Political cowardice has left health and social care unreformed, in both Northern Ireland and rest of UK

There is a common theme running through provision of pensions, health and care in Great Britain and Northern Ireland - political cowardice.

Health has been broken in the UK as a whole for many years, as has social care.

There is a reluctance ever to call out inefficient NHS provision, for example in NI where experts have for 20 years advised a smaller number of world class hospitals. Politicians know this is needed but won’t enact it because they fear being seen to close hospitals.

Much of the waiting list crisis is rooted in the failure to act.

There is a similar problem over elderly care. The current UK system is a lottery. A family could see their mother and father live far into old age with only minimal help. Another family could see both put into care homes, costing £40,000 a year each — £80,000 total. People are liable for those costs if they have assets above £23,000. This is particularly unfair on the middle class, whose diligently accrued life savings are wiped out. The rich can afford it, the poor don’t have to pay.

But fixing this lottery costs money, and Boris Johnson’s proposal yesterday of an extra 1.25% on National Insurance is at least an attempt to raise the funds. That, though, creates its own injustices, including the fact that the current ‘young old’, people in their 60s, are benefiting from retirement ages and pension levels that the younger generation will never enjoy, but won’t pay any more under this plan. It begs the question as to why, for example, a well paid person working past state pension age does not have to pay National Insurance at all?

The so-called ‘Triple Lock’ to protect pensions raises similar problems about inter-generational fairness, now that much of the retired class is better off than the working age population. The DUP is naturally concerned that its 2017 deal to protect the lock is now gone, but Covid has distorted inflation and would make the lock rise unaffordable.

On all these topics there should be honest examination of cost liabilities, and how it impacts on society as a whole.

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