Gladly I have found that if genuine attention is paid to member participation and democracy, and with the right conditions, health co-ops and mutuals can be built and can survive.

The Liberal Lord William Beveridge wrote at length on his passion for mutual and voluntary aid and of the sickness benefit friendly societies that existed for centuries before the welfare state. Their diversity and peculiar names, as well as their practices, are amusing. For example, the Old Amicable Society of Grantham had a rule that five shillings should be spent on ale for each monthly meeting, but disappointingly that it should not be consumed until the business had been transacted! Some meetings were conducted in public houses which was, according to the eccentric philosopher Jeremy Bentham, ‘like choosing a brothel for a school of continence’.

More seriously, the impact of the welfare state on the friendly societies was great and many perished, much to the disappointment of Beveridge. Co-ops and the state do not have to compete, but can coexist and complement each other. Even after the creation of the NHS, some friendly societies and hospital contributory schemes have happily survived to this day in modern forms and with new services.

The Benenden Healthcare Society is one example of a modern healthcare mutual. It provides health cash plans (eg for dental or optical costs) and ‘discretionary’ health insurance. They decide whether the treatment should be by the NHS or by them at their hospital or regional treatment centres. This discretion keeps payments affordable and at a flat rate, as opposed to contractual benefits offered by private health insurers. Benenden operate a member democracy that encourages member participation in, for example, voting for motions and mandating delegates for annual conferences. The society is run by members, for the health of members, not with profit as the primary driver, although this is also important. Social goals coexist with financial goals.

Readers may also be surprised to know that there is a cooperative pharmacy – unsurprisingly called the Cooperative Pharmacy! It is part of the Cooperative Group, which many people know simply as ‘The Co-op’ food shop. Owned and run by its members, it has a member democracy elected from the grassroots members exercising influence all the way to making up the majority of the members of the group board. Members also get a ‘divi’ payment depending on the amount they spend. Again, social goals of community activism and health coexist with financial goals.

Co-ops are not a panacea, however. We must remember that they can fail like any enterprise. Two questions initially arise*. The first is whether health co-ops can survive as enterprises, and the second is what factors do or do not contribute to their survival, e.g. democratic governance between members, ownership or economic conditions. For example, do the members have a real say in governance or is there an illusion of participation? Participation must be genuine, but we must not be too rigid. As a united Labour, union and cooperative movement, it pays to be clear what genuine cooperation and collective action are. But we must take care not to be too inflexible or reject innovation.

A danger is that our political opponents will destroy health co-ops and their potential because they simply do not understand what they are dealing with. Or it could be worse, that they do understand, and they are using the pretence of ‘co-ops’ as a smokescreen for cuts to public services. So we must learn to detect a wrong’un or a googly, a trick, and be clear what we are against. This requires skill and knowledge of what is genuine. Tories have attacked public services and co-ops on many occasions. We must protect both.

We must prove the critics and pessimists wrong. The cooperative tradition can live on and thrive. The state and co-ops can coexist. The good news is that modern healthcare cooperatives live on from before the NHS existed. But if they are to expand we must encourage genuine member participation and democracy, not an illusion of participation. We must show what genuine co-operation can bring to our society. Advocate for cooperative action in your local Labour parties, councils and trade unions.

If you haven’t got involved yet, do so now – join a co-op and join the Cooperative party. Get active. Get cooperative. 

* These questions, amongst others, are being investigated in my research at Middlesex University Business School and in the Third Sector Research Centre, as part of work being partly funded by Cooperatives UK.

For space and simplicity reasons, I use the terms co-ops and mutuals to mean the same thing. According to the International Cooperative Alliance, the international body for cooperatives, it is: ‘an autonomous association of persons united voluntarily to meet their common economic, social, and cultural needs and aspirations through a jointly-owned and democratically-controlled enterprise’ (ICA 2009a).