Part 2: Rethinking social care: how does this relate to the policies of the unions?
Photo: Michael Havens
Part 1 outlined a new model of social care: a National Care, Support and Independent Living Service, locally co-produced. Part 2 looks at recent union visions for the future of social care.
Not surprisingly the main focus of unions during the Covid crisis has been on the immediate consequences for their members, writes Richard Hatcher. But in June 2020 Unison published ‘Care after Covid: A UNISON vision for social care’. [8] It proposes five ‘Interim measures’: A substantial funding boost, Improved pay and conditions, A new focus on training and professionalism, Workforce strategy, and Moving away from the commissioning model. Under the heading of ‘Towards a national care service’ it proposes that
“The aspiration over time should be to deliver the vast majority of social care through public funding, and to substantially increase the direct public provision of social care. This would begin to remove some of the differences in service quality between NHS and social care services, and would address the glaring inequality around access to care that is built into the current care system. It would also enable care providers to have greater certainty over their funding streams and therefore to plan better for future needs, particularly in terms of workforce.
Ultimately the goal should be to bring social care up to equivalent levels of equity and access as those associated with the NHS. And there should be a corresponding aim to bring about greater parity between health and social care in terms of pay and reward, training and development. This would then hold out the possibility of fully integrating hospital and NHS community care with care homes and domiciliary care – in terms of both service delivery and pay systems – as part of a genuinely integrated national health and social care service, based on NHS principles.” (p1)
The report’s concluding paragraph is:
“Any such plans must be undertaken in conjunction with both the NHS and local government. Along with other mechanisms – such as fair wages clauses in public procurement – the merits of sectoral bargaining in social care should be considered, particularly for those workers who cannot be covered by existing national Agenda for Change or NJC agreements. As a first step, a move towards a “social partnership” approach in social care is essential to bring together commissioners, providers, governments and trade unions to at least begin to scope out solutions to the already well-known problems in the sector.” (p7)
It is not clear what Unison means by ‘a genuinely integrated national health and social care service’. At present social care comes under the auspices of local Councils, and while there needs to be effective operational integration with the NHS the policy of Reclaim Social Care is that local control of social care needs to be maintained in order that there can be local democratic participation in policy and provision by service workers and users (a point I return to later). [9]
But the issue I want to focus on here is who Unison envisages as the participants in constructing its new ‘vision for social care’. What is striking is that the ‘social partnership’ that Unison advocates does not include the users – the clients – of social care provision, contrary to the policy passed at the Labour Party conference in 2019.
The Unison report is not unique in excluding the voices of social care service users. In September 2020 the TUC published a report titled ‘Fixing social care: Better quality services and jobs’ [10]. It ends:
“A national Social Care Forum: A new body is needed to bring together government, unions, employers, commissioners and providers to coordinate the delivery and development of services, including the negotiation of a workforce strategy.”
Again there is no involvement by service users in the TUC vision of a reformed social care service. The TUC report was welcomed by Unite the day it was published in a report headed ‘A ‘New Deal’ for social care in England called for by Unite’. [11] Unite assistant general secretary Gail Cartmail said: ‘Unite strongly supports the TUC report and we would like to see a once-in-a-generation New Deal for social care that gives the elderly, vulnerable and disabled the fully-resourced support they need, and which also properly rewards and respects the contribution of social care staff.’ But there was no recognition of the need for an effective voice for service users that respects their contribution, or of its absence from the TUC report.
Multi-stakeholder co-operatives for social care and support for independent living
What form of organisation would enable the empowerment of both service users and service workers in a democratic participatory structure within the context of the local authority? There is a third Labour Party consultation report, Alternative Models of Ownership, published in 2017 and followed up by a conference headed by John McDonnell in 2018, which offers some answers. [12] It advocates, as well as nationalisation and municipal ownership, various forms of community-owned and worker-owned non-profit social enterprises, including co-operatives.
In 2019 The New Economics Foundationpublished Ownership in social care: why it matters and what can be done, which advocates forms of democratic ownership for social care. [13]
“Rather than reinforcing a top-down model of private ownership, we argue that any new money for social care should be used to support new forms of democratic ownership that shift power to care workers and, above all, to people needing support, their families and communities. Short-termist, cost-driven, competitive tendering should be scrapped and replaced by public-social partnerships, where the local state collaborates with socially driven, not-for-profit organisations. Shaping service provision and its relationship to the state in this way has the potential to drive improvements in care quality through refocusing on a core purpose of supporting people to lead the life they want. (pp 3-4)”
It is the model advocated by the Social Services & Wellbeing (Wales) Act 2014, which places a duty on local authorities to promote co-operatives, social enterprise, user-led and third sector organisations for social care, and also seeks to ensure that citizen-users of social care have a strong voice and real control. [14] The Social Co-operation Forum, funded by the Welsh government, ‘believes that user-led and multi-stakeholder co-operatives, embracing co-operative principles of democracy and co-ownership, are ideal models for achieving the Act’s aspirations.’ [15] Of these a multi-stakeholder co-operative (sometimes called a solidarity co-operative) seems the most appropriate model for social care and support in a local area. The stakeholders would comprise service users and workers in a local area, and perhaps relevant community organisations, but also, and crucially, the local council. This multi-stakeholder co-operative model would not displace elected representative government and the role of local councillors but complement it with opportunities for direct participation by citizens in the policy process: a new combination of representative and participatory democracy.
Key strategic policy decisions would be the responsibility of the council, including the funding of provision, quality standards, workforce pay and conditions, and the powers of service users in their relations with providers. The decision-making process should be based on genuine co-production. That would require participatory democracy at the strategic policy level of the council to enable service users and service workers to have an effective say in the policy framework and process. That could be achieved by, for example, a council Social Care Committee with representatives of service users, workers, councillors and officers, a Social Care Scrutiny Committee with representatives of service users and workers, and regular Social Care forums. In addition, in order to make access to the policy process more accessible to all, Councils should set up digital networks to enable online participatory democracy in policy-making, including the use of Zoom. [16]
Within that context staff teams could organise themselves internally on a self-managing basis rather than a hierarchical one. As Ruth Hannan says in her 2019 RSA report, [17]
“The central principle behind self-managing teams is that “the teams themselves, rather than managers, take responsibility for their work, monitor their own performance, and alter their performance strategies as needed to solve problems and adapt to changing conditions”. They are therefore teams without a manager taking overall responsibility, setting direction and allocating work. Rather, these functions are undertaken by the whole team.” (p13)
The RSA has been exploring a number of case studies where domiciliary home care services in the UK are being delivered through pioneering self-managing teams. For example:
“One of the largest social care organisations in Scotland delivering care to 2,700 people each year, Cornerstone started moving towards a ‘local branch’ structure made up of self-organising Local Care and Support Teams (LCASTs) of social care practitioners devolving autonomy and accountability to the frontline. This was inspired by the Buurtzorg model and other innovative social care providers in the Netherlands and has been adapted to work in a Scottish context.” (p16)
Within the self-managing care home-based and home-based support teams co-production would be the basis of the culture of relationships and practices between service users and staff, in which users were able to co-produce provision and support with professionals to support independent living as much as possible. This is the new model of social care, support and independent living that the unions need to be campaigning for.
References
8. Unison (2020) ‘Care after Covid: A UNISON vision for social care’. June. https://www.unison.org.uk/content/uploads/2020/06/A-UNISON-Vision-for-Social-Care-June-2020.pdf
9. Simon Duffy (2019) ‘Reforming Social Care and the case against Integrated Care’.
10. TUC (2020) ‘Fixing social care: Better quality services and jobs’. 7 September.https://www.tuc.org.uk/research-analysis/reports/fixing-social-care
11. Unite (2020) ‘A ‘New Deal’ for social care in England called for by Unite’. 7 September.
12. The Labour Party (2017) Alternative Models of Ownership. https://labour.org.uk/wp-content/uploads/2017/10/Alternative-Models-of-Ownership.pdf
13. https://neweconomics.org/uploads/files/Ownership-in-social-care-report.pdf
14. Social Services & Wellbeing (Wales) Act 2014. https://socialcare.wales/hub/sswbact#:~:text=The%20Social%20Services%20and%20Well%2Dbeing%20(Wales)%20Act%20came,transforming%20social%20services%20in%20Wales
15. Richard Hatcher (2019) ‘Co-production, social care and participatory democracy’. https://www.healthcampaignstogether.com/pdf/1907%2019%20RH%20co-production%20article%20v3.pdf
16. The Social Co-operation Forum: Building a Co-operative Care & Support Sector for Wales
https://socialcoopforum.wales/ . See also Margaret Lund (2011) ‘Solidarity as a Business Model: A Multi-Stakeholder Cooperatives Manual’. https://community-wealth.org/sites/clone.community-wealth.org/files/downloads/tool-oeoc-multistakeholder-coop.pdf ; Mark Harrison (2014) ‘Ideas and Outcomes of Social Action’ http://socialaction.info/docs/social_outcomes_booklet.pdf; Flemig and Osborne (2019) ‘The Dynamics of Co-Production in the Context of Social Care Personalisation: Testing Theory and Practice in a Scottish Context’ https://www.research.ed.ac.uk/portal/files/77564418/FlemigOsborneJSP2018TheDynamicsofCoProduction.pdf.
17. Ruth Hannan (2019) ‘Radical Home Care: How self-management could save social care’. https://www.thersa.org/globalassets/reports/2019/rsa-radical-home-care.pdf
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