Guilty
Conscience

When I first experienced this, last year, my dentist pointed out to me that as a 66-year-old pensioner, I was entitled to free mouthwash - and he "prescribed" four large bottles of Corsodyl.  I used them up, over a six-month period.

But then my ol' Presbyterian conscience kicked in.  Why should I, as a well-heeled working pensioner, be using free NHS "drugs" - particularly for a mere medicament of convenience like this?  Merely because of an entitlement?  Hardly.  Today, I bought a smaller bottle, which cost me £4.15 at Sainsburys. The market value of the previous prescription must have been at least £25...

It would be quite wrong to introduce even more means-testing to "weed out wealthy pensioners".  We have far too much unnecessary means-testing as it is.  But in the persuasive battle for hearts and minds, wealthier pensioners should surely be encouraged to consider the NHS drugs bill - to use their "free issue" only for any serious, long-term or expensive medication.  And if there were truly local, participatory health trusts, the self-denying pensioners who bought their own mouthwash would know at least that the moneys saved would be devoted to health services in their own area.   To buy your own mouthwash would be the equivalent of making a £4.15p donation to the local NHS!   Each Trust could publish a regular total of "moneys contributed" by such moderation.

• I feel an idea coming on...

4/7 Response from Fabian Solicitor Peter Fitzgerald, of Caerphilly

Interesting ideas Roger -

There are a number of different issues here that need unpacking -

1.   Universality v. means testing is certainly one;
2.   Possible state pension increase, so that "inexpensive" medication
         is paid for by the pensioner;
3.   The underlying ethical "belief systems" -
         individual self-interest v. the common/community/society interest;
4.   Socialism and conflicts with personal values - problematic area!

Your point about local participatory health trusts is a good one. If you can crack the administrative problems and ensure the take-up, then there would be merit in moving away from universality.  The addition of a more refined post code when applying for such medication may be an appropriate criterion.  Exceptions could then be considered against the criterion, if need be.

From most of your recent thinking, am I correct in assuming that you want greater powers given to local democratic institutions where this sort of decisions can be dealt with?  I hope you are recording all these good idea that you are having!

Regards,

Peter FitzGerald
 

My response 5/7

Peter

Good to hear from you - and you are right to highlight the various "issues of principle" raised by the Great Mouthwash Incident.  But let me tackle your more immediate - and wider - question about the creation of new elective, democratic institutions, capable of adapting to local requirements.

You are right to detect a growing interest on my part in this form of alternative public sector institutionalisation. I am dismayed at the decay of our Victorian Councils - District, County, Unitary - the format originates in that remarkable inventive period 1885/1895.  Local government is in my bones - my father was a Cardiff Councillor, I have been a Hackney Councillor, and a Swansea Chief Officer.  Yet it is clear to me that Councils are rapidly losing their authority and institutional effectiveness. Labour's "reforms" of the Local Government Act 2000 show no signs of improving matters - and more Councils will now disappear, to accommodate Labour's woefully inadequate English "Regional Assemblies".  Council recruitment is becoming very difficult - both for Councillors and professional staff.  As governmental institutions, these "Councils" are dying on their feet.

For management purposes, they are too small

There remain over 400 elected Councils (there were 1200, before 1972), many performing major functions - social services, highways, public health, planning, education, housing, emergency planning, libraries, leisure provision) - a recent municipal Council advertisement claimed that the organisation performed 217 statutory functions.  For many of these purposes, the Councils are far too small.  Peter: you live in Caerphilly, which in strategic terms should clearly be governed (like all the Cardiff Valleys) by a strong city regional council for "Greater Cardiff"..

For democratic political purposes, most of them are too large

As the number of local councils has declined (from 1200 to 400), the number of Councillors has been slashed (before 1972, the ratio was 1:1750 voters, it is now 1:4500 voters) - Councils have become remote institutions embracing many different perceived local communities, without the ability to differentiate legitimately between them - there is a growing alienation between electors and elected, and that is undermining all institutions of local government.

For the purposes of public participation, each multifunctional Council does too much.

Leading Councillors have to devote most of their time to their Council duties - the more so, with the 2000 Act creating salaried "executive Cabinet" Councillors, effectively professional politicians. This leave no "democratic space" for the lay citizen involvement which has traditionally been the stuff of local government democracy.  If we are to bring back the local citizenry into government, we must slice up the responsibilities into smaller and more digestible packages, allowing local elected citizens to do less.

I seek a new mix between -

• (a) "strong, large territorial authorities" (for my money, city regions) and

• (b) much smaller elected functional entities (in education, health, sports and leisure, planning, neighbourhood governance). 

The city regions would retain responsibility for the key big government, big-area functions - development planning, highways and transportation, major public works, housing, social services, public health, civil emergency, Police and fire services. There would be only 50-or-so such authorities throughout the UK, and they would be the responsibility of elected professional politicians, offering challenging regional political careers.

• All other functions would be performed by thousands upon thousands of smaller elected bodies - both territorial (community councils) and functional (health boards, school boards, leisure facilities boards, town-and-country planning boards).  Local community (Parish, Town) councils would be established everywhere (there are 738in Wales already, with another 150 communities still without), and their functions would be supplemented by local functional agencies - all elected by the general local electorate.

In Wales, the National Assembly would perform legislative and strategic functions, where appropriate, for the province as a whole. And all English Regions should be offered precisely the same constitutional deal as Wales already has.

Yours  Roger WE

753  7 July 2003  

Much Ado
about Everything

Our hope must be that the Government is very subtle - and that by lighting the touch-paper of age discrimination, they are laying the ground for radical pensions reform.  The current debate is incredibly thin, insubstantial.  But by openly debating the extension of working-life to 70, the Government could be laying the ground for a radical shift to a £140 per week state pension-at-70. 

These are two sides of the same coin - the universal fear of impoverishment, and of irrelevance, in old age. This has been the stuff of human experience, since time immemorial.  And it represents a standing challenge to all contemporary socialists, to find the right way to counter these corrosive fears.  The Right has nothing to offer.

"Private" investment institutions offer solutions only for the wealthy - at most, the top 10% of the UK hierarchy of wealth.  For the world as a whole, the proportion must be well under 1%.  The Stock Market jungle, while lucrative for its big players, is a dangerous place for the poor, even when they pool their resources. The corporate scandals of the last two years have destroyed whatever fragile confidence may accumulated since the 1980s - and it will not quickly return.  Labour should decisively reject any reliance upon private investment, in propounding its own solution.The City is a busted flush, for these purposes.  It is only the wider national communities of the world, acting through their state governments, that can give to their citizens the necessary assurances of long-term support, of the payment of old age pensions.

With a credible State promise to pay a satisfactory Pension at 70, I believe that the entire population would adjust life styles and paths accordingly.  For those seeking earlier retirement, the City could offer a range of simple and reliable "prior retirement" packages, covering the years of ones 60s. Employment conventions would become more flexible, accommodating more and more part-time employment during ones 60s.  For the overwhelming majority of the population, the good-pension-at-70 would offer a glittering haven of security, and a beacon of confidence to keep up peoples spirits, from the age of 50 onwards. Occupational pensions would continue to supplement this system, and contract law would be deployed to ensure the enforceability of pension claims, even in the event of employer-corporation failure.

Given that systemic elimination of anxiety, working-lives would I believe extend "naturally" into the 60s, with older employees being welcomed to stay within the workforce.  I would also suspend the Minimum Wage laws for all those over 65, giving them a bit of competitive edge, in contesting age discrimination.  I know that the trade unions condemn that, as permitting the use of "cheap" labour.   But union leaders are understandably preoccupied with the "economic" significance of labour, rather its social and psychological functions - indeed, TUs commonly think of the "sale" of labour as a commodity, and that has conditioned much traditional TU thinking. That posture is not helpful, when it comes to solving the problems of elderly employment.