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This month, the Health Foundation’s Chief Executive, Dr Jennifer Dixon, got together with Madeleine Bunting, author of Labours of love: The crisis of care and Professor Dame Anne Marie Rafferty, Professor of Nursing Policy at King’s College London, and President of the Royal College of Nursing (RCN). Together they debated and explored the meaning and future of care for our latest podcast. Here are four big questions and selected highlights that emerged from their discussions.  

Did clapping for carers change our attitudes to care?

Jennifer: We all need care at some point in our lives and yet care is so often undervalued. A striking moment in the pandemic was people standing on their streets clapping for carers. Will that show of solidarity be the start of real change? 

Madeleine: Never in my wildest imaginings did I think that the nation would stand on its doorstep to clap for carers. In those first tumultuous few weeks of the pandemic, there was the most astonishing inversion of our understanding of the value of labour, of work. I hope we can find the political will to follow through on that. 

Anne Marie: It would be wonderful to think about the clap for carers as having that continuity, but I get the impression that the initial outpouring of emotion has not really been maintained. The challenge here is how to build a sustained form of political pressure. 

What do we really mean by care? 

Jennifer: It’s a small word but it has multiple meanings. Do we have a shared understanding of what we mean by care? 

Madeleine: When you unpack the word ‘care’ and the ways we use it, it is multi-faceted. We all share one characteristic: our vulnerability at different points in the life course when we need care. I spent five years researching what we mean by care. There were three consistent characteristics: presence, attention and touch. 

Anne Marie: For nursing it’s not just a question of some of those characteristics, there’s a science underpinning the care. There’s a ‘virtue script’ within which nursing was born but has since tried to reject... because we don’t just want to be seen as sentimental creatures, empty vessels into which emotion is poured in the caring process. 

How have we viewed care over time? 

Jennifer: It’s interesting to consider how our attitude to care has changed over time, the connection with women’s history, and what impact the history of care has now. 

Madeleine: One of the things I tackle in my book is the persistence of various forms of mythology that are now really problematic. From the 18th century onwards, the great traditions of western philosophy and economics completely ignored the labour of care and this essential process by which human life is sustained. Care has been taken for granted and along with that came the idea that it was women’s work. It was feminised and therefore dismissed. 

We then get the incredible trap that nursing has been in, that nurses are saints and angels and they do it out of the goodness of their heart and they don’t really need to be paid properly. Every part of the care labour force is desperately underpaid.  

Anne Marie: When my Mum did nursing, the career choice was to go into nursing or work in a factory or a shop. I think we are in danger of over-sentimentalising motivation – sometimes it’s very pragmatic. Back then, in the 1930s, the environment of care was one of regimen and routine – it was a hard emotional environment. 

As a relatively rich society, how much do we value care and how much are we prepared to pay for it? 

Madeleine: We are going to emerge from this pandemic with a shattered economy. The battle for state resources will be really fierce. The paradox about the pandemic is that it’s made us aware of the value of care, but actually it’s going to leave us with fewer resources to really invest in the kinds of care we’re going to need. 

That’s why I find this particular historical moment so incredibly painful. As an ageing population, the demand and need for care is increasing significantly. We all know this. But we seem to be peculiarly incapable at a collective level, to meet that challenge. 

Anne Marie: What do we do when we are debt-ridden and we have a shattered economy? What about a Keynesian care economy? What about actually using our health needs for growth in the economy through jobs?  

The RCN has just done a piece of work on the pay deal. We’re asking for 12.5%; that seems like a big jump, but it’s actually not in the context of having lost something similar to that over the last ten years. When you look at what pay rises do, in terms of re-investment back into the economy, creating jobs, consumer spending, it comes out at a fraction of 12.5%. We have got to invest in the care sector as never before.  

Listen to the full podcast  


This content originally featured in our email newsletter, which explores perspectives and expert opinion on a different health or health care topic each month.

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