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How much do we care?

February 13, 2013 by
Filed under: Public policy, The RSA 

The question ‘how do we meet society’s need for care ?’ has emerged as one of the most important and intractable we face. We need to see it as a challenge not just for policy makers or care professionals but for society as a whole and for the values and capabilities we need to thrive in the coming era.

On Monday we had an important, and in my view welcome, announcement by the Coalition, of its response to the Dilnot Commission . It is true that the new policy will not be implemented for four  years and that in relation to the overall problem of social care it will only offer some help to some people, but it does at least provide a framework which can subsequently be built upon (this is often the best way to introduce policy change).

Today there is (yet) another expose of poor care standards. In this case it is the home care services and their commissioners and providers in the frame .

I am also told that on Friday the ONS will be publishing an estimate of the total value of informal care, something that will no doubt highlight how little support unpaid carers feel they receive from the state and wider society.

Fundamentally, the problem is simple: whether we are talking about children, adults or elders there is not enough free and affordable care to go around. It is a very specific example of what I have termed the social aspiration gap – separating the society we would like to live in from the one resulting from our current behaviours and attitudes.

In effect we have silently abandoned the welfare state’s promise to offer universal decency and collective insurance against predictable risks. One economic consequence is that among over fifties and mothers we have lower employment rates than many other countries and this is drag on economic performance. This problem is leading to millions of our fellow citizens suffering today and without concerted societal action things will only get worse.

There are a thousand and one ideas and initiatives to close the care gap and we have discussed many of them here at the RSA. For example, Circles of Care – which was developed by Participle is often quoted and I am a great fan of Shared Lives, but it is proving hard to scale up these and make a substantial difference to the underlying problem.

Practical innovation must continue but alongside it, indeed supporting it, we need a much bigger debate about care and society. We tend to see the care crisis as the result of the interaction of economics (public spending and market supply) and demography (ageing and the birth rate), but there are surely other factors at play.

Whatever pious words we utter, care (both formal and informal) is a low status activity. Both interpersonally and collectively we find it hard to talk honestly about the experience of caring as something which combines great rewards and satisfaction with drudgery and resentment. On Friday the ONS will come up with a big figure for the value on informal care but it is not a value you will see reflected in the national accounts. This is not unrelated to the fact that caring is seen as ‘women’s work’ and also our ambivalence about whether the child care and elder care is primarily a familial or a social responsibility.

Talking more honestly about care, enhancing our ability and willingness to provide care – not just to loved ones but as part of a wider social effort, using care – rather than the more nebulous ‘well-being’ – as a prism through which to re-examine the way we think about economic and social value: All this is necessary.

I am planning to make the care society the focus of my annual RSA lecture, and tomorrow I will float a practical idea I have to improve public attitudes and develop care capabilities.




  • Carl Allen

    When discussing the supply of care one must talk about healthy living practices i.e. the context of meeting and reducing demand without having to raise policy barriers to restrict access to the care supply.

    But often the discussion leans one way or the other by too wide margin and thus policy and resource allocation decisions are … bad, poorly made, ineffective, uneconomical, inequitable, inefficient, wrongly targeted. The list is longer.

  • Graham Rawlinson

    The paradigm slip occurred a long time ago, maybe Descartes and his fans are to blame. Socrates knew better. The paradigm slip was of course to think that cost and value are closely connected, In most of the world care has high value and low cost. To the shame of the western world there is an attempt to increase value by increasing what ‘people’ are prepared to pay for it. World economy is shifting back to societies which don’t have this paradigm problem, which has to be a good thing.

  • Graham Rawlinson

    I agree with most of what you say Robert, though I would guess most people do live in family and community groups, they have to, being poor makes them essential features of life. Isn’t it odd that many elderly poor people will have much richer lives than many elderly rich people, money can’t buy you love, as the song goes.

  • Zio Bastone

    ‘In effect we have silently abandoned the welfare state’s promise to offer universal decency and collective insurance against predictable risks.’ [MT]

    Oh really? Let’s take the NHS as an example of how the public has been subalternised and misled.

    In 1980 all consultants were for the first time allowed to work in the private sector. It was the BMA, not the public, who asked for this change.

    In 1990 the NHS internal market system was railroaded through parliament despite widespread public opposition.

    In 1997 New Labour promised that it would do away with the internal market. This was untrue. Instead the language was changed: ‘purchasing’ became ‘commissioning’ and so forth.

    In 2001 Tony Blair lied about New Labour’s attitude to the NHS: ‘The NHS exists for patients, not the other way around.’

    In 2003 Gordon Brown confirmed that this was a lie: ‘In healthcare we know that the consumer [sic] is not sovereign.’ 

    In 2010 David Cameron lied (the biggest political lie in UK politics in my lifetime) that the NHS would not suffer further top down meddling.

    In 2013 Michael Portillo confirmed that this was a lie:  ‘[The Tories] did not believe they could win an election if they told you what they were going to do because people are so wedded to the NHS.’

    This is the briefest of thumbnail sketches. And I haven’t even mentioned PFI.

  • Ewen McKinnon

    ‘ Nebulous well-being’ is a strangely mis-leading term to use in this context. Much work has shown that the subjective wellbeing of informal carers is lower than non-carers, all other factors being held constant. We can not only measure the size of this effect but can also use wellbeing in a utility function to estimate the economic impact on the individual. In such a way wellbeing can actually help to reflect the aggregate economic impact of informal care in national accounts – an outcome you indicate would be desirable.  So ‘nebulous well-being’ is not a term I would recognise as being accurate neither in this context nor many other policy areas.

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