Gale's View - Social Care and Healthcare
September 9th 2021
For far too long successive Governments of all political persuasions have failed to constructively and definitively address the related issues of social care for the elderly and the disabled and healthcare at both primary (GP) and Secondary (Hospital) levels and to find the means to adequately if not generously fund both.
The present Prime Minister therefore deserves at least one cheer for trying to grasp this nettle. The problem is that he has painfully grasped the leaves rather than the roots and in conflating the demands of social and health care and then trying to railroad his prescription through the House in in a hurry I believe that he has in haste laid the groundwork for policies that we shall repent at leisure
Not that we have time to waste. There is , caused by the demands of the pandemic, a truly daunting and still growing backlog of patients awaiting diagnosis and treatment and it has to be the case that in preventing the NHS from being overwhelmed and the saving of the lives of many suffering from Covid 19 we will have sacrificed the lives of others who might have been saved had they been treated sooner. Time is therefore of the essence. It is going to cost a very great deal to clear the backlog and, given the shortage of medical and ancillary staff at every level, a quick fix is not realistically on the cards. Project ‘Clear The Decks’ is going to cost shedloads of money and that money has to come from somewhere and that somewhere is through the only source available to any Government: taxation.
As a traditional low-tax Tory I nevertheless have no problem is saying that taxes are going to have to rise. When the economic landscape changes dramatically as, because of the pandemic it has, then policy has to change with it. The Prime Minister was right to say that “Covid 19 was not in the election manifesto either” and it is cheap politics to try to hold him to account for undertakings given in a very different `pre-war` world.
That said, it is the way in which the necessary funds are to be raised and then dispensed with which I have great difficulty. I do not accept that using an increase in National Insurance in a manner which will inevitably hit hardest some of those on low incomes – including nurses and hospital ancillary and care staff – and then trying to present that tax rise as an `NHS levy` is either fair or honest. If we are to raise taxes because we must then let us be open and straightforward about it and raise income tax and if necessary corporation tax and not try to use smoke and mirrors to seek to disguise that tax rise as something else.
Then there is the `confusion` over the way in which funding the £36 billion raised through tax rises over three years to clear the NHS backlog will, after three years, then be whisked away and committed to social care. Really? Are we seriously saying that the Social Care sector can wait until 2024/5 before receiving the money that it needs now? And are we suggesting that, were that to happen, it would not be perceived as a cut in NHS funding.? People may want `more` but they always complain the most bitterly when something that they have is taken away from them. It may have been politically expedient to tie the `NHS levy` in with Social Care for the purpose of political presentation and getting these measures past the Tory backbenches but let`s not try to pretend that it solves the problem. It does not and I think we would have been better off concentrating all of our firepower and tax hikes by whatever means on meeting the immediate needs of the NHS while taking a little longer to resolve the matter of social care.
Let us be clear: the social care proposals are unlikely to preserve the assets of the thrifty for onward transmission to children and grandchildren in the manner claimed. Hidden if not camouflaged in the “Build Back Better” plan for Health and Social Care is the revelation that there will be a cap on personal care costs. Only. That cap does not extend to the `hotel` costs of those receiving residential or nursing care and those costs of accommodation and food add up to a considerable amount of capital. It will take some time for the personal care costs to reach the proposed £86,000 cap on charges, during which time and afterwards the `hotel` costs will still have to be met out of personal resources.
For all of the fanfare the deal offered in respect of Social Care is not the answer. There has to be a solution that overcomes the imbalance between total costs met by the NHS in hospital and zero care contributions from health budgets towards those suffering from, for example, Alzheimers` Disease in residential care. The adoption of a model based upon Government-underwritten insurance and/or a mandatory contribution policy (as with occupational pensions) accrued over a lifetime of work, a system adopted in various forms by a number of developed countries, has to be a better response to a very real and growing problem.
Over the coming weeks and months, the Government`s policy will be set out more fully and I suspect that the devil will be in the detail. I did not vote for the “Ways and Means” resolution this week because I am not satisfied that we have yet got this right: whether I support the emerging measures in the future will depend upon that detail.