Sharpening the care diamond
A society’s capacity for providing care (which, as one reader pointed out to me, is not the same as how much it cares) can be seen as a diamond comprising the market, the state, close family and the wider community.
Thinking about how to generate more and better care involves looking at how we might increase the contribution from each source but also thinking about the relationship – sometimes additive sometimes subtractive – between them.
Care funded by the state is perhaps the most straightforward to analyse in the sense that it is fully stretched and it is difficult to see any significant increase in capacity in the foreseeable future. In terms of the overall pattern, the last decade has seen an increase in state support for child care (although under the Coalition it has been a case of swings and roundabouts as the child care element of tax credits has been reduced but the entitlement to nursery provision has increased). In relation to adults and older people, some national care-related entitlements have been tightened while at the local level provision is now limited to the most needy.
The market for care is also very stretched. The private provision of care is expanding in line with need but in all domains of care there is a major affordability gap between what the market can offer – even paying rock bottom wages – and what most people can afford. Austerity is also putting ever greater pressure on the publicly funded aspects for private care. For example, there is a growing gap between the cost the private sector charges self-funding clients of residential care and what it is able to charge increasingly cash strapped local authorities. Coalition ministers had expressed the hope that the implementation of a new long term care funding framework could create an opportunity for a new care insurance market to emerge. But such hopes have been expressed – and dashed – before.
When it comes to families the top line is that informal familial care is the bedrock upon which the whole societal care system rests. On the one hand, nearly all parents enthusiastically provide loving care for their children; on the other, a recent ONS analysis of the 2011 census estimated the total weekly provision of informal adult care in England and Wales at 3.4 million working days (up substantially on ten years ago). In rough terms, valuing an hour of unpaid care at the minimum wage level this means that unpaid care is worth about £170 million per week or about £8.5 billion per year. In fact the value is much greater as those cared for at home are also being housed and fed by their loved ones.
Arguably the problem of informal care by families is oversupply. While parental negligence and ‘granny dumping’ is still very rare, some care, both for children and adults, is not as good as it could be if informal provision was mixed with formal care. Vitally for the economy, levels of employment of mothers and people over fifty are lower in the UK than many other advanced economies. The need to provide care and the costs of buying it are the crucial factor inhibiting mother’s employment and an increasingly important factor keeping older people from full time employment.
This leaves the fourth point of the diamond, the community. We might define this as the contribution voluntarily made by people other than close family to the provision of care. This primarily comprises volunteer time but other contributions include money (in the form of philanthropy), the provision by employers of flexible working and, more generally, the framework of norms and values which shape the status of caring and the degree to which we see it as a collective responsibility.
In relation to this aspect today sees two contrasting contributions. This Guardian piece from Erin Mee http://www.guardian.co.uk/society/2013/feb/26/care-workers-plea-older-people-lonely underlines how much unmet need for even for the simplest forms of care there is lurking in every community. NESTA has today published a new report on a system response to , the Endowment is also calling for new ideas for its website celebrating innovative responses to ageing .
As NESTA says, many innovations can work alone and do not require or benefit from a system wide approach. But, as the report also says, despite lots of activity and concern about ageing social innovation is lagging behind technological innovation and we have a very fuzzy idea of what actually works, which is perhaps why we need to shift our whole orientation. But if we do need to look at the system, what is the system? Is it the system of ageing, the system of care, or more narrowly the system of older care and the system of child care?
My feeling now is that, firstly, there is something essential to the human activity of providing all forms of care, and, secondly, there are common issues and dilemmas in the mixed systems of care which apply to children, adults and elders. This is why it is caring which should be the focus of our system view rather than a particular demographic group.
But, as is always the case when I start thinking in earnest about my annual lecture, I may well change my mind several times before I reach any kind of conclusion.
Comments
5 Comments on Sharpening the care diamond
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David Wilcox on
Thu, 28th Feb 2013 4:49 pm
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Brian Cox on
Thu, 28th Feb 2013 9:11 pm
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Digital technology and care – how do we promote more connected thinking? | Connecting Social Care and Social Media on
Fri, 1st Mar 2013 6:58 am
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David Wilcox on
Fri, 1st Mar 2013 10:34 am
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Benjamin D on
Sat, 2nd Mar 2013 1:25 pm
Thanks Matthew for that really helpful model. A couple of thoughts:
1. Could this be a useful field of exploration among Fellows, partly because of the diversity of professions and interests, and partly because those later in life would have a personal interest in making a contribution? There’s rightly a lot of emphasis on recruiting new, young Fellows. This could be one way of acknowledging the expertise of us older FRSAs!
2. The second point arises from work I’ve been leading on exploration for Nominet Trust into the contribution technology can make at a personal level. Shirley Ayres has produced an excellent complementary paper about technology and care services. There’s now the NESTA work as well. What strikes us is how little collaboration there seems to be among agencies, researchers and innovators in the field. Shirley recommends a knowledge hub … which I would expand to cultivating a knowledge ecology.
The further point that arises – as I blogged here – is how little work is evident in translating innovation into applications that can be used by individuals and helpers. There’s more and more projects funded by innovation agencies – but very little to help people figure out whether it is useful to give mum a smartphone or tablet, what apps to choose, and how to get started. Maybe Fellows could be good testers there too!
So – yes, we need more innovation, but also convening, curating and converting which may be less glamourous but at this stage could add enormous value.
How can we care, and how – in practice – can innovations help.
Hi Matthew,
Thanks again for the blog.
A few thoughts.
Firstly caring and care are reciprocal, we give and receive in various quantities through our lives. Most of the time we don’t even know it is going on – but it is there is all its complexity, all the time and is part of being a healthy and engaged human being. Your reference to the very real and all too common story of loneliness of many people in old age is a good example. Older people are very often the recipients of care (quite appropriately) but are stripped of their human role as care givers – not only through the major loss of loving relationships but through the loss of small scale interaction with neighbours, colleagues, passers-by and strangers.
Secondly I think we should think about friendship and kinship networks as well as families. This seems to be more fertile territory for the future as demographic, economic and social trends reshape our lives.
Thirdly I think your diamond formulation is a good way of thinking about markets, people and society and helps us think about what is the most desirable relationship between natural caring activity within communities, families and kinship groups and that provided by state and businesses. There are some interesting parallels with the current debates about the future of capitalism and the State here. For instance the Government’s economic strategy has been based on the theory that the state’s expenditure “crowds out” the private sector and that shrinking the state will automatically (and magically) stimulate the private sector.
In a similar way some argue that state care activity crowds out natural caring and withdrawal will enable the spontaneous blossoming of informal care arrangements freely chosen. A preposterous notion in my view as we see in the consequences of current policy for women, carers, children, frail elderly and disabled people.
We need instead to achieve a supportive and helpful balance between the four points of your diamond in order to create a good society.
[...] Sharpening the Care Diamond by Matthew Taylor Chief Executive of the RSA explores society’s capacity for providing care which comprises the market, the state, close family and the wider community. [...]
Update: the conversation about more connected thinking is taking off over here http://bit.ly/YFM1x7, with a post from Shirley Ayres referencing this post and other key interests. Is there anyone from RSA we should involve?
Its probably not a new idea at all, but with elderly care (and nursing) homes, is there alternative funding model that could work?
Finding a model where care homes are not run by faceless large firms who are making significant profits (ironically pension funds might even be invested in these firms), but run and owned by the community. If local authorities (at district/parish council level) could levy a local ‘caring tax’ on the understanding that (a) a place would be available – or outreach services into your home (b) you would still contribute to receiving the services, but at less than the typical £750 a week.
There would obviously need to be some sort of residency criteria for eligibility. My only hope after failures of the market and failures of New Labour top-down control is local devolved solutions.
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