Home |  Elder Rights |  Health |  Pension Watch |  Rural Aging |  Armed Conflict |  Aging Watch at the UN  

  SEARCH SUBSCRIBE  
 

Mission  |  Contact Us  |  Internships  |    

 



back

Who will look after the elderly?

By: Will Hutton
The Guardian, January 28, 2001

Scotland's Executive is now committed to free personal care for its country's pensioners. New Labour must follow their lead.

There are two risks that every reader of this column runs. The certain risk is that you will grow old. The contingent risk is that you may suffer some catastrophic accident that renders you disabled or incapable. This may happen before you are old though it is much more likely when you are already old. A fifth of Britain's pensioners are incapable of looking after themselves; injury as much as infirmity is the cause.

The philosophic and political question is how should society respond. The conservative view is that such risks should be each individual's responsibility, and that the only intervention by the state should be to underwrite the circumstances of the very poorest who simply do not have the wherewithal to look after themselves. The liberal view is that because old age is certain and the consequences of a catastrophic and unpredictable accident are just that - catastrophic and realistically uninsurable - then these are definitive areas where the responsibility should be collective. The division is decisive; it defines a crucial difference between Left and Right.

In Britain the conservative view has held sway for 20 years. The large moral proposition about the superiority of individual responsibility has been supported by two important sub-propositions.

The first is that the delivery of support for the elderly by the state is often inefficient, and is better performed by the private sector; even the state's 'promise' about providing a good pension is fragile and better respected by the private sector. The second is that the state cannot afford - given an increasingly ageing population - to undertake collective responsibility for personal care and guarantee the value of the basic state pension even if it wanted.

We must abandon universal provision and substitute targeted, means-tested provision only for the very needy. Thus the state pension has been allowed to become worth progressively less, indexed only to the growth of prices generally rather than wages. A safety net, the Minimum Income Retirement Guarantee, is de facto replacing the universal provision element of the state pension, meaning that individuals, from young disabled to elderly, who need personal care have been means tested to ensure only the poor get their care paid for.

But last Thursday came a crucial dent in the conservative consensus. Liberal Democrat members of the Scottish Executive, under pressure from their party in the Scottish Parliament, forced the Labour leader of the Executive and Scotland's First Minister, Henry McLeish, into an extraordinary U-turn. Scotland is now committed to the universal provision of free personal care for the elderly, and a study group is to report by August on how to proceed. Scotland is demonstrating that it belongs to the European liberal mainstream, and is declaring independence from conservative England. More ominously for New Labour, it is yet more evidence that the custodianship of Britain's progressive tradition is passing from them.

For New Labour strongly and passionately disagrees with universal and collective provision for old age and its consequences. It is readier to build a stronger safety-net for low-income groups than the Tories would consider, but its position is conservative even if at the liberal end of that spectrum. It has refused to consider the central recommendation of the Royal Commission on Long Term Care for the elderly that it set up after the election: that personal care for the elderly should be provided by the state free of charge with only living or 'hotel' costs to be means-tested.

Instead, in its new Health and Social Care Bill, New Labour wants to standardise nationally the current lottery of means-tested charging, currently varying between local authorities, and wind down a worthwhile universal basic state pension. In this area, Labour is becoming the party of One Nation conservatism. The Liberal Democrats are assuming the mantle of championing the liberal and centre-Left propositions on collective responsibility.

The case for universal provision of free personal care for the elderly was made eloquently by the Royal Commission. 'Long term care,' it reported, 'is a contingency not a probability. Neither its incidence nor the scale of care needed are predictable. It is equitable and proper for the state to meet at least one element of the catastrophic costs for everyone. And the costs in the future in relation to people's likely means will remain catastrophic.' It rejected outright the notion that individuals could take responsibility for the cost of personal care that might follow a catastrophe, because this was not a risk the mainstream insurance industry was prepared to accept. Indeed, standard insurance for personal care in old age is prohibitively expensive.

As for the argument about open-ended public expense with an ageing population, the Commission was simply scornful. It dismissed the widespread notion that the country is labouring under a demographic time bomb; Britain's pensioner population is growing, but not greatly in relation to the numbers of people of working age. In any case, the costs of providing long-term care for pensioners and the disabled are not great (£800 million to £1,200m), and affordable if we choose.

The report was completed before the emergence of a structural budget surplus, which further weakens the argument about unaffordability. The moral and practical imperative, the Commission felt, was to offer personal care free, with individuals still paying for living and housing costs while means-testing protected the poorest.

In short, the key conservative arguments - individual responsibility, the relative efficiency of the private sector, the ageing population and the cost to the Exchequer - cut no ice. In this area the balance of the argument was to act collectively. Yet apart from some concessions on lifting the threshold of wealth before the means test applies, the Government has been stoutly opposed to any reform. But now it confronts the move in Scotland, which if it isn't fudged, is a direct challenge to its stance.

In my view, the argument extends to the basic old-age pension. The state 'pension promise' has not been solid. But then the private sector-pension 'promise' is a lot less solid than the propaganda assumes, being subject to the vagaries of stock-market performance, annuity rates and, as 900,000 holders of Equitable Life pension plans found out, to pension fund mismanagement.

What future pensioners need is neither to be wholly reliant on the state nor on the market, but to have their risks balanced. Just as everyone has the right to free universal personal care, so everyone has the right to a solid universal state pension whose level is automatically linked to the rise in general living standards. We should rely on a combination of our savings, our employers' pension scheme and a good state pension for income in old age - and not try to pretend that the private sector provides a free option.

Because it doesn't. The Government may boast about healthy public finances, but if the consequence is to displace risk on to those incapable of accepting it then the boast is hollow. Universal personal care and a universal state pension are hallmarks of a society that understands the limits of individual responsibility. Congratulations to Scotland's Liberal Democrats. Without them the proposition would be dead. And welcome devolution.