Finding co-op solutions to the health and social care crisis

With the sector coming under increasing pressure, can the co-op model deliver better results?Examples from the US and UK

Healthcare, as a global sector, is one that always appears on the edge of crisis. From the coronavirus to stories of American hospital workers unable to afford their own healthcare, it is rarely in the good news columns. 

In the UK, government policies have the potential to create more bad news. Under recently revealed post-Brexit immigration plans, low-skilled workers would not get visas. One area that would have a huge impact is adult social care. There are 840,000 care workers providing daily help to older and disabled adults in care homes and the community; of these, 6% are from outside the UK – and currently one in 11 posts are unfilled. Most roles are not classed as skilled jobs, the pay is usually under £20,000 and it is not classed as a shortage occupation. It is hard to see how applicants could meet the government’s proposed new points criteria in a sector that is already low-paid and precarious – and set to get more so with an ageing population.  

Peninsula Homecare Cooperative

In the United States, homecare co-operatives are being set up to meet some of these challenges. As elsewhere, care providers are some of the lowest paid workers in the US – but co-operative model is recognised as empowering workers and enhancing their working conditions. In 2016, Peninsula Homecare Cooperative (PHC) became the seventh worker-owned home care agency in the country, opening in Port Townsend, Washington (population 9,551) with 13 caregivers and a waiting list of clients.

Port Townsend, home to the US’s seventh homecare co-op

“The organisation was founded by a group of caregivers devoted to keeping our community elders safe and happy in the comfort of their own homes,” said Kippi Waters, administrator for the co-op. “The US Department for Agriculture had earmarked funds to start homecare co-ops in rural communities. With the help of Rachel Williams and the CoLab, we met with Northwest Cooperative Development Center (NCDC) to look at the feasibility of starting homecare co-op here in Port Townsend. Just 14 months later we opened our doors.”

The Cooperative Development Foundation’s MSC Fund provided a $9,000 grant to NCDC to support technical assistance and marketing, legal and licensing expenses associated with the development of PHC. But the biggest challenge was engaging the new worker-members, evolving from individuals to a co-operative and from caregivers to business owners.

“I didn’t know how I was going to inspire the caregivers to the ownership of their co-operative,” said Ms Waters. “As an administrator, that troubled me.” She attended the 2016 worker co-operative conference in Austin, Texas, sponsored by the Federation of Worker Cooperatives and Democracy at Work Institute, was inspired, and brought back lessons of member participation and active engagement. Another turning point was the instigation of an annual national conference for worker-owned homecare co-operatives, sponsored by the Cooperative Development Foundation. 

“The goal of the conference was to help existing and nascent co-operatives think in terms of systems and collaborations that can improve wages and job satisfaction as well as client care,” said CDF, which surveyed potential delegates ahead of the event to determine its content and format. Through a USDA Rural Cooperative Development grant and support from the MSC Fund and other organisations, CDF covered expenses related to travel, lodging and lost wages for home care providers to participate in the conference.

It discussed issues such as economies of scale through collaboration, joint services, the economics of the home care industry, increasing revenue through new services and how to communicate the benefits of co-operative membership. 

“There was great information on marketing, governance, finance, client retention and member development,” says Ms Waters. “I brought all that inspiration back and at our next month we talked about how we really are a co-op for our members, ie our caregivers. Because here, empowered members make the very best caregivers.” 

Be Caring

There are examples in the UK, too. Equal Care Co-op in West Yorkshire’s Calder Valley is an emerging care and support platform co-operative with four membership types on a multi-stakeholder model: supported members, advocate members, investor members and worker members. 

Equal Care Co-op is part of the burgeoning platform co-op movement

Also in the north of England is Be Caring (formerly CASA), which in November was highly commended for employee ownership culture at the Employee Ownership Association awards. It’s the UK’s largest employee-owned provider of social care services in the home, with 850 employees operating across Newcastle and Tyneside, Leeds, Manchester and Liverpool. 

“Our clients’ needs always come first,” says the organisation. “So, our range of services covers everything from traditional domiciliary care to more complex needs like dementia, learning disabilities, palliative care and reablement. 

“Our colleagues are all co-owners of the business, and so share in its success. Like being part of a family, we support and encourage each other to be the best we can be. We put people first, not profits. This goes for our colleagues as well as those who we support.”

In particular, it offers career opportunities, development and support to help colleagues develop skills and achieve their goals. It can help people qualify as a nurse, occupational therapist or social worker, and partners with Sunderland College to offer accredited awards.

“Our colleagues have told us that training and the chance to learn new skills is important to them,” says Darren Scholes, head of recruitment and training at Be Caring. “It’s one of their key reasons for choosing Be Caring as a preferred employer. [We] can link the choices our colleagues make with their learning to real career opportunities.” 

But Be Caring CEO, Sharon Lowrie, acknowledges that colleagues in the care industry “are under-valued because the sector isn’t viewed on a par with the NHS”. She adds: “We’re starting with the basics to create a strong foundation based on our core values. We have highly skilled colleagues who have the ability to support and transform the health and social care system. Through better commissioning, and working in partnership with our health colleagues, we can make a difference.”

Last year, Be Caring participated in the All-Party Parliamentary Group (APPG) on Social Care, holding up Allendale Court in West Denton, Newcastle, as an example of such forward-thinking commissioning. 

Allendale Court is a purpose-built supported housing service for young people with learning disabilities. LIFE by Be Caring delivers the service at Allendale to support adults from across the Newcastle city region enabling them to live as independently as possible. It was developed as a collaboration between Newcastle Local Authority, Your Homes Newcastle and Be Caring.

Following a visit, Professor Martin Green, chief executive of Care England, said: “The commitment of their staff supports people to have a life and not just a service. I believe the partnership approach shown [here is] truly groundbreaking and a model for the rest of the country. Quality support is dependent on the quality of the workforce. The values of Be Caring Ltd are absolutely lived by their people.”

Co-op council collaborations

The Co-operative Councils Innovation Network (CCIN) is a collaboration between local authorities in the UK who are committed to finding better ways of working with, and for, people. As part of its programme of work, it awards funding for projects on a local and national scale: policy prototypes that are delivered locally on behalf of the Network; and policy labs, which are bigger collaborative pieces of work that CCIN members worked on together. Previous topics have covered asset transfers, housing, food and more. But in 2020 it was decided to narrow the focus to one area: policy prototypes in health and social care. 

CCIN received 13 bid submissions from eight councils; a joint meeting of the CCIN’s Executive Oversight Committee and the Values & Principles Board was held in Stevenage in January 2020, where members reviewed all of the bids and graded them according to set criteria.  It was agreed to fund all 13 Policy Prototypes.

Cllr Chris Penberthy

“Health and social care is a broken system in the UK,” says Cllr Chris Penberthy of Plymouth City Council, who chairs the CCIN Values & Principles Board. “But if you look elsewhere – northern Italy, for example – there are lots of co-operatives doing health and social care quite successfully.”

He thinks one issue is around how people feel and are treated – whether they are recipients, guardians or givers of care – and believes co-operative values and principles speak to this issue. “Care co-operatives give people back control of something that is very intimate and important,” he says. “The current system doesn’t do that. Recipients can’t choose the care that they get and the care workers can’t give the care they want to.”

He was encouraged by the diversity of the 13 bids, which varied greatly in terms of approaches and themes and cover different parts of the health and social care agenda. 

“It was also good to see bids submitted from lots of different types of councils, and nice that we had enough budget to fund all of them,” he said. “Every single idea was one that people wanted to fund. It’s not vast sums of money but it’s enough to start some important conversations. 

“As we being to pool this learning, we hope that we are able, as a network, to bring a distinct voice on health and social care to a debate that is going to have to happen nationally at some point. If we can bring co-operatives into that conversation with a strong evidence base, we can help move that agenda forward.”

Applications varied in scope from events and printed materials to evidencing and evaluations. 

Rochdale Borough Council, for example, wants to expand its Co-operative Engagement Toolkit Tests, which will enable Rochdale Council and partners to test, refine and shape its Co-operative Engagement policy and toolkit.

“Toolkit Tests will ensure that engagement in Rochdale moves beyond traditional engagement methods which focus on consultation, to one underpinned by co-production principles and provide an evidence base for this approach to be embedded within health and social care arenas,” said the council. “With a whole-system approach, this project will be reflective of Rochdale’s co-operative history and transform our boroughs approach to working with people and communities.” 

Community transport was the focus of Stevenage Borough Council’s (SBC) bid, which looks to pioneer an approach to improve wellbeing and reduce isolation among older people using the Stevenage Community Transport Service. The council has run a community transport scheme for over 30 years throughout which it has seen numerous examples of older people’s wellbeing improving as a consequence of the relationships and connections to services that are made. “We would like to formalise this, to train and develop the role of Community Transport Drivers to become Community Connectors [recognising] the role of relationships in improving wellbeing for older people,” said SBC.

Related: Co-op councils network calls for new policy research ideas

Plymouth Council submitted three bids, to support the work of Diabeaters and the Plymouth Health and Wellbeing Hubs, and to fund a workforce development programme for the Plymouth Complex Needs Alliance (PCNA). Diabeaters was set up at the request of local GPs for people on the cusp of, or who have just developed, Type 2 Diabetes.

A volunteer-led project, it uses the Grow Share Cook model, to reconnect people and food, and will use the funding to assist three additional households in dealing with their diabetes and produce a toolkit for others to follow.  The Wellbeing Hubs aim to enable and help people in the local community to live independently, while the PCNA offers a flexible and creative, person centred approach to addressing a wide range of needs such as homelessness, substance misuse, offending and mental health.

Tameside Council is looking at developing its Living Well at Home (LWAH) initiative, a model – co-produced with clients, their families and carers – that prioritises a client’s needs and outcomes over process. “We’re moving from care as a backstop or safety-net, into an enabler of lives and re-invigorator of individuals,” said the council. 

In Southampton, the Neighbourhood Conversations project is looking at a co-operative approach to strengthening community resilience at a locality level, to consider opportunities presented by the recent development of GP-led social prescribing and primary care networks in strengthening communities. The council also submitted a bid to deliver a one-day co-operative care summit to “strengthen the capacity of the community, social enterprise and co-operative sector to deliver effective preventative social care solutions”.

Cllr Sharon Taylor, chair of the CCIN

CCIN believes there is a need to define a new model for local government built on civic leadership, with councils working in equal partnership with local people to shape and strengthen communities. It sees health and social care is a critical element of this.

“This means a new role for local authorities that replaces traditional models of top-down governance and service delivery with local leadership, genuine co-operation, and a new approach,” says Sharon Taylor, CCIN chair. “This approach needs to be built on the founding traditions of the co-operative movement: collective action, co-operation, empowerment and enterprise.”