................................................................................
ON THE RECORD
RECORDED FROM TRANSMISSION BBC-1 DATE: 22.10.95
................................................................................
JOHN HUMPHRYS: Good afternoon. The debate is hotting up
again over whether a Tory Government should edge away from offering us cradle
to grave care. Should old people have to sell their homes to pay for the
nursing they might need? I'll be asking the Health Secretary, Stephen Dorrell,
On the Record ... after the news read by Moira Stuart.
NEWS
HUMPHRYS: - it didn't take long after
the summer holidays for the first political crisis to blow up...approximately
twenty minutes, in fact, before the Government was in deep trouble over the
prison service. But it didn't take long for it to go away either.. a storming
performance by Michael Howard in the House and that was that - for the moment
anyway.
But there is something on the agenda
that can't be resolved with one quick knock-out on the floor of the Commons and
that's because it has the potential to re-open old divisions within the party.
Public spending - how much need the State do in a civilised society? The hot
potato at the moment - how to meet the nursing bills for old people. Should the
State pick up the cost? That was then first question I put to the Health
Secretary, Stephen Dorrell, when I spoke to him earlier this morning.
STEPHEN DORRELL MP: The State has picked up a dramatically
larger share of looking after the care of elderly people over the last fifteen
years. It was a waiting list position, when I first became an MP I used to
have to spend large amounts of time every month looking for places in local
authority homes for elderly people who were clearly incapable of looking after
themselves at home. That's a waiting list that had been abolished because the
government has provided huge sums of extra money for those who can't afford to
pay nursing and residential care home fees for themselves, to ensure that they
are properly looked after.
HUMPHRYS: But you know what I'm talking about, the
nursing fees of people who find themselves having to need a great deal of
nursing and maybe because they can't afford it, have to sell their homes to
meet the cost because of the rules that now apply.
DORRELL: But it's well known that the government
recognises there are special sensitivities that arise when people have to sell
their homes and there's a feeling that this is a burden for which many families
haven't prepared and perhaps in the future will need to prepare. The whole of
that subject is something that the government is looking at and it's not
something where ministers have yet reached conclusions.
HUMPHRYS: But that's in the future, as you say, in
the future they'll need to prepare, I'm talking about now rather than in the
future and there are lots of people in this difficulty as you know.
DORRELL: And that was why I started off answering
your question by referring to now and reminding you that we pick up the tab for
residential care for a far larger number of people than was ever the case
before.
HUMPHRYS: Inevitably because of demographics and
because we're living longer and all the rest of it.
DORRELL: No, no, not just because of
demographics, because we meet that demand much more flexibly, much better now
than we did fifteen years ago. As I said, when I first became an MP you went
on a waiting list, these days there is no waiting list, the waiting list has
been abolished because the system is more flexible, we have a vigorous private
sector which meets that demand with State support for those who need it most.
HUMPHRYS: Right, but once you find yourself in a
home you have to pay the cost of nursing, somebody has to pay the cost of
nursing, should it be the individual or should it be the State?
DORRELL: Well the position we're in now is that
those who can't afford to pay the State pays, those who can afford to pay are
expected to make a contribution themselves.
HUMPHRYS: Even if that means they have to sell
their home for instance, to do it?
DORRELL: That is the position now and that of
course is precisely the reason why the government has indicated that it is
looking at how we can ensure that families are properly prepared for this
obligation which will..which there's a significant risk will come to all of us
at the end of our lives.
HUMPHRYS: Do you think the situation as it is at
the moment is too tough on old people?
DORRELL: Well there is a...we're obviously all
aware that there are many families who are surprised by this obligation that
they find late in life, that is the reason why the government has said that
it's going to, that it is currently reviewing those arrangements in order to
ensure that people are fully prepared for the obligations that there's an
increasing risk that all of us will have to meet at the end of our lives.
HUMPHRYS: The fact is you've made it more
difficult, the government has made it more difficult because of the increasing
pressure on hospitals not to keep old people in hospital beds that are
used..needed for other things. So, you have an obligation here, the
government...the State has an obligation and this isn't a Party Political
issue particulary but does not the State have an obligation.
DORRELL: You say we've made it more difficult,
with great respect I don't accept that because the development over the 1980s
of the system based on Social Security which later was transferred into
Community Care, run by Local Authorities, has made it far easier for those who
need residential assistance to find that residential assistance and if they are
unable to pay for it themselves, to pick up...to secure State support to pay
for it. That was something, whereas I said there were fifteen years ago
repeated examples of elderly people, clearly in need of residential care, who
weren't able to get it because the only residential care around was that which
was available from the Local Authorities. Incidentially, residential care that
is increasingly now being found to be below the standards that we require from
the private sector and which we are requiring Local Authorities to improve to
match private sector standards.
HUMPHRYS: But the problem is that there are many
people who have to sell their homes in order to afford the kind of
accommodation AND - and this is the thing that I'm talking about at the moment
- the nursing costs that they need and what you seem a bit reluctant to deal
with is whether the State has an obligation to pick up those costs.
Notwithstanding whether they've got eight thousand pounds or more.
DORRELL: I've answered your question very
directly.
HUMPHRYS: Well I've missed the answer somewhere
along the line in that case.
DORRELL: Well the answer is that I think that
individuals should pick up...should accept responsibility for caring for
themselves at the end of their lives. I also think the State should support
those who are unable to pay that bill for themselves, I think that there should
be proper arrangements to encourage individuals to plan to meet that cost and
the government is reviewing those arrangements at this moment and that's why
I'm not giving you a precise answer to every question that you ask because I
actually think it's a good idea for ministers to reach their conclusions before
talking about them.
HUMPHRYS: Well let me just pursue the bit about
which you were quite clear then, you said in the first part of that answer, if
I understand you correctly, if you have the money, the wherewithal to pay for
your own nursing, when you get older, you should do it. And if that means, if
that means you have to sell your house in order to meet those bills so be it.
That's okay.
DORRELL: And what's obviously better for everyone
is if the arrangements are made earlier in life...
HUMPHRYS: Of course I accept that..
DORRELL: In order that it doesn't come as a
surprise.
HUMPHRYS: Absolutely, but we're not looking at ten
or fifteen years down the road, we're looking at today where many people felt
when they were youngsters and as they grew up that the State would look after
them because we have a cradle to grave system, at least that's what they
thought. Now you're quite happy to sit there and say "no, no, that isn't right
they have to pay their own nursing costs and if that means selling their house
so be it."
DORRELL: Well if you want to compare the position
now with the position fifteen years ago I simply ask you to compare..
HUMPHRYS: I don't particularly, I'm looking at the
situation...as it is today..
DORRELL: That was the underlying theme of your
question. I simply ask you to compare the totality. It's certainly true that
the NHS used to run more geriatric hospitals, that's what they were called, we
don't actually like the title any more, but the label geriatric hospital
applied to a very specific...
HUMPHRYS: ....geriatric wards in hospitals, many
of which no longer exist for very obvious reasons.
DORRELL: And the geriatric hospitals and very
often the geriatric wards in the larger hospitals were a standard of care that
very few people would want either for themselves or for their families these
days. Furthermore, there were many many people who didn't get into hospitals
because the consultants quite rightly said they didn't need clinical care, they
simply needed residential support and for those people, in the old system, the
only option was local authority part-three accommodation which was an extremely
scarce source and which MPs used to have to spend large amounts of their time
trying to find people ways into that kind of care. Both of those I think have
been improved. We don't provide sub-standard geriatric care in the NHS any
more, when people need hospital care, whether they are old or young we set
higher standards for that kind of care. Where people need social care, we
provide, as we always have done, support for those who can't afford to pay for
themselves, and we do expect people to meet their own social costs if they can
afford to at the end of their lives.
HUMPHRYS: I note you use the phrase social costs
not nursing care. Do the two mean the same, is that what you're saying?
DORRELL: It's very difficult, isn't it? When you
look at the needs of a specific elderly person to determine where the boundary
is between health and social costs.
HUMPHRYS: Well alright let's be specific then.
Let's try and make it easier then. There is an old lady who has been - I don't
know - she's reached the age of seventy-five, she doesn't desperately need
clinical help but she needs nursing care, she can't look after herself
properly. She needs a nurse to help her with injections, or whatever it may
be.
DORRELL: With great respect a nurse is a
clinician.
HUMPHRYS: Ok. Alright. Well, let's not quarrel
about the words. She needs nursing care. She has relatively little money in
the bank but she does have a rather nice house which she was hoping - or not a
very nice house - which she was hoping to pass on to her children. Now, I'm
still looking for some sort of answer as to whether you believe it is right
that she should have to sell that house, rather than relying upon the State to
provide what she believes is a part of the National Health Service and if not
ought to be.
DORRELL: No, it's never been part of the National
Health Service obligation to provide residential care for those who need
support with their shopping, who can't do their own cooking.
HUMPHRYS: No, no. I'm not talking about that.
DORRELL: Well, you are, actually - you are. If
she can live at home and all she needs is a bit of nursing support to allow her
to continue to live at home the NHS provides that. That's what the Community
Nursing Service does.
HUMPHRYS: Right. She's in a home, she's in a
residential home.
DORRELL: Indeed.
HUMPHRYS: And she needs nursing care.
DORRELL: Well when she's in a residential home,
other people are meeting her cooking costs - they're doing the cooking for her,
doing the shopping, doing the cleaning and that is what I mean by the phrase
'social costs'.
HUMPHRYS: Right.
DORRELL: ..and that, indeed, has always been a
means-tested benefit. We provide support - much more generously now - than has
ever been done before for those who need that kind of support. In order to
allow them to have a decent standard of living.
HUMPHRYS: But that's not in dispute. It's
nursing, on top of that, that I'm talking about.
DORRELL: Indeed and nursing where it's necessary
to have nursing in addition to that residential care but not...the individual
doesn't require hospital care, in the opinion of the hospital-based clinician.
That has always been regarded as nursing residential care and has been regarded
as, therefore, social care.
HUMPHRYS: And you don't believe that the State
should pay that cost.
DORRELL: That's the....the position has been ever
since the foundation of the Health Service and the development of Social
Service Departments in the Sixties, that residential nursing care has been
regarded as part of nursing...of social care.
HUMPHRYS: See there's a...and the reason I raised
this specifically and have spent so much time on it, there seem to be - there
are - fundamentally different views in British politics in the Conservative
Party. Those who want to get away from universal benefits, who would say the
sort of thing that you've said this morning, interestingly enough - that we
ought to make provision for our old age - tax breaks or whatever it happens to
be. The State will encourage it but nonetheless we've got to make our own
provision so we move away from the cradle to grave care into which category I
would put nursing care and I think many other people would as well, towards
more private provision.
DORRELL: Well, I don't actually think you'll find
any distinction between different Conservatives. Or come to that, across many
people outside the Conservative Party as well, any difference on the principle
that people should be encouraged in a modern world to provide for themselves,
rather than relying on the State. For example, on the development of pensions,
I regard it as one of the great successes of the last thirty years that we have
in this country, one of the best funded pension systems to be found anywhere in
the developed world. People do now have - the huge majority of people do have
second pensions based either on their own personal pension provision or on
their Occupational Pension provision. That's an example of people providing
for themselves.
Where we also have - what we've also
done in this country is to maintain a commitment to universal benefits,
specifically in the field of Health and of Education. Those two aspects of the
Welfare State, are not safety net services. They're services that set out to
provide the highest quality of Education and Health care that a modern society
can afford and provide for the whole of the population, not just for those who
don't provide for themselves.
HUMPHRYS: Ah well, because what you seem to be
telling me is that you're encouraging to use that word, to use your own word -
people to provide some basic health services for themselves. Because that,
after all - to return to it - is what nursing is all about.
DORRELL: Well, the position as regards nursing
care in a hospital or in your own home is that that is an NHS obligation. We
have always in this country regarded a nursing home as part of social care.
But what I - the point I am making to you very strongly - is that we maintain
in this country a universal Health Service. Health care available on the basis
of need - not ability to pay - available to the whole population, not as a
safety net. Similarly, in the Education Service, we maintain a State service
for Education, designed to deliver the best quality education that we can,
available to everybody, to put the starting blocks in line for all children at
the beginning of life. Those are two universal services within the Welfare
State. They're different from the system...the support available from the
Welfare State for housing, where we provide a minimum, for pensions, where we
provide a minimum through means tested support and encourage people to improve
upon that minimum to make the best of their lives.
HUMPHRYS: You say there's no great debate about
this. There are no great debates about universal provision. But, there have
to be. There are because there are those who say the State must spend less of
our money. If the State is to spend less of our money and the State spends a
vast amount on Health and Education it follows - you don't need to be a great
mathematician to work this out - there has to be rather less spent in order for
us to compete effectively on the world stage on things like Health and
Education. Now, if we're going to provide the first class service that you
talk about and it not just being a safety net, to use your other phrase that
follows, doesn't it?
DORRELL: No, it doesn't follow, at all. I
followed your argument when you were saying: if we're going to provide high
quality health, high quality education and reduce the total size of the public
sector, there is a consequence, of course for other aspects of the public
sector. I, certainly, agree with that. But, the kind of public sector I want
to see is one that continues to deliver its obligation for a universal Health
Service, a universal Education service but, then, recognises that if we're
going to do that and have an acceptable tax burden that allows Britain to
compete in the increasingly competitive markets of the early part of the next
century, there is a necessary consequence for the other things the State can
afford to do. And, that is precisely why I'm strongly in favour of ensuring
that people develop their own pension provision, people develop their own
independence of the safety net services, which the Welfare State still spends
actually rather more on than it does on either Health or Education.
HUMPHRYS: Indeed. But, Health and Education takes
up a huge amount of money. So, therefore, there must be enormous amounts saved
on these other things, mustn't there? Great, slashing cuts have to be made.
DORRELL: Health and education are very major
spending programmes but I....
HUMPHRYS: Health second only in the list.
DORRELL: Health and Education are two that are
running roughly neck and neck. Both of them in roughly crude 'back of the
envelope' terms half of what we spend on Social Security. And, what we're
looking to do - not just in the Social Security budget - but right through
other things that we do on agricultural support, on industrial support, on a
range of other activities that the Government does, is to question whether they
still represent the best use of taxpayers' money and to look for ways of
delivering the proper obligations of the State more efficiently in order to be
able to cut the share of national income, taken by public expenditure. That is
a process that the Treasury has engaged on every year, engaged on, perhaps,
with particular...attaching particularly high priorities.
HUMPHRYS: Do you believe that the share, the slice
the State takes is about right now, at the moment? Or, should it come down
substantially?
DORRELL: It's something that's been on a
declining trend ever since 1970...since '81.
HUMPHRYS: Well, I raise my eyebrows at that
because that's not the figure shown me, but anyway.
DORRELL: Well, I will tell you why I say that.
Everbody knows that the figure, the proportion of National Income taken by the
State will oscillate through the trade cycle. When there's a booming time more
Tax.
HUMPHRYS: Since 1979 we've seen what's happened.
The share at the moment is higher than it was it in 1979.
DORRELL: No, that's not true of Public
Expenditure. Public Expenditure is not taking a higher share.
HUMPHRYS: As a proportion of our total income it
is true.
DORRELL: No, it is not true with respect. What
is true is that we're financing the Public Expenditure that we're doing now
without incurring the kind of borrowing that allowed the Tax levels in 1979 to
be abnormally low. What we've seen from 1981 onwards is that the peak share of
expenditure of National Income in 1981 was not repeated in the recent
recession-
HUMPHRYS: Right.
DORRELL: - and there is a downward trend.
HUMPHRYS: And you want that downward trend to
continue?
DORRELL: And I think that downward trend should
continue. Let me tell you why. There are two reasons. First it's a political
choice, I want to have people spending more of their own money in their own
way. But, secondly, and perhaps even more importantly I think if you look
forward to the next ten or fifteen years, we're going into a world where
competition from the Far East, from Eastern Europe, from other parts of the
world, is going to put stresses on the Western European economy including our
own which is going to require us to be flexible in a way we've never been
flexible before and that compels us to make choices that deliver low Tax
burdens as well as freer Labour markets and all the other things the Prime
Minister talks about.
HUMPHRYS: A pretty difficult trick to pull off
that one, isn't it? So, what kind of levels ought we to deliver? You say
it's on a downward trend at the moment. Some people might say: well, maybe,
maybe not. But, are we looking at what - twenty-five per cent? Instead of the
forty-one per cent we've got, at the moment?
DORRELL: Wonderful if we can get there, but let's
go one step at a time. I-
HUMPHRYS: I'm trying to take - because we don't
have terribly long left of this discussion -
DORRELL: Yes, and I'm-
HUMPHRYS: I'm trying to look into the future,
really, and be a little philosophical about this.
DORRELL: I'm not adopting your figure of
twenty-five per cent. What I am adopting is a downward trend that takes us
below forty.
HUMPHRYS: Below forty. But, the reason I offered
you the twnety-five per cent is because people like Mr Portillo - who said
there is no difference within the Party over these matters - to people like Mr
Portillo have said that that's the kind of thing that serves other countries
terribly well and we must take that into account....
DORRELL: And I said it would be wonderful if we
can get there but I think we-nobody has accused Mrs Thatcher's government of
having been a slouch on the subject of reducing the subject of reducing the
share of National Income...
HUMPHRYS: Except you haven't been very good at it,
that's the trouble.
DORRELL: Over fifteen years we have established a
downward trend and that trend must continue.
HUMPHRYS: Our highest goal is to minimise the size
of the State. Do you agree with that as a proposition?
DORRELL: No I don't. Well Michael Portillo says
that. No difference you say but that's his view - October '93.
HUMPHRYS: Our highest goal is to ensure that in
the next century Britain is able to compete in an increasingly competitive
international marketplace. If we don't do that then all this argument frankly
is purely academic because if we don't-if our economy is hidebound by social
chapters, minimum wages, high marginal rates of tax, then Britain will lose in
international competition. We shan't be able to afford either personal living
standards or Health Service or Education that all of us want to see, so the
highest goal is to make certain this country is able to take on international
competitors, and win.
HUMPHRYS: And in order to do that you cannot
sacrifice any spending at all, on Health and Education?
DORRELL: Well, every year - year by year -
difficult choices to be made. Nobody asks - nobody can expect to be
emancipated from that - but there's no point in putting anything else in first
priority. If - it has to be the British economy's capacity to pay for all of
these things that is our first priority because if the British economy can't
afford to pay for it, the rest of it is, frankly - the discussion is pure
self-indulgence.
HUMPHRYS: Thank you very much indeed Stephen
Dorrell.
DORRELL: Thank you.
..OOOOOO..
|