Reshaping ownership within adult social care

Adult social care is broken. After years of marketisation and outsourcing we are left with a service where large market players dominate, particularly in areas such as nursing and residential care. Taxpayers’ money, and the savings of older people, are being extracted out of the system for shareholder gain. Today we release the new publication Reshaping ownership within adult social care. Here the report’s author, Tom Lloyd Goodwin, reflects on how ownership models must be shifted.

There is now widespread political support to challenge ownership models within social care and to bring care homes, for example, back under state control. However, reshaping ownership within the sector will require a major new funding settlement, as well as a substantive and wide-ranging vision for reform

Key to this will be a wave of new local practice and political action. This is why we have written Reshaping ownership within adult social care: a policy and practice guide. Building on our recent proposal for a people-centred industrial strategy for adult social care, this new publication seeks to arm local politicians with a realisable vision to advance alternative models of ownership within the sector. These would help to minimise the extraction of wealth, whilst providing choice and control for service users as well as better conditions for care workers.

“a plurality of providers who augment existing core service”

The publication calls for adult social care markets to be reshaped, using a community wealth building approach, so that services are run by the state in conjunction with a plurality of providers who augment existing core service – co-operatives, community businesses, social enterprises and the like.

This may require greater insourcing but also some shift towards service delivery by the voluntary, community and social enterprise (VCSE) sector, which has a key role to play in the delivery of services such as adult social care. As such, it is therefore entirely appropriate for commissioners to seek to involve the many organisations and individuals who, whilst not directly part of local government, are equally passionate about public values and offer a unique contribution to the delivery of public services.

“we must reject the idea that hard pressed communities can or should provide a substitute for the state”

However, whilst the VCSE sector will be a key part of an inclusive care economy, it is not a replacement for the local or national state. With our public services stretched to breaking point and with the economic and social crises stemming from Covid-19, we must reject the idea that hard pressed communities can or should provide a substitute for the state. Not only would this threaten to mask the reality of the brutal cuts to services we’ve seen over the last 10 years, but it also threatens the scrutiny and accountability that can only be guaranteed by the democratic oversight that the local state provides.

“it is possible to move from a system that favours wealth extraction”

To illustrate this vision for adult social care, the publication draws on a number of examples of progressive local practice. In this, we demonstrate that by adopting innovative commissioning techniques, framed by a community wealth building approach, it is possible to move from a system that favours wealth extraction towards one that promotes more locally generative forms of ownership. And – crucially – it is possible to do so in such a way that promotes choice and control for service users and avoids passing the buck to hard pressed communities.

To amplify and scale this practice, our new publication also offers a number of recommendations for local policymakers.

  1. Position adult social care as a key sector within strategic local economic planning.
  2. Support the development of alternative models of ownership through the use of community wealth hubs.
  3. Explore opportunities for more insourcing – particularly within nursing and residential care.
  4. Make greater use of ethical care frameworks – to in effect create a form of social licensing to influence the kinds of organisations that can gain access to local care markets.

In services such as adult social care, we should be building a resurgence of a public service movement based on new forms of democratic and citizen involvement. Nevertheless, communities should not be handmaidens to the continued marketisation and erosion of public services. We are in an era of political contestation, and we ignore the UK’s austerity addled political economy at our peril.

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