Carers’ Agency: Building agency and institutions

A year into the pandemic, Renewal is publishing a series of essays by careworker Paul Cotterill on power, professionalisation and decommodification in care work. The final essay in this series grapples with the tasks of professionalisation, the role of progressives in facilitating the agency of careworkers, and how careworkers as a profession can lead the development and embedding of new models of care.

Real progress in developing a new care profession will only be made if we can succeed in, to use David Smail’s terminology, instituting agency— by both helping to create the initial conditions in which careworkers can start to exert their agency, and by employing joint agency on institutions, working on a wider footing to ‘soften up’ distal power structures, so that an emergent care profession can push further their journey of professionalisation.

Clearly, there will be overlap between these two sets of efforts; there is already a ‘vanguard’ of unionised, politically conscious careworkers who will want to push on towards the new economic structures needed as a condition for a truly emancipated profession, but there will also be times when those pressing on with new models of working will need to reflect on whether proximal powers such as the ‘double shift’ are holding back truly inclusive professionalisation in the same way as occurred in nursing, and thus demand greater initial militancy around pay and conditions.

In what follows, I move from what I call ‘solidarity actions’, which challenge proximal power, to ‘structural actions’ challenging distal power, but I also pay due attention to a central tension already apparent in the broad thinking about where society goes with what we broadly call care.

Instituting agency: pitfalls and proposals

Let me start with the most obvious solidarity action.  This is helping to continue and consolidate the new level of esteem that the public hold for care workers, but at the same time to start to make better cases than the one I make here for them being viewed as a latent profession.   

And if not now, when?  It is not nothing that Ipsos-Mori have just found a 76% trust level in care workers in their 2020 Veracity Index of professions, but it is also not nothing that this is the first time care workers have ever featured in the Index; a decent indicator of whether there is any progress to wider recognition of care work as a profession may be whether the 2021 survey keeps the careworker question, as well as whether the trust level increases.

This means that those putting forward the case need, however constraining the format, to push beyond arguing for seeing careworkers as good and selfless people, and onto what in their daily work makes them a latent profession, which is a set of as yet unwritten standards of behaviour.  

It also means contributing to the challenge of separating out notions of class and professionalism.  This can and should be provocative, asking how and why the idea of a ‘middle class professional’ has come to stick in the way that it has, asking whether, for example, there is actually such a thing as a ‘banking profession’, when that industry largely has whatever rules and conditions applied to it by state agencies external to those who work in banking and not by an autonomous body which takes responsibility for membership standards.

Alongside such proactive staking of the claim for professionalism, though, comes a broader issue: what might detract from the development of a narrative which unifies careworkers and those interested in the care model from different perspectives?

One of the key points that social care activists make, and with great justification, is that the industry as a whole needs to be decentralised; it needs models of care developed where the person cared for is the decision maker in respect of their care, or at the centre of decision-making about that care in situations where clearly evidenced lack of capacity requires decisions in their best interest.1  

This demand for decentralisation and real rights for those cared for is at the forefront of both the Care Manifesto, of Neil Crowther’s and colleagues’ ambitious Social Care Future project and, as we’ll see below, the broad idea of breaking up large facilities in favour of smaller, more personalised care facilities and services also has support from what might seem a more surprising quarter.

It is not, though, currently at the centre of demands made by careworkers themselves, or the organisations that directly represent them.   

For reasons of power already explored, careworkers are not yet generally in a position to make the first moves towards a unified narrative around what care models should exist, and how they can be delivered.   Thus, while their main union (Unison) does call for “enough time to care” in its new Care Workers for Change campaign, the main emphasis in that campaign is on narrower but vital terms and conditions issues.

Given the power dynamics as they stand, there is only one way forward.

This is for those who want to change care in the long term to step forward and offer whatever they can in term of material and moral support to careworkers in the short term

So what might such short term solidarity and support towards careworkers look like, beyond a general campaign in support of careworkers being afforded greater respect? 

First, there’s the seemingly straightforward task of getting behind the existing union efforts to secure a meaningful pay rise – Unison currently suggest a rise from the national minimum wage of £8.72 per hour, which most careworkers are on, to £9.50 (at current rates).  

Of course, that’s not quite as easy as it sounds, because there is no collective bargaining power – a product of the private sector takeover of the care industry.     This means that the rise will have to come via one of three routes: a) negotiated piecemeal with each employer (unlikely to be a universal victory); b) working with local authorities to ensure they only commission from those employers who pay the better rate (a legal minefield in current circumstances); c) via a hike in the national minimum wage, meaning that careworkers will remain on that minimum wage.

Whatever negotiation route is chosen, and it may be better simply to keep all options open as a campaign develops, the important thing for the wider left to do is to use its talents to help bring the campaign to wider attention than it currently enjoys.

And the way to do that, as I have suggested, is to talk up the need for a pay rise in the context of the profession that is emerging, and the skills that are now being recognised.  There are links here to other campaigns, such as the one to save the Union Learning Fund about to be cut by the government, or to get it reinstated in a way which links directly to professionalisation agendas.

In addition, unions and campaign groups might do well to organise for change around the apprenticeship levy, so that some of the funds raised go into a new ‘professionalisation fund’ in the hands of emerging professions, as part of a wider effort to wrest control of the skills agenda from private sector training firms offering low quality, conveyor belt online courses.  

Overall, the strategy should be about levering the extra-union left’s campaigning talent to argue in favour of a sea change not just on terms and conditions of current employment, but also the autonomy of careworkers to set their own standards and their own training methods, as the first crucial step in self-professionalisation.

This should then feed into a wider set of facilitative actions, focused on empowering careworkers to establish what I will call their ‘model of care’; just as nursing broke through as a profession by distinguishing their new nursing model from the medical model, so careworkers need to break through by distinguishing what they do as distinct from what nurses do.  

How they might be distinguished is an essay in itself, but will boil down to the idea that, while nurses facilitate a shift from patient dependence to independence as far as possible, carers work with people who are less likely to move towards independence in the longer term. Carers therefore seek other ways of helping those cared for maintain and improve their quality of lived experience, not least through promoting independence of decision-making, with the respect—and time—that this requires.

None of this is simple, and in the end, careworkers need to do the bulk of the work to make it happen, but civil society institutions can help by providing facilitated spaces and critical support, such that, in time, careworkers might be able to establish their own institutions.

As Anthony Painter and Joanne Choukier of the RSA set out in a recent podcast, institutional innovation needs a “sense of agency” to make it happen.   But that sense of agency needs institutional help in the first place, when the challenges facing those would-be agents are as great as the ones that currently face our careworkers.

Agents and institutions

Such actions of solidarity, then, aimed at helping careworkers build the confidence and sense of agency needed to challenge more immediate constraints on their lives and livelihoods, are a sine qua non for any long term shift towards working-class professionalism.

Concurrent to such actions of agential solidarity, though, those committed to supporting this process of professionalisation really need to engage in actions of structural solidarity.  These are a wider set of actions aimed at making the structural and economic conditions within which care workers currently operate more amenable to working class challenge and change.

I will move on shortly from this level of abstraction to a more concrete set of recommendations, made to left activists broadly but more particularly to two sets of people within the left – those with some control of trade unions resources, and those interested in the theory and practice of community wealth. 

First though, I want to ‘pan out’ to an overview of the wider political moment in which I argue that the care sector can come to professional status. I want to do so because, while at first sight trying to acquire a new status for low paid, marginalised workers in the midst of an major economic downturn, during which ‘Econ 101’ tells us that unemployment will depress terms and conditions, I actually think the nature of the new phase of British Conservatism creates opportunities which might not be there in a more ‘traditional’ cyclical downturn of capitalism. The very lifeblood of the Johnson regime, evidenced in the disastrous handling of the pandemic and the potential for post-Brexit mayhem, actually contains within it some of the interstitial plasma within which a socialist economy might grow, in a way which allows for replication of quite new cells – cells which, as the old cells die off, create a whole new economic body.

The new phase of Conservatism and the Cummings-Kruger effect

The Johnson government’s operational code and political ideology, while likely to be deeply damaging to the people of the UK over the forthcoming post-Brexit period, also offers up some opportunities for civil society not just to mitigate some of the worst impacts of government excess and negligence, but to develop and replicate new (or renewed) forms of cooperative economic activity in a way which offers light at the end of long, dark tunnel.

Under this new phase of Conservatism, the elite is quite prepared and politically thick-skinned enough to let the people of Britain suffer an extended period of raised living costs and general economic decline. The benefit, the Tories believe, will be that freedom from EU rules allows the elite to pursue an export empireofhi-tech goods and services produced via a mix of exploitation within these shores and a brain-drain immigration system. 

In a largely overlooked article, published on the eve of the pandemic, Danny Kruger MP described the Johnson project as “not a revolution but a restoration”, argued that the country will thrive when it has “better elites” prepared to control properly the “functional specialists” under their command, and committed the government to “transfer of money as well as authority” to local communities.

Encapsulated in this article by Kruger, who is both Johnson’s former political secretary and Cameron’s former speechwriter, is the confirmation of a return – begun under Cameron but stalled under May – towards a pre-Thatcher style ‘dual polity’ Conservatism. As described by Conservative political scientist Jim Bulpitt in 1983, under the dual polity, a narrow elite at the centre takes control of all ‘high politics’ decisions but is content to leave the ‘low politics’ of day-to-day administration to the ‘periphery’, just so long as that periphery acknowledges its overall subservience.2  

But there is a radicalisation of this shift under the Johnson regime that wasn’t there under Cameron.  Under Cameron, the return to dual polity still had a veneer of modern governance about it, with ministers still expected to have a grasp of departmental detail, for example, even as Cameron and Osborne’s kitchen table cabinet put backbenchers in their place. Under Johnson, the operational code is less ‘dual polity’ than an eighteenth century-style ‘court and country’ (also a term used by Bulpitt in respect of traditional Conservatism).  

There is, though, another aspect to the shift which is more relevant to our purposes here, and it’s here that Danny Kruger MP, and the aspect of the New Conservatism he represents, should really come to the fore in the analysis. Kruger himself is more than just a compliant observer of the new Johnsonism.  He is an active and intelligent participant. 

Kruger’s September report ‘Levelling up our communities: proposals for a new social covenant’ is much more radical than I thought it would be when it was commissioned by Johnson in June 2020. The details in the report have been largely ignored by the left because of its provenance, and perhaps also because it drew praise from ‘centrists’, but they are worth taking seriously precisely because Kruger has earned himself credibility through his loyalty to the wider project, and may well see many of the recommendations implemented.3 

The whole report merits a read, but of particular relevance to the care worker professionalisation cause is the proposal for a newly legislated ‘Community Right to Serve’, under which “communities, charities and social enterprises [get] a voice in the design of policy and where appropriate a role in the delivery of public goods” (p.24).  

While this looks a bit like a restatement of the Right to Challenge set out in Cameron’s 2010 Localism Act, the overall report suggests a wider ambition; where the Cameron legislation was about the third sector doing things cheaper, the specificity of “public goods” does suggest that Kruger is convinced of the need to develop a more relational model of delivery, even if it is at greater expense.

Vitally, one target for change is social care, and the report says:

Social care is already heavily reliant on community provision, including the informal provision of friends and family. This informal care badly needs more support. The care sector as a whole is admirably plural and independent, but owning to the structure of the market and the quantum of public funding, is dominated by large private providers rather than the SMEs and social businesses that patients and their families would prefer. We need to shift the burden of funding and responsibility upstream, away from medicalised management in impersonal and underfunded homes and towards a new family-centred, community-led model, in which residential care is properly integrated with the life of a neighbourhood. (p.24-25)

This paragraph, I contend, would not look too out of place in the progressive Care Manifesto, although it does not get as far as the idea of decommodifcation of care.  

So the questions arise: how should left civil society react to such overtures?  Should there be full-throated support and engagement?  Should we see it as make-believe, feelgood stuff of the type that Red Tory Philip Blond sought to sell to Cameron a decade ago, only to see his ideas cast aside when austerity came calling?

My own view is that, while a cautious welcome is appropriate – we may yet see a rapid return to Thatcherite public spending control and the binning of this kind of initiative – but that caution should not mean wait-and-see.  

For the reasons I’ve set out, the time to start to act in favour of care professionalisation is now, and if this kind of legislative measure, along with other facilitative measures such as enhanced business rate relief for social enterprise and any other indirect or direct mainstreamed funding, then the professional decommodifiers and community wealth builders need to be first in the queue for the largesse;  if it does not come through in the end, then the moves made now will not be wasted anyway.

In practical terms, this means establishing partnerships of careworkers, trade unions, alternative finance providers, and grassroots activists willing to get on with the detail of setting up organisational forms ready, for example, to react to ‘community right to serve’ opportunities by making demands for capital finance to take over care homes leveraged for profit by equity funds and/or establish smaller, more adaptive settings on the basis that improved services will be funded at the expense of the equity funds, who then have to get out of the sector at the appropriate loss.  

While there is not the space to drill down into too much detail here, the best organisational form for this is likely to be the Community Benefit Society, with the community of benefit defined (as legal requirements) as careworkers, those cared for and their loved one, and local communities.  This legal model, with non-transferable shares operating under Society law, can create stable, long-term financing and stakeholder control, insulating the new models of care from the vagaries of transferable shares that underpin the capitalist economy and depend for their success on increasing levels of worker exploitation. I’m now deeply involved in the establishment of a Community Benefit Society at town level, which seeks to enable existing firms that are struggling financially to move voluntary towards community and worker-based ownership, such that over time the town can be said to be run as a stakeholder economy, at least in respect of the town centre and its public spaces.  While that’s not perhaps immediately relevant to the care sector, it does help to test both the legal model and the withdrawable (non-transferable) share investments which underpin pin it

In other words, we should be looking to exploit, for our own purpose, the new phase of Conservatism, symbiotically with a new profession. By doing so, we create a pincer movement of decommodification.

Towards a left coalescence:  melding Mason & Robertson

But it is important to recognise here, if any level of momentum is to be built for such an ambitious approach, that this approach to de-commodification is not the only one under consideration, and indeed is currently probably a minority position on the left.

The alternative approach is neatly summed up in ex-Corbyn advisor Mary Robertson’s insightful essay for the New Socialist on the route to participatory socialism:

We need the state to challenge the entrenched power of big capital and expand the scope of democratic decision-making in the economy in a way the bottom up competition can’t, for example, by imposing policies such as the IOF [Inclusive Ownership Fund] and nationalisation. State-level coordination is also essential to coordinate economic activity to address social objectives such as climate change and to achieve the redistribution of resources that is an essential pre-condition of democratic participation for all.

For Robertson, proper de-commodification can only be achieved by state action.   For many others on the Corbynite left, the idea of a bottom-up approach is destined for failure in the absence of state action to remove whole sectors of the economy from the vagaries of the market.

Paul Mason, once a favourite of the Corbynite left but now out of favour on account of his enthusiastic embrace of a Starmer leadership, takes a different view in his 2015 book Postcapitalism:

The socialists of the early twentieth century were absolutely convinced that nothing preliminary was possible within the old system. ‘The socialist system,’ Preobrazhensky once insisted categorically, ‘cannot be built up molecularly within the world of capitalism.’4

I am drawn to Mason’s optimism that progress can in fact be made at what Preobrazhensky called the molecular level.

For one thing, I find it hard to accept that the next three and a half years of Tory rule should consist solely of “deep strategy and planning”, as Renewal contributing editor Joe Guinan puts it;  it seems obvious to me that spending all of the left’s time and resources on planning for future control of government is less likely to build support in the red wall towns  Labour needs to win back than is getting stuck in with new initiatives, even at the risk of being seen to approve of the Kruger “levelling up” programme by seeking to acquire the resources it may offer.  

This is, I should stress, not exactly Robertson’s argument – she expresses support for the trialling of new models of ownership at local levels, but suggests they should be seen for what they are: discrete trials ahead of large scale rollout, rather than institutional shifts in their own right.  

Nevertheless, effectively relegating such work to the position of ‘example’, in a way which downgrades its status in relation to the more vital work of winning state power, may lead to splitting of resources on the left, especially in the context of the ongoing rancour between Corbynites and the so-called ‘soft left’

So the question arises of whether it is possible to draw together around some kind of common project these two fractious parts of the left, in a way which allows them to contribute resources and organisational talent, in the likely absence of any leadership on the matter from the Labour leadership.

But it is possible to draw together around some kind of common project, and that is by focusing on the potential for decommodification via professionalisation.    

As I’ve argued in my previous essays, the process of professionalisation is, more than anything else, about claiming authority over how labour time is deployed, in precedence to any requirement of the market, and in favour of the needs of the person or people served by the professional.   Professionalisation is, therefore, a process of decommodification in its own right.   

As such, engagement on professionalisation actions stand to meet the requirements of those, like Mary Robertson, who see widespread decommodification as only possible under state control, because it develops support amongst sets of working class people who see others in their class emancipated from the market, and it meets the requirements of those, like Paul Mason, who believe that “elements” of a postcapitalist stakeholder economy exist even within capitalism. 

My argument here has been that careworkers can, if assisted along the way, be the agents that trigger a quiet revolution in the way we organise the ‘care economy’.  And, if that works, why stop there? 

Paul Cotterill works in care and lives in Lancashire.  He is treasurer to the New Economy Organisers Network (NEON) and founder member of West Lancashire Resilience Society.

[1] Neil Crowther of the Social Care Future project has suggested in comments on the initial draft of this essay that a better guide for an emergent care profession may lie in Article 19 of the 2016 United Nations Convention on the Rights of Person with Disabilities, and in particular in attention to the General Comment No.5 by the Committee on the Rights of Person with Disabilities (2017).  I am grateful for this insight.

[2]  J Bulpitt, Territory and Power in the United Kingdom (1983), Manchester University Press

[3] The thesis that Kruger will have his way is supported by sections in the government consultation Green Paper, published in December 2020,‘Transforming Public Procurement’.

[4] Paul Mason, Postcapitalism: A Guide to our Future (2015), Allen Lane