The social care system is on its knees: what is the Chancellor going to do?

This week's Spending Review and next week's Lords debate of the Care Bill provide the government with opportunities to start solving our care crisis.

On Wednesday millions of older and disabled people who rely on support from their council to get up, get washed and dressed and get out will be closely following the Chancellor’s Spending Review.

The social care system is on its knees.

Budget cuts to councils have seen them upping the bar for eligibility for support, with 83 per cent of councils now setting the threshold at a higher level. According to London School of Economics 69,000 disabled people have been pushed out of the system.

At the same time many are squeezing the support for those that are in the system. A Scope survey found almost 40 per cent of disabled people who continue to receive social care support are not having their basic needs met including eating properly, washing, dressing or being able to get out of the house.

The consequences are dire. Take away the preventative support and people fall into crisis.

It’s no surprise that there’s now a widening consensus that the crisis in local care is a factor in the pressures on A&E.

It’s also no surprise that there’s cross-sector and cross party backing for the Chancellor to use the Spending Review to invest in preventative social care.

Intriguingly on Friday there were strong hints that the Department for Communities and Local Government, while potentially taking a 10 per cent budget cut, could take responsibility for £3bn from other departments' budgets.

The momentum is there and social care looks set to be a crucial Spending Review issue.

But in case the Chancellor needs further convincing let me introduce Angela Murray.

Angela is an independent, sociable young woman who has a degree in psychology. She volunteers three days a week. She’s also disabled; she was hit by a car when she was two.

For the last ten years, she’s lived in her own home and has had support from her council to get up, get washed, get dressed, go to the toilet, cook, eat and shop.

But recently her social worker told her that her care was being cut from 20 hours-a-day to just three hours. Angela was given five days’ notice.

Angela described her new care routine as ‘depressing and undignified’. She had to be in bed at 9.30pm every night. She also lived off microwave meals because her 30 minute evening call didn’t give the carer enough time to cook for Angela as well as take her to the toilet.

Angela says if she has to live under that regime for the next 50 years, life would not be worth living. She’s fighting back: the local media have already covered Angela’s story and she has a solicitor on board fighting the changes.

The council, reluctantly, agreed to temporarily reinstate Angela’s old care package until a second reassessment, when her care package is likely to be cut again.

And while we’re at it, let me also introduce the 45,000 members of the public who have signed Angela’s petition calling on the Chancellor to invest in social care. It’s clear that Britain cares about social care.

Wednesday will be crucial. But it doesn’t stop there.

The following week the Government will publish its plans for deciding who is in and out of the social care system. This is critical.

The announcement will come as the Care Bill is debated in the Lords. The reforms seek to tackle the crisis in care by introducing a cap on costs, a new means-testing threshold and national eligibility to end the postcode lottery in care.

But the plans, as they are, will also raise the bar for eligibility to social care (see p32 of the White Paper). According to the London School of Economics (LSE) this will leave 105,000 disabled people outside of the system altogether.

If the Chancellor takes the opportunity to invest in social care, that cash needs to be channelled into a system in which disabled people are eligible for care before their situation has deteriorated into crisis.

Properly funded social care is now a ‘no brainer’.

Research by Deloitte has shown that investing in £1.2bn in social care for disabled people will result in a £700m return for central Government and £570m return for local Government and NHS, because it prevents disabled people falling into crisis and needing to access more costly support.

By acting decisively the Chancellor can go a long way to solving the social care crisis, protect A&Es, and save cash across government departments. It’s a triple win.

But the Government will only be able to claim that it’s solved the social care crisis once it has decided who is in and who is out of the system.

Richard Hawkes is chief executive of the disability charity Scope

Take away the preventative support and people fall into crisis. Photograph: Getty Images

Richard Hawkes is chief executive of the disability charity Scope.

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Donald Trump's cartoon nuclear rhetoric draws on a culture of American jingoism

Senior Republicans avoided condemning Trump's incendiary speech, and some endorsed it. 

From recent headlines, it seems as though Donald Trump isn't content with his Emmy-by-proxy. The US president told the United Nations General Assembly this week: “The United States has great strength and patience, but if it is forced to defend itself or its allies, we will have no choice but to totally destroy North Korea.” Trump’s speech raised eyebrows for its bellicose tone, especially when contrasted with his predecessor’s endorsement of a war-averse approach. 

A widely circulated image of Trump's chief of staff John Kelly with his head in his hand might suggest that most listeners loathed the speech. But Trump said many outrageous things on the campaign trail and voters - at least a critical number of them - agreed. So how did his words go down at home? 

My contacts in international security were unwilling to go on the record condemning it. They were mainly Americans in their twenties, hoping for a government job one day, and fearful of saying anything that could be interpreted as "un-American".

The one person who would speak to me asked for their name to withheld. A former military analyst in the US Department of Defence, they told me that “the US has the military capability and legal responsibility to address threats to itself or allies". What Trump said, they suggested, should be seen in the context of the wider US institutions. "While Trump may have advocated for isolation in the past, the political and military forces he leads are built to enforce the adherence to international law and regional security," the former analyst said. "They provide a real counterweight to the bombast in Pyongyang.”

Trump's speech may have been colourful - his nickname for the North Korean leader Kim Jong-un, "Rocket Man", is a reference to Elton John’s mid-Cold War musical hit – but the speech should be seen as yet another reassertion of US military dominance. North Korea may boast of its Inter-Continental Ballistic Missile (ICBM) development,  but its arsenal is simply not well-equipped enough to present the same existential threat to the US that the USSR did at its peak. 

Rather than lacking comprehension, the analyst said of the speech: “Trump's rhetoric is intended to galvanise recognition that the current rules based order is threatened by North Korea's actions”.

Trump’s jingoism is not unique amongst the current American elite. Back in 1983, in his book, The Wizards of Armageddon, the liberal journalist Fred Kaplan characterised the hawkish US military strategy as simply ejaculating combative statements without a long-term plan. Kaplan quoted Herman Kahn, one of the early nuclear strategists, who called one proposal targeting the USSR a “war orgasm”. 

The US Senate recently passed a defence policy bill to increase military spending to $700bn, which includes $8.5bn for missile defence purposes. Overtly catastrophic language, meanwhile, has long been a staple of US foreign policy debates. In 2015, Trump's rival for the Republican presidential nomination, Ted Cruz, made headlines when he vowed to carpet-bomb Isis until he found out "if sand can glow in the dark". While most leading Republicans chose to stay silent after Trump's speech, a few, such as Paul Ryan and Rand Paul, publicly endorsed the message. Cruz, despite the rivalry, was among them. 

On social media, the American public are vocally divided. Some called for Trump to be denounced for his inflammatory speech, but others tweeted #MakeAmericaGreatAgain. Even some Trump sceptics agreed that the North Korea “nuclear summer” needed to be kept in check.

By contrast, overseas listeners have perceived the speech, and this administration’s foreign policy, as unnecessarily incendiary. Matt Korda, a Canadian research assistant on strategic stability at the UK-based Centre for Science and Security Studies,  told me: “Kim Jong-un perceives his nuclear weapons to be the only thing guaranteeing his regime's survival”.

“He will never give them up, no matter how much Trump threatens him," Korda added. “On the contrary: Trump's threat to ‘totally destroy’ the entire country (including millions of innocent and oppressed civilians) will only tighten Kim's grip on his nuclear weapons”.

The effects of Trump’s speech are yet to fully play out, but it is clear that his words have rallied at least a section of American society, and rankled everyone else. The Donald may seem to be mirroring the culture of nuclear recklessness his North Korean opponent helped to create, but this is also the kind of hostile and hyperbolic rhetoric which fuelled his rise to power. In reality, once Trump’s unpleasant vernacular is decoded, he can be seen to be echoing the same global view that has long pervaded the collective American consciousness. Trump's speech was not addressed at his UN doubters, but rather at his domestic fan base and his allies in the South Pacific. This is not a shift in US foreign policy - it is tradition with a spray-tan.

 

 

Anjuli R. K. Shere is a 2016/17 Wellcome Scholar and science intern at the New Statesman