The Care Crisis: What Caused It and How Can We End It?

By Emma Dowling
Published by Verso, 2021, RRP £16.99, £12.99 at Bookbuster

Review by Tim Barton

The care industry, in a broad definition that covers childcare, nursing care, care of the elderly, and others with challenging support needs, is facing a major crisis. It has been a long time coming – we have watched the financial support for care being sucked down the beach for decades, and seen with foreboding the dark line of an approaching tsunami. As with so many avoidable problems, this one has been exacerbated by inaction: after all, ‘tomorrow’, ‘next week’, ‘next year’… is not ‘today’… until it is.

Demographic changes have long been predicted to give a sudden rise in the numbers of elderly requiring care, alongside too few youthful workers to man the posts that need filling… in point of fact, mostly to ‘woman’ the posts, as there is a considerable gender disparity in the industry, alongside low pay and, frankly, low regard (these are other factors in the crisis, ones that Dowling sees as inflection-points for change). A ‘greying’ population is always a problem. Importing the labour to patch the gap is a luxury for rich countries that merely ensures a larger care deficit in migrant workers’ home countries.


The increasingly globalised and liberalised economy may aid the transfer of labour, but is itself so profit-oriented and so obsessed with privatisation, and a shift from state-sponsored and subsidised provision to (in the UK) a ‘Thatcherite’ religion of ‘self-responsibility’, that it also significantly feeds the crisis. Ability to show ‘responsibility’ through paying for or directly providing for care is more and more judged through a lens of individual failure or success. Ideologically, suggesting political, economic, or social factors may stop whole classes of people from fulfilling such obligations is beyond the pale – after all, “there is no such thing as society’” Our last, best hope of altering this was sunk when the good ship ‘Corbynism’ hit the iceberg of financial sector, corporate, and establishment hatred.

That black line on the horizon? It has suddenly and unexpectedly risen up the beach, faster than expected, driven by the government’s populist anti-immigrant stance, and the year of pandemic. These factors have been the straw that bust the camel’s spine, and now it is plainer than ever that the costs of the destruction of support services, from nurseries and after-school clubs, through private and state care homes, to the National Health Service itself, are extreme and have serious ramifications for the well-being of both individuals and the nation.


‘Crisis’ is, as you can see, a mostly negative experience. Dowling’s book is a necessary aid to creating a positive outcome from this crisis point, as her aim in explaining the causes of the care crisis is to suggest ways to end it. The upside of our increased awareness of crisis is that it becomes less possible to maintain the rank complacency we have seen in government circles whilst the conditions for a breakdown in care provision became insurmountable, and thus, as the public awaken to the fact that the Spirit of ‘45 is, in effect, dead, an opportunity arises.

A crisis can also be a critical point where the need for alternatives becomes so grossly exposed that public anger may, just may, give those looking for change a fillip. Sadly, the populist wave created to achieve the neoliberal establishment wet dream of ‘Brexit’ means that the country’s mood is more right-wing than left –  what is needed, and urgently, is socialised state-funded care provision, but what we just gave wings to is massively increased privatisation, asset-stripping and an economic race to the bottom.

Anyone affected by the loss of sufficient care provision (which, fact fans, is all of us) will be both angered and, hopefully, motivated by this excellent book.

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