UK: Who will speak for the old and disabled, trapped in their homes?
We hear a lot about how cuts affect women and the young – but the crisis in social care is perhaps the greatest of them all
You lie in your own mess. You are cold. You are hungry and confused. You can’t remember whether you have taken your pills. You feel ashamed. You feel angry. It is still five hours before someone will knock on the door, let herself in, and wash you. You hope for a few minutes’ talk but you know that it won’t happen. She only has a quarter of an hour for your appointment …
This is how it ends for many people now. This is how it may end for you, your parents, your siblings, your loved ones. Social care isn’t sexy. But it is perhaps the greatest avoidable crisisfacing British politicians – certainly bigger than immigration, energy supplies or bad schools.
There is a short-term crisis, and a longer-term one that is even worse. The short-term problem is that local authority cuts mean 70% of councils intend to increase social care charges, and 40% of them are going to further tighten eligibility. That translates into fear, loneliness and humiliation for old people living in their homes and desperately reliant on this poor-relation service.
They can’t go out on the streets and march in protest, or camp outside a cathedral, or strike on 30 November. They are rarely seen in newspapers or on television, or interviewed on the Today programme. Many councils really do limit care visits to 15 minutes, which doesn’t give the carer proper time to wash, dress or feed their client.
A report by the Equality and Human Rights Commission (EHRC), due this week, will put flesh on the bones of such statistics. It has heard evidence, for instance, of people being left in filthy nightwear and bedding; of being left without a wash for several weeks; of being put to bed at 5pm and not helped to get up until 10am the following day.
If this were happening in a public place there would be cameras and an outcry. But it happens behind closed doors in flats and terraced streets, and it often happens to people who don’t complain. The EHRC says that of those who responded to its call for evidence, one in five said “they would not complain because they didn’t know how to, or for fear of repercussions”.
Meanwhile, the paid carers – doing tough and often unpleasant work – don’t get paid for their travel time, so as they hurry from one house to the next, many are now concluding the money is so poor they must give up.
It isn’t even cost-effective because the carer of last resort will be the NHS: more and more elderly and disabled people are ending up in hospital, and staying there for longer than they ought to – “delayed discharge” where there is no care available at home, increased by 11% last year.
This has similarities with the pensions crisis. Many of us thought pensions were too boring to think about, until they started to vanish. The 2 million public sector workers expected to strike at the end of this month no longer think pensions are boring. Many more of us are learning about them too late, the hard way. Yet because pensions are funded by today’s working people, who can protest and cause disruption and make a noise, at least the political system responds.
Social care, like pensions, is a matter of inter-generational fairness; and that’s a tricky issue. Many people would say that the generations now in their 50s, 60s and 70s had it comparatively lucky. They had the jobs in the boom times; they bought homes when houses and flats were more plentiful and cheaper; and yes, many of them still have very respectable pensions. Younger families, struggling to get into the housing market, or younger people, aghast at the lack of proper jobs, are in a worse position.
This is true, but it leaves out the innate anti-oldies bias of the current political system. Today’s leading politicians, political commentators and broadcasters are typically men and women with school-age children, more interested in education, jobs and consumer issues. The problem of the old is low on their agenda.
Here’s an example. on Sunday when Anglican bishops launched a broadside against government welfare reforms, they concentrated on the £500-a-week benefit cap and its effect on larger families. This is an important issue. The bishops were right to express their “moral obligation to speak up for those who have no voice”. But the most vocally excluded of all are the old and poor, trapped in their homes.
So far, we’ve heard a lot about the effects of the economic crisis on the young, and on women. But there’s been far too little focus on the effects on our senior citizens. Savings are worth less, annuity payments are cut, prices are up, and social care is withdrawn – yet without the chance to earn any more, those in retirement just have to accept declining living standards. And, as more people live longer, the problem is going to get worse.
This slow-motion disaster, demography insists, cannot be avoided without a major shift in resources. The longer-term crisis means that by 2025 we will have to find an extra £12bn a year to fund existing, insufficient levels of care, and another £3.5bn if Andrew Dilnot’s sensible proposals for a cap of £35,000 for each individual, over which the state will pay, are accepted.
This can only be answered through a cross-party deal. The sums involved mean higher payments or taxes, and these have to last for a long time to come. If one party refuses to play ball – as Andrew Lansley and the Tories did before the last election, then the prospect for a radical change collapses.
Ed Miliband seems at least to be taking this seriously, having appointed Liz Kendall to the shadow cabinet to take charge of social care. Labour is now asking for a return to cross-party talks, which it says must be confidential, and must have the support of the Treasury. So far, there has been no ministerial response. Time is not limitless. If a deal on paying for a decent system for care is to be ready to go into the party manifestos for the next election, the talking has to start now.
I know none of this sounds excitingly confrontational. It may make you yawn or turn away but, Reader, it will reach you, or someone you love. Unless you die early and quickly, or are swaddled with vast amounts of cash and a big-hearted, capable family, the social care crisis is not to be shunned. For one day, you will look up and find it standing, staring you down, at the end of your bed.