Unpaid Care in the Social Care System: Recalibration or reconceptualization?
In a discussion on unpaid care in the social care system, Professor Liz Lloyd, Honorary Research Fellow at the University of Bristol, pointed out the significant history in the UK of both mobilization by carers and policy development over the last thirty years or so. She spoke of the achievements by carers’ organizations in securing a place for care in the policy process. However, the actions taken have left those who need care and those who provide it in a generally poor position. That is, while there is greater public and policy recognition of the work done by carers, the demands for recognition and better support for unpaid care have not been significantly heeded. In the speaker’s words “the promise of game-changing policies has not been realized”, and even COVID-19 did not really change that. Yes, there have been some improvements in the rights and entitlements of unpaid carers but these have not produced material benefits or strong rights for carers.
Yet at the same time, the balance of responsibility for providing care has tilted towards unpaid care. Professor Lloyd pointed out, for example, that it is unpaid care that has made care in the community a possibility, and that the work of unpaid carers also makes a major contribution by helping to solve the problems of meeting increasing demand for care in a context of spending cuts and austerity. But this comes at a cost for unpaid carers. The current situation of greater turbulence in social care provision and less secure funding is placing extreme pressure on unpaid carers.
In Liz Lloyd’s view no single set of actions will be sufficient. One thing that would be good to see, though, is a shift in the balance between service provision and unpaid care so that, for example, the unpaid carer role could be a choice, or more of a choice than it currently is for many people. This would also mean that people are given a choice of types of services, and more flexibility in making use of services. In this changed scenario, family relationships would be more likely to flourish free of pressures associated with heavy care responsibilities but there would still be room for input from families.
The discussion recognized that recalibrating (or reforming) the existing system might be insufficient. A point very much emphasized by the speaker was that we must rethink the entire ‘system of care’. Of course, very complex issues are involved. One is how we understand care. If we conceive of it in a broad and connected way (moving beyond existing meanings of social care for example which highlights service organization), there are actually no boundaries or limits to it – we all need and give care throughout our lives and there is much more to care than the giving of physical care in situations of pressing health need. We must also recognize that cultural values are involved and that struggles over these values shape the experience of care and how it is organized. Among such values are an abhorrence of dependency and a characterization of people with care needs as burdensome. Care is often seen as being about managing dependent people rather than enabling people to be independent or recognizing us all as interdependent. There also exist very idealized perceptions of unpaid care and carers – think of the notion of the ‘heroic carer’. While such idealizations might make us feel ‘warm’, they can also justify the situation remaining as it is. We should have well-resourced carers rather than hero or heroine carers. There are also many people who are hidden as carers. In this context, we should consider the question of whether carers themselves should be more explicit about and visible in their role as carers. Some people want to deny it: “I am not his carer, I am his wife”. One benefit that would come from people more publicly acknowledging their role as carers is that it helps to show what carers actually do and how many people are involved.
Rethinking care also brings in the matter of justice and the question of what is a fair balance between paid care and unpaid care. This is a very difficult balance to achieve. Trying to address it takes us deep into the current arrangements, raising issues such as who gets eligibility for services and who decides on this, how needs are perceived and recognized (and especially those of care givers and people receiving care) and also which carers are recognized. In fact, the current arrangements, including the drives to cut public spending, mean that we have a situation whereby services can exacerbate rather than relieve needs. On a somewhat similar point, a member of the audience observed that the recent changes increasing the pension age for women will have deep implications for care and people’s capacity to give care on an unpaid basis, particularly women who dominate the population of carers. There is a important point to be made about connecting policies and activities in one sphere with those in another.
Inequalities in power within care relationships create an urgent need for principles of fairness to inform policies and practices. It is not just a question of focusing on fairness to individuals but also of justice in the context of the relationships between the people involved. Care is always embedded in some kind of connection or relationship, which means that fairness has to be worked out in the context of relationships between at least two people.
We should also consider professional practice and ask whether professionals pay sufficient attention to unpaid carers. According to Professor Lloyd, the evidence suggests that they do not. What should prevail is support for care relationships and openness to the perspectives of all parties. The discussion questioned the feasibility of this, the point being made that budget cuts and pressures on services may heighten or deepen a sense of opposition between carers and the system.
The possibility of greater solidarity between carers and other groups who are actively mobilizing for change was also raised. It was observed that there is a tendency for carers’ groups to mobilize alone and that this may be less effective than mobilizing together with other groups or sectors of the population.
Liz Lloyd’s latest book is Unpaid Care Policies in the UK: Rights, resources and relationships
Professor Mary Daly, Green Templeton College Governing Body Fellow
