The Welfare State We're In, The website of the book by James Bartholomew
October 21, 2010
"And while a generation ago only one in ten families in social housing had no-one working, this had risen to one in three by 2008-09." The section on housing and social care in the Comprehensive Spending Review
I can announce that grant funding for social care will be increased by an additional £1 billion by the fourth year of the Spending Review.

And a further £1 billion for social care will be provided through the NHS to support joint working with councils – so that elderly people do not continue to fall through the crack between two systems.

That’s a total of £2 billion additional funding for social care to protect the most vulnerable.

Mr Speaker, we will also reform our social housing system.

For it is currently failing to address the needs of the country.

Over ten years, more than half a million social rented properties were lost.

Waiting lists have shot up.

Families have been unable to move.

And while a generation ago only one in ten families in social housing had no-one working, this had risen to one in three by 2008-09.

We will ensure that, in future, social housing is more flexible.

The terms for existing social tenants and their rent levels will remain unchanged, new tenants will be offered intermediate rents at around 80% of the market rent.

Alongside £4.4 billion of capital resources, this will enable us to build up to 150,000 new affordable homes over the next four years.

We will continue to improve the existing housing stock through the Decent Homes programme.

And we will reform the planning system so we put local people in charge, reduce burdens on builders and encourage more homes to be built, with a New Homes Bonus scheme.

Within an overall resource budget for the Department for Communities and Local Government that is being reduced to £1.1 billion over the period, priority will be given to protecting the Disabled Facilities Grants.

This will go alongside a £6 billion commitment over four years to the Supporting People programme, which provides help with housing costs for thousands of the most vulnerable people in our communities.

The full speech is here.

Posted by James Bartholomew • Indexed in Care for the elderly • Housing • NHS

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December 05, 2007
"Two thirds of the adult population are frightened by the prospect of having to move into a care home". Hypocrisy, selfishness and vanity are reflected in the way we care for the old. Care homes made 'normal' by the welfare state.

Most people say they are "frightened" by the prospect of going to a care home. This emerged in a recent opinion poll:

The ICM poll found:

· 40% of Britons fear being lonely in their old age

· Two thirds of the adult population are "frightened" by the prospect of having to move into a care home;

· More than 90% said they knew they could not survive on the state pension and would need to rely on savings

Although most people said they care well for older members of their own family, the poll found 55% do not believe older people in Britain are generally treated with respect.

I suspect this poll is reflects some pretty unpleasant truths:

1. People fear being in a care home which, by definition, is away from their home surroundings, takes away their independence and removes them from friends and/or family.

2. At the same time, most people decline to save their own parents from living in precisely the same kind of place that they themselves would fear to go.

3. In many cases this is simply selfishness but it is selfishness that is made to appear OK to the outside world because the welfare state has made it 'normal' for people to put their aged parents into homes. So it is now 'normal' to send old people where they fear to go.

4. The welfare state has, in effect, made it a kind of 'human right' to be looked after in your old age by people who do not know you and to take you away from all you know and love.

5. A way for caring for the old age that originally was probably a last resort has been changed into a first resort.

6. Middle aged people are relieved of the duty of looking after their parents. But then, of course, they find themselves old and find themselves in the same unpleasant position they put their parents in.

Of course it is true that some old people appear genuinely to wish not "to be a burden". But they are making a sacrifice in saying so. Becoming old surely does not mean one loses the desire to be with family or friends and familiar things.

I know of several people who died not long after being admitted to care homes. I wonder if anyone has done some research into whether life expectancy is reduced among those who enter care homes (comparing them, of course, with others of similar health and age). I suspect this is the case. I accept, too, that some people are quite happy in care homes and make friends. However I have been to some of what are said to be the best. They are, by their nature, pretty depressing places. People spend hours alone in their rooms, often slumped watching TV. Mealtimes can mean a group of very old people seated around a table in silence. Some places organise entertainments. Many good people do their best. But these are not genuinely happy places.

Care homes reveal our society being hypocritical and selfish. Vain, too. The poll showed that people like to think that they themselves are doing well by their parents. It is just 'others' who are letting their parents down.

The story in the Guardian is here.

Posted by James Bartholomew • Indexed in Care for the elderly

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March 31, 2006
Should not children take prime responsibility when elderly parents can no longer look after themselves?

Tom Utley, commmenting on Sir Derek Wanless' report in the Telegraph today, bravely puts forward a point of view on care for the elderly which is not often publicly expressed:

One of Sir Derek's ideas is that most means-testing should be abolished, so that many fewer pensioners will be forced to sell their homes in order to pay for their care. I understand the appeal of what he says, because means-testing punishes the thrifty and rewards the profligate.

But I am now going to make myself extremely unpopular by saying that I don't really see why pensioners shouldn't be expected to sell their homes in order to pay for their care in old age.

Many will argue that they have financed the NHS and the social services by paying their taxes throughout their working lives - and so why shouldn't they reap in their old age what they sowed during their youth?

Posted by James Bartholomew • Indexed in Care for the elderly

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March 30, 2006
The elderly British appear to be among the most neglected in the world

Page 14 of "Social Care Needs and Outcomes - a background paper for the Wanless Social Care Review, July 2005", shows that no country (out of a wide selection) has fewer people over 65 in institutions and no country has fewer people receiving some kind of care in their homes. It would be lovely to imagine that this is because British people over 65 are so healthy. I am afraid that what the statistic really shows is that no country neglects its elderly as badly as Britain does.

There are many thousands of elderly people in Britain who are in their homes, alone and not really able to cope. They are receiving no help from anyone. There is state provision of care for the elderly in Britain. Therefore there is rationing of care. Many people who need it simply do not get it.

The link to this supporting material of the report is, if the technology serves, here. The table is on page 14.

Posted by James Bartholomew • Indexed in Care for the elderly

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Wanless against means-testing

How interesting and encouraging that the Derek Wanless report on care for the elderly has - on the whole - come out against the current high level of means-testing.

It is good to see resistance to the idea that there can be two people - one of whom spends everything through life while the other saves prudently for old age - who then find themselves in next door rooms in the same care home. The first gets care in old age at the expense of other taxpayers while the second pays for the same care out of savings. It is not fair and the fact of it discourages people from saving - which generally is a sensible and empowering thing to do.

No wonder that this is a King's Fund report and not a government one.

Posted by James Bartholomew • Indexed in Care for the elderly • Welfare benefits

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March 06, 2006
Not 'to the grave'

Many people remain committed to the NHS, I believe, because they think "if I get seriously ill at any time in my life, I will be looked after and it will be free". In their hearts, they may think the care may not be great, but at least they will get some care and it will be free.

But this is simply not true. Last night on Panorama there were graphic portraits of people who had believed this. But then they had got severe Alzheimer's Disease or had endured disabling strokes or had been knocked down by a car and become totally paralysed. They were treated, for a while, as patients in NHS beds - for free. But then they were shunted out into private nursing homes and told that they would have to sell their homes and pay for their care.

In theory, the government pays for medical care by not for 'social care'. In the Coughlan case, the Appeal Court upheld this distinction and insisted that the government should pay for someone with medical problems. But the programme eloquently argued that, in practice, the NHS ignores the Coughlan judgement and in many cases goes to great lengths to categorise people as being in need of social care, rather than primarily medical care.

In other words, the NHS shuffles off responsibility for paying for people who have become totally dependant on the help of others. It says, "you pay for it, we won't".

The NHS - and the government as a whole - offer the myth that you will be looked after, for free, if you become disabled for the long term. For many people, it is simply not true.

The welfare state has created an insurance policy that does not provide what it claims. It is another welfare state mis-selling scandal. It would be better if the welfare state were honest about it from the start - if it said, "We will not provide. Take out proper insurance because this is not it. Rely on us and you could lose your home."

"We are an accident and emergency service. We don't do long-term care." But such honesty is not a part of the welfare state. Perhaps it is just not a part of democracy as it has developed in Britain in recent years.

Posted by James Bartholomew • Indexed in Care for the elderly • Media, including BBC bias • NHS

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October 05, 2005
Charitable work for the dying. How much should the state pay?

One of the evening fringe events I went to last night was about care for those who are dying. A Marie Curie nurse spoke impressively and movingly about caring for people dying of cancer. Apparently there are 2,000 of these Marie Curie nurses and it sounds as though they act very well in helping people die in their own home and helping the families to deal with this traumatic experience. The nurse was sensitive and sensible. It sounds like an excellent charity.

An important theme of the evening, coming from the other three speakers rather than the Marie Curie nurse, however, was about how the government should give more money to 'palliative' care for those who are dying. The Conservative spokesman on the subject, for example, said that his party wants the percentage of funding given to hospices to be raised from 35% of their expenditure to 40%. He said the hospices would not want 50% as it would endanger their independence.

I questioned whether raising the level of government was really a good idea.

Posted by James Bartholomew • Indexed in Care for the elderly

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May 27, 2005
What is the difference between government inspections and a waste of money?

The following comment on the government inspection of care homes seems worth putting up as a posting, too. I asked the author for a glossary of terms for those who are not familiar with all the organisations he refers to. They are at the end.

The government regulations are amazingly bad, cost a fortune to both care home owners and the public sector, and achieve nothing.

There are several problems.

(1) They are applied quite staggeringly inconsistently. Some hammer people for minor or invented infractions, some just ignore them. This tends to (IME) bias towards those run by the Public Sector. largely because the inspections are done by the former colleagues of the people in the public sector ; back scratching stuff.

It's a bit like Fire Regulations. With LEA schools the line has always been basically getting them up to scratch would cost an absolute fortune, so they are effectively exempted. Private Schools do not have this luxury. This seems to apply in NCSC/CSCI/CHAI as well.

(2) The Inspectors are laughably ignorant about the actual work, literally, I once had to leave the room because I had a fit of the giggles. It is tickbox mentality run riot. Because they have no clue, they focus on minutiae like how big the windows are, because they have no qualifications or experience to evaluate what is actually happening.

Posted by James Bartholomew • Indexed in Care for the elderly • Waste in public services

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May 25, 2005
Who would be old in the welfare state?

Part of a Help the Aged report, quoted on BBC Online.

Older people who die in hospital often endure their final days in dirty and noisy wards, where busy medical and nursing staff can devote little attention to them

Posted by James Bartholomew • Indexed in Care for the elderly • NHS

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May 24, 2005
'We have more compassion for animals in this country than our elderly'

How are the elderly treated in different countries and in Britain in particular? There is an interesting selection of letters in The Times today which raises a lot of the big issues in a short space. Does government involvement do more harm than good? How much damage to provision has been done by government regulations? Should people be looking after their aged parents themselves? Is it better for the elderly to be in their own homes, rather than in a care home (the cost is not very much greater)? Here is one of the letters:

MY 98-year-old grandmother has been in residential care since a fall in September left her unable to care for herself. The care home is under-staffed and under-resourced. The food is awful and there is real lack of warmth. She cannot walk and has been given a room two floors up, so is forced to sit all day in a lounge with others or be left in her room alone as there is not the staff to move her. It makes me very sad and angry that her life has come to this.

Posted by James Bartholomew • Indexed in Care for the elderly • NHS

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