Yesterday we saw yet another report on yet another scandal involving neglect and abuse of frail older people. I suspect many of us lucky enough not to already be in the system try to ignore such stories as they only feed into our fear of having to care for our own loved ones when they can’t cope or needing such care ourselves. As a society we seem simply to have given up on the idea that people should be provided with dignity and a reasonable quality of life at the point when they are most unable to meet their own needs.
Instead we mutter something like ‘I hope someone will put me out of my misery if I ever get like that’ as if the prediction - probably mistaken – that we will want euthanasia somehow relieves us of culpability for the profound scandal going on around us today. And it’s getting worse. Without urgent and concerted action there will without doubt be many more stories than none of us want to read, including large scale care home bankruptcies and, I fear, cases where older people – and sometimes their desperate and vulnerable carers – have, in effect, simply been left to die.
There are three distinct but mutually reinforcing dimensions to this tragedy. Despite population ageing, social care for older people is still a relatively small part of public spending, less than £10 billion in England including both the costs of care and the two major care related benefits. Yet with the extra money needed to make a big difference modest, we persist with squandering public money on a range of universal benefits and tax breaks for relatively well-off older people.
The granny tax episode following George Osborne’s budget was an utter disaster. The Chancellor could have done much better in communicating the rationale for equalizing older people’s tax allowances and it might also have been wise to make some link between this measures and some further funding for older care. But Labour ’s opportunistic exploitation of the issue was also low-grade politics which may come back to haunt the Opposition. In the longer term decisions about implementing some version of the thoughtful and fair conclusions of the Dilnot Commission have yet again been deferred.
Behind the immediate policy issues a deeper problem is the general trend of policy, which is to shift power from the central state to localities and individuals (preferably, using market based mechanisms), does not fit the nature of the challenge. On the one hand - perhaps because we find the whole prospect of ageing depressing – most people simply don’t plan properly for their futures. This is one reason why the Government’s proposal to make state-backed care cost insurance voluntary probably won’t work. Every major private sector attempt to create an affordable care insurance scheme has floundered due to an inability to reconcile the resistance of individuals to pay for needs they hope they won’t have and the need for insurers to make provision for cover worst-case costs. It is also the case that some of the money that currently goes into the system – for example for care related benefits - is not used in ways which give people the greatest chance of dignity and independence. While individual care payments work well for some groups – particularly younger people with disabilities to say the jury is out on their usefulness for frail older people is an understatement.
On the other hand, there is a strong case to be made – indeed Dilnot made it – that basic care and dignity for older people should be seen as a universal welfare right not something which depends on where you live or how well off you or your family are.
But the crises goes beyond policy. As I argued in relation to a previous report highlighting squalid treatment of older people in hospital, a critical variable in relation both to older people’s quality of life and to the care they receive in the system is whether they have loved ones caring and fighting for them. Millions of older people, and often carers who are not much less vulnerable, are lonely and isolated. If we are ever to be able to feel anything but shame about the way we as a society deal with frailty in old age we will have both to explore the life decisions we make and the ways these impact on the support we can give or will receive, and to recognise a wider need for many more people in society to see caring for older people – family, friends and strangers - as simply part of what we do as good citizens.
A few weeks ago I was speaking to an impressive young MP who has a strong personal and political commitment to doing something about the social care scandal. She told me that despite her efforts it was still an issue that most MPs – particularly men – refused to prioritise; ‘it’s not sexy, it’s not ideological and there are no easy answers’ she said sadly.
Over the coming weeks and months we face all sorts of statements from politicians and other public figures along the lines of ‘if we can make organise the Olympics surely we can….’. This will quickly feel trite and tiresome so with four days competition to go, I will pre-empt the cliché:
We have successfully revived one ancient Greek invention, how about reviving something else from that era – a positive and respectful view of old age. If we can plan, fund and deliver such a wonderful Games why can’t we plan, fund and deliver the policies and services which would bring dignity and a reasonable quality of life to today’s frail older people and lift some of the cloud of guilt and fear which hangs over the rest of us?
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