It is in the nature of us as people to care… and at times not to care.
There is a care economy out there. Many of the most important and fulfilling parts of our lives – such as parenting, neighbourliness and favours – are about care, even if they are not conventionally classed as economic activity.
When people are motivated by a need which inspires care, whether unpaid or paid, such as a care worker or nursing, there can be a richness in the motivation, because it is needs driven and sustaining of people and society.
When it comes to organisations, care is bit more of a slot machine.
The welfare state, in particular, plays a vital role in peoples’ lives. It can be a life saver, a safety net or a transformer. As one person explained to a friend of mine, Richard Simmons from the University of Stirling – “There are things that, if I didn’t experience them here at the day centre, I wouldn’t have ever done them in my life. Before, I never got out. I was a right scaredy-cat. Now, I’ve tried so many different things, I think “Yes, I can do it”. So that’s what it’s done for me’
But the welfare state can also lose a caring touch in random acts of thoughtlessness, pervasive bureaucracy or the demeaning nature of being assessed as in need. Talk to any parent over the years who has had to get one of their children ‘statemented’.
The language that is used to describe and plan care services mirror that confusion.
Richard, who I mentioned above, was doing research on people who use social care services. He wanted to explore the different ‘labels’ they have – citizen, consumer, client, customer, user, member of the public – all labels with slightly different connotations.
He showed the list of terms to one person and asked ‘How do you think the service providers see you?’ The man looked genuinely confused, and then replied ‘They just call me John’
The words that professionals use to talk about health and social care today, including that great ugly noun, personalisation, are no more than bits of Lego. Terms can be assembled, fit together and sound good, but they don’t capture the fundamentals of care. They don’t answer the question ‘why care?’.
At root we need to understand care as about meeting human needs and creating human dignity.
This needs to be good work. Fritjof Capra puts this as ‘we can’t be empowered by work that destroys the environment around us or creates systems of inequality. No matter how our work is organised, it cannot fully empower us unless we believe in its purpose’.
This is not how the care system, or the wider economy, works.
• In paid work, people are often being rewarded in terms of money and status when they are behaving destructively.
• Those who care at home or in the family that are unpaid suffer low status, poor conditions and often stress and personal costs.
• The burden of this work continues to fall disproportionately on women, whether they are out of or in the labour market.
• The entry of venture capital into the care of children and vulnerable people shapes the culture of providers towards an instrumental model of care, where service is means to an end in the form of a return on capital.
The co-operative model is now well-known and, thanks to the efforts of pioneers in the field, is increasingly looked to as an alternative, potentially better approach.
A co-operative is a business, owned by its members and there for no reason other than to serve their needs.
If the language is confusing, then yes, we can say that co-operatives are a form of social enterprise – something that is run commercially but with people in mind. What is distinct about co-ops is that the people in mind are not passive beneficiaries. They have a say. They have responsibility.
The Foster Care Co-operative, for example, gives a voice to foster carers. It can match pay and good working conditions, though not exceed them, but it adds a precious commodity – dignity.
The challenges of running a business focused on health and care, particularly in the context of local authority financing, are well known. The most impressive examples I know are long-standing health co-operatives and mutuals that in fact pre-date the NHS, such as Simplyhealth and Benenden, which has recently opened its services to all.
But when you talk to co-operatives like this, they stress that what makes the real difference is values and culture.
We are surprisingly unreflective as a nation about the institutions that serve us, surprisingly complacent about turning the care of vulnerable people into a market. To create an economy that cares for people in need, we should take a better road – the path to co-operation.