Care for the elderly must come first in Keir Starmer’s healthcare reforms

It was one of less surprising announcements of the week, but that didn’t stop the mainstream media from running collectively with “reform or die” headlines, when prime minister Keir Starmer announced yesterday that the NHS is in deep trouble.

The PM’s warning  that the health service has to “reform or die” came hard on the heels of the findings of a detailed study by Lord Ara Darzi, which was commissioned with great urgency when the Labour Party swept away 14 years of Tory rule in July. According to most press reports, Lord Darzi has warned the government that it’s highly unlikely to deliver on its pre-election promise to get treatment waiting times back on track “within five years”.

Lord Darzi says in the 142-page report: “I have no doubt that significant progress will be possible, but it is unlikely that waiting lists can be cleared and other performance standards restored in one parliamentary term.” The peer, who was health minister under Gordon Brown and has spoken out consistently over the years about the plight of the NHS, is on record elsewhere as saying that sorting out waiting lists would take “four to eight years”. So the five year promise could be perfectly achievable, and it’s more likely that the government is hedging its bets given the rapidly deteriorating internal state of the NHS and the overwhelming demands being placed on it by a population that is allegedly growing, ageing and becoming increasingly sick.

In a rather strange analogy Lord Darzi points out that: “long waits are likely to be causing an additional 14,000 more deaths a year – more than double all British armed forces combat deaths since the health service was founded in 1948”. In particular three events are cited as bring responsible for the deterioration – 14 years of Tory government, the disastrous 2012 health and social care bill driven through parliament by David Cameron’s health secretary Andrew Lansley, and of course the Covid pandemic.

Portraying the NHS as being on its knees after the policies other people’s governments and an unexpected pandemic is an easy play, and certainly the health service – which was never meant to be run as a business –  is in a desperate state like never before. According to Darzi the number of people forced to wait more than a year for hospital treatment which they should get within 18 weeks has risen 15-fold since March 2010, from 20,000 to more than 300,000; cancer survival rates have “slowed substantially” and across most specialisms the standards, efficiency and effectiveness of care and treatments is also declining rapidly.

The worst area of healthcare is unquestionably the social care sector where Darzi describes the situation as “dire” and failings are placing “an increasingly large burden on families and on the NHS, with a profound human cost and economic consequences”. The solution, it seems, is a radical but inevitably painful new plan to get the edifice back in order, with the “reform or die” messages being an early signal that whatever comes down the line needs to be accepted as unavoidable, and is legislated in without significant debate or dispute.

Consistent with Keir Starmer’s ideology of a ‘mission-led’ government focussed on long term solutions rather than quick fixes, the PM has already hinted at “long-term health reform – major surgery, not sticking-plaster solutions.” Early rumours suggest this is going to be a 10-year plan that will push a lot of hospital care out into the community – where presumably it will be transferred to private enterprise, coupled with ‘public education’ programmes and punitive legislation to drive down diseases associated with common leisure habits such as drinking, smoking and sugar intake – though no doubt this ‘education’ programme will need to be balanced carefully against the tax implications of reducing national levels of alcohol, tobacco and sugar consumption.

Given the broader social and moral outlook of the current government, it’s also highly likely that funding will be increased for the provision of services to deal with sexually transmitted diseases, rising abortion demands and other gender-related issues. This will of course be explained as merely a reflection of what society is demanding of government, rather than what government is imposing on society – but we know only too well that ‘sexual health’ means very different things to different people.

This may seem but a small aside given the overwhelming problems that the health service is facing, but when one is going to have to make apparently ‘painful’ choices about healthcare provision and as a consequence who may live and who may die, there’s no avoiding the moral issues – and this debate needs to be had sooner rather than later.

Sadly, one only has to look at the dreadful decision to scrap pensioners’ winter fuel payments to see that moral decisions are being made already, and very significant ones at that. Labour research in 2017 – which was quoted at the time in parliament by Keir Starmer himself  – claimed that Tory plans to scrap this increase could well result in 4,000 additional deaths of vulnerable, elderly people. Yet seven years later it’s one of the first changes out of the gate and the PM has even admitted that this decision was made without carrying out any form of impact assessment. The subsequent furore, which has included revelations that millionaire cabinet ministers have been claiming thousands of pounds in second home heating allowances, has only served to underscore the dangerous lack of moral compass that is clearly driving contemporary politics.

At the deepest level, there also seems to be hardening of antagonism towards those who are in the later years of their lives, which is may seem contradictory to the historical roots of the Labour party, but less so if one looks at the party in terms of more hard left revolutionary politics – where compliant workers are a benefit, and unwelcome non-workers are a burden.

This mentality is already starting to have a negative impact on those who have worked hard and paid taxes throughout their lives, and the assault is only likely to get far worse. Those who lived and worked through the halcyon era of the 1950s and 60s enjoyed both an exceptionally stable and wealthy existence which in most cases saw them enter retirement with a decent level of wealth and security. Subsequent economic and social mismanagement by successive governments has reversed that trend for all but a very fortunate few, with most people now entering retirement as extremely soft targets for tax raids, reductions of benefits and allowances and numerous other state-imposed deprivations.

According to the latest figures from AgeUK, 1 in 5 (3.4 million) people aged 50-69 and 1 in 12 of over 70s (670,000) in Great Britain have had to borrow more money or use more credit than usual in the last month compared to a year ago, and 1.3 million over 50s in Great Britain had a Direct Debit, standing order, or bill they have not been able to pay in the past month.

Figures from the government’s own Office for National Statistics show that 45% (11.3 million) people aged 50+ in Britain are currently finding it difficult to afford their energy bills and a quarter of those over 50 could not afford an unexpected but necessary expense of £850.

No doubt one factor for this decline has been the increasing tax burden that has chased workers into their retirement. For most UK workers the government of the day has taken 20% of their income straight out of their pay packet; on retirement any pension benefit is then taxed at 20% and heavy tax burdens are levied on any attempts to withdraw hard-saved pension cash. Even the old age pension counts against tax free allowance should a pensioner be lucky enough to continue working. In the day the Catholic Church would have condemned such practices as usury – a word we well could do with resurrecting!

Far worse, and pertinent to the health care debate, many pensioners now face the dreadful dilemma of either staying in a cherished home that can no longer support their needs, or selling up and paying tens of thousands of pounds for often impersonal and highly isolating final years residential care – and this in a private sector where standards are declining even more rapidly than in our beleaguered NHS hospitals.

In the Jubilee Year 2000, which introduced the people of God to the third millennium of the Christian era, a special day – 17th September – was set aside for older people. In anticipation of this, in 1998, the Pontifical Council for the Laity produced a profoundly insightful document entitled The Dignity of Older People and their Mission in the Church and in the World, which laid out a pretty comprehensive manifesto for the dignified treatment of people who have dedicated their lives to the service of the common good. In particular the notion of intergenerational solidarity is a concept which offers a powerful antidote to the prevailing notion that older people are a burden on economic and social prosperity.

Traditionally, the Catholic Church tends to maintain a passive, instructional stance towards social challenges, seeing itself at one and the same time as being part of society, but apart from it. There are good reasons for this, especially in a social framework where certain moral and ideological limits are in play. Unfortunately at all levels contemporary society is moving into territories where the theological assumptions and safeguards of the past are being swept aside without much consideration for the consequences.

That is why in the debate about the future of our NHS far more is stake than just the fiscal management of hospitals and care homes. At its core are profound questions about the very nature and worth of the human person, and the solutions simply cannot be left to government ministers and those with productivity and profit as their first priority.

Joseph Kelly is Catholic publisher and theologian