Guest Blog: CASA, a mutual solution to social services

04 June 2014

Meeting The Demographic Challenge Through Developing A Mutual Solution 

If you are not scared by the economic and social consequences of the demographic challenges facing western society, then arguably you do not understand the data!

For example, in the UK, 10 million people are over 65 years old – that is some 6.3% of the total population. The latest projections are for 5½ million more older people in 2034. This number will have nearly doubled to around 19 million by 2050.

Furthermore, the number of very old people grows even faster. There are currently three million people aged more than 80 years and this is projected to almost double by 2030 and reach eight million by 2050.

But these statistics are only part of the challenge facing health and social care delivery systems

Advances in medical technology mean more infants with complex needs are surviving into child and adulthood

In addition, there are labour market challenges. Again in the UK, while five-in-six of the UK population is currently aged 65 and under, by 2050, only 75% will be under 65 years of age. It all begs the question – ‘how will we meet the growing labour market requirements, of a health and social care sector that is characterised by (certainly in the UK), poor terms and conditions?

And finally fiscal constraints – put very simply, growing demand and a smaller tax payer base.

One part of the solution to these monumental societal challenge could be to develop a mutual solution. The co-operative movement in the UK was crystallised in 1844, borne out of a need of factory workers to source unadulterated food-stuffs – co-ops have a tendency to appear where there is a societal and economic need for them to do so.

So what’s all this got to do with employee owned home care?

Rather than start at the mutual solution, let’s consider what ‘good’ might look like in terms of a response to the societal health and social care challenges set out above:

It is not enough to simply just respond by stating the value of ethical business provision of health and social care. Rather it is crucial to define what ‘ethical’ actually means in practice.

I think the provision of ‘ethical home care’ means:

• No Financial Leakage – Surely all money spent on health and social care should be focussed on delivery – is there room for external shareholder profit?
• Profit motive & Incentivisation – profit is not wrong – but a reasonable profit should be generated by delivering a quality service, NOT by cutting costs, corners and ultimately, quality.
• Financial accounting should be open and transparent to all – employees, service users, and commissioners should all be able to see where the money goes and why.
• Efficient – A commercial and enterprising approach needs to be the default position. Health and social care will become an increasingly precious and scarce resource. Innovative approaches need to be deployed to ensure its impact is maximised.
• Co-production – we need to move away from the traditional commissioner provider split, to where all stakeholders get together to work out what’s best.
• This mutual model of health and social care provision is exactly what Care & Share Associates Limited (CASA) is trying to roll out in the UK. CASA is a social franchise of employed owned health and social care providers.
• Established in 2004 to provide essential support services to older and disabled people, through developing a franchise network of majority employee owned social care providers. It is based on the award winning Sunderland Home Care Associates model, which has been delivering quality domiciliary support since 1994.
• CASA is the UK’s leading social enterprise in the social care sector. It currently operates employee owned services across five locations and delivers over 13,500 hours of personal support per week, principally commissioned by the public sector.

CASA’s underlying social enterprise values can result in:

a)  Low staff turnover, thus making a significant contribution to continuity and quality of support

b)  More profit is re-invested in staff training and development

c) Commitment to service innovation with commissioners, in particular the development of self-directed support services

d)  A genuine desire to create employment in excluded communities

The CASA group of companies, which has its roots in the co-operative movement, brings an ethical approach to everything it does. The way CASA provides care and support is shaped by a belief in mutuality, participation and quality, which is shared across the whole of the company’s’ workforce.

CASA has developed a robust business model. For CASA, being a social enterprise means being a successful business that is viable and sustainable in a competitive market. CASA has had to adapt quickly and efficiently to local conditions and demands. Although as a social enterprise, its main aim is not the generation of profit, CASA does not describe itself as being ‘not for profit’, as some of the profit generated by its franchise companies is shared out to employees. A better description is to say that CASA is about ‘more than profit’.

Employee engagement is increasingly being seen as key in terms of driving patient satisfaction and clinical outcomes. Indeed a recent IPA report (Meeting The Challenge: Successful Employee Engagement In The NHS 2014) stated:

It’s increasingly clear that (employee) engagement is vital to high quality care in the NHS’ (IPA 2014: 4)

CASA’s clear view is that genuine employee engagement is borne through investment in employee education, providing clear and accessible business information, and ensuring an equitable share in the outcome.

CASA regards itself as part of the community, rather than simply coming in to an area to make money for shareholders and owners. It aims to ensure that social and environmental impact is always positive, for example by targeting areas of high unemployment, working in sustainable ways and using other social enterprises as suppliers, where possible.

Finally, CASA is about providing value for money, working in close partnership with Local Authorities, Health Authorities and other commissioning organisations to help them make better use of finite resources. Employees of CASA franchise companies are trained and encouraged to help reduce people’s dependency on more expensive and intrusive services, which not only contributes to their quality of life but also saves money. Partnership working also means being transparent about our structures, finances and policies.

The demographic challenge of an ageing population cannot be ignored and will not go away. It is also often said that a society is judged as how it supports its most vulnerable members. Our current systems of support are ‘creaking’ now, and ‘more of the same’, will not address the significant demands ahead. We as a society therefore need to take a long hard look at how we have chosen to organise, both in the public, and private sectors, and seek to embrace a more innovative and mutual solution.

By Dr Guy Turnbull
Managing Director, Care & Share Associates Limited
June 2014