Research
You will find a complete range of our peer-reviewed monographs, multi-authored and edited works, including original scholarly research across the social sciences and aligned disciplines. We publish long and short form research and you can browse the Bristol University Press and Policy Press archive.
Policy Press also publishes policy reviews and polemic work which aim to challenge policy and practice in certain fields. These books have a practitioner in mind and are practical, accessible in style, as well as being academically sound and referenced.
Summarising the book’s overall conclusions, Chapter 8 suggests how a gradual transition to free universal care could be achieved in stages. It argues for recognition of the need for much higher care workers’ pay to sustain an adequate workforce, and debate about the complex trade-offs between scope and quality of care services, their reach in terms of needs thresholds, and the extent of support given to intensive family carers. Growing informal support from beyond the family is crucial to helping both them and seniors without close relatives; informal support must engage the wider community to keep up with rising needs. Lower unit costs and better quality of care could be achieved by expanding non-profit provision and outcomes-based approaches. A table lists how an ‘age-friendly communities’ approach could be supported by various components of solidarity action. These address several needs that are rarely covered by formal services. Formal and informal care are complements; there is limited substitutability between personal care from formal services or close relatives, and support from non-kin. Both need to expand. Community engagement with informal care can drive forward a consciousness of the importance of better formal services and political pressure to raise their priority in national budgets.
This chapter highlights a growing gap in the unpaid care system that family care may be unable to meet. The need for care will rise by almost two-fifths up to 2040. For many reasons, informal care may not keep pace. These include the rapid relative growth of the oldest age groups, declining family size, labour market factors and the rising rate of disability among younger generations. Support of younger disabled people is in fact the most rapidly rising element in local authorities’ caseload. All these factors underline the case for expansion of formal care. They also pose the challenges of how to ease carer stress, while sustaining and expanding informal care to keep up with growing need. This invokes the question of how to share informal care more widely, involving friends, neighbours and volunteers in providing support with non-personal care and social/emotional needs.
Suggestions are made for better support for family carers, based on international experience; reforming Carer’s Allowance, greater carer’s leave rights, and possibly a basic income scheme. The ‘substitution debate’ about whether cheaper or free formal care would induce less unpaid care is considered in relation to the Scottish experience of free personal care.
Chapter 1 summarises the overall themes of the book, chapter by chapter. Describing recent trends in supply and demand for care, it then shows how care budgets have not kept pace with the rising number of very old people in poor health, nor the rapid increase in disabled younger adults. Inadequate local authority funding since the financial crisis of 2008/9 has induced rationing of council-arranged care to those in greatest need, with a rising proportion of clients paying for all or part of their care package. Many have started buying care privately, outwith council arrangements. Many more cannot afford care. Shrunken council services mean extensive unmet need. Unpaid carers are caring for longer weekly hours, taking them away from their paid jobs and causing stress and ill-health for many. Several organisations have advocated a free national care service, in parallel with the free National Health Service and inspired by the Scottish policy of free personal care. The attractive long-term aim of universal free care raises many questions about how it should be defined, its affordability and priorities, workforce recruitment and funding sources, which are discussed in Chapter 4.
This book explores the critical issue of how to manage the ever-increasing demand for social care in Britain’s ageing society. With informal care, from family members and friends, now the dominant form of adult social care in the UK, this precarious system is struggling to provide enough support.
Exploring the relationship between formal and informal care, this book develops ideas for a ‘caring economy’, showing the potential to integrate paid-for and unpaid care within a framework of solidarity based on the strengths of the community, working to improve the quality and quantity of state-funded care provision while sharing unpaid support more widely as a community responsibility.
Reducing the need for care is a crucial complement to care reform. It can be attempted through extending the healthy share of the life-span, and reducing barriers to daily living through a more accessible and inclusive social and physical environment. Community solidarity can support preventive health measures through advice and information including digital skills coaching, falls prevention, addressing fuel poverty, encouraging exercise and alleviating loneliness. Local authorities can reduce care demand by addressing poverty and social exclusion, ensuring better housing for seniors, home insulation, less air pollution, more accessible public transport and street or shopping-centre design, provision of community centres, age- and disability-friendly parks. The concept of ‘age-friendly communities’ offers a holistic approach to these measures with an emphasis on giving seniors a voice through co-production. Some local examples are offered here, linking them to the potential of community activism mentioned in the previous chapter. This leads to a vision of an imagined ‘caring neighbourhood’ which would bring together non-profit homecare, social enterprise and community mutual aid in an ‘age-friendly community’ framework.
This chapter describes the types of community project that might help to address the care deficit of coming years. It focuses on mutual aid, assessing its capacity to grow a culture of mutual support between neighbours, and to help build collective projects for supporting family carers and the growth of non-profit social enterprises. Mutual aid is broadly defined here; the examples described include the mutual aid groups of the COVID-19 pandemic period, timebanks and community unions. An example of traditional volunteering, the National Health Service’s Volunteer Responder scheme, is introduced by way of contrast, to show both its potential and its limitations.
Mutual aid groups and timebanks could support the growth of social enterprises, including micro-enterprises and care cooperatives. They can help to run collective services like day centres and lunch clubs. Timebanks share much in common with mutual aid groups, although with some differences. While exchanges of support between individuals have been more prominent in their history in the United States, China and Japan, timebanks’ main function in the UK has been to provide a volunteering opportunity which helps people build supportive personal friendship networks, alleviating isolation, and offering sociable exercise and a sense of purpose.
This chapter considers the scale of unpaid care, who are its givers and receivers, and how it meshes together with formal (paid-for) care. It examines the tiny scale of formal care relative to much larger informal (unpaid) care, ways of measuring the amount of unpaid care and the number of people involved. The volume of unpaid care is only being sustained because more people are caring for very long hours, leading to acute carer stress. Evidence from the growth of the care workforce demonstrates expanding self-funded purchases of care services in recent years. But this has failed to fill the gaps left by shrinking council services; unmet need remains high. Lastly, the chapter examines how the amounts of formal and informal care received vary by whether someone has a partner or children to help; and long-term trends in how informal eldercare is distributed between relatives and non-kin.
This chapter aims to introduce realism and detail into current debates about a universal free care service in parallel to the National Health Service. It considers several questions about what a universal care service would provide; including whether free or more heavily subsidised care should be for personal care only, as in Scotland, or a wider range of support; what level of needs should be eligible for a national care service; should the priority be reducing charges, extending coverage or improving quality; and what would be the fairest way to reduce charges in stages. Cost estimates are provided. These show the huge budget challenge of paying a sufficient wage to recruit and retain enough care workers, posing a trade-off between higher pay and lower charges. The funding needed to transform Carer’s Allowance into a payment for work done is also considered. Several ways are suggested to reduce unit costs, giving examples from local experiences of micro-enterprise, care cooperatives and outcomes-based commissioning. Extra-care housing is suggested as a way to reduce costs of residential care.
Unpaid care, which provides the bulk of care hours, needs to expand at least as fast as the population in need. Considering how to widen the circle of support, especially for isolated seniors and family carers, this chapter shows how friends and neighbours can contribute to helping with mobility needs, befriending and escorting, shopping, housework, and advice on digital communications; things which are often unsupported by formal services. National survey evidence shows how tasks are typically divided between formal care services and different informal helpers; partners, daughters, sons, other relatives and non-kin. Some community voices reported in this chapter illustrate the support needs and concerns of unpaid carers. This leads to an examination of the qualitative and ethical basis for a vision of ‘widening the caring circle’, outlining key values of solidarity – ‘relational care’, ‘politics of compassion’, the ‘commons of care’, mutual support and co-production – which form foundational concepts for engaging the community to address the care deficit. This chapter then attempts to identify the first building block of a ‘caring economy’ – supportive personal networks – and assesses the value of certain community projects like the Southwark and Rochdale Circles which have worked to widen them.
This chapter uses fieldwork data to discuss retirement migration in relation to the social precarity that can result from age-based discrimination. We show how the ageism in our interviewees’ home countries led them to feel excluded or to anticipate this, and how they found that they were valued in their new countries, rather than burdens. Avoiding ageism and social exclusion was not their primary motivation for migrating, but finding that they were not marginalised in their new countries based on their age emerged as an important aspect of their happiness. Further, the apparent absence of ageism mattered regardless of our respondents’ class. We begin the chapter with our respondents’ accounts of being considered burdens in their home countries, which they contrast to their perception of being valued as contributors in their host countries. We highlight the experiences of older women, who feel more visible and safer than they had felt at home. Then, we discuss the advantages retirement migrants have found in residing among age peers. We discuss the internalised ageism that many respondents demonstrate, which we take to suggest that their avoidance of social precarity is, at best, incomplete.
