Blog article

Guest blog: participatory care services for the twenty first century

In the run up to our next forum on co-operative approaches to care, one of the UK’s leading authorities on participation in public services, Peter Beresford, argues for user and worker led social care in a new indepent piece.

In recent years the prevailing rhetoric about public services has been transformed by a new emphasis on public, patient and user involvement. There is less attention paid to worker involvement, but is one possible without the other?

High level cross-party political interest in user involvement has been reflected in the government slogan for the NHS, ‘No decision about me, without me’ and a fierce emphasis on consultation, market research and satisfaction surveys across public provision.

However, this new public service consumerism doesn’t always sit comfortably with the rise of new managerialism in the public sector. This has been described as the American sociologist George Ritzer as the ‘Mcdonaldization’ of public policy, where the focus is on standardised procedures.

It is difficult to see how such bureaucratic, hierarchical, tightly regulated and controlling approaches to human resources are likely to encourage a supportive and enabling public service ethos among workers. It is also difficult to see how a disempowered workforce is likely to be able to support the empowerment of service users.

Such organisational problems have impacted deeply on health and social services and are arguably associated with such high profile tragedies as the death of Baby Peter and the Mid Staffs Hospital scandal. Yet if we check back through the welfare state’s history as I have done in my new book, All Our Welfare: Towards participatory social policy, we can see a different much more promising tradition emerging during the late1960s and 70s.

These were times when new kinds of community and voluntary organisations began to flower. They were very different to the large Victorian charities that preceded them and were frequently linked to the aims and values of the new social movements of the time.

Organisations like these often had a particular commitment to being organised and working in more equal ways. There was also an impetus to create new forms of more participatory and equal governance. This resulted in experimentation with co-operative and collective working. Most visible were the big new co-ops which received government support, but at the same time less high profile but perhaps more enduring and influential were smaller scale developments in public services.

One in-depth study by Alan Stanton’s followed how workers in a local social services agency, Newcastle Family Service Units, became a co-operative. It shows how the aim and practice of self-management grew within the organisation’s conventional hierarchy as a result of the commitment of a majority of the workers. Stanton makes clear that working in this different way was feasible, effective and valued by most workers. At the same time, he highlighted the big shift it demanded – with workers taking responsibility not only for the work they did, but also for running the organisation. He concluded that empowering workers was integral to an agency empowering its service users.

Since then we have also seen the emergence of service user movements, like the disabled people’s, mental health service users’/survivors and other movements. These have established their own ‘user led organisations’ (ULOs), which have generally been committed to working in more accessible, inclusive and equal ways, in some cases developing user led services and support.

While some of these are formally constituted as social enterprises, many seek informally to work in more co-operative and collaborative ways. They offer many insights and much experience of how people who have often been excluded from mainstream society can work together in more equal ways, using modern technology, social networking and virtual structures to do so. These organisations are a valuable source of knowledge and expertise about how we can work in more equal and collaborative ways and they complement the pioneering co-operative initiatives established by service providers.

Such organisations are of course vulnerable, because they tend to have less access to funding and resources than more traditional ones. Similarly there is some pressure from government to set up co-operatives and social enterprises to replace local government services, when these are likely to be less powerful and less secure than the former.

This points to the need to establish strong umbrella structures to ensure that these organisations can have a collective voice to counter to political pressures from the centre. Then we might see ways to realise the participatory and sustainable social policy that will be needed if people are to be able to look after each other in twenty first century societies.

Peter Beresford OBE is Professor of Citizen Involvement at the University of Essex, Emeritus Professor of Social Policy, Brunel University London and Co-Chair of Shaping Our Lives, the national disabled people’s and service users’ organisation and network. His latest book is All Our Welfare: Towards participatory social policy, published by Policy Press.

Learn more about the work we are doing on co-operative approaches to care here.

Written by Peter Beresford
Updated: 11/08/2016