Care in Crisis: time for Labour to think radically

By Lynne Segal, author, Radical Happiness (Verso 2018)

Care is the politics of the moment, or at least it should be – care for each other, and care for the world. It encompasses everything. But here I’ll address two main things: the enduring crisis of care, at all levels, and the need to rethink the whole notion and value of care, including its relation to the economy and to society overall.

The problems are so multiple, it’s hard to know where to begin. Even Tory councils, such as Northampton and Torbay, have simply declared themselves bankrupt, no longer able to provide basic services, as they try to balance one critical need against another – whether for health provision – mental or physical,  disability, housing, education, libraries or prisons.

The care crisis has been brewing slowly for some forty years, when the very first cuts began under Callaghan. But it has escalated dramatically since 2010, now reaching monumental levels, as the geographer Danny Dorling illustrates in his book, Peak Inequality: Britain’s ticking time bomb. Indeed, I would agree with those who now argue that our failing in relation to care provision constitutes the key contradiction of our time which, one which with US  feminist scholar, Nancy Fraser, for instance, sees as undermining capitalism itself. Maybe so, but in the meantime its cruel impacts are affecting almost everyone, but – as ever – impacting most harshly of all upon women, especially working class, black and ethnic minority women, while everywhere entrenching both gender and ethnic hierarchies.

We could discuss at length the immediate, concrete, suffering of so many: alternatively,  we could ponder why care work has always been so undervalued. This is true however far back we gaze, though in recent times never more so than now. We know the context,  the near ubiquitous adoption of a neo-liberal rationality over many decades, with its determined welfare shrinking, privatisation, uber–individualist values. It is a mindset as contemptuous of dependence as it is of the collectivity that makes life more joyful and worth living. However, it is since 2010 that inequality has soared, with the billons pumped into financial markets for ‘quantitative easing’ vastly enriching the wealthy, especially asset managers, hedge funders and property investors, while simultaneously curtailing investment in welfare. Over the last decade, the wealthy 3,000 have benefited over 100 times more than the least wealthy 10%.  And it is precisely during this time that carers of all stripes, including especially single mothers and ethnic minorities, who have been the shock-absorbers for cuts, around 85% of cuts to benefits having been taken from women doing caring work.

This is why we can read of some new care crisis almost every day, amounting to little short of a national calamity. The calamity exists at all levels, much of it triggered by drastic cuts to local government – with central governments cuts of almost 40%, along with the evisceration of public services overall, and ever-rising inequality since 2010.  The result is evident everywhere: mounting homelessness, with some 130,000 children alone without any permanent home at the start of 2018; school budgets savagely cut; the UK having the poorest record on health, both physical and mental, compared with the rest of Europe, between 2010-2018. As we know, it is not just the elderly who are suffering from lack of care, the closure of care homes, the privatising and deterioration of home help, but also younger people, especially those who have had their disability benefits slashed.

Indeed, as Dorlling shows in Peak Inequality, completely reversing the promise of Beveridge’s post-war welfare state, there is now increasing suffering from cradle to grave:

– Infant mortality is rising for children born into poorer families;

– Youth facilities have been slashed, with some 600 centres closed since 2010, even as anxiety over youth crime, especially gun crime, escalates;

– Mothers in general report feeling overstretched, anxious and inadequate – although given poverty wages and escalating childcare costs, it is poorer mothers (whether in or out of work) who are most beleaguered trying to care for their children;

– Family carers, often middle-aged women, attending to the chronically sick, disabled and especially elderly parents or spouses, are now experiencing constant strain due to the combination of benefit cuts and collapsing community resources, with the latest report from the Social Market Foundation showing that working-class carers (again inflected by race and ethnicity) are far more likely to be living in poverty, unable to pay for any form of caring relief and likely to show signs of mental and physical ill health;

– Finally there are rising mortality rates for the poor elderly, and indeed for elderly women from all social classes.

As I said, increased suffering is present from cradle to grave, in ways, Dorling suggests, that would have seemed unbelievable just few years ago.

Of course, it all links up, care responsibilities, poverty, homelessness, joblessness, long working hours, precarious employment, producing physical and mental ill health. It is why, after the US, the UK has the highest levels of mental illness of the affluent countries where records exist. Indeed, mental illness is now said to have reached epidemic proportions – one in four of us, on some figures, are currently likely to be diagnosed with some form of mental illness, including one in ten children. Suicide is on the increase and waiting time for any form of mental health has lengthened, now being well over 6 months. We keep hearing about more funding for mental health, but with bursaries for mental health nursing scrapped, it’s unserious, as the Royal College of Nursing says: ‘There is already a dangerous lack of workforce planning and accountability, and under this government there are actually 5,000 fewer mental health nurses.

Looking specifically at the provision of social care, the first thing to note is that it is in complete disarray due to its unchecked outsourcing to private companies over the last 30 years, with today, around 90% of private care provision in private hands. Back in 1979, 64% of residential and nursing home beds were provided by local authorities or the NHS; by 2012 this was a mere 6%. In the case of domiciliary or home care 95% of it was directly provided by local authorities as late as 1993; by 2012 it was just 11%. To say this leads to chaotic and uneven services across the country is a massive understatement. Moreover, whether provided, as it increasingly is, by unaccountable global corporations, local businesses, or charities, staffing is typically untrained, very poorly paid, and hugely pressed for time. The resulting care provided is thus routinely quite as difficult for the overstretched carers employed, as it is inadequate for those receiving such homecare. We know that it is overwhelmingly women, and ethnic minority and immigrant women especially who are doing most of this care work, which also helps explain its terrible conditions. Finally, the provision is not free. Most will have to pay for it, since having any assets over £23,250, including not just income or pension, but housing and savings, mean a person has to pay for all homecare.

People will have their own accounts of the resulting tragedies. The sociologist Bev Skeggs, working in London, recently wrote about her appalling experiences in the final years and death of each of her parents, as she kept trying, and failing, to negotiate any adequate support from the dual institutional collapse of the NHS and the caring systems where they lived up North. Indeed, she described the situation as ‘a crisis of humanity’. On the one hand, she wrote, it was devastating to see the levels of exploitation of the carers, and their resentment towards their employers, who offered them no respect, zero hour contracts, minimal training, no payment for travelling, etc. On the other hand, it was worse when, having finally moved her severely disabled mother into a home, for which she was paying more than for schooling at Eton, she found staff there still had no time to care for, or even to feed, her now blind mother. ‘Neglect by design is the name of the game,’ she reflected. ‘This is an institutional condition that even the middle class cannot defend against or ameliorate with money’.

Just as clearly, it is also why it is it is quite impossible to see how the current government proposals for integrating privatised social care with NHS provision could happen in any coherent, smooth and affordable way. One answer is to create a new free and publicly funded National Care Service, with fully-trained, properly paid, care workers. Other things to push for in the short term would be to urge that all councils, together, start fighting the trend to replace small providers by giant, unaccountable global ones. The latter would need to be replaced with smaller, not for profit, local providers, which would hopefully ensure greater awareness of the needs of local people, while helping to rebuild local infrastructures and community businesses. Something else to insist upon is that care providers actually pay UK taxes, unlike the current situation of the wretched Richard Branson’s Virgin Care business, which receives a billion pounds worth of NHS contracts, making Branson the dominant private provider in the NHS market. Yet, Virgin Care pays zero tax in Britain, with its parent company registered in the tax haven, the British Virgin Islands. As you probably know, the company also sued six NHS commissioning care groups (CCGs) last year after failing to win an £82m care contract, which went to an NHS provider and two social enterprises. The struggle will not be easy.

So much needs to change! Our immediate goal should be for local authorities to begin building up their own accountable, flexible provision anew, which in turn could help facilitate user-led organisations or social enterprises to begin recruiting carers, and trying to service needs in more responsive, innovative ways, actually listening carefully to the desires of both carers and those cared for. However, since social care is now at breaking point, literally, it’s surely a good time to rethink it all, from the bottom up.

This brings me to my points. We need to argue for the LP explicitly to rethink the whole nature and all our concepts of  ‘work’, ‘care’ and the ‘economy’, in line with the best feminist thinking. What most feminists always stressed was that care work (and especially all the unpaid, and hence marginalized and undervalued work women traditionally did in the home) is in actuality essential for capitalism itself, both in the literal production of the workforce, and in the care and functioning of communities, hence enabling markets to thrive. Nowadays all this maintenance work, once seen primarily as the ‘unskilled, labours of love’, is often drawn together under the broader rubric, ‘social reproduction’. This means, in turn, that the whole way in which notions of ‘value’ are used, and the gross domestic product calculated, is politically loaded and misleading, since it sees care-work, unless it is paid, as outside the market, and hence without ‘value’. Feminists, in our heyday, usually wanted to see the entire structure of domestic and social reproduction reconceptualized and transformed – fairly distributed between women and men, underpinned by adequate welfare benefits and expanded, democratically run community resources. We also campaigned for shorter paid-working hours, and improving the social infrastructure generally. These were exactly the feminist demands that were altogether jettisoned in neo-liberal thinking, despite and because of the mainstreaming of a feminism, now presented as a struggle for equality in the workforce, and for women to enter positions of power.

Clearly today, trying to end the outsourcing of care, expanding social services and, relatedly, tacking the escalating inequality between households, are all necessary aspects of undoing some of the immediate chaos and suffering surrounding care. More fundamentally, however, I think we must push for a distinctively alternative economic strategy, one refusing to see social reproduction – the nature of intimacy, and the care of people, communities and the environment generally – as secondary to market production. Plans for just such a caring and sustainable economy have been pushed here by the Women’s Budget Group, in what they’ve labelled the Plan F. It begins from a vast expansion in spending on social infrastructure, investing in social care generally, as well as in green technology. It also requires an ideological retreat from the idea of paid work for its own sake, with official encouragement for shorter hours and ‘part-time’ work treated as the norm, rather than a secondary source of earning.  And this, in turn, requires some sort of guaranteed living wage for all, something I hear that John McDonnell is apparently currently planning to pilot in the next Party manifesto.

After all, it’s now 90 years since John Maynard Keynes predicted that technological advances would enable us to work a 15-hour week. He was probably right. Yet we’ve taken the exact opposite turn, with people either working longer hours than ever, often in pointless jobs (encouraging compensatory over-consumption), or else finding themselves unemployed and near destitute.  Given predictions that robots are already replacing humans at an alarming rate, expected to take over some 800 million jobs by 2030, according to one global report, it is surely time at least try to push for dramatic change. That change means placing the hybrid worlds of care and intimacy well above productions for profit. It is only this sort of fundamental shift in outlook, valuing non-monetarized, creative, life-affirming ways of recognizing our mutual human interdependence,that would finally solve our caring crisis.

There are ways of paying for this, at least in the writing of these feminist economists, once we begin restoring fairer tax revenue, implementing the Tobin tax on financial transactions (supported by most EU countries) and curtailing forms of pointless military spending, for a start. Utopian, you may think! Yet, given ongoing climate change, a shift in this direction also just happens to to be necessary to preserve our resources for any sustainable future at all.