The fantasy of 'social care'

Many years ago, my late father-in-law developed a form of dementia. He was a kind and sociable man, but his memory and his ability to care for himself steadily deteriorated. My mother-in-law found it increasingly difficult to manage him at home, and he was referred by his GP to a rehabilitation hospital. After various tests, they recommended he be placed in a nursing home. We went through a painful search for a suitable home, until a nearby one was located. There was very little help from the local Social Services Department, apart from their completion of a financial assessment. My mother-in-law was not eligible for financial assistance from the local authority because she had a limited amount of savings. There were therefore substantial fees to pay which would have almost completely depleted these savings had my father-in-law not died within a few months. 

A few year’s later, my mother-in-law’s health declined. She had become physically-frail and depressed. She fell over (‘had a fall’) one day and was admitted to a local hospital for treatment of her leg ulcers. The hospital had a warm and caring atmosphere and provided the equivalent of good hospice care until she died after a few weeks. Because this was an NHS hospital, there were no fees to pay. 

This is a common experience for many families in England, and illustrates some key problems with our health and social care services. The first of these is that the boundary between ‘healthcare’ and ‘social care’, is not based on need but on who pays. A person with a diagnosed and acute physiological illness is usually treated as ill and receives free hospital or domiciliary health services. Some one with a chronic physiological disorder or a psychiatric disorder such as one of the dementias is categorised as the responsibility of local authority social care services and is usually required to meet all or a substantial part of the cost. Although dementia is an illness and intensive nursing care was recommended by the NHS, my father-in-law had been passed from ‘heath care’ to ‘social care’. 

The boundary between ‘heath care’ and ‘social care’ has shifted in the last few decades because the NHS has progressively withdrawn from providing long-term inpatient care. Hospitals which once housed infirm elderly people and people with mental disorders have long since closed. This has been presented as a move toward ‘care in the community’, but the reality is that NHS units which were free at point of use have been replaced by residential and nursing homes operated by private providers and which charge their occupants. In other words, it has been an exercise in privatisation, with the cost of care shifted from the state to chronically sick people and their families. 

Successive governments have avoided dealing with this problem, largely because of its complexity and the cost (both political and financial) of resolving it. There are two contradictory problems with cost. The first is that the need for expensive long-term ‘social care’ strikes individuals and families at random. It thus resembles the cost incurred by people with severe acute disorders who receive intensive hospital treatment. The most common political response is to propose a lifetime cap on the payments made for ‘social care’, with the remainder to be met from public funds. This was proposed by the Conservative Government in 2021 with a lifetime cap set at £86,000, but implementation was delayed and eventually cancelled. The second problem with cost is the grossly inadequate funding for ‘social care’, whether this comes from public or private sources. Funding for social services has fallen by 22% since 2010, taking into account the rise since that date in the number of elderly people. Local authorities have consequently frozen the fees they pay to providers of nursing or residential care. The private providers have responded by increasing the fees they charge to those residents who do pay for their own care, and by cutting costs. They have done so by following the old institutional strategies of building ever-larger institutions, keeping staffing levels at the legal minimum, and paying staff the minimum wage. This has led to high staff turnover (about 30%/year), a high proportion of unskilled staff, and probably a poor quality of care.

These two problems with cost are incompatible because setting a cap on individual contributions will not by itself increase overall funding for ‘social care’, and may have the opposite effect. Governments may respond to the cost incurred in paying for the lifetime cap by cutting back or at least freezing central funding for local authorities. In the end, an effective and fair system of care for chronically-sick people will require a substantial increase in public funding. This might take the form of an additional scheme of social insurance combined with an annual or lifetime cap, as used in France and Germany. Or the NHS could once again accept responsibility for the care of people with dementia in their final years. Either way, this will not be easy to implement. Much of the the electorate has slipped into a fantasy land where they demand better public services and lower taxes.  

Days of Lost Hope

In 1975, the BBC screened a television series called ‘Days of Hope’. This was directed by Ken Loach and portrayed the lives of a working-class family from 1916 to the General Strike in 1926. It showed how the revolutionary fervour of the time concluded when it was ‘betrayed’ by Labour leaders when they called off the General Strike. The programme thus followed a narrative common on the left, in which failure is explained by the cowardice or malevolence of the leadership. This explanation is selective because only some politicians are deemed to be traitorous. The greatest betrayals by left-wing leaders were in the communist states of Soviet Union, China and Cambodia which slaughtered millions of their own people.

There is a wider significance to Days of Hope, and that is that it marks the conversion of left-wing movements and specifically Marxism in Britain from hope to nostalgia. The predominant intellectuals on the left by this time were historians rather than economists. There was little attempt on the Left to understand how changes to the production and distribution of goods and services were radically changing society. Instead, the Left became committed to heroic retreats in a futile defence of declining industries. The extreme example is the miners’ strike of 1984-5. An heroic organisational effort supported coal miners opposing the closure of loss-making pits, and its defeat had catastrophic results for miners and their communities. But other European countries managed a similar decline in coal-mining as cheaper and less polluting forms of energy were introduced. The difference there was that governments did not regard miners as enemies to be crushed but as people to be helped. In one former mining town in Western Germany that I visited ten years ago, the Land and Federal governments had funded a new university and shopping centre, and invested in re-training former miners.  

My own days of hope were less radical than those experienced after the First World War. The election of a Labour government in 1997 brought in many reforms, economic growth and significant improvements in public services. I remember a sense of optimism, as well as a shared commitment to common European values of peace, welfare and respect for different cultures. All that is now in retreat. We have domination by staggeringly wealthy oligarchs, who have discovered that electoral success comes from spreading hate and fear without regard for the truth. They fund compliant political parties led by mediocre salesmen and journalists who dutifully minimise taxes on the rich and direct massive public funds in their own direction. The public purse has become a resource to be looted instead of the means for supporting a better quality of life for the population. This criminality is supported by spreading hatred and suspicion, which in turn legitimises violence against people of different ethnicity or appearance, all of whom are falsely designated as ‘immigrants’. 

We face a difficult few years ahead. It is up to us to do what we can to oppose the oligarchs and assert our common values.  

Tales from Long Ago No. 3

For some years in the 1970s, I was employed as a social worker in a medical centre in what a rather grim town called Blackburn in West Lothian. The social work team included a kind and sociable clerk called Cathy, who was also a rather puritanical adherent of the Church of Scotland. One Monday she told me that she and her husband had gone to the cinema at the weekend to see the film Emmanuelle under the impression that it was a biblical epic. It soon became apparent that this was not the case, and Cathy told her husband that they had to leave because the film was “dirty”. He responded that they should not waste the money they had paid for their tickets. Impressed by this spirit of frugality, she agreed to stay. “The things they did - I would never have imagined”, she said. 

I suspect her husband was rather less innocent in this episode than she believed. 

The Law of Large Round Numbers

Most people have a mobile phone and most mobile phones have an app which measures the number of steps completed, at least while the owner is carrying it. Medical research confirms the importance of regular exercise for maintaining health, but there is no consensus on how many footsteps constitute sufficient exercise, or how this figure may vary by age and sex. Most people, however, are undaunted by this lack of evidence and set 10,000 steps as their daily target. Why this number? It was devised as part of a marketing campaign in Japan, and was chosen because 10,000 is a large round number and large round numbers are impressive, easily-remembered and therefore persuasive. 

This demonstrates the Law of Large Round Numbers: that large round numbers are made-up, and are made up for a purpose. Politics is a wonderland for large round numbers, with objectives and achievements set out as arbitrary large round numbers, often with the minimum of justification. The most absurd recent example in the UK has been the promise by the new Reform UK Ltd administrations in various county councils to each identify £100 million in efficiency savings. This was part of Reform’s cosplay of Elon Musk’s short-lived DOGE initiative in the USA, which made indiscriminate cuts in essential public services as pretended ‘efficiency savings’. Where did Reform’s figure of £100 million come from? It was not based on any detailed scrutiny of expenditure and commitments or any examples of gross waste. Instead Reform just made it up because it looked impressive. Later on, when it became apparent that only lesser ‘savings’ could be made only by such ‘economies’ as cutting school transport for disabled children, the target for individual local authorities faded from view. Instead, Reform UK Ltd recycled the figure of £100 million/county as their equally-spurious claim for the total savings achieved by all ten Reform-run counties taken together. Large round numbers, however fictitious, have staying power. 

Reform’s dishonest efforts are but pale imitations of those made by their true leader over the water, Donald Trump. Having discovered rather late in the day that the BBC made a minor error in editing a tape of the speech he made to his supporters before they attacked the US Capitol Building in 2020, he threatened to sue the BBC for $1 billion unless they made an apology. A apology was made, but Trump responded by claiming $5 billion in damages. An apology, for Trump, is a sign of weakness and a reason for a more intensive bout of bullying. The latest large round number of $5 billion is of course ludicrous. Claims for damages are made for loss of income and/or reputation. It is difficult to see how Trump’s reputation could be any lower after numerous criminal convictions, allegations of rape by several women, a prolonged association with Geoffrey Epstein, and a long history of fraudulent business practices. Nor did he suffer electorally or financially, winning the 2024 election, followed by much enhanced opportunities for raking off public funds. But large round numbers have a life of their own, invented and believed, and Trump will continue to promote this claim for damages, no doubt supported by his Quisling supporters in Reform UK.   

How to organise a genocide

Genocide has, after a long interval, once again become fashionable. This is a guide to how to organise your own genocide, either against internal populations or those otherwise under your control. 

1.    Gather the subjects of the genocide in one or more convenient places. This may present some organisational problems if the subjects are dispersed through the population. You will need to either designate special areas or build camps for their confinement. Methods for distinguishing subjects from the rest of the population may be required, such as special clothing or identification documents. In some cases, the subjects will already live in discrete areas and genocide is much simpler in such cases.

2.    Ensure your local population are sufficiently prepared to support you or (where necessary) participate in the genocide. This is often achieved by emphasising the ways in which they differ from your local population, in speech, habits, or religion. It is particularly useful to accuse them of breaking social norms, such as eating domestic pets or having sex with children. These claims will have an effect even without the slightest evidence. Jewish people for centuries were accused of the ‘blood libel’, in which it was alleged that they killed Christian or Muslim children to use their blood in religious rituals. This absurd story is still active in parts of the Muslim world and even in Qanon conspiracy websites in the USA. Accusations of this kind can be strengthened by claims that the subjects of the genocide are planning to exterminate your own people. This can work even if they are few in number, as seen with the persistence of the Protocols of the Elders of Zion, a supposed plan by Jews to take over the world.

3.    Decide on the best method of extermination. One of the simplest and cheapest is starvation. This can be achieved by taking food away from people, even in places where food is otherwise plentiful, as in Ukraine from 1932 to 1933. This policy in the Soviet Union caused the death of as many as five million people, although there are no accurate records. A variant is to drive people to places where there is little food. This occurred in the Ottoman Empire between 1915 and 1916, when about a million Armenians were driven into the Syrian desert, with the few survivors starved to death in prison camps. If no desert is available, then a viable alternative is to make where they live into a desert. Destroy all buildings, particularly hospitals and schools. Make sure the area is sealed off so that little if any food is available. Starvation can be combined with other methods of extermination like that currently practised by the Israeli and US governments in Gaza. Lorries bringing food into the territory are blocked, while some distribution centres for food have been set up by the two governments. People approaching these are shot. 

    The commonest method of extermination is of course direct murder. This can be carried out by the general population, as in Rwanda in 1994, where machetes were distributed to the Hutu population to enable them to exterminate their Tutsi neighbours. Over half a million died. A larger number (as many as two million) were killed by small arms in Cambodia between 1975 and 1979. These figures are far exceeded by the killing of European Jews by Germany and its allies in the Second World War. This involved military death squads as well as industrialised slaughter houses using poison gas and starvation. Modern weaponry of course makes slaughter far more efficient. 

4.    Make sure the rest of the world is not well-informed. This can be achieved by banning journalists on your own side from the site of the genocide, and killing any who are brave enough to report from among the victims. Where reports of killings do leak out, it is possible to excuse them as regrettable casualties in a necessary military operation. Films of civilians being killed can also be excused by claiming they were terrorists or were being used as ‘human shields’ by terrorists. It is also useful to confuse the issue by disputing the exact definition of the word ‘genocide’. In that way, people who do support the mass killing and extermination of others can comfort themselves with the thought that what they favour is not, after all, genocide.         

If you are concerned about the effect of genocide on your long-term reputation, do not worry. It is true that Hitler is widely denigrated, but there are still people who wave Nazi flags at demonstrations. Other genocidal rulers are national heroes. A giant picture of Mao Tse-Tung (at least 50 million killed) hangs in the centre of Beijing. There is a vast metal statue of Genghis Khan (at least 50 million killed) near the capital of Mongolia. Timur (possibly 20 million killed) is a national hero in Uzbekistan, once again celebrated by a giant statue. As long as mass murderers are celebrated and as long as politicians can gain power by spreading hate and fear, then genocides will continue. 

A guide to speaking like a Reform UK supporter

 Once you follow the utterances of Farage and his fellow Reform politicians, you realise two things. First, his political language and ideas are lifted directly from those of Donald Trump with hardly any adaptation for British circumstances. So Reform speak enthusiastically about abolishing what they call ‘DEI hires’, although DEI is a term used in the USA that has no meaning in UK law. They also propose to implement a ‘DOGE Team’ (named after the US department briefly headed by Elon Musk) to reduce expenditure in the local authorities they control, although almost all this is determined by statutory obligations. Farage’s most recent statements on ‘law and order’ go even further down this road, with pledges to send criminals to El Salvador (the destination chosen by Trump for deportees from the USA), and to loosen gun controls. 

The second striking feature of Reform politicians is that, like Trump, they have changed the meaning of words with the aim of making racism acceptable. So here is a guide to two revised definitions:
▸    Immigrant. This word traditionally means a person who comes to a country to become one of its residents. But the revised Trump/Reform meaning is ‘a dark-skinned person, irrespective of their place of birth’. A corollary of this definition is that white people are never defined as immigrants. This redefinition provides a means of bypassing legal prohibitions on racist language. So when Trump accuses ‘immigrants’ of being genetically violent, he does not include the white South Africans he welcomed to the USA, nor of course his own mother and grandfather. Instead, he means blacks, browns and even first nation Americans. He believes all should be deported whether or not they are US citizens because he believes the USA is a country for white people, to be run by white men. 

▸    Free speech. Legal restrictions on using racist language are keenly resented by Reform and the rest of the far right, who look back with nostalgia on the days when they were able to use derogatory racist epithets in everyday speech. They therefore demand ‘free speech’, which for them would restore the days when they could use the might of the media to smear and bully ethic minorities, women, gays, or whichever of ther many groups they feel contempt for. ‘Free speech’ in this sense does not apply to their opponents. In the USA, critics of Trump are threatened with costly legal action and an army of lawyers. Farage expresses outrage that by opposing legislation to protect children using on online media places him on the side of sexual abusers like Jimmy Savile.

This way of speaking, for all its absurdities, convinces a great many people. It taps the basic tribal fear of the other, of people unlike ourselves, who the fearful believe threaten our lives, our children and our identity. By stoking this fear, unscrupulous politicians are able to rob and cheat the public, and be free to carry out the many crimes of which they accuse the immigrants.

Trump and the tariffs

International news is dominated by the continuing slaughter in Gaza, distracted by almost daily announcements by Trump of changes to US tariffs on imports from foreign countries. His almost indiscriminate application of tariffs and their frequent changes is bizarre and unique in history. In the past, tariff policy was a means by which countries could protect their goods or protect industries from foreign competition as well as raise revenue. Countries recognised that tariffs increased domestic prices, and imposed them as a considered and long-term economic policy. Trump is not a successful businessman and has no long-term plan for the US economy. Instead, his tariff policy meets three emotional needs: his desire for attention, his need to bully others; and his fear of foreigners and especially non-white people. 

Traditional tariff policies involve setting selective tariffs, usually for several years. This results in minimal publicity. By contrast, endlessly imposing them, withdrawing them and modifying them means daily opportunities to star on the media and receive the attention Trump has always craved. Tariffs are also be an opportunity to bully people who have offended him. Targets can vary from day to day. At the time of writing, he has threatened the BRICS nations and specifically Brazil, both of which he will have heard about on Fox News. Finally, tariffs are an opportunity to strike back at all foreigners, even though it is Americans who meet the cost and American industries that will be forced to pay more for goods that have to be imported because there is no local alternative. Trump persistently campaigns against ‘immigrants’, even though his mother and grandfather both fell into this category. But of course he uses the word ‘immigrant’ as a code word to designate non-white people, who he believes are genetically disposed to rape and theft (crimes for which he himself has been found guilty). 

Trump’s emotional needs correspond to those of many of his supporters, who will doubtless continue to worship their leader however much harm he inflicts upon them.