作为英国数十万拥有阿尔茨海默症父母的人之一,安迪·伯纳姆演讲中关于社会护理的那段话让我感动落泪。
As one of many hundreds of thousands of people in the UK with a parent with Alzheimer’s, the passage in Andy Burnham’s speech about social care moved me to tears.
当我观看特雷莎·梅在哈利法克斯的一座大厅发布2017年大选宣言——以护理资金为核心——时,母亲甚至还未确诊。
My mother had not even been diagnosed when I watched Theresa May announce her 2017 general election manifesto in a hall in Halifax – with care funding at its heart.
近十年的政治忽视过去了,母亲如今已在养老院生活三年,费用绝大部分来自我们家庭自掏腰包。
Almost a decade of political neglect later, and Mum has now been in a care home for three years, with the funding coming overwhelmingly from our family’s own resources.
因此,听到伯纳姆清晰阐述他对个人护理应属于“社会保险”范畴的信念——即由家庭共同分担风险——令人印象深刻。
So it was arresting to hear Burnham speak with clarity about his belief that personal care should be a question of “social insurance” – sharing the risk across families.
实际上,个人护理仅占住院式社会护理总成本的一小部分。大部分是伯纳姆的改革不会覆盖的“食宿费”:烹饪、清洁和维护。
In practice, personal care makes up a minority of the total cost of residential social care. Much of it is the “bed and board” that Burnham’s changes won’t pay for: the cooking, cleaning and upkeep.
但让人感觉负担有所分担将是重大进步,伯纳姆显然决心将护理工作者置于计划核心——并为此投入政治资本——同样意义重大。
But a sense that the burden is somewhat shared would be a significant step forward, as would Burnham’s apparent determination to put care workers at the centre of the plan – and to expend political capital in doing so.
他直接对护理工作者说:“我看见你们。我感谢你们。抱歉我的职业辜负了你们的职业这么久。”这是伯纳姆长期持有的观点。我记得在工党2024年党大会上,我们曾同台参加一个关于就业与技能的边会,当时我们都强调,觉得支持我们各自父母的护理人员并非“低技能”工种。
Addressing care workers directly, he said: “I see you. I thank you. And I am sorry that my profession has let down yours for so long.”It’s a long-held view of Burnham’s. I recall speaking alongside him at a fringe event about jobs and skills at Labour’s 2024 party conference, at which we both underscored the fact that we didn’t feel the carers who supported our respective parents were “low-skilled”.
然而,对于正艰难走在确诊之路及后续旅程上的家庭来说,承诺与国民医疗服务体系(NHS)更紧密对接的国家护理服务,感觉还遥遥无期。
Yet the national care service, with its promised closer alignment with the NHS, will feel a very long time coming, for families making their agonising way down the road to diagnosis and beyond.
下届议会似乎等待时间太长。政府研究所的斯图尔特·霍迪诺特在伯纳姆演讲后表示,首相应该“敢于坚持自己的信念”,更早建立该机构。即使只是一个空架子,它也可以着手制定标准,更好地与国民医疗服务体系(NHS)协调护理工作,并可参与该行业公平薪酬协议的谈判。
The next parliament seems too long to wait. As Stuart Hoddinott of the Institute for Government said after Burnham’s speech, the prime minister should “have the courage of his convictions” and stand it up sooner Even as a skeleton body, it could get on with setting standards and coordinating care better with the NHS, and could become involved in the negotiations on a fair pay agreement in the sector.
这是工党雄心勃勃地试图在一个分散且薪酬低下的行业引入集体谈判,涵盖薪酬和职业晋升等方面。
That’s Labour’s ambitious attempt to introduce collective bargaining, including pay and progression, across a fragmented and poorly paid industry.
这个初建的谈判机构达成的任何协议预计将于2028年4月生效。到目前为止,在基尔·斯塔默领导下,工党已拨出5亿英镑资金,用于资助任何薪酬上涨。
Whatever the fledgling negotiating body agrees is set to come into force in April 2028. So far, Labour – under Keir Starmer – has set aside £500m to fund any uplift in pay.
近年来将社会护理作为竞选议题的费边社总书记乔·德罗米认为,这可能还不够。
Joe Dromey, the general secretary of the Fabian Society, which has made social care a campaigning issue in recent years, suggests that may not be enough.
他说:“首要任务应该是解决劳动力危机。我们必须通过更具雄心的公平薪酬协议,给予护理人员他们应得的加薪。”
“The first priority should be fixing the workforce crisis. We must give care workers the pay rise they deserve, through a more ambitious fair pay agreement,” he says.
在2030年后调整“三重锁定”政策是明智之举,将其与社会护理挂钩感觉像是伯纳姆的高明政治操作——但这不会立即为紧张的行业注入任何资金,更别提把钱装进护理人员的口袋了。
Tweaking the triple lock beyond 2030 is a sensible policy, and tying it to social care feels like good politics from Burnham – but it won’t put any money into an overstretched sector now, let alone into the pockets of those care workers.
正如霍迪诺特所说,在现在和下届大选之间取得进展“将给伯纳姆一个强有力的故事可讲”——并使其变革在工党失利时不太可能被推翻。
As Hoddinott says, making progress between now and the next general election “would give Burnham a strong story to tell” – and make it less likely his changes would be swept away if Labour loses.
虽然政治阶层似乎已将其遗忘,但鲍里斯·约翰逊在2021年曾准备打破保守党宣言承诺,引入每年120亿英镑的“健康和护理税”以“修复社会护理”。
While it seems to have been memory-holed by the political class, Boris Johnson was prepared to bust a Conservative manifesto promise in 2021 and introduce a £12bn-a-year “health and care levy” to “fix social care”.
可以说,这比重写“三重锁定”政策耗费了更多的政治资本,且原定几个月内生效。
That was arguably a greater expenditure of political capital than rewriting the triple lock, and it was set to take effect within months.
但最终,约翰逊因封锁期间参加聚会而挥霍了他所有的政治资本,并将该政策一同拖垮。
In the event, of course, Johnson torched his entire stock of political capital by partying in lockdown, and took the policy down with him.
但随着路易丝·凯西预计将于明年夏天就如何建立和资助国家护理服务提交报告,随后再花费可能两年时间进行“全国性对话”,对受影响的家庭来说,这将显得是一段漫长而艰难的跋涉。
But with Louise Casey set to report next summer on how a national care service could be built and paid for, spending perhaps another two years after that in a “national conversation” will seem a very long slog for affected families.
坦率地说,作为曾报道过2017年那场竞选活动的人,当时梅的计划迅速被贴上“痴呆税”的标签(事实上早已存在一种,老天爷啊),伯纳姆寻求达成政治共识的期望虽崇高,但几乎注定无望。
Frankly, having reported on that 2017 campaign, when May’s plans were quickly dubbed a “dementia tax” (there already is one, for goodness sake), Burnham’s hopes of achieving political consensus are high-minded but almost certainly hopeless.
还存在一种风险——一位工党议员在利物浦向我表达过这一担忧——即将关于社会护理筹资正确方式的讨论延续到下一次大选,会挤占他们可能需要提出的其他论点。
There is also a risk – voiced to me in Liverpool by one Labour MP – that extending the discussion about the right way to fund social care right through to the next election crowds out other arguments they may need to make.
毕竟,在“三重锁”微调之外,筹集所需额外资金的途径只有那么几种,而且早已被反复讨论。
After all, there are only a certain number of ways of raising the additional money that will be needed, over and above the triple-lock tweak, and they are well rehearsed.
要么像约翰逊那样提高国民保险缴费,或许仅针对年长工人;要么对所有遗产征税(15年前伯纳姆上次主张此举时,保守党称之为“死亡税”)。
There’s a national insurance rise à la Johnson, perhaps applied only to older workers; or a levy on all estates (a “death tax”, as it was called by the Tories when Burnham last advocated it, 15 years ago).
或者采取一种在政治上更艰难但或许更诚实的做法,承认因人口老龄化需求增长,普遍税收必须上涨——将更慷慨的社会护理解决方案作为更广泛巩固公共部门的一部分来提供资金。
Or there is the politically tougher but perhaps more honest approach that acknowledges general taxation will have to rise because of the growing needs of an ageing society – funding a more generous social care settlement as part of a wider shoring up of the public sector.
伯纳姆想为他信仰的事业构建政治理由,这令人钦佩且耳目一新——而社会护理早就成熟到可以采取这种做法了。
It is admirable and refreshing that Burnham wants to build the political case for causes he believes in – and social care is more than ripe for that approach.
但像我家这样的家庭已经有太多,在一个辜负他们的体系中,无依无靠、被遗忘地艰难挣扎。
But enough families like mine have struggled their way unsupported and forgotten through a system that fails them.
一旦他有了计划,就应该毫不犹豫地着手实施——这包括筹集使其运行所需的资金。
Once he has a plan, he should just crack on with it – and that includes raising the money needed to make it work.