DEMOCRATISING SOCIAL CARE
A NOTE CIRCULATED BY RICHARD HATCHER OF HEALTH CAMPAIGNS TOGETHER
FOLLOWING THEIR ‘RECLAIM SOCIAL CARE’ CONFERENCE IN DECEMBER 2018.
The notes of the Reclaim Social Care Conference Follow Up Meeting on 13 December list the points of a ‘common platform’ for the campaign. Point 5 says ‘Services should be locally provided, locally accountable and designed as far as possible by service users.’
Local government would have a, if not the, key role in this. It raises the question of what we mean by local accountability and local democratic participation. Local councils (and Combined Authorities where they exist) as presently constituted are deeply undemocratic in the sense of largely excluding public participation in the policy process. A locally provided and democratically accountable and participatory social care system would require not only the restoration of the cuts in council budgets but a radical reform of the structures and processes of local government.
Co-production of public services
The revival and reform of local government is an issue that the Labour Party has scarcely begun to discuss, but a new Labour Party Consultation Paper, Democratic Public Ownership, published in September 2018, establishes some principles and arguments which are very relevant to local councils and their role in the provision of social care. In their introduction John McDonnell, Shadow Chancellor, and Rebecca Long-Bailey, Shadow Secretary of State for Business, Energy and Industrial Strategy, say:
Labour wants to hear from constituency parties, trade unions, activists, campaigners, professional experts and users of public goods and services alike about how we transfer power into your hands, in order to deliver public services that will transform the lives of all of us who use and work in them.
The consultation paper argues that
There is … considerable evidence to suggest that greater “co-production” of public services – the involvement of citizens in how public services are produced – does produce beneficial effects in terms of performance, as well as making public services more accountable to citizens and enhancing people’s sense of ownership and support.
The principles of this document need to be translated into a set of radical policies for the reform of local government in its role in social care. They also have fundamental implications for private providers of social care, who employ around three-quarters of the workforce. To take the West Midlands as an example, according to Social Care as a Local Economic Solution for the West Midlands, a report published by the New Economics Foundation with Localise West Midlands in August 2017,
77% of the region’s 165,000 care workers are employed by the independent sector; 7.5% directly by local authorities; 7% in the NHS, and 8% through ‘direct payment’. The region is likely to need an additional 25,000 care workers by 2025. (p14)
As the NEF report notes, the social care market is dominated by a small number of large private providers.
The increasing dominance of large-scale providers, with debt-laden business models, is a major vulnerability.
Built into every contract to a major provider will be the underlying need to deliver a significant return on investment – CRESC found that big care providers expect to offer 11% returns to investors (including costly debt repayments which often return to the parent operating company). The business models of the largest five residential care chain companies in the UK offer returns to investors that account for as much as 29p in every £1 of their costs – the second biggest drain on expenditure after wages. (p10)
The NEF report argues that what people want is smaller-scale provision offering personalised care, and community care by small local organisations is ideally suited to cooperatives, social enterprises and other forms of non-profit provision. These types of organisations, unlike the big profit-driven private providers, lend themselves to the participatory model of ‘Democratic Public Ownership’ that the Labour Party Consultation Paper advocates. Even under the present Conservative government local authorities could use their powers of procurement to allocate as much as possible of their social care budget to non-profit providers with participatory models of management involving service users and workers.
How local authority social care policy-making could open up to more democratic participation
There are also some immediate steps that a local council could take to open up its policy structures to more participation by social care service users and workers.
First, it could open up its Social Care Overview and Scrutiny Committee. The large majority of local Councils in England have an Executive and Scrutiny model, with an Overview and Scrutiny committee responsible for social care comprising a number of councillors. The Centre for Public Scrutiny, an independent charity that supports councils’ overview and scrutiny functions, has set out four principles. One of them is this: ‘Scrutiny should reflect the voices and concerns of the people and communities as users of public service as well as electors.’ But there are no mechanisms, no structures and processes, to enable this to happen.
But there is a simple step Councils could take. According to the Centre for Public Scrutiny’s Practice guide 6, ‘Scrutiny bodies: membership and political management’ (June 2014) ‘Few councils co-opt members onto their overview and scrutiny committees’, though they can do so and some do.
What all Councils should do is open up the Scrutiny Committee responsible for Social Care by co-opting representatives of service users, workers and their unions, on an advisory basis but with full rights to speak, to have access to documentation, to make proposals etc.
The expanded and participatory Social Care Scrutiny Committee should be complemented by a local authority-wide Local Social Care Forum, meeting regularly, a place where service users and workers can come together to share, discuss and come to conclusions about their concerns and how they might be addressed. In a large local authority several smaller-scale locality-based Forums might be appropriate. One function of the Forum or Forums would be to elect representatives to the expanded Social Care Scrutiny Committee, as described above, who would feed the views of the Forum into the Council body and report back.
The third step that a local council could take would be to set up a Council Social Care Committee with participation by service users, workers and their unions. Under the Cabinet and Scrutiny model all the executive power is in the hands of a small Cabinet, with one councillor responsible for Social Care, an unmanageably large task for one person. One consequence is that a great deal of policy-making is actually done behind the scenes by officers not councillors.
How much better if there was a Social Care Committee with that responsibility shared among not just a number of councillors rather than one but also with representatives from the users of social care services and the workers in them, again in an advisory role (so recognising the particular status of councillors) but able to contribute their professional and practical knowledge. Again, the representatives could be elected by the Local Social Care Forum or Forums.
In all these proposals for increasing democratic participation care would need to be taken to ensure that service users’ voices were heard and that there was fair representation in terms of gender, ethnicity etc.
And all of these proposals could be introduced right now, even under the present government, by a Labour Council committed to increasing democratic participation and accountability.
Democratic Public Ownership
The Return of Public Ownership From the collapse of Carillion to the failures of the railway companies, Royal Mail, and the water and energy sectors, evidence of the inability of privatised solutions to deliver affordable,
Social Care as a Local Economic Solution for the West Midlandshttps://neweconomics.org/uploads/files/West-Midlands-Social-Care-report.pdf
5 Social care as a local economic solution for the West Midlands 2) Build the evidence base for alternative models of care provision: Map current and future care needs and how they overlap with community