Introduction

Care occupies a complicated position in the welfare state. There are many groups that are commonly recognised to be to a greater or lesser extent dependent and in need of care – the young, the old (especially frail older people), and people with disabilities – but many would argue that all healthy adults require care, emotional if not physical. Care may be informal, with family members, kin or neighbours delivering it, or formal, with care taking place in an institutional setting; it can be paid – even neighbours and family carers may be paid – or unpaid (as is usually the case with informal care); and outside the family it may be delivered by the public, private or voluntary sector. There is no avoiding the issue that carework, wherever it takes place, in the family or institutions, is profoundly gendered. The responsibility for the vast majority of unpaid carework rests with women, and they also form the vast majority of what is in all western countries, to a greater or lesser extent, a low-paid formal care workforce.

Care is hardly a new issue, but it is new to the political agenda. This is in large measure due to the major changes that have been taking place in the relationships between families, labour markets and states (examined in Section 1). The changes are sufficiently dramatic to warrant new thinking about care and carework, and care accounts may have a part to play. But I argue that, given the nature of care and carework (Section 2) and the existing policy inheritances and logics (Section 3) it is unlikely that care accounts can be a major part of the answer (other than possibly in the US) (Section 4). In particular care accounts make two related claims that I call into question: first for the importance, possibly superiority, of cash provision over services, and, second, the opportunities that they present for exercising greater individual choice.

Why care has become a major issue for welfare States

It is perfectly possible to interpret the development of modern social policies as being centrally concerned with care needs (Jenson, 1997), whether for health care, or cash support in times of sickness or unemployment. However, this is ahistorical; provision for care has not been the stated aim of social policies in 20th century welfare states.