Your caring, sharing NHS at its most cruel

I know the term 'health fascism' is pretty polemical and intended to shock. But the truth is that increasingly public health 'campaigners' (as the newspapers always call them) have created a culture around their obsessions that is unpleasant, officious and even cruel:

What happened I found out in stages - apparently someone saw me at the week-end refilling the vape from the 'sipped case' - and told them. This evening a nurse walked over to me me and said, 'what a sweet little teddy' and proceeded to play with him - 'Oh do you keep your pen in there, good heavens no its a vape'. It was so odd that I didn't twig at first. Well, I got the rules and regulations read to me in such a patronising tone of voice.

This dying woman has one small remaining pleasure removed because the rules - rules without any basis in health - don't allow it. As Dick Puddlecote points out this is a women "on a regime of intravenous Ketamine - the drug designed to stun a rampaging elephant - and Oxycodeine, but apparently nicotine is not to be tolerated." But it's worse - part of this torture is where nurses left the vape pen just out of this paralysed woman's reach.

We're told almost daily how NHS staff are wonderful and caring yet somehow we've reached a point where "as there wasn't evidence to prove that e-cigs were safe or unsafe, they were banned on health grounds" - for people in a hospice receiving palliative care for a terminal illness. Not only is this stupid but it is really cruel. So much for the caring, sharing NHS.

Since you asked, this is what I mean by health fascism.
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Why we should redirect public health funding to social care

"3-5% of people are responsible for 39% of our spending."

This is your NHS folks. The statistic comes from Bradford's three Clinical Commissioning Groups at a meeting today. Dwell on that statement for a second or two - here in Bradford just 15,000 or so people use up 40% of the money we spend on health care. Out of a population of 500,000.

There are lots of reasons for this situation and for the continuing pressures created by expensive treatment. Most of those 15,000 are elderly and in that stressful and traumatic end-of-life situation. Nobody is saying that we shouldn't spend the money we spend on that treatment.

What bothers me is that, time and time again, I'm told that the answer to this concentration of costs is to shift money from acute care into 'prevention' (or 'Tier 1' in the jargon). This is lots of jolly and cuddly stuff like fat clubs and smoking cessation clinics plus a whole panoply of annoying fussbucketry wrapped up in a thing called public health.

Think about this for a second and you'll realise one of two things:

1. This fussbucketry and huggery doesn't make a blind bit of difference. The money is wasted but also loads of people are irritated, businesses are shut down and products banned.

2. The fat clubs and advertising bans do work and people live longer. The money wasn't wasted but we still have to spend loads of cash on that end-of-life stuff. We just do it at 85 instead of 75.

For what it's worth (and this being the NHS it's worth a fortune) there is pretty much no evidence at all that tells us 'Tier 1' investment works (except in the economic sense of price hikes, bans and other restrictions impacting consumption). Yet we continue to spend millions on this - something like £10 million in Bradford alone - while moaning about bed-blocking, shortfalls in social care funding and hospital overspends.

Scrapping this sort of public health spending wouldn't solve the problem of funding care and the NHS. But it would be a damned good start.

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Wrong, stupid and unsustainable - old people and the funding of care

Much of the discussion following the Autumn Statement concerned Brexit and the forecasts. Plus of course the prediction from the Institute for Fiscal Studies that we're not going to see "real incomes" rise until after 2021 (or something along those lines). I don't plan on making any comments about these forecasts except to say, as Chris Snowden at the IEA points out, even the much-heralded and 'independent' IFS isn't infallible when making predictions.

Instead let's talk about old people. The Local Government Association made great play of there being no mention - or extra money - for social care. It seems to me that, as Jeremy Warner observes, nearly all of the financial challenges facing government can be traced back to the inconvenient fact that us Baby Boomers (who have all the assets, or so we're told) are going to live a long time yet.

There are two reasons why people living a lot longer is a problem for government. The first of these is the impact on revenue budgets of looking after older people. Not just the very expensive end-of-life care but also the everyday costs of catering for people with declining mobility, poorer eyesight, incipient deafness and a collection of chronic but manageable health conditions.

The second is that, while we are busy not dying, the wealth we've accumulated stays safely tucked up in housing and other assets. And because we're living longer the circulation of that wealth within society is slowed down. It might be true that the explosion of home ownership post-WWII (culminating in Margaret Thatcher's brilliant right-to-buy legislation) represented the biggest transfer of wealth away from the elite in our history but right now us Boomers are sitting pretty atop all that wealth.

The proportion of the population that is over-65 is set to grow further. The ONS predicts (I know forecasts, pah) something like this:


This increase (and the corresponding stagnation in the numbers of young people) completely alters the balance of our demography. From a position where 'youth culture' dominates we are moving gradually to a sort of gerontocracy where the needs, expectations and preferences of the old vastly outweigh those of the young. It's notable that, after a time when political leaders seemed to get younger (Major, Blair, Cameron, Clinton), we now have a slew of older leaders. The two main UK political parities are led by a 60 year old and a 67 year old. Over in the USA the presidential election was fought out between a 69 year old and a 70 year old - with the 70 year old winning. If the current indications are right, France will get a 63 year old as President and Germany will keep its over-60 Chancellor.

It's also interesting to note that the question of age (as opposed to the matter of health) is never raised. When Ronald Reagan was elected his age was seen as a problem, yet no-one (so far as I can see) is challenging Trump on the basis that he ought to be getting comfy in the armchair with slippers and a pipe. This change just reflects the fact that there are millions of fit, healthy, active and involved folk in this age category. When your Dad is walking Munroes at 75 or your Mum riding at 81 then no-one's fussed about a Prime Minister who is 60 or a President of 70.

The difficulty is that our public finances (and to a considerable degree our economy) start with the assumption that people retire in their 60s and die in their 70s. When the NHS was founded its planners believed that the costs would diminish (OK they were batty) rather than increase as universal access improved overall population health. What we've seen instead is that, as health has improved, people have lived longer with the result that more and more of NHS resource gets directed to the health of old people. Today around 75% of NHS spending goes on the over-65s.

We can add the pressures on social care to these numbers - adult social care used to be an important but relative minor element in local government spending. Today it represents perhaps a third of spending with this proportion set to rise (under the current model at least) as the numbers of frail elderly increase in line with the numbers of people over 80. The current arrangement where local government contracting dominates the market for care provision results in downward pressures on costs that are simply unsustainable given rises in minimum wages and expectations in terms of service quality.

The third major element creating pressures in the simple fact of the old age pension (made more problematic by the so-called 'triple lock'). Of the current welfare budget over 40% goes on paying old age pensions and once we add in other payments such as mobility allowances, carer allowances, free TV licences and fuel discounts, nearly half of the money we spend on welfare goes to those receiving an old age pension. By way of comparison, just 1% of that welfare budget is spent on unemployment benefit.

In a world where there are fewer people working to pay the taxes to provide these benefits, it's pretty hard to see how such public largess - in health, care and benefits - can be sustained. Something has to give especially when it is clear that wealth is increasingly retained by the older generation, primarily in the form of those housing assets obtained during the great home ownership boom from the 1960s to the 1990s.

I don't believe that the answer to all this is the sort of anti-Boomer rhetoric of the Resolution Foundation where the fact of those assets (and the fortune of the increases in those assets' value) is seen as some sort of selfishness on the part of people aged over-55. Nor do I think that the answer lies in inventing a new tax so as to carry on with the market-fixing methods that result too often in expensive and poor quality social care. What is needed is an apology, some honesty and a better market.

First the apology. Aneurin Bevin lied to you and every subsequent government regardless of its political stripe has repeated and compounded that lie. National Insurance, for all the trappings of an insurance scheme, is just an income tax. So when people say, "I'm entitled, I paid my stamp all those years" they are merely repeating Bevin's lie. The government should stand up and apologise for this lie.

Next some honesty. People aren't stupid and can deal with facts so perhaps we should give them some. Starting with the one where we say that we can't go on with above inflation increases to the NHS, to social care and in old age pensions. That means we've either less money for other things that matter like policing, defence, firemen, roads and schools, or else your sons and daughters (the one's you're helping out because they struggle to buy the school uniform) will have to pay higher taxes. So old people with lots of money tied up with high value property assets need to start thinking about how they use those assets to provide the care and health support they'll need as they get older and more frail. This means no more "family house" nonsense and no more assumption that the Council will pay so you can leave those housing assets to your children.

And the market. Markets are very good at providing the things that people want. This isn't about ownership it's about how prices are set. Right now the UK's health and care system is (see above) unsustainable. Getting wealthy people to realise they are responsible for their own life is a start but, if we do this, we've got to have a market where they can purchase the care and health support they need.

None of this is about Boomers being selfish. After all part of the problem is that the Boomers' kids are anticipating the glorious day when that South London semi turns into £750,000 cash and some don't want any rapacious care homes, stair lift companies or walk-in shower fitters spoiling the prospect of this lovely lolly. A few weeks ago I was told by a housing officer how equity release schemes to improve home warmth were often blocked by families who saw this as eating into the inheritable asset. It's shocking but true that people will leave granny cold with no handrail on the front steps so as to keep ten or twenty grand on the inheritable value of granny's house.

At the core of all this is changing our presumption that care is some sort of absolute entitlement rather than something that's a matter of personal responsibility. When I sit in Bradford's Health & Wellbeing Board meetings is hear about the idea of 'self-care' - essentially people taking responsibility for their own health. Often this is little different from good old nannying fussbucketry -don't smoke, change your diet, cut out the booze, do more exercise - but it has within it the idea that we are, as individuals with agency, responsible for our own lives. And this means paying for stuff. The long term implication of self-care for an informed public taking decisions that reduce health harms and, recognising that some support in inevitable at some point, being prepared to pay others to help deliver that self-care.

In a nation obsessed with the idea of a "free" National Health Service, it's going to prove difficult to deliver the changes to our attitude to health necessary if longevity isn't going to turn almost all of government into a health care provider. And the core of all this is to recognise (or rather rediscover some we once knew but has lost sight of) that the assets we accumulate during our lives - houses, pension funds, cash savings and so forth - are there to be run down during our old age not something to which our descendants have any sort of entitlement. Getting the government to tax relatively poor people so you don't have to use your assets has always been wrong. Now it's wrong, stupid and unsustainable.

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Death doesn't become us - revisiting the case against 'assisted dying'

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My Mum has just gone into a nursing home. It hasn't been an easy time for my Dad and I feel slightly guilty that, for reasons of distance and business, I haven't been there as much as perhaps I should. But this isn't about me visiting my angst on you, dear reader, but rather about what it costs. Not because I think that johnny taxpayer should pick up the tab willy-nilly but rather to demonstrate the financial advantages - for families and the government - of people dying more quickly.

The fees at Mum's home run to about £1000 per week, which my maths tells me is £52,000 per year. And this is a hell of a lot of money. More, I suspect, than my dad ever earned in a year and comfortably more than the average earnings of people today (my Dad retired in 1997). Again, let's be clear that I do think our savings and assets are best directed to our own interests and this includes providing care - I really do not feel that I have any right to demand that young people with big mortgages and families to raise pay more tax so I can inherit Mum and Dad's house.

But this cost - £26,000 in a six month period - is one very good reason to question the seemingly inexorable move to what is called 'assisted dying'. Now when I read the advertisements placed by Dignity in Dying I am, like you will be, touched by the stories there of people's last days and how a quick exit would have saved them suffering. I don't doubt the sincerity of the people involved - knowing their beloved brother, wife or mother was dying they sought only to make what was left of their life less painful. And they think that helping these people to die would have been a release from that pain.

It's hard not to find the case compelling. So to help you understand my doubts, let me tell you something else about my Mum. Something I wrote some while ago in a little article called, "Death doesn't become us":

My Mum spent 25 years and more working with old people in and around Penge – delivering meals-on-wheels, driving the mini-buses and running Penge & Anerley Age Concern’s lunch club and day centre on Melvin Road. In this time she saw every sort of folk – from Mr Squirrel who worried that he couldn’t (at 96) dig the garden as in times past to Dr Arnott, communist party member, academic historian and employer of a maid.

Every day, my Mum would tell us, one or more of the people she saw would proclaim – in that depression of loneliness so common among the old and infirm – “I’m just a burden, I’d be better off dead”, or some similar formula of despair. Mum’s response would be to tell them not to be so silly, have a cup of tea and a chat.

But Mum’s view – informed by bitter experience – was that not all the relatives and carers took the same view as she did.

And this last sentence captures my concerns. You and I may be good, honest folk who wouldn't dream of having granny bumped off so we could inherit earlier. But can you be certain that others have our scruples? That there is no circumstance where 'six months to live' is liberally interpreted:

...where a depressed, slightly confused, sad old person signs to say they want to die, where the bureaucracy takes this as consent and Auntie Sissie or Grandpa Geoff is shipped safely across the Styx leaving his worldly goods behind for the inheritors to enjoy.

I know there will be safeguards. I'm sure people have considered how they would mitigate the possibility of the six months rule being abused. But I am less sure. My Mum told too many stories of rapacious and uncaring relatives, of useless solicitors and deadening, rule-bound social workers or doctors for me to be so sure that, despite the agony of those stories in Dignity in Dying's advertisement, we can go to a place where we deem it acceptable to kill another human being.

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On the proper use of public health funding...

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Public health funding is about improving environmental factors - things like making homes warmer, reducing air pollution and preventing trips and falls. Here's a good example of how the funding can be used:

A ‘Boiler on Prescription’ scheme to demonstrate the impact energy efficiency improvements can have on ill health has been launched by social business Gentoo Group.

The Sunderland pilot will create a framework for GPs to prescribe a range of free home improvements to help those who have medical conditions exacerbated by cold, damp homes.

This sort of spending isn't nannying but targeted, specific and intended to get the greatest impact from the funding. It's a shame that we're spending hundreds of millions on nannying fussbucketry really.

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Assisted suicide requires one person to kill another person. That's wrong.

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We have taken another step towards allowing the killing or the old and the ill - or 'assisted suicide' as the modern euphemism describes it.

The legislation of assisted suicide has moved a significant step closer after the Government made clear that it would not stand in the way of a change in the law.

Conservative and Liberal Democrat MPs and peers – including Coalition ministers – will be given a free vote on a Bill that would enable doctors to help terminally ill patients to die.

Such a step would be terrible and tragic. I don't say this for reasons of religious conviction - I'm not sure I have much of that left - but for reasons of consequence and because we assume that the motives of the killer are always pure.

I've written before that my Mum worked with the elderly for over two decades - running a day centre, delivering meals-on-wheels and organising a whole range of other support and service. And one thing she said more than once was that almost every day she heard at least one old person wish they were dead.

"I'm just a burden" the old person would say. Or "I'm trapped in this flat, it's not worth living". Even "were I dead the grandkids could have the money".

And my mum, in her practical way, would tell them not to be so daft, to have a cup of tea and that she'd get her onto the minibus next week for the trip to Ramsgate. If mum knew the family or the neighbour she'd ask them to call roand - give a bit of cheer to a depressed old person.

Imagine instead the world of 'assisted suicide'. There'd be a form to fill in, a signature or other indication of assent to obtain and probably a certificate from a doctor confirming the old person was compus mentus. The minibus wouldn't be to Ramsgate but to a comfortable hospital bed where that old person would be made comfortable. The family might cluck round a bit but probably not - just enough to make sure the deed was done.

And then the doctor would kill that person. Dead.

Is this what we want in a civilised society? Is this progress?

I don't think so. It doesn't matter how you wrap it up, how many tragic circumstances are produced to support the proposals, 'assisted suicide' requires one person to kill another person. And that is wrong.

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The ideology of social work: "we are all guilty"

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Michael Wharton, in his guise as Peter Simple, so often found his satire cropping up in real life. So it is with the mantra of Keinz Kiosk, psychologist -  "we are all guilty" he would cry as the audience stampeded for the exits. However, this collective sin sits at the heart of much soft left thinking and damages society in being so.

At a time here in Bradford when we must look to our practice and policies around child protection for all the wrong reasons, the idea that there is nothing wrong with the training, management and development of social workers must be challenged. So I am cheered when Michael Gove, as the responsible minister says:

"In too many cases, social work training involves idealistic students being told that the individuals with whom they will work have been disempowered by society. They will be encouraged to see these individuals as victims of social injustice whose fate is overwhelmingly decreed by the economic forces and inherent inequalities which scar our society."

This isn't to deny inequality or to say that the inconsistency of our education system doesn't result in inadequate parents. It is to change the focus away from the idea that social workers should not judge the actions of their clients.

As the health and achievement of many families demonstrates being poor simply isn't a precursor to dysfunction. However, we have rather got use to the idea of using poverty as an excuse or explanation for dysfunction. For all that each tragic child protection case is different, recent cases have a depressing similarity - not simply the presence of broken families, drugs and alcohol but the apparent failing of seeing a starving child and assuming poverty rather than neglect or abuse.

We are not all guilty, people are not poor because others are rich and Britain is a generous nation - collectively and individually. So when social workers see that starving child, they should perhaps ask themselves whether the fault lies with a neglectful parent rather than an unequal society.

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May I have permission to care, my lord?

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I attended a day's presentation and workshop for the Joseph Rowntree Foundation's "Neighbourhood Approaches to Loneliness". Mostly I went because one of the study areas was the village of Denholme, part of Bingley Rural ward.

The work is interesting and useful. I can commend it's basic idea - that communities can be helped (assuming this is needed at all) to respond to the problems of loneliness. And loneliness, as much as any other so-called public health challenge, is a killer:

Loneliness is a bigger problem than simply an emotional experience.  Research shows that loneliness and social isolation are harmful to our health: lacking social connections is a comparable risk factor for early death as smoking 15 cigarettes a day, and is worse for us than well-known risk factors such as obesity and physical inactivity.

Put simply, meeting our need for social interaction can help us live longer, healthier lives regardless of the other choices we make about our lifestyles.

Much of the work is about what might be done - not at the grand level of national policy but at the level of the neighbourhood. And in presenting these findings two observations stood out to me: one depressing but not surprised and the other chilling.

The first was:

Regulation kills kindness

People who want to help are put off helping because of the regulations - the safeguarding checks, the insurances, the mandatory training, the forms, the licences, the sheer bureaucracy of trying to do a good deed. This is depressing - and my depression was worsened by advocates of regulation defending the use of regulation. Pleasingly the project head amended her statement to say that regulation and bureaucracy kills kindness.

The second, the chilling one that went almost without notice, was:

We need to give people permission to care

That's right - permission to care. That professionals in the employ of the Council, the NHS or their satellite agencies needed to allow people to look out for their neighbour. In this I saw a dead culture - one murdered by the good intentions of public agencies. That we might not be allowed to pop in on Mr & Mrs Jones to make sure they're OK, maybe make them a cuppa and have a chat for half and hour. Unless we've undertaken the official "befriending" course, got the required clearances from the state and been attached to an organisation that "delivers" looking out for the neighbours.

So tell me you caring professionals, what kind of world are you creating where someone needs your permission to be a good neighbour? Chilling indeed.

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Is it ideology or bureaucracy? On the failings of social work.

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Douglas Carswell points out the cruel truth about the Daniel Pelka case:

The boxes were ticked. Training was complied with. Meetings were held. Meanwhile a little boy went hungry and his injuries grew worse. Officialdom's culture of compliance produced only inertia and incompetence. This should make us alarmed and very, very angry.

The suggestion here is that bureaucracy - Kafka's castle - was to blame for the lack of intervention. But why when:

Since the 2007 killing of Baby P, there has been a huge surge in the number of youngsters being removed from their families by social workers.

The children’s court advisory service dealt with 10,199 cases between April 2011 and March 2012 – a near-doubling of the numbers in just four years. 

It is almost impossible to believe that, in this world of heightened awareness, authorities didn't think to intervene, merely to jot down details of the child's distress in their notes.

With each case we see the same explanations and excuses, the same sophistry as social workers fail to explain why they pursue some parents to the ends of the earth - parents who are less of a threat than were the parents of this poor child.

And why are councillors - me included - so complacent or reluctant to ask the hard questions of our social services management?  Can we really be content, given that we haven't asked the questions, that everything is fine? Or are we nibbling at out nails muttering "there but for the grace of god"?

The problem isn't simply bureaucracy - that is just a reflection of the problem. The real concern is the ideology of social work, the faux non-judgemental approach, the obsession with 'cultural sensitivities' and the view (unsupported by evidence) that there are no demographic or social factors that influence child abuse or neglect. This isn't true and social workers - as well as the ideologues who define social work practice - know it isn't true.

Like so many areas ruled by experts, social work (and the parasitic growths of lawyers and such that attach to the business) has become impenetrable - the verbiage of the profession excludes anyone seeking to understand, the sophistry of the professionals' defence is iron clad in its certainty and the elimination of challenge is now so sophisticated that it is impossible for us charged with being "corporate parents" to exercise that role in any way beyond the guided tweeness allowed by social workers.

Right now we take too many children into care yet allow children like Daniel Pelka to remain in terrible circumstances. Right now social services leaders prefer to blame the problem on government, "the cuts" or "austerity" rather than explore why they are failing.And when those unfortunates arrive in care, we fail them again  - as a momentary glance at educational performance, crime and the tragedy of grooming would tell us.

Perhaps we need to start behaving like parents - interfering, judging, worrying, badgering and annoying. Getting in the face of those we care fore - not because we don't like them but because that's what parental love is about.

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It's capitalism not "fair" trade that lifts people out of poverty...

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It always depresses me to see people who are essentially caring led down a path that really isn't in the interests of those they care about:

An early signatory to the petition, Mrs Palframan has been invited by the Fairtrade Foundation to help hand in the petition to the Prime Minister. 

And the petition well Mrs Palframan sums it up:

“Despite producing 70 per cent of the world’s food, over half the world’s hungriest people are smallholder farmers who struggle to earn a living from their crops.

“Unless they receive support and improvements to terms of trade, they will remain in crisis due to an unjust food system.

“The farmers still only get a tiny proportion of what we pay for our food and agriculture needs to be made much more sustainable to create food security.” 

The truth, of course, is that these farmers are subsistence farmers - living mostly off the things they raise or grow and selling what small surplus they have for the small amounts of cash they need.  The problem is that people such as the Fairtrade Foundation and Oxfam wish to keep these poor farmers scrabbling in their tiny, unsustainable smallholdings. I'm guessing that, Mrs Palfreman, living in Ilkley as she does, isn't struggling to feed her family from a tiny small holding on the side of the moor! So why does she want to keep people in faraway places in that condition rather than seeing them get the same chances we have?

We've seen the fastest reduction in world poverty in our history over the last decade - over a billion people saved from poverty. This is brilliant but can we remember that it wasn't fair trade, in wasn't aid and it wasn't the hectoring of Oxfam that did this. If we'd followed their prescription that massive decline in poverty would not have happened.

What caring people should know is that is was capitalism, free trade, property rights and that evil neoliberalism that saved that billion from poverty. And, if we let it, capitalism will get the rest of the world's poor out of poverty too. And, you know folks, that means that just as we aren't subsistence smallholders all those Africans won't be smallholders either.

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It's not care, it's neglect...

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So we take a child "into care". Most often this is quite right and proper (although the secrecy behind the process makes it more-or-less impossible to know which taking of a child is good and which egregious) but then we put many of these youngsters in homes.

And quite frankly, three square meals aside, that's not much of an improvement:

The NSPCC has warned that children in residential homes are three times more likely to go missing than other youngsters as figures revealed that nearly 3,000 children repeatedly disappeared from care last year. 

I'm sure that these are 3,000 differently tragic cases and that social workers are struggling under a mountain of paperwork and an avalanche of stupid rules - not to mention ideas such as being "non-judgemental" that damn children to not knowing what is good or bad behaviour. But yet again it indicates just how poor our care system has become as a result of the laissez faire parenting approach mandated by the law and by the ideology of social work.

But this doesn't excuse the person in charge of Bradford system saying this:

“Some of the ‘missing reports’ are in relation to young people staying out overnight – something that all teenagers can be prone to.” 

Did your children ever stay out overnight without you knowing where they were, who they were with and that there were responsible adults present?

This attitude entirely sums up why we have a problem - it is not care, it is neglect.

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Marking your own homework - the problem with inspection

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From BoM comes the quote of today:

A government regulator regulating a nationalised industry is always going to be the public sector marking its own homework. And while the Government Inspector may strike fear into the hearts of employees - witness the hatred of Ofsted among many headteachers - that's because the regulator becomes an instrument of Commissariat control rather than an objective assessor of standards.

Absolutely - writing lists of 'standards', mostly based on subjective appraisal and qualitative enquiry, is no substitute for giving people choice.

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Quote of the week...

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From Leg Iron:

You like to complain that smokers ‘cost you money’ but you are happy to pay for crap like this while your grandma dies of thirst in a bed caked in her own faeces because the NHS is too busy nagging me to bother with them.

Got that folks - it's closer to the truth than you dare admit.

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Labour's plan - tax the poor to pay for the care of the wealthy.

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Fresh from championing recipients of housing benefit earning over fifty grand, Labour is now planning to be the hero of the relatively wealthy. Apparently, the proposals on social care - where how much we might have to cough up is capped at £75,000 and people with £125,000 or less in assets will receive state help - still mean that people will have to sell their home.

I'm fine with this. What possesses people like Andy Burnham to believe that the taxes paid by people on minimum wage should go to pay to care for someone sitting in a house worth hundreds of thousands? Does he really think it justifiable - I mean morally - for a struggling family to pay taxes so someone else can inherit mum's house? Is it really OK that government borrowong climbs through the roof - taxing future generations of children - so someone can leave their "life savings" fructifying in some investment fund?

If there's one thing that makes me cross it's the assumption that these assets, these savings are simply there so people can inherit the cash. Surely those assets and savings are precisely there to look after mum or dad in their lifetime - to provide comfort, to secure care and to provide a little pleasure.

So rather than talking rubbish about family homes and nonsense about life savings, sit down with your parents and talk about how to use that money to make the last years of their lives less or a worry, more of a comfort. And stop counting the money in their bank and expecting the poor to pay higher taxes so you can inherit that cash.

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Process or people?

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Surrey County Council let an old lady starve to death:

Officers from Surrey Police have begun an inquiry following the death of 81-year-old widow Gloria Foster.

She passed away at Epsom Hospital on Monday (February 4) after being found abandoned, starving and dehydrated at her home in Banstead.

Mrs Foster was left alone at the property in Chipstead Road after the Sutton-based firm that cared for her, Carefirst24, was shut down following a raid by the UK Border Agency and Metropolitan Police in January.

I don't know the details of the case so can't say whether anything criminal was done. But I have a question - was Mrs Foster killed by the process or the people?  And it's an important question because it impinges on the failings in our National Health Service as shown by the enquiries into various hospitals and hospital departments, most recently Mid Staffs NHS Trust.

If it's the process - or the system or the "culture" - then we must ask how it is that repeated reorganisations and restructures have affected our care provision. Has each revolution in NHS or Council organisation merely, in Kafka's words, resulted in "...the slime of a new bureaucracy"?

Or is it the people - should we really be asking how someone - or worse still several people - can leave an old lady without the care she needed to live for nine days? That's nine days turning up to work with the request sitting on the desk, nine days to make a phone call and arrange some care, nine days to do something so Mrs Foster can live.

Is it the people? Those altruistic nurses passing by a bed where an poorly woman lies in her own urine and faeces - was it the process, the system, the culture that made them neglect her needs? Time and time again, not just in Stafford but across the NHS and in Council care provision, we read of this neglect, this failure to do basic, civilised acts of caring.

Can we ask again - is it the process or the people?

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Labour - the party for the wealthy

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Or so it seems.

Andy Burnham MP, Labour’s Shadow Health Secretary, said the Government had “fallen far short” of a fair solution to the care crisis. “A cap on care bills of £75,000 per person, or £150,000 per couple, will not protect the home and life savings of an average family,” Mr Burnham said. 

Read that carefully. What Burnham is saying is that the government should pay rather than have people spend those "life savings" or realise the capital value in their home. Labour is arguing for the wealthy to be allowed to keep their wealth rather than use it to provide care for themselves.

So who pays. Burnham doesn't mention this but it's the taxpayer - thousands of people on incomes below the "poverty line" that Labour folk keep harping on about will be coughing up cash so these people don't have to touch their life savings or sell their valuable house. Lots of low paid workers paying taxes so well-off elderly home-owners - or rather their children - can keep those "life savings" and have (the money from) that "family home".

Just as we saw over child benefit, we're seeing Labour championing middle-class welfare benefits that will be paid for by higher taxes on those hard-working families - those strivers - that the party is always gibbering on about.

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Culture and adoption....

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Much excitement over the case of what seems to be blatant political bias in a child protection case in Rotherham.  And there is an oddity in all this around culture and the manner in which we treat its significance during child protection cases. Indeed, it does seem that this is the central reason for the decision that Rotherham took in that they:

"...were severely criticised by the courts in terms of not meeting their cultural and ethnic needs."

And because UKIP has been critical of inward migration from East Europe, the council took the children away from the UKIP supporting foster parents. The rest - emergency placement, crass comments about UKIP's policies and so forth - is just spin (albeit bad spin).

We should also note that the parliamentary by-election in Rotherham provides great cover for the Labour politician who leads on Children & Families - under the daft 'purdah' rules council press during elections doesn't allow for politicians to be quoted or featured.

The interesting bit in all this, however, relates to what we understand by the term 'multi-cultural' or 'multiculturalism'. It does seem that the default social work interpretation is for 'cultural and ethnic needs' to be met through preference for a placement in the same culture. This seems to me more akin to apartheid than 'multiculturalism'. Surely in a multicultural society placements should be blind to the culture of the foster parent but attuned to the need for children to 'access' their birth culture.

It is this that worries me and, indeed, the manner in which the courts have pontificated on 'cultural and ethnic needs' without asking what that might mean in practice. With the result that we trip into the left-wing mind set of the social worker - UKIP are 'extreme right wing' ergo UKIP are racist. And the result of this is that some kids lives are messed about, a good couple (in the true meaning of that term) are upset and po-faced council folk litter the airwaves with obfuscatory explanations for their crass decisions.

The first question we should be asking in child protection is around safety not culture or ethnicity. And the second question we should ask in about stability but culture or ethnicity. Only once the child is in a safer and more stable place should we be considering culture and ethnicity. It appears that this is not the case - culture and ethnicity are made paramount and children are suffering for this reason.

Finally an observation. Would it not have been refreshing if the Council Director had said something like:

We got this wrong and can only apologise for the upset caused. Of course we shouldn't make fostering decisions on the basis of potential foster parents' political opinions. We will be speaking to the social workers responsible to ensure that this doesn't happen again and I will be personally visiting the couple concerned to express our sincere apologies.

Not going to happen though is it!

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So do you care?

A long while ago I recall – in a slightly vague and woolly way – my mum talking about recruiting volunteers. People to do simple things like drive mini-buses, serve teas and coffee, deliver meals-on-wheels, run a housebound library service and many other little tasks.  The gist of my mum’s grumble was that people weren’t prepared to help out. Not because they were too busy or helping somewhere else but because they had off-loaded “caring” onto the government.

“That’s the Council’s job,” they’d say adding a comment about how they pay their rates before turning back into the house. And, as the volunteer leadership crumbled away it was replaced by paid workers (as was my mum when she finally retired as Secretary of Penge & Anerley Age Concern) – professionals whose job it was to do the “caring”.

I’m sure all this is a bit of an exaggeration but the essence is true. As state social services professionalised and expanded into areas previously the world of the local voluntary group, the idea of ‘caring’ was lost. The word wasn’t. It became a stick to beat those who believed – and still believe – that private action in our local community cannot be replaced by state social services. Conservatives – those who believe in private social action – were told that, for holding to this belief, we didn’t ‘care’.

I also recall listening to an earnest, green socialist (who as it happens cares deeply, but that’s a different story) saying that volunteers shouldn’t be used to do tasks that a paid person could do. So much, I thought, for the community litter pick, the hospital car service and the Working Men’s Club old people’s Christmas party. Volunteers were to be reduced to the margins – ‘caring’ had been nationalised. Our only act of care was to be the paying of taxes to employ the carers.

And it got expensive. Back in Penge, when mum retired, the cost of running that day centre rose because where once in was run by volunteers now it is run by professionals. All provided for through a grant from the Council. This change took place everywhere as social action in local communities run by volunteers was replaced by services delivered by paid staff.  Most of us got this – rather than have any social pressure to be charitable, we could go about our lives secure in the knowledge that our taxes were going to provide all the ‘caring’ the community might need.

The problem is that, for all the sense of vocation in the “third sector”, people working there are not merely ciphers for all the ‘caring’ that the rest of us used to do but don’t any more. And neither does the enormous social services bureaucracy or the vast behemoth that is NHS non-clinical services serve this ‘caring’ purpose. It may be right for taxes to fund these services but that does not make the taxpayer ‘caring’.

Nor does ‘delivering’ (how the public sector loves that word – perhaps they all had a secret wish to be postmen) social services make us ‘caring’. These are just jobs – useful, worthwhile, valued (we hope) jobs. But not ‘caring’. Government does not ‘care’ only people, by themselves or with others of like mind, can ‘care’.

Most of us care about our nearest and dearest – children, parents. More than we think, people care about their neighbours, about the neighbourhood where they live and about giving other folk the space to succeed. None of this caring requires government, taxation or the employment of ‘workers’. It just requires us to care.

It may be a failing of government that there are children going hungry. It seems very likely that it is surely a failure of parenting as well. But the debate about this issue is not a debate about whether or not people offering differing solutions “care” and to couch it in those terms is to debase the idea of caring, to make it meaningless.

If there is one area in which our political debate is ill-served it is in this use of “caring” and “non-caring” as terms of political positioning. This was made possible by what we can call the nationalisation of care. This isn’t to say that people stopped caring – that would be impossible – but to say that the scope for us to care beyond the narrow confines of family and neighbours has been taken away from us by the dominance and control of state social services. And by the way in which the voluntary and community sector – the remnants of Burke’s little battalions – came to rely on the taxpayer rather than on the idea of charity.

I had hoped this was changing, that social action – local, communal and caring – would replace that childishly futile debate about who does or doesn’t care. But no, writers in left-leaning papers still routinely press the “Tories don’t care” button that they know their readers will love. And their counterparts respond by becoming ghastly caricatures of John Galt in their celebration of designedly uncaring language.

The other day I read something by a left-wing economist sort that reminded me why I’m a Conservative:

But there is another strand of conservatism which is wholly consistent with the idea that we owe our fortune to the past. Edmund Burke famously said that society is "a partnership not only between those who are living, but between those who are living, those who are dead, and those who are to be born."

Which raises a paradox. Whilst economic research now supports Burke's view, much of the right no longer does so, preferring ahistorical inidividualist tosh...

In its way this was the idea that Cameron tried to rediscover with the “Big Society”. The idea of stewardship, that ownership isn’t everything and that we all – rich, poor, young, old – have something to contribute. Not to the state. Not just in the form of money – let alone taxes. But in whatever way we can, in the place we call home.

We built this place. And each of us should care for it and for our neighbours who live in it. And, you know, the truth is that we do care.

Take of English flowers these --
Spring's full-vaced primroses,
Summer's wild wide-hearted rose,
Autumn's wall-flower of the close,
And, thy darkness to illume,
Winter's bee-thronged ivy-bloom.
Seek and serve them where they bide
From Candlemas to Christmas-tide,
For these simples, used aright,
Can restore a failing sight.

These shall cleanse and purify
Webbed and inward-turning eye;
These shall show thee treasure hid,
Thy familiar fields amid;
And reveal (which is thy need)
Every man a King indeed!

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So what exactly is that money for?

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Again the unedifying debate over care for the elderly - characterised by the sons and daughters of comfortable middle-class folk arguing that their parents assets shouldn't be use to provide care for those parents.

"It seems so wrong that after mum and dad worked hard all their lives, everything that they saved for had to go. The day we sold the house my sister and I could barely speak for tears, as we packed all their belongings up." 

The mum in question is on her own, is 85 and has dementia. Of course it's sad that lives end this way, dementia can be a terrible slow death and is traumatising for the person's family. But what exactly did mum and dad save for? It seems to me (and always has done) that part of the reason for saving is to provide care when we can't look after ourselves any more.

There really is a need to look at how we provide care for the elderly, it is one of the biggest public health challenges that faces us. But the standards and breadth of care will never come about so long as we carp and wail about the loss of inheritance. Is it not worse that people with significant assets (or more commonly those who stand to inherit those assets) expect someone else to pay for their care? Especially when that someone else is a struggling family or a young man earning just above minimum wage.

And while we're talking about tax - we are still living with the consequences of Nye Bevan's great lie. With this idea that we "pay in" to the National Insurance system. It is - and always has been - just another tax on income but we still hear this:

"They paid into the system all their lives"

No they didn't. They just paid taxes to provide the things government was providing - they had the benefit of hospitals, schools, roads, police, an army and all the other things we've voted for having. The truth is that they've eaten the cake. And it was a pretty big slice.

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I always knew a lot of doctors were in it for the money...

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Not all, of course, as this comment shows:

Dr Dan Poulter MP said: "As a doctor, my first duty is to my patients. That is why I would not participate in strike action. Doctors have taken the wrong decision today, urged on by their trade union the BMA.

"Industrial action will harm patient care. With the Government's final offer to doctors being a pension of £68,000 a year, the public will simply not understand why doctors have called for strike action over pensions that private sector workers and many other frontline NHS workers can only dream of."

I watched a row of wealthy men in suits - the BMA bosses - lined up at a press conference claiming to be hard done by because some doctors will have to wait until they're 65 (like the rest of us do) to get their pension of nearly seventy grand a year (like the rest of us don't).  And I wanted to put a bar stool through the telly. How dare these people act in this way, how dare the BMA - usually so ready to lecture us on how we're living our lives wrong - threaten patient care so they can retire to the golf course or the Dordogne a few years early. How dare they....

...they're only in this for the money it seems so perhaps they'll shut up with all the "caring public sector professionals" rubbish now. I do hope so.

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