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Care Workers Are the Foundation of Our Economy – And the Government Should Act Like It

While the government rolls out grandiose schemes to make Britain a 'global superpower,' it continues to neglect the care sector at home – priorities which show it has learned nothing from the Covid-19 pandemic.

Credit: Marko Geber / Getty

Last week, with much media fanfare, Boris Johnson unveiled plans for a new National Science and Technology Council. The mission: to ensure the UK’s ‘world-leading science and ideas’ turn into ‘solutions for public good’, as part of ambitions to become a ‘global science superpower’. Meanwhile, on the home front, it was widely reported that the Prime Minister had yet again postponed crunch meetings intended to generate a solution to the adult social care funding crisis.

The stark contrast between grandiose dreams of supremacy on the global stage and apparent incapacity in the face of a broken care system is not a temporary bug: it’s a feature. Nor is the neglect of residential and domiciliary care, those most domestic of domestic policy areas, a coincidence. It speaks to a deeper problem with our economic system – which no amount of high-risk, high-reward innovation could ever solve.

The Fetish of the Frontier

Amid the flow of attention-grabbing spending commitments and newly-established organisations, Johnson’s announcements were marked by the persistence of two established themes: on the one hand, flashes of techno-chauvinism, with measures to ‘restore Britain’s place as a scientific superpower’; on the other, the spectre of the ‘left behind’, and the promise ‘to level up’, delivering ‘a growth that goes beyond the golden triangle of Oxford-London-Cambridge and across the whole country’.

This juxtaposition of those elements—high-tech R&D as the key to boosting productivity and reviving flagging regions—has been familiar since the 2017 Industrial Strategy White Paper. While the March 2021 Budget has effectively replaced the 2017 ‘Industrial Strategy’ with a new ‘plan for growth strategy’, the core objective remains the same: to raise productivity, and to solve the UK’s much-invoked ‘productivity puzzle’.

In its current shape, this strategy will likely fail in any attempt at ‘levelling up’. It lays heavy emphasis on frontier industries such as robotics and life-sciences, which is understandable given the core stated objective of raising productivity – but focusing on frontier industries is unlikely to lead to better jobs or wages for most people in most places.

As one study has identified, the sectors likely to benefit from the Industrial Strategy Challenge Fund account for little more than one percent of the whole UK economy, and ten percent of manufacturing jobs. The jobs in these sectors are unevenly spread across the country, with the spend in effect heavily weighted towards the South-East. The focus on frontier sectors thus threatens to increase, rather than reduce, regional divides.

In the Shadows

However, the problems with the government’s approach to innovation go beyond the smouldering question of regional economic imbalance.

The breathless exaltation of the frontier that can be found in the pages of the Industrial Strategy—or indeed the innovation policy document of any high-income country—is animated by a particular ideal of human achievement. Here the hero is the scientist, the inventor, the disruptive entrepreneur, restless in pursuit of a world that is ever faster, harder, stronger.

But as Andrew Sayer has pointed out, humans are vulnerable as well as capable. Vulnerability is not an aberration, or the fate of unlucky minorities; it is a universal feature of the human condition. We all need clothing, food, shelter, emotional nourishment, and care in infancy, sickness and old age; even the most dynamic scientist would struggle to advance the frontiers of technology without them.

And it is in addressing each other’s basic needs that many of us spend most of our days. Much of the UK economy consists of ‘foundational’ sectors meeting the everyday needs of households and small businesses. These range from ‘providential’ sectors like education, health, and care, to ‘material’ sectors such as utilities, high-street banking, and food. Distinct but related is the ‘overlooked economy’, providing goods socially defined as essential, such as haircuts or house maintenance.

Taken together, the foundational and the overlooked economies make up nearly two-thirds of UK employment. Unlike frontier sectors, they are a major presence across the UK.

The foundational economy is typically thought of as ‘low-value’ and ‘low-skill’, and associated with low gross value added (GVA) and low productivity. But this apparently straightforward ‘low-skill’, ‘low-value’ status can only be fully grasped when we understand many of these forms of work as reproductive labour.

Feminist economists have drawn attention to the firmly embedded hierarchies in capitalist societies resulting from the gendered division of labour: ‘productive’ labour is associated with men, while ‘reproductive’ labour is associated with women.

Reproductive labour can be understood as the work of ‘social reproduction’ or ‘life-making’: sustaining our everyday existence through providing care, preparing food, maintaining relationships, and attending to hygienic, emotional, and other needs. It is closely associated with the domestic sphere, where it is usually unpaid, but in contemporary capitalist societies much of it also takes place outside the home, in schools, hospitals, creches, or in offices by out-of-hours cleaners.

From the viewpoint of mainstream economics, this reproductive labour is both undervalued and under-appreciated. And yet ‘highly productive’ sectors are heavily dependent on unpaid or low-paid reproductive labour for their profits. The existence of ‘low-value’ labour is a precondition for others to make money.

The result of this deeply embedded hierarchy is that even in societies with high rates of employment and high GDP, people who carry out reproductive labour often struggle to secure their own wellbeing. The crisis surrounding adult care in many high-income countries, including England, is a striking illustration.

The Crisis of Care

In England, the recent trends of an ageing population, increasing life expectancy, and a growing proportion of women entering waged labour outside the home have not been matched by an expansion in publicly funded services to meet the care needs of the elderly, sick, and disabled. The consequences are well-documented. For unpaid family members—usually women—the attempt to provide care at the expense of or in addition to paid employment leads to exhaustion and/or material hardship.

Although the majority of care work in England continues to be unpaid, a proportion has moved from the unpaid household sector into paid sectors. Its low social status, however, has not been changed by this shift. Where healthcare has become the domain of a hallowed national institution, providing universal coverage ‘free at the point of need’, social care continues to be provided on a means-tested basis by local authorities, largely using the non-ring-fenced Revenue Support Grant from central government.

For paid care workers, increasing privatisation over the last thirty years has led to a race to the bottom in terms of pay, conditions, and security. Disproportionately represented among them are migrant women, often forced to leave behind their own children or elderly parents, to be looked after by other relatives, driving the formation of a ‘global care chain’. Finally, of course, the recipients of care also suffer: the positive effects of a longer lifespan are increasingly negated by loneliness, social exclusion, and vulnerability to abuse, with major scandals exposing instances of neglect and ill-treatment by some homes and residential care bodies.

The devaluation of reproductive labour also manifests through extractive business models and reductive service models. In residential care, the quest of investors to capitalise on consistent publicly-backed cash flows has led to heavily financialised business models, resulting in ownership churn, financial fragility, and poor pay and conditions. In home care, rather than creating the conditions for positive and fulfilling human relationships, the dominant service model reduces care work to the performance of basic bodily maintenance tasks in 15- or 30-minute slots. Although easy to quantify and cost, this model ignores the wider social interactions and values that give independent life its meaning.

The adult social care sector illustrates the perverse results of the devaluation of reproductive labour, but it is only one among many foundational and overlooked sectors so devalued. Other examples include retail, cleaning, and childcare. Not coincidentally, it is these largely these sectors that have been recognised as ‘essential’ during the Covid-19 era.

While the pandemic and the experience of lockdown has undoubtedly increased public recognition for the vital contribution of care workers, among other groups of key workers, it is unclear how deep or enduring this epiphany will be. The recent announcement of an NHS pay rise of just one percent does not signal a fundamental shift in attitudes. Their contribution is most frequently evoked in the idiom of heroic sacrifice, and high rates of Covid-19 deaths among many key worker occupations suggest that sacrifice is, distressingly, exactly what has taken place.

So what would it take to translate applause into something more concrete?

Back to Earth

In sectors like social care, it is not just a matter of ‘plugging the funding gap’. Pumping more money into the current broken care system would not result in improved pay or conditions without addressing the problems of financialised provision, and the narrow prevailing models of care which are so clearly inadequate in meeting the needs of care receivers.

Nor will a narrow focus on driving up productivity be sufficient. Insofar as foundational sectors like adult social care currently receive any attention in mainstream economic policy, they tend to be approached as ‘low productivity’ sectors, where wage rises are assumed to depend on productivity increases. This neglects the distinctive human dimension of care as a personal service – where increasing productivity would, beyond a certain point, inevitably lead to a deterioration in quality. It is also blind to the fact that ‘low productivity’ in care comes back in the end to the undervaluation of reproductive labour, which is, in a way, self-fulfilling: poor conditions, poor pay, and low training standards can lead to poor quality services, in turn fuelling perceptions of care work as ‘low-skilled’.

A recent report from Common Wealth and the Centre for Local Economic Strategies offers an alternative approach. It sets out a ‘people-centred industrial strategy’ for adult social care in England. Rather than narrowly pursuing productivity gains, it would aim to increase the social value of adult social care for care receivers, care givers, and society at large. It would focus on developing care services which meet the holistic social needs of care-receivers, securing them a full set of capabilities, rather than treating them as maintenance problems. It would ensure as a basic minimum a real Living Wage, as well as dignity, fulfilment, and opportunities for creativity in work for care workers.

The report sets out a range of measures towards transforming the care sector over the next decade. These include a new funding settlement based on progressive taxation, and a full transition to public, co-operative, non-profit, and community forms of provision by 2030. They also include a new national innovation mission directed towards dignity in adult social care, built around a major fund to support diverse new models of provision and local experimentation. Further measures are proposed around regulating financialization, collective bargaining, decarbonisation, properly funded state support for unpaid carers, and promoting the fair gender distribution of paid and unpaid care work.

Such a strategy for transforming care work should be a key pillar of any Green New Deal – just as important as green manufacturing, technology, and infrastructure. Ecofeminist scholars and activists have highlighted the strong links between the exploitation of reproductive labour, the exploitation of natural resources, and the climate crisis, connected by a common experience of being treated as an ‘externality’ in our current economic system.

The tendency of reproductive labour to be less mobile and more locally-embedded than work in tradable sectors means also that women tend to be disproportionately affected both by climate change and by attempts to tackle it through decarbonisation. Just as there is a danger in socially regressive climate policies that unfairly affect poorer sections of a population, there are many decarbonisation measures which could, implemented thoughtlessly, increase the reproductive labour load on women. A just Green New Deal, then, must address the devaluation and unequal distribution of reproductive labour alongside the devaluation of and exploitation of the natural world.

Beyond Superpower

The development of the Covid-19 vaccine in the last twelve months has made clear the importance of innovation, particularly well-funded scientific research, to the country’s wellbeing. But the devastation experienced by workers in the health and care sectors and those they care for—as well as by other ‘key’ staff—proves that frontier-pushing alone won’t save us.

In designing a more just and sustainable future economy, we need to orient investment and innovation policy towards those activities which enable and sustain human flourishing day-to-day – and which give our lives meaning. And it’s not only care receivers and care workers who stand to gain. The ability to care for and enable all to live in dignity is one superpower worth having.