Given the parliamentary time and political capital being expended on the ludicrous Rwanda scheme, one could be forgiven for thinking that small boats carrying asylum seekers were the only thing the government has to worry about. But the fact is that this is a useful distraction to be employed by an administration on its way to the electoral equivalent of Dignitas. The real problems that beset the country continue to mount, but the prime minister, Rishi Sunak, has little incentive to try to tackle them. Instead, they will be waiting for Keir Starmer and his team when they take over.
The NHS is genuinely on the brink of collapse; social care is teetering; local councils are going bust, and “levelling up” has proved to be the verbiage of a snake-oil salesman. And there is no cash to provide a solution, or even a temporary sticking plaster, to these fundamental issues.
The first two are inextricably linked. You may recall, or probably instantly dismissed as meaningless, that, in his first speech as prime minister in July 2019, Boris Johnson promised that his government would “fix the crisis in social care once and for all with a clear plan we have prepared”. It was just another of his mythical “oven-ready” proposals for which the ingredients had not even been sourced.
So elderly people continue to block beds in hospitals because there is no provision for them elsewhere. Having spent some time as a patient in St Thomas’ hospital in London last autumn, I saw the difficulties this can cause. An elderly man with dementia loudly, vigorously and at length made clear his intention to break out of the ward, a sad distraction for staff trying to cope with dozens of cardiac patients.
The lack of care-home places is gradually being exacerbated as the private equity companies that snapped them up in search of easy pickings are finding that higher interest rates mean the sums no longer compute and so they are closing the homes down. Not that elderly care was the only social ill adding to the strains I saw.
One inventive patient kept conjuring up new symptoms that required more tests because she was more comfortable on the ward – with regular meals, plenty of heating and access to daytime television – than at home, eking out her meagre benefit cash. Apparently, this is not an unusual syndrome, a consequence of poverty and loneliness. Greater use of social prescribing by GPs might go some way to ameliorating the latter and could even help the long-term unemployed develop the confidence to rejoin the workforce.
Staff at Tommy’s were unfailingly patient and kind, despite being massively over-stretched because of shortages, irrespective of the doctors’ strikes. But several I spoke to were making plans to take the much more remunerative locum route or, more drastically, head to Australia, where their skills are better appreciated. Those who kept things working came from all over the world. The UK simply has not trained enough medics and nurses not to rely on overseas help, no matter what those who would like to pull up the drawbridge believe.
Money is not the answer to these problems, which is just as well since Starmer and his team will have none. Instead, drastic reform is required. They will have to face down the local pressure groups that wage war against any suggestion of closure of local hospitals, and speed up the development of diagnostic hubs and centres of excellence specialising in particular treatments.
Wes Streeting, the shadow health minister, has indicated that he has an appetite for radical change, and he will have to retain it. He must immediately challenge the operators of PFI hospitals, the product of a crazy idea that the country could enjoy lavish new public-sector projects for no outlay.
Instead, the PFI operators charge a fortune to provide hospitals and related maintenance services: in the financial year 2020-2021, the interest bill alone was nearly half a billion pounds, with another £1bn being charged for captive maintenance charges such as cleaning. The gag about “how many men does it take to change a light bulb” is no joke in PFI hospitals!
The Starmer government must be brave enough to implement the conclusions of the Dilnot report, or something very similar, and ensure that those who can make a fair, but limited, contribution to the cost of elderly care do so. Then it has to look at whether there are better ways of providing it than the country currently employs. It has been proved, for instance, that elderly people fare better if they are in regular contact with children, so combining care homes with nursery premises could be mutually beneficial.
But providing social care is just one of the responsibilities of local authorities, which are now heading towards bankruptcy – if they are not already there. The government has seemed oblivious to this catastrophe, but those who do not travel by helicopter or have their own heated swimming pools are already seeing the results of local services being decimated.
Starmer will need to find some innovative ways of helping local authorities to bolster their finances. Many have assets that could be put to better use: insistence on the drawing up of effective balance sheets would be a useful starting point for getting a more accurate picture of the true state of local authorities’ finances.
None of this will be easy, but a new government with a mandate for change could really address problems that have been mounting for decades. Fingers crossed!
