In Labours of Love, published in October 2020, author and former journalist Madeleine Bunting presents a far-reaching investigation into the meaning of care, its history and its current status in the UK.

Throughout the book, Bunting covers the numerous pressures that many of us already know are facing the UK care sector. There is rising demand for care from a population that is both growing and ageing, but a lack of funding and staff to deal with this demand. Over the years, budget cuts and austerity policies have resulted in low pay and undesirable working conditions, which in turn has led to recruitment and retention difficulties.

However, Bunting attributes the crisis of care not just to these factors but also to how we, as a society, view care – exploring what she describes as a “cultural blindness” to it. Care is something that people don’t like to think about, thanks partly to its associations with old age and death, and we therefore avoid talking about it. Nobody likes the idea that they could one day be dependent on another person in daily life, but with the population living longer than ever before, it’s a reality that we can’t afford to ignore.

Bunting argues, compellingly, that the UK has a history of under-valuing care. As just one example, she cites a poll where a majority of people said they were opposed to NHS cuts, while a much smaller number were against cuts to social care. When working on the book, she even found that some carers are prone to belittling themselves, describing what they do as ‘not a proper job’ and considering themselves less valuable than, for instance, NHS workers.

We follow Bunting as she spends time shadowing care workers, nurses, GPs and more. Across these different settings, there are common threads that emerge. The people she meets care deeply about what they do, but are stretched too thin and struggling. They want to build meaningful relationships with patients but simply don’t have the time, and feel they are only judged by management on how ‘productive’ and ‘efficient’ they are. There is a strong feeling that it’s “just a business to those up top”, as one healthcare assistant puts it.

Domiciliary care workers talk about a divide between themselves and the people at head office, who don’t understand what it’s like on the ground. One carer describes “fighting a tide” and feeling shunned by colleagues for complaining about the way things were done in a residential care home.

At a teaching hospital, nurses and nursing assistants are aware of a “depersonalisation” that is developing because they’re spending more time on paperwork, chasing test results, etc, than they are with patients. Meanwhile, a doctor working in a busy GP surgery talks about an increasing focus on data collection and measurable targets, and worries about a future where patients are reduced to a set of numbers to judge risk.

Bunting also spends time in a charity that helps families of disabled children, and hears about politicians who offer verbal support for the cause of such charities but don’t put this into practice with funding. After a series of heartbreaking conversations with charity workers and desperate families at their wit’s end, this chapter of the book ends with a sobering reveal that a few months after Bunting spent time there, the charity was forced to closed down its services in several cities due to a major grant provider pulling out, with a third of staff losing their jobs.

Labours of Love does an excellent job of arguing that relationships are the key to providing high-quality care, and that we are in danger of losing this in a system increasingly focused on cutting costs and saving time. It might be a tough read for care managers, but it's hard not to empathise with the care workers and others shadowed by Bunting, frustrated and wanting to do more but not having the time or space to do so.

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