‘I haven’t had the time…..’ An excuse that tends to be seen as a lie, even if a white lie. There are 168 hours in a week, full-time work is supposed to take 40 hours or so, sleep maybe 45. Mmm, 83 hours left.

I haven’t had the time to work on ‘Empty Plates Tomorrow’ recently, which probably doesn’t matter to anyone who happens to read this, but it feels a failure to me. Well perhaps I should have had the time. Yesterday I went riding for an hour, today we had lunch in the pub. The issue may not be raw time, but uninterrupted time. I do not have uninterrupted time, except when asleep, and the 3am nightly visit of my father’s domiciliary carers interrupts that, not that I mind because he needs their attention.

Life as a main carer for my parents, both in their 90s, is no doubt similar to that of nearly six million people in the UK, 1.2 million of whom care for an elderly, ill or disabled person for more than 50 hours a week. One in five of the 45-64 age group is, like me, a carer (figures from Key Facts at www.carers.org). Millions of frail and incapacitated people need care, showing that rising longevity is not the same as a longer healthy life. I think the consequences of the rising need for care need to be considered in greater depth.

Public spending has to be slashed because of the UK’s debt mountain. There will be less money to care for the elderly and infirm, and this will increase the need for friends and family to devote time to caring. The alternative is for vulnerable people to go without care, to be forgotten, and to suffer. Strangely enough, as I write this, ‘Election Uncovered’ on Channel 4 is considering this very issue: less public money for care is indisputably possible.

Family and friends who care will have to cut out one or several aspects of their lives. First, discretionary time: fewer hours for holidays, meals out, sports, hobbies, leisure.

Next, caring time cannot also be used for paid work, so carers’ incomes decline. This means lower tax revenues, further damaging public finances. Welfare benefits for non-working carers and for the people they look after could be reduced, giving further force to the downward spiral. For those like me who can work at home a lot, the frequent interruptions mean that each task takes longer and longer to complete. Phone calls and visits from health professionals, the chiropodist, the mobile hairdresser, prescriptions to collect, medical supplies to order, pills to give, meals, drinks, entertainment, company, a care rota and back-up rota to organise, to ensure that a carer is present 24 hours a day, seven days a week. This is not a complaint, just an observation that people who are carers have to cut their other activities.

Why not rely on residential institutions? Standards of care are already woefully low in too many homes (remember the Gerry Robinson TV programmes on deficient dementia care?). Slashed public finances will mean worse care homes, except for the very few individuals who can afford to pay for private, personalised care. The decision whether to send an infirm person into an institution, or to support them at home, may exact a high price – from those admitted into institutional care, if standards are low, or from their carers if they have to stop work, stop pension contributions, and neglect their friends and other members of their family.

People who are recently retired have, for decades, been invaluable as volunteers in community organisations, also as elected councillors and as selected representatives on QUANGOs (definitions vary, but ‘quasi autonomous non governmental organisation’ is a popular one). A bonfire of QUANGOs might not have a detrimental impact on government, but community volunteers and councillors are extremely important to our nation. As more and more of the fit retired, as well as people under retirement age, need to care for ailing family members and friends, the pool of potential volunteers and representatives will shrink.

It may sound bigoted to the guardians of political correctness, but might it be a mistake to protect the NHS from cuts and to prune harder elsewhere to compensate? This policy could prolong the lives of people like me, but if we need long-term care as a result, who would benefit? Should the artificial extension of life be unquestioned as a top priority? It doesn’t appear to be a question that is asked in government, but I reckon that it needs to be both asked and seriously debated.

The UK’s National Health Service has a £102.3bn budget for 2010-11. Doesn’t look much? £102,300,000,000? The problem with zeros is just that, they convey nothing. Yet £102.3bn is £1,644 for every one of the 62.222m people in the UK in 2010.

No one, apparently, likes to contemplate cuts in the NHS, which as a concept has become a Great Unquestionable, like ‘Democracy’ in the world’s wealthiest nations, or ‘Capitalism’ as a force for good.  In my mind it is long past the time when we should have begun to interrogate these and other ‘Common Sense’ notions that permeate our lives. I am very interested in ‘Common Sense’. If anyone has an hour or two to spare in Didsbury, Manchester, there is quite a bit about Common Sense in my (little read) PhD thesis, to be found in the library at Manchester Metropolitan University, and titled: ‘Lay Inspectors, Educational Values and Policy Change: the significance of emergent outcomes’.

The ‘Common Sense’ that the NHS is too essential to subject to deep scrutiny means that counter arguments will be unpopular. The journey of any belief from startling novelty to general acceptance is paved with persuasion, as summarised by the philosopher Bertrand Russell, who noted “pure persuasion leading to the conversion of a minority; then force exerted to secure that the rest of the community shall be exposed to the right propaganda; and finally a genuine belief on the part of the great majority, which makes the use of force again unnecessary” (‘Power: a new social analysis’ by Bertrand Russell, George Allen & Unwin  1938, 1960 reprint by Unwin Paperbacks, p.93).

Given the nasty situation of government debt which could easily exceed the UK’s GDP, if bank bailout money is not recouped, juxtaposed with rising costs of energy and raw materials, and the expense of protecting the nation against the extreme weather events that appear to be a manifestation of climate change, and the NHS’s annual budget of £102.3bn begins to seem one sacred cow too many.

An important issue for me is whether we have a National Health Service or a National Medical Technology Service. A health service would surely focus on preventative medicine, and a vital part of that is the availability of nutritious fresh (and that means local) food.  In reality, though, the NHS has become the source of technological interventions which often keep people alive but not in a healthy condition. I am not anti-technology, but it is a matter of balance. With any technology, we have to ask “just because we can do this, should we do it?” The technology-led approach has turned ‘health’ into ‘illness’, and has closed local community services because of the funding needs of huge medical technology centres a.k.a general hospitals,  which need vast car parks for staff and patients, and which require the consumption of large quantities of oil and gas — as fuel and power — to function.

The NHS, it appears to me, has turned us into a nation of ill people dependent on machines and drugs to try and restore ‘health’, and I think we need to re-examine the purpose, scope and costs of the service.

The same tendency to technology-led gigantism applies to schools, too, but I’ll return to that another time.

It’s been several months since I contributed to Empty Plates Tomorrow. The main reason is that I have been and remain very busy looking after my parents, who are both in their 90s. Earlier this month, I took them to a care home for a temporary stay, to see how they liked it. The experience was so bad for them that I removed them after only five days, and that’s it for care homes as far as we are concerned. Fortunately we have a choice. What about all the older people who have nowhere else to go?

My father had two falls and came back with a sprained ankle, a shear wound on his left leg and grazes down his right arm. He got stuck in the lift and was terrified that no one would ever come and let him out. My mother returned with a urinary infection, because the personal care provided was inadequate, nowhere near the excellent standard upheld by the county council’s domiciliary care team, who wash and change mum at home.  They soon settled down again at home, but their short stay raises several questions:

• Why do we incarcerate elderly people in institutions?
  

Unannounced visits into care homes often reveal dispiriting realities of neglect and oppression. The neglect may be unthinking, by omitting to help those who cannot feed themselves, or by forgetting to provide sufficient fluids to drink. The oppression comes when residents are shouted at for getting in the way of staff routines, or are deliberately left waiting when they need to visit the toilet. Sometimes you receive the impression that the residents are impediments to the smooth running of the business.  The use of the word ‘home’, as in ‘care home’ is comforting for those who send the elderly there, but often misleading because residents have few of the freedoms they would enjoy in their own homes.

• Why do we allow care of vulnerable elderly men and women to be a profit opportunity?

The marketisation of ’services’ has gone too far, in my opinion, when the very survival of people who can no longer look after themselves is deemed a market opportunity. Unlike babies, some older people are not cuddly. They may swear, dribble, shout and moan, but often these are reactions to the stressful situations in which they find themselves, and which they no longer have the capacity to question. Or if they do question, no one listens. The quest for profits tends to include continuous efforts to cut costs. I was horrified to learn, for example, that in care homes only one meal a day has to be cooked, and so proprietors keen to make money can exploit this by relying on fillers such as bread and margerine.

• Why do so many families need to offload the care of their older members?

The tangle of reasons why families no longer care for their own elderly obviously includes family breakdown and geographic dispersion, and also the cultural expectation of individual fulfilment, a life path prioritising personal ambitions. Personal ambitions come to an abrupt end in most care homes, though. In too many cases the residents are no longer perceived as people with interesting life histories, but as depersonalised patients with ‘problems’, waiting to die. What we don’t know about we can often shunt to the back of our minds, and in the interests of ’security’ care homes these days are often locked, keeping residents in and the neighbourhood out. So families don’t need to think too much about the experiences of older members who are put away in care homes, because they can maintain a state of blissful ignorance.

• Why is there not a greater choice of care options?

I discovered a scheme in France, called ‘Villa Families’, which keeps elderly people — generally over-80s — in their own neighbourhoods, living in specially designed villas, constructed in a public-private partnership non-profit scheme. A villa consists of two semi-detached homes, each housing a host family and usually three elderly people. The host families cover for each other in emergencies, and there is also accommodation for substitute carers to allow the host families to take holidays, and to enable friends and relatives of the elderly residents to stay in the villa. I would like the Villa Families concept to become widely known and applied in the UK. See ‘VillaFamily: Providing Care for the Elderly in Rural France’ by Philippe Loubens, case%20study%20villa%20family.pdf.

Also, for those families willing to care for their elderly, there should be a wider choice of properties suitable for extended families, which means that planners and builders have to think beyond the conventional range of properties built for one, two, three or four people.

I have not even started to consider the economics of elderly care, but it is worth pointing out that many of those who struggled to buy their own home have to sell it to pay for care.  In 2008, 45,000 care home residents in Britain sold their homes to pay for care, according to the Daily Telegraph (‘Record numbers sell home to fund care’, by Laura Donnelly, www.telegraph.co.uk, 21st February 2009). So every year thousands of people have to sell the proceeds of a lifetime of saving to pay for institutional care that they accept reluctantly in the absence of any better option. Anyone in England with assets of £23,000 or more in 2009-10 — the figures are slightly different in Scotland, Wales and Northern Ireland — does not qualify for any state help with the costs of care.

Is it any wonder that there are so many demoralised, confused elderly people in our United Kingdom?

You may ask why I appear to be asking the nation to spend more on caring for the elderly when the whole tenor of Empty Plates Tomorrow is to prepare for a era when we will all have to reduce our use of energy and raw materials, buy less, shop less, spend less. I don’t think I am asking for that. I think that often we are spending on the wrong sort of care, or indeed are spending on neglect. In future families  and local communities will have to take over more of the work of caring for elderly members, who when happy in their familiar environments can often contribute wisdom from long perspectives.

Sir Gerry Robinson’s two-part series on dementia care, screened on BBC2 in December 2009, was devastating, but much of the response that I have seen was focused on a perceived need for better staff training. We need to recognise, I would argue, that care in an institution is not inevitable, that care is not a product, and that accepting a scenario of ’staff’ and ‘patients’ tuns old age into a pathological state.