“Whatever Andy Burnham does to reform Britain’s care sector will already be too late for us. It’s been too late for millions of elderly people and their carers.” (Christopher Furlong/Getty)
My mother-in-law was discharged from hospital last Monday. She is 92 with Parkinson’s and that night, she fell out of bed twice. A discharge coordinator was supposed to be arranging the details of her return home — but forgot to call the care company to arrange any extra help, and also overlooked the need for a hospital bed that would have prevented her from falling. My father-in-law, also 92, is too frail to help — he is falling himself. Luckily my husband was still there, but the second time she fell, he could not get her back into bed. Once again, he had to call the paramedics.
Such are the details of care at this stage of life — and there will be hundreds of thousands of families dealing with similar situations right now. Whatever Andy Burnham does to reform Britain’s care sector will already be too late for us. It’s been too late for millions of elderly people and their carers.
I have written extensively about care in the past — interviewing careworkers for my book, Labours of Love: The Crisis of Care, investigating the precarious finances of care homes, and arguing that we need a complete reframing of care. Still, even when you are familiar with the details, nothing fully prepares you for the reality of caring for those closest to you.
What I find particularly painful in the case of my in-laws is seeing their own commitment to self-reliance, so characteristic of their generation, turning against them. Both were wartime children, raised in modest circumstances to work hard and be careful in their budgeting. They bought a modest bungalow, and have a small nest egg of savings. Until only a few months ago, they were insistent they could still cook their own meals, and were reluctant to accept any help. On my visit at Christmas, my mother-in-law insisted on making me a cup of tea. She brushed aside my protests, saying she needed the exercise of the painful walk to the kitchen. Stoical to a fault, uncomplaining and proud.
Now, they have finally acknowledged that both of them are falling too often for them to manage at home. They will have to move into a care home, and the costs are eye-watering: £10,000 a month for the two of them, which will wipe out their lifetime savings in a few months, and the value of their bungalow in a couple of years. “And then what?” asked my mother-in-law yesterday, with characteristic acuity. We promised her that the local authority would step in. That is what we have been assured by the care home manager — but Adult Social Services have not yet provided the crucial care needs assessment and financial assessment forms, despite my in-laws being categorized as a priority. For now, they will have to pay for their own care — despite already meeting the financial eligibility criteria for state support.
Given all that, I found it hard to remain unmoved last week as I watched Burnham’s speech on social care alongside Baroness Louise Casey, who is now heading up the review into the care sector. Burnham declared that he would not forgive himself if he didn’t do his best to sort out the scandalous, expensive mess of social care, that this would be the defining test of his premiership, and that he was going to “stick this out”. The crack in his voice was unmistakable, as he said he was doing this for his father, who suffers from Alzheimer’s, and for the millions like him.
But as I watched the speech on YouTube, I skimmed the comments scrolling alongside, and found a depressing litany of cynicism, impatience, abuse of migrant care workers, and antisemitism, only occasionally interrupted by someone suggesting that some of what Burnham was saying made sense. It was a reminder that our political culture has profoundly changed over the last 25 years, and that the electorate’s patience, interest, and even tolerance of politicians has evaporated.
This matters, because at the heart of Burnham’s care agenda is a bold ask of the media, his fellow politicians and the electorate: please, please can we have a grown-up conversation about this? (He actually called it a “factual debate”.) Everyone is affected by the care crisis, either directly — those unfortunate enough to be dealing with the social care system — or indirectly, since the NHS is crippled by coping with its failures. Burnham’s sincere hope (and it really does seem sincere) is to get beyond point-scoring and “screaming headlines” — that is, to face up to the scale of the problem and reach a consensus. Do we have the collective wisdom to recognize the necessary trade-offs and back a plan that will last? Britain managed to achieve something like this in 1948 with the founding of the NHS. Can we do it again in a time of bitter and impatient hyperpolitics? I’m doubtful, but these are the right questions to be asking — and not just of our politicians but of ourselves.
Burnham is of course correct that any future National Care Service will depend on a properly paid workforce with secure, rewarding jobs and appropriate levels of staffing. He is, however, less convincing when offering paeans to how “hugely valuable” care work is. It might mean something coming from Angela Rayner, who has worked in the sector; but we’ve heard these words from countless (male) politicians, and it has always meant little in terms of pay or job security. Indeed, it plays into an age-old gender stereotype of idealizing women carers who do it all for free — or near to.
Care remains deeply gendered. No philosopher or economist took any interest in the labor of women in raising and sustaining human life until the arrival of feminism and the breakthrough academic work of the last 50 years. But, too often, that work has remained in academia, with little percolating through to mainstream politics. It has meanwhile been ignored by career feminists focused on individual ambition.
When I wrote Labors of Love, drawing on the brilliant work of Annemarie Mol, Nancy Folbre and countless others, I wanted to acknowledge how care is full of paradox. It is boring and deeply creative; it is routine and spontaneous; it is a complex interplay of physical and emotional labor, medical expertise and heart. We have failed to find a public language for this, let alone the appropriate respect for the work. The carers I interviewed were suffering from a kind of moral injury. Their work is not respected and they know it. A young woman in Norwich reflected: “I suppose I just wipe bums — that’s what my friends think — but I think that I make my clients’ day better, we have a smile and maybe a laugh, and that’s worth more than working in a nail parlor.”
It’s no easy task to suggest a nation reappraise its value systems, so that the act of looking after another human being is recognized as a difficult — though bold, creative, fulfilling, intelligent and dignified — career path. But it has been done before, and in my research I found several examples. One radical re-framing of a form of care work is famous. When I began to read about the life of Florence Nightingale, the figure that emerged was infinitely more interesting than the saccharine Lady of the Lamp of childhood picture books. Prior to Nightingale, hospital nursing was seen as the lowest form of work, filthy, riddled with alcoholism; only women who were desperate for the money would turn to nursing. Nightingale transformed standards with a relentless military-style focus on discipline and cleanliness, and made the job a profession. However, her real skill was in public relations. She challenged the strict conventions about the role of women in mid-Victorian England, and made it possible for single women to care for male bodies. Using Christian references to self-sacrifice, she made it possible for women to leave the home (and parental supervision) to earn a living. This was nothing short of revolutionary — though it came at a cost. Nightingale’s legacy was also to confirm the assumption of women as “angels of the hearth”, a gilded cage which we are still reckoning with.
Interestingly, it’s another Christian who is now challenging us to a new paradigm shift. Burnham is the first practising Catholic at No. 10 and the first Prime Minister since Gordon Brown to communicate a clear sense of moral purpose. Faith feels relevant here, since care is primarily a question of how we value people. Care is profoundly ethical in its attentiveness to another person as an end in themselves, not in how they contribute to the economy — this is deeply countercultural when the language of the market has established a crippling stranglehold on our culture. Indeed, on that hideous YouTube comment thread, there were plenty of commenters asking why bother spending money on old people who have nothing to contribute.
In his Catholic education, Burnham will have had drummed into him the dignity and value of every human being made by God — as I did in mine. Does this Christian ethic still have purchase in a country where Christianity has declined dramatically? Catholics number a quarter of what they did 60 years ago, and the Church of England’s decline is even more dramatic — hence why Burnham balanced his speech to appeal both to the ethics of caring for the elderly and the utilitarian argument that the current system is crippling the NHS’s ability to care for all of us.
One thing that is clear is that if Britain’s care sector is to be reformed, the issue that has to be tackled is ownership. Private equity and investment funds have turned care into a lucrative money-making venture. This is where tragedy becomes scandal. Using care home property as collateral, huge borrowing has loaded the sector with debt. A large part of the faintly unbelievable costs of care homes are to pay interest on debt; pay dividends to investors; and to pay huge salaries to the chief executives who have constructed rickety financial structures teetering on insolvency. This is the really thorny part of Casey’s review, and it is analogous to how investors have preyed on another essential service: water. The public won’t stump up more money in taxes if it is going into the pockets of overseas investors. It’s not entirely clear if Burnham has fully grasped the issue. All he had to say on this when questioned was that there should be “no profiteering in the system’” and lamenting that “the vulnerable pay with everything.”
Indeed. My parents-in-law’s assets are modest, and they look set to lose everything. Both have exceptionally clear minds for their age and it feels like a betrayal of everything they have believed in over their long, hard working lives: a state that stood by them in their hour of need, if they played their part. It was heartbreaking to stand by my mother-in-law yesterday, as she adjusted to her new reality. I can only hope — and it is not much more than hope — that future generations will not have to go through this.