Lesley Riddoch: Welfare system at the crossroads
THE country can’t afford ‘universal’ costs, so it must change from central to local responsibility, writes Lesley Riddoch
The universalism debate grinds on, with Labour’s Johann Lamont returning to the fray in last week’s First Minister’s Questions. Alex Salmond’s Sky package at Bute House is now the latest in a series of entertaining red herrings. Two big questions have yet to be asked about all welfare services.
Do they empower the people they serve? Do they help prevent social and health problems from arising in the first place? The answer to both is usually no – if the questions are even asked.
And yet they are vital.
“Universal” benefits cost roughly £800 million per annum and constitute 2 per cent of the Scottish budget. But emergency hospital admissions of old people – most without a serious clinical problem – cost £1.5 billion. Some simply feel unwell or in pain but lack support at home so they’re taken into hospital for safety. Job done or real problem (and therefore real solution) avoided?
Likewise, the care budget is set to double in 15 years. A third of us need care at some time; almost all prefer to receive it at home and that option’s ten times cheaper than institutional care. But only a tiny proportion (just 1 per cent of those eligible in Dundee for example) claim direct payments to run their own care package. Why the low take-up when self-directed care is what people want?
Each of these “welfare mismatches” eats up more cash than the vexed “universal” benefits. Indeed, the Scottish Government’s consultation document on their preferred solution – the integration of adult health and social care spending – puts it bluntly: “There is little association between the amount spent currently on health and social care services, and the outcomes achieved – spending more does not necessarily result in better outcomes.
“We spend more annually on unplanned admissions for older people than we do on social care for the same group.”
This candid but shocking admission should knock all other problems of welfare delivery into a cocked hat – or at least widen and sober up the present emotive debate. But it doesn’t. And it probably can’t.
Our welfare system is at a crossroads – tottering under the burden of new responsibilities and old, unfixed problems, and administered by two governments diametrically opposed in political mission and social outlook. Neither Westminster nor Holyrood possesses enough statutory control, political single-mindedness or vision to fix the welfare state. So politicians on both sides of the Border do what they do best: patch and mend, blame and carp. Debate cuts, mergers, budgets and entitlement.
And yet there is only one welfare reform worth the candle – shifting the locus of power, focus of decision-making and balance of budgetary control from the centre to the community. Such a radical reversal is the only way to harness the power of mutualism, self-help, neighbourliness and human capacity that gets the chance to blossom in empowered (not passive “done to”) communities.
On Saturday night, for example, I went to see Lifeguard at Govanhill Baths – a play by the National Theatre of Scotland celebrating the success of a decade-long campaign by Scotland’s poorest, most disempowered community to retain their swimming pool against the wishes of Glasgow Council.
The restoration project has produced much more than a beautiful set of Victorian Baths – the people of Govanhill are now purposefully organised in their own development trust and taking on responsibility for their own health and wellbeing. The more services that can be channelled through this popular, community-driven vehicle, the better.
And yet the vast bulk of social and welfare spending in Govanhill and elsewhere is micro-managed from on high by distant, absent officials who send a clear message to local, active, capable Scots. Our job is to fix you. Your job is to pick up the pieces when we fail.
Now I’ll grant you, fixing the welfare state is like repairing a boat at sea – tough. We are in a recession where protecting the real jobs of existing council workers with families matters more than easily dismissed airy-fairy-sounding ideas about empowerment. Some welfare budgets are under the complete control of the Scottish Government but most are managed by health boards, councils and quangos. These realities drive the direction of political debate.
But until we ask why so much social spending fails to hit the mark, we are fiddling while Rome burns.
What does it say about our welfare system that take-up problems begin when a benefit is not freely available to all? It suggests that welfare is still a glorified extension of the poor house, a last resort, an admission of weakness, failure and defeat – a graceless place.
This is not the Folkhemmet – “the people’s home” developed by the Nordic nations. It is not a place for everyone. And that’s where Scotland’s problems with “universalism” really begin.
Education is a “universal” good – yet parents send children to fee-paying schools. Healthcare is universally provided and yet people “go private”. Bus travel is free for pensioners and yet many prefer their cars. Defenders of universal services assert Fred the Shred is hardly likely to use a bus – even if he can claim a bus pass. We should be asking why.
Our Nordic neighbours aim to create public services for everyone – and ask for contributions. In Sweden, there’s a £20 flat rate to see the doctor. In Norway, an exemption card is claimed after £200 upfront spending on health services. There’s an upper ceiling of £200 per month for kindergarten care. Those on benefit don’t pay. Those who do pay extra don’t seem to complain. Here, we swing between “free for all” or “full market cost”. We inhabit a black-and-white world that leaves many paying taxes for services they don’t opt to use – except in extremis.
Most people resent paying tax for poor-quality services. This “failure to fix” (arising partly from a chronic lack of real localism and empowerment in Scotland) is the primary problem with our welfare services – how they are accessed, by whom and at what cost – is an important but secondary issue.
To envision the welfare state as the People’s Home in Scotland is nigh-on impossible. And yet if Scots want to do something important with autonomy, this should be objective number one.
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