All hail today’s Dilnot Commission report.
If ever there was a shining – or should I say less than shining – example of the way in which Government has failed its population it is long-term care.
This failure has manifested itself in the difficulties faced by many people in accessing and paying for good quality care. But the real failure, is the way in which all Governments have dodged a proper and open public debate on the issues over the last four decades.
The origins of the long-term debacle can be traced back to the sixties when the then Government (I believe the Minister was Enoch Powell no less) began to close the old hospital nightingale wards with the aim of moving provision into the community. It was the right move but poorly implemented. You could argue that local authorities have been playing catch-up ever since given the lack of resources and backing they have had to take up provision at the level needed.
By the time I arrived at the Alzheimer’s Society in 1992 we were reaching the final chapters of this massive abandonment by the NHS of those with highly complex needs. The postcode lottery was firmly in place and many old people were finding themselves in a quick-sand of bureaucracry and betrayal which was quite literally dragging them into poverty.
That no one told them that this was what waited in store for them, is one of the more shameful aspects of how our modern society has evolved in recent times. Indeed, it took six months for the Society to get NHS authorities to cough-up the figures for the number of beds they had got rid of and only then because we got MPs to approach them on our behalf. Perennial questions to Ministers in the House during this time had simply drawn the answer that ‘this information is not held centrally’…i.e. they didn’t know.
One of the ironies in how matters have unfolded is that, then, we and other campaigners went to great lengths to stress how the growth in long-term care needs was entirely manageable and not the ‘timebomb’ others liked to call it. Of course, twenty years of inaction and prevarication can make a problem a whole lot larger than it ever needed to be.
I wonder if others involved in the issue feel the same. I have a distant memory of going to see a Shadow Health Minister by the name of Alan Milburn around about ’95 or ’96, who put his full support behind our campaign for a Royal Commission into long-term care. When New Labour took office in 1997 it duly set one up.
Two years later the Commission, Chaired by Professor Sir Steward (now Lord) Sutherland, published its report and called for personal care to be provided free with the living costs of providing the necessary accommodation covered from people’s income and savings.
The Labour Government – or rather Gordon Brown – kicked the report into touch finding the costs unpalatable although the decision was driven as much by acute anxiety over its own popularity as so many things were in those days. Nonetheless it shouldn’t shoulder disproportionate blame to its predecessors or successors for exhibiting a lack of political will at a critical moment.
Since then the issue has seemed suspended in mid-air with few daring to touch it.
I have a distant recollection that in the run-up to the General Election the Health spokespeople in each of the political parties got themselves in a right old tangle about a supposed agreement to take an all-party approach on long-term care. First they had, then they hadn’t and then everyone ran for cover the nearer it got to the starting gun. Shame. So I am pleased that 26 charities including the Alzheimer’s Society have today come out challenging the parties to work together to solve the mess we are in.
Today, understandably, the costs of such care dominate our thoughts. But I hope that we do not also lose sight of the fact that this is not just a debate about the cost of the roof under which we are cared for, but about the quality of care that we will actually receive in the future. And that will only improve if we continue to research the needs of people with long-term care needs and the sorts of services that meet them.
Dilnot’s plans for a partneship between state and individual are not that far removed from Lord Sutherland’s own approach in that sense. His report provides us with a second opportunity to have a proper public debate and tackle the issues head-on, a second opportunity that those facing long-term care today do not have .