How a care co-operative offers community-based support
Care co-operatives are demonstrating value and impact in forging a meaningful shift towards community-based care and support, devoid of the indignities often baked-in to time and task-based care.
Greater choice and control for people who draw on care as well as care givers provides for improved consistency of care. This is a major factor underpinning wellbeing and enriching the conditions that provides for a more sustainable workforce; simply, more meaningful jobs supporting people to lead more fulfilling lives.
TLAP understands that care co-operatives experience very low staff turnover compared to the market, reinforcing the benefits of mutuality, with great potential to reverse the retreat from adult social care, operating as employers of choice for local people.
Registered with the Care Quality Commission, The Equal Care Co-op (opens new window) is a care and support co-operative society putting power back in the hands of the givers and receivers of care. We spoke to Emma Back, Co-Founder and Strategy Lead, about the co-operative…
Why did you start The Equal Care Co-operative?
We started The Equal Care Co-operative in order to scrutinise and change the balance of power within social care, which is so commonly out of the hands of those who are the most important - the people both giving and receiving care.
We are very much about seeing care as a two-way relationship, a two-way street, and the moment that you start thinking of it like that then you get all sorts of wonderful conversations about reciprocity, mutual respect, and about understanding one another’s humanity. This makes for long-lasting care-giving relationships and therefore high-quality care and support.
How does Equal Care Co-op work?
We work with ‘teams’. Each team is owned by the person receiving support and consists of family, people external to Equal Care; whoever the person nominates. The team has final say over the care and support, unless there’s an extremely good reason for them not to, for example, a very serious safeguarding concern.
Each team is then associated with a ‘circle’. Circle membership is fluid and open. In our Yorkshire circles, these are local networks of care and support workers; they are responsible for supporting and enabling their teams to flourish and be well and hold a variety of 'hats' (roles) to be able to do this. In London, circles are developing with a cross-section of members of the community, disabled people and PAs.
How about commissioning?
Initially social workers, health commissioners and social care commissioners often treat us with suspicion, they’re not sure if it will fit into their assessment framework.
On the bright side we’ve often found that the longer people work with us, the more positive they become. There’s a few stand-out examples, where they’ve started off thinking “Who are you?!”, “What are you?” but these people have turned into some of our biggest cheerleaders because they’ve seen the impact that we’ve had on the people that we support, particularly with people who were predicted to go into hospital or would be going into residential care.
An easy change that commissioners could make, and are making in some areas, is to make framework contracts act a bit more like personal budgets.
If all they did was just trust the provider a bit more to have a conversation, to allow some flexibility, that would be a great step. For example, if you have been assessed and funded for ten hours of care a week, that’s fine you can bank it, use it, compress it, you can do what you want with it as someone receiving support. You can do that in a way that you still have control over, on what you can compromise on and what you can’t.
If there’s someone that you connect well with but they can only visit at certain times, and you want that person rather than someone else, that’s a decision for you to make. Maybe to stay in bed an extra 45 mins in order to be supported by this specific person rather than the provider or the social worker making that decision for you saying “no it has to at this time because that’s the assessed need” and that means that you don’t get the right person or you get lots of different people.
How does this approach benefit those receiving care?
Recently we’ve been supporting a man who has Parkinson’s and cancer. Previously he had been receiving care on a rota-based system, which was very disruptive for him and his family. People were showing up late, the family didn’t know who was coming or when, and they had up to 40 different people coming in per week.
When the family came to us the number of people visiting went down to three, with a fourth person joining the circle as back up. We were also able to compress some of the visits, because as a family they had decided what worked for them.
With these changes to the schedule, other things changed too. The man, previously bed-bound, started getting up, walking around again, and his mental state improved too.
His team members, knowing about the horrible disruption that the family had experienced before, worked hard building the relationship with him and his family, it was very much a team thing. You are all there for the same reason, to support this man and his family.
This is what’s at the core of Equal Care’s model – consistent relationships, mutual respect, knowing who’s going to show up when, working within your zone of consent rather than without it, coming together for the team, for that person, with their ownership: it's their team!
We are relationship centred, rather than person centred. A relationship is this ineffable thing that exists between people and you can’t force it, you can’t control it, all you can do is everything in your power to support it to be the best it can possibly be.
Commissioners interested in developing a replicable, long-term, sustainable response to increasing demand for social care should consider the wider impact, not least, stimulating growth of the local circular economy, attracting investment from and accountable to local people through the democratic structure of cooperatives. Whilst care co-operatives typically require a longer lead time to establish it seems clear that they have an important role to play in supporting the growth of the core economy capable of sustaining relational care and support and should be encouraged.