On the glory of state supplied services

Tim Worstall comments pithily on this subject today, but the "damning report" on state provision for the elderly cannot really have been a surprise to anyone likely to rely on such services. As someone who has visited family in state-run care homes and knows people who work in them, how could I (unless blinded by ideology) not be aware how bad they are? I blogged about it ages ago, commenting in the context of the horrors of the "Baby P" case;

Not only does the welfare state create perverse incentives to feckless breeding, it also divorces people from the need to care personally for the young, the sick and the elderly. Practical caring for others involves skills that need to be learned and maintained by practice. When every widowed grandparent incapable of looking after him or herself moved in with their family, the children of the house learned both to value them as humans and to help take care of them. They were family, after all. Nothing could be more natural. Now they are looked after in state nursing homes, where “carer” is just a job title; usually with as much relation to reality as most modern job titles. An old school-friend works in just such a home and routinely starts her shift by cleaning up residents who have been allowed to sit in their own filth by "carers" who couldn't be bothered because "they will only do it again." Tellingly, she reports that residents are only really cleaned up (other than by her) when relatives are due to visit - for fear that the families will "make trouble." The very families who would, if the welfare state did not exist, be looking after their old folk themselves.

With all due respect to those commentators who will worthily discuss how to reorganise the NHS, this problem is in the nature of the beast. It's not to do with how management or staff work in a socialised system of "care". It's to do with how such a system takes away responsibility from the people who care in the real sense of that word.

Of course good, kind people can be found to take care of you when you are sick, disabled or elderly. However, if you are not able to pay them and hold them accountable for their work yourself, someone who loves you needs to take on that role. If I am ever in a nursing home, I want my daughters to be paying the bills, checking up on the service and making it clear to the proprietors that they are ready to take our family's business elsewhere if they are dissatisfied. No bureaucrat, however kindly s/he may be, can replace that.

That the State could replace - or even do a better job than - a loving family is the most barbarous of the fallacies by which the 1946 generation has lived. They were so hung up on this fantasy that they systematically undermined the very concept of family at every opportunity. They actively encouraged people to depend on a burgeoning, state that would nurture them "from cradle to grave." Not only was that wrong, it was corrosively wrong. In fairness to the hapless wimp, that is what the boy David is trying to signal to the nation behind the backs of the Guardianisti with his "Big Society" schtick. The blank incredulity on the faces of the Polly Toynbees of this world is quite genuine. Their confusion between "society" and "state" is as total as their confusion between "the economy" and "the Treasury". But then Polly is wealthy enough never to sit in her own piss in her dotage as most of the nation's grannies - thanks to idiots like her - have good reason to fear.

Don't tell me that socialists "care" more than conservatives or libertarians. Ignore their fine words and look at what they actually do.

Comments

[Christine Hockett]

I agree with your response to Trooper Thompson, there are good care homes and we are lucky to have found one, and participate as much as possible, but whilst that is the major concern there can be other problems:
I was appointed Receiver/Deputy by the Court of Protection in 2003 for my now 89 year old aunt when she went into care. We eventually found her a home near us where we can frequently visit and enjoy her company. Fortunately she is in very good health apart from her deafness, poor sight in one eye and collapsed vertebra in her spine. Her home is excellent and very well run. Our only concern is that the capital raised from the sale of her home and contents to fund her care will be sufficient for her needs. It was lodged in the special account at the Supreme Court where it was earning 6% interest which met the top up needed on her pensions and attendance allowance to pay the care fees each month. However this interest rate is now 0.5% and although I have permission from the Court to move this money to other institutions, given the current climate I have decided to leave it in the “safe haven” of the Supreme Court where it is 100% guaranteed. The top up for her care fees now comes directly from this capital. Her pensions and the small amount of interest is still taxed. A consultation paper has just been published by the Ministry of Justice proposing increases in the annual fees charged to Deputies by the Office of the Public Guardian, the administrative arm of the Court of Protection. (Increases are also proposed for registration of a Lasting Power of Attorney). Under these proposals my aunt’s annual fees will go up from £550 (£175 Type II Supervision Fee & £375 Indemnity bond which is set according to the amount of capital held) to £695 (£320 Flat rate supervision fee for all and £375 bond). Also, although her affairs are non contentious and I manage them with the knowledge of my aunt (however, she is not aware her home and contents have been sold to fund her care) and the support of the rest of the family, any change in the arrangements which may be necessary will necessitate a Court Order which will cost £400. I am happy to be supervised by the Court of Protection while I have responsibility for my aunt’s capital, but feel that as the cost of good care is very high they must be careful to ensure that their fees, which they charge to ensure that her finances are properly handled, do not now impinge on her ability to fund her care for the rest of her life. Whilst she has her own money there are choices in her care. She is not a burden on the state so the state should not be a burden on her.
It is a public consultation and they want you to comment on the fee increases. It can be found on the Ministry of Justice website under “consultations” “open”.

[David Phipps]

Excellent post! I too have experience of care homes as reluctantly I had to place my mother in one when it became impractical for me to take care of her personal hygene.

She is in a council care home in West Berkshire and I cannot fault the level of care she receives. However the staff there admit to me privately that it could be even better but for H&S regs which affect how that care is delivered. It helps that those working there were 'born' to this type of work with most of them having been there 15/20 years.

However the general thrust of you post is most noticable when considering sheltered accommodation where it would seem the authorities lay themselves open to prosecution under the Vulnerable Groups Act 2006!

[tomsmith]

excellent post

[Tom]

That generation sincerely believed socialism would provide a loving family for all, including those not blessed with one by nature or luck. Not only is the road to hell paved with such good intentions but the rate of progress varies with their ambition. "Progressive" may even be a sub-conscious reference to this rule. :-). Certainly they forget that speed of "progress" is only good if you are heading in the right direction. How else could they (eg Obama) see "change" as a good in itself?

Conservatives are not people who oppose change, they are people who insist on only good change, intelligently thought through with due regard to the law of unintended consequences.

[Trooper Thompson]

Tom,

I take your points. I speak of personal experience, and dumping is the apposite word, and I do think there is an attitude amongst what you call the 1945 generation, that rejected certain parts of family duty. I don't deny that some old people need to be cared for outside the family, especially if they really lose their marbles, but too many are considered nothing but an inconvenience.

[Tom]

Care homes can be fine, but - as with all businesses - the customer needs to be alert and provide feedback when service falls short. In my own business, I did my best but I owe a lot to clients who picked up things that could be improved. In a home, the immediate customer is not always on top form (by definition) and his or her family therefore needs to fill the role. "Dumping" is a bad word, but families can hire professionals to take care of their elders with a clear conscience, as long as they stay involved.

The problem with state services is that they cut the link between the customer and the provider. Just watch your GPs body language next time you meet. You are not his customer, you are a troublesome task he performs to get paid by his real boss.

That's not to criticise GPs. It's inevitable, because they are human. I have used GPs in four other countries where the doctor/patient financial relationship is not intermediated by the state. The difference is immediately apparent.

[Trooper Thompson]

Excellent post, I may have to quote from that last paragraph. I have some personal knowledge of this, which makes me very much against the practice of dumping one's relatives in care homes.

[Tom]

I have to take you up on that sometime. I am personally ok, thank you, but Mrs P is very seriously ill which is why I am quiet. Right now, I mostly just don't have the heart to blog.

[David Davis]

Good and sharp commentary on Stae-GramscoNazism. The old are of course no use to the State (I almost typed "Tate", how Freudian in a "modern" country) being not any more a "resource".

Something Charles Moore said a few years ago, and I know he is unpopular for being an Eton Toff, but he said:-

"Things get old, because they are good."

Tom old man, I continue to hope you are all OK. Please get in touch if you are ever up North, and we can entertain you in the Chimps' nissen hut (see earlier, etc...)

[jameshigham]

They were so hung up on this fantasy that they systematically undermined the very concept of family at every opportunity

Yet I've seen the spectacle, in Russia, of no services whatever and the family really struggling with their elderly. I agree with your basic premise though, Tom.

[Katabasis]

Hear hear Tom!

[Suboptimal Planet]

Superb post, Tom. Great to have you back.

Hope all is well.