So the party that has objected to the nanny state for so long is now proposing it in quite literal form — Cameron and Co announced last week that they want to provide a maternity nurse for every household, if only for seven days.
Actually, we have been here before. It was not that long ago that the Tories were looking at Nordic plans for subsidised parental leave. But now it is the Dutch, apparently, that we must all emulate, while they must endure a fact-finding visit from shadow Tory ministers Michael Gove and Andrew Lansley. They will then, no doubt, subject the nation, via Newsnight, to eager perorations on the wonders of state support for young mothers. They will be keen to stress how cheap the scheme is, with initial costings of just £150m a year, to provide help for the estimated 340,000 new mothers.
Care for all, from cradle to grave — that was the early shimmering promise of the post-war welfare state, a distant sounding pledge in these cash-strapped, marketised times. Cameron is to be praised, at least, for making the moral case for proper early years support.
But it is just a touch too easy for the new-look Tories to concentrate their policy firepower on parenting when the acknowledged crisis in the welfare state is clearly at the other end of the life cycle. It's not hard to see why: rosy-cheeked children are a politically sexy issue; dribbling pensioners are not.
Experts on this issue accuse us all of turning our faces from a looming catastrophe. More of us are going to live much longer but, as we age, one in five and one in four of us are going to suffer minor and major health problems, respectively.
While the ever-stressed NHS still provides free care at the point of use, that care stops dramatically where ‘medical’ intervention shades into social support. Some recent reports underline the longer-term warnings. Only last week, junior health minister Ivan Lewis announced an independent inquiry into the massive discrepancies in local authority help available to elderly people.
According to a separate report from the Commission for Social Care Inspection, 73% of local authorities plan to refuse care to people whose needs are not considered to be ‘substantial’ or ‘critical’. Currently, 281,000 older people in need get no aid in life-sustaining tasks, and another 450,000 receive insufficient assistance.
Lewis is to be congratulated for doing the politically risky, even unpopular, thing, in at least acknowledging that there is a grave problem. He is to be less praised for issuing the usual disingenuous central government strictures concerning ‘local authorities living within their budget’, as if the problem were red tape, not resources.
Many local authorities simply don’t have the money to provide social support to all who are eligible to receive it. Lewis also fails to acknowledge that meaningful reform requires more from central government.
New Labour plans a ‘new deal for carers’ in the spring; sounds great but there will be no new spending attached. Similarly, plans to review and reform ‘eligibility criteria’ risk, in the neat formulation of Age Concern’s Brendan Paddy, providing ‘more consistency, yes, but care that is consistently not good enough’.
Almost everyone in the field agrees; social care for elderly people requires fundamental reform.
Consultation is under way for the green paper due out in the summer. Here, the dire warning in Sir Derek Wanless’s report is uppermost in everyone’s mind — in 20 years’ time, it will require £14bn extra per year just to keep the current system staggering along.
So what should be in its place? Scotland’s Utopian proposal for free care for elderly people has already run into trouble, with a £63m shortfall recently announced, and the country’s services showing similar discrepancies in provision to England and Wales.
A more realistic model, backed by Wanless, Age Concern and, since last week, the Liberal Democrats (who had previously supported a ‘free’ service along the Scottish lines), is for a partnership model: a sharing of costs between state and individual.
The most encouraging element of this proposal is that all citizens would be granted an acceptable ‘minimum standard’ of care, a universal pledge, cutting away at a stroke the postcode lottery problem. It would then be up to people — or their families — to top up or tailor care, if they can.
Not perfect, but vastly better than vastly uneven and unequal treatment.
But even this proposal does not get away from the need to increase overall funding. Care for elderly people needs significant investment along the lines of the NHS, if we are to deal with the looming crisis.
Like the recent pension wrangle, it is time we squared up to both the demographic realities, and the political challenge (sexy or not) of granting millions of citizens substantive support in their old age.
