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My first article for the Guardian was headlined “Elderly need more right to choose” and was a report of the Wagner review of residential care. The sector was held in low esteem, the government review had found, expressing “burning indignation” at the way the lives of those most in need of help and support were devalued. Urgent reform was said to be needed to make residential care “A Positive Choice”, which was the title of the review’s two-volume findings. The dateline was March 1988.
As I prepare to leave the Guardian at the end of the year, I could not begin to count the number of articles I have since written on much the same theme. Should anyone require evidence of the continuing Cinderella status of residential care, they need look no further than the way care homes were abandoned to coronavirus nine months ago after the deadly disease was knowingly sent to them via infected patients discharged from hospitals to protect the NHS.
It will be for an independent inquiry to investigate that and to identify those responsible. I look forward to the reckoning. For now, it’s worth wondering why that article 32 years ago could almost be read today as a commentary on the state of a sector providing care for 500,000 older people. And this is no isolated example. Why are we so incapable of reforming our creaking, often moribund public services when the case for doing so is set out time and time again with unarguable logic and facts?
The obvious answer is politics. Our adversarial party system and electoral cycle do not lend themselves to decisive action, especially where solutions imply losers as well as winners. The failure of the past 25 years to reform how we pay for social care, the inequity of which constitutes an enduring stain on our society, provides an object lesson: a dozen or more inquiries, commissions and in-depth reports by the great and good, clamouring for change and setting out practical solutions, yet the politicians have hesitated, wavered and failed us every time. For all Boris Johnson’s brave promise almost 18 months ago of “a clear plan we have prepared” to “fix the crisis in social care once and for all”, the government looks in danger of continuing this abysmal trend.
Optimists think the chastening experience of Covid-19 may shock our leaders into radical action on social care and other reform agendas. In the third of his BBC Reith lectures last week, the former Bank of England head Mark Carney suggested that the pandemic would spark a renaissance and “pull forward” economic and societal change. But Chris Naylor, the interim chief executive of Birmingham city council and one of the sharpest of a new generation of leaders in local government, voiced scepticism. In a broadcast post-lecture discussion with Carney, he said he saw no evidence of “political imperative from the top” to address, for instance, the fact that more than 60% of health spending goes on treatment of preventable conditions.
As the former Labour prime minister Gordon Brown observes, Covid-19 has shown how the British state remains hobbled by a centralist mindset that thinks Whitehall knows best and frustrates initiative in the regions. Yet it is often forgotten that Margaret Thatcher, of all people, trusted local government to take on what amounted to the biggest extra responsibility it has been given over the past 75 years.
Just a week after publication of the Wagner review, I reported on the deliberately downbeat release of a report by Sir Roy Griffiths, then managing director of Sainsbury’s, who had been asked by the Tory government to look at the spiralling costs of long-term care of older people and those with disabilities or mental ill health. Such care was then funded by social security and the bill had risen fivefold in just six years even though the quality of provision was often lamentably poor, as Wagner found. Griffiths’s recommendation was to pass control of the money to local councils, an idea that officials and other ministers assumed would be anathema to Thatcher – hence the low-key release.
It took another 16 months, and a private meeting engineered by Griffiths, before Thatcher asked her astonished cabinet to give her one good reason why she shouldn’t agree to the plan. The transfer of responsibility to eager English town halls for what we now call adult social care eventually happened in 1993, and today it represents their major function, accounting for 38% of all spending by relevant councils.
In view of the national government’s failure since to reform social care funding, some at local level may reflect on the transfer as a poisoned chalice. But councils delivered: the system was stabilised, soaring costs were capped and the headlong growth of residential care at the expense of other forms of support was stemmed. Councils have been delivering again throughout the pandemic, often in spite of incompetence at the centre. When it comes to the aftermath, and the inevitable reassessment of the balance of national and local in our public services, ministers should take this particular leaf out of Thatcher’s book.
Source: The Guardian
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