The dementia tax row: a sorry spectacle

The Twitter hashtag #dementiatax has been haunting the Tory Party ever since it announced it would make more people pay for their social care if it gets re-elected. The Tories had said that older people would pay for their care costs if they had assets of more than £100,000. On top of their plans to means-test the winter fuel allowance and end the so-called triple-lock on pensions, this was widely seen as an attack on the old.

A flustered Theresa May was forced into a u-turn, announcing that the amount anybody would be expected to pay for social care would be capped (she didn’t say by how much). This was just days after the social-care shift had been launched as a flagship policy. The Conservatives’ commanding double-digit lead in the polls was reduced to single figures over the course of a weekend, as those older, more affluent voters otherwise minded to vote for them had second thoughts.

From the start, the policy was being presented as an attempt to address the fact that wealthier pensioners were being subsidised. On the day of the launch, health secretary Jeremy Hunt was insistent that the £35,000 cap proposed by the Dilnot Commission – which is favoured by Labour – would unfairly favour the wealthiest, with the cost falling on the taxpayer. Ben Chu, economics editor at the Independent, concurred: ‘It’s a strange world we live in where the Tory prime minister scraps a subsidy for wealthy families and Labour complains that it’s terribly unfair.’

There will be two million more people aged 75 and over in the coming decade, and three quarters of them will own their own home. Without drawing down on those assets, argued May, ‘the social-care system will collapse’. ‘These are good and sensible plans – they provide the beginnings of a solution to social care’, she insisted. But others disagreed. As the King’s Fund argued, the policy would put an increased burden on the health service, family members and residential care, as people would refuse help at home for fear of the cost.

There is an in-built unfairness, as commentators have spotted, in the system as it is. Cancer treatment is provided free of charge on the NHS, while dementia sufferers are made to pay potentially very large sums of money for their care. If we ever solve the housing crisis and build enough homes to meet demand, prices will fall and leave the funding regime on even shakier foundations. But internal Tory politicking and a failure of leadership has also played a part in this controversy.

Former chancellor George Osborne, in his new role as editor of the Evening Standard, mischievously tweeted moments before the prime minister was due to speak: ‘U-turn coming on social care. There will be a cap.’ While May was insistent that ‘nothing has changed’, it was obvious it had. A policy offer aimed at saving £2 billion – if you include means testing of winter fuel payments – was swapped for something that could cost as much as £2 billion, all thanks to a panicked tweak aimed at pacifying those with assets to lose.

Whether or not this was a calculated risk – taken because May is more or less assured a bigger majority on 8 June – it has done her considerable damage. It has only affirmed the perception that May’s inner circle of special advisers are making up policy as they go, shielding her from the country and colleagues alike. If it wasn’t for the intrusion of the awful events in Manchester, the scrutiny would have intensified. This sorry episode has confirmed that the prime minister’s political instinct is to run and hide rather than debate.This doesn’t bode well for Brexit negotiations, as critics have rightly pointed out.

But all sides need to raise the level of debate. Jeremy Corbyn wrongly claimed that the so-called dementia tax would ‘leave thousands of the most vulnerable at risk of losing their homes’. But the cost would be deferred until after the individual had passed away. ‘If you or your loved one has or will get dementia, they are coming for you’, said the Liberal Democrat leader Tim Farron, in a none-too-subtle attempt to scare older folk into voting for him.

All sides should stop taking opportunistic potshots and propose a way out of the social-care crisis. This is a longstanding problem that has been kicked down the road again and again. At least, as coverage in the Guardian put it, ‘May’s advisers decided to grasp the nettle’ and have a go at ‘resolving one of the most pressing challenges in British public policy’. That they then bottled it is regrettable. Not because the policy was necessarily the right one – a pooling of risk through a system of social insurance would make more sense – but because it meant they made things so much worse.

First published in spiked

Nothing great about the welfare state

In The Welfare of Nations, the decade-later follow-up to his The Welfare State We’re In, James Bartholomew – former leader writer for the Daily Telegraph and the Daily Mail – takes us on a tour of the world’s welfare states.

It’s fair to say he isn’t a fan. He argues that the welfare state undermines old values and ‘crowds out’ both our inner resourcefulness and our sense of duty to one another – including our own families. Instead of aspiring to be self-reliant, the welfare state makes us self-absorbed. People aren’t encouraged to exercise responsibility anymore; instead, they are handed a plethora of ‘rights’. Welfare states ‘have diminished our civilisation’, Bartholomew concludes.

The welfare state has always been a problematic entity, from its modern beginnings in the nineteenth century with Bismarck’s cynical ‘state socialism’– built as much to placate the increasingly politically active masses as to attend to their welfare – to the vast systems maintaining millions of economically inactive citizens across the world today. The welfare state, as its advocates contend, always promises a better society, with higher levels of equality, but, as Bartholomew counters, it also tends to foster unemployment, ‘broken families’ and social isolation.

Some versions of the welfare state are better than others. Wealthy Switzerland has a low unemployment rate despite generous social insurance-based benefits. But, at the same time, the Swiss state imposes tough conditions: there’s no minimum wage and workers can be fired on the spot. Sweden’s benefit system is generous, too, but if you can’t afford the rent on a property, you have to move out.

In the UK, matters are equally complex. For instance, shared-ownership schemes, ‘affordable housing’ and planning regulations contribute to distinctly unaffordable house prices. Indeed, housing costs have risen from 10 per cent of average UK household income in 1947 to over 25 per cent. For the poorest sections of society, it is worse still. This is despite the fact that the state subsidises dysfunctional, workless households on bleak public housing estates.

And what of state education? Nearly one-in-five children in OECD countries is functionally illiterate. The best performing advanced countries have autonomous schools, ‘high stakes’ exams, quality teachers and a culture of discipline and hard work. Compare that to the US, where you can’t get rid of bad unionised teachers in the state schools.

Bartholomew convincingly argues that state schools’ ‘shameful’ inadequacy, for all the rhetoric to the contrary, breeds inequality. He fears that the success of the free- and charter-school movement is at risk, too, from ‘creeping government control’. Bartholomew is upfront about his own old-fashioned conservative views. He’s a kind of evidence-based Peter Hitchens, using ‘bundles of academic studies’ to show what he suspected of the welfare state all along. The care of ‘strangers’, he argues, is bad for children and aged parents alike, and damages the social fabric. Over half of Swedish children are born to unmarried mothers, whereas the family in Italy, he says approvingly, is ‘the main source of welfare’, with charity-run ‘family houses’ (no flats or benefits) for single mothers. At a time when Conservatives aren’t really very conservative, it takes Bartholomew to ask important questions about social change.

Again, southern Europe offers a useful contrast to the situation in northern Europe. Over half of single people aged 65 or over in Italy, Portugal and Spain live with their children. Just three per cent of single Danes do. Should individual autonomy trump the burden of caring for children and family members? What role should the state play? UK social workers are office-based, writes Bartholomew, and contracted care workers follow ‘rules rather than doing things from an impulse of loving care’.

By 2050 over a third of the European population will be aged over 60. Even though the age at which people are eligible for pensions is increasing, state pensions can’t be sustained, says Bartholomew. In Poland, Greece and Italy, pensions account for more than a quarter of public spending. The UK spends nine per cent of its national income on healthcare, the US an insurance-fuelled 18 per cent, and Singapore just five per cent (though Singapore has to put twice that into ‘personal’ health-savings accounts). ‘Wealth leads to better healthcare’, says Bartholomew, but the monopolistic UK system, despite the NHS’s officially cherished status, is one of the worst of the advanced countries for health outcomes, including, for example, cancer-survival rates. ‘Obamacare’ notwithstanding, millions of uninsured Americans – neither poor enough for Medicaid nor old enough for Medicare – struggle to pay for healthcare.

Democracies, says Bartholomew, are susceptible to the fantasy that welfare states can solve our problems without consequence or cost. This is despite US public spending increasing from seven per cent of GDP in 1900 to 41 per cent of GDP in 2011. In 2012, France revealed that public spending accounted for 57 per cent of its GDP.

But it’s Bartholomew’s critique of the wider welfare culture, rather than his carps at benefits systems, which provides an important corrective to what can be a narrow and mean-spirited discussion. He also offers practical solutions: let’s increase housing supply but abolish public housing; let’s have a system of ‘co-payment’ for healthcare between state and individual; let’s allow schools and hospitals to compete in markets; and let’s give individuals the opportunity to save and insure themselves to pay for social-care needs and pensions (albeit through Singapore-style compulsory bank accounts).

So what do we do with the welfare state? As Bartholomew puts it, the welfare state, rather than capitalism or communism, was ‘the ultimate victor of the turmoil of the twentieth century’. But Bartholomew makes clear that this is a hollow victory with many millions left idle and communities undermined. So yes, let’s cut the welfare state down to size and stop infantilising its dependants. But we also need to get more ambitious than Bartholomew allows. He thinks it’s too late to get our freedoms back and argues for a minimal ‘welfare’ state only. But why stop there? If the architects of the welfare state have anything to teach us, it is to be bolder in our visions.

First published in sp!ked

Care in the community is vital to help pensioners and disabled people

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THE Care Bill is a bid to tackle the agreeable problem that we live in a society where more people are living for longer.

It sets a cap on what people will have to pay for their care and a minimum threshold of need at which people will be eligible for social care.

But the critics are not hopeful. There is the demographic challenge, the slashing of budgets and concern that the reforms will bankrupt local authorities without necessarily making care any more affordable.

This is where community comes in. The idea is that communities have an important role to play in supporting old people. As former Care and Support Minister Paul Burstow says, “without community, independence can become miserable isolation”.

While we might expect care workers to have regard to the person they are caring for, they can’t take the place of neighbours, family and friends.

Norman Lamb, the current Care and Support Minister, has therefore proposed the setting up of Neighbourhood Watch-style schemes. But can we really expect people to act in a neighbourly way? Negligent, if not downright abusive, neighbours are apparently responsible for the loneliness and isolation experienced by many pensioners.

Health Secretary Jeremy Hunt has referred to this as our “national shame”.

He argues that, instead of putting our elderly relatives in care homes, we should adopt the “reverence and respect” towards the elderly typical of Asian societies and, presumably, accommodate them ourselves.

But can we put our trust in our families and communities when local authorities too, in an effort to appear pro-actively protecting ‘vulnerable’ older folk, would rather give the impression that we are routinely abusing them in their own homes?

Despite these mixed messages, most of us understand that our communities are, on the whole, safe and caring places. But community is all about relationships and these are made possible by a good degree of mutual trust.

This trust is being eroded by the obsession with alleged abuse and neglect on the part of the authorities.

Confirming people’s worst fears is hardly conducive to building a sense of community. Indeed, the interventions of supposed protectors of the vulnerable represent the biggest threat to community, by actively undermining the relationships that underpin it.

Communities really can, and often do, play a safeguarding role towards those who, as a consequence of old age, ill health or disability, may need support.

While an unburdening of the state and a reburdening of communities is no answer to the elderly care problem, there is much to recommend the idea that neighbours, by looking out for each other, can safeguard vulnerable people.

First published in Derby Telegraph

Early Intervention? Why not No Intervention?

BigbenLast week I attended the launch of The Deciding Time published by the Early Action Task Force. Early Action – usually referred to as Early Intervention – has a good deal of support in official circles.

Indeed, not only did the debate take place in Westminster but none other than Louise Casey, Director General for Troubled Families at the Department for Communities and Local Government, was there to respond to the report. I confess my own position isn’t one of enthusiasm. Though I found Casey surprisingly engaging – and oddly endearing – with her no nonsense case against the ‘liberals’ that dominate in welfare and social care circles; like many who hold to orthodox opinion about the supposed need to intervene in families to arrest their spiralling intergenerational decline, she was far less controversial than she imagined.

Like I say, she got a number of things right. ‘There is nothing wrong with being judgemental’ insisted Casey, presumably hoping to pre-empt the frankly none-too-apparent outrage of the invited audience. That is what we ask social workers to do all the time, she quite rightly said. While I am no fan of the dubious grounds on which families are disrupted and potential carers refused the opportunity to start new ones; where there is cause to intervene it should be done with the not insignificant authority that the law allows. As I’ve commented before it is the failure to act on that authority rather than the stock-diagnosis of professionals not ‘working together’ that is so often to blame when things go wrong.

But that doesn’t make the case for earlier intervention or more intervention, just better intervention. Indeed I would argue – as I did with Casey at the launch – that the problem isn’t one of when to intervene but of whether to intervene at all. Whether its with regards her current brief or her previous high profile roles as head of the Respect Task Force and before that director of the Anti-Social Behaviour Unit; she has made a career of responding to problems caused by too much – not too late – intervention. Rather than quibbling with the timing, something for which the evidence is at best mixed and the grounds for doing so evidently illiberal, wouldn’t it be better not to intervene at all?

Now I confess in my own modest career working in the public sector I too have worked on an early intervention or prevention project or too. They’re hard to avoid in my line of work. But they don’t have to be illiberal. Actually, I think the approach can be defended up to a point. For instance, working with older people who may be at risk of being accommodated into a health or social care setting – with all of the attendant loss of independence and the expense involved in providing that more intensive care and support. If it is possible to find ways in which they might be able to continue to live in the community with a little more support – whether its insulating their home from the cold, arranging for somebody to pay them a regular befriending visit, or getting adaptations fitted in their home so they are less likely to trip and fall – then that is a good early intervention in my book.

Having said that, even then, because we live in a culture of presumed vulnerability and incapacity that is only amplified in the health and social care sectors, there is the danger of over-identifying needs and deepening levels of dependency; rather than encouraging people and the communities of which they are a part to fall back on their own resources or become more self-reliant. While public services are often dysfunctional and if not under-funded certainly badly targeted, it is important to get that relationship between state and society right. It is all too easy to undermine people’s confidence or sense of responsibility for themselves by intervening too much – something that welfarism, ‘troubled’ families policy and social care provision are blatantly guilty of.

So while the issue of how to use scarce public resources more wisely to support those who need it is very important, and The Deciding Time is a contribution to that discussion worth engaging with; we need to acknowledge first of all that investing in the greater public good can sometimes be as much about withdrawing state support for those who don’t need it rather than necessarily doing those interventions sooner or even differently. Whatever policy makers do they need to be sure that they don’t create more problems for society than they solve. As I said to Casey that’s how we got into this mess.

One in Four? Tip of the iceberg

First published in Huffington Post

It’s the favoured statistic of fear-mongers everywhere. 1 in 4 of us will experience a mental health problem in the course of a year. 1 in 4 women will experience domestic violence at some point in their life. In the United States, according to one campaign group, 1 in 4 college women have survived rape or attempted rape. According to another group, 1 in 4 people in Ireland experience sexual abuse. And in the UK too. As the aptly-named One in Four UK has it: ‘Research has consistently shown that one in four children will experience sexual abuse before the age of 18’.

Research? I objected this weekend to an item in which a necessarily hysterical spokesperson for the child protection lobby repeated this ‘research’ in the context of the ongoing Savile witch-hunt. The implication being not only that abuse is very prevalent but that it is of the vile predatory paedophile kind. Of course, as I hope most of us realise, neither of these things are true. The after-the-fact pursuit of Savile, an allegedly despicable pervert who after his death looks every bit the dirty old man, has only confirmed the no less perverse dynamics brought into being by child abuse hysteria. Still one Twitter-follower objected – and maybe not all that unreasonably given the disorienting climate of suspicion – ‘if you know the real figure (as you clearly think you do), now would be a good time to share it’. Which I did. You see while I would prefer to trust that most of us don’t suspect our friends and family of abusing their kids, there comes a time when you have to counter a bad stat with one that has some substance to it.

So here goes. At the end of March 2011, the latest period for which the Department for Education collects statistics, there were 42,700 children in England subject to a child protection plan. That is 42,700 children out of a mid-2010 total estimated at 11,045,400 0-17 year olds. If you do the maths that comes to 0.38658%. You may have noticed that this is rather less than 1 in 4. But what does being subject to a child protection plan, or what used to be called being on the child protection register, actually mean? It means that local authorities are sufficiently concerned that a child may be at risk of neglect or abuse that a social worker and various other professionals are investigating the case to decide what, if any, action to take. And what is meant by abuse? In most cases (42.5%) there is a strong suspicion of child neglect rather than abuse per se; most other cases being one’s of suspected emotional abuse (27.3%) or physical abuse (13%). The DfE Statistical Release doesn’t even mention sexual abuse as a category. Such is its rarity.

Just to be clear. Far from confirming the much-cited 1 in 4 rate of child abuse, the DfE figures show that less than half a percent of children in England are even suspected of being subject to neglect or emotional or physical abuse. And there is an even smaller chance that they are suspected of being sexually abused. No doubt child abuse campaigners will argue that this is just the tip of the iceberg. They always do. Or maybe, like the campaigners against domestic abuse, they will claim that the definition of abuse isn’t wide enough. As I might have said to my Twitter-critic even when you do have the evidence with which to rubbish the dodgy stats produced by those who have already made up their twisted minds; it won’t convince them. The cultural imagination that produces the kind of Savile-related hysteria we have been witness to over recent days and weeks is deeply ingrained. Having the facts on your side is only one part of the battle. The other is to ask why influential sections of society find it so easy to believe 1 in 4 of our children are being abused in the first place?