“Covid ripped through our care system. We can’t ignore its problems anymore”

Madeleine Bunting, journalist and author of the new book 'Labours of Love - The Crisis of Care' speaks to ehospice about the state of care in the UK.

Madeleine Bunting’s new book, Labours of Love, arrives six months into a pandemic that has focused the world's attention on the caring profession like never before. However she was in fact researching and writing the book years before the arrival of Covid-19. Covering the history of care and caregiving in all its forms, she spent five years travelling around the UK and speaking to different kinds of care professionals, including nurses, end of life care providers, social workers, GPs and parents caring for children with a disability. She says the project confused people at the time who didn't understand why she was doing it. So why was she?

"I think any reporter who covers public services has noticed that over the last 20 years we've been stuck in a loop. We repeatedly have these commissions on social care, and proposals put forward by the government, and then politicians pull out because they're terrified of the costs.

"But it's not just social care.  There is a power deficit at multiple points that we come up against as we go through life. Part of it was watching this endless repeat of not being able to put proper care services into place with proper funding, but also it's my life experience. First as a young mother discovering the absurd lottery of childcare, and how botched and precarious the whole child care system is in this country, leaving families harassed and desperate. Now I'm at a stage where I'm deeply concerned about my elderly mother and the kind of care that's available for her.  And along the way there are other aspects of life where somebody gets sick and we don't really have the right care systems."

A sector under pressure

The concept of a crisis in healthcare has been amplified as a result of Covid-19, but it’s not new. A 2019 survey found that a third of adult social care workers were planning to quit the workforce due to low pay or the stress of the job. With the pressure of the pandemic and Brexit looming, this statistic is unlikely to have got any better. Meanwhile, the population is aging at a fast rate, with the number of people aged 85 and over estimated to double over the next 25 years.

“Elderly people now have on average six years of frailty. I've seen that with my mother who is 89, and that means being in and out of hospital and multiple long term conditions, which is a really hard thing for anyone to manage” Madeleine says. “I've seen how partners tried to look after their loved ones, like my aunt and uncle, and I saw the devastating cost to my uncle's health of trying to look after his wife. We've been really effective at prolonging life, but far less effective at understanding how to look after people in these longer lives.”

At the same time the last few decades have seen more and more women join the workforce, leaving behind their traditional role as unpaid caregivers. “What we haven’t done as a society is recognise that this unpaid labour of women can no longer be taken for granted. Women need to work to support their families and take on the responsibilities of breadwinning. But we haven't worked out who does the care now.”

She cites Scandinavian countries as having been more effective at recognising these long term trends and the consequences for care, implementing welfare programmes that fill the gaps. “That of course hasn’t happened in the UK. On the contrary, what we've had is 10 years of austerity which has stripped back an already inadequate system. That's why I think that when Covid-19 arrived we were in such a mess already, and the virus just ripped right through that. None of us can ignore these questions around care anymore. “

The future of care

One of the standout questions is what happens next. Given the renewed appreciation for the NHS and care workers generally, many hope this will lead to better funding. “The problem is that the economy is likely to get another terrible shock over the course of this winter. I'm not confident that we are going to be particularly economically stable in the next year or two, as they’re predicting the economic aftermath of Covid will last for decades.

"On the other hand when the NHS was founded in 1948, we’d just had the Second World War so we were hardly economically buoyant at that point. In fact we had a massive economic crisis across Britain in 1947. It is entirely possible that despite a state that is going to be saddled with huge debt at the end of Covid, we could draw on that parallel and say well, we managed it then, so we can manage it this time round. That would be an amazing moment, just to start thinking about how crucially important good quality care is and begin to think about what that looks like.”

What could a well-funded, well-managed care system look like? Madeleine suggests it shouldn’t be a national, centralised service. “We don’t want huge bureaucracies. I'm more interested in bottom-up, mutualist or cooperative-type initiatives, very local. One of the things we've really discovered because of Covid is how local care is, like who's next door who can go and buy your pint of milk.”

She adds that hospices are a great example of this. “They work with communities in a very deliberate way. Their funding comes from their local communities, they fundraise within the community, all the links hospices have are very local. I've seen that in hospices in London that I volunteered with, how they build that sense of community. They're really powerful engines of community engagement, and are a great model for locally-driven, locally-generated care.”

More information

- Labours of Love - The Crisis of Care is out today. Visit publishers Granta for more information