Our neoliberal care system trades on the marginalised and vulnerable… it’s time for change

Michael Sandel argues the free market is not just a mere mechanism designed to deliver goods, it also embodies certain values, and the problem is these values ‘crowd’ out non market values which are really worth caring about and preserving, such as compassion’.

Increasingly ‘neo-liberalism’ is up for debate. Whilst well known to economists, politicians, Guardian readers and academics (like me!) it is rarely thought about in wider society. Yet its impact on our society over the last 40 years is immense, many would say for the good, others are not so sure.

For example a report published by Lancaster University  entitled ‘A Trade in People’ clearly expresses the failure of  a neoliberal care system. The report states

‘it is clear to us that the way in which the healthcare economy has been encouraged to develop by recent governments turns people into commodities and liabilities. For local authorities and CCGs they are liabilities that they have often sought to export to other areas and for independent hospitals they are a commodity and source of millions of pounds of income and profit.’

Whilst this report is referring to learning disability services from my experience I think it could also easily apply to a  broad range individuals who require care;  older people, those with mental health difficulties, substance misuse, physical and cognitive disabilities, child care, indeed just about any care need you can think of has been turned into a commodity to be traded and profited from.

This is why I think it is important to be aware of the influence neoliberalism has in shaping our daily lives because it has provided successive governments with a framework to deliver its ideas, ideals, values and beliefs about the world and provides a guide on how life should be lived, how society should be structured and our role in society , along with that of government and the free market. Most controversially for me has been its wholesale export into the realm of health and social care, where ‘care’ has become a commodity to be profited from.

In short it determines the nature and limits of that state, what matters and whom.

There are a number of strands to neoliberalism. In recent years, from a political perspective, successive  governments have used this ideology as a vehicle  firstly, to stigmatising those who require support, just look at the reforms to welfare,  and then to disinvest in the public sector that provides their support, instead promoting open unregulated markets and the transfer public services into the free market.

This has resulted not only in the deregulation and privatisation of publicly owned assets, such as housing, but also the transfer of responsibility for those requiring public services away from government, so when there is a failure in the system, i.e. Grenfell Tower; Winterbourne View; Mid-Staffs, holding someone to account is almost impossible due to a diffused chain of responsibility government has put between it, and the individual, by creating a host of intermediary layers of officials and organisations , such as management companies, contractors and sub-contractors.

A key tenet of neoliberalism is the role of free market in delivering everything from baked beans to iPhones’ and cancer care. The free market is highly valued in neoliberal ideology because it is viewed as a more efficient system in providing goods and services, and promotes individual liberty by empowering society through consumer choice.

Whilst neoliberal ideology has indeed empowered us to upgrade our iPhone at will and purchase cheap clothing and chemically enhanced food, what has this meant for those most vulnerable in society who might require quality  care rather than consumerism?

Whilst an economic and political system premised on the commodification of people and neoliberal theory maybe a reliable form of wealth generation for some, it is also associated with little compassion for those who require support, as well as structural inequality and poverty for many.

Nobel prize winning economist Joseph Stiglitz is clear, we are now engaged in a battle which is ideological, describing free market neo-liberalism as  a stifling economic ideology which has run it course.

Neoliberalism has an insidious presence in our lives, much like the air that we breathe, everywhere, yet unseen. George Monbiot  provides a compelling argument against this ideology, which values the free market as the place in which citizens can exercise their democratic choices through consumer choice and the private provision of goods and services.    Supporters of neoliberalism maintain  “the market” delivers benefits that could never be achieved by government, and that the more unregulated the market, the better the efficiency. Within this framework everything we do, and every person is a potential commodity that can bought, sold and traded for profit.

However, for me,  the free market  is associated with a loss of compassion, dignity and respect for one another as an inactive state projects structural failure onto the individual, along with an outdated mantra of ‘private sector good, public sector bad’.

One need not dig too deep to see the flaws within the current system. The research by Lancaster University adds to a plethora of  reports, all stating the same thing. This system is broken!

Just consider  housing and the care of older people to establish the limits of the free market.

Shelter’s report on the barriers low-income households face in private renting exposes the private housing  market’s limitations,  clearly arguing significant government intervention is needed if it is to play an expanded role in preventing homelessness and housing people on low incomes.

The same issues arises in the care of older people, where significant market failure is a continuing problem.

Over two years ago the King’s Fund  highlighted what many in the sector already know, the free market is failing stating

‘Social Care is now a complex and sprawling sector – more than 12,000 independent organisations, ranging from big corporate chains to small family-run businesses, charities and social enterprises, which makes the NHS provider landscape look like a sea of organisational tranquillity. Less than 10 per cent of social care is actually provided by councils or the NHS – their retreat from long term care provision is virtually complete. But unlike the NHS, when a social care provider hits the financial rocks, bankruptcy not bail-out is the more likely scenario.  But a deeper problem is the failure to think through the consequences of shifting the bulk of our care provision to a private business model’.

This is supported by  Andrew Dilnot , former drector of the Institute of Fiscal Studies, who suggests social care is is a classic example of a market failure where the private sector cannot do what’s needed.

However, the effect of the failure of the free market and neoliberal ideology extends beyond money,   the real effect of failing markets rests upon the poorest and most marginalised in society, like the  residents of Grenfell Tower and those with social care needs in private institutions, the frail and vulnerable who require support.

The problem in government today is that many of those who govern this country are woefully out of touch and too quick to blame individuals for their descent into a commodified system of care, and those who provide care, rather than look at their own role in creating a a system of care that has no space for compassion, whilst those on the frontline still fight to demonstrate, and deliver, care with compassion, dignity and respect in an increasingly brutal system .

Michael Sandel argues the free market is not just a mere mechanism designed to deliver goods, it also embodies certain values, and the problem is these values ‘crowd’ out non market values which are really worth caring about and preserving, such as compassion’.

Where values and ethics are weak in any system which seeks to support those in need, we need a strong and active state to intervene, where both are weak those most vulnerable in society will continue to be denigrated and exploited.


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