What can you expect from our campaigns in 2017?

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Better social care [which is many times cheaper than hospital treatment] will also help to keep people fitter and healthier thus staving off the need to go into hospital in many cases.

A cousin of mine is a district nurse [or whatever they are called these days] and provides domiciliary care for lots of elderly and ill people in a cluster of villages giving injections, attending to wounds and changing dressings, post-operation supervision, organising aids and adaptations, taking blood samples and doing routine tests, checking medication, ante- and post-natal support, and reporting back to the doctors on the condition of their patients. Apparently there are not so many of these nurses nowadays but they are an invaluable resource taking a load off the primary care services and the clinics and hospitals. She is well into her sixties now and still enjoys doing the work and has no desire to give up at some arbitrary age limit.

The other need is for non-medical daily care, bathing, feeding, cleaning, and other duties for the growing number of people who cannot look after themselves properly. These services are vastly overstretched but if the funding were made available I think they could be expanded quite quickly to cover more people more effectively and give more hours to each client – much quicker than trying to recruit and train legions of hospital nurses whose skills are not being used to best effect if they are looking after wards half full of people who could be discharged.

This is getting quite urgent. The post-war baby-boomers are approaching the point where they will start to impact on the health and social services in a big way. Many of them have retired, or will be retiring, to areas of the country where services are thinly spread, where numbers are growing, and where the local authorities are under-funded because the council tax yield is low relative to the demands placed upon them.

One of the things the government could do at a stroke, if necessary at the expense of other controversial capital projects, is to wipe out the Private Finance Initiative [PFI] debts of the hospital trusts and free their governors from all the worry these debts cause so they can run their hospitals with patient care uppermost in their minds instead of a debt-laden balance sheet. This might attract better quality governors and senior health care managers.

Your first point is so obvious one wonders why there are repeated cuts in social care in the community. And I suspect we do need more care homes – or will need, certainly – and they will cost both to provide and staff.

One thing does occur: the increasingly large numbers of people in our service industries come from the EU.

Ian – Given the outcome of a recent poll I deliberately abstained from mentioning that point in your second paragraph but it is indeed highly pertinent in the present situation. I was hoping – with not much hard evidence to support it at the moment – that the combination of (a) a rising home population, and (b) the reduced labour demands of government, commerce and industry, would supply, numerically at least, sufficient people to boost social care in line with rising demand.

I’m sorry but things aren’t quite that black and white. Imagine you are an elderly person say 80+. You have been reasonably healthy up to date but you have a bad fall and are admitted to hospital. While there you are assessed by health and social care staff who feel it is unsafe for you to return to the home you have lived in for say 50 years and is full of memories for you and you have a social support system around you at that address (church, neighbours etc). How long would you need to come to terms with that huge change in your life which has come out of the blue. Who really wants to go into care -at any age? Also, how long should we give you (and hopefully your family) to find a care home you like and that you can afford (if you have more than £21k capital which includes property)? A week, a month, two months ………..how long? This is probably going to be the last place you call home. Will you be happy to sit in front a tv surrounded by other people and unable to choose which programme to have blaring out at you: happy to have staff provide your personal care while they chat to each other about their families and issues without looking at you or talking to you: i.e. having no control over your life. How do you and your family judge which home will suit you? Is it near to where you or any family member live? Your choices are going to be very limited to meet any such critiera. We all need to think what we would want if we were in that situation.

You are absolutely right, Kate. That is why we need to develop a social care system that can look after people properly in their own homes without being forced into a residential care home with all the characteristics you have portrayed. I am a member of a local organisation that has its regular meetings in the library of a care home and I see all the things you have mentioned and more, and I think it is one of the better establishments. It has filled me with fear of reaching that situation.

However, I think there is a responsibility on people to plan ahead as they get older and review their lifestyle, see whether they should move to a smaller property in a more convenient location, and progressively part with some of their possessions to make the housework easier and a move more manageable. But, as you say, things are never so clear-cut and the one thing that cannot be dispensed with or easily replaced is the local community network of organisations, support groups, and friendships. A compassionate society must take these things on board and work out a humane approach. While no two individuals are identical in their needs at any point there is a uniformity at the younger end of the age range that is absent at the upper end of life where there is an infinite number of variations to be catered for. The challenge for a caring society is to recognise that and provide for it. There is no reason why it cannot be extremely rewarding for the individuals involved on both sides.

Paying for social care is essential if we are to release hospital beds for those who need them. Council tax surcharge would add one component. But there are other ways of getting funds. All over 60 get £200 a year winter fuel allowance, whether they need it or not. Pay that instead only to people who do not pay income tax and you could release around £1 billion. Large numbers of people get free prescriptions who could afford to pay, and if they use drugs regularly an annual card costs (I think) just £104; again, restrict it to those who cannot afford it, and that could raise somewhere around another £1 billion. Every little helps. When we are better off as a nation we can restore these nice-to-have benefits perhaps.

Good point about the Winter Fuel Allowance, Malcolm, which I agree with.

The same could be advocated for the free TV licence for tax-paying 75+ year olds [which possibly even gives rise to some unintended avoidance opportunities]; there would need to be a financial adjustment between the BBC and the government to transfer the funds but that’s probably not a big problem. The important thing would be to guarantee that the benefits would be restored if people’s circumstances changed and they stopped paying tax.

Something that has been suggested in the past is the Concessionary Travel Pass giving free bus travel for pensioners but that is not a direct payment or relief; if holders don’t use the buses then there is no charge to the issuing authority and ultimately the government.

More controversially, I suggest a higher rate of VAT on dog food all of which should go straight back to the local authorities who have to spend a lot of money dealing with dogs’ mess and other public nuisances.

The forthcoming ‘sugar tax’ on soft drinks might be another source of revenue for the NHS potentially generating £520 million a year, although it has already been agreed that in England the revenue will be spent on increased funding for sport in primary schools [Scotland, Wales and Northern Ireland can make their own decisions on how they spend it].

Yes, Malcolm; I don’t know about that. Apparently, we’re the one of the best performing economies in the Western world, yet the stats simply lend weight to the view that no one actually understands international macroeconomics.

You base your suggestions (and other things you’ve said in other topics) on the Thatcherian mantra of ‘we can’t pay ourselves more than we earn’ yet I suspect that the entire comprehension and body of knowledge on even national economics is seriously flawed.

Saying “When we are better off as a nation” is a form of economic solipsism; it’s essentially meaningless, since no one knows how well off we are, and no one understands macroeconomics (particularly economists, it seems) sufficiently to make such pronouncements.

The government produces figures which claim to represent the cost of the NHS, Education, the Civil service and so on, but are they even remotely accurate? A mounting body of evidence says they’re not even close. This week the Bank of England’s chief economist, Andrew Haldane, has admitted his profession is in crisis having failed to foresee the 2008 financial crash. But what he goes on to say is even more worrying.

Admitting his profession is about as useful as a chocolate fire-guard in economic terms he then goes on to make the most worrying statement I can imagine: “Out of that (the 1930s recession) something good spread. It brought us [John Maynard] Keynes and the birth of modern macro-economics. Out of this crisis, there could be a rebirth of economics….the models we had were rather narrow and fragile.”

So in a single breath he’s saying economists really don’t understand economics, then saying Keynsian economics was good, yet simultaneously admitting the Keynsian models they had were ” narrow and fragile”.

So if we do need to make cuts I don’t believe it should be at the expense of those who need life-saving drugs all the time. I could go along with means testing the fuel allowance but I do feel the higher rates of income tax ought to be raised. Second home owners could easily be taxed significantly and greater taxation could be applied to all who live in a major conurbation but who choose to drive 4 x 4s.

But let’s not kid ourselves: we’re well off enough to afford £17bn on Trident, apparently. What an effect that would have on the NHS.

“Better off as a nation” means that the wealth creators – commercial organisations – earn more and pay more in tax, directly and through employees’ earnings for example. Tax funds our public services. So the better we perform as a “business” the better our services will benefit – unless we waste it on more PFIs, Trident and the like of course.