further development within Further and Higher Education.

Children get the best education when schools, parents and communities work together and when they feel their views are taken into account. This approach is at the heart of co-operative education: supporting children to feel valued and to take responsibility for themselves and their communities.

In the last ten years, a growing number of co-operative schools and places of education in England have offered this alternative vision of learning. It is a vision of learning founded on co-operative values and principles. These schools have the ability to ensure that they are democratically engaged with the local community; driven by ethical values; and have an emphasis on improving learning outcomes through co-operation rather than competition. The move to a co-operative model provides a framework in which everybody with a stake in the school’s success – parents, teachers and support staff, local community organisations and even pupils – has the opportunity to be involved in running it.

These principles can and should be applied to the Further and Higher Education sector. Emerging proposals to create co-operative universities rather than the ‘for-profit’ model will offer much to students and staff.

Co-operative schools

In England, there are now hundreds of co-operative schools, spanning most types of schools, and they must be allowed to be at the vanguard of demonstrating the benefits of co-operation to their pupils.

Specifically, the Co-operative Party believes that the Education and Inspections Act 2006 should be amended to enable co-operative schools to legally form under the Co-operative and Community Benefit Society Act 2014. It should also allow nursery schools to become co-operative trusts and to join co-operative clusters.

Existing charity law should be reviewed to ensure that the co-operative trust model is able to develop in as democratic and participative a manner as possible, as well as enabling schools to benefit from international associations. Legislation should be amended so that all mainstream state funded schools and Further Education colleges can establish co-operative governance structures should they wish to.

Collaboration between schools

Working collaboratively helps to avoid duplication and raise standards, by allowing school leaders to better focus on the effective leadership of teaching and learning and enabling best practice to be shared.

Many of the co-operative trusts established in the last year are clusters of primary schools, sharing responsibility for working with all schools in the trust. Increasingly school improvement is becoming a priority of the national network of co-operative schools, the Schools Co-operative Society.

The government can enable collaboration for school improvement via co-operative models by encouraging more co-operative trust schools to become academy sponsors, enabling them to formally support other co-operative schools. There should also be support for the development of school improvement co-operatives like the ones created in Leeds and Manchester.

Mixed stakeholder models in education

Communities, parents, students and teachers should be at the heart of our education system. Therefore, parent teacher associations should become mandatory in mainstream schools and each should have responsibility for appointing at least one third of school governors. Schools should provide numeracy, literacy and IT for parents, to enable them to better support their children and take part in running their school.

Every school should also be required to have an elected body for students, which will play an important role in setting its ethos and overall direction.

Co-operative curriculum

A failure to educate students and pupils in co-operative action and governance continues throughout the education system, which is holding back a new generation of co-operators. This must be addressed through co-operative studies where appropriate on business courses and syllabuses.

Sure Start

Sure Start Children’s Centres are one of the last Labour Government’s finest achievements, and they should remain at the forefront of endeavours to transform the way services are delivered for young children and their families in England. We believe the reduction in the range and number of services provided by Sure Start in some areas, due to cuts to local authority budgets, has been damaging.

More can be done to give communities a sense of ownership and involvement in the remaining Sure Start services to improve services and empower parents who use them. Community ownership can help remove barriers and develop trust, so that the organisation is accessible to people who otherwise would be less likely to use the services.

The UK and devolved governments should recognise the advantages of the ‘community mutual’ model for Sure Start, and work to ensure the development of the model. In particular, they should encourage local authorities to consider converting existing Sure Start/Flying Start centres to the ‘community mutual’ model, as well as using it as a model for the provision of new services.

Local authority role in education

Education should be not-for-profit, and allocation of places, funding and caring for vulnerable or excluded children should not be left to the market. Therefore, local authorities should continue to have a role in planning school places, fair funding, the care of excluded and vulnerable children, and providing additional support to schools. Schools should be enabled to work together to procure back office services and resources such as SEN and school improvement support, as happens with successful co-operative cluster arrangements, and exam boards should be publicly owned or not-for-profit with a strong public service ethos.

Supply and music teachers

The overwhelming majority of supply teachers deliver their work through agencies and umbrella companies. These organisations can be exploitative for the teachers using them and expensive for the schools employing them.

The government should support supply teachers and other freelance or peripatetic staff in the sector, such as music specialists, educational psychologists and SEN professionals, to organise into co-operatives. For example, Swindon Music Co-operative was set up by music teachers following Swindon Borough Council’s decision to close down its instrument teaching service. Similarly, First Call Supply Teachers Co-op provides an alternative for supply teachers who are otherwise dependent on commercial agencies.

However, First Call have had difficulty in obtaining status as a teachers’ agency from local authorities and face stiff competition from big players who use their market dominance to offer uncompetitive incentives to organisations using their services. The government has a key role to play in removing the barriers to recognition of alternative structures such as these by local authorities and academies, and by reviewing monopolistic behaviour by players in this market.