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Who will look after the elderly?By: Will Hutton 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.
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