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DAVID GROSSMAN: Getting old ain't what it used
to be. We're now living longer and stronger than ever before. The Paisley
Piranhas is a Seniors ice hockey team, not for them a stroll in the park
to feed the ducks. Believe it or not, some of the players crashing round
the ice and are well into their seventies. In a society increasingly obsessed
by youth, they prove that retiring from work needn't mean retiring from
life.
These players are obviously in splendid health, but one concern that worries
us all is what will happen if we can no longer take care of ourselves.
At the last election, Labour picked up votes from the middle classes by
promising they'd no longer have to sell their homes to pay for long term
care. Now though, the government at Westminster is pleading a lack of funds.
Here in Scotland, Henry McLeish's Scottish Executive seems to have found
the money. Mr McLeish's expected generosity is threatening to make Mr
Blair look uncaring and miserly just before a General Election.
DAVID HINCHLIFFE MP: I believe that the long term
care issue will possibly prove in the very near future, to be another seventy-five
p issue for the Labour Party and I worry about that because when people
realise that we have this unfairness, we have this problem that won't be
easily resolved, then there will be great pressure on Labour MPs in particular
to do something about it.
ACTUALITY
GROSSMAN: Giving thanks for plenty
at a retirement home in Edinburgh. Few issues are more emotive than how
much of society's wealth is distributed to our oldest citizens. Tony Blair
promised to end the practice whereby the only way the elderly could get
long term care was to sell their homes. He set up a Royal Commission to
look at how best to deliver on that promise.
Headed by Sir Stewart Sutherland, an Edinburgh academic, the commission
concluded that only the board and lodging element of care, the so called
hotel costs, should be means tested. Everything else, it said, should
be free.
SIR STEWART SUTHERLAND: Right at the core of this was the
belief that people who are in need should have that need met. This is
basic in all of the up bringing I've ever had. It's basic in the way in
which people in our country think, I have no doubt, meet that need. We
don't for example say to somebody when they come in to hospital in need
of a operation for lung cancer, how many fags a day did you smoke, this
is your own fault. We actually see them as someone in need and we respond
as a humane civilised society.
GROSSMAN: In Scotland, health is
one of the range of services now provided by the Scottish Parliament and
Scottish Executive. When Scotland's first minister, Henry McLeish took
office, he gave his backing to delivering the full Sutherland Commission
recommendations, much to the delight of his Liberal Democrat coalition
partners. Indeed all the parties in the Scottish Parliament agree with
him. Scotland's health minister is due to make an announcement on Wednesday.
MARGARET SMITH MSP: We've got a long tradition
in terms of wanting to see good funding of public services and decent social
services available to our population. And I think what the Scottish Parliament
allows us to do is to actually feed in to the experts working in the fields,
to talk to carers, to talk to professionals and say to them, if you have
the money available to you and you now have a Parliament available here
to make these things happen, how would you improve the services to the
people of Scotland, how do you think we should proceed? And we've done
that with long term care, we've taken the evidence, we've talked to the
people involved and they're saying to us, go ahead, implement this in full.
GROSSMAN: Such a move would be
very popular in Scotland. Angus Gillon is a frequent visitor to the Edinburgh
care home, where is father is a resident. The Reverend Blair Gillon may
be ninety-four and retired from the church but he continues to study.
What he can't do is take care of himself and paying for help is now eating
away at his capital.
ANGUS GILLON: In order to pay for his care,
my father is using all his pension income, he's using the interest from
the capital from the sale of his house and in addition, there is a small
proportion of his capital, going simply to pay for him to reside here.
Now, if any change were to come and some proportion of that were subsidised
by the Scottish Executive, Scottish Parliament, or provided by the Scottish
Parliament, I guess that that would make our lives and his life a little
bit more comfortable because we could look further ahead to the future.
At the moment he's becoming more dependent as you do as you get older and
we're not sure what lies ahead.
GROSSMAN: The prospect of having
two different prescriptions for long term care north and south of the border
puts Scotland's First Minister Henry McLeish in an awkward position.
Tony Blair would far rather he opted for the same remedy as England and
Wales - where spending on long term care has risen but is targeted on those
most in need. The UK government fears that if Scotland goes ahead with
the plan for free care, this fact will be lost, amid a flurry of unflattering
comparisons to Scotland. But Edinburgh isn't Westminster.
JOHN McALLION MSP: Oh Henry McLeish faces completely
different political pressures from Tony Blair. We have the main opposition
party, the SNP, pressing us from the left and they of course are demanding
the full implementation of Sutherland. Even the Conservatives in Scotland
are demanding the full implementation of Sutherland. And Henry really didn't
have any political space to go to, other than agree with them because if
he did then Labour would would lose out significantly in terms of the left
of centre vote that tends to dominate in Scottish politics.
GROSSMAN: Coming to see how the
other half live - a coach-load of pensioners from the north-east of England
on a visit to Scotland. This could become something of a promised land
to pensioners from the rest of the UK. Although these visitors from the
Durham Friendship Centre have come to see the famous buildings and beautiful
scenery - they're also flashing a few admiring glances at the health-care
system in Scotland. Another country where they do things differently.
It's among people like this that the government could meet considerable
hostility. If a day-trip over the border to Scotland reveals a health-care
system that's managing to fund the full recommendations of the Royal Commission
Report, there are plenty of voters in the rest of the UK who will want
to know why they are apparently being left behind.
FRANK HEDGES: If the Scots can afford it,
then I'm quite sure that we can afford it in England. It can't be right
that you pay into National Insurance for all your life, and then, because
you have the bad luck to be somebody who needs long-term care, your small
savings are eroded, completely eroded by paying for your long-term care.
JOAN McELROY: I think it's very unfair.
If they pay the same taxes as us, why can't we have the same benefit?
And I don't see why I should have to sell my home to pay for care. I've
worked hard to get a home and people who are on benefit all their lives
are still going to get benefit, that I'm going to have to give up my home
for.
GROSSMAN: The reward for three
hours on the bus is one of Edinburgh's finest views. The reward for a working
life spent saving and paying taxes may now depend on the Blair government's
distinction between types of care. In the future the NHS will only pay
for nursing case, for example handing out medication. Other care, like
help with dressing, will be called personal care and will be means tested.
That's say critics, is completely unworkable.
SIR STEWART SUTHERLAND: If it weren't so tragic, it would
almost be a joke in the profession. How do you decide when a bath is a
social bath and when it's a medical bath? It's absurd just to have to
ask the question. But the current government plans will require that to
asked and answered and charges made accordingly.
They will have to set up a large bureaucracy to work out where the charges
fall, who should pay, and then they've got to go and collect it. That
will take a lot of money out of the actual provision of care into bureaucracy.
HINCHLIFFE: I can see understandable
anger, particularly where you are in the north of England, not that far
from Scotland and over the border the policies are very distinct and different
and in most people's perception a good deal fairer. I think that that
will lead to pressure to bring about certain changes. It may indeed bring,
bring about legal challenges at some point.
GROSSMAN: A care assistant helps
residents with their daily routine. The UK government's answer to the
difficulty of drawing up legally robust definitions of nursing care and
social care is to give that decision to nurses, so that for each case,
an assessment would be made and the distinction not fixed but flexible.
DR LIAM FOX MP: We don't have a problem
with the government's judgement that there are better ways of using a large
amount of money than extending the nursing care through to personal care,
our worries with it are really with definition, on how, in terms of legislation,
you can clearly define what is nursing care and what is personal care and
how you would separate that out in practice. For example, would it create
perverse incentives for nurses to actually say somethings were nursing
care when they're really personal care, in other words, in order to make
them free for patients?
ACTUALITY
GROSSMAN: Everyone likes a bit
of a flutter - but Henry McLeish may well be gambling with his political
future. He can't please both London and Scotland. He's already upset
more than a few in Westminster by calling his Executive the Scottish Government.
And the Scottish Parliament's already voted through an exemption from
higher education tuition fees and is now finalising a huge pay-rise for
its teachers. At Westminster, envious Labour MPs are beginning to grumble.
HINCHLIFFE: There is already a
good deal of concern among English MPs about the discrepancy between the
funding levels and the ability for example, in terms of delivering community
care packages between local authorities in England and local authorities
in Scotland. I've personally raised this matter with the Chancellor who
himself of course is a Scots MP, so he's a vested interest probably in
retaining the advantage that Scotland's got.
GROSSMAN: Henry McLeish though
is a long way from winning any trophies. There's now speculation that
he's about to back down under pressure from London. But that too would
be risky. He needs the Liberal Democrats on side to control Parliament
and many of them are now muttering darkly about breaking the coalition
if he doesn't implement the Sutherland Report in full. For some of his
own backbenchers the issue is now a matter of Scottish Labour's entire
credibility.
McALLION: Above all Henry McLeish
has to be seen to be independent of Tony Blair and of the Labour Cabinet
in Westminster and to be taking decisions because they make sense in the
Scottish context, not because they make sense in the UK context. So that's
a pressure that Henry's consistently under. Henry also has to take in
to consideration that we are one party and we want to see Labour win as
many Westminster seats as possible in Scotland. So we're not going to
do anything stupid and foolish to put at risk Labour victories here in
Scotland. But at the same time what would really put Labour victories
at risk in Scotland would be the perception that the Scottish Labour Party
was now run from London. If that perception started to gain ground in
Scotland, Labour in Scotland would be in very serious trouble indeed.
DR FOX: It was inevitable that
they way the government pursued their devolution agenda, was going to lead
to conflict between Edinburgh and London. We said all the way through,
this was a recipe for conflict. It was a recipe for the potential break
up of the United Kingdom and we're now seeing, when you've got the same
party in power, in both the Scottish Parliament and Westminster that this
tension is already arising, how much greater would that tension be if you
had different parties in power and what would the consequences be for the
country as a whole?
GROSSMAN: It's hard to see how
Labour can win. If Henry McLeish goes ahead with free long-term care now
it will be embarrassing for Tony Blair and Labour in the rest of the UK.
But if he doesn't, he'll risk humiliation and Labour could suffer at the
polls in Scotland. The Royal Commission was meant to remove elderly care
from the political melee, now devolution has put it right back in the fray.
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