The Oxfordshire Care Co-op Pilot, led by Co-operative Futures aims to understand and test how co-operative and co-produced models and approaches can fill gaps in the current market and solve challenges in the Adult Social Care sector in Oxfordshire and create more ownership and voice for both care workers and care users.
We held an online webinar where three existing care co-operatives, Co-operative Care Colne Valley, North West Care Co-op and Equal Care explained how care co-ops work and shared their experiences of setting up a care co-op in their localities.
You can find out more about the Oxfordshire Care Co-op Pilot here.
Graham Mitchell from Co-operative Care Colne Valley, presenting about their care co-operative.
Find out more about Co-operative Care Colne Valley here.
Transcript
Graham Mitchell: I'm part of the group called Co-operative Care Colne Valley, and I've shared this photo, not just because it's a nice picture, but I think it shows something quite important about where I live in terms of the terrain, and how that impacts on our business model. Because one of the big things about our care business, and we are running a home care service, is the time and distance it takes to travel between people's houses and that's quite a key factor really in terms of business planning. And the fact that we are living in this landscape which is full of valleys means that you get communities along valley bottoms generally and not so much along the top. So moving from one community into the next. Means sort of going over the top into the next valley and that you know there can be quite a lot of time involved in that so I just thought it'd be really important to mention that point actually, because it's not always obvious.
So anyway, moving on if I can. Yeah, so we're a place-based organization. We're based in this place called the Colne Valley in West Yorkshire. Our model and our approach means that we're led by local people. We provide a regulated home care service. So this is CQC-regulated domiciliary care, to use the jargon. So our people look after the people we care for in their own homes. Our whole approach is about inclusivity. We're born out of a sort of a social movement of active citizens. And I'll talk a little bit more about that history just to give you some context in a moment.
We're structured as a community benefit society, which is a particular flavor of cooperative. And as part of that, we're registered with the Financial Conduct Authority. They're the regulatory organization that looks after these types of legal entities. And obviously, we are a cooperative so we're committed to the values and principles of cooperation. That's what we do.
So a bit of context, bit of background. The conversation that led to our creation goes back to about 2017 - 2018, pre-pandemic. If you can cast your mind back that far, it's quite a long time ago, but the world was in quite a different place then. And there was some issues floating around the crisis in social care then as now that's not changed at all. The fact that what we were seeing was a general disrespect and poor treatment of people working in the care sector. And I think that's still true today. And a lack of access to care for people in need. So there was, I think some of those problems are being addressed, but at that point in time, it was clear that there was more demand than there was supply in the so-called care market. And so we want to try and address that. That situation has changed quite a lot in the intervening years.
And that's something that I guess in terms of your business planning, you'll need to take account of for your project. Certainly here at the moment in my locality, there is more supply now than there is demand. And that has come about as a result of the pandemic largely, we think. But we think also that picture's starting to shift again now. So that's something that's really, really crucial, I think, in terms of trying to develop a sustainable business operation in this sector. And of course, you know, we're operating in concert whith local government and NHS. At that point, we are really struggling. Local government had been defunded by the government of the day for the last decade or more. That picture might be slowly starting to change but I'm not holding my breath, and obviously we've got this sort of NHS situation that we're probably all well aware of, and these are two big purchasers of the care services that we provide so their financial health and well-being is critical to our business. Actually not a huge amount has changed and with those four sort of real pinch points that drove the idea to do something in this market.
Moving on; our vision is very simple. We are just looking to do something, to intervene in this space. We were a group of people that live locally and we said, "we're really worried about what was happening." So we came together to try to intervene, the choice being that we could have stood aside and done nothing and been passive consumers of whatever was available. But as a community, we decided that we wanted to try and change the situation a bit in our favor, so we chose to intervene.
And these are the groups that we're interested in working with and supporting. So, service users and their families, people who work in care, our staff, members of the wider community, those are the three big issues that we want to try to work in context of, and try and improve the positions of. And we've also got this fourth thing, which we were very keen on and remains a really key point in our organizational thinking, which is about achieving scale through replication and adaptation and federation, rather than through becoming a large monolithic business. And this was driven really by being accountable to the local community, being responsible to the community that we serve, and being accessible.
So if you're a large monolithic corporate organization it becomes increasingly difficult for ordinary people to access that organization and understand it and work with them. If anyone's tried to get sense out of a public utility, for example, it's really challenging because they're very remote. They don't relate in the same way. So we wanted to stay small so that somebody in our local community could see themselves without special training or qualifications or anything like that. They could see themselves as being a useful and effective member of our Board of Directors. They didn't need to be an accountant, or a specialist in care, or any of these other things. So that was one of some of the stuff that was affecting our thinking around how big we needed to be, and how we grow.
Also, I mentioned that we're a society for the benefit of community rather than a worker co-op or a cooperative society, which is run for the benefits of its members only. And that was a conscious decision because when we did our planning and our theory of change work right at the beginning of the process, we came to realize that if we were going to be successful in the long term, we were going to have a positive impact on our wider community, not just the people who worked for the organization - not just people we looked after - but the people outside of the organization in the communities that we serve. And we were going to have an effect there, and that was part of the broader vision of the organization. So that's why we set up using the model that we did.
So directly trying to address some of the fault lines in the care system, we really like the Italian social cooperative model - which is quite popular and very successful in parts of Italy - where they provide care, but they also provide a whole range of other services around that as well. And we're not in this thing to make profit or anything like that. We're of the view that this sort of service needs to operate beyond any concept of market, outside of the market, really.
We're trying to develop multi-stakeholder governance, and I'll talk a little bit more about that in a bit. And we're trying to integrate this concept of regulated care within a broader community-based provision. And we did a lot of that thinking around that at the beginning, but where we are now is we've set a lot of that aside - and for fairly sensible reasons, I think - but we're looking to come back and look at that again. And this idea of organized neighborliness, in a sense, is something that we're trying to build. One of the people that we spoke to a few years ago was a guy who'd been working on the South Coast in Torbay, and they were running a social care organization in the broadest possible sense, where they were being funded by their local authority out of the social care budget because what they were doing wasn't really delivering social care, but it was about preventing the need for social care. So if you rang them up, the first person who would answer the phone would be somebody who would be a recipient of service rather than a professional, and the first thing they would ask you is what would you like to contribute, rather than what do you need. And their whole model was about trying to give people purpose and a sense of belonging because what they've found is that if they have those things then they stay healthier. Their wellbeing goes up and they don't need to rely on care services quite as much. So it was really positive outcomes. They were being funded by their local authority out of the social care budget because they were reducing the demand on that budget by the work that they were doing and that was something that I thought was really inspirational and something that we would aspire to working towards within our own thing.
So, going back to the story: benefits for service users. We wanted to ensure that the people involved had a real say in shaping the service, wanted to try and move beyond this idea of time and task, and develop social activities and provide a broad-based care regime which was about enabling people to live the lives they wanted to live, rather than someone said the other day, sticking a butty in front of somebody is the basic provision in many contexts, certainly for the groups that we work with: older adults, and to a lesser extent adults with disabilities. We're trying to work with our staff team to bring them into these cooperative contexts much more, improve care quality through their well-being. And obviously, we're very keen to treat staff as well as we can possibly afford to, so we're always looking to keep our pay rates as high as we possibly can whilst not impacting the sustainability of the business. And, trying to develop this idea of a holistic approach really.
So staff members being treated as professionals: they have a say in shaping the service, staff representation on the board. These sorts of things are basic principles that we're trying to live to. We're an accredited real living wage employer. We pay people for travel time between appointments. We pay for training time that they undertake. We don't ask them to pay for their own uniforms or pay for their own DBS checks and these sorts of things, which is often the case in the sector. So we're trying to work really hard to build a great package of terms and conditions for the people that work with us. We try and focus on having locally based teams; again, partly to minimize travel and impact on the environment, but also just because it's better, because people know each other better and you get more continuity of service. And trying to build this idea of professional development: people not just being in care as a short-term job, but as a career. And wider community benefits: we think that by doing what we're doing, we're contributing to local wealth building. Filling a gap or at least when we started, we were filling a clear gap. That's less the case now, but I think there are still challenges there. We're about community cohesion and building resilience in our community. And trying to work together with other organizations in their community to provide a sort of a more of a meshed approach and offer something to the local authorities and the statutory agencies that are looking to develop a more preventative approach.
I talked a little bit about the strawberry patch type model, where we grow through replication and federation rather than becoming a big monolithic organization in their own right. We got some funding from Power to Change some years ago to assist with that, and that helped us build some resources which we're very keen to share, and I hope that you'll be able to pick that up and use it and develop it further. We think that the key way forward here is about collaboration between organizations. So you can achieve some economies of scale through shared back office services, whilst maintaining that very much locally centered, locally owned and controlled approach. But you can get the economies of scale by taking some of the back office stuff and centralizing that. We think there's a real scope to do stuff there, because I think once you start building your business plan, you'll realize that you've got some fixed central office costs that you really have to try and streamline. This is a website that we built with our Power to Change funding and we're keen to see that develop into a shared resource. So we're very happy to provide log-ins for people there so people can go in and edit, and build more content there and rewrite the old stuff that we wrote a few years ago, and improve it and build on it.
We think that it's taken us an enormous amount of time to develop the expertise and skills that we've got now, and the knowledge that we got, and the learning from all the mistakes that we made along the road, and we're very keen for people and organizations that want to follow in those footsteps so that they can accelerate their process by not making those same mistakes, so we can hopefully point them out early and stop you, enable you to go further, faster, really.
Some challenges that we faced along the road, which we didn't really know were coming when we started up back in 2019. We were registered as a co-operative in 2019, we started trading in 2020 just as the pandemic hit. And obviously COVID was a massive game changer for what we do. Initially, it was actually quite positive because it freed up lots of resources and we got funded to do things at a very early stage in our life, which is really helpful, but obviously it's had long term impacts, which have totally changed the face of the operation. After COVID, we had all that stuff with energy price hikes and the cost of living crisis, which obviously impacted us because some of the providers that we compete with, that are much bigger and uglier than we are, that were able to ramp up pay rates. And we were less able to respond in that context, so we've had some recruitment challenges.
It's really difficult to recruit experienced senior people. We've had some internal people issues along the road which have been really challenging for us, and difficult to resolve, and costly in terms of time and money. We've had this situation which I think everybody in our sector probably faces where it's in the nature of looking after older people that their care needs ramp up, and up, and up and then all of a sudden they'll go into residential care, or they'll going to hospital, or they will die. And that's a reality of the industry I guess, but what happens is that you've ramped up your capacity to deliver support to that person, then all of a sudden they disappear, and the revenue disappears at the same time, and that's really quite challenging to deal with sometimes. So we have that as an ongoing problem and so we're thinking strategically about how we can mitigate the risk on that sort of stuff.
And then most recently, in the spring of this year, a lot of the government brought in changes to employers NI, which we think is gonna cost us around about 10 or 12,000 pounds a year straight, out of our bottom line. So that's a really significant impact on our operation.
A few key learning points...
Host: Graham, we might have to run through these a bit quick here, I'm just saying, sorry.
No, that's okay, no worries. So, points of advice, it'll probably take you longer than you think, so don't think you can set a business up in five minutes. It'll probably take you more money than you'd think. We had ₤165,000 in working capital when we started and we pretty much burnt all of that. And so if I was going to do it again, I'd probably be looking to raise at least twice that.
And this is a really complicated business to operate. It's not straightforward stuff. We're operating sustainably now after five years, but we're still quite fragile as a business. We need to grow further significantly in order to build reserves and resilience in our organization. We've made a huge number of mistakes despite having some fantastic expertise in our team. We've learned an enormous amount of stuff. We're beginning to get some things right. We're convinced of the need. To cooperate across other organizations and other geographies in order to develop the sector. We think that's vital as a way forward. We want to use our co-operative values and principles to drive the next phase in our development, continue to collaborate with other initiatives. We think a network - which we've done some work to develop a few years back, but had to take a bit of a backseat more recently - we think that's really important. And this idea of shared services we think is crucial. That's me, I think.
John Roberts from North West Care Co-operative, presenting about their care co-operative.
Find out more about North West Care Co-op here.
Transcript
John Roberts: Okay, so my name is John Roberts. I've generally tended to describe myself as the chief cook and bottle washer of North West Care Cooperative because I've been the person- the first employed person who's been around since we started, helping to put this whole thing together. So that has been me and I'm going to talk to you about our model.
And I think the first thing to say is that so much of it is actually in the values and the ethos and what we're trying to do is so similar to what Graham has described with Co-operative Care Colne Valley. And and I've known Graham for a while, I suppose we popped up on these kind of events over the last few years. And North West Care Co-op, we are a similar vintage to Co-Operative Care Colne Valley, I think we might have started maybe a year ahead of you, but we're a similar vintage. It's been a kind of similar journey. Although I would argue we perhaps started from maybe a different place and in that sense have taken a slightly different angle on it.
And so what I'm gonna probably focus on in the next 20 minutes or so is everything that Graham said about values and the general approach is what we do, but I'm going to show you perhaps how our journey has been a little bit different and the nuances that are different in the particular journey that we've taken.
So, firstly, that's how we describe ourselves, that's our strap line: "Together we can live life well," and we offer safe quality care that's under your control and informed by your experience. And I think I fully 100% go with what Graham says about collaborating and collaboration being the future. I genuinely believe that in the world, or the future of social care - I don't think there's necessarily a magic bullet to fix it - but if there is, I think the closest thing to it is to involve the people who receive social care services in the design and the day-to-day delivery of them. And I think there are - out of this sector, in other industries - as an example of how that does work, to really transform both outcomes and costs and the way things operate.
And I think that generally our kind of vision, I think, Co-operative Care Colne Valley's vision probably aligns with the vision that I put on the screen here, which is that of an organization called Social Care Future. If you don't know about Social Care Future, then I would recommend you Google them and you look them up. They've done a lot of work. They're a kind of a bit of a lobby group, a kind movement that's looking at trying to influence the future of social care. That is their vision, and I think it's a really simple one. And I think it's one that any cooperative or co-productive organization could quite probably easily sign up to, or be a part of in that context of the wider collaboration that Graham's referred to earlier. And we would certainly sign up for that.
And I think the sense of community that that implies is, I think what both ourselves and Graham and Co-operative Care Colne Valley have been looking to do. Social Care Future are kind of big picture; us and Cooperative Care Colne Valley are kind of down at the lower end, in the weeds, on the ground, as it were. And I think the way that we contribute to that bigger picture is to fulfill the direction really from Gandhi, which is very much "be the change that you want to see in the world." And I think Graham's explained very well, that's what Co-operative Care Colne Valley have done locally for them. And that's also what we've tried to do within North West Care Cooperative.
And it's probably worth just telling you a little bit more about us geographically. So North West Care Co-operative, we operate in the western half of Cheshire, really the sort of Cheshire area and on the Wirral. We call ourselves North West Care Co-operative for reasons that I'll explain in a moment. It's kind of interesting, we have a slightly different starting point to Co-operative Care Colne Valley and in some of these presentations that I've done in the past where we've talked about what we've done, there are some sort of dyed in the wool members of the Co-op movement who've looked at the way that we're structured, and what we do in our governance and where we take it from, and all that kind of stuff, and said to us "you're not really a proper cooperative." And the reason why they say that is because we are actually a business that is registered at Companies House, rather than an equitable care society or a mutual, who are registered with the Financial Conduct Authority - as Co-operative Care Colne Valley is, for example. So they've kind of said that we're not a proper co-operative, but then in the same breath, really - those same critics, if you like - have been people who've said, "but you know what, we've been trying for the last 20 years to launch a care cooperative in social care, and we've never quite been able to do it." And there's something really about the question that that implies has been already answered by them, which is that- this saying here really, on this slide, which anyone i think has ever been involved in the design or the building of anything would have heard of the idea, that "form should always follow function," and it's an american architect from the end of the 19th century, who said that.
If you're defining a cooperative in terms of which particular regulatory authority it works from, or or how it's structured, or how its governance, then you are perhaps kind of missing the point really, if the function is to do things co-productively - to engage your membership in the decision-making around the direction of the organization, to share the profits and benefits of the organization, all those kind of cooperative values - then that function can drive all kinds of structures that may not be different to the traditional ones. And if you set yourself up in a traditional form, you may well limit the function that you can deliver. And I think it's important that form follows function. You identify the function and then the form should follow that.
And in terms of North West Care Cooperative, the function, if you like, that was identified back in 2018, very much the service specification, was born out of the experience of a number of disabled people's user-led organizations from around the North West, hence the title North West Care Co-operative. And the principal one of which was the sponsor of the project, and the holder of the money, and the organization that we're now a trading arm of, which is Disability Positive in Cheshire. And that was formerly what was known as Cheshire Center of Independent Living. And if you know about disabled people's organizations, there is a history of centers of independent living around the country. And things have moved on since that term was kind of in use. But they are organizations that are designed to advocate for and offer services for disabled people.
And their vision was that these DPOs came together to bid for some money from the community fund to set up a care cooperative. And their vision was not to produce a care provider, but to set-up an organization that would enable people to live their life well, which again reflects very much the values that Graham's already described. And for them, it was all about choice and control, and the ability for the person receiving service to be in control of the service that they received, and be able to direct that service and how it was provided for them. For the DPOs, there was very much a focus on what you might describe as self-directed support. So our target audience, our market, was people who were already in receipt, or likely to be in receipt of, either direct payments or personal health budgets. And the challenge, or the gap in the market that they saw us as trying to fit or fill, was people who might be on some kind of self-directed support, but then was struggling with the complexities of actually managing and administering that self- directed support. So the role of being an employer. Some of those people problems that Graham talked about within the organization, and all the hassle that goes with being an employee, doing the health and safety, doing all those kinds of bits that any organization does.
So the idea was that if we created a care cooperative, we could create something in which North West Care Cooperative could act as the employer, and effectively own all the hassle that goes with employing people, whilst the people who were funding that - the care users, the people we were providing services to - could just focus on the important bit about their care and support, which was the sort of fun around living their life well. And so that was very much part of the service specification.
We also recognize that in terms of the relationship between the personal assistants or PAs, or the care workers as they would be known, and the people that they are supporting, that it was more than simply training and employing people who were capable. We needed to train and employ people who were matched to their clients, if you like, people who would get on well with the clients, will form a relationship with the client. And so we define that in an article that we wrote in a blog, which was: people who are fun to be around, people who actually you want to do stuff with, you want to live your life with - well with, if you like - and not just people who would provide transactional care and support for you.
And finally, the critical thing that these DPOs recognize is whatever it was that we designed, it had to be regulatory compliant, And particularly, it had to jump through the hoops that the Care Quality Commission had in place at that time. And that very much drove the kind of structure that we then introduced to be North West Care Co-operative.
So the form that we chose to follow that function was- we were guided on this by a leading firm of charitable sector lawyers in the North West, and so they identified this for us. So we didn't particularly come up with the idea ourselves; it was based on best advice, and they identified a form for us where we would set up a not-for-profit service company - which is what North West Care Co-operative is - but that service company has one client, which is North West Care Cooperative/Chester, which is the cooperative. It is all the people who receive our services, it is the people that deliver those services, and it's a third category of membership who support those people. And I'll come on to that in a moment.
And what that did, is it enabled us to jump through the hoops of CQC regulation. Because CQC register and regulate two things: they register and regulate a service; and they register and regulate a location. So if we were a traditional care service provider running in a care home - we might be Acme Care Services, for example - and we might have care homes in Chester, and Liverpool, and Manchester. So the service would be Acme Care Homes, but the location and the place that would be inspected in inspection would be Acme Care Homes/Chester, and the care home in Manchester, and so on. So the co-operative became the equivalent of the care home in Chester - it became the location - and the service was the not-for-profit service company. That fitted very well with the requirements to jump through the hoops of regulation, which again we did in early 2019.
We had the idea of membership exactly along co-operative lines, so the people who receive our services who we call our principal members, the people that provide those services are personal assistant members, and a third category of member who might be the mother or father of a principal member, who might actually be the person responsible for holding their direct payment or personal health budget, we call a supporting member. They are all members of the co-operative.
And the critical thing about that kind of three-way membership is it means that you'll never really- what we hope from that, you'll never really get in a position where the personal assistant will be able to bully, for want of a better word, the principal member, because there's this supporting member who's always able to advocate for them. So we built in a natural thing, we believe, which will always ensure and underpin that choice and control is in the hands of the principal members, the person receiving services.
We very much targeted the direct payment and personal health budget market. We currently support 53 people within the cooperative, all of whom are direct payment or personal health budget clients. And we've got one new private client, our first private client who's likely to join us soon. And the form of the business was designed along what we call a lean startup. So We began trading in early 2019, and we began trading as early as we could to start generating money for the business as soon as we can. And because we started with some grant funding, we didn't have to repay investors, so we were able to move quite quickly, relatively speaking, despite the difficulties of COVID. And we actually first became sustainable and we turned a surplus in a month in February, 2021 and we continue to turn a surplus every month ever since.
We're registered as a domicilary care agency, we support people in their homes and in the community, but our workforce is a very agile working base. So a lot of working from home, or working in the place that they work, there's more supervisory and managerial kind of roles quite working for home. We have a registered office, as we're required to have for regulatory purposes. That's in the building that Disability Positive owns. And we have an in-day every week on a Wednesday where the key staff who run the business, if you like, meet together and collaborate together on the day. But the rest of the week, they're working out in the community where they're operating. And we also operate according to some principles known as systems thinking, which is outside this sector. And if you want to learn about systems thinking you can spend hours doing that. But the critical thing that I would say is Toyota transformed the motor industry through systems thinking in the 1990s. And it is about a ruthless pursuit of value rather than cost. And there is a saying in systems thinking which I can bore you with much later, but if you try and pursue and drive down costs you just push costs up, whereas if you pursue value you can drop costs. And it is about the pursuit of value.
We operate on tight margins and low prices. The direct payment rate is considerably lower than the care agency rate, so in order to offer our services at a rate that is affordable to people on direct payments we charge a much lower price, about £6 per hour lower than we would do as a domiciliary care agency if we were paid the care rate. But we are able to do that because we're systems thinking, we operate on tight margins, and we've had this performance approach known as the aggregation of marginal gains. And that is the stuff of David Brailsford in UK sport cycling, and it's about understanding the business in great detail and making tiny little improvements that aggregated together can save you money or improve the value. And continuous focus on that is really important part of the way that we operate.
And the result of that - and you'll be pleased to hear, I think this is pretty much the final slide - is that we developed a culture, which again is very similar to what Co-operative Care Colne Valley has managed to establish, which is kind of asset based, I would describe it. So it's more than just being an employer of care and support. We have the idea, really, that we, everybody needs support, PA's need support, our members, our principal members need support. We just support each other in different ways. So the employer supports the PA by providing them with employment. The PA supports the principal member by enabling them to live their life well. And we have this idea, exactly like Graham described, of being a community that doesn't offer care. It offers more than care. And we had the idea of caring about rather than for each other. So actually, there's a mutuality there.And I can talk more about that in detail later. But in equivalence, we all need support. Sometimes the care where the PA will need to finish early or finish late. And we kind of work around that, and that mutuality is there within the way that we operate on a daily basis. More recently, we've been developing this idea of "more than care," which is about two things around purposeful activity and moving forward. Graham's spoken about what we would describe as purposeful activity. We've engaged our members in a series of - generally, it's either been fundraising activities or activities supporting a local charity that provides support to elderly people who live alone and face loneliness. So we ran activities where our members visited them and brought them - it was around Christmas time - brought them a Christmas hamper that they prepared. So we engage our members in this kind of purposeful activity that is giving something back, is generating and promoting their wellbeing and their self-worth. And the value of that is exponential.
And then the other piece of work which we're working around is what we call moving forward. We have a number of principal members who are the sons or daughters of mums and dads who manage their direct payment, and help with their managing of their lives. And of course, mum and dad are preparing, or worried about the time when they will move on. So we're trying to explore the ways that we can set up trust and other kinds of arrangements in place so that our community can actually provide for our principles when some of their supporting members have moved on, as it were.
One of the interesting things, which is a product of our culture, is that when we first started on this journey - and this is a bit about form following function - we had a constitution for Chester Care Cooperative which was based on a co-op UK constitution which envisions just having four general meetings a year to consult with our members and get them to direct the services that we provide. And from that you have a vision of a drafty village hall, points of order, a long agenda, people sitting in rows - and to a client group which is people with neurodivergent autism, and all sorts of things that make it difficult to sit in a room for any length of time, non-verbal in many cases - you look at our client group and you think how are they ever going to sit through that kind of formal cooperative general meeting. And so we move completely away from that.
What we've noticed are people like to socialize together and do events together. So we have a whole series of social events that are now part of what North West Care Co-operative is all about. And we use those social events to kind of gather feedback from our members about how they want the organization to develop and grow and what they want to do and what don't want to do, and what's good and what bad. So social events are a fundamental part of our decision-making. And rather than regular general meetings, we have a more or less continual, continuous culture of consultation with the critical consultation being the relationship between the personal assistant and the principal member, or the team of personal assistants that might support principal member, where we always try and make sure that we match those people together so they get along well, and it's the same personal assistant, and the same team of personal assistants supporting that member, ad infinitum, so we can build a proper relationship of them with them, rather than a more time-and-task based kind of thing.
So I think the slides seem to have just frozen at the moment. The final thing really to say, and it goes back to Graham's point about scaling and replication is there is a thing called Dunbar's Law if anybody's heard of it. Local to you, he's an Oxford University Professor in social anthropology, wrote a thesis in the '90s that suggested that the optimum size for any kind of social group, before it becomes too big and unwieldy, is around 200 people. And he defines it as the number of people that you could walk into a bar, the number of people who you could know, who you would walk into a bar and if you met them you'd feel happy to have a drink with them. And that, he says, in most people's lives is about 200. And once you get bigger than 200, you start to lose the sense of community and the connectivity and you become just a little bit amorphous.
And big organizations actually are not big organizations, they're just collections of Dunbar's law groups of around 200. So that's our message. We are around the 200 size with our principal PA and supporting members. So we're feeling that we're probably at the limit of our size. And that the way we would develop and grow is by offering a different range of services within our service, such as purposeful activity and moving forward. And if we were to spread what we do more widely, it's about replication elsewhere. You can follow our story on our website. There's quite a lot of information on that. All sorts of social media feeds and I can put some of those as links on the chat. But apart from that, that's me.
Emma Back from Equal Care Co-operative, presenting about their care co-operative.
Find out more about Equal Care here.
Emma Back: Hello everybody. So Equal Care's premise is based on putting power where it belongs, that is the basis of it. It is about moving power around, because it's a bit like money: it's always present and if people say that it isn't, then they're not being honest about that. And our view is that power in social care is very asymmetric, balanced in favor of the people who aren't doing the caring, or receiving the caring, and is producing an incredibly exploitative, very problematic culture which people are naming "the social care crisis" because obviously nobody wants to be working in a situation where they feel powerless. Nobody wants to be receiving support in a situation where they feel powerless either. So this is the problem that I think all of us here - all of us co-ops here - have been setting up to solve.
And it's a complete lack of choice and control, and disempowerment across the board, and so we've gone about that in a bit different way. We've developed an alternative model of support and a platform to go with it. So the digital platform is there to support and enable the model of caregiving. So we're a platform co-op, owned by givers and receivers of care and support, and our families; and we are relationship centered. We think there's a lot wrong with the person-centered philosophy in social care. It's basically comes from more of a consumer-led approach which we're not really up for. And people receiving support want committed understanding, respectful relationships and people giving support want the opportunity to build those as well. So that is the 80%: solve that 80% and then you're a long way towards fixing the social care crisis. So, "to share power and enable care and support to exist in abundance.".
Just a brief view of how our ownership structure works - so, we do have investor members, but they're weighted to only have a very small share of the vote - and then we have supported members, advocate members, and worker members, who are all one member, one vote. And they sort of switch around.
Our structure is decentralized as far as that's possible, given the 2008 Act. We use sociocracy, which is a form of decision-making by consent, so our structure is circle-based. And fundamentally, the way that we enable it for care and support workers, and people receiving support is that, you know, you can see here that people work out their own rota. So the decisions about when to support someone and who to support, and how long to support them for, is made with that person themselves. So it is the person giving support, it is the the person receiving support, it might be the family member that's doing the coordination. It is not made by somebody sitting in the office and organizing the rota for the week. And that is absolutely transformative and goes a really long way to enabling the kind of flexibility that people receiving support need, and people giving support needs as well. So this is the structure.
We work in teams, so every single person receiving support - as John described really - owns and leads their own team and they choose who's in it. So that could be private PAs, it could be other agency members, it could neighbors, could be family. And that is what makes up the team and it's also paid Equal Care employed or self-employed workers. Those teams are supported by the local circles which operate sociocratically and have got specialized roles to help those teams start, flourish and finish. And then the shared circles are there to support those local circles. And then finally there's the board and the membership down there. This is the structure of a typical team. So you might have particular roles that are required to get the care working and working well.
We do have quite a few team owners who are their own profile holders, so they'll keep their support profile up to date - and also some team owners, who manage their own rotas and things like that. Then there's family members who might be holding the medication for example and it's just it's a real mix. So we call these added roles - which are usually just piled on to a manager who's usually really stressed, is also doing it for 50 other people that they don't actually know and haven't met half of them - instead, these roles are distributed amongst the team who are doing the support, and the person who's receiving it, and the family members that are doing that labor as well. So this is just an extract from our welcome book around the wonder of hats, because the point about these roles is they can be put on and they can taken off, which is crucial for burnouts in this sector. So on this side you see, this is actually the hats worn by a mother of somebody that we support who has very complex needs and sort of 48 hour care - so two-to-one care at all times.
And the mother is- she's the MAR admin so she keeps the medicine administration record updated, liaises with the pharmacy, and she's also the profile holder for her daughter as well. We do operate ethical gig work, so we do support people to be self-employed or employed and people joining us can choose that. It's all flexible by default because of the choose-your-own-rota kind of structures, as well as being a real living wage employer for our employed people. We also extend those really important employment protections to independent workers. So that's whistleblown protection, and right to a proper problem solving procedure - which is something that gig platforms are really, really bad at doing.
Onto earnings: we have managed with very lean, so we have a very tidy back office team, because 75% of our hourly rate goes directly to the person doing the care. So for indies, that's an average net of 18 pounds, 89 per hour at the moment, and then the hat work is paid at slightly less because that comes out of the co-op funds for that work. So we pay people to do hat work, and that includes people getting support and family members, so we offset that amount against their bills because that is real work, that is really labor. And then our top earners for indies are kind of between three and four thousand pounds a month - that's with overnights and things like that. And then for our full-time, they are on the real living wage, which is an equivalent full-term salary of 24, 570, still with the option to flex up and to flex down as needed. And then once you factor in - because we pay for travel, holiday, etc., and training - that hourly rate for our employed workers is actually comparable to our indies because we're looking at caregiving hours.
This is just a sneak peek of what's about to come out on the platform as a bit of an upgrade around our matching process. So that's an example of a profile: that's Bob, who's giving support, and the idea is that this is then supports to be able to make those really, really crucial matches - supportive matches, long term, sustainable matches for your team - so that you don't get the revolving door of people doing care work, and then you see them for one week and you see somebody different the next, and vice versa for the person giving support. They want those long lasting and sustainable support relationships as well.
So there we go. Five minutes, that was the quickest I've ever done that presentation. We've recently published a playbook and Graham, don't worry, we have name checked the handbook that the Colne Valley Co-op have done, because let's not reinvent wheels. This playbook is kind of setting out from the commissioners perspective, so it's for policy makers and kind of looking at more of a how do you commission a service according to the model Equal Care has developed.
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