Ed. note: A different version of this piece was previously published on Radix UK here.
In an uncertain world where crisis, reaction, and receding state support appears to have become the norm, how do we reconnect the value of the care economy in social, cultural, and political life?
Care deficits and structural mismatches
The insights of the care economy – the love, care, empathy, and nurturing arising through household, neighbourhood, and community level association – serve as a critical precondition to change. But its generative power hinges on our ability to perceive and systematise this whole into our social support and livelihood systems.
Or, to put it another way, the positive outcomes towards which we strive for often disadvantaged citizens (i.e., healthy, connected individuals and communities) are closely interwoven with the ways in which their care and support is conceived of and provided. Care embodies a relational quality. And yet, looking at the present-day adult social care landscape, we can spot several interrelated patterns that are systematically undermining the care economy upon which it rests. What is frustrating efforts at change?
Economically, we persist with an impoverished conception of care work. Care is visible in patterns of knowing, patience, empathy, trust, hope, courage, and humility. However, orthodox (and some heterodox) economics views paid care as unskilled labour: a fixed, scarce, unchangeable entity, stock, or economic quantity. Subject to standardised business models that prioritise labour productivity growth or ‘efficiency’, care work is commodified, defaced, and shadowed by low paid and precarious work.
Economic orthodoxy is here like self-fulfilling prophecy. What is essentially humane, fulfilling and rewarding work can quickly descend into a world of low morale, blame and burnout, decimated rotas, and long working hours. The cost shifting managerial ‘more for less’ agenda continues unabated. But in my experience of frontline care and support, this social strain is undoubtedly brought into care spaces and the care relationship, often with disastrous outcomes.
Moreover, systemic risk and responsibility is distributed unevenly and borne disproportionately by people supported, ‘informal’ family carers and frontline care and support providers, the latter mainly performed by women. Working under a hierarchical, often hawkish relationship with the state, providers not only carry the social stigma of low paid and ‘messy’ work, but often the implicit distrust of government officials and the public at times as well. How can the conditions be created for better coordinated and valued, effective support?
In liberal-individualist cultures, economic forms of exchange value dominate, often to the detriment of affective, caring roles in society. The imperative to compete and pursue self-interest – pressed on us as much by the state as by the market – assumes a false view of the citizenry as a collection of selfish, maximising individuals. In such ways, Western notions of ‘value’ have generally asserted narrow monetized categories, overshadowing more holistic visions of the good life.
Austerity and a recent politics of regressive, xenophobic sentiments and nationalist values has only served to victimise perceived weaker members of society and divide us further. Tragically for matters of the heart, too many fail or are simply unable to acknowledge the everyday healing power of empathy and mutual support, despite some wonderful exceptions. Shouldn’t expressions of need such as anxiety, loneliness, or grief be contained within the private family, or left to charitable giving or the state, so we can get back to business as usual?
Many will have seen the two-part Panorama series in 2019 revealing the alarming mismatch between the lived realities of people who need support and dysfunctional state systems. This was instructive, and rightly brought public attention to the human consequences of toxic government policy and management in social care. But the roots of a care system in crisis go much deeper. As legal scholar Ugo Mattei points out, public spending on social welfare is inextricably linked to an unsustainable economical-quantitative model blind to caring communities and living systems: no economic growth means no social rights.
The COVID-19 pandemic and government response to date has only stressed the care deficit further. According to The Right to Care, a 2020 report by the London School of Economics and Political Science, the social foundations of recovery from the pandemic are being undermined by a lack of care in policy making. The absence of courageous and conscientious policy making is serving only to disconnect and further weaken the role of communities, mutual support networks, and households in economic and social life.
The alignment of locally crafted solutions with enabling public authorities is essential if we are to address the tensions between the social nature of care and the flawed systems that provide it. But while ‘integrated care’ rightly points to continuity, operationally it simply tries to fuse the conflicting interests of clinicians, commissioners, care providers, and citizens. The subsequent drive for standardisation carries the predictable consequences of wresting power away from citizens who lack the resources and power to realistically participate in decision-making processes.
Moreover, so-called wicked problems cannot be resolved by looking to inspired individuals to overcome resistance, shift organisational inertia, and force through compliance and change at the expense of others. Essential caring traits such as trust and empathy, or the integration of human rights and legal literacy, can crystallise and find expression – or indeed, fade – in delicate webs of human interaction, diverse cultures, and organisational form.
Whether stuck within largely inept public systems or in fast-paced, alienating working environments, people have developed a remarkable capacity for resilience. But the monumental waste of creativity and human resources through unemployment and structural exclusion tell us emphatically that we can do better.
Care by design: A renewed focus for co-production
What is needed now is a holistic framing of human need, where care and social interdependency are reconnected through organisational form to broader public structures of human rights and social responsibility. The question we might ask now is: can we support distributed, community-level responses to the COVID-19 crisis become major waves of reconstruction? Of equal importance, given the policy response so far, is: to what extent, or in what form, can the state be a partner in this?
The ideas, desires, innovations, and community-led practices are abundant. Alongside the COVID-19 Mutual Aid response, Caring Town, Village in the City, microenterprises, multi-stakeholder cooperatives, Time banking (and other forms of social currency, exchange, and social markets), Buurtzorg neighbourhood teams, community support brokerage, movements for neighbourhood democracy, and Hilary Cottam’s Circles all represent important points of reference. These platforms have established (in varying forms and to varying degrees) the boundaries and the self-written and self-managed protocols of a commons; cultivating the patterns of openness, resource pooling, reciprocity, cooperation, and care found in healthy communities.
Distributed cooperative organisations (DisCOs) propose a particularly compelling platform for work that co-creates systems of value accounting centred around care work. Guided by shared social and environmental commitments, DisCOs use innovative tools such as care value tracking and complementary metrics to produce positive outcomes for both workers and their communities. This is not intended as lip-service, but a practical pathway to embed this value ‘in cultural, productive, and organizational processes [as well as] technical/legal statutes’.
But what about a sensible conversation about state support and priorities? The resilience of communities is often despite top-down, debt-heavy social care systems, or the administrative blueprints from centralised authorities. ‘Neoliberal’ state forms have generally left notions of autonomy and freedom to the workings of the ‘free market’, with ruinous social consequences. Public-Private Partnerships are perhaps one of the best-known expressions of this, where short term gains are gradually overtaken by hidden, longer-term costs such as higher fees, resource depletion and degradation, and lower quality.
At the level of policy, the authors of A Right to Care propose new policy evaluation tools and accountability measurements that bring into focus household inequality, and how it is deepened or reduced by government policies. This renewed focus on social support networks and care labour could indicate a shift away from ‘productivity’ leading only to a ‘dead end of automation’ or ‘consumption-led growth that support middle class households only through hard times’.
In Italy, meanwhile, the Bologna Regulations for the Care and Regeneration of Urban Commons serves as a timely and hopeful example of the ways in which citizen and state can work together based on trust and transparency. The Bologna Regulations are based on five design principles and a recognition of the innate capacity of self-organised communities to adapt solutions to their own needs. The solutions provided by Commons-Public Partnerships include formal platforms of collaboration between citizen and state to restore abandoned resources such as buildings, parks, and support services, often at lower public cost.
Caring present, caring futures
There cannot be too many across the political spectrum who would not choose a move away from an outdated welfare state and towards a more compelling vision based on the humanity, autonomy, and creativity of all citizens. But one is not a substitute for the other; a scenario played out in austerity and the ‘Big Society’ narrative. The power to reclaim citizen space is unlikely to be ceded by public authorities and their advisors pursuing dead-end growth policies from a by-gone era.
Citizen communities need the legal recognition of Nobel Prize winner Elinor Ostrom’s 7th design principle for the management of successful commons: the right to devise their own institutions, but while retaining state funding and enabling support as a key partner. The task now is to create and federate a parallel care economy, while engaging with existing forms of defunct governance through methods such as advocacy and independent support brokerage.
Foregrounding care as a core assumption and as the essence of value creation may seem fluffy or fanciful. However, it is not only being integrated into new and persuasive models for economics, but also based on realism: including the full, nested range of livelihood and social reproduction that constitute economic activity.
A journey into the oft-fraught arena of the heart does not have to signify a descent into fear, resentment, and rage. Indeed, Building Back Better may depend on it. As Milton Mayeroff highlighted, On Caring, in the context of any person’s life – not just the young, older, or the most vulnerable – caring has an innate way of creating basic stability in life. With its focus on present realities, shared vulnerability, insights from the past and anticipations of the future, it is as good a place to start a conversation about societal change as any.
Teaser photo credit: A care home in Norway. By Thomas Bjørkan – Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=23829953