Labours of Love

The Mint: Good afternoon, Madeleine welcome. Thanks very much for giving us some of your time.

Madeleine Bunting: Thank you. Great pleasure to be here.

The Mint: Brilliant. Well, I’d like to just start, with looking at how your analysis of the care sector r elates to a feminist perspective and the valuing of care, which is obviously traditionally seen as a female occupation.

Madeleine Bunting: I think a big thread of the whole book that I’ve written about care, is its curious characteristic whereby it’s either invisible or taken for granted. And, I looked at care in a whole number of different contexts, whether that was paid in various types of jobs, or it was unpaid care in terms of intimate domestic relationships. What I was trying to find was the sort of commonalities between those very, very different forms of care, particularly from an economist point of view, one is paid and one is unpaid, but actually the kind of substance of what they entail, has an enormous amount in common.

And one of the profound challenges to our society, I think is that care has an invisibility to it.

And one of the profound challenges to our society, I think is that care has an invisibility to it. That’s one of my key arguments so that in whatever context you look at care, it has been curiously marginalized, neglected, or sort of basic lack of curiosity as to what exactly it is. So we’re very, very curiously ignorant about care.

What we mean by it, even though there’s plenty of rhetoric about crises and plenty of rhetoric about the importance of care, but you really probe people as to what exactly is care. And there’s a tremendous kind of confusion and uncertainty. Now that invisibility has a long, long history. And I think that’s where it goes back right into, you know, hundreds of years, centuries in which there was, a very sharp distinction drawn between the  activities of a marketplace, and a public realm and the activities of the private domestic realm.

One got described, in great detail. and the other was relegated as a matter of private preference really. so the ways in which care was provided, within the home and within the family was regarded as women’s work and therefore of very, very little interest and regarded as very low skill.

I mean, that’s one of the other characteristics of what I’m describing that in visibility that ignorance, that lack of curiosity means that people can very, very quickly assume that care is, is not a particularly skilled activity. It doesn’t require much intelligence and therefore it doesn’t deserve any better pay.

you know, they’re kind of chronic problems of low pay within many forms of care work, I think has a legacy of that history of, of this is women’s work. And this is, something that is, you know, not very difficult and it just requires virtue. I mean, that that’s really how Christian Western industrial history has constructed care.

That is a matter of virtue. And that is a matter of, female self-effacement and self-sacrifice.

The Mint:  I was really interested this idea of invisibility, because you could say on the face of it that all of us obviously, well, when I say all of us, all the people who are lucky enough to be cared for as a child and obviously some people aren’t, but a lot of people are. So a lot of people have a very strong experience of care. So how does that relate to it being invisible?

Madeleine Bunting: Well, that’s a very, very good point. I mean, I thought you were going to get into the sort of gender, and the gendering of care because so many of our early experiences, are of mothers particularly.

So let’s, let’s park that and come back to the point that you make, which is, which is that I think that the can be really. You know, one of the kind of driving points of the book is to say that this is a profoundly important experience and that we have an innate capacity actually to provide care.

Why is it that men having received just as much of this embodied form of care as women then tend to leave that behind them?

I’m sort of trying to remind people of something that gets overlooked. And I think that our early experiences of maternal and it does tend to be predominantly maternal care. What a psychoanalyst I quote says, you know, this is the sort of warp  of our personalities or the weft, you know, it’s, it’s what we build our personalities on, but it becomes so deeply integrated into our sense of being in the world that actually to, to make that explicit, to bring it to the surface and recognize it is, is actually quite a sort of complicated psychological task. I mean, if you think of how many women tend to replicate the care that they’ve received as children, that’s a very natural process. How you have been cared as a child, you then replicate as a mother yourself. And that’s very much, you know, one of the comments I made in my book, which is that I cared for my children and the way that I remembered being cared for.

But there’s a very interesting distinction for men because they are mothered. And then it’s, it’s, you know, what happens to all that experience of care, because it’s not something they assume that they then have to replicate in the way their mother provided them with it. And I’m fascinated by that disjuncture.

Why is it that men having received just as much of this embodied form of care as women then tend to leave that behind them? and not actually replicate that in their lives. They may, they may become very good fathers, but it’s often it’s, it’s rarely, although increasingly less rare, but it’s rare for men to do that hands-on care day-to-day of a small infant  that of course they will have in their backgrounds,

The Mint: But they might not all it wasn’t it. And of course the elite in the UK  quite often have spent their formative years in boarding school. And even before they went to mainly boarding sail eight to seven, their mothers may have been preparing themselves to actually let go, of, of the caring role.  And is there’s quite often a contrast drawn between, say the example of the Danish students and what is happening in the UK? Do you think the UK is in a worst situation because a lot of our, cabinet ministers, a lot of people are powerful actually did not really experience that sort of care.

Madeleine Bunting: Well, now that’s an  interesting question. I mean, I’m tempted to say that that elite experience is of such a minority that I didn’t regard it as significant enough to dwell on in the book. Having said that you’ve got a point, which is that that elite is disproportionately powerful. So could that have had an impact on our understanding of care?

experience of being cared for by someone who is not your blood relative, your, your mother or father is actually, it was a very, very common experience.  It wasn’t just the elite.

Another point, which is relevant is that I do think that the care provided historically by servants needs to be given much greater acknowledgement. And, I come back again and again, and in my first few chapters, thinking about the history of care and thinking about the role of servants. Now, that was not actually  as an elite experiences as we might think. Up until the 1930s, it was quite standard for most families to have enough resources, to get some form of help with looking after small children. So even if you are, you know, quite modest circumstances, mothers did not do all of the care on their own because certain labor was relatively cheap. So actually care has always been distributed, even within domestic contexts between paid and unpaid work.

So, but to get back. So, you know, there’s a lot of relevant factors here that experience of being cared for by someone who is not your blood relative, your, your mother or father is actually, it was a very, very common experience.  It wasn’t just the elite.

 To go back to your interesting additional challenge and question around boarding schools, which is such a sort of specifically English, experience, you know, it’s not. True. I think of, I think it’d be hard put, ready to find any other country around the world.

The Mint: You look at the Americans and say, they’re mad about guns. I think you could say the English are mad about boarding schools.

Madeleine Bunting: Yeah, good point. Good point. And I don’t know about you, but I went to one for six years. So, you know, this is a bit of personal experience as well,.

The Mint: I did 11 years from aged 7. And so actually I do remember the point when I was taken to school and my mother came with me and the master who welcomed us, made a point of instructing my mother to hand my case to me. So then I have to carry my case up to the room. And I still remember that because it was like a symbolic sort of your mother no longer cares for you. And then they specifically had a rule that parents could not visit for a couple of months. So that to give you times to make sure that you’re indoctrinated and realized there was no help. There was no parental support.

Madeleine Bunting: Really two months?

The Mint: Two months. So at aged seven you had two months when you learned you’re alone.

Madeleine Bunting: Wow. I mean, you know, we’d described that as child abuse don’t we, I was, at least I was 10 and I was able to go back home every three weeks, but I would still describe it as I’m sure you would, as a very, very painful experience. And I was adamant that I didn’t want my children to have that. I’ve read very interesting analysis of boarding schools and the impact in England about how they were specifically designed to break family attachment, create peer attachment, to ensure elite reproduction that the elite would, look to, to their fellow members of the elite to ensure their collective survival as an elite, and particularly in the context of empire, when it required a high degree of mobility from that elite. They have to be prepared to go off to India or Africa.

What that does in terms of care. Well, Well, I think there’s several factors. Ultimately, I would say that patriarchy is a more significant factor in the, in the kind of the invisibility of care  and that is actually more important than boarding schools. On the other hand, clearly boarding schools were designed to reinforce a certain model of masculinity  and so these, these factors all play in  a very intricate and interesting way.

One of the interviews in the book. quite early in the book is from a friend of mine who went to boarding school from a very young age. and he chose after he had left Cambridge, he chose, work as a carer. And so in a way to go to your initial question, I found an interviewee who was probably had, had, the least experience, of having to provide care.

He said, he had in every context with his prep school, his education at Eton, and then at Cambridge, he had had lots of low paid women employed in one context or another to look after him. And when he reached the age of 21, he wanted to turn that round and offer care. I was fascinated by a whole number of things that he was sort of turning upside down in, in that decision.

no matter what your background, in terms of your masculinity or your femininity or your, all your kind of elite life experience, there is an opportunity for you to learn how to care. This is not just something someone else does. You can do it.

So high class elite you know, very high status choosing to provide care in a very deprived area of London, and doing that work to support his work as an artist and as an environmental activist. and it was a very, very moving interview because what he said is that he was of course he was turning the gender issues upside down as well, because as a, as a young man, he was not expected to become a carer. Whereas young woman is not nearly so kind of unusual. and you know, his kind of the revalatory process that then was for him, and how it profoundly changed his worldview, and brought a great, great  experience to him of his own human condition  and that of these people who he was caring for whose lives had been so dramatically different from his own.

So in a way, by putting that interview right up at the front of the book, I’m was implicitly  challenging  everybody. I was saying, you know, no matter what your background, in terms of your masculinity or your femininity or your, all your kind of elite life experience, there is an opportunity for you to learn how to care. This is not just something someone else does. You can do it.

The Mint: There is hope but interestingly you also say that liberal feminism was partly a movement for women to get away from that caring role. Is that right? To leave it behind and   to enter a sort of standard male world.

Madeleine Bunting:  Well, absolutely. And I think this is a, this is, you know, feminism has many, many strands to it. And I think what happened in the 1980s was one particular strand of feminism, which I characterize as liberal feminism, became dominant and  another strand of feminism, which was much more anchored down  in the experience of how you provide care typically for children, but also inevitably for parents, elderly parents, and so forth. and that, that strand, which I think had been evident in the seventies where they. feminists were discussing, you know, alternative ways to raise families look after children set up nursery groups together which was much more of a kind of collective approach. And I think that sort of lost ground in the eighties and an American form of feminism emerged. And in the book, one of the things I was doing is, you know, as somebody who became an adult in the eighties, I was very, very influenced by that kind of liberal feminism.

I think what’s sort of difficult to really get the balance, right. Instead in some respects that liberal feminism was incredibly sort of exhilarating to women of my generation who felt that for the first time there were opportunities that they could, they could see and, ambitions that they could set their sights on.

there was a very kind of defiant kind of bravery to the liberal feminism of the 1980s, which was, you know: Put on your shoulder pads and  go for it, you know, and it was quite sort of fighting to the top.

So the liberal feminism, I’m not going to, you know, do it do it down. I think it had some great strengths to it, but I don’t think it was ever a sufficiently kind of wide, a kind of wide enough perspective. I think it, it, it let certain things drop off the edges as it were, or, or lose focus and  that was really, you know, the story of what women of my generation, then struggled with because we got. Into being young mothers in the nineties and it was like, Oh God, help nobody explained this bit of it. You supposed to have children, you know, compete in the office with your male colleagues, and insist that, you know, you don’t need any special treatment.

You know, there was a very kind of defiant kind of bravery to the liberal feminism of the 1980s, which was, you know: Put on your shoulder pads and  go for it, you know, and it was quite sort of fighting to the top. And, you know, when you got to, when you had the baby, you were, you were kind of in a kind of one legged race, because you were kind of constantly trying to look after everything at home.

So, I think that balance between work and care got substantially easier in the sort of two thousands, as people began to recognize greater maternity leave, I mean, there’s more maternity leave now considerably more than when I had kids, there’s more than this the principle of paternity leave is established.

It was much more a willingness for fathers to recognize that they have a major role to play. We still have a kind of fundamental problem, which is, you know, that the conflict between work and care, it’s all, there’s always a tension there. And how that tension is eased is, is all about good quality childcare. And we have not yet resolved that. Then that is one of the issues in the book, which is that, you are going to create these awful care work conflicts for people who can’t afford good quality childcare, whose hours don’t fit in with, with childcare. And that leads to all sorts of desperate strain and stress on families  unless you provide prepared to get a decent childcare system up and running, which in this country we’ve not been prepared to do. You know, we simply haven’t invested in, in the way that most European countries have.  The pay of childcare workers is, is just horrific. I mean, the worst sector, quote unquote by far says the low pay commission.

Childcare managers can earn more money on a checkout till, which is insane. You know, they’re responsible for sometimes 10 or 11 three-year-olds and two members of staff. And they’ve got to somehow keep everybody learning flourishing, safe.

The Mint: That seems a good opportunity to move on to that sort of general question of how we actually deliver social care in the public service often with voluntary activities as well. And, obviously you’ve talked about a lack of funding and a lacking lack of a willingness to invest, but you also talk about the bureaucratization and the marketization of care. Which has been worse. I would say both than that. I mean, are they linked, how do you see that?

Madeleine Bunting: Hard to know which has been worse. I think both have been very, very damaging to care. The thing about care is that several thing, really: One is that it’s full of risk. Care is inherent because it’s dealing with vulnerability, whether  you’re sick and you’re lying on a hospital bed with a broken leg or it’s because you’re a three-year-old child or because you’re an eighty year old, you know, it’s always dealing with human vulnerability of one form or another  and, with that risk comes, you know, tremendous amount of fear and anxiety and what we’ve seen over the last 20 years, 25 years of some shocking scandals where that relationship of trust, which is essential to care has been so, so badly damaged. And that’s true of Harold Shipman, the doctor who killed, we believe hundreds of patients, it’s true in the mid staffs hospital, a scandal when the ill treatment, of hospital staff led to the death, premature deaths of dozens and dozens of patients. So there was a really key question, which is how do we ensure quality care? And the, I think, you know, the answer that we’ve come up with is disastrous. It’s complete, you know, it’s counterproductive, which is enormous kind of system of regulation and inspection and audit.

it’s an illusion that care is cheap.

That is enormously time-consuming quite apart from anything else. You know, a nurse on a ward ends up spending enormous amount of time filling out forms or, or looking at a computer screen. the alternative is that what research has shown and again, you know, lots and lots of research is that if you have really good teamwork, teamwork, I think is essential to quality care.

And if you have good teamwork, so that individuals feel really supported by good quality management and leadership. Then that’s how you, you, you ensure, and, and you avoid overload, you know, work burnout is the fastest way to the abusive care. So care is never cheap. Okay. I don’t think we should ever, you know, it’s an illusion that care is cheap.

It’s actually often extremely expensive. Anyone who’s tried to look after. an elderly person is terminally ill, you know, suddenly realizes, Oh my God, I had no idea. You know, care is an expensive business, but as a rich society, my argument would be all what’s more important to human wellbeing than actually ensuring that we use our wealth, to ensure good quality care.

there are two areas of human endeavor where it’s dangerous to over-emphasize efficiency. One is war and one is care.

S, the kind of audit, and this kind of quest for efficiency, I think that’s one of the other problems that’s really led to a, sort of an attempt to standardize and routinize  care. Efficiency, and productivity. These are the measures we’ve used and used in the last sort of 40, 50 years to drive up productivity and increase wealth. And that works in a commercial context. I mean, this is, you know, key principles of economics. I think the point is if you map efficiency onto care, you come unstuck. And there was one very clever quote. I came across once where some very insightful person said, you know, there are two areas of human endeavor where it’s dangerous to over-emphasize efficiency. One is war and one is care.

The Mint: I hadn’t heard that, but I would argue actually that this problem of centralized bureaucracy is actually quite widespread, the undermining of professionalism. Talk to the teachers and talk to other health works. I used to work in the environment agency and one of the big problems is a very centralized approach to measuring outcomes, very sort of narrow measures that distort, behavior and so on and, and a lack of trust and treating people at the front end as if they have to be controlled. and actually the first woman who won a Nobel prize in economics, so called, Elenor Ostrom, one of her key things that she said is that we shouldn’t be in the center trying to get people through what we want them to do. We should be designing institutions within which people do the right thing.

And obviously professions are exactly those institutions. So isn’t this much bigger than then just care this problem.

Madeleine Bunting: Yes. I mean, I was writing about a book about care. So that’s my focus. And of course care has been affected by all sorts of trends going on in society at large. So I think that’s how I would say completely agree with you, but just sort of turn it around a bit.

I wanted to bring this sort of focus onto care, and of course it’s been affected by other wider societal trends and one of the which okay. Is the issue that you raise, which is this loss of autonomy in many professional professions. and that this lack of trust, I would just add to your point. you know, I completely agree with you, around the, the relevance of this issue.

Now, how are you going to build the confidence of a care worker to make those kinds of decisions in that kind of crisis moment, unless they’ve been given a degree of autonomy and respect up to that point?

I would add though, it’s not just professions that loss of autonomy for many care workers, I think is a major, major problem. So. If you are a domiciliary care worker, which means you go into somebody’s home for half an hour, or if you’re really unlucky 15 minutes to make sure they’ve got up and taking their medication while you know, your phone is bleeping away. if you overstay by by five minutes, I mean the degree of monitoring and supervision that is possible on all forms of work. Now we know. And, I think that, the problem about care is it is fundamentally about autonomy. And this is the same of, of other professions that. You need the care worker to, to be, to have that sense of power in their own agency to be effective care worker who arrives in a, in an elderly person’s home, discovers the elderly person on the floor with, a terrible mess, deeply distressed. Now that care worker has got to be capable of making a lot of decisions. Very fast. I need to phone the ambulance. I need to clean this elderly lady. I need to comfort her. I need to tell my boss I can’t make it to my next call. Okay. There’s a sequence of several different things all at the same time.

Now, how are you going to build the confidence of a care worker to make those kinds of decisions in that kind of crisis moment, unless they’ve been given a degree of autonomy and respect up to that point?

The Mint:  How do you get out of the catch 22, because it seems the more you put pressure and control, the more likely people are to make mistakes and do the wrong thing. But then of course their action. We have to control them even more to make sure that they don’t do it when the problem is actually in the control that the tendency towards control in the first place.

Madeleine Bunting: Yes. I mean, absolutely. There’s a fundamental sort of dilemma there, in human relationship, really, which is that trust is essential.

you know, we, we, we can’t run all sorts of services or activities without trust. So that trust in the individual care worker is essential. So we need to think about, about how do we. You know, because because degrees of control have emerged from a history of abuse and risk. So how do we work out how to reduce the risk and abuse rather than increase the control, which we don’t actually think leads to a decline in the abuse. So, so, you know, there were really complicated issues here. it seems to me, but we’ve taken probably the worst possibl route

The Mint: it’s a good old, British way. Seeking to sort of take us to a more positive place before we end. I wondered where you saw sources of hope. I know you said maybe COVID 19, maybe we reset and values to some extent, but in terms of sort of practical models, I wonder what you thought of the Froome model, for instance, in terms of creating more caring, societies as such,

Madeleine Bunting:  well, I like the free model very much because that like other projects that I’ve come across, take a sort of community wide approach to care rather than an individual. And I think in the end, that is exactly the right way to go. So, a project that I mentioned in the book called compassionate neighbors is about the idea that you build communities. of compassion and care. And that is that that particular project was about palliative care. So, you know, volunteers, and, and, you know, I saw this when I, I worked as a volunteer. There were hundreds of volunteers supporting a local hospice to provide the friending and going into people’s homes. so I, I think that, those kinds of community projects are actually terrific, but I think it goes beyond that kind of voluntary effort.

So I think actually there is a kind of huge possibility for innovation and new ideas. And the, the really sort of sticking point is when will the people who hold the purse strings, have the confidence really start putting money behind some of those experiments.

I think there needs to be a bit of a redesign. You know, there needs to be redesigned services. the welfare space state spends huge amounts of money on care. I mean, billions on care. So that is where we really need redesign. And I’m very interested in the work of Hilary Cottam whose book radical help,  I think is, is sort of the part of the kind of pioneering thinking about, well, if we’re going to spend hundreds of thousands of pounds on intervening with problem families, how can we make sure that that actually it works. and, another initiative that I really really find fascinating is shared lives, where. social care is being arranged in a completely different way where they match individual volunteers, some of whom say, you know, it turns into a fostering type relationship and somebody with, with, various needs and as in a required social care, moves in with, with the volunteer. Other occasions, it’s  about a visiting relationship.

So I think actually there is a kind of huge possibility for innovation and new ideas. And the, the really sort of sticking point is when will the people who hold the purse strings, have the confidence really start putting money behind some of those experiments. So the shared lives, one has been very successful.

It’s now 14,000 people. being cared for through that model and Manchester, has said, you know, it’s gonna move all of its social care into that model. So those are kind of bright points where we’re seeing changes scale rather than small piecemeal inspiring projects. But I would say that the real kind of hope lies actually in an even bigger sort of macro kind of framework, which is, and I looked at, you know, the chief economist of the bank of England.

Yeah. So he gave a speech at Oxford university in 2018 where he said the future of care will be enormous because with automation, it’s going to be a major source of employment and we need to really radically rethink how that workforce, is respected, valued, paid the career structures. If we began to see that as a really creative part, rather than a burden on the economy. What’s a very, very good way of spending your time because that’s going to be the challenge with automation is, you know, what are we going to be doing?

The Mint: it has to be fundamentally upward. More and more men might have to do it as well, even.

Madeleine Bunting: Even, and, you know, that’s one of the kind of key points of my book is that I deliberately found and looked for men who could talk, you know, with, with great eloquence about the experience of care, about providing it, and how they understood it.

So there’s nothing inherent about men and masculinity, which means they can’t provide care.

The central part of that job and they may have been GPs. So that was a big professional vocational calling, or it may have been, people was one care worker, social care worker who went into elderly people’s homes and he’d been a painter decorator all his life. and he said, you know, to my amazement, I discovered that I absolutely love this work.

So I think there’s a real challenge that, models of masculinity, and, and, you know, there’s nothing actually, if you look in the past of the history of care, you know, men have always provided care for each other on the battlefield, and in the great sort of monastic institutions, which are the origins of hospitals, they provided care there as well.

So there’s nothing inherent about men and masculinity, which means they can’t provide care. It’s just that we’ve been through several hundred years in which, you know, care has been denigrated because it’s not. economically productive in the sense that the 18th century economists defined and, it’s, I think it’s, it’s that way in which care was put outside the industrial economy and therefore not regarded as significant, you know, the old argument about GDP, which is that if you have an affair with your housekeeper still contributing to GDP, the minute you marry her, her labors are irrelevant to GDP.

You know, there’s a nonsense and lots of economists have been working out the value of care to, the global economy and the figures get bigger. Every time I look, you know, this sort of endless kind of rows of naughts. but you know, that’s a, that’s a crucial corrective, and you know, any government minister knows the NHS and the social care system in this country, which are teetering on collapse would completely collapse if all the unpaid pairers withdrew their care tomorrow, you know, the whole system implodes. because basically they are saving the NHS and the social care system. Billions. so that kind of recognition of the value of, of unpaid, care work is, is, you know, absolutely vital.

The Mint: Well, I really hope that ministers read your book when they come to think, when they have a moment to think about this, of how to address the fundamental inadequacies, the social care system in once where through the current crisis. So thank you very much, Madeleine.

Madeleine Bunting: Okay. Thanks a lot. Bye-bye.

 

Madeleine Bunting

Madeleine is an award winning writer of non-fiction and fiction. Her most recent book, Labours of Love, the Crisis of Care, published in 2020 was longlisted for the Baillie Gifford Prize. In …

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