Photo by Benji Aird on Unsplash
Front page of the Daily Mail October 2017:
“Britain is a ‘selfish’ society where families shirk their duty by ‘outsourcing’ the care of their elderly relatives, a Government minister has warned. Phillip Lee, a GP, said families needed to face up to ‘uncomfortable’ truths about the demands of looking after elderly parents or grandparents, rather than expecting the state to care for them. He said society had become too ‘selfish’, with help delivered only by workers who were ‘paid to care’. He said the UK was becoming an ‘atomised’ country that failed its most vulnerable – and it could learn from how the Muslim and Hindu communities look after their elders”.
Why did an anti welfare state, pro austerity, patriarchal national newspaper print this in bold on the front page?
Why has a Government minister put this out? Why has Theresa May allowed this minister to say these things? Why is this the latest plank in the Tory strategy?
One reason is Boris of course. We need to be distracted from ‘clearing away bodies’.
Another is fear. They fear a Labour resurgence.
Another is that they need to continue to gather support for cutting public spending.
Another might be post Brexit concerns that care staff who are EU nationals will not be here in enough numbers.
An atomised society? The Doctor however points to the causes of the ills of society to its victims rather than its perpetrators.
‘A selfish society’. Who is he referring to? The nurses who work overtime for no pay? The firefighters, alongside many other workers, who have had a pay cut over the past 7 years ? Women who give up an income to look after children? The army of retired volunteers who work across a variety of charitable organisations ? The RCN calculated that unpaid overtime by nurses saves the NHS about £360 million per year. How selfish is that. The bastards.
Is he referring to the top 0.01%, many of whom have enjoyed a massive increase in wealth for merely owning stuff, inheritance, luck and engaging in speculation?
Those that enjoy the fruits of finance, rentier and crony capitalism?
No. He means ordinary people dealing with myriad social and economic pressures who no doubt also include the ‘just about managing’. Except, in his eyes they are not managing well enough by adding neglect to the list of sins they daily commit.
If there is selfishness in society it can be found in the unwillingness of many in the capitalist executive (CE) and their friends in the political power elite (PE) to value and pay for caring as labour vital to keeping everything else going. This activity is also known as ‘social reproduction’. Capitalism recognises only two domains: The Public and the Private, in which labour is a commodity to be bought and sold in a market. Strip away the social, political and technological complexity that sits upon ‘cash for labour’, and you are left with this base relationship.
Capitalism does not recognise the other two domains: the household or the commons. In the household, labour is expected to be given as a gift. There is no cash nexus in the household. The commons is merely a resource to be used. Care is a commodity in the public and private sectors, but as a product of labour it merely stands as a proxy for labour and therefore is a cost which reduces capital accumulation. Just as capital tries to reduce wage costs, it has to reduce care costs through wage control. If capital can shift care back into the household where it is a gift, then it magics away a cost. Patriarchy assists in the ideological work required to shift care out of the public sector and back into the household. Religion based patriarchy is a powerful tool in this process, in that you can get women willingly to sacrifice themselves to the family in the name of holiness and love. Under capitalism, thus is sacredness made profane.
The need to reduce cost requires an attack on graduate professional nursing alongside devaluing what nursing is. Graduate nurses are expensive to employ. Ideally, and ideologically, what nurses do should be done for free or for minimum wage because it is ‘merely’ care that does not require a degree, and is something all women can do.
In order to control the public finances the CE and PE are dismantling structures which have supported people in times of disability, illness and unemployment. This is done because they fear capital accumulation will be jeopardised if the national debt is not paid off. This ‘systemic structural selfishness’ thus places the requirement for capital accumulation above the needs of those requiring care. As a result, care is provided in many cases on low wages, terrible conditions and quite often as a gift freely given, a fact exploited by employers in care homes and hospitals. Health and Social care is conceived of as a capital cost rather than as fundamental to individual and social well being.
Underpinning this is the ideology of the patriarchal traditional family, in which the (male) breadwinner supports the (female) carer who looks after children and elderly parent. Social conservatism aligns with the political economy of Austerity. In short, you can cut public spending by getting women back into the home to provide unwaged, unpensionable care work as a gift to themselves, to their family, to society and to the economy. If you can designate nursing and social care as low skilled women’s work, it is easier to push it out of the public sector and back into the household.
The good doctor is a patriarch living in an affluent bubble cut off from the social and economic realities of millions of people’s lives. He projects his own values onto everyone else without considering if people are able to take the opportunity cost of lost wages.
His reference to Muslims and Hindus is interesting. Put aside that this is a sweeping categorisation, how exactly do these families look after their elderly? The picture is changing as some Asian families respond to changing social and economic realities. I don’t know if it is simply about their ‘family’ values, although it is often reported that this is a key aspect of caring for parents at home. However, do those values operate within large families were there are many children to take responsibility among them, and where women stay at home or work part time? If this is the case, is this the lesson we should be learning – have more children, don’t move away, women to leave the labour force? What if women do not want to pay the ‘motherhood penalty’ (could be 10-14% for maternal leave and taking 5 years to catch up) or in the case of parental care, the ‘daughterhood penalty’?
I think the narrative behind this ‘shirker’s’ comment is the current long running story: “There is no magic money tree, Labour crashed the economy, we have to pay off the debt”. When you want to pull the plug on financial support for social care you have to come up with a more forceful moral argument other than ‘there is no money’. The Tories realise that more and more people do not believe them when they say there is no money. They have seen for example an instant ‘bung’ to the DUP. The Tories realise that more and more people know that the banks, not Labour, crashed the economy. They also know that more and more people know that a national economy debt is not the same as a Household debt.
So, arguing for continuing Austerity is electorally more and more looking like a busted flush.
The Tories are getting desperate, they need a new narrative, or more correctly, to reinvent the old one.
The answer is to repeat and fall back on the ‘moral underclass discourse’ which asks you to think about strivers v skivers, welfare cheats, benefit scroungers and now add to that list we have ‘family shirkers’.
It is part of Thatcher’s ‘No such thing as society’ narrative. The pooling of risk through general taxation and then state spending to spread the financial burden across the whole population is ideological anathema to many, but not all, Tories. They prefer that only individuals and families should provide social care, with a minimal (affordable) input from everyone else.
This is not just about money…it is a deeply held ideological belief and moral position about who should care for whom. Of course, how that is paid for cannot be disentangled from this moral position.
Watch out for more stories about how ‘selfish’ children are abandoning parents in ‘sink’ care homes to ram home this ‘moral neglect’ narrative.
This will be done without referring to issues around geographical and social mobility, precarity in employment practices, house prices and affordability, wage stagnation, the cost of education, the disappearance of pensions, restructured families, family size, gender roles, inequalities in health, social inequalities, parental leave issues, employment attitudes and gaps and the level of consumer debt.
Instead, as with benefit cheats, there will be a focus on dysfunctional family relationships, a ’cause’ rather than as also ‘symptom’ of much bigger issues.
Of course families will want to, and do, provide care. Dr Lee knows this. But he is tapping into deeper moral intuitions in order to facilitate the cutting of the social care bill.
Andrew Dilnot in the Lancet lays out a less sensationalist argument:
“First, there is a fairness argument. In universal health-care systems, such as the UK’s National Health Service, the financial burden of health care does not fall on those unlucky enough to need it. Money is raised through a progressive tax system, and used to provide health care free at the point of use. If it is right to act in this way in the case of, for example, someone with cancer, why is it right to expect someone with dementia or acute arthritis, who cannot look after themselves, to bear the financial burden of their own care?”
“Second, there is a market failure argument. In the case of health care, in the absence of universal state provision the alternative is private insurance, which is available in most countries, and is seen at large scale in, for example, the USA. But this alternative is not feasible in the case of social care. The uncertainties surrounding the possible cost of social care provision are so great that private insurers do not and will not make such cover available. Therefore, in the absence of state activity, individuals cannot pool their risk, so that although most of them will not face high and extended costs, they are all left facing that possible worst case scenario. This scenario is terrifying for individuals, and very inefficient. If the private sector cannot pool the risk, the case for the state taking that responsibility, at least in part by providing social insurance, is very strong”.
Well in response, the Doctor argues that individuals and families should bear the burden rather than shirking their responsibilities. The real target is not shirking families, it is of course the ‘cradle to grave’ welfare State.