Democratically Accountable Ownership Model for Health and Care Services

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Pat Conaty:

"Is there a democratically accountable ownership model for health and care services that could make a difference? Could the active membership and co-operative ownership of workers, service users, volunteers and family members rebuild public trust in services and put an end to cruelty and neglect through a socially inclusive solution where the system of care is owned by the recipients?

In a growing number of countries, from Europe to Canada and Japan, diverse co-operative models of social care are expanding. We believe these approaches can be further developed in the UK and that they would benefit the lives of vulnerable people by empowering them directly in decisions that affect their care.

This week saw the launch of the UK and Wales co-operatives research report Social Co-operatives, a Democratic Co-Production Agenda for Care Services in the UK. With austerity measures placing pressure on all aspects of public sector delivery, the publication identifies opportunities for co-operative approaches to deliver social care across the UK.

We have researched social co-operative approaches extensively and the Italian co-operative movement provides a good example. The movement has been at the forefront of innovation in the provision of social and health care services. During the fiscal crisis of the late 1970s it pioneered a social solidarity system that enabled workers, volunteers, service users, family members and providers of co-operative capital to become member stakeholders in the governance and ownership of care services. Legislation in 1991 fostered national expansion through the introduction and promotion of flexible legal structures.

Alongside active partnerships with a growing number of local authorities, these changes allowed a renamed social co-operative movement to take off. What makes social co-operatives unique is that they celebrate and prove that small is beautiful, and do so through dynamic forms of democracy. Most Italian social co-operatives have fewer than 30 worker-owners and less than 100 other stakeholder members.

Recognition of Italian success has been spreading across Europe and similar care co-operative models have been developed in Portugal, France and Spain. Development in the UK has been slower but good practice is evident. Some co-operatives in the UK are delivering home care services at scale. Care and Share Associates has expanded into a number of regions in England through a social franchise pathway. The childcare co-operative and foster care co-operative are also highly successful and have spread nationally.

In Wales, co-operative approaches to care delivery are specifically advocated in the Social Services and Well Being (Wales) Act which received royal assent at the beginning of May.

Our review has found there are several challenges where guidance is vital to position a social co-operative agenda so that it is primed for success in England, Wales and other parts of the UK. These are some:

• The involvement of multiple stakeholders in the ownership and governance of co-operatives is not straightforward. How to balance sometimes conflicting areas of interest poses major management challenges.

• Collaborative partnerships are crucial to success both with local government and other commissioning bodies, but also with co-operative capital investment partners ranging from social banks to community development finance institutions.

• Digital technology, volunteer involvement and social currencies can be used creatively to reduce organisational costs and to mobilise the co-delivery of services.

• An association of co-operatives can enable them to collaborate effectively, procure jointly, secure social finance, pool risks, share research and development and replicate services more rapidly.

• Open source information, action-learning set education and the fostering of a social solidarity culture can help with sharing ideas and knowledge. And care quality marks need to be developed to certify, maintain and enhance standards.

• Involving stakeholders in the ownership and governance of social and health care services enables transparency, accountability and trust to be built.

Organisations in Wales are taking a strategic lead in the UK in developing social co-operatives. The hope is that other hubs will be developed in other parts of the UK over the next year or so.

The recommendations in our report can help frame a national strategy for social co-operatives to thrive across Britain and flourish in the years ahead. Social co-operative multi-stakeholder models are a dynamic form of democratic social enterprise that may go some way to providing inclusive solutions to many of the issues within our care systems." (