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The times we are working in now need a great deal of accelerated change and there must be no negotiating that down. So my mission statement for this part of my consultancy career is to be clear that there needs to be and will be a lot of change from the work that I do with individuals and organisations and if organisations don’t want that, then it is probably best to go somewhere else.

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Much more money needs to be spent on social care for the elderly -so how can we develop the politics to make the case??

Filed Under (Expenditure, Health Policy) by Paul on 14-06-2012

Recently I went to an interesting seminar that was looking specifically at how to develop the case for extra public spending on social care for the elderly.

The seminar was held under Chatham House rules (you are allowed to report what was said but not who said it) which meant that people with a variety of different relationships to decision-making could say not only what they really thought but also what they really thought was going to happen.

The room contained a number of people who had spent decades of their life working out how to get more public and private money into social care for the elderly. These were policy wonks of all ages – and each had some important and interesting detail concerning the means of raising the necessary funds.

What was most interesting about the discussion however was not the detail of the different policy propositions but the almost universal agreement, among people that revel in disputes about policy, that the problem was not getting the policy right, but getting the politics right.

And the development of this politics contained a number of heartening themes.

Whilst most people in the room had spent their policy lives within a world view that believed that money could and should be raised to pay for services by taxation, nearly everyone recognised that the simple answer – just raise general taxes to pay for it – was not going to work this time and for these services.

Several people talked about the politics of intergenerational fairness. Imagine just a few years hence. It is 2014/5 and the next election is looming. It is quite likely that most people in the country will have experienced a drop in income over the previous 7 years of about 10%. Many a bit more. Some a lot more. At best personal income has stalled and prices are going up. To say to the general public that we have a crisis in social care and that what we have to do is raise taxes by a few hundred pounds a year, is not just politically unacceptable but would smack of a government punishing the people for something that it (as well as the people) has failed to save up for.

People of working age and their children are having a very tough time (and it may well get tougher). It is going to need a greater subtlety of approach to raising resources than simply to suggest that they have to stump up more taxes.

As I hope readers have picked up, I am myself now approaching my mid-sixties, and don’t tend to see myself as a burden that will bring down society. I also can’t really see the prospect of living for another 20 years as anything other than a really good thing. So whilst I know there is a problem, there are some upsides to this.

I also know that I am in the top 10% of the retired population in terms of assets and income. But it is also the case that nearly everyone of my age is better off than their parents were when they retired. I also think we will probably be better off at this stage in our lives than the next couple of generations will be when they retire.

So it’s not that we are all rich, we aren’t. But we are nearly all better off than our parents were at this stage of their lives and probably nearly all better off than our children will be.

So a big part of the cost for social care for this generation has to come from that income and those assets. Those of us who have retired with more resources need to pay more for what is going to be financial problem of increased need for social care. But probably all of us need to pay a bit more than our children.

Interestingly there are mechanisms for raising money from better-off retired people which might include, for example, retired people paying national insurance on earned incomes.

However one of the problems is that there is so little trust in the way in which the exchequer works that not many people of my generation would trust that, for example, the money saved from paying National Insurance would actually go into better social care for less well-off retired people. In the recent budget the granny tax that I will be paying from next April will reduce the 50p income tax rate to 45p for better-off people.

What became clearer to me at this seminar was that the problem is not the mechanics of how the money could be raised. The problem is with the trust the public have in the way in which the money raised is spent.

Taxation and trust in taxation and spending is key to political trust and that is one of the main political issues that will need dealing with. Who would we trust to wisely spend this money that has been compulsorily taken from our pockets?

This led to an interesting discussion about how any money could ever be rigorously ‘ring fenced’ and how the Treasury hate the idea. But whilst the Treasury may hate it if people are going have money taken off them we will need something different from the existing system to generate the very high trust that will enable the money to be raised.

The other issue that was discussed was about a different implication for the politics of social care for the elderly.

One of the main activities that policy organisations undertake is to work to raise the public consciousness of this as an issue. There are techniques of working with the media and lobbying which can have an important impact upon raising the importance of issues with politicians.

(Two MPs were at the seminar and they reported that whilst they may get 4 or 5 letters about the crisis in social care, they will get over 90 on the threat from privatising the forests. The latter is the result of good tactical lobbying).

But the issue with social care is different. Worries about social care for the elderly are not abstract – where the public needs to be told that something is wrong.   Probably the most relevant thing about this issue is that most families are worried about it for some of the time. People of my age have usually just lost their parents, but have themselves and their immediate family to worry about.

The younger generation have their parents either entering or already in the fragile period of their life where they are worried about what is going to happen. Many extended families travel up and down the country trying to fix up a combination of relatives friends and paid care to look after people – all the time feeling that we aren’t doing enough for the people who have given so much for us.

So this is a private worry for many families and they just about figure out how to make the money, the time and the care work. Then something catastrophic happens to our loved one and all the plans need to be put aside for the period of the crisis – which may be a long one.

Many of the public are acutely aware of this issue. They worry about it. Some worry about it a great deal. So people don’t need to be told there is a problem.

But mostly they see their problem and their worries as private ones. There appears at the moment to be no political link between our own private worries and the social care budget being cut. There are hundreds of thousands of personal crises, yet this has not been turned into a political issue.

This will take a lot more sensitivity of language and conversation with the public than we have managed up until now. And until something like this happens the outrage that people in the field experience will not become a part of the politics that drives the priorities of the country.

One of the conclusions of the seminar wasn’t that more work needed to be done on this or that aspect of funding or policy. That is probably as worked up as it can be.

But a lot of work needed to be done on every aspect of the relationship between private concern and public politics. What language do we use? What are the actual intergenerational experiences that the families are constructing to make this work? What can we learn from the private for the public nature of this issue?

Given the pressure on the NHS this issue will run and run.

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