More from the Realisation Festival: Madeleine Bunting on the crisis of care, our pervasive and ever-necessary "labour of love"
Continuing our run of previews of the Realisation Festival this weekend (9th - 12th June), here’s a 2021 piece from Madeleine Bunting, reflecting six months after publication on the response to her book Labours of Love: The Crisis of Care. Madeleine is speaking on this subject on Saturday morning. Thanks to the Local Government Chronicle for its reproduction.
Madeleine Bunting: Care has been subject to a historic distortion. We should rebalance
When an author publishes a book, another takes shape six months later. After the reviews, interviews and talks are done and readers have commented, a book one could have written takes shape.
In Labours of Love, I started out with a simple question: what is this short word, care? I interviewed dozens of people whose paid work is care, from doctors to nurses, from social workers to care workers; and I listened to people who cared for family members.
I wanted to find the commonalities between the professionalised, institutionalised and the personal, intimate forms of care. What are we doing when we care? The book’s combination of history, analysis and personal story has hit a nerve and I’ve received moving emails from readers thanking me for affirming the work they do – the labour of love. That was my aim, and it’s gratifying to hear it, but alongside it is a nagging sense that I did not do enough to describe the alternatives.
A marginalised activity
No book can cover the entire subject of care because it touches on so many different areas of life, and I focused on putting forward an argument about why care has been marginalised and overlooked for hundreds of years, and how that is now contributing to a crisis of care. To take the argument of my book further, three insights are crucial.
First, since the book’s publication, I’ve met inspiring people and it fills me with hope that we could be on the verge of a significant paradigm shift to see care as a form of wealth creation, not as a burden and drain on public expenditure as it has so often been characterised in the past.
That may sound like wishful thinking but it is at the cutting edge of economics; the economist Mariana Mazzucato, adviser to many governments around the world, brought out the Value of Everything, a profound challenge to our conventional thinking about value.
As the Victorian thinker John Ruskin aptly summed it up: “There is no wealth but life.” She followed it up with Mission Economy, which urges bold, ambitious thinking to tackle issues such as climate change and inequality.
The September 2020 report Levelling up our Communities by Danny Kruger MP (Con), commissioned by the prime minister, shows clear signs of her influence as it urges a new ‘social value purpose’ for public spending. No longer should the huge sums of public sector procurement (£300bn) be driven solely by narrow financial considerations, but should be aimed at a broader measure of social value for money.
This big broader debate is essential for radical change in how we organise care as Mr Kruger explains in the report, and in social care he calls for a “new family-centred, community-led model in which residential care is properly integrated with the life of a neighbourhood”.
My second insight is outrage. The financialisation of the care home sector is a scandal, and I feel it particularly acutely because in the past year my siblings and I reluctantly had to move my 89-year-old mother into a care home.
It is owned by a San Francisco based private equity firm and the lack of accountability is shocking; the turnover of staff is relentless, and the family have frequently been disappointed by the level of care despite enormous cost.
Research by Christine Corlet Walker for the Centre for the Understanding of Sustainable Prosperity brilliantly analyses why the care home sector is a dysfunctional market with “sticky consumers”.
My family is typical: we had little reliable information on which to base our choice of home, and now it would be dangerous to move my mother again, the disorientation and confusion could be fatal. It feels like paying a ransom. We have no idea why the huge fees are necessary or whether they are paying staff properly.
I worry that the kindly eastern European carer who wheels my mother to meet me (divided by the plastic screen which bewilders my mother) is desperately struggling to provide a decent level of care in the midst of constantly changing managers and not enough staff.
The consumer product fantasy world
Meanwhile I have become deeply cynical of the endless promotional marketing material produced by these private care home chains with their smiling, pretty elderly ladies and even prettier care workers.
They conjure up a fantasy world of care as a consumer product – boasting of the quality of their furnishings and food – which is a far cry from the single biggest ingredient of good care: kindly, strong, stable relationships.
Third, it is heartening that there are people and organisations thinking about new ways of organising care, whether that is in early years, social care or care for the dying. One of my favourite quotes is by Albert Einstein: “The world as we have created it is a process of our thinking. It cannot be changed without changing our thinking.”
Since the book came out I have met some of the people intent on doing just that. Alex Fox is the founder of the Shared Lives project which has pioneered a new model of social care and now has 14,000 placements. Mr Fox has produced a blueprint in his book, A New Health and Care System.
It makes the very simple but blindingly obvious point: ‘We need to ditch the idea that the value of our public services resides in buildings, kit, drugs or budgets… It resides in the people who use and provide the service and the relationships between them and the health and wellbeing they create together.”
Shared Lives rightly sees relationship as fundamental in all care work, and it was deeply moving to listen to the programme’s users explain how the strength of relationship with their carer had transformed their lives. Another inspiring example, Project Art Works, a Hastings-based group of neurodiverse artists, has just been shortlisted for the Turner Prize 2021.
Such initiatives break down the boundaries of care giver and recipient to acknowledge that care can be about reciprocity and relationship, and the prize shortlisting brings welcome profile to such innovative models.
I quote Andy Haldane, the chief economist to the Bank of England, in my book and a speech he gave to Oxford University in 2018 when he said that employment in the care sector would continue to expand and as a worthwhile, valued activity could offer purpose and meaning to countless lives.
He asked Oxford to consider how an elite academic institution could contribute to this revaluing of care – that foundational work of human societies without which we all suffer – but his challenge is equally relevant to all institutions.
The pandemic demonstrated our dependence on carers, often the worst paid; now surely the recovery must include a rebalancing of a historic distortion whereby care was ignored or dismissed as ‘women’s work’ and expected to be free or cheap.
More on the Realisation festival here.