The COVID-19 pandemic has inspired several new books, which seek to analyse the impact on our healthcare systems and broader society and propose reform. I have read a number of these as background to a paper for a European wide study of the impact of the pandemic on older persons and other work. In this blog, I will share two contrasting examples of these.
The Care Manifesto (Verso Books) has been written by a group calling themselves the Care Collective. It analyses the impact of the marketisation of care, which has resulted in those most at risk from COVID-19 receiving too little support. This has allowed multinational corporations to make huge profits out of financialising and overleveraging care homes while work in the care sector was subsumed into the corporate gig economy, mostly at the expense of women as workers and carers. This has been achieved because “ideas of social welfare and community had been pushed aside for individualised notions of resilience, wellness and self-improvement, promoted through a ballooning ‘selfcare’ industry which relegates care to something we are supposed to buy for ourselves on a personal basis.”
They argue for a model of ‘universal care’, which puts care at the heart of our society from our kinship groups and communities to our states and planet. Chapters explain how this would apply to our politics, family, communities, the state and the world. It addresses care in its broadest context, rather than looking specifically at systems or structures. I thought the communities chapter was strong, chiming with a number of the themes I set out in my recent Reid Foundation paper. They propose four core features to the creation of caring communities: mutual support, public space, shared resources and local democracy.
While it is hard to disagree with most of the content, even if it is prone to assertion rather than evidence, the language is likely to jar with the general reader. As they say, “The Care Manifesto offers a queer–feminist–anti-racist– eco-socialist political vision of ‘universal care’”. Fine, but this is not likely to find its way into a political programme. Overall, it’s a concise and broad picture of what a different society could look like, but too few practical steps to really call it a manifesto.
In contrast, Madeline Bunting’s, Labours of Love: The Crisis of Care (Granta Books), is a more personal argument about the invisibility of care, and its historic under-valuing – based on extensive interviews with people caring for others. The purpose of the book is to make visible the nature of the vast web of care – its importance, extent, subtlety and complexity. She too hopes the pandemic will see a new politics of care emerging which recognises our interdependence as families, friends, communities, nations and as a human species.
The chapters take the reader through various aspects of care with a final section in each chapter on what we mean by key words, kindness, compassion etc. I enjoyed her story of the manager who, “advised staff to ‘populate the document’ with the ‘likes and dislikes’ of the ‘service user’ as a form of person-centred care: it amounted to getting to know someone with the help of tick boxes”. To be fair, I have seen much worse management speak in the sector.
The hospital chapter includes a story about a snap session with a consultant, which had to be followed by the nurse spending time finding out and sorting the patient’s problem; “Once he (the consultant) has gone, the work of nursing starts. Sam (the nurse) sits down, and places a hand on Derek’s arm to try and calm his anxiety. Finally, he can start to explain”. This is something every nurse can relate to. Time to care is a key issue as the pressure to free up beds is intense and becomes one of the main preoccupations of nurse managers. Hospitals are clocking up record, and potentially dangerous occupancy levels as the number of hospital beds have declined - by a quarter in Scotland since 2009. The chapter on GP services shows similar time constraints.
When it comes to time to care, the chapter on home care highlights much that is wrong with social care. Even in what looks like one of the better care organisations in the private sector, “More than half the clients left every year, and the turnover of staff was just as high. The instability necessitated continuous marketing and recruitment, requiring full-time dedicated staff, a substantial cost for this small business”. In another company, home-care visits were fifteen minutes. A new care worker was shocked, ‘I was very green and willing; they trusted me with very vulnerable people after only three hours of basic health-and-safety training. I had no training in moving and lifting, and it’s left me with historic back pain. I wasn’t paid for travel time”. Another care worker highlighted a common response that I used to see in UNISON surveys, “A lot of people literally pleaded with me to stay for a moment, just to have a cup of tea”.
This is a beautifully written book that balances traditional evidence with the stories of care workers and communities, all in language we can readily understand. She spoke to individual care workers who are expected to reconcile market principles with their own understanding of people’s needs and their responsibility, and it is those at the bottom of institutional hierarchies who felt the contradiction most keenly. It is also an overwhelmingly gendered role, which in itself says much about our society.
Bunting concludes that the marginalisation of relationships may be most graphic and disturbing in low-paid parts of the care economy, but it has infiltrated virtually every dimension of care. Paperwork has become the way to avoid blame and manage risk and marketisation, bureaucracy and technology, is diminishing the primacy of people and the care relationship.
Two contrasting studies reach similar conclusions through different routes. Well worth a read.