Living at home with carers -

Bill Mathieson (with Annie)

Date of photography: 21st October 2016

Towards the end of his long life, Bill was amongst the fortunate few in being able to employ a live-in carer.   By contrast, most of us will have no such luxury in our old age:  having paid National Insurance for all our working lives, we will have to rely on the state for personal care services that are rapidly diminishing.   Since 1991, such state provision has been gradually privatised, exposing this crucial service to the chill wind of market forces.   Purported to increase efficiency and reduce costs, thus eliminating any need to provide additional funding to meet the burgeoning demand for elderly care, these changes have, in under 20 years, seen ‘administrative costs’ rise from 5% (1991) to 14% (2010) and, as might have been predicted, the need for ‘care businesses’ to generate profit has significantly reduced the resources available for the provision of care itself and the adequate remuneration of carers.  Politicians on the right continue to argue that reducing taxes offers people greater choice in the deployment of their own resources;  this is true, of course, but when it is a continual struggle for so many in our society just to ‘get by’, choice is, in practice, only really enhanced for the wealthy.   As we approach the ends of our lives, one in four of us will require nursing care costing more than £100,000, an almost unimaginable sum for most people to contemplate having to find.

The full story:

Though now well into his twilight years, and recently widowed, Bill Mathieson still values his independence more than anything else, living in his comfortable West London flat with Annie Tierney, his companion and carer.   Annie keeps house for him and attends to his daily needs but, most importantly, she ensures that his failing memory and waning acuity are constantly stimulated and exercised by  frequent outings in and around London.

Though born in Scotland, Bill has lived in London and the Home Counties for some 40 years.   He worked as a company director, serving on the board of the giant property company, Land Securities, and later as Chairman of the Waterman Group and a director of the department store chain, House of Fraser.   However, age takes its toll:  he is now quite frail and, like so many other elderly folk, his mental faculties are declining.   Having lost his life-long partner after 60 years of marriage, he is now increasingly reliant on the help of others:  his family, who live round the corner, and Annie, who lives in.   Annie is his essential daily support;  she keeps Bill active, mentally stimulated, and comfortable in his own home.

While for some old people, moving into a care home is a welcome solution to many of their problems, for others the very idea of leaving their homes and not being surrounded by their own possessions is something to be avoided if at all possible.   Bill is amongst the fortunate ones and, given the unappealing handicaps that old age will bring to all of us in time, he has succeeded in maintaining a life that is as happy, comfortable and stimulating as it could be.

Bette Davies once said, “old age ain’t no place for sissies” and how right she was;  the calamitous state of what we in Britain now call ‘Social Care for the Elderly’ is hardly ever out of the news.   When the prevailing dogma of austerity, decreasing taxation, and the concomitant cuts in welfare spending are combined with the continuing increase in longevity and thus the number of elderly people needing care, it is hardly surprising that we have reached a crisis point.  

Since 1991, the provision for those elderly people who cannot afford to pay for their own care has been gradually privatised, exposing this crucial service to market forces.   This move was supposed to increase efficiencies and reduce costs, thus eliminating any need to provide additional funding to meet the burgeoning demand for elderly care;  instead, in less than a decade, administrative costs have risen from 5% (1991) to 14% (2010) and, as might have been expected, the need for ‘care businesses’ to generate profit has left a significantly smaller slice of the cake for the provision of the care itself.   One effect of this has been to drive down the wages of care staff, many of whom are engaged on the meanest of contracts, and receive barely the Minimum Wage.  

Politicians on the right continue to advance the argument that reducing taxes offers people greater choice in the deployment of their own resources - this is true, of course, but mostly choice is enhanced only for the wealthy.   As we approach the end of life, one in four of us will cost more than £100,000 in nursing care, an almost unimaginable sum for most people to contemplate having to find.   Only through the sale of the family home (for those lucky enough to have one to sell) can such a sum usually be liberated.   The most sensible option must therefore be the collective pooling of risk, and the manageable spreading of costs, like any other form of insurance - after all, this is why the NHS was created in the first place.  

Local authorities have been charged with the responsibility for providing social care to those who lack the funds to pay for themselves.   At the same time as demand has risen exponentially, local authorities have seen their funding drastically reduced (by almost 40%, broadly speaking, over the last Parliament) and their straitened circumstances now force them to dictate to private providers what has to be the ‘affordable cost’ of caring for each individual - a true market is no longer able to function.   As a result, many such providers, having extracted good profits from their business initially, are now facing insolvency or are, of necessity, paring down costs to such an extent that homes are being run unsafely;  hence the nightmare stories about the conditions in some homes (for both residents and staff) that have hit the headlines almost daily.  

In parallel, the social care that is delivered to the elderly who, with the help of peripatetic carers, are still able to live independently at home has also deteriorated, with only one or two fifteen-minute visits per day, often provided by carers on zero-hour contracts who are hardly able to meet their clients' minimum needs.

Given that Britain is often celebrated as the fifth richest economy in the world (in terms of GDP) the way we treat our elderly people is surely a disgrace.   We are told by politicians that we must turn society away from the post-war culture of dependency and towards a regime where people have to help themselves, either literally, by doing more to care for their own ageing parents, or indirectly, by saving specifically for their own long-term care needs - in other words, by taking greater personal responsibility and exercising a choice.   Of course, this is perfectly reasonable advice for those who have adequate resources but, sadly, it is the fact that the majority of (low paid) workers in Britain can barely manage to save any money at all, even for topping up their own modest state pensions.

Ministers appear either breathtakingly remote from the lives of ordinary people, or else they are shockingly disingenuous:  David Mowat, a Health Minister, recently told a House of Commons Select Committee that we need, “to start thinking as a society about how we deal with the care of our own parents”, comparing this to looking after one’s own children (“It is just what you do …”) and thus implying that, in his opinion, families are just not doing enough and failing in their familial obligations.   This is both offensive and absurd for we know that over six million people do care for their elderly, infirm or disabled relatives and, very often, these carers are the spouses, partners or children of those whom they care for - many of them are elderly too and often in need of care themselves.   And the Minister also chose to ignore those who have no families, whose families live far away or indeed abroad, or whose families are struggling just to maintain a roof over their heads.

The affluent will always be able to afford to take care of themselves, they always have, but surely how a society looks after its children and young people, and how, at the end of the life cycle, it supports the elderly and the infirm must be one of the most telling indicators of how civilised it is.   Do politicians who fail to recognise this deserve to govern us?   Almost everyone now knows that our system of social care for the elderly is in crisis but does anyone have the courage to recognise that letting market forces rip cannot be the solution to every problem, and patently not to this one?   To sacrifice the old on the altar of political dogma is despicable.  

We shall most of us be old in the end and that applies to ideologues and their families too, something they should bear in mind.   Bill is one of the lucky ones:  he has been able to circumvent the increasingly overstretched and dysfunctional local authority social care system but he still has to rely on NHS hospital services to deal with his occasional accidents and complications - and rightly so.   Through his taxes, Bill has contributed to the provision of these services throughout his entire working life, just as we all have and should continue so to do.   If the costs of a well-managed NHS are rising, then the contributions should rise too - after all, the pooling of resources, on the model of National Insurance, is easily the most efficient way of making sure that essential services will be there when we need them.   The NHS is, in comparison with other western democracies, a model of efficiency and value-for-money, yet the UK spends less on its health and care services than most comparable (rich) countries.  

Text edited 10th November 2016 and extended and re-edited 10th February 2017  

Update  (April 2017)

We have to report the sad news that today, Sunday 30th April 2017, Bill Mathieson passed away;  he was 86 and his health had been failing for some considerable time.  Bill will be greatly mourned by his family and by everyone who knew him. May he rest in peace.

Page modified: 6th April 2019