Covid shows why care is in crisis: we have crushed the humanity out of it
Care is a short word that is ubiquitous, used for the most intimate relationships with vulnerability and dependence from birth to death. Fired by curiosity, I have hunted out people whose lives are dominated by care, either unpaid or as part of their work. I started every interview with the same question: what do you understand by this word care?
From the 19-year-old social care worker to the experienced GP, from the mother of a child with disabilities to the hospice social worker, from the healthcare assistant to the president of the Royal College of Nursing, I have sat and listened over the last five years to fascinating explanations of this “labour of love” – the words they often used. Many started the interview assuring me they had nothing to say, they were “just” carers. Yet by the end of their deeply moving answers, they were astonished at themselves – and even grateful for having had the chance to explain their work. Several said no one had ever asked before.
I saw how many of these individuals were dedicated to a set of values profoundly at odds with wider society and often even with the organisations for which some of themworked. For instance, the healthcare worker on a busy oncology ward sighed that the hospital management seemed to think it was a business, but she told me she knew it couldn’t be: her work was about relationships. And as I shadowed her for a day, I saw how she patiently coaxed an elderly gentlemen to wash and reassured another confused patient. She insisted that even when people are dying, they enjoy a joke and a smiling friendly face. The ward’s other healthcare worker showed me the equipment cupboard, labelled with prices; some of the injections were worth more than a shift’s pay, he commented bitterly.
The sense of being beleaguered was true not just of low-paid healthcare assistants and social care workers, but also of GPs, consultants, professors and directors of nursing. They were just as eloquent and impassioned about the fact that the vital, unquantifiable nature of care was being squeezed to the margins. It’s partly a matter of workload but it’s also a deeper, more systemic shift that has been under way for three decades, in which care is reduced to tickboxes in an attempt to standardise this most unpredictable of human activities.
I could see the resulting tussle of priorities: did the healthcare assistant hurry the elderly gentleman in need of a wash? Did the ward sister race round doing the hourly checks, hurriedly filling out the form – an activity that research has shown is a largely pointless exercise? Care has been routinised and bureaucratised in pursuit of reductions in human error and abuse.
That has been combined with a quest for efficiency, productivity and value for money – measures many veterans have long argued are of strictly limited use in the field of care. One wise old hand pointed out that prioritising efficiency over all else is dangerous in two realms of human endeavour: war and care. Needless to say, Covid has made this abundantly clear in the latter case.
This type of managerial control of care has been counterproductive, says Alison Leary, a professor of nursing and a former engineer and mathematician. It generates anxiety, andabuse of patients is thus more likely to emerge.
The medical researcher Paquita de Zuleta argues that neuroscience studies have shown how our capacity for compassion is inhibited in threatening and competitive environments. A director of nursing, who didn’t wish to be named, admitted uncomfortably that recently, when she visited a ward, a junior nurse had jumped up from a bedside and apologised for “just talking”. Reflecting on her own training, she feared that something had changed: “Perhaps we don’t value relationships enough socially and culturally.”
Suddenly, my reading and research into the history of care began to make sense. Never having fully appreciated the importance and complexity of care – too often it has been dismissed as women’s work, simply a matter of in