Fixing the UK’s care crisis must be about more than government funding
Family and friends will always play a vital role caring for loved ones. So why is the debate about care policy ignoring their voices?
How do we solve the UK’s care crisis? In recent weeks this question has returned to the top of the political agenda. Given the discourse surrounding the government’s proposed shakeup of social care funding, you’d be forgiven for thinking that the problem is lack of state care – and therefore that the solution is more of it. Improving state services is certainly necessary to support the 6.5 million people who are informal caregivers in the UK today, but the absence of sufficient alternatives is not the sole reason that most care is performed by family members. Instead, we need to pay attention to the underlying assumptions being made about care so that we can create a better informed and more effective policy approach.
Women are the default caregivers of our species. Frustration with this assigned role fuelled the 1970s women’s liberation movement, with women across the world calling for recognition of the value of domestic labour. Manifestos and pamphlets of the time advocated for the socialisation of domestic responsibilities so that women could have a choice about their lives, instead of being shackled to the home. It is obviously unacceptable to assign a role in life to someone based on their gender, but we mustn’t allow the question of who performs care, and the problems of sexism therein, to obscure why we perform care. Imagine this: tomorrow you get a call informing you that a parent is terminally ill. What do you do? You could call the council and, depending on funding, have carers visit them over the coming weeks. But do you want to continue going to work while strangers spend the last weeks of your loved one’s life with them? Maybe you could quit your job, but when?
Terminal diagnoses are a gamble – they might live six months or six weeks. Too much policymaking is done devoid of lived experience. When a real caring situation collides with your life, you may want to perform that care, at least some of the time.
In the UK, the discussion is centred on social care provision and the conditions of paid care workers. Both are important issues, but so, too, is our total lack of policies that respond to these love-based needs. For example, many countries such as Belgium and France have entitlements to paid carers’ leave. In Norway, parents of adult disabled children get ten extra paid days off per year and those caring for the terminally ill receive 60 days off at their full pay.
After tireless campaigning by organisations like Carers UK, the UK government finally consulted on carers’ leave in 2020. The government responded in September 2021 and confirmed that it will introduce the right to one week of carers’ leave. This will be helpful for many working carers who often use up annual leave to meet their responsibilities instead of having much-needed breaks. However, the government is introducing only an unpaid entitlement. This will prevent all but those with savings or higher salaries from taking advantage of the leave, and contribute further to the documented financial strain carers are experiencing.
When a real caring situation collides with your life, you may want to perform that care, at least some of the time.
It should be obvious, too, that five days a year will be sufficient only to cover the needs of the most straightforward caring situations. How will a person caring for someone that is terminally ill choose when to request this leave entitlement, given that death is unpredictable? In its consultation response, the government notes that employees are allowed to request flexitime, as if that solves the problem. But flexitime is not an employment right and it doesn’t reduce the overall load of both work and care that is so strenuous. If you are a carer, there is a crucial part of the legislative infrastructure that is missing which may mean flexitime is unlikely to be granted. Earlier this month, a mother won her case against her employer for its refusal to let her leave work early to collect her daughter from nursery. The tribunal ruled that this was sex discrimination because “most mothers find they have difficult feelings returning to work after maternity”. She won because gender and maternity are protected characteristics under the Equality Act 2010, but ‘carer’ is not.
There are no workplace protections for this most basic human need because of the underlying, capitalism-friendly assumption that we should outsource care rather than perform it ourselves. If you leave your job because of caring requirements and you meet various other conditions, you’ll be eligible for Carer’s Allowance, which is a meagre £67.60 a week. How will you pay your bills? When we focus solely on solving social care provision, we risk making millions of unpaid carers – mostly women – invisible, as they have been throughout history.
When you have first-hand experience of being a carer, a second and equally flawed implicit assumption in the current discourse becomes apparent. This is the idea that caregiving needs are routinisable and predictable. Within this understanding, paid carers (whether provided by the state or the market) can be booked, vetted and timetabled, and care itself delivered within prescribed pockets of time. This is the model of childcare translated across to the care of those who are impaired, elderly or sick.
The problem is that the situations are not identical. Sick bodies and minds are frequently chaotic. Diagnoses that sound straightforward, like ‘cancer’, translate into years of unexpected hospitalisations, medication reactions, infections and so on, that wreak havoc on the best-laid plans. This embodied reality means that kin are crucial, regardless of how much social provision exists. It is the unpaid family or friends who are there in the gaps between shifts, navigating bureaucracies and unpredictable emergencies, in all the interstices that current policy ignores, sometimes because they must be there, and sometimes because they want to be there. That role certainly should not be apportioned based on sex, but this is a distinct issue from understanding how care really happens and why. When we take this love-based, embodied perspective, family and friends will always be a crucial part of the picture, and so a holistic policy approach is required.
By focusing on the need for freedom from care, we are missing the need for freedom to care
Finally, we must also ask for whom we are socialising care provision under a state-led approach. In reality, rights-deprived migrant women will be its labour force, caring for our loved ones and not their own in order to earn a wage. Feminist theorist and activist Silvia Federici has recounted the point made by a mother on welfare benefits: she said that if the government would pay women only when they cared for other people’s children, then women should simply swap their kids. We are repeating the same problem with this form of caregiving. By focusing on the need for freedom from care, we are missing the need for freedom to care – and this plays out in labour market policies that make no provision for caregiving necessities outside parenthood.
For the middle classes, savings may enable leaving paid employment to perform unpaid care, but for the working classes the only option is to keep caring for strangers even if their kin need them. This means that even if we revolutionise the kind of social care provided, moving from too-short shifts to round-the-clock support from a changing cast of strangers and familiar faces, this will not be sufficient.
If we continue to consider care policy separate from wider labour market policies, we will continue to prioritise waged labour above our need to care for our loved ones. Instead, we must rebalance our focus and question the premise that social care is the solution because we’re all too busy with waged work to care for people. Every person must be able to provide care and in a materially supported manner. This would require us to stop treating it as a discrete policy area, and instead recognise that its separation from general labour market policy and other areas is yet another falsehood of patriarchal capitalism. Otherwise, we will continue to make policy wearing unhelpful blinkers, designing ‘solutions’ that are completely removed from the realities of peoples’ lives.
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