Does the following clarification help us better frame the debate over care?
Our care system is in a state of disrepair, bordering on crisis.
Just to recap the main evidence:
The continual flow of examples of poor care for vulnerable people in institutional settings
Linked to this the identification of an alleged decline in compassion in caring professions such as nursing
The worsening local funding situation for social care leaving services restricted to a basic entitlement for the most needy
Talk of all local government spending being consumed by social care within a few years
Worsening problems of affordability both for elder and child care exacerbating issues of living standards and work incentives
The caring sector is overwhelmingly one of low skilled, low paid, low status employment
Many care activists argue that systems continue to trap people in dependency and disempowerment
Despite good work from bodies including Participle, NESTA, Shared Lives Plus, we still lack innovations which have the capacity at scale to make a difference to social care productivity and effectiveness
The pattern of care tends to reflect and exacerbate social inequalities of class, gender and disability
The continued social isolation and effective invisibility of many carers (including children), old and vulnerable people
A failure to measure and value care as part the social economy
From such a base line it can seem inconceivable that we might create a care system (by which I mean a social system not just a policy framework) which is:
Equitable and just
Supported and fulfilling
Safe and decent
Affordable and productive
In a context of rising needs and severely constrained private and state resources the long term continuation of a gap between our care aspirations and the reality is inevitable. However, understanding the scale of this gap in terms of both material needs and political values (the denial of rights and justice) is an important starting point for a deeper debate.
But why is it that the public discourse about care focusses on a series of symptoms of crisis but rarely explores the more fundamental dilemmas and problems from which these symptoms spring?
One is surely the ambiguity over whether care is primarily a matter of personal moral choices or public political choices. Take these three examples:
The ambivalence in public discourse over the degree to which parents (and particularly mothers) should accept that having children involves making financial sacrifices.
The sense that whether or not we end up having our economic opportunities and basic quality of life profoundly adversely affected by caring for chronically ill or disabled relatives is something determined by fate and private choice, rather than public policy and social support
The idea that nurses (or other caring professions) should be expected to demonstrate ‘compassion’ over and beyond good customer care.
In a good care system there may be social approbation for self-sacrificing parents and carers and (in the same way as medals are awarded in the military precisely for doing more than can be reasonably required) for caring professionals who choose to go above and beyond the call of duty. But a system which demands substantial sacrifices be made by carers is one which is implicitly denying a collective interest in and responsibility for creating future generations and caring for the vulnerable.
Whatever we might hope that carers would choose to do in a good system the point is that these things should be choices (and thus in Avner Offer’s terms aspects of the ‘gift economy’ or ‘the economy of regard ‘) not requirements or unavoidable realities.
The point of identifying clearly the gap between a good system and the current system is not simply to generate some depressing and impossible numbers for the funding shortage. As I have argued in an earlier post, the care system is a diamond comprising the market, the state, the family and the community. And, as I also argued, it may be that the aspect of the diamond which has the greatest scope to be enhanced without negative trade-offs is the one that currently receives the least attention, the community.