This week is the 200th anniversary of the Peterloo massacre. It was Britain’s Tiananmen Square, with pro-democracy demonstrators facing off against the military, on St Peter’s Fields in Manchester, 16th August 1819.
My great-great-great Grandfather was in the front line of the demonstrators and an eye witness to the violence.
If you know a lot about C19th British history, maybe from Fred Wharton’s A level class, you can skip the next bit.
Harsh economic conditions and a political system that excluded most people in the North had created enthusiasm for political reform. Parliament had passed the Corn Laws – protectionists legislation that benefited landowners at the expense of ordinary people.
A mass meeting was held to hear radical orator Henry Hunt give a speech urging parliamentary reform, which attracted a crowd of nearly 80,000 people. At the time only a tiny number of people, all men, could vote, and cities like Manchester had no MPs
The demonstration, while entirely peaceful, was seen as deeply threatening by the local magistrates, who had no official police force to keep order. The Terror of the French Revolution and the subsequent Napoleonic wars had scared the English ruling classes beyond belief and demonstration of this size terrified the local magistrates. Fearing a revolution, local magistrates ordered the 15th Hussars to charge the crowd forcing them to disperse, killing 18 and injuring nearly 700.
The impact of the Hussar charge was huge. The incident was nicknamed Peterloo, after the battle of Waterloo. The campaign for electoral reform was strengthened hugely, and reform of the police followed shortly after.
Percy Bysshe Shelley immortalised events in his poem Masque of Anarchy, where he describes Tory leader Viscount Castlereagh and the Manchester magistrates in these bleak terms:
I met Murder on the way – He had a mask like Castlereagh – Very smooth he looked, yet grim; Seven blood-hounds followed him:
My ancestor, Thomas Chadwick, was in the front ranks of the Chartists on the day, and was an eye witness to events. History books recall Thomas as a mill owner, but I think this is a bit overstated. He came from a family of weavers, and his mill probably only had a few looms run by family members. His descendant Robert Chadwick would go on to become a large scale mill owner, and by all accounts a proper bastard. Robert married into the Staffordshire branch of the Chadwick family in order to gentrify himself. Another relative, Andrew Chadwick, was a slum landlord, who died fabulously wealthy. Thomas is my great-great-great Grandfather.
His brother James’ best friend was next to him, and was killed in the Dragoon charge. The next day he wrote to his brother and described the events. His description contains one of the most memorable lines ever written about Peterloo:
“an inhuman outrage committed on an unarmed, peaceful assembly.”
I was able to secure a copy of the letter in it’s entirety from the Rochdale archives.
Matching the letter to the list of victims I think he is describing the death of William Bradshaw, who was shot with a musket.
The significance of letters like this was crucial to the way Peterloo was perceived. The magistrates fought hard to get their version of events across, and newspapers like the Manchester Mercury were happy to oblige, praising “the necessary ardour of the troops in the discharge of their duty”, and blaming the radical orator Henry Hunt, who deserved “the deep and lasting execrations of many a sorrowing family”.
The Times however went with the account of a Manchester businessman John Edward Taylor, which appeared on their front page on August 18th 1819
Taylor went on to found the Manchester Guardian as a direct response to Peterloo.
The Press condemnation, and the impact of letters like Thomas Chadwick’s had a profound effect. EP Thompson wrote “Never since Peterloo has authority dared to use equal force against a peaceful British crowd.”
Tiananmen Square by contrast did not prove to be decisive in changing Chinese history despite the stark image of the protestor facing down the tanks:
The true nature of events at Tiananmen Square are still disputed, however it is likely that nearly 10,000 were killed by 27 Army Group, according to a British Diplomatic cable:
It would be great to think that modern events would have more Thomas Chadwick’s recording their accounts, which would make it easier for the truth to get out. Instead it is easier for people who want to create a counter-narrative to spread disinformation and for Government’s to control the flow of information.
It would be great to think that current events in Hong Kong would have a better outcome than Tiananmen, but looking at troops massing at the border I am doubtful that is the case
Chadwick History Bit
For those of you interested in Chadwick family history this is my Grandfather, Robert:
My grandfathers grandfather was George Chadwick of Prestwich Manchester, baptised St Marys Prestwich 12/7/1807, married and buried All Saint Stand. His father was Thomas Chadwick, baptised 27/6/1766, St Marys Prestwich, the witness to the Peterloo massacre.
Thomas’ mother was called Alice, and his father was Samuel. Samuel was baptised St Chads Rochdale 24/4/1721, married Sarah Lock, 11/9/1757. His father was Robert.
At some point in the C17th my family moved from Rochdale to Prestwich. The last family member to live in Rochdale was Robert or Roberte Chadwick. The problem is that there are so many Robert(e) Chadwicks in Rochdale in the C17th that it’s hard to work out which one. There is a Roberte Chadwick who married a Dibrah Healey, but I think that the last Rochdale Chadwick is a generation older.
Working out why the family moved is equally hard. My best guess is that after the English Civil War Colonel Lewis (Louis) Chadwick, a hero of the New Model Army, moved to Lancashire. He was from the more aristocratic Staffordshire branch of the Chadwicks, but married into the Lancashire branch, gaining land.
This would make my family Roundheads; Puritans or Presbyterians. It does stick out that my family seem to have a rather limited choice of names; lots of Roberts, Andrews and Johns, which continues to this day. This is a feature of puritan families. We also have in the family tree a female relative called Silence Chadwick, which is about as Puritan as you can get.
My guess is that we were a fairly austere puritan family working in the cloth trades, probably as craftsmen working from home, who moved to Prestwich following Lewis Chadwick and his son John, who also served with distinction under Cromwell. A century later the black sheep of the family Thomas Chadwick, joined the Princes Manchester Regiment to fight for Bonnie Prince Charlie, for which he was hung drawn and quartered at Tyburn. Accounts at the time stress the pious protestantism of his family, and their aversion to popery.
Getting much further back from the mid-C17th is a tricky task, give the numbers of Robert Chadwicks in Rochdale. In the C19th Robert Chadwick, the horrible mill owner, had a number of his poorer ancestors dug up and re-buried in his new family vault, in order to disguise his humble origins. Without their grave stones to act as a cross reference we have little that allows us to work out which Robert Chadwick is our ancestor.
Two sharply contrasting policy announcements from the two major parties over the last couple of weeks, but equally frustrating.
First up was BoJo, with an announcement that he will prioritise funding for health and social care:
Next up was Shadow Chancellor with an announcement about ending public sector outsourcing:
There is of course one policy that would address both sets of policy issues:
Bring care homes back into public ownership.
Frankly this makes a lot more sense than bringing school catering contracts back in house. Delivering health and social care is a core competency of the public sector. It’s bloody good at it, and operates the largest health care organisation in the world. Schools are good at teaching, but mass catering isn’t really one of their core skills. It’s something that the private sector does much better.
[As a side note – lots of Local Authorities – many of them old Labour operated race and gender bars in Council employment well into the C21st. The most highly paid manual jobs were reserved for white men. Women and non-white workers were paid much less. Councils face huge bills for discrimination – Birmingham Council will spend more than £1bn on equal pay claims. It was easier to outsource these jobs to different providers]
If you don’t mind I’m going to shift between talking about policy and talking about economics. Health care is provided or commissioned by the NHS and is free at the point of use. Social care is means tested, and is the responsibility of the individual to look after themselves. This distinction goes back to the establishment of the NHS in the 1940s.
Where it gets complex is NHS Continuing care, where the individual has social care needs which are contingent on a healthcare condition, for example someone who has dementia. If you aren’t eligible for NHS continuing care but you are in a Nursing home you can be asked to pay for the social care costs. This is what BoJo is referring to in his Express article. There is a perception that having to sell property assets to pay for social care rather than handing them down to your children is an affront to people’s rights to inherit wealth. If you are reading this in Scotland social care in residential homes is free, although I think that money would have been much better spent tackling chronic ill health and falling life expectancy
Before we use this definition to start and look at some statistics about care it is important to acknowledge that an enormous amount of caring takes place within families, and isn’t recognised in the statistics. As services have shrunk in the age of austerity so the amount of unpaid caring has increased.
The number of local authority residential care places peaked in 1984. Councils provided 144,564 places, the private sector provided 66,700 places and the voluntary sector 42,704. Although the extent of private sector provision was low, it was increasing rapidly – in 1980 it had only been 37,177.
By 2017, Local Authorities provision had shrunk to 19,200 places, the voluntary sector was roughly the same – 44,600, while private sector provision had soared to 179,000 places
Some of this was due to the Private Sector building more homes, while Councils closed them. Durham County Council closed it’s last remaining care homes, including Chevely House in Belmont a few years ago, claiming that the cost per bed £918 per week per bed for Council run homes compared to £474 it paid to the Private Sector.
By comparison there are just over 200,000 nursing home beds. The average cost for a care home bed is just over £600 per week, the average cost of nursing care just over £800
Demand is growing as the number of over-65s increases, and even though people increasingly prefer to be cared for at home we are close to the point where there are more people who want/need residential care than there are beds. This has huge implications for the NHS were the main reason for a delayed discharge of care is the lack of a suitable residential placement.
But lots of the shift was pure outsourcing. Council homes were handed over to the private sector who ran them at a profit, and at a lower cost.
It might be helpful to explain my own perspective here. I did lots of work on older people’s care when I was a PCT CEO. The NHS had inherited a massive mess from the outgoing Conservative administration. They had been encouraging the NHS to reduce the number of cases funded through continuing care in order to force more people to meet their own costs.
If you are already familiar with the history of continuing care legislation you can skip the next bit, as it deals with shifts in Government policy over the last decade or 2.
The Thatcher government were keen to change the original definition of health and social care contained in the 1946 Act in order to reduce the amount of care which was free at the point of use, and increase the amount that was means tested. This led to the 1990 Health Service and Community Care Act, and in particular a rather awful policy document issued by the NHS Management Executive – HSG (92) 50:“Local Authority Contracts for Residential and Nursing Home Care: NHS Related Aspects”
HSG (92) 50 starts with the ominous sentence:
“The original distinction between health and social care contained in the 1946 Act had been changed by the 1990 Health Service and Community Care Act” .
It went on
“The local authority is responsible for purchasing services to meet the general nursing care needs of that person, including the cost of incontinence services (eg laundry) and those incontinence and nursing supplies which are not available on NHS prescription. Health authorities will be responsible for purchasing, within the resources available and in line with their priorities, physiotherapy, chiropody and speech and language therapy, with the appropriate equipment, and the provision of specialist nursing advice, eg continence advice and stoma care, for those people placed in nursing homes by local authorities with the consent of a DHA”
This redefinition of nursing care shifted costs from the NHS to the individual because Local Authority care was means tested. If you really want to hate the Tories for doing bad things to the NHS hate them for this.
HSG (95) 8; LAC (95) 5) made this clearer:
“Many people regard care in a Nursing Home as health care, and therefore the purchasing responsibility of the NHS. However, under the NHS and Community Care Act, Social Services were given a new responsibility for purchasing Nursing Home beds. As with the previous arrangement through the Department of Social Security this is subject to a means test. The regulations governing this are laid down nationally”
If you didn’t work in the NHS in the last days of the Tories you have no idea of the tyranny of Health Service Guidance and Health Service Circulars (HSG and HSC) often issued more than once a day by the Health Service Executive. The vast expansion of NHS bureaucracy under Thatcher, then Major had spawned the HSE housed in a purpose built impregnable management fortress near the Leeds ring road:
If there is one thing to praise the Blair Government for it did at least get rid of the Health Service Executive, and limit the number of HSCs that could be issued.
The continuing care rules were legally challenged in R. v. North and East Devon Health Authority, ex parte Coughlan, a landmark judgement which had forced the NHS to accept liability for a large number of continuing care cases.
Justice Hidden, in his judgement made the following ruling:
“I conclude that nursing is “health care” and can never be “social care” and that ….. HSG (95) 8 did not make any change to any NHS responsibility for health care services including nursing”.
In this context I was a newly appointed PCT CEO charged with sorting out the impact of this judgement on local patients.
Redcar and Cleveland Council still had a mixed economy. There were large Council owned Care Homes across the Borough, mixed in with private provision. We had continual battles with the private home owners, and kept a common line over costs:
While all of this was going on the Council was closing some of it’s own residential homes, moving patients into the private sector and replacing them with sheltered housing or specialist dementia care.
My experiences with the care home market in Redcar and Cleveland left me with a profound belief that models of service provision based on outsourcing everything don’t work. In a key market like care provision the public sector should retain their own provision, even in a mixed market, in order to be able to shape market provision.
As a side note to this when we were reviewing patients for eligibility I came across an individual who had been allowed to move into older people’s residential care in his mid-50s because he was mates with the Councillor who chaired Social Services committee. For my generation a moving into residential care seems like a terrible way to live, clearly not for some!
Now that we have established the policy/legal context lets look at the private sector market structure.
The 4 largest providers have only 15% of the market between them: Four Seasons (4.9%), Bupa Care Homes (4.7%), Barchester Healthcare (2.8%) and HC-One (2.4%). The top 25 provides have 30% of the market. Small and medium sized providers still have lots and lots of the market. HC-One are in the process of aquiring BUPAs business, making them the single largest provider. The majority of companies in the market have less than 3 homes.
This would indicate that there are few economies of scale, and the cost base of care homes is driven by people costs – the number of staff needed to cover care rotas. At the moment staffing costs are 57.5% of total costs across the sector, and in order to maintain profit homes need to reduce the percentage of their income which goes out in wages. The problem of costs is linked inextricably with high staff turnover, as high as 30% of staff per year in some regions. The industry has a high level of immigrant employees, and the hostility to immigration over the last decade has made staffing problems worse.
As well as these direct care costs there are significant costs associated with the purchase or construction of buildings and meeting Care Standards Commission standards. These costs are typically funded through borrowing, and the whole industry has high levels of debt. The largest providers have high levels of Private Equity debt.
It was this kind of financing crisis which brought down the Southern Cross, the then largest care home provider in 2011. Things improved briefly, but a similar financing crisis forced Allied Health care into administration in December last year, and Four Seasons into administration 4 months later. There have been similar, smaller regional collapses on a regular basis.
These companies have 2 main customers; those funded by Local authorities, those funding their own care. Local Authorities have a lot more purchasing power than private funders, and can negotiate a much better price, typically 40% lower. Roughly 60% of customers are LA funded. The bigger chains of care homes have much higher proportions of LA funded clients. Smaller, privately owned homes have much higher proportions of private payers. Homes with higher proportions of private payers are much more profitable, and are concentrated in more affluent areas. The bigger chains have higher numbers of LA funded clients because they offer a more stable and predictable source of income which their investors like
This is one of the commercial factors that drives BoJos policy – not only are some people having to fund their own care, but there is a perception that by paying higher prices they are subsidising other residents. In reality private paying clients tend to live in homes with low levels of Council funded residents and vice versa.
The Competition and Markets Authority investigated the care home market last year to investigate cross-subsidisation, although they concluded that the problem was lack of funding into Local authorities rather than private funders being ripped off. This reflects the reduction in fees paid by Local Authorities – since 2010 Local Authority rates per bed have fallen by 6% in real terms.
There is a starct contrast betwen the golden age of social care funding increase under the last Labour Government – peaking at 4% above inflation in 2006/7, and a rea terms cut in central government funding for social care
The Coalition Government’s 2010 Comprehensive Spending Review, local government spending fell by 26% in real terms by 2014/15, although the fall was mitigated to 14% once council tax increases and other factors were taken into account.
Spending on care by local authorities (including funds transferred from the NHS through the Better Care Fund) fell by 5.3% in real terms between 2010-11 and 2016-17 despite rising demand and a more acute illnesses.
As fees fell so did the profits of care home companies. EBITDA across the sector has fallen from 30%+ 10 years ago to 20% now. This still seems pretty generous but when the costs of finance are taken out there isn;t much profit left
Despite the Coughlan judgement people with conditions like Dementia are still liable to pay for their own social care costs until their assets fall below a particular level. At the moment the floor is £23,500. The last Conservative Manifesto Conservative proposed raising that floor to £100,000 and introduce a life time cap of £72,000. For the first time in the case of people being cared for in their own home, that calculation includes the value of their house. This was attacked by the Labour Party as “the Dementia Tax”forcing a Government U-Turn. Crazy that a supposed left wing Labour leadership would defend inherited wealth in this way.
This was a massively expensive promise, costing nearly £15bn over the next decade. It would nearly as expensive as implementing a Scottish style free social care model.
Sadly this bit of politicking has made the debate harder – the system isn’t sustainable without additional resources. Because older people are richer than working age adults any policy which increases tax payer funding for social care in highly regressive. Any policy changes are expensive – £20 per week extra in costs per person equals £1bn a year
The current generation of older people have large amounts of unearned wealth generated by the property market, and the fairest way to fund the increase in social care funding is using this accumulated wealth. We would still need additional taxpayer funding, but by asking older people to contribute some of the wealth tied up in their properties we would make the burden on current taxpayers (most of whom don’t have the same level of accumulated property wealth
But extra funding doesn’t answer all of the problems. It will help raise the prices homes can charge, which will stabilise the sector.
In order to expand supply the state should start and by up distressed chains of care homes. The big cost that is sinking homes is debt. The Government can refinance this debt at a heavy discount. Once the state is actively playing in the market it can start and expand it’s own provision taking advantage of cheap Government borrowing. As an active participant in the market it can start and shape future provision and address market failure.
The state can also give care home workers more chances for career progression, from caring into Nursing for example, making care work more attractive as a career.
The UK also has a shortage of housing with care – effectively retirement communities. Only 0.6 per cent of over 65s live in housing with care, 10 times less than in more mature retirement housing markets such as the USA and Australia, where over 5 per cent of over 65s live in housing with care. Obviously the climate in Florida is more attractive than Saltburn or Seaham, but areas like this with cheap land would be obvious areas to expand purpose built retirement communities. At the moment the way that Local Authorities and the NHS are funded mean that no-one would welcome such a development in their local area
This gets us to the existential problem. Without an expansion of supply the sector we will start and run out of beds in the next 5 years. In some parts of the country it is a lot less than that, and residents will have to move a further and further away to find a place. This is the urgent problem that needs Government to solve, not protecting inherited wealth, or re-nationalising dinner ladies.