Called to account

Alan Milburn believes a 6 per cent rise in
social services spending is sufficient to fund the shortfall in
care home places, but his previous promises turned out to be
woefully inadequate, says Conrad Russell.

All ministers are optimists, but some are more
optimistic than others. Alan Milburn, the health secretary, is an
optimist of the first order. He once promised us an end to
bed-blocking in discharge from hospitals, and, to this end, offered
to make his promise good with spending of £300m. Now local
authorities have been told that they will need to use some of the
extra money from last week’s Budget to cure bed-blocking, on top of
the £300m.

To say
the least, Milburn’s mathematics are interesting. According to
Liberal Democrat MP Paul Burstow’s report No Room at the
, between April 1999 and March 2000, 21,522 people over 75
experienced delay in being able to leave hospital. These were not
all trivial delays: 2,083 of them were delayed for over 28 days.
Put another way, and not confining the case to older people, 32.7
per cent of all patients suffered delay in discharge after they
would have been fit for it.

However, if we give Milburn the
benefit of the doubt and confine the financial need to the 21,522
who were over 75, his original £300m added up to £139.39
each. Since it costs £233 a day to keep them in hospital, this
would sustain them for just over half a day each. Since it costs,
on average, £319 a week to keep them in a care home, this
money would buy them a care home place for just over half a week
each. And since we cannot suspect secretaries of state of planning
to increase the death rate, Milburn can only pass himself off as
evidence of the declining standard of mathematical

Budget announcement suggests that he has realised the error of his
ways. We have lost 50,000 long-term NHS care beds over the past
five years, 28,000 of them over the past two. For the loss of beds
in NHS hospitals, the blame is very widely placed on the private
finance initiative, since it is necessary for the firm taking the
PFI deal to generate a revenue stream. This may, of course, be
unfair – the requirements of commercial confidentiality make the
idea as hard to deny as it is to prove. Either way, the government
has now had to find billions of pounds in extra funding to reverse
the decline.

care homes, it is necessary to postpone admissions until an
existing resident dies. This used to be the system in 17th century
almshouses. As a historian, finding it in operation now, I am
reminded of the professor of accountancy who was once allowed, in
the 1960s, to inspect my college’s accounts to see whether its
claim that it could not afford to pay salaries monthly was
justified. He came back rubbing his hands in glee, saying he had
heard that such a system of accountancy once existed, but he had
never hoped to live to see it in operation.

Milburn has provided a 6 per cent
increase in social services spending, thanks to the Budget. He
believes that this is fully sufficient to fund the necessary
shortfall in care home places and therefore proposes to fine local
authorities for any failure to supply a care home place for people
ready for discharge from hospital. He clearly shares the Treasury
view that the proposition that any sum of money is sufficient for
the purposes for which it has been granted is

belief that government grants have recently been sufficient for the
purposes for which they were allocated is not self-evident. Members
of the Victoria Climbie and Lauren Wright inquiries would be
surprised by the suggestion that all increases in social services
spending should go to older people. It is more likely that, as
local authorities fear, they will be fined for failures that are
not their fault. It is high time that government grants were
subject to judicial review under the Wednesbury principle – namely
that the belief that the sum is adequate for its purpose is so
unreasonable that no reasonable minister could have reached

Meanwhile, we can only ask, in
relation to Milburn, John F Kennedy’s famous question about Richard
Nixon: “Would you buy a used car from this man?”

Conrad Russell is Liberal
Democrat social security spokesperson and professor of British
history, King’s College, London.


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