Among the most interesting documents released today, 28 June 2041, under the 30-year rule concerning the release of government papers, is the following memorandum from the senior special advisor to the then Chancellor George Osborne:
"Chancellor, you asked me to outline for Cabinet's discussion of the imminent publication of the Dilnot Commission's report on the funding of care for the elderly, the salient demographic and financial issues and the most cost-effective solution, fitting these straitened times.
"At the beginning of the last century there were just 61,000 British men and women over the age of 85. Today there are 1.5 million over-85s. In 20 years' time we expect that figure to have risen to 2.5 million. Our colleagues at the Department of Health tell us that no less than 70 per cent of emergency hospital admissions are now of retired people who have had a fall. The average cost of an occupied hospital bed is £3,000 a week, so we can begin to appreciate the cost to the working taxpayer of the physically doddery.
"The chief problem, however, is not one of physical decay. We are much more concerned by the recent research by the private-health provider Bupa, showing that by 2015 the number of British men and women with dementia will exceed the total number of hospital beds within the entire NHS hospital network.
"One would hope that the great majority of such dementia sufferers remain in their homes looked after by their families. However, we do not have the structure of family life that persists in some of the Mediterranean countries – you might know this, Chancellor, from your many holidays in Italy – and so the burden falls overwhelmingly upon care homes funded at local-authority level. You will have seen the recent report by Dr Ros Altmann, director-general of the Saga Group; she points out that 'there are huge gaps in our social-care budget and even the latest extra £2bn that the Government has announced will be given to local authorities to fund care has not been ring-fenced. So the money is not getting through and local authorities are cutting care spending on the elderly by 8 per cent'.
"We understand that under the Coalition's decentralising principle of removing the Treasury from any and all involvement in local expenditures (a brave decision, if we may say so, Chancellor) they are completely free to spend the money we allocated to elderly care on – just by way of example – new twinning arrangements with various towns on the Florida coast and the Caribbean; this is perhaps regrettable, especially bearing in mind that this 8 per cent decline in available funds on social care for the elderly implies a much sharper drop in the amount spent on each old person, given the expected increase in their number.
"Of course, if the number of old people with dementia (or other conditions requiring full-time care) were not to grow, or even to fall, then the problem would not be of the order which has caused you to commission this briefing. That simple observation, combined with your exhortation to 'think outside the box' leads us to ask, Chancellor, if you have ever read The Fixed Period, by Anthony Trollope. We know that you are a keen student of Trollope's Palliser novels, full of insight as they are into 18th-century Parliamentary politics; but perhaps you have not read this lesser-known work. The Fixed Period, published in 1882, imagines the world a hundred years into the future, in particular the events in Britannula, an invented British colony.
"The president of Britannula, an arch-rationalist called John Neverbend, believes that compulsory euthanasia at the age of 67 – this is the fixed term – will solve all his nation's future problems of poverty, which he believes will stem from overcrowding with old people without any productive use. This policy does not go down well with the older members of the population, even though Neverbend tells them the result of their sacrifice will be that Britannulans will become 'the richest people on God's earth'. The older Britannulans alert the British Government, which intervenes via gunboat and removes Neverbend from power. In captivity he consoles himself that a hundred years hence his policy will be seen as both enlightened and essential.
"We do not suggest, Chancellor, that you emulate President Neverbend. Euthanasia of the unproductive and inherently uneconomic as an overt policy of the state has never recovered from its association with the most unfortunate German government of the late 1930s – although its Reich Chancellor's personal 'euthanasia decree' of 1 September 1939 used the phrase 'mercy death' (Gnadentod) which some still find a very appealing term.
"We would have to act in a much subtler manner, gently encouraging the social acceptability of euthanasia – and we are happy to say that the BBC has done some wonderful work on this. If it is legalised, we can expect large numbers of families to be prepared to suggest such a painless end – in a sensitive manner – to their elderly and suffering relatives. This would not, of course, be because they wanted to get their hands on granny's house before it was sold to pay for care bills, but purely out of concern for her well-being. Dignitas in Switzerland charges around £5,000 for its service, but the basic cost of the poison is no more than around £50; so if it were legalised here, you can see, Chancellor, what that would imply for future healthcare costs.
"Again, this would have to be with the explicit consent of the subject – although we have drawn up some interesting proposals for incentivisation: perhaps, given the potentially vast savings for the Treasury, we could propose that those taking this step would be exempt from all taxes on their estates: or in the case of poorer families, an outright cash offer could be made.
"We know that such measures will, at the least, require the full support of the Health Secretary; we have taken the precaution of asking our colleagues to place in his red box an American text, The economic argument for euthanasia, which points out that 'Legal euthanasia is the ultimate cost-control measure for the health care industry.'
"Good luck with the Cabinet meeting, Chancellor – and please try not to wear black, as we would not want jokes to deflect us from the essential seriousness of these proposals."
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