New Labour's free–market ideological drive is shown at its worst in the growing crisis in long term care. Privatisation, means–testing, legislative trickery and rejection of expert advice have brought consequences for the elderly and poor in impoverishment, ill health and loss of rights. What has happened is quite simply shameful and must in conscience be urgently addressed by the whole labour movement.
A recent report by the Care Standards Commission Inspectorate has exposed poor standards of care in many care homes across the country. Another report has focused on local authorities and the financial pressures which have led to them to tighten their criteria for receipt of care support. A third report has drawn attention to hundreds of deaths from MRSA and C–difficile deriving simply from poor standards of hygiene in care homes.
Eighty per cent of residential care is now privatised, with enormous numbers of our frail elderly looked after in the profit driven sector. Local authorities have abandoned most of their own care homes to the privateers, under pressure from central government, both financial and legislative. The model commonly found a few years ago was of care homes owned and run by local authorities and in local communities. Those going into care could thus remain local and be cared for by committed public service staff, again drawn from the local community and with proper local democratic accountability. Such provision has now been all but abandoned.
A second damaging factor in the care sector is means-testing, perpetuated by the government's refusal to accept the Royal Commission recommendation that all long term care should be provided free and publicly funded. For those in receipt of care, government now distinguishes two sorts of care – health care and social care – and for the social care component, those with more than £21,500 of assets have to pay. The 1948 National Insurance Act required those with substantial assets to make some personal contribution, but at that time this applied only to the wealthy. What has happened is that the level of assets at which it becomes a requirement for people to contribute to their own care has now reduced to a level affecting almost everyone who is an owner occupier. Millions of ordinary working people now own modest homes, and therefore have some small amount of equity in their families. It is no longer just the wealthy who are affected by the limitation on personal assets.
The logical way to overcome the whole problem is to have free care for all who need it, paid for out of progressive taxation. The sums involved nationally would in fact be relatively small, and at the time the Royal Commission reported paying for free care for all would have cost only about £1 billion a year, equivalent to one third of a penny on the standard rate of income tax. As the population ages and we all live longer, this amount will rise gradually, but projections even to the middle of the century suggest that the amount involved will be easily payable out of taxation and a tiny fraction of the vast tax gap, the gap between the tax which should be paid and that which is actually collected. Tobacco smuggling alone accounts for £3.5 billion a year, three times more than the Exchequer cost of free long term care.
Finally, there is a serious question of human rights. Those in public sector care homes are automatically covered by the 1998 Human Rights Act which governs relations between the individual and the state. A commitment was however given 10 years ago that means would be found to ensure that those residents in private care homes would also be covered by the Human Rights Act. But because of the way care is now funded, some residents are 'self funders'. As they are private citizens paying a private company for their care, the Human Rights Act does not therefore apply to them.
Attempts are being made by human rights organisations and those representing the elderly to extend the Human Rights Act to all those in care homes, but even if the government is persuaded to provide human rights coverage for those who are publicly funded in private care homes, the situation would arise that residents in adjacent rooms would or would not have recourse to the Human Rights Act depending upon how their care was being funded. If all care was funded by the state as recommended by the Royal Commission, this complication would never have arisen, and if all care homes were in the public sector, again, there would be no such difficulty. Thus privatisation and means–testing have taken many residents of care homes out of the scope of the Human Rights Act. Local authority care home self–funding residents moving to a private care home may not appreciate that they were also losing their protection under the Human Rights Act.
It is now time to do what the Royal Commission on long–term care urged, and provide all long term care free of charge and funded by the state. In the longer term, a future Labour government should also look to bring residential care back into the public sector under local democratic control with permanent, properly qualified, properly paid and fully unionised staff.
With life expectancy continuing to increase, many more of us will spend our last days in care. Labour must guarantee that that care is safe, humane and genuinely caring in the fullest sense. That care should be motivated by compassion and public service ethics, not by profit.
Kelvin Hopkins MP
