Foxhunting was once described by Oscar Wilde as “the unspeakable in pursuit of the uneatable”. In the case of the former defence secretary, the quest has proved nobler and the quarry easier to swallow alive. Those chasing Liam Fox have uncovered such a grisly diaspora of rich lobbyists that critics hope the sacrificial feast will feature not only roasted Fox but a kebabbed prime minister.
Sir Gus O’Donnell’s report should offer a damning verdict on the activities of Dr Fox and his best friend, Adam Werritty, the human dynamo driving an unsavoury shadow foreign policy. Others, too, have questions to answer, not least Sir Gus, given the unexplained failure of senior civil servants to raise the alarm over the ubiquitous Mr Werritty. Nor is Labour ideally placed to preach after taking funding from Cellcrypt, a company central to the Fox allegations.
Although the Fox fiasco will cement the mistrust with which voters view politicians, David Cameron is likely to emerge unbattered. With worsening growth forecasts, soaring unemployment and today’s inflation figures making little impact on Kevlar Cameron, the bombshells unveiled by Operation Werritty are unlikely to dent the PM’s body armour.
Mr Cameron, however, is not invulnerable. Within his ranks is a minister with the capacity to destroy him and bring down his Government. This potential assassin lurks not on the Europhobic Right, nor in the liberal fringes, nor yet among freelance schemers. The PM’s likely nemesis is the loyal and stolid figure of Andrew Lansley.
If being attacked by Geoffrey Howe was like being savaged by a dead sheep, as Denis Healey claimed, then expunction by Mr Lansley is akin to finding oneself annihilated by a lightly sedated basset hound. The lugubrious but diligent Health Secretary is not after Mr Cameron’s job. Many think him lucky to be clinging to his own. His mutant health Bill, mangled by changes, is likely to limp on to the statute book after the Lords last week failed to put it out of its misery. It would have been better for Mr Cameron had they succeeded.
Some disputed issues, such as competition and the accountability of the Secretary of State, will be resolved after the Bill reaches committee stage in the Lords a week today. Even so, the giant quango that will administer the new system sits uneasily with decentralisation, as does an overload of bureaucracy (what, exactly, is a clinical senate for?). The impossibility of combining expensive restructuring with unprecedented savings should alone be enough to alert the PM to trouble ahead.
None of the above is, however, necessarily terminal. The existential (and little-noted) threat to the NHS lies in the worsening betrayal of the ageing population. Within 20 years, the number of people over 80 in Britain will double. This is no country for the old, with the Care Quality Commission revealing that half of English hospitals have left their elderly patients hungry, thirsty and stripped of dignity. Too many care homes are also offering a brutal limbo between life and death. While that lack of compassion is rightly arousing public fury, the need to treat elderly people better is also about hard-nosed economics.
When the NHS was founded, social care was hived off as a safety-net service reflecting the notion, entrenched since the Middle Ages and implicit in the Poor Law of 1834, that families and volunteers would fill the gap. Now, with 1.7?million more adults likely to need help at home by 2030, the system is at breaking point.
The estimate by the King’s Fund think tank that local authorities face a £1.2? billion social care shortfall in the next few years reflects a grim reality. Those judged sick or demented or poor enough to qualify for help get 15 minutes of assistance, during which a carer must feed, wash, console and nurture a confused or frightened pensioner before dashing on. The travelling time between appointments is often unpaid, leaving carers, many of whom are over-worked or under-qualified or both, being paid the equivalent of about £3.50 an hour.
Enter Andrew Dilnot, the economist who, after years of government dithering, finally produced a package greeted by all political parties as the last best chance to create a durable settlement. Measures include a cap of £35,000 on personal liability for care costs, with encouragement to take out private insurance to meet that bill, and a more generous means test for state support, raised from £23,250 in savings and assets to £100,000. That deal, heralded only months ago as the route to a more integrated system of health and social care, might now be sliding towards oblivion.
While (yet more) consultation goes on, with a White Paper due next spring, many are beginning to despair. Although Dilnot is said to be “bullish”, one campaigner reports “grave doubts as to whether Andrew Lansley is behind it”. George Osborne is said to be likely, even certain, to refuse the £1.7? billion state investment required by Dilnot. Without the explicit backing of the Treasury and an enthusiasm that Mr Cameron has failed to evince, the plan has almost zero chance of success.
The political cost of dumping Dilnot would be high. Labour’s effete opposition has been galvanised with the comeback of the former health secretary, Andy Burnham, and the shadow cabinet promotion of the impressive Liz Kendall, both of whom are powerful advocates for social care.
Mr Cameron’s greater problem is that, without a fair deal for the elderly, the NHS cannot ultimately survive. As Richard Humphries, of the King’s Fund, says: “No reforms will make the NHS work properly without sorting out social care funding.” Or, as Kendall puts it, social care erosion “is what’s going to make the NHS fall over”.
The consequences are simple. If people cannot cope, they will inevitably end up, in ever greater numbers, in long-stay hospital beds. Each £1 spent on help at home saves the NHS £4, yet the massive annual health spend of £49? billion on older people includes just £9?billion on social care. The economics of the madhouse are now conjoined with the care regime of the almshouse. That combination may test the NHS and this Prime Minister to destruction.
Much as Mr Cameron may seem unsullied by his Government’s travails, he cannot disassociate himself from the fortunes of a health service that he pledged to protect. Voters who heard him speak of the debt his family owes the NHS are unlikely to forgive a calamity incubated on his watch. Perhaps the PM does not yet sense the danger, since his past eagerness to embrace huskies and hoodies has seemed unmatched by an enthusiasm for granny-hugging. Does anyone even recall a Cameron speech about the elderly?
The PM will pay dearly for such oversights. A cold winter looms, and, only six months into a four-year austerity drive, the fissures in the health service are widening. Mr Cameron may discover soon that the danse macabre that beckons for the NHS will make the defence imbroglio look like a foxtrot in the park.
