Corrupting care

Here is an extract from a speech given yesterday by Liz Kendall Labour’s shadow spokesperson for care and older people:

Our goal must be to create a new care covenant between citizens and the state, involving all parts of our society and economy.  This covenant should be based on the principle that care is a shared responsibility - its risks and benefits are mutual and should not be left to individuals and families to shoulder alone.  It must be grounded in values of dignity and respect for those who need and provide care, ensuring older and disabled people and their families have the same choices and chances to live the lives they want as any other section of society.

And it must seek to strengthen mutual care and support within our families and communities, as well as through care services

Fine words, as my grandmother used to say, butter no parsnips. But it is good to see an emphasis being put on values, mutual care and shared responsibility as well as Government policy. As I have argued here before, we need a ‘whole system’ reform of care - something which involves attitudes, behaviours and norms as well as policies.

Yesterday I interviewed the philosopher Michael Sandel for the next edition of the RSA Journal. We discussed his book ‘what money can’t buy’ which has just come out in paperback. In it he bemoans the ‘marketisation’ of more and more areas of life evidenced, for example, in poor children being bribed to study or sports memorabilia being turned from personal objects collected by fans to a billion dollar mass market. His objection to such practices lies in the way they exacerbate inequality.

The more things that are paid for, the more difference having money makes to people’s lives. Take the example of ticketing. If the criterion for access is a willingness to queue early or long, the tickets will tend to go to the most passionate, but if the rich can buy tickets whenever they want from on-line sites, wealth rather than passion becomes crucial.

Sandel also worries about the way financial incentives ‘corrupt’ motives and meanings. If we bribe children to read, do we reinforce the idea that reading is onerous? If we can pay for a footballer’s autograph, it lacks the intrinsic value which we would attach to something we had collected ourselves in a memorable encounter or just standing in the rain for hours.

Bringing together Michael’s analysis and my interests, we had a fascinating conversation about care. This is surely the most important example of the way the value of something changes when it is marketised. The very idea of care contains within it a notion of emotional commitment. Yet, however much we might teach nurses how to be compassionate, we cannot get inside the heart of someone who is paid to care and force them to experience the feelings that we have when we care for a loved one and which we want to believe lead loved ones to care for us.

Michael reminded me of a famous article from 2001 by Arlie Hochschild called ‘The Nanny Chain’ which ponders what we are doing to people and relationships when immigrant carers are paid to look after middle class children and use their remittances to pay a different stranger to look after their own children back home.

In terms of Sandel’s idea of corruption, consider the contrast between the value we place on care in the private and public domain. In the former we say that nothing matters more than the welfare of our loved ones. We give and receive care as part of a web of reciprocity which goes towards defining who we are as social beings. But in the market, care is low status and low paid. Might it be that the low value ascribed to paid care might corrupt the status of voluntary and familial care, adding a loss of self-worth and status (and influence) to the other challenges of being a carer?

To argue that the socialisation and marketisation of care may be problematic is difficult. It might sound like a suggestion that there was a golden past of unlimited compassion, or a failure to appreciate the radically different conditions created by population ageing and female employment, or – worst of all – an attempt to force care back into the home and onto the shoulders of unpaid women.

Politicians are under pressure to come up with solutions. Labour is putting its emphasis on the need to join up social and health care commissioning and perhaps underestimating the reasons why this is very hard to do. But no reconfiguration of spending or services is going to be enough to resolve the care crisis. Liz Kendall is right: we must explore care as part of our lives and our society as well as a particularly intractable set of funding and policy problems.