BRITAIN: MORE CUTBACKS FOR THE SICK

On Britain's present trajectory, they will eventually just have bureaucrats and no medical staff at all

Hundreds of thousands of elderly people will no longer get home care services because of a funding shortfall and the widening impact of NHS cuts, the social care watchdog says. The Commission for Social Care Inspection reports today that nearly two thirds of the 150 councils that provide social services changed their criteria last year to provide social care only for the most dependent people. In more than 100 councils, elderly and disabled people who used to get regular help with cleaning, bathing, dressing and shopping will no longer be entitled to care unless they fall into the top two categories of "critical" or "substantial" risk. Only the very frail, immobile or those at risk of abuse will be entitled to these services, forcing other vulnerable people to rely on families or friends or to go without help.

The commission says that the situation is already getting worse in at least three authorities - North Yorkshire, Northumberland and West Berkshire - which are restricting home care to critical or life-threatening situations. It predicts that this situation will apply in many more authorities next year.

The number of households receiving home care has fallen by 174,000 since 1992 to 354,000 last year, a drop of 30 per cent. The commission says this is mainly because councils are concentrating scarce resources on the very needy. "People entitled to social care are getting better care," a commission official said. "But that leaves thousands of others with no care at all." Mervyn Kohler, of Help the Aged, said that withdrawing preventive services from less critical groups could affect their quality of life crucially. People who no longer had help with cleaning, shopping or dressing would stop inviting people round, lose their self esteem and stay in bed all day. "Councils will end up paying the price for restricting the criteria with more people becoming dependent. This is a foolish, short-term economy."

Councils are being forced to change their eligibility criteria because government grants for social services have failed to keep up with growing numbers of very elderly people, local authorities say. Many also complain that they are bearing the brunt of NHS cutbacks. In some cases they are treating people who would have been cared for in hospital, while in others primary care trusts are refusing to pay for services provided by local authorities where they would have done so in the past.

The commission's annual performance rating of adult social services for 2006 shows that three quarters of the 150 councils gained either two or three stars. Although no council was zero-rated, 33 got only one star; 24 of these had been given one star for the past three years. Ten councils went up to the highest three-star category, but nine dropped in the rankings to two stars. In total 25 councils improved their services, while 16 fell back.

Ivan Lewis, the Care Services Minister, said that a number of councils need to "up their game" as he announced plans to intervene in 21 councils which had failed to improve their ratings since 2002. "Adults and their carers who use services in this area deserve better, therefore I am asking (the commission) to work with these councils to develop improvement action plans by March next year," he said. Social care leaders broadly welcomed the latest league tables. John Coughlan, president of the Association of Directors of Social Services, said: "We cannot ignore the fact that these improvements have been made in the teeth of one of the most severe financial squeezes social care has experienced for a long while."

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The return of Hillarycare?

In the wake of the Democratic victory in the midterm congressional elections, Hillary Clinton announced that Democrats would once again make health care reform a top legislative priority. "Health care is coming back," Clinton said, apparently giddy with triumph, adding, "It may be a bad dream for some." Indeed, it may well be a nightmare for American health consumers. No one knows for certain what the new Democratic majority has in mind, but its initial proposals -- expanding Medicaid and the Medicare prescription drug program -- are certainly steps in the direction of more government interference in the medical marketplace.

Perhaps it has been so long that Americans have forgotten exactly what Hillarycare was. If so, it's worth reminding them. Under the Clinton plan, the government would have taken control of nearly one-seventh of the U.S. economy. It would have established the world's largest government program -- dwarfing even Social Security -- created a huge new bureaucracy and required massive tax increases.

The entire idea behind the Clinton health care plan was that government knew best -- better than businesses, better than doctors, and better than patients.The Clinton plan would have required every business in America to provide health care coverage to its employees, regardless of cost. The mandate would have devastated small businesses and cost thousands of jobs. Clinton's plan would also have forced Americans to give up their current health insurance, even if they were happy with it, in return for a government-designed standard benefit package that could be far more expensive. What the policy covered would be determined not by consumer preference or even medical necessity, but by the lobbying power of various special interests.

Such policies would have been "community rated," meaning that people would pay exactly the same premium regardless of whether they were healthy or on their death bed, practiced healthy lifestyles or smoked six packs a day. That would have meant a huge premium increase for young and healthy people.

The plan established rigid price controls through a series of premium caps and other measures. That, in turn, would have forced insurers to ration the care they provided. Clinton apparently hoped that indirect rationing through managed care would avoid the direct rationing that results from price controls under every other national health care system in the world. But just in case, the proposal would also have established a National Health Board, with back-up authority to ration health care directly if indirect rationing failed to reduce costs sufficiently. And the Clinton plan would have forced all Americans into managed care, effectively denying them the ability to choose their own doctors. Indeed, the Clinton proposal actually included criminal penalties for people who tried to pay for unapproved health care out of their own pockets.

There is no doubt that our health care system is badly in need of reform. Too many Americans lack health insurance. We need to do more to lower health care costs and increase access to care. The system is riddled with waste and the quality of care is uneven. Government health care programs like Medicare and Medicaid threaten future generations with an enormous burden of debt and taxes. But the answers to these problems lie with more choice and competition, not less. More government regulation, subsidies, and control would simply drain the medical marketplace of the quality, dynamism and innovation that save lives. Hillarycare would have put the health care equivalent of FEMA in charge of our health care system. Surely this is not what the American people voted for on Nov. 7.

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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