Money Alone Won’t Fix the Care Crisis – We Need a Radical Rethink

by Emma Dowling

29 September 2020

Residents and their families in an elderly care home.
Photo: Rapport Housing & Care. Design: Bronte Dow.

Perma-austerity and the persistent devaluation of care work have left social care in a deficit of millions. But throwing money at the problem won’t make it go away, as we’ve seen with the incursion of private equity and hedge funds into the sector. What we need is a radical rethink, one that puts care workers and the communities they serve at the helm. 

In Ken Loach’s latest film Sorry We Missed You, Abbie Turner (Debbie Honeywood) portrays the dilemmas facing care workers today. She chases around Newcastle tending to the complex physical and emotional needs of too many clients in too little time for too little pay, while trying to care for everyone else, including her kids and partner.

A few months since the film’s release, the coronavirus crisis has revealed that caring is work that no society can do without; 4.5 million Britons have become informal carers during the pandemic. At the same time, care workers are some of the most precarious and lowest-paid there are – unsurprising, given that most are women, and many are migrants. A lack of resources, both human and physical, the product of a just-in-time economy that systematically disregards the need for reserves to weather bad times, has left the UK’s social care system struggling to respond to the pandemic.

This immediate problem is symptomatic of a longer-term one. Over the last decade, austerity has picked away at care infrastructures and left them threadbare. Cuts to local government have taken their toll in particular. In March, the government provided an extra £1.6 billion to local government to deal with the pandemic, yet even without the additional pressures, the care sector was already facing shortfalls of at least that amount, possibly up to four times as much.

Social care desperately needs more funding. Yet that is not to say that money alone will solve the problem. If austerity has worn out the fabric of social care, privatisation and financialisation are unravelling it. It is not just the extractive logic of dividend payments or offshoring. It is that the entry of private equity and hedge funds into the residential care sector is saddling homes with debts whose interest payments further erode their already paltry resources. This forms part of a broader trend towards the devaluation of care work, of which low wages are just one expression. Others are the way in which those in more “productive” sectors employ others to do their care work for them, or how a weekend of self-care is geared towards optimising the working week.

Yet it transpires that illness, disability and old age cannot be packaged up and sold. The reason is that care is labour-intensive. Caring takes time, so does not lend itself to economies of scale or to corporate efficiency. In an economic system in which time equals money, this means squeezing the means and time for care.

Money will not solve the care crisis if it is used to prop up commodified care. Real change needs to address the failures of privatisation by regulating against wealth extraction and ending the competitive procurement practices that incentivise a race to the bottom. We must also radically reorganise how we care for ourselves and each other by rethinking access and ownership within care infrastructures. The idea of “care municipalism” could galvanise a strategy, bringing social care (back) under the control of public bodies, where it can be planned and delivered directly, and democratising public ownership models in partnership with communities.

In Britain, campaigners have been calling on local authorities to bring outsourced care services back in-house, and have achieved some successes in recent years. Such efforts could also include the development of bottom-up models for caring that take seriously the expertise of care workers; the nurse-led community care model developed by Buurtzorg in the Netherlands is a good example of this. Lastly, we need the means and time to integrate care – and not just of the nuclear family – into our everyday lives, as a requirement for finally completing the “unfinished feminist revolution” of transforming the gendered, classed and racialised expectations of whose job it is to care.

Emma Dowling is a sociologist and political economist. Her book The Care Crisis is out in January 2021 with Verso.

  • The Future of Work focus is part of Novara Media’s Decade Project, an inquiry into the defining issues of the 2020s. The Decade Project is generously supported by the Rosa Luxemburg Foundation (London Office).

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