Turfing out the elderly in Middle England

The state can't pay to look after our ageing parents. But do politician s have the guts to tell us?
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The Independent Online
"If you try to better yourself by hard work, you get crucified. But if you're a taker, you can live in a council house and get everything that's going. My father was a furniture shop manager, never earned much, but he went without to buy a roof over our heads, while other families around us just spent it. Well, he shouldn't have bothered."

There speaks the authentic voice of Middle England, and it is seething with a bitterness that frightens Downing Street. David Anderson is one of a group of six families who have been sitting in to protest at their elderly relatives, victims of Alzheimer's disease, being shunted out of NHS care in North Worcestershire into the hands of the social services. They don't want their relatives moved from Church-view, a pleasant, well- staffed, purpose-built bungalow in the grounds of a local hospital.

There is another issue, too. For some of the families, a move would also mean their parents' capital could be used up in paying nursing home bills. Mr Anderson's father's house is worth pounds 60,000, money he and his sister were depending on inheriting, and it could all go. This is causing a rumbling middle-class rebellion that makes the Prime Minister quake. Will he have the nerve to tell people like these that they will have to pay and that there is no alternative?

The NHS has retreated rapidly from caring for the elderly. In 1970, a third of frail old people were cared for in hospitals. Now it is only 10 per cent. Geriatric wards everywhere have closed as hospitals rush to vacate the bed of anyone who isn't getting better.

Some health authorities have turned devious in their haste. North Worcestershire HA came up with a complicated wheeze: by moving patients into a bungalow and handing it over to a housing association, they redesignated them as nursing home residents.

As residents, social security pays out pounds 170 in various invalidity and attendance allowances. Any further costs have to be borne by the patient, if they have any money. In this area, nursing homes cost about pounds 400 a week.

This time, however, social security refused to pay, saying these were still NHS patients in disguise who should be paid for by the NHS. So the health authority and the housing association decided to close it, but relatives staged a sit-in and won a judicial review. "I said my father's staying there for life, and if anyone touches him, I'd sue them for assault," said David Anderson, the voice of the new consumer, born of the Patient's Charter, taught to question and demand.

We are facing a crisis in care. The state can't pay, won't pay, and the middle classes (most of us) are angered at being made to. This week, a remarkable collection of 24 agencies providing community care, led by the Association of Directors of Social Services, has written to the Cabinet to warn of a severe unexpected cash shortfall, partly because of a miscalculation in the numbers of old people. In North Worcestershire, there are nearly a third more people over 60 than were budgeted for.

Social services are squeezed on every side. Hospitals' new fast throughputs score great ratings in the league tables, but it means frail old people hardly have time to draw breath in the recovery room before they are turfed out of their beds into the feeble arms of social services.

On top of that, social services were told to assess all carers. Suddenly, that whole silent army of relatives (estimated at six million), who had struggled alone with incontinent, demented relatives, started to demand help. But the law only promised assessment, and that's all they got. It raised expectations, only to disappoint yet more Middle Englanders.

The Government is right to worry. Protest about care and its cost is growing. Age Concern has had 30 per cent more inquiries - nearly 12,000 - this year from people shocked at being made to pay . (Though even Age Concern has no other policy, beyond ironing out some of the anomalies: they know people will have to pay.)

Matters are getting worse. Social services' charges for home care are soaring. Oxford has started to charge the same rates as if the person was in residential care. Relatives waiting for wealth to cascade down are seeing it dissolve before their very eyes.

So, on the one hand, there is the mountain of need. If it goes unmet for much longer, there will soon be a spate of stories, not about community care, but community death. On the other hand, there is the growing fury of people forced to pay for something they always thought would be free. The small print of the 1948 National Assistance Act said those who could afford it must pay for non-NHS care, to prevent the upper classes getting free maids and companions. But no one noticed, since so few people were ever made to pay until recently.

Christine Hancock, of the Royal College of Nurses, says it is a disgrace that the NHS has abandoned free care of the old without notice or public debate, while it cheerfully continues to treat fit young men with sports injuries free. She has a point. It is the lack of honesty by politicians of all parties that has created this outcry. Everyone went on pretending that the state could and would pay for it all, with No New Taxes. But there isn't enough care, there isn't enough money, and someone has to pay. Most experts dismiss the idea of another insurance system as too cumbersome, tying up too much of the economy in yet more savings, when only 12 per cent of people end their days in residential homes. So who is going to tell the taxpayers that either they pay more taxes, or people must pay more for themselves if they can afford it?

John Major is trying to wriggle out of the dilemma. One suggested "solution" would be to let those with capital put it in a trust and only spend the interest on their care. That would cost at least pounds 500m, as it would mean people contributing far less towards their care, a sum that will turn to billions by the time the baby boomers hit the old folks' homes.

It would be yet more money leeched from the shrinking working population to pay for the monstrous regiment of retired. And where would the money go? Not to old people, but to their well-off fiftysomething children, in no need of windfalls. If Mr Major wastes taxpayers' money to buy off this angry group before the election, it will be a despicable act of political opportunism, mortgaging the future.

But has he the guts to look the Worcestershire protesters in the eye, and tell them that even though they won the war, and paid their national insurance, they must pay more? It is for Mr Major to face his own people, these valiant small savers of the home-owning democracy, and tell them the bitter truth.

It will be for Tony Blair to face his people and tell them another bitter truth - the NHS cannot provide everything for everyone, for ever, for free, and there will need to be changes, choices, and probably charges, too. But as with all the most unpalatable political medicines, people can hardly be expected to swallow it unless politicians have to explain honestly why they have to.

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