Purpose – The aim of this chapter is to explore the current trend for new ‘mutual’ models of public service delivery as part of a process of personalisation and commodification of health and social care design and service delivery. Design/methodology/approach – The authors use the thesis of commodification and the concept of value to explore, with the aid of three examples from previous research, the complexity of transfer of large-scale services from local government and health bodies and the potential contribution of co-operatives and mutuals to this agenda. Findings – Mutuals may provide an alternative to the supposedly inevitable progression to wholly commodified health and social care provision. However, a top-down push to encourage employee-owned enterprises may fail to take account of significant issues: high capital and labour costs; transfer of risk to consumers purchasing services; quality of care assurance; scope and scale of services; and enabling policies and structures to support democratic ownership and control of enterprises. Research implications/limitations – Although the chapter focuses on Welsh experience, there are implications for the future provision of public services more generally. Originality/value – This chapter contributes to a growing discourse and critical awareness of co-operatives and mutuals as potential public service providers. In particular, the nature of democratic engagement and involvement; models of co-ownership and co-construction of public services and the role of the State in promoting alternative non-marketised systems of design and delivery for the public good as well as maintaining accountability through local and national democratic processes.