Emma Dowling - The Care Crisis

The Care Crisis

The Care Crisis

What Caused It and
How Can We End It?

Emma Dowling

For all who care

First published by Verso 2021

Emma Dowling 2021

All rights reserved

The moral rights of the author have been asserted

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Verso

UK: 6 Meard Street, London W1F 0EG

US: 20 Jay Street, Suite 1010, Brooklyn, NY 11201

versobooks.com

Verso is the imprint of New Left Books

ISBN-13: 978-1-78663-034-6

ISBN-13: 978-1-78663-037-7 (US EBK)

ISBN-13: 978-1-78663-036-0 (UK EBK)

British Library Cataloguing in Publication Data

A catalogue record for this book is available from the British Library

Library of Congress Cataloging-in-Publication Data

Names: Dowling, Emma, author.

Title: The care crisis: what caused it and how can we end it? / Emma Dowling.

Description: First edition paperback. | London; New York: Verso, 2021. | Includes bibliographical references and index. | Summary: Emma Dowling examines the care crisis in the UK, looking at the changes to the care system over the last decade. Dowling gives an account not only of the impact of austerity measures on care provision in the UK but also of the underlying logic of neoliberalism driving the crisis Provided by publisher.

Identifiers: LCCN 2020041746 (print) | LCCN 2020041747 (ebook) | ISBN 9781786630346 (paperback) | ISBN 9781786630377 (ebk)

Subjects: LCSH: National Health services Great Britain. | Health care reform Great Britain.

Classification: LCC RA395.G6 D69 2021 (print) | LCC RA395.G6 (ebook) | DDC 362.10941 dc23

LC record available at https://lccn.loc.gov/2020041746

LC ebook record available at https://lccn.loc.gov/2020041747

Typeset in Sabon by MJ & N Gavan, Truro, Cornwall
Printed in the UK by CPI Group (UK) Ltd, Croydon CR0 4YY

Contents

Open the papers on any day in Britain and you will find articles about the crisis in social and health care: an ageing population and the increase in dementia without the necessary care facilities or resources to deal with it; reduced mental health services; fragmenting community services; the abandonment of refugees; the lack of nursery schools; cuts to disability care budgets; overworked doctors and nurses; stressed children; cuts to education maintenance allowances. The list goes on. Since the financial crash of 2008, the toxic cocktail of recession and austerity has seen those who rely on disability payments suffer inordinately.

On top of cuts and economic hardship, societal care needs are actually increasing, due to demographic changes. From 2012 to 2022 the number of seventy-five-year-olds will have increased by over one million, from 5.1 to 6.6 million. This is a rise of more than 20 per cent and is exacerbated by a shrinking younger working population.

At the same time, precariousness and insecurity continue to rise. Since 2008, insecure self-employment has grown considerably in the UK and the number of agency workers has increased by nearly 50 per cent. Zero-hours contracts are becoming the norm in the homecare sector.

Zero-hours contracts are said to give workers the flexibility to work when it suits them, particularly those with caring responsibilities.designating caring responsibilities as something that people do in their own time, as their own responsibility, constitutes part of the logic of relegating care work to the unpaid realms of the personal.

All the while, a wellbeing industry is booming for those who can afford it. Proliferating too is the advice literature on self-care alongside a concomitant insurance industry, startups for new care technologies, along with personalised care services, from care budget planners to cuddle therapists. The crisis of care does not affect everyone in the same way: as care becomes more and more commodified, access to care becomes more and more dependent on what you can pay. Moreover, one persons care needs are often played off against anothers, separating and dividing people and putting their needs in competition with one another in a context of manufactured scarcity, producing significant care inequalities. All too often this arises from political decisions about whose care decision-makers consider dispensable and whose they do not.

Needs are also played off against one another when care workers are pitted against those they care for, or vice versa. When junior doctors went on strike in the UK in 2016 over changes to their contracts which would make them work even more hours, with less access to training and less pay, the then health secretary Jeremy Hunt positioned himself as championing the interests of patients against the actions of junior doctors he branded irresponsible. No matter that the proposed changes would be to the detriment of junior doctors welfare and would increase the safety risks resulting from understaffed hospitals with overworked personnel.

The evident failures of the privatisation of health and social care services are part and parcel of the current crisis of care. For example, in 2019, all four of Britains biggest residential care home providers were up for sale owing to financial difficulties.

The restructuring of welfare states in Europe and North America is but one facet of a manifest global care crisis, in which a growing number of the worlds population cannot access the care and support they require. However, care for these recipients is increasingly difficult to ensure.

While the number of the worlds population unable to satisfy basic care needs grows, so too does care inequality not just within, but across, societies. Where Global North countries display dramatic disparities in access to care, developing countries face a situation where a lack of health-care infrastructure exacerbates the challenges of chronic illness and epidemics, natural disasters and political conflicts.

Too often the problems we face as a society are couched in economic terms, with all else appearing as secondary: get the economy back on track, facilitate economic growth that is how to solve the pressing issues of our time, be they climate change and environmental degradation or social inequality, exclusion and want. However, were we to change our view and look at the economy from the perspective of care, our debates about the problems we face and the solutions to them on a local and global scale would also change.

When we think of care we usually think of individual sentiments or behaviours the feeling of caring about someone or the act of caring for someone, or even caring about the state of the world. Yet individual intentions and actions appear inadequate in the face of the overwhelming problems of our time. It feels so futile nave, even to believe in the possibility of everyone being more considerate of each other so as to bring about a better world. It is painfully obvious that massive economic disparities and major political power imbalances are the root of our present predicament. Can something so seemingly fragile as care be powerful enough to transform such forces? Acts of kindness may make us feel better, but can they really be both the means and end for change? And it is not just the cynics who are suspicious of the imposition of an imperative to care. Ways of caring can also be patronising and confining. Immediately, the questions arise: who defines? Who decides? Who enforces? And how?

The Framing of Crisis

Everyone should be able to live a materially secure and meaningful life premised on emotional wellbeing, physical health, fulfilling social relationships and maintenance of the ecological environment. Deprived of the means, time and capacity to care for ourselves and one another, we struggle to maintain not only physical but also mental health, straining to hold on to a sense of self-esteem in the face of multiple pressures. A crisis of care means that more and more people are unable to do these things or to get the help they need. A crisis of care also means that those who provide care to others are unable to do so satisfactorily and under dignified conditions. To speak of a crisis of care is to speak of the changes to the material conditions for the provision of care whether within households and families, in communities, by public or social services or through the market, private corporations and agencies. To speak of a crisis of care is to point to the growing gap between care needs and the resources made available to meet them. To speak of a crisis of care is also to look closely and critically at the kinds of ideological assumptions about human nature that inform not only policies, but also dominant economic theories. In an unequal world, no crisis affects everyone equally. To speak of crisis is thus to ask the question,