Structural problems with care

I think for a lot of us the pandemic has revealed the real structural problems in the organisation of care in a lot of economies. In the early days of the pandemic, we had increasing death rates in many economies, but in a lot of them, the death rates in care homes were much higher. That actually even included countries like Norway, which didn't have a very high death rate in general, but still had a high death rate in care homes.

Photo by Gumpanat.

That's because a pandemic is a rare event, though predictable; it would happen sometime. A private sector organisation, however, doesn't prepare for everything on the basis of what would happen to the people within it, but decides what it would do for its bottom line. For a very rare event, you may not prepare properly. As private sector organisations, they were supposed to provide their own protective equipment and prepare for every eventuality, but they didn't – and that was predictable. It's only collectively that societies can prepare for things like a pandemic through the State. The States that had privatised their care systems did not provide or think about providing for those parts of the economy that they had privatised. So, the inadequacies of a highly privatised care system were really revealed by the pandemic. Further than that, it was also shown that we just didn't have enough care, enough health care; there wasn't actually enough invested there. That's part of the economy I would call our social infrastructure, of which care is an important, but not the only, part. It includes our health service, education and so on. Economies that were doing very well in GDP terms may still have had a very inadequate social infrastructure system, and that came out clearly in the pandemic too.

Care in the public sector

I would like to see care as part of the public sector. I think it would improve its quality and ensure that everybody got the care that they needed. In terms of how it’s actually provided, I think it's important, first of all, that it be funded nationally but locally provided. We would not want regional inequalities due to what local authorities could raise financially, but I think the provision would have to be organised locally. I don't see any reason why it cannot involve some of the very good providers of care services that we have today. I think quality on the whole is not good, but there are some real exceptions, and those exceptions are not due to the fact that these are private sector providers, but I would say despite the fact that these are private sector providers, many people care deeply about the quality of care they are providing and have difficulty doing so and making a profit.

Investing in care instead of construction

As a result of the pandemic, there is concern that a lot of economies will take some time to recover. There's been quite a lot of talk about stimulating the economy by new investment, but an investment in infrastructure is what is usually talked about. What in this country is meant by infrastructure is more roads, buildings, train lines and so on. What I would propose as an alternative to that is investing in our social infrastructure, and in particular in our care systems. This is also infrastructure because it underpins how the economy works. It has benefits for everyone, not just the direct users, and it’s an investment, because it's money that we want to spend now in order to have benefits in the future. Better cared for, healthier, better educated people will in themselves have greater well-being, but they will also keep from needless expenditure on them in the future. This is an investment; it’s spending money now in order to have a payback in the future. I would like us to be spending a lot of money, money comparable to the sort of stimulus programs that Biden, for example, is talking about in the US, on our care infrastructure. That would mean investing in training and the workforce, so that we would spend a lot of money on employing far more people to provide care. In the UK, there are a million and a quarter people with care needs that are simply not being met.

Nearly twice as many jobs

Photo by Sirisak_baokaew.

We need more care workers. If we aren't going to have fewer workers somewhere else, let's have more care workers. One of the calculations that a colleague of mine, Jérôme De Henau, and I have done is to show that if you spend money on care rather than on construction – which is the content of most normal economic stimulus programs, some construction project – if you spend the same amount of money on care as you might spend on construction, you produce nearly more than twice as many jobs. This is true even if you pay the care workers properly. When we first did this research, people said, well, all you're talking about is creating lots more badly paid jobs. So we looked at it and modelled it again, but as if you paid the care workers better, paid them well, and then you still got far more jobs created – twice as many jobs created through investing in care as you did for investing in construction. So, when you invest in a sector, you not only create jobs directly in that sector, you also create jobs in the sectors that supply that sector. You also create jobs through the spending of the wages of the workers who you employ directly or indirectly in that sector.

Closing the gender employment gap

Under current gender arrangements, you produce far more jobs for women. The sorts of programs that are being proposed for spending on construction will produce a lot of jobs for men and very few for women. This is because the construction industry is heavily male dominated. Actually, if you spend on care, you will produce more jobs for women, but not quite as many more. It's not quite as biased towards female employment as the construction industry is towards male employment. So, if you spend on care, you'll produce more jobs overall, far more jobs for women than if you spent on construction, but actually still slightly more jobs for men than if you spent on construction. As a stimulus program, there's no question that spending on care is a better stimulus. It's also unlike spending on construction, which will worsen the gender employment gap; spending on care will make it better.

Why is construction prioritised?

I think there are two reasons why the construction sector continues to be prioritised rather than the care sector. One is just traditional thinking, that these are seen as real jobs. Going out and building a bridge is a real job. Going and looking after an old person is seen as something really that women should be doing for nothing anyway – it's not a real job. And we have to change that. That's a really important part of any program, to change that by providing good training and making it a well-paid job, too, so that it's seen as a job that both men and women would be proud to undertake. Interestingly, a lot of people who work in care really like it. They put up with the poor wages, even if they could get better jobs in many cases, because they like it. Obviously like any job, it doesn't suit everybody, but it is a valued job by many of the people who do it. It's not properly valued by society.

I think the other reason is a fear that they're going to have to continue to make this spending. If you build a bridge, it's seen as a one-off; when we spend a lot of money and we've made that investment, we get the payoff in the future. We don't need to do that investment again.

In practice, of course, it doesn't work like that. Once you build one bridge, you build another bridge somewhere. However, it's quite clear with care spending that although it's an investment, it is recurrent spending. We'd have to keep doing it. In one sense, that's a good thing, because this won't be a one-off stimulus that comes to an end. It will continue, but it's more of a commitment – a commitment to a different type of economy, one in which a large proportion of the population is employed in care.

Worth the cost

Photo by PhotographyByMK.

One of the calculations we looked at was: what happens if we matched the Scandinavian levels of spending in the UK and in various other countries? How much would it cost? Now, obviously, it costs different amounts in different economies in the UK because we are not particularly good spenders, in particular because our wages are so low. Because we also looked at improving the wages, it would cost a fair amount. Nevertheless, for spending that amount, we would get far more jobs out of it and a better effect on the gender employment gap than spending the same money on construction.

We should all care about care because, first of all, we do care about care. In practice, it is what makes up the quality of lives, whether we ourselves or the people that we care about are well looked after. Secondly, we need to care about care because the economy is built upon it. The economy is built upon our care system: if we don't have a functioning care system, we don't have a functioning economy.

Discover more about

the case for care

Himmelweit, S. (Ed.). (2000). Inside the Household: From Labour to Care. Palgrave Macmillan.

De Henau, J., & Himmelweit, S. (2020). A Care-Led Recovery from Coronavirus. Women's Budget Group(1),459–469.

De Henau, J., & Himmelweit, S. (2021). A Care-Led Recovery From Covid-19: Investing in High-Quality Care to Stimulate And Rebalance The Economy. Feminist Economics, 27(1),459–469.

Brennan, D., Cass, B., Himmelweit, S., & Szebehely, M. (2012). The marketisation of care: Rationales and consequences in Nordic and liberal care regimes. Journal of European Social Policy, 22(4), 377–391.

Why investing in care is crucial