Ten days ago my Twitter timeline was humming with comments, mostly highly critical, about an article by Giles Fraser for the website Unherd(i). The article was entitled 'Why won't Remainers talk about family?' I don't know if you saw it but in it he set out the argument that the free movement at the heart of the European Union has unhelpfully disrupted our communities and the caring, reciprocal relationships within them.
What really got a lot of people angry was nothing to do with Brexit but a section that seemed to assume it is a woman’s job to look after her ageing parents if and when they need care:
“A South London GP friend told me a disturbing story last week. I paraphrase, but this is roughly it. A woman in her fifties called up the surgery. Her elderly and confused father had soiled himself and she wanted to know if the surgery could send someone round to clean him up. “Did you have children?” my friend asked her. She did. He went on: “When they were babies did you ever contact the state to see if it would come round to change their nappies?” She went quiet. Ouch, what a question.”
Later in the piece Giles Fraser wrote, “Children have a responsibility to look after their parents. Even better, care should be embedded within the context of the wider family and community. It is the daughter of the elderly gentleman that should be wiping his bottom. This sort of thing is not something to subcontract.”
Age UK's new report
This week Age UK has produced a new short report about women carers, sandwich carers especially, in which we argue that it is indeed women who are mostly bearing the brunt of the crisis in social care provision. We wrote this report for International Women’s Day, which this year happens to fall on the second anniversary of the Government’s so-far broken promise to produce a Social Care Green Paper – a horrible, if apt, coincidence.
The woman who features in Giles’s Fraser’s anecdote may herself be a potential ‘sandwich carer’ – depending on the age of her children – and our report sets out some case studies demonstrating how tough being a carer, whether of the ‘sandwich’ kind or not, can be.
Is this fair?
Is it fair to ask women – people – to do this? Whether it is or not they often take this task on willingly, because they want to, but our case studies make clear that sometimes they effectively have no choice because of the lack of decent, affordable care for older people. This is disastrous, not least for the significant and growing numbers of people in our society who do not have any family to care for them.
Even when women – people – care willingly for their older relatives, with or without caring for under 16s too, the definition of a ‘sandwich carer’ – what seems desperately unfair to us at Age UK is that they often receive very little support from the State. Many are left to bear the full responsibility for someone who is highly vulnerable, without much if any back up help or any regular, reliable opportunity to take a break from a way of life that is mentally and physically exhausting and may go on for years.
An impossible juggling act
Many women carers keep working and somehow juggle their home and care commitments, but others give up their job, finding it too much to keep all these balls in the air. If they then become reliant on the benefits system they may be eligible for Carer’s Allowance; however, this pays a pittance, even less than if you are unemployed, so if you have any savings you may well have to use them to stay financially afloat, jeopardising your own chances of living well in retirement. All this for the privilege of saving the State a fortune in care fees for your parent or partner. If this isn’t unjust I don’t know what is. In this respect the State definitely has its cake and eats it at the moment.
Last week at the Nuffield Health Summit I listened to an excellent presentation from Natasha Curry(ii) about what we can learn about social care reform from Germany and Japan – the two nations generally regarded as having done most to grasp the nettle. A difference between the policies in these countries, she said, is that in Japan only social care services are available from the State system, whereas in Germany you can chose to take a service or the equivalent in cash to fund a family member to care. This reflected a cultural norm in Germany, it was suggested in discussion, and Germany was happy with it. Conversely, Japanese policymakers had made a very definite decision to try to encourage more women into work – in the face of big demographic challenges – and so did not offer the option of using State funding to pay for family care as happens in Germany.
In this country the majority women of working age are now employed, albeit often part time, and most dual earner families would struggle to survive on just one income. This is the reality now, whether we like it or not, and yet our care and benefits system does not adequately recompense those who provide care for ageing loved ones and who leave paid employment in order to do so. Nor has any government so far used its muscle to make flexible working the default option. Lack of action on all these fronts leaves family members to fill the gap and pick up the cost in lost wages.
Time to debate
In effect the State pimps off the goodwill of carers. Let’s challenge this and have a proper debate about it I say. I think we need a big public conversation about what it is right to ask carers – often but not always women – to do, and what we should give them in return, and I hope that the Green Paper – if we ever see it – kicks this debate off. This discussion is long overdue – just like the Green Paper!
Lastly, four quick observations about Giles Fraser’s article – which I am sure delighted him by capturing many people’s attention and prompting such a vigorous debate.
- It may be that what the daughter in question was really contacting her father’s GP about was whether he was in need of and indeed eligible for social care. If so the right response from the GP would have been to explain how to contact his council to ask for an assessment.
- It is sometimes said that families do less to support their ageing loved ones here than in Southern Europe; this is a myth as there are roughly similar rates of family caring across the UK and the Mediterranean countries.
- In his article Giles Fraser comments approvingly about the higher rate of family caring within the Muslim community here; this is I think true, and it is perhaps both a cause and a consequence of the lower labour market participation of older generations of Muslim women. However, younger Muslim women are more likely to be working and are thus less available to care for relatives at home, so my understanding is that things are changing within the community in this respect and quite fast.
- Finally, Giles Fraser asserts that intimate personal care of an older person ought always to be the responsibility of their family members. My experience is that many older people do not want their adult children washing or toileting them and would prefer a paid care worker to do so, especially when the parent and adult child are of different sexes. Many adult children feel the same and I can understand why.
Join the conversation
If you have thoughts on this topic, or similar experiences you'd like to share, get in touch on our social channels.