Co-operative Care: an Act of the Imagination

A guest blog from Cliff Mills of Anthony Collins Solicitors and part of The Exchange at Greenbelt

“Care” describes an act of kindness by one person which helps to improve the situation of another. It is an interaction between two people, whether motivated by love, compassion, neighbourliness or a professional calling.

The potential of care has been transformed by the huge advances of medical science in the last 100 years or so. Our ability to help people deal with otherwise life-limiting events; the ability to cure diseases which would have been fatal to previous generations; the ability to help people to regain lost or impaired abilities; and knowledge of how best to live; all of these can and do both transform and extend lives.

Here come two “buts” …
1. The availability of those wonderful benefits – around the world, within our own country, and within communities – is very variable, and unfairly distributed.
2. The ability to provide these benefits is complex, and requires not just lots of caring people, but a “system”. That system might be a public health one, funded by taxation; or a private one, funded by investors and paid for by those citizens themselves who can afford it. And both systems bring their challenges.

As is widely reported and commented on in our media, our publicly funded health system in the UK is facing enormous stress due to a range of factors including longer life-expectancy, the increasing costs of care, and insufficient funding. Every day sees a new crisis.

In parts of the system like elderly care, where many private businesses are contracted by the state to fulfil its obligations, there is a crisis because those businesses are either withdrawing due to the inability to generate a sufficient profit, or continuing to operate by driving down costs – mainly impacting on pay and quality of care.

We don’t know where this will all end. But we do know that the operation of a publicly-funded care system in a democracy today (not just in the UK) is extremely challenging. We also now know that we all need to take much greater responsibility for our own health and wellbeing, to help reduce demand and cost. But will we?

The contemporary, consumer-based approach to, and transactionalisation of public services does not encourage greater citizen responsibility, let alone altruism. And while private care helps to take some pressure off the public system, it does nothing to address health inequalities. “Buying” care just reinforces a contemporary tendency to see care as another commodity that can simply be bought or sold.

Which takes us back to where we started.

Can we imagine an alternative approach for care based around human relationships, and driven by social purpose rather than generating a return on investment? A system designed to listen to the voice of citizens, as well as the voice of trained professionals? A collaborative endeavour between qualified care workers, the individual, and family/friends who provide so much hidden care? And an approach to health and well-being which encourages and incentivises us all to take greater responsibility for our own health and well-being?

There are some people who are very excited about the idea and possibility of co-operative care. Co-operatives are a mechanism for securing human relationships, in a collaborative endeavour. They employ people, and trade as businesses, but for the common good rather than private reward. Could we have care co-operatives?

Some say that there are already lots of co-operative health and care organisations around the world already (there are, up to a point ), and that globally we are on the brink of finding some holy co-operative care grail (we might be).

But nobody has found it yet. Co-operation (1844) predates modern care by more than a century, and is playing catch-up as an approach to care. Similarly, most people in care either haven’t heard of co-operatives, or certainly don’t imagine that they might make an important contribution to care today. But they probably will do.

There are some pioneers on this journey, and you can hear from two of them in the Exchange this year. Cartrefi Cymru has a work-force of over 1,200 and it helps 650 people in supported living in Wales; its CEO Adrian Roper and his board and senior managers have embraced a co-operative structure in which they must now learn to share power with citizens and workers. And Debbie Shannon and colleagues have established Link Psychology Co-operative as a mechanism to enable them to work as educational psychologists in the North West, removing the barriers of politics and waiting lists, making services more accessible and responsive.

These are ground-breaking initiatives; co-operative care is on a journey. If you are interested in this idea, want to hear more and to help us all to imagine how care can be different, come and see how it’s going.

Cliff Mills
Anthony Collins Solicitors