Labours of Love: The Crisis of Care (Madeleine Bunting)- A Review

Publisher: Granta Publicatons (2020)

Review by Helena Fraser Rowe

In ‘Labours of Love’, Madeleine Bunting amplifies the voices of those who bear the brunt of the UK’s chronic health and social care crisis. Bunting situates the contemporary care deficit as both the product of austerity policies and an accompanying managerial culture which reduces care to a quantifiable service deliverable, a set of tasks allocated to the lowest level of skill possible. She deepens her material analysis through a historical feminist line of enquiry which prompts the reader to consider how the longstanding devaluing of care as ‘women’s work’ and marginalization of domestic labour in classical economic theory still informs it’s low-paid status today.

The assumption that women will provide care to the sick and elderly within their family remains pervasive yet Bunting notes, not viable. While women’s employment rates within Britain are at a record peak of 78 per cent (our cheap and flexible labour welcomed by employers), investment in care remains meagre. Astoundingly, childcare for under-threes remains the most expensive in Europe. So why are women still expected to take on the so-called “double shift”? Bunting forwards the argument that the invisibility of care through centuries of Western thought is to blame. Economist Adam Smith’s self-interested market actor is free from childcare restraints, his behavior governed by rational cost-benefit calculation. Women were conspicuously absent from 18^th century economic thought, their care duties relegated to the private domain, considered a natural aptitude rather than a valuable form of labour that sustained the market. Smith’s abstracted homo economicus worked to invisibilize women and advocate for an ethics of care devoid of interdependency. Instead, liberal individualist morality calls on us to take responsibility of our own wellbeing and leave others alone.

Bunting’s exposition of the history of care remains pertinent. Although care work makes up 13 per cent of UK jobs, its importance is seldom recognized. In 2015 the unpaid work of carers was valued at a dizzying £132 billion a year.

A further dimension of the health and social care crisis Bunting explores in her book relates to its commercialisation. How does this process erode the quality of care provision? What notion of care is upheld by care systems inflected by market principles? The result, Bunting argues, is that the complexity of care work (it’s emotional, unpredictable and communicative aspects) are flattened into a deterministic, static set of tasks that are to be optimally delivered to meet the consumer’s (recipient’s) desires. Bunting argues that this culture of consumerism within public services was ushered in by the New Labour governments of the 2000s and subsequently, care has been increasingly redefined in business terms, as a matter of financial prudence.

In one chapter, Bunting arrives at the offices of a voluntary-sector organization which supports families with a disabled child. One mother she interviews describes her interaction with uncoordinated silos of health, education and social services and the frequent changing of professionals:

“At the moment, we’re fighting a running battle because when a child goes into residential care, your benefits go into chaos… I now have to fill out a form every six weeks to account for the dates he was home, and then they recalculate the benefits.”

The charity’s caseloads consist of victims of buckling care systems. Social-work budget cuts leave social workers with overwhelming case numbers and reduced administrative staff, leaving no time to build relationships with families and provide comprehensive care. One social worker Bunting speaks with describes the trauma endured when cutting support desperate families rely on, leading him to have a breakdown and retrain in another field. This is not an uncommon outcome, 40% of social workers told researchers they were planning the leave the profession. The hollowing out of care systems by austerity policies make them ill-equipped to deal with recipient needs, leaving families and care professionals distressed and the humanity of care recipients unrecognised. It seems tied up in Bunting’s fight for well-resourced health and social services is the very struggle for recognition that disabled, sick and elderly people have a right to exist in warranting such costs.

The book interrogates the structural mechanisms of political exclusion inherent in welfare retrenchment and underscores how the neoliberal tenets of individualism and self-sufficiently harm both carer and recipient. Bunting’s chief assertion remains that human dignity relies on an embrace of the universal fact of illness, fragility and dependence.

In her author note, Bunting recalls how the arrival of the proofs of her book coincided with the eruption of the Covid-19 crisis. Suddenly, the past decade of underinvestment in health and social care took centre stage in political discourse, and the poorly paid labour of social care workers was deemed essential. Within the current climate the book provides an answer to those questioning how we reached this point and what political and cultural shifts are required to repair our starved care systems. Although I felt the book lagged in places, I found the ethical considerations throughout thought-provoking, and Bunting’s humanising depiction of carers and recipients delicately handled.

Helena Fraser Rowe is a PPE graduate from Goldsmiths University of London, specialising in the position of disabled women in contemporary Britain.

The views expressed in this article are those of the author and do not necessarily represent those of the Women’s Budget Group.