In 2017, in a surprise TED talk watched by 3.5 million people, Pope Francis addressed the ways in which our futures are deeply connected and dependent on one another. ‘I become an I, through a you,’ the Pope declared. His words echoed the writings of the German philosopher Martin Buber, whose 1920s treatise I and Thou describes the way that we become human through our relationships with and care for each other and the natural world around us. Just as trees stand tall in their individual beauty by entwining their roots with one another, so we as individuals, communities and nations only fully reach our potential within ecosystems of care and support.

This idea that the work of caring for one another is core to our humanity and human wellbeing was well understood by our ancestors. In my own work and practice, I draw on Aristotle’s concept of eudaimonia. Often translated as ‘happiness’, Aristotle’s concept is closer to that of ‘flourishing’. Aristotle argued that we need support to grow and develop and we need a sense of meaning; of our place in the world. For Aristotle, this meaning comes through collective participation in the home, the market place and societies’ wider institutions. In other words, tending to one another and the wider infrastructure that shapes our world is what enables us to flourish.

In the West this understanding of human flourishing has gradually unravelled. Our implicit understanding of human thriving as a collective endeavour in which caring (and our need to draw on support) plays a central role, was replaced by a utilitarian model perhaps best characterised by that rapscallion homo economicus – the individual who realises himself through a ruthless quest to maximise individual material gain. Caring in this utilitarian model would be outsourced, placed elsewhere, out of sight. If we could find a way for others to take on this messy business, so this logic runs, then that is the route to wellbeing.

There were good reasons for this shift, not least the realisation that the work of care – everything we do to maintain, continue and repair our world, our bodies, our selves and our environment– was increasingly not shared, but was racialised and feminised. Falling on women within the household and again on women, and in particular women of colour, within institutionalised welfare systems. Care work, these women remind us, can be joyful and fulfilling. But it is often repetitive, tedious, oppressive and rarely valued either in monetary or any other form. A world in which caring is neither shared nor valued oppresses: it does not enable the carer or the cared for to flourish.

But today I think we see a hunger to reimagine these tensions and to think again. Growing numbers of us want to put care for each other and the environment before money. Attachment Economics, Restoration Economics, the Foundational Economy, the work of the Women’s Budget Group – all this thinking and more represents an enquiry into how we might reorder our economies. The intention is to heal the current split in consciousness whereby we are asked in myriad ways, explicit and implicit, to contribute to the economies of extraction in the hope that invisible others will do the work of repair and care, on which we all depend.

Today we face a binary world that falsely assumes work and care are mutually exclusive spheres. Millions of us live lives of acute stress as we try to manage this border war: the competing demands of caring for small children; friends who perhaps need some extra support; young adults whose minds and bodies are deemed not to ‘fit’, or for our beloved parents. Before the pandemic struck I was conducting workshops across Britain with people from all walks of life: nurses, carers, grave diggers, university professors, nuclear weapon makers and more. All cited this ‘juggle, juggle’ as the single biggest challenge in living good lives. Everyone wanted to rethink the linear working life in new ways that would allow work to be rewoven with time for connecting, learning and caring.

These demands are not new. We stand on the shoulders of decades of feminist scholarship, the activism of disability and carer movements and more recently environmentalists, who understand the ethical connections between care for ourselves and wider living webs. But might this moment – in which the forces of a technology revolution (which is disrupting our work); a looming environmental catastrophe (which must reorder what work counts); and the cruel effects of the pandemic (which have so brutally exposed the fault lines in our existing care systems) – offer us a real chance to reimagine and reorganise?

Work and care: a new relationship

I originally studied history and I have a deep interest in the relationship between technology revolutions and social change. The relationship is not linear: the social gains that have previously accompanied shifts in technology – better health, longer lives, better working conditions – have been hard won and are not irreversible. But the longer run trends are clear: new technology disrupts and creates opportunities for radical social change.

If you had told those who crowded into our cities in the last technology revolution – that of mass production – that they would gain guaranteed decent incomes, paid holiday and a 2-day weekend, you would have been roundly mocked. And yet it happened. I want to suggest that the weekend – that totemic gain of the early 20th century – should be echoed in this century, in a rethinking of the relationship between work and care. Care time should become as normal as the weekend.

Some perhaps – like their early 20th century counterparts – believe such a change sounds utopian. But the lessons from history and from modern-day experiments prove otherwise. Weaving care and work together enables higher productivity and greater life satisfaction. It might also enable us to repair the fragile ecosystems on which our human life ultimately depends.

Let me give you just two examples. The first, from the 1930s when Kellogg’s, the largest manufacturer of breakfast cereals in the world, started a radical experiment: 6-hour working days. Workers at Kellogg’s embraced the change – in the 1930s people assumed that technology would deliver such liberation as the norm, the economist John Maynard Keynes after all had recently written a treatise predicting the 15-hour week. What detailed economic and household studies of the Kellogg’s experience show are two things. Firstly, workers used their time in many different ways, but all recorded their increased health and happiness from having the time for ‘maintenance’; taking care of children, making things from culture to good meals, joining clubs and just passing time together. Secondly, Kellogg’s productivity and profitability rose even though workers were earning the same wages for less hours. Cared for and happy workers were better workers: output rose and industrial accidents fell dramatically.

Such evidence would not surprise modern-day experimenters such as Karen Mattison and Emma Stewart, the founders of TimeWise. Their consultancy is built on a simple premise: if you offer good, part-time, flexible work you will attract a talented, loyal and highly motivated workforce. It is not surprising that, particularly in the beginning, many TimeWise clients were new mothers seeking ways to balance the care of small children with the continuing love of their professions. TimeWise grew in the early years because employers realised they were attracting higher calibre candidates through offering predictable but flexible work: time to care. More recently the gender balance has evened out – after all, fathers also want to care as do older workers and many more. TimeWise are pioneers because they have shown over almost two decades that work and care can be reintegrated so that life and business is better.

The common thread running through the reorganisation of Kellogg’s, the innovations at TimeWise, the words of the Pope and the interventions of activists, is a recovery and reconceptualisation of what it is to be human and to flourish.

Our systems – social and economic – are designed around who we imagine humans to be. Today that imagined human is the solitary, calculating and insatiable homo economicus, already referred to. To create change we need to explicitly recognise that scholarship across the widest range of disciplines tells us that humans are not in fact wired in this rational, individualistic way. This human template no longer fits and must be consciously replaced. It is time to give homo economicus a good death and to replace him with sapiens integra. Sapiens integra works, cares, loves, plays and learns for pleasure. They become who they are in relationship to others, assuming, valuing and making visible whole, connected human beings with our unique aspects, blemishes, affects and defects. We grow, we compete and sometimes we suffer. Sapiens integra is the template around which we can design our new systems.

I am arguing that at a profound level improving wellbeing is not about the design of a great social care system that patches up the gaps where real life should be. It is about turning this thinking on its head. We must think first how to create the conditions for good lives: which means the ability to support and care for one another, across the life span. We can acknowledge that this work is messy, sometimes painful and that its pleasures and pains need to be shared. We must recognise that care is a continuum: we need every-day time that allows us each to contribute, and we need the expertise of professionals working within redesigned support systems. This redesign then does not start within the current system. It starts with this very different understanding of the role care plays within human and natural world systems. This in turn provides the very different principles that can guide and govern the creation of those new systems.

In nature, the new is frequently born through cataclysm: the flood, the forest fire, the ravages wreaked by a storm. Perhaps we can use the current conjuncture in a similar way. We could free our imaginations for just a moment by imagining the death of an institution that exemplifies the impossible boundaries we have placed between every day human care and the service that goes by the same name; an institution that in this pandemic has been the site of so much grief and death: the care home.

The story of a friend of mine may be familiar to you. Shortly before the pandemic made such things impossible, she visited her mother who is frail, elderly and lives in a home where she must be bathed, dressed and fed by others. My friend no longer recognises the wisp of a figure her mother has become. Her mother in turn has long forgotten who her daughter is. This situation is a source of anguish for my friend – let’s call her Mary – who, despite the fact she will not be recognised, makes the long trip from London to the North East on a regular basis, full of love for her mother.

On one particular visit Mary found her mother distressed and in considerable pain: it seemed her tooth had broken. Unable to get a proper look, she suggested to the doctor on duty that perhaps an anaesthetic could be arranged in order to examine the problem without causing her mother distress and address the pain. Oh no, the doctor demurred; the anaesthetic would need to be general and it might kill her.

The care home is a place fraught with complex emotions and contradictions. Few of us can bear to think about the frailty that is inherent in being human. And hardly anyone wants to live within an institution. Our apprehension that we may be moved from our home to ‘a home’ is not only a fear of death – the only exit. It is a fear of loss, of the disruption of life’s natural rhythms. Being dressed in someone else’s cardigan, eating things you dislike, next to people who do not interest you, losing your memory and your mind.

Of course, care homes for older people are only one part of our industrial care system. It surprises many to learn how few of us will in fact reside in such places and surprises even more of us to learn of the substantial care need among younger adults and among the 15 million of us who suffer from chronic health conditions that require active care, as opposed to the medicine on offer. In fact, of those receiving care paid for by their local authority, around a third are younger adults who account for around half of annual funding.

But the care home perfectly symbolises the care system we know today. It is a node in a form of warehousing that is euphemistically called ‘care’ and is on offer for everyone, not just older people. Childcare – another point in this failing system – is also organised according to the same industrial logic. This logic seeks to lower the unit costs in order to increase the scale of production. The answer is low wages for carers and as many young children as possible allocated to each carer. Against the advice of childcare experts, up to eight pre-school children can be left with one adult carer. Policymakers assure us that the carers are increasingly well trained. But no adult, however well qualified, can take eight very small children on a walk or make something with so many tiny hands at once. The activities core to our human development are curtailed.

For older people, and for adults who are cared for within their own homes, the ‘care’ on offer is not much different: you simply find yourself at a different point on the industrial conveyor belt. This is the system that will offer a young person ‘a befriending service’ rather than seek ways to make every day connections to existing friends. It is the system that confuses the practical support adults need to live their lives, with paternal ideas of care provision. And it is the system that leaves notes by the door, reminding the visiting carer – who will rarely be the same person and will have a 15-minute visiting slot – that the white flannel is for the face and the blue flannel is for the bottom.

Care today is not defined by the warmth of human connection or the practicalities of support needed, but by an uneasy relationship between the market place and transactional state regulations. The care home is a place where fortunes are made. It is well documented that too many children’s homes and older people’s homes in the UK are centres of profit: physical assets are wrapped into complex financing structures where taxes can be avoided, and immense wealth is made from ‘flipping’ the assets when the time is right.

Unsurprisingly, given the mismatch between human need and the state/market structures, few can bear to work long in these conditions. In her moving and magisterial study of the crisis of care Labours of Love, Madeleine Bunting writes of her visits to a care home that is well run, ‘…but the quiet routine seemed to amplify the sense of surplus, of unneeded human beings and of unwanted time.’ In the end, Bunting can’t bear to go back, ‘I had retreated, overwhelmed by the sheer scale of human need bursting out of that neat building.’

I have written before of the choice faced by many thousands of health workers, social workers and care workers, between burn out and numb out. Working shadow shifts in different institutions (such as care homes for older people and residential care for at risk young people), I notice the gap between the ‘personal care plans’ routinely referred to by my colleagues and the reality of the person sitting waiting – to be moved, fed, medicated. Bunting describes the ‘distant, bland competence used by the staff, with varying degrees of cheerfulness’. She describes a lack of humanity as a way of coping.

The alternative is to leave. Care is a sector with high turnover rates and an estimated 100,000 plus vacancies. Kelly is one of thousands of carers who cannot bare to stay. ‘My shift was 7am to 3pm, but I would work sometimes until 8pm because I was always behind. Later I discovered that my insurance stopped at 3pm, and after that it was at my own risk.’ Kelly recounts the worry – that she had not done a good job, the pain at leaving people who plead with her to stay just 5 more minutes. She lost weight, took the worries home, stopped sleeping. After 18 months she has to resign. She explains to her manager that this is not care. He explains to her that this is what social services can afford.

In his 2019 film Sorry We Missed You, the filmmaker Ken Loach shows the impact of this form of industrial care work on the care worker’s home and family life: the costly social spill overs that undermine us. Abbie loves her care work and we see her kind and mindful care for those in her charge. We live her long shifts (impossible to fulfil on public transport once she loses her car) and we see how the combined low pay and long hours of her and her husband’s work (Ricky is a delivery van driver) make it impossible to juggle caring for their own children. Supervising homework, noticing when her teenage son runs into trouble, doing the laundry, saving enough money for the electric meter and the myriad more things that are required to maintain family life are out of reach for the care worker. We watch as, in debt and exhausted, Abbie’s once loving home life comes apart in the face of impossible odds.

The low wages that Abbie must endure may contribute to the profits of the private care provider but they create costs elsewhere: the untold personal cost of an unravelling marriage; the significant financial costs to the state through the need for police intervention; the court appearances of her son; the need for school intervention, a truancy service and mental health support.

Too often when we talk about redesigning care, the conversation is about redesigning pathways into and out of these systems. We also talk about how these systems might be better funded. But the reality is that we need to talk about the stuff of care itself and we need to start to unpick and reweave our systems in new ways. This is hard. It requires new stories, new ways of seeing and working, and new forms of data and accounting.

The work and methods of the French philosopher and historian Michel Foucault provide us with one such shift in perspective. In the middle of the last century Foucault embarked on a unique study of institutions. In invoking the death of the care home, I am echoing and inverting one of the most famous of these studies: The Birth of the Clinic.

The Birth of the Clinic is a study of the transformation of a system: a moment in history when disease – which up until the end of the 18th century had been located in the family and the family home (with family members responsible for care) – moves into the medical space of the clinic. Once established, the clinic becomes associated with certain rules and practices. Power becomes vested in the new medical profession whose systems of observation and classification create an almost abstract science that is no longer about the individual human or the wider social context. The contemporary development of statistics played a particular and important role in this new culture and practice.

It’s hard not to see the parallels between the clinic and the care home: a focus on the body, rather than the whole social being; a binary shift from family to institution; a sanctity of the professionals – the ones who know – and the reliance on data and indicators, which officially tell us what is happening – whether the home is clean and the residents are ‘cared’ for, but in fact occlude most of what we want to know: how people are feeling, the quality of human interactions, the balance of power between those in need of support and those paid to offer support.

Foucault likened his historical analysis to archaeology. In seeking to uncover how institutions come into being he was trying to understand and make visible the way certain institutions come to order society in ways that are so deep rooted they are perceived as immutable and beyond question. The procedures and ways of operating of these institutions – the clinic, the prison and I would add the care home – are tightly regulated but seldom questioned. Indeed, Foucault’s studies show that such institutions are rarely reformed even when they have clearly failed. Instead the impulse is to reinvoke or redesign the original, such is the strength of the wider systems of data, regulation and professionalism that these institutions hold in place.

Again we can see the parallels here with the care system and the ways in which plans for deep reform are regularly stalled, ignored or watered down. We can also see the abstraction to which Foucault refers in the striking way in which care debates today are largely conducted without reference to the wider social context: the increasing poverty and widening social inequalities that impact on children’s care in particular. Children in Britain’s 10 poorest neighbourhoods are 10 times more likely to be taken into care compared with their affluent peers. And yet this correlation between poverty and care is not central to current plans for system reform, which continue to emphasise the regulation and practice of the system as if it operates in a social vacuum.

I’m using this comparison because I want to illuminate the way things within the care system that we currently see as disparate: research, data, working conditions, our understanding of risk, of cost, of regulation, even the language of care, are part of a connected way of thinking and operating that can no longer serve us. By invoking the death of the care home, I am not necessarily suggesting we do not need homes, rather I am asking a bigger question about how we might free ourselves from the concepts that no longer serve us in order to think again and to flourish. I’m also situating our need to redesign and reimagine within a particular historical context. We have inherited an industrial system of care. In this century – a new technological era in which we face new challenges and have new possibilities – we can create something new.