The NHS - a curse or a blessing

Yesterday evening the 'Panorama' strand on BBC1 explored the 'unlawful' compulsion of elderly people to sell their homes to pay for NHS care. I am not a lawyer so I have no idea whether the use of the word 'unlawful' is mere hyperbole to reinforce the message of the programme-makers or whether it is literal truth. In any case this is not in any way what my post is about.

The contention of the programme, and a similar programme broadcast several months ago, is that an artificial distinction is being drawn between care necessary to treat a medical condition and the continuing care very often necessary because of the infirmities that come with age. The former is 'funded' (in the arcane terminology of the NHS), whereas the latter's funding is subject to a 'means test' before the State agrees to pay. What this means in practice is that those who have substantial personal assets are required to pay for their own continuing care, whereas those who do not have such assets have their continuing care paid for by the State. In the 50 years since the creation of the NHS, average longevity has increased substantially and medical treatment has advanced so much that many more people are able to be treated for medical conditions which would formerly have resulted in death so that more people continue to live for many years after they are able to take care of their own physical needs because they have become physically or mentally infirm through age. Unsurprisingly this costs a great deal of money. Equally unsurprisingly this has put severe strains on NHS budgets so that, over the years, the definitions of what is and what is not 'medical' treatment have been narrowed so that 'sparse' resources may be targetted at those whose own financial resources are meagre, simply because of the increasing numbers of people who live on long after they have become economically inactive (i.e. have retired).

The way in which the NHS was set-up, and 'sold' to the British people, was that the State would take care of them from 'the cradle to the grave' - classic socialist philosophy. The crux of the criticism of those who think that the NHS is delinquent in refusing to meet the costs of continuing care for all who require it, irrespective of their own financial circumstances, is that a 'pact' between the State and the citizen has been broken.

All the mainstream British political parties have promised the electorate that a vote for them would result in this basic promise being adhered to. Most political parties which have any serious chance of winning an election have, nevertheless, simultaneously promised that taxes will not rise. The one reasonably important political party which has said it would raise taxes to meet specific outlays has, so far at least, been remarkably unsuccessful at elections. In reality whilst opinion polls indicate regularly that people would be prepared to pay more in tax to fund an improvement in specific services, too few are prepared to vote for this at an election.

Over the past 15 or 20 years, and indeed particularly over the past nine years of this Government, younger people have been encouraged to plan earlier for their own retirement with the not so implicit, but not exactly explicit either, message that the State was no longer able to provide in the same way it had always promised to in the past. However, the political rhetoric has remained exactly the same - the NHS (for example) will remain 'free at the point of use'. The problem is that all State provided services are not paid for out of income generated from earlier taxation, but from current taxation. Citizens over 40, who had always been promised that the State would look after them from 'cradle to grave' are now faced with the unpalatable reality that the State is now seeking to distance itself from such promises - although it is actuarily far too late for those affected to do much about it if they have not been prudent in earlier years to accumulate enough of their own resources to fund their own old age, post-retirement. Naturally the Government Health Minister who appeared in last night's programme struggled to disguise this, but few who watched the programme would have been fooled for one second about the truth.

Governments of all stripes during my lifetime have connived at this subterfuge, the prize being the votes of a gullible electorate. It would be far better, as I have opined in this blog a number of times previously, for political parties to start telling the truth to the British people - largely taxation-funded medical care for all sectors of the population and the continuing care of the elderly and others who require it is unsustainable at the levels of taxation which the public seems willing to tolerate. We should move as rapidly as possible either to individually-funded medical and continuing care for as many people as possible; I have no strong views about how this should best be accomplished although it seems probable that insurance-based solutions, not directly State-managed, are the most viable way forward. Those who have not had the prudence to plan for their own futures should be told, pretty bluntly, that the consequences of their actions will have to be borne by them and they alone. I believe that the vast majority of people would be motivated into taking measures themselves to protect their own futures if these stark choices were honestly explained to people. Naturally all this would involve a significant reduction in overall levels of taxation, because the State would be promising a great deal less, in terms of services, for its citizens. I do not shrink from acknowledging that there is likely always to be a small percentage of the population which is unable to provide for itself and I would not myself advocate a completely laissez-faire policy, but I do believe that the safety-net available should be set a very great deal higher than it is currently.

To come back to some of the practical issues raised by last evening's programme, however, it is clear that the strongest objections to the elderly liquidating their own major assets, usually a dwelling, to help fund their own later years, comes from the children, allegedly endeavouring to protect the interests of their elderly parents, but in reality attempting to protect the assets they hope to inherit when a parent dies. I can really see no good reason why the State should continue to pay for the continuing care of people who require it when they have property assets which they no longer require for themselves and which could readily be liquidated to meet much of the cost over many years, solely for the purpose of providing children with a very significant inheritance. It really is that simple and it is about time that at least one of the major political parties, for example the Conservative Party, began to say so.