THEAMERICANCONSERVATIVE (David Goodhart) - Burnham’s Big, Bad Speech Offered One Good Idea
The prime minister highlighted real problems with elder care but ignored deeper crises. The post Burnham’s Big, Bad Speech Offered One Good Idea appeared first on The American Conservative .
UK Special Coverage Burnham’s Big, Bad Speech Offered One Good Idea The prime minister highlighted real problems with elder care but ignored deeper crises. UK Special Coverage (Andrew Aitchison / In pictures via Getty Images) Britain has a new prime minister who can, at least, deliver a speech. Andy Burnham, the former Blairite who has reinvented himself as an old-school socialist, electrified British politics at the end of September with a speech that promised to take Britain back to the 1970s. Not since John Smith, the Labour leader whose early death paved the way for the Blairite centrist revolution in the early 1990s, has there been a Labour leader, and PM, who is so unapologetically Labour, and he lovingly caressed every party prejudice about why Britain isn’t working as it should. And in further proof that most of British politics remains an argument with the legacy of Margaret Thatcher, he got his biggest cheer for a promise to undo the former Conservative leader’s privatization of the water industry. The speech was left-populist, tribal, emotionally manipulative, ideologically blinkered, and wrong about most of Britain’s biggest problems. But it also had one useful and original idea at its heart: paying for reform of the underfunded system of elder care by ending the expensive so-called “triple lock” on the public pension system, which guarantees that the state pension rises in line with earnings, inflation, or 2.5 percent, whichever is highest. Burnham’s lackluster predecessor, Keir Starmer, would not have had the courage or imagination to come up with such an idea. But neither would he have been so naively ideological to suppose that Britain has a built-in center-left majority waiting to govern in perpetuity once the old first-past-the-post voting system is replaced with a new, more proportional system, another of Burnham’s promised reforms. Nor would Starmer have been apparently so unconcerned with Britain’s constipated state machine and spluttering economic engine as to make a whole speech without, as one commentator noticed, using the words “entrepreneur,” “biotech,” “Oxford,” “Cambridge,” “London,” “financial services,” or many of the other right-coded things that Britain is actually quite good at. Nonetheless, the speech has had its desired short-term effect and provided a Burnham bounce in the opinion polls, allowing Labour to narrowly lead the insurgent right-populists of Nigel Farage’s Reform party, mainly by winning back some of the disillusioned younger graduate voters in the big cities and university towns who had deserted the party for the leftist Greens. Does Burnham really believe in all that back-to-the-1970s and public-ownership stuff? It is one thing to take back control of failed organizations like Thames Water, but all of energy and water? Burnham’s leftist ambitions will certainly be constrained by the fact that he can’t increase public spending and Britain is already paying more for its debt pile—which reaches nearly 100 percent of GDP—than comparable European countries. But the left-inclined voters cannot be fed on rhetoric alone. The run-up to the next general election in 2029 is more likely to confirm the view that the great tragedy of British politics is the failure of the Boris Johnson–led realignment after the big Conservative election victory in 2019. In the light of the Brexit vote to leave the European Union, there was an opening for the main party of the right to lock in a new swathe of socially conservative lower-income voters who were impatient with the left’s social liberalism but also wanted protection from the harsh winds of the market economy. Johnson—the joker anti-politics politician—should have been the perfect figurehead for such a realignment, but the combination of his capricious personality, Covid, and the fact that the Conservatives were constantly divided between their conservative and liberal wings put paid to the realignment and ushered in a badly timed Labour Government in 2024. Labour entered with a huge majority—thanks to the divide on the right between Reform and the Conservatives—but with no idea what to do with it. The new government was certainly in no position, temperamentally or ideologically, to respond to the accumulated failures and unintended consequences of the Blair/Cameron era. One reason I am no longer a member or supporter of the Labour party (I was a member from my student days until 2017) is that I believe we need a government that can address those problems. What are they? The problem of overregulation, state incapacity, and too much dispersal of power to the courts and regulators; the absence of “tough love” in health and social services, including the over-diagnosis problem and the inability to control welfare spending; the economy-throttling high energy costs, which are the result, in part, of the chaotic and over-rapid path to “net zero” in the name of global leadership; the indifference to both high levels of immigration and deindustrialization (from both Labour and Conservatives), the combination of which has been a main driver of populism; the neglect of technical/vocational education in favour of university over-expansion; the creation of a new progressive establishment—Oxbridge, the British Medical Association and all health institutions, the Senior Civil Service, most of the legal profession—with views some way to the left of the average voter on both social and economic issues. It is very hard for the party that ushered in most of these changes, admittedly with some help from the Conservatives, to perform a volte-face. And Burnham’s speech underlines just how little he wants to. He expatiated on public ownership, though with the wriggle room provided by the phrase “public control,” and said nothing at all about the overregulation/state incapacity problem, or the welfare incontinence, or the self-inflicted energy cost wound, or even how to stimulate economic growth. Moreover, while Burnham has proved adept at appealing to the economic nostalgia of less-well educated, more locally connected people, often in post-industrial places—the people I call the Somewheres (as opposed to highly-educated, more mobile Anywheres)—as the leader of a party dominated by liberal graduate Anywheres he has had nothing to say about their social and cultural anxieties. In his speech, Burnham made cursory reference to stopping the wave of refugees illegally entering Britain on small boats. He also talked about the common belief that “the powers that be are pulling against the people, not with them.” He clearly did not include himself or the progressive-establishment-dominated Labour party in the “powers that be.” But many former Labour voters believe that free speech, promotion on merit, and common sense itself have been abandoned by the Labour “powers that be,” who are also indifferent to the dramatic demographic change in many towns and cities. The white British population of the UK was still around 90 percent in 2000 and it is now shy of three-quarters: London, Birmingham, Manchester, and several smaller towns and cities are all now majority-minority or close to it, and the school population of England is now barely 60 percent white British. Burnham has nothing to say about this, because social liberals do not think there is an issue. The centerpiece of Burnham’s speech, and the most powerful political punch, was the elder care reform/triple lock combination. Almost everyone agrees the care status quo is unsatisfactory in many ways. I do too. I even wrote a book partly about how to reform it (The Care Dilemma: Freedom, Family, Fertility). Yet is there really a care crisis? What about the defense crisis, or the energy cost crisis, or the overregulation crisis, or the economic growth crisis? Are there not more important places to start sorting out the country? Elder-care reform is in many ways a surprising place for Burnham to invest so much passion and political capital, and is perhaps further testimony to the importance of personal experience in setting political priorities. (His father was in a care home with dementia for several years and died just before the conference.) The failure to reform has become, in the political class, an emblem of the inability to think beyond the short-term. But there are good reasons why the issue has not been tackled by preceding governments. For a start, the public does not prioritize it. Only 3 to 4 percent of people mention it as one of the top three issues facing the country, compared with more than 30 percent for the National Health Service (NHS). Moreover, many more people are already getting heavily subsidized care than is generally realized, despite the ungenerous means-test; meanwhile local and central government combined are already spending about £35 billion a year on care. There are about 300,000 younger people in the care system with long-term, often severe, disabilities, like cerebral palsy. The number is rising because of modern medicine’s ability to keep more people with severe conditions alive for longer, and most if not all of their care is paid by the state. Another 600,000 people are in the elder care system—roughly 350,000 in care homes and 250,000 receiving visits from carers in their own homes. Over half of care home residents are getting much of their care, and accommodation, paid by the state, and nearly three-quarters of people receiving care at home are substantially covered by the taxpayer. But most elderly people do not use the formal system at all and any support they have comes from their family. There are roughly 6 million people over the age of 75 in England, and around 5 million people who provide some degree of informal care for the younger disabled or elderly relatives. The means-test for those in residential homes includes the value of someone’s house, but the house is excluded from the calculation if a spouse or a child, or even a friend in some circumstances, is living in it. The King’s Fund, a health think tank, reckons that at any given time only about 220,000 people are fully self-funding for elderly social care. Politicians have quietly accepted that it is perfectly fair to claw back some of the unearned property value increase that some people have enjoyed in recent decades, especially in more affluent places. Polls suggest public opinion is on their side. It is true that a few people are exposed to very high costs, which is why there has been interest in some kind of cap on overall costs even for those blessed with expensive property. So the irony is that the main beneficiaries of making care free would be affluent home owners, mainly in the south of England, and the main losers, assuming that ending the triple lock would mean less generous pensions, would be poor pensioners concentrated in the north of England, Burnham’s territory. But Burnham is nevertheless right—there may not be an imminent crisis of elder care, but we do need a much better organized and better funded system. The current system is unfair in that cancer treatment is free, covered by the NHS’s general tax-based insurance, while dementia might in rare cases cost you hundreds of thousands of pounds. Moreover, there are plenty of unmet care needs in the current system and there are those 5 million informal carers, mainly family members, who might be able to contribute more to the GDP if their relatives could lean more on the formal care system. And by 2047 there will be 3.3 million people over the age of 85, many of whom will need some kind of support in an era when families are smaller, if they exist at all, and more dispersed. Although Burnham ventilated hyperbolically about his National Care Service reform, planned for 2030, being equivalent to the founding of the NHS, he is glamorizing what should actually be a few relatively prosaic decisions about structure and funding. The NHS analogy is, in fact, completely inappropriate for elder care reform, and we have to hope that Burnham was using it as a kind of metaphor. The NHS is an increasingly unpopular and struggling institution based around giant, publicly owned, hospitals. Elder and social care is delivered by about 18,000, mainly small, private institutions, hand-in-hand with local authorities. It does make sense to raise the visibility of the system and give it a name, a logo, and a clearer identity. I argued in my Care Dilemma book that it should be called the National Preventative Service (NPS). The job of the NHS is to deal with your problem and get you out the backdoor as quickly as possible; the job of the NPS should be to stop so many old people going through the front door in the first place. The 1.6 million people who work in care need to be better paid and trained. Their pay should be pegged to that of an NHS care assistant with a greater possibility of career progression. There is a case for more care staff to have some limited medical skills—minor wound care, injections, taking vital signs—and to review some of the archaic demarcation lines that prevent a care worker cutting someone’s toe-nails. Better links between family carers and the care system could also keep more elderly people self-sufficient for longer. There needs to be much more emphasis in care packages on taking exercise—old people falling over costs the NHS £2 billion a year—and much better use of technology especially in the smaller homes which tend to resist innovation. More volunteering and gap years should be encouraged in care homes, with perhaps an equivalent of Now Teach (the organization that encourages professional people near retirement to spend a few years teaching) for care managers. Burnham talked, again hyperbolically, about how the failures of the care system are causing the NHS to collapse. True, the chronic illnesses of the elderly in an aging society inevitably take up more of the NHS’s resources, but a better organised and funded care system will only be able to relieve those pressures to a limited extent. Moreover, some of the problems of bed-blocking by the elderly are due to the NHS’s organizational inefficiencies and the length of time it takes to organise a care package, and these are problems that could in principle be sorted out right now. Providing the entire care service free to a decent standard for everyone who needs it plus improving pay and training for care staff would be both prohibitively expensive—costing maybe around £25 billion—and regressive. When Burnham talks about free care for all, in fact he seems to mean the state covering the care element of a weekly care home charge, now about £1,400 in total, with the accommodation costs left to be paid by users, at least by better-off ones. When people discover that they may actually be paying more for Burnham’s supposedly free service he will have a bit of explaining to do. But by then, Andy’s premiership is likely to have been engulfed by all those other, bigger, potential crises that he didn’t talk about at all in his speech. The post Burnham’s Big, Bad Speech Offered One Good Idea appeared first on The American Conservative .