We need to talk about how the UK supports its growing number of older people, and in particular about the end of life. One of the many weaknesses of British politics is that its structure does not make it easy to link related issues, But the age of retirement, pensions for the elderly, the rising proportion of the NHS budget spent on those over 70, the cost of drugs, social care, palliative care, and the debate over assisted dying, are all interlinked – above all by the pressures they all put (now and potentially) on the UK budget.
The problem of providing and funding long-term care for the elderly was grasped by (Liberal Democrat minister) Stephen Williams during the coalition government, but weakly supported by Conservatives and opposed by the Labour opposition.
Theresa May as Prime Minister tried again to address the balance between private and public funding of long-term care, only for Labour to attack it as a ‘Death Tax.’ Since then care provision has drifted and costs have risen. The dominance of the private sector has grown as many cash-strapped local authorities have sold off their care homes, as charities have retreated from the sector and private equity has bought into it – driving up what Councils have to pay and holding down carers’ wages. Enterprising private providers have built retirement villages and apartment blocks for the well-to-do, but there is little new provision for poorer retirees. Local Council budgets are now weighed down by social care costs to the exclusion of other needs.
Right-wing attacks on the size of Britain’s welfare budget have omitted to mention that nearly 60% of welfare spending now goes on pensions: 8% of GDP, up from 2% after World War 2 as life expectancy has risen. When Lloyd George introduced old-age pensions, less than half the population lived long enough to benefit. Many of us now draw our pensions for 25 years or more, and medical advances will continue to lengthen life expectancy (and increase what the NHS spends on elderly people).
Liberal Democrats in the coalition government were proud of our commitment to the ‘triple lock’ on pensions. 15 years of pensions rising faster than inflation have shrunk pensioner poverty and enriched those also benefitting from post-employment pensions (like me). The case for ending the triple lock is strong – although the temptation for opposition parties to oppose the government doing so may still be stronger. The case for increasing taxes on better-off pensioners is even stronger; we benefit from a range of financial concessions but pay a lower rate of taxation than those in employment – because we no longer pay national insurance. But there’s little chance that Reform and the Conservatives, the parties of older people, would accept the logic of any increase, faced with the wrath that the Mail and the Telegraph would unleash.
As the Terminally Ill Adults (End of Life) bill moves slowly through the Lords, Sir Dávid Davis MP has just sent us a letter proposing that we should include ‘a clause that explicitly states the high-quality palliative care must be available to all in their final years of life, obviously including those who seek an assisted death.’ He does not mention the current funding crisis that hospices are facing, nor estimate what the impact on the NHS budget would be if hospices were to be fully funded by the state. The additional costs of the legalization of assisted dying, in terms of safeguards and regulation as well as accommodation, could be considerable.
When the Lords returned from the Covid lockdown, I took to greeting colleagues by asking them ‘How many pills do you take?’ and was shocked to discover how many were tsking a dozen a day or more – in addition to the regular injections all elderly people receive – without payment. The NHS budget for drugs has been held down by hard-bargaining with drug companies – but is about to increase significantly as Trump attempts to squeeze the excess profits drug companies make in the USA and those companies threaten to move research and production outside the UK.
Policy Exchange, a leading right-wing think tank, has just published a paper – Beyond Our Means – on how to shrink public spending by 3% of GDP. Its proposals include freezing state pensions for three years, raising the retirement age to 70 for those 55 or younger, and cutting other pensioner benefits (winter fuel, free prescriptions, bus passes, etc.) for all except the poorest – as well as cuts in payments and benefits for younger adults and children. This is refreshingly honest, in contrast to politicians and papers that call for tax cuts without suggesting parallel cuts in spending. But neither Nigel Farage nor Kemi Badenoch would dare to propose such cuts to their voters as they respond to the budget.
Liberal Democrats are in principle in favour of limiting the size and reach of the state. We believe in providing opportunity for every citizen to develop their potential and their skills – which means directing public spending at the younger generation rather than the elderly. We live in a country which has funded increasing state spending on health and pensions over three decades by cutting the defence budget, and has now discovered that we desperately need to repair our defence capabilities. Do we accept the need for higher spending, or want to argue for policy changes that will be painful for many older voters?
* William Wallace is Liberal Democrat spokesman on constitutional issues in the Lords. He has enjoyed state and private pensions and associated benefits for two decades, and hopes to enjoy them for at least a decade longer.