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

This book examines the state of the British health and social care system in the age of fiscal austerity. In her kaleidoscopic analysis, Dowling situates the decline of care within the larger context of the even further neoliberal reorientation of the UK government after the 2008 financial crisis. The author paints a vivid picture, replete with a plethora of statistics of the deteriorating state of UK public care. Dowling chronicles the long-standing commitment by successive UK governments of all stripes to increase the role of private business in the care sector on the unproven assumption that the profit motive would improve efficiency and quality beyond what government managers could achieve. Oftentimes private business has indeed achieved cost reductions—although not through better management but through reductions in the number of workers and a more thorough exploitation of the remaining labor force, leading to a reduction in the quality of care, overworked and underpaid staff, and, consequently, recruitment problems. The discussion of UK public care is set in the context of care as an affective, personal relationship between caregiver and care recipient and the class, gender, and racial dimensions of care work. In the United Kingdom, the privatization of large parts of the social care system in particular has led to deteriorating working conditions and precarity for care workers—mainly women and minorities—with low pay and zero-hour contracts. Care in all its manifestations is essential for the social reproduction of (capitalist) society. Within the family it is unseen, unremunerated, and still predominantly women’s responsibility, unless child care and household maintenance are “outsourced.” Then it tends to become the underpaid task of minority and poor women, who also predominate in the home care and care home sector. For Dowling, “ending the care crisis will require a profound shift in mentalities.. . . It does mean giving care a prominent place as a structural condition of our lives.. . . Some kind of ‘we’ built on inclusive solidarity is necessary to achieve change” (206). The key requirements she sets out are as follows: