Tory manifesto pledges with regard to health and social care continue their increasingly desperate efforts to make changes at a structural level to the way the UK provides health-related services. This paper looks at the two central planks of these aims, the pledge for extra cash to the NHS and the plan to include the property assets of older people when calculating how much individuals need to pay towards care costs.
In the days following the publication of the Tory manifesto the Telegraph trumpeted ‘Tories pledge £8bn rise in NHS spending’. They added ‘Conservatives would also triple the fees charged to migrants for using the NHS, to help raise more funds from overseas patients’. The overt racism of this proposal – along with its celebration by the Telegraph – won’t surprise us and won’t be considered further here. What do we make of the £8 billion pledge? The figure is over the course of the next government, so roughly £1.6 billion per year. In 2010, the year of the Coalition government and the start of the onslaught of policy initiatives designed to radically speed the pace of privatisation of the health service, of the 240 NHS trusts and foundation trusts only 5% overspent annual budgets. According to the Kings Fund, by the end of 2017 this figure will have risen to 51 percent with a predicted overall deficit of £2.5 billion. In other words, the first tranche of the ‘extra’ cash won’t even cover the deficit so far. The overspend trend is set to continue, despite continued ward closure and staff cuts. Why? In large part as a result of these staff cuts.
To make up for staff shortages the numbers of (much more expensive) temporary locum and agency staff has rocketed, exposing the un-fit for purpose nature of pay and workforce supply policies put in place to hasten cost cutting in a bid to enhance the NHS’s saleability to private capital. Staff shortages are likely to persist since the number of nurse training places has declined by 20% over the last decade, according to The Perfect Storm, a survey of rising NHS costs. The rising costs, resulting from policy initiatives, also provide a useful ideological tool with which to undermine the idea of a nationally funded health system.
The government’s Five Year Forward View, which outlines its plans for making ‘productivity’ savings in the NHS up to 2020, encourages NHS Trusts to make cuts in permanent staff. The strategy is patently counterproductive for a centrally planned and managed national health service. It might make some sense if what you want to develop is a splintered, decentralised system of competing private health capitals. So we might see the £8 billion in this light – as a temporary bung to Trusts managers to support them as they progress towards full privatisation through lowering costs by increasing the rates of exploitation of fewer staff. The government are also helping with this project more indirectly by capping the hourly rates paid to agency staff, which currently run in excess of 60% more than the hourly rates of pay of substantive staff. Meanwhile, PFI, though relatively less important than staffing cost issues, continues to leak out of the system millions each year into the pockets of private finance capital and speculators.
So what about social care funding, the issue that threatened to undermine the Tories’ electoral hopes completely in the days before the bomb in Manchester? The Tory plans aim to extend to care in your own home, charges which individuals already have to pay if they move into residential care. As it stood before the election, anyone with assets over £23,250 had to pay the full cost of their care if they move to a care or nursing home. Care costs in homes are high, with 1 in 10 older people spending more than £100,000 in their lifetimes; £700 per week for residential care or £1,000 per week the average cost of a nursing home place. When calculating who pays what, the value of your property is taken into account, and there are a whole raft of rules and regulations that seek to prevent older people passing their home on to others in order to avoid this. This system will be extended to include people receiving care in their home should the Tories win the election. There are exceptions to this. If you’re one of the estimated 1.9 million older people living in poverty, this doesn’t apply to you. I’m sure that’s a great relief for them. Also, as the Guardian reassured us, if your home is worth less than £100,000 ‘you’ll be fine’. According to a BBC survey, the lowest average house prices in the UK are in Bradford, standing at £118,302. So, everyone will have to pay something. No one will be fine.
It’s a less generous version of the already miserly American Medicaid system. There, to apply for Medicaid older people must have less than $2,000 in the bank, no savings, no pension, and no other form of income. They can have debt, a house and a car. If people do have extra funds, they can choose to spend down by purchasing a Pre-Funeral plan. This, and only this, is an acceptable purchase in the eyes of Medicaid. All other fund and/or property transfers will be tracked and chased down later for Medicaid reimbursement. In other words, relatives potentially become liable for care debts pursued by debt agencies.
The parallels extend further and give a clue as to the structural change element intrinsic to this proposal. Health insurance companies are set to massively benefit from them through what’s known as ‘equity withdrawal’. Through this, older people can lend money against the value of their property from an insurance company, who’ll fund care in advance of payment – at a cost. So, for example, an insurance company lends you £200,000 against your house aged 65, charges say 5% interest a year until your eventual death at 90. You now owe them £200,000 plus 25 years' interest at 5%, some £359,000. Heaven forbid there should be a property crash, or prices don’t grow as planned. In that case, as with Medicaid, relatives are likely to become liable for debts and pursued.
Since the late 1970s, with the onset in decline of council house building, we’ve all been encouraged to ‘get on the property ladder’, working our way up aided and abetted by the banks who’ve charged us a tidy sum in interest payments as we went. We regard our homes as part legacy, a stock of value we’ve worked hard to establish that we can bequeath as we please. But, if the Tories win, no longer. In that eventuality, the home becomes little more than a store of future care potential. Not only that, the Tory plans are the vehicle through which they entrench parasitic debt-driven insurance capital into how the UK does ‘care’, making a mockery of the word in the process.
Dr Lee Humber, Tutor in Health and Social Care at Ruskin College, Oxford