3 reasons why we need more co-operatives and self-managed teams in health and care

Co-operatives have been around since the 19th Century, and still feel relevant today. I am interested in them because of my work with Wellbeing Teams: both share a common thread of self-management.

There are some exciting co-ops emerging in health and care, and there are three examples that colleagues of mine have established. Neatly, we also think there are three reasons to take a closer look at both co-operatives and Wellbeing Teams. Before looking at these, let’s start with what exactly a co-operative is.

What are co-operatives and what is the connection with self-managed teams?

Co-operatives are businesses owned and run by the people closest to them – customers, suppliers, employees, local residents – and often a mixture of all of these. Members have an equal say in what their co-op does and decide together how its profits are shared. All co-ops embed seven principles within their articles of association. These are:

  1. Open voluntary membership
  2. Democracy – one member one vote
  3. Finance – members pool their resources
  4. Independence – an independent business owned and controlled by its members
  5. Education – a co-op provides its members and staff with the training needed to run a high-performing business
  6. Co-operation – co-ops aim to work with other co-ops, and there is a strong sense of mutuality
  7. Community – co-ops work in ways that benefit society and environment, building a better world

Worker co-operatives often organise themselves as a self-managing team, with workers having an equal say in what the business does, and an equitable share in the wealth created by the enterprise.

Self-managed teams are simply teams that organise themselves without a manager. They work in other organisational structures as well as in co-operatives. You can find self-managed teams in both for profit and not-for-profit organisations, and they are often part of larger organisations. Buurtzorg in the Netherlands, and Wellbeing Teams in the UK are examples of self-managed teams in health and care.

Co-operatives and Self-managed teams in practice

Three of my colleagues have been part of starting co-operatives in health, and care. Clenton Farquharson, chair of Think Local Act Personal is part of the Better Lives Co-op; Martin Walker, the lead for Individual Service Funds with TLAP is part of Choices for Doncaster; and Mervyn Eastman co-founded Change AGEnts Co-operative: The Older People’s Participation Co-operative. The most famous example of self-managed teams in health and care is Buurtzorg, founded by Jos de Block, and in the UK, Wellbeing Teams are self-managed teams inspired by Jos’s work.

Better Lives Co-op

The Better Lives Co-op is initially aimed at Personal Assistants (PAs) and people who work with PAs. Clenton and his colleagues want it to be easier for people to become PAs, and for the role to be better understood and appreciated. They want relationships rather than economics to be central to the co-op’s work of helping people achieve better lives.

Choices 4 Doncaster

Choices4Doncaster (C4D) is a new multi-stakeholder co-operative, which has emerged through a shared frustration with the existing system. It helps individuals who need social support to secure funding for a personalised solution. Members fall into three categories, users, supporters and employees. People needing support are at the heart of the organisation as users. Supporters encompass a range of independent, community and voluntary organisations and providers as well as individuals with wider life experience. Employees have equal representation both as members and at board level.

Change AGEnts Co-operative: The Older People’s Participation Co-operative

Change AGEnts came out of the Government’s Better Government for Older people (BGOP) programme. When it finished in 2009 Change AGEnts spun out to become an independent and autonomous co-operative. Its vision is a society of all ages and it has four main programmes: the older adults’ Collective; a daily radio show; a platform for Baby Boomers; and EngAGEme2 for the seldom heard.

Wellbeing Teams

I am working with colleagues to start to establish Wellbeing teams in health and care. Wellbeing teams are small, self-managed, neighbourhood teams inspired by Buurtzorg. There are several Wellbeing Teams currently working and the next three will be based in GP surgeries and a hospital. Each team has no more than 12 people, includes a Community Circles Connector, and is supported by a coach.

Why do co-operatives and self-managed teams e matter in health and social care?

Co-operatives are under-represented in the health and social care sector in England, and Wellbeing Teams are just getting started.

Ed Mayo talked about co-operatives as being able to deliver more efficient and compassionate social care. We think they also offer co-production in action, and greater engagement and happiness for the workforce. At the King’s Fund conference last week, Sharon Allen, CEO of Skills for Care, said that retention was the greatest problem in workforce in social care. Greater engagement could be part of the answer.

We’ve identified three key areas where co-operative and Wellbeing Teams offer real, tangible benefits.

1) They deliver co-production in action

One of the key priorities identified by the Think Local Act Personal Care Markets and Quality Forum is that of ‘better conversations’ between people who need support, commissioners and providers of support in order to inform more effective commissioning. Co-operatives provide a framework that is ideally suited to this way of working, particularly multi-stakeholder co-operatives, which enable these three parties to come together and share power equally to explore what a truly co-produced system would look like.

Wellbeing Teams also have co-production at their heart, as people co-design their service deciding what support they want, when they want it, and how they want it, in order to meet their outcomes. People also choose their own team members.

2) They deliver greater productivity

The co-operative advantage is realised by giving the people involved a stake in its success. This results in better productivity, a fostering and encouragement of innovation and growth, leading to further entrepreneurship – and for those wondering whether this is evidence-based, take a look at Bologna and its surrounding region in Italy, which has the highest density of co-ops in Europe, generating close to 40% of GDP there. It also has the lowest socio-economic inequality between the richest and poorest right across Europe.

Virginie Perotin found that worker co-operatives are more productive than conventional businesses, with staff working “better and smarter” and production organised more efficiently. Buurtzorg, has also demonstrated greater productivity and lower costs – the average business’s back office costs are 25% but Buurtzorg’s are only 8% and Wellbeing Teams’ are 11%.

3) They can deliver greater colleague engagement

Worker co-operatives survive at least as long as other businesses and have more stable employment (Virginie Perotin). In a sector like health and social care, where staff turnover is a real problem, this is a major benefit of adopting a co-operative approach.

In Wellbeing Teams we’re measuring engagement through a different kind of staff satisfaction survey called Peakon, where the questions are based around research on engagement and generate a score that illustrates overall employee engagement. It can range from 0 to 10 and the average for organisations using Peakon is just above 7; for Wellbeing Teams it was higher, at 8.3.

Buurtzorg’s excellent colleague engagement is shown in its consistent winning of the best place to work in the Netherlands.


Last month Ed Mayo shared ways that the government can support co-operatives, and presented them as a way to more efficient and compassionate social care.

In my own experience of Wellbeing Teams, and that of my colleagues working in co-operatives, we’re seeing real benefits to this collaborative way of working. Not only do co-operatives and Wellbeing Teams save money because they are more productive, but they can also deliver far more targeted, individualised support that fully involves the people receiving it as equal partners. Let’s hope the government sees the potential and gets on board, and that when commissioners think about market shaping, they include co-ops and self-managed teams.

Thank you to Clenton, Martin and Mervyn for their help in writing this.