Effort to tackle the social care funding crisis through changes to council tax have been accused of creating a “postcode lottery” for care. Guy Ware argues there is no lottery: variations in services result when local priorities meet with national policy.
Back before Christmas, Sajid Javid attempted to stave off the social care crisis by letting council tax rise a little bit faster than it would have anyway. Cue a barrage of cliché: Javid was simultaneously robbing Peter to pay Paul, shuffling the deckchairs on the Titanic and — my personal bete noire — exacerbating the “postcode lottery”.
When Greg Clark introduced the social care precept a year earlier, he’d spotted the fact that it might raise most where it was needed least. Distribution of the new improved Better Care Fund (iBCF) was designed to counteract this problem. But by pulling forward the precept rises while the iBCF does not really kick in until 2019/20, Javid reminded us that the two don’t quite match up. As Augustine of Hippo might have put it: Lord, make me broadly redistributive, but not yet.
We’ve grown so used to condemnation of the “postcode lottery” that we forget it’s not real. It’s a metaphor. (Except, confusingly, when it’s the People’s Postcode Lottery, which actually is a lottery.) Like all metaphors, it tells you at least as much about the people who use it as the thing it describes.
The Victorians invented postcodes. Lotteries had been around for ever, of course, but the first UK National Lottery draw took place in 1994. Exactly six years later, the Guardian felt impelled to publish a Q&A defining “postcode lottery” as “shorthand for seemingly random countrywide variations in the provision and quality of public services”. But if you plot usage of the phrase “postcode lottery”, you get a line as flat as the ECG of a long-dead corpse right up to 1997 when, quite suddenly, it takes off like an Apollo moon-shot. And doesn’t stop.
So what happened?
The General Election happened. New Labour happened. Tony Blair thought the National Health Service should have national standards (and so should everything else). In the PM’s new Delivery Unit, it was an article of Taylorist dogma that inputs should lead to predictable outputs. Variation was evidence of deviance to be ruthlessly eradicated. The 2001 election manifesto committed the Stakhanovites to “further tackle the lottery of care”. But still, use of the pejorative phrase “postcode lottery” rose twenty-fold each year. Arguably, it was the inevitable messiness of human endeavour — rather than the deliberate bloody-mindedness of public sector workers — that left scars on the PM’s back.
Lotteries are random. Provided you buy a ticket, your chance of winning is just that — chance. But many things now routinely decried as postcode lotteries — access to cancer drugs, care costs, parking charges, bin collections and council tax itself — are not random at all. They are the product of our choices. The fact that council tax is based on 1991 valuations may seem odd to an economist, but it is not an act of God; neither is the capping/referendum limit or the formula that determines council grants. Variation in the level and quality of service is what happens when these national choices interact with local priorities. And localists should think very carefully before condemning it.
One Labour council leader responded to Javid’s announcement by saying, “We don’t think it’s acceptable for social care to be funded increasingly by taxation.” This might seem odd — so odd that I suspect what he really said, or at least meant — was that it shouldn’t be funded by local council tax payers.
Meanwhile, a Conservative MP chipped in the observation that council tax is the biggest bill most people face, after their mortgage. It isn’t, of course — anyone on average income will pay more income tax than the highest Band H council tax in the country (£3,633, Weymouth & Portland, since you ask) — but we know what he meant. He meant it is the most visible tax bill most people see. And with the business rates debate raging at the same time as Barnet’s “Graph of Doom” begins to feel less like an awful warning than a straightforward historical account, many are now questioning whether local — that is, visible — taxes can really be expected to fund the growing demand for social care.
Priorities
This is not surprising. Really, it’s more surprising that we’re having the debate at all. Think back a couple of years. Everyone was saying that integrating heath and care was the only way forward; but there were always two ways to approach that task. In the great existential toss-up between a National Care Service and a Local Health Service how many of us really bet that George Osborne’s coin would come down in favour of greater localisation?
But Osborne is no longer chancellor. In a Brexit world, there’s enormous hunger for the apparent certainties of old-fashioned ways. Just as I didn’t bet on health devolution, so now I wouldn’t bet too much against a shuddering 180-degree volte-face. For all the denunciations of the nanny state, the (small-c) conservative belief that nanny knows best runs deep.
Before council treasurers heave a sigh of relief, we should remember that it was the NHS’s legendary inability to limit spending and deliver consistent outcomes — despite a command and control culture to rival any in history — that brought us the “postcode lottery” in the first place. Local government works, in part, because local politicians are routinely susceptible to the pressure of local opinion; and in part because it has to balance its books. Different politicians will respond to these pressures differently, reflecting the concerns and priorities of their communities.
That isn’t a lottery, whatever Blair might have thought: it’s democracy.
Trivia bonus. The introduction of postcodes was itself a bit of a postcode lottery, even if the phrase didn’t exist. First adopted in London in 1856, and in Liverpool and Manchester a few years later, they didn’t reach Norwich until 1974. (Just saying.)
Guy Ware is director of finance, performance and procurement at London Councils.
