A crisis of care grips British society. For those who can afford it care is expensive, yet the work itself is usually poorly-paid, performed under increasingly stressful conditions and often contracted out to private providers. Those who can’t afford to navigate the system of privatised care, or who the country’s strained public system will not stretch to accommodate, have to spend longer caring for their relatives and loved ones. Such inequality further compounds the miserable monopoly of waged and unwaged labour over leisure time in the new world of work, and its effects are, as in all crises of capitalism, unevenly felt. For young people who have left Britain’s deindustrialising regions, and with them our family commitments, for far-off cities, the scale of the care crisis can be hard to see. But in the country’s Northern and Midland towns, devoid of the industries that once kept them alive (if not prosperous), the intertwining of post-industrial decline and the rise in the demand for care work and care services is inescapable.
1. Crewe: All That Is Solid Melts into Care
Recently, I returned to my hometown of Crewe, a post-industrial enclave on the otherwise prosperous Cheshire Plain. Usually the town is not known for much more than being the most southerly point in the North of England. As the poet W.H. Auden said, Crewe Junction was his “Never-Never Land”, that “wildly exciting frontier where the alien South ends and the North, my world, begins.” On the train from London that chugs up the West Coast mainline, arrival at Crewe signals your presence in England’s other half. The landscape around you changes slowly at first, almost imperceptibly, then the rapid filing by of post-industrial towns begins to offer a sharp contrast to the rolling countryside and languid cows of the Southern shires shuttling past the window.
The town was also, once, a thriving industrial centre. Founded in the early 1840s, it quickly became, in the words of Nikolaus Pevsner, “the railway town par excellence”. From an initial 200 families who moved there in 1843 to form the railway colony, it boomed into a major manufacturing centre, its famed Railway Works building thousands of railway locomotives that serviced lines across Britain and the world for over a century. At its peak, the Works employed some 20,000 workers in a town of little over 70,000 people. Such work became, for many, the structure around which community revolved; the Works the central hub of this company town, and influence of the railways can be still felt throughout. As the novelist William Cooper, whose childhood memories of the town are collected in his memoir Scenes from Early Life, said, people from Crewe have “steam in [their] veins”.
The trip was my first I’d taken since the outbreak of the pandemic. The journey itself was a fairly miserable one. The train mostly devoid of passengers and where once the platforms would have been filled with busy commuters, there was now just empty space. Even those markers that once I would have used to orient myself on the journey, one I must have taken hundreds of times — the W.H. Smith at Euston marking its beginning, the Crewe Station pub at the other end — were temporarily shuttered. The initial impetus for the trip was to see my mother who over the past few years has been the primary carer for my dad. A little over a year earlier he was diagnosed with dementia and by the start of this year it was increasing apparent that he needed more care than my mother alone could provide.
The walk from the station to my parents’ house passes what remains of the town’s former Railway Works, a famous site once set behind a vast red brick perimeter wall. Not long before my father’s initial diagnosis the wall began to be slowly demolished in order to make way for a new housing estate, and by the beginning of this year I could see through the now open gate to the construction site occupying the former place of the Works. Inside, skeletal new builds were emerging from where once stood the vast, hangar-like workshops: another cluster of Barret Homes to warehouse the commuters travelling to Manchester or Liverpool.
A few years ago, my father gave me a book of photographs of the Works taken during its century and a half of activity. In it are dozens of images of railway locomotives in various stages of construction, and looking through it again now it’s hard not to feel a little in awe of the sheer scale of the industrial operation. It’s also difficult to avoid seeing them as merely sepia tinged reminders of decline and deindustrialisation, of once-gleaming glory days now long gone. In one of the images, taken in early 1966, there are at least 15 train engines spread out across the floor of the repair shed, and even then the building looks half empty. There are people there too, spread out between the locomotives, but they’re barely perceptible, tiny figures in dark overalls dotted about between these mechanical beasts. When we talk about processes like deindustrialisation or the shifts in the global economy away from industry and towards service sector employment it’s easy to miss its human scale. Those people in the picture each have lives outside of it, they are flesh and blood and the changes that happen in the figures and statistics have real consequences. Macro-level history can serve to hide the humans who toil away lower down the scale, making us miss the very real consequences of economic and industrial change.
It was the railway that brought my family to Crewe. My paternal great-grandfather was a labourer employed to do the back-breaking work of laying tracks on the ever-expanding Victorian network. His early death, when his son John, my grandfather, was just 8 years old, stands as a harsh reminder of the dangers of heavy industry. After his father’s death he was brought up in the town’s Webb orphanage, a beautiful building built from the town’s ubiquitous deep red brick set in an open field on the town’s edge and left as a bequest by one of its industrial pioneers. The labour movement developed partly so as to reduce the working classes reliance on such paternalism, but still the work that sustained the town was often difficult and dirty, and frequently dangerous. Accidents were common. The Works once hammered out hundreds of false limbs to replace those that workers across the network had lost on the job alongside the thousands of locomotives.
Industrial employment left its mark on workers, as well as on those who toiled in the background to provide care to their families. But decline leaves its marks as well. Deindustrialisation creates its scars, less visible perhaps but no less real. If we look closely enough we can read the history of industrialisation and deindustrialisation in the official statistics and on the bodies of those who live and work in such areas. While Crewe’s prosperous neighbour Nantwich, just a few miles walk further on past the Works site, has done well for itself with the economic changes of recent decades, the life expectancy in Crewe is now a decade lower.
Walking along Nantwich Road, just before I reached the old Works site, I saw a sign hanging from the metal fence that surrounds a local retail park. The sign, in large white letters, advertised job opportunities for care workers. “Immediate start with excellent training”, it read, “up to £7.50 per hour + mileage paid”. I’m not sure how long the sign has been there but at current rates this is below the minimum wage for adults. The contrast between the two — the old railway works, demolished to make way for new houses, and the advert for poorly-paid care workers — seems a perfect encapsulation of the profound shifts that have taken place in nature of work across so many deindustrialised areas of the country. Where once they were sites of skilled industrial labour, they have been, under the intense pressure of seemingly impersonal political and economic forces over the past half century, replaced with zero-hours, poor quality, badly-trained service jobs, and now as these town’s populations age and state provision falters, with care work.
2. Care, Work and the Crisis of Capitalism
We first began to see signs of my father’s illness a few years ago. It began with periodic bouts of confusion which were soon followed by increasing forgetfulness. Since his diagnosis over Christmas 2019 his condition has deteriorated rapidly; the initial forgetfulness turning into widening, often gaping holes in his short-term memory. As with many dementia sufferers perhaps the worst of his symptoms, if not for him then for those around him, has been a roiling frustration that frequently erupts into bursts of vicious anger. Some months were relatively calm, stability reigning for a period only for his fury to reappear. And then it all became too much. My mother, herself suffering from long-term ill-health, could no longer cope. The informal structures and the networks of care built by friends and family to hold back the worst effects of the dismantling welfare state are difficult to maintain in the long run, and harder still when families are spread thinly across the country. His anger became a risk too serious for her to bare alone. My family, like many others, is now reliant on the meagre help available from Britain’s care system.
At present in Britain there are an estimated 1.52 million people working in adult social care — around 5% of the total British workforce. And this number is growing every year, having increased by 9% since 2012/13. The insecurity of this form of work is compounded by the fact that it is increasingly outsourced away from local authorities into the private sector, as austerity has undermined the public care system over the past decade. Prior to the COVID-19 pandemic, non-UK nationals represented 17 per cent of the social care workforce in England, 6 per cent higher than the figure for the total British workforce, and of the total care workforce around 20 per cent are from Black and Ethnic Minority backgrounds. Many of these first-generation migrant care workers are recruited from Eastern Europe or from places in Asia and Sub-Saharan Africa, often Nigeria and the Philippines. Around 80 per of the workforce is female. Alongside formal care workforce, there is also the huge number of people like my mother who provide unpaid care for friends or relatives. Carers UK estimates that around 6.5 million people, or 1 in 8 adults in the UK, is a carer, with this figure increasing again with the strains of the Covid-19 pandemic.
Such stark figures pose a problem for how we think about work in the 21st century. As industry has retreated from towns like Crewe, in its wake it has, in the words of historian Gabriel Winant, “left behind populations that were poorer, sicker and older.” Winant is here discussing the legacy of deindustrialisation in Rust Belt America, but Britain’s own Rust Belt in the North and parts of the Midlands is no less effected. What’s come to replace industrial employment, difficult and dangerous work though it was despite its relative well-pay and high union density, is increasingly poorly paid and insecure work. And it’s not just the nature of work that it’s changed. With the proportion of care workers in Britain’s ageing regions higher than in the large cities, the ethnic makeup of these towns is changing with it. The image of monocultural blocs of white working class that fill the political fantasies of both the left and the right is belied by the reality of such shifts.
All of which will provide little relief to many people like my parents. Just a few weeks ago, my father was sectioned under the Mental Health Act. Getting access to care, particularly without the financial resources to pay for it privately, is difficult; residential care even more so. It’s been difficult to admit, but his sectioning came as something of a relief. At least now he is in residential care and the chances of finding a permanent nursing home for him afterwards is greatly increased. My family, as with many in similar situations, cannot afford private care and so must take comfort in extremes.
As our society ages, the gap between generations, both financially and socially, is growing. Those who are old and ill will need to find ways for the young to look after them. Yet, with younger workers ever more precarious and economically and socially insecure, finding the means to do so outside of the market is proving increasingly difficult. If, as Nancy Fraser says, “social reproduction is an indispensable background condition for the possibility of economic production in a capitalist society,” then here we see capital undermining its own conditions of reproduction. It’s the “externalizing [of] carework onto families and communities, [while] simultaneously diminish[ing] their capacity to perform it.” The undercutting of the social safety net, the crisis of care, is a crisis of capitalism itself.
This situation demands a change in the way we see and value work, and with it, care. We can no longer hope to bring back the kind of tough, masculine industrial work that once proliferated in towns like Crewe, nor would we want to do so. And nor can care work, unlike many other forms of labour, be automated away; there is no robot that can take the place of nurses, family members and carers. What we need is to ensure that this work, one that is vital to the functioning of contemporary capitalism, is well-paid and properly regulated. One necessary step towards this will be ensuring that the process of privatisation of care that has worked to undermine the pay and conditions in the sector ends, and that a properly socialised care network is set up in its place — not only for those who rely on the labour of mainly underpaid female workers to survive, but for those workers themselves. Care work as it currently stands is often unpaid, gendered, racialized, and harsh. When it is paid, it’s insecure, under-resourced, difficult, and often emotionally and physically draining. What we need to do is change the way we see care, and its centrally to society; as Winant says, “there’s no reason the care economy has to be as inhumane as it is.”
Since my father’s hospitalisation, my mother has been surrounded (if only remotely) by friends. People have gathered around her to offer support and care as she grieves the sudden shift that has taken place in the life she once had. The nurses and doctors that are now doing the work of care for my father are the same people who have done so much for the hundreds of thousands who have been affected by this horrendous year, one marked by COVID-19 and a global medical crisis on a previously unimaginable scale. Care is now very much on everyone’s mind. If there is some solace to find in all of this, it’s the strength of those who have done so much to shoulder the burdens of care. Such solace may be meagre, but it’s all we have. Perhaps, though, in this are the splinters of something better, fragments of a better world yet to come, one built from the shattered remains of the old.
This article is part of an occasional series examining the politics of care, which will run on the Blog throughout the summer. Check the homepage for more in the coming weeks.