ILC: PSI Win for Care as State Responsibility: Global Labour unites to oppose PPPs

The Outcomes Document recognizes the state’s primary responsibility to deliver care services and acknowledges that care work is not a commodity: a significant win for PSI and the wider Global Labour movement which united around these demands.

However, the Outcomes Document also promotes Public Private Partnerships, which consistently undermine the delivery of quality public services across the world.

During the General Discussion, Global Labour coalesced around PSI positions across the following key principles:

1. Care is a human right.

2. Care is a public good.

3. The commodification of care is driving the privatisation of services where profit is put ahead of workers, service users and wider societal well-being.

4. Migrant and informal care workers such as community health workers and domestic workers deserve decent work and access to social protection.

Our affiliates shared their experiences of how the crisis in the care sector existed well before the pandemic struck. They outlined how how the expansion of private care services will lead to further exploitation of care workers and poor outcomes for service users.

We secured key outcomes on ensuring decent work for care workers such as access to collective bargaining, freedom of association, the elimination of discrimination and occupational health and safety.

We secured the inclusion of the State being the primary provider of care services and the need for a robust policy and regulation framework.

However, as the ILO prepares a Plan of Action for implementing the General Discussion conclusions, workers and unions globally need to remain strong and united to push back against the false promises of Public-Private Partnerships (PPPs).

Commercialization of Care isn’t the solution to the care crisis - it’s the cause of it.

Cash-starved governments are often led to believe that Public Private Partnerships could be a cost effective way to deliver care services, for which they are responsible. Yet around the globe and across sectors, PPPs and privatizations have consistently failed to deliver on promises, put profit-making ahead of people and cost states more than they would spend via direct provision.

A recent study by the University of Oxford Lancet found hospitals that are privatised typically deliver worse care with higher mortality rates after converting from public ownership and that increased profits were made by reducing staff levels. An international analysis of PPP projects by Eurodad found that 90% of PPPs lacked transparency and/or failed to consult with affected communities, and undermined democratic accountability.

There is no evidence to suggest that more PPPs in the care sector would create positive outcomes for workers and service users.

Those who will actually benefit from the promotion of PPPs are the same corporations which have been shown to consistently put profit-making ahead of providing quality care. Like in France where the Orpea care home group has been accused of profiteering through a range of abusive practices including systemic understaffing and the rationing of food and healthcare products for elderly residents. These are not the sorts of actors that the ILO or any government should be promoting partnerships with.

While care services are overwhelmingly provided by women, its a small group of ultra-wealthy (mostly male) investors who make large profits off the back of their work. One example is Forrest Preston, owner of Life Care Centers of America, who has extracted over a billion dollars from his care homes. For an average American care home worker to earn that much they would have to work for 33,000 years.

Meanwhile research by CICTAR shows many of the corporations which claim private finance is necessary to fund care services are engaged in tax avoidance which deprives us of very the funding needed for stronger public care systems. Tax havens currently cost our governments over $500 billion per year in lost tax revenue.

As Phillip Alston, the UN Special Rapporteur on Extreme Poverty, states, “Ever-greater reliance on the private sector to defeat global poverty, whether through PPPs or philanthropy, is a blind alley. This trend represents an abdication of responsibility by governments and international organizations.”

We are glad the ILO has acknowledged that labour in the care economy – like labour every where - is not a commodity. But we must not endorse the abdication of care as a public responsibility. As stated in the outcomes of the General Discussion we must continue to fight for the State to be the primary provider of care services to ensure quality care and decent work for all care workers.

The social nature of care means it must not be commodified, commercialized and designed to generate profits for the wealthy few at the expense of the rest of us.

PSI calls on the international trade union movement to be more united than ever in opposing the commidification of care, including through PPPs. We will strengthen our global alliances with the feminist, human rights and economic justice movements to fight to rebuild the social organisation of care as one of the pillars of social justice, including gender justice and decent work.

Care is a public good. It’s time to treat it as such.