Memorandum by the Co-operative Union (FT2)
Governance and accountability
1. The co-operative movement has always
strongly believed in both subsidiarity—that decisions needs
to be taken at the lowest level for effectiveness—and in
accountability. Real accountability is only possible where stakeholder
groups are identifiable and given a real role in decision-making
at a strategic level. The structure and governing instrument of
the organisation—whether trust or other—needs to specify
clearly who the membership groups are, what their role is and
what the lines of communication are.
2. We would contend that the three main
membership or stakeholder groups are:
— staff (and not just clinicians);
— patients and users; and
These constituencies need clearly mapping and
should democratically elect their representatives. Such representatives
should then be empowered through training and access to high quality
information. Stakeholders can then take ownership at the strategic
level and most importantly help the service be responsive to the
needs and concerns of the communities they serve.
3. Management by the identified membership
will give accountability and this will drive efficiency and success.
We believe that this harnesses public sector values and ethos
and private sector flexibility. Success will also depend on
governance structures being open and transparent as this
will harness both the energy and good-will of all stakeholders.
4. The Co-operative Union has over 130 years
of experience in constructing high quality governance structures
for such organisations. It would also urge that the experience,
structures and practice of mutual and co-operative hospitals and
care centres overseas are examined (notably in Europe, Canada
and the US). We urge that working models of such structures both
at home and overseas are examined, and democratic and accountable
PCTs and Trusts piloted in the UK. The Co-operative Union would
be pleased to help in signposting such examples.
5. The co-operative movement has long experience
in encouraging lay participation. The contribution it can make
to the new developments is knowledge and experience of organisational
democracy, practical participation and encouraging collective
action and involvement. The movement has a long experience of
involving people in enterprises of all kinds and with varying
ownership and participative structures, including multi-stakeholder
solutions, with employees, users and community representatives
able to participate in the running of initiatives and enterprises.
It has worked through various organisations, in particular through
the Co-operative Union's training and education arm, the Co-operative
College. The Co-operative Union is already working with the Active
Community Unit in developing a support service to community organisations
on good governance.
6. In conclusion, good, effective and wide
participation is dependent on:
— structures which allow good participation;
— knowledge and confidence.
These latter two factors can be developed through
good training and support. The co-operative movement would be
pleased to share its expertise and experience in this field with
the DoH and other relevant departments.
7. Crucial to the success of any new structures
will be the engagement and empowerment of staff. Job satisfaction
is also dependent on autonomy and empowerment. These can spring
from genuine democracy and clear input as of right into key decisions
as to how the organisation is run. This may range from issues
as to how best meet the needs of a section of the community to
staff rostering. It is the staff at all levels who will often
know how to solve problems and they need to be empowered to do
so. An empowered and satisfied workforce, with the best possible
terms and conditions, is more likely to stay, and energetic and
confident workers are more likely to be recruited and retained
at all levels.
The Co-operative Union is an autonomous trade
association of co-operative businesses, comprising consumer owned
co-operative societies, employee owned businesses, multi-stakeholder
businesses and secondary co-operatives of sole traders, including
General Practitioner co-ops (out of hours services and multi-fund).
It has focussed some attention in recent years on both health
and social care: it has some 40 domiciliary care co-operatives
in membership and has worked to develop various new models of
residential care services, involving staff, users and the community.
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