Committing a benevolent insult?

In the case of care, two needs are assumed in progressive political spaces: the need of the person receiving care to be supported, and the consequent structural need of society to have a state-provided socialised service which meets that first need. This is the logic underpinning calls for a universal care service kindred to the NHS and the general sense that, if the ‘burden’ of care is falling on unpaid family and friends, it's due to the under-resourcing of state provision. Those 6 million unpaid carers are labelled as either a vestige of past and archaic arrangements that need to be removed, or a worrisome harbinger of things to come, in which social spending dips even further. Under this ‘need interpretation’, care is construed as impinging on the natural order of our capitalist lives – taking us away from productive activities – that is, wage labour – and preventing women from pursuing freedom, located in the notion of the career.

Second, many care receivers do not accept support from people outside of their family unit. One study that sought to understand caring relationships between neighbours and frail older people asked why and how the former were stepping in to support the latter.8 It found that, in some instances, it was because the older people had refused offers of government services, even lying to avoid being deemed needy. Others had simply refused support or cancelled it once it was in place. When we forget that people with care needs are people, and therefore have preferences and claims to self-determination, we fail to design a system that is truly human.

These four factors add up to one truth, which is absent from current policy prescriptions and how we understand our need for care: however good our services become, it won't change whether most of those 6 million people are carers. Instead of ignoring carers, or treating them as an unfortunate afterthought, we must take a systemic approach that addresses the now-revealed need – the right to provide care to our loved ones in ways which don't undermine our mental, physical, social and financial health.

We can see this in the example of the Older Women's Co-Housing (OWCH) project in north London. Twenty-five women aged 50 and over live ‘together but alone’ in a smartly designed complex of private apartments and shared spaces. While they must have care arrangements in place for intensive care needs, there is also a lot of interpersonal care taking place, as within a family. They have health buddies and, when needed, have created rotas to provide support.13 Importantly, there are 25 of them, a far broader base for care than provided by the nuclear family. Theirs is the kind of collective care we need but which sits uneasily with current policies. We lack a way to articulate this kind of arrangement: for example, if the OWCH residents were completing a census, they would tick the box for living alone because they have private apartments. But they don't; there are 24 other people involved in their daily life, a mesh of support ready to catch them. OWCH is a great success story and part of a growing movement towards co-housing across the world, including in Denmark, the Netherlands and the US. But this success hides an uncomfortable fact: it took decades to bring OWCH into being due to financial and regulatory obstacles. Other co-housing communities in the UK have faced barriers too.14 Planning permission, building regulation, property prices, financing models and real-estate practices all have a role to play here. Just as with working time and income, we need government to provide the physical infrastructure, space and support for care to occur.

If we had stuck with our original and flawed ‘need interpretation’ of care, we would have obscured these systemic and imaginative roles for government. In attempting to end the extreme suffering of unpaid carers, we would have committed a benevolent insult, ignoring the reality of care in favour of theoretically attractive, but practically ungrounded, solutions. The future of care is not one in which it occurs solely as waged work, which excludes both love and lived experience. It is one in which care is embedded into the rhythms, rights and structures of our everyday lives.