Dividing Lines: Getting old

The graph of doom.

In local government they call it “the graph of doom”. It is the chart with one steep downhill line showing budget resources and, soaring above it, another line showing the demand for services to look after an ageing population.

According to the latest census, one in six Britons is past retirement age. The number of pensioners will rise from roughly 12 million now to 16 million in 2050. The number of people aged over 100 (now around 12,000) will double over the next decade. As local authorities are responsible for adult social care, they won’t be doing anything else in the future unless the system changes.

What about the National Health Service?
It isn’t designed to provide long-term care for the elderly. Many people discover that only when they or their parents need urgent help. By some estimates, a third of all hospital beds are occupied by elderly patients. Long-term social care, arranged by councils, isn’t free for all. There’s a means test.

That’s the bit where I sell my house, right?
Under current rules, if you are worth more than £23,250 you pay. How much depends on the kind of care you need and where you live but the exposure is potentially unlimited. That often means cashing in equity.

Politicians should do something.
They are. The government is proposing a cap of £75,000 on the amount any one person would have to spend, starting in 2017. There will be a new, tapered means test starting at £123,000 – and so someone worth £50,000 still has to pay something, but less than someone worth £100,000. No one should pay a penny beyond the £75,000 cap.

Really?
No. In the small print, you are still liable for some “hotel costs” – the bed and board element of residential social care, the logic being that you’d still be paying for that sort of thing at home. But the state will now ease the burden for tens of thousands more pensioners.

If all these people are being let off the hook, where does the money come from?
The Treasury will need to find about £1bn extra per year. Some of this will be coming from additional employer National Insurance contributions. Most will be raised by freezing inheritance-tax thresholds, skimming more revenue over time from legacies of the dead.

Death taxes! Yuck!
Funny you should say that. It’s the very line that the Tories used in the 2010 general election campaign when attacking a Labour plan for universal social care, funded in part from inheritance taxes.

Oh, the irony.
That’s one word for it. That campaign poisoned relations between the Labour and Tory health teams, which made cross-party agreement impossible even though everyone agrees this is one of those big, long-term issues that demands collaboration. After the election, the coalition commissioned Andrew Dilnot, an eminent statistician, to come up with a plan. His report, published in July 2011, forms the basis of the coalition’s proposal. The government’s cap is a bit less generous than Dilnot recommended.

It took them 18 months to make that tweak?
It took them the best part of 18 months to summon up the courage to do much at all. There was a social care white paper last year that avoided the Dilnot route, which sounded a bit difficult and expensive to implement. Then the coalition parties realised that they needed some policy for the second half of the parliament. That became more urgent the clearer it got that fixing the national finances – formally declared Tough Issue Number One and the coalition’s stated raison d’être – wasn’t being tackled to anyone’s satisfaction. So Dilnot’s plan was fetched into Downing Street from the long grass.

And how’s that cross-party consensus coming along?
Labour has responded cautiously to the new coalition plan, with variations on the classic “too little, too late” holding rebuttal. Separately, Andy Burnham, the shadow health secretary, has devised a grand plan to integrate social care with the NHS. The idea, under the rubric of “whole-person care”, is to find ways to maximise the value that society gets from the huge health budget with a more strategic focus on promoting healthy, happy living – supporting the elderly to stay in their homes, for example. That, in theory, works better and costs less than the present inefficient process, which intervenes too late and ends up throwing money at random at the consequences of unhealthy lifestyles and poorly managed chronic conditions.

What does that mean in practice?
There’s a review to work out the details.

What about the money?
The right kind of interventions at the right time save money in the long term, as health and social care spending would go much further if the system wasn’t forced into making so many costly last-minute emergency interventions. Hospitals wouldn’t be turned into vast geriatric warehouses.

Long-term savings appear only in the long term. You’d need money upfront to fix social care, even just to match what the government is doing.
Yes, you would. And when Labour finally decides what its spending priorities are, there is a strong chance this will turn out to be one of them.

Rafael Behr is political columnist at the Guardian and former political editor of the New Statesman

This article first appeared in the 25 February 2013 issue of the New Statesman, The cheap food delusion

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Air pollution: 5 steps to vanquishing an invisible killer

A new report looks at the economics of air pollution. 

110, 150, 520... These chilling statistics are the number of deaths attributable to particulate air pollution for the cities of Southampton, Nottingham and Birmingham in 2010 respectively. Or how about 40,000 - that is the total number of UK deaths per year that are attributable the combined effects of particulate matter (PM2.5) and Nitrogen Oxides (NOx).

This situation sucks, to say the very least. But while there are no dramatic images to stir up action, these deaths are preventable and we know their cause. Road traffic is the worst culprit. Traffic is responsible for 80 per cent of NOx on high pollution roads, with diesel engines contributing the bulk of the problem.

Now a new report by ResPublica has compiled a list of ways that city councils around the UK can help. The report argues that: “The onus is on cities to create plans that can meet the health and economic challenge within a short time-frame, and identify what they need from national government to do so.”

This is a diplomatic way of saying that current government action on the subject does not go far enough – and that cities must help prod them into gear. That includes poking holes in the government’s proposed plans for new “Clean Air Zones”.

Here are just five of the ways the report suggests letting the light in and the pollution out:

1. Clean up the draft Clean Air Zones framework

Last October, the government set out its draft plans for new Clean Air Zones in the UK’s five most polluted cities, Birmingham, Derby, Leeds, Nottingham and Southampton (excluding London - where other plans are afoot). These zones will charge “polluting” vehicles to enter and can be implemented with varying levels of intensity, with three options that include cars and one that does not.

But the report argues that there is still too much potential for polluters to play dirty with the rules. Car-charging zones must be mandatory for all cities that breach the current EU standards, the report argues (not just the suggested five). Otherwise national operators who own fleets of vehicles could simply relocate outdated buses or taxis to places where they don’t have to pay.  

Different vehicles should fall under the same rules, the report added. Otherwise, taking your car rather than the bus could suddenly seem like the cost-saving option.

2. Vouchers to vouch-safe the project’s success

The government is exploring a scrappage scheme for diesel cars, to help get the worst and oldest polluting vehicles off the road. But as the report points out, blanket scrappage could simply put a whole load of new fossil-fuel cars on the road.

Instead, ResPublica suggests using the revenue from the Clean Air Zone charges, plus hiked vehicle registration fees, to create “Pollution Reduction Vouchers”.

Low-income households with older cars, that would be liable to charging, could then use the vouchers to help secure alternative transport, buy a new and compliant car, or retrofit their existing vehicle with new technology.

3. Extend Vehicle Excise Duty

Vehicle Excise Duty is currently only tiered by how much CO2 pollution a car creates for the first year. After that it becomes a flat rate for all cars under £40,000. The report suggests changing this so that the most polluting vehicles for CO2, NOx and PM2.5 continue to pay higher rates throughout their life span.

For ClientEarth CEO James Thornton, changes to vehicle excise duty are key to moving people onto cleaner modes of transport: “We need a network of clean air zones to keep the most polluting diesel vehicles from the most polluted parts of our towns and cities and incentives such as a targeted scrappage scheme and changes to vehicle excise duty to move people onto cleaner modes of transport.”

4. Repurposed car parks

You would think city bosses would want less cars in the centre of town. But while less cars is good news for oxygen-breathers, it is bad news for city budgets reliant on parking charges. But using car parks to tap into new revenue from property development and joint ventures could help cities reverse this thinking.

5. Prioritise public awareness

Charge zones can be understandably unpopular. In 2008, a referendum in Manchester defeated the idea of congestion charging. So a big effort is needed to raise public awareness of the health crisis our roads have caused. Metro mayors should outline pollution plans in their manifestos, the report suggests. And cities can take advantage of their existing assets. For example in London there are plans to use electronics in the Underground to update travellers on the air pollution levels.

***

Change is already in the air. Southampton has used money from the Local Sustainable Travel Fund to run a successful messaging campaign. And in 2011 Nottingham City Council became the first city to implement a Workplace Parking levy – a scheme which has raised £35.3m to help extend its tram system, upgrade the station and purchase electric buses.

But many more “air necessities” are needed before we can forget about pollution’s worry and its strife.  

 

India Bourke is an environment writer and editorial assistant at the New Statesman.