19
inequities’ (Guardian September 1, 2000). Experts queried the feasibility of private insurance, the
mechanism by which the majority of then population was expected by the government to protect itself
against the risks of disablement in old age. The Sutherland report found that only 4% - 5% of Americans
were covered by private insurance, and 80% of the population would never be able to afford it (Sutherland,
1999: 5.38). It seemed highly unlikely that the pattern would differ in England since evidence suggested that
few people on average incomes would be able to afford to take out long-term care insurance care
14
. Added
to this, there was a real danger – intensified by the advances in genetic science – of adverse selection by
insurers with those most at risk (e.g. of Alzheimer’s) having to pay most to protect themselves.
15
The key political point here is that, in other circumstances, the Government would have been able
to claim – as it did for instance in the controversy over the Private Finance Initiative – that whatever people’s
reservations, its approach was the only realistic and workable one: ‘the only game in town’. The decision of
the Scottish Executive to press ahead with free personal care pulled the rug from under its feet. Pensioners'
groups in England warned that there would be great anger and bitterness if the frail elderly were denied
what was freely available in Scotland. ( Guardian January 27, 2001). Age Concern declared that ‘older
people in England and Wales will be jealously eyeing the Scottish parliament’s decision to make personal
care free. That decision wholly undermines the case which UK ministers have been making’ (Guardian 26
January 2001). According to the Scotsman both the Chancellor, Gordon Brown and the Health Secretary,
Alan Milburn were besieged with demands from elderly campaigners that England follow Scotland’s lead.
(Scotsman 3rd September 2001).
The countrywide-scope of the NHS had institutionalised a sense that equal and uniform treatment
should be available to all, irrespective of where they lived, on the basis of need. (Keating, 2001) This is why
‘postcode prescribing’ has traditionally caused so much anger and resentment. Help the Aged stated that
‘we can't have a system that gives better care for people in Scotland than in the rest of the UK. That goes
down the road of creating a new postcode lottery. The NHS is meant to provide care at the point of need
throughout the UK and should not be dependent on where people live’ (Guardian January 26, 2001).
According to Age Concern it was ‘patently ridiculous that we are now going to have a situation where an
elderly person living a few miles across the border will be up to £350 a week worse off in terms of paying for
their care’ ( Guardian January 30, 2001) The IPPR called it the Berwick question: ‘Mr Jones in Berwick might
Convention