October 1979. Second week at Medical School. Most of us were 18 or 19 years old, mustard keen to learn how the human body worked, on our certain pathway to becoming world leading surgeons or cardiologists. And then they made us study Sociology! To make matters worse our first lecture involved watching a film.

John Pitman made What shall we do with Granny? back in 1972. The clue to the subject is in the name. For some reason the memory has stuck with me; maybe because as an Orthopaedic Surgeon, I finally realised that Sociology was just as relevant to the care of my patients, as Anatomy or Physiology. So Felix Nobes’ excellent article (Behind the News: Who Cares?) brought memories flooding back.

Our failure to think this one through dates back over half a century. It’s one of the biggest political failures of post-war Britain. A problem not owned by any one political party, and all of them bearing responsibility.

Fifteen years later, a massive compounding issue was highlighted. This time it was “Mr Mad” on Steve Wright in the Afternoon (Radio 1 in those days if you’re old enough!). He rabbited on about “the demographic time-bomb nightmare”. Yet again no one listened (seriously), and now the chickens are coming home. As Felix points out there is £57 billion of informal care in the UK which is the same as the Schools budget in England. Right now over 10 per cent of the adult population in Ceredigion are unpaid carers, and with a third of us going to be over 65 in the not too distant future, this is a serious and worsening problem.

Collectivists will immediately conclude that the Government must do something; perhaps create a “free” National Care Service as they are planning in Scotland. But who then is going to bother to provide £57 billion of informal care when someone else is willing to take the responsibility? Just as in “free” healthcare, the demand will rise to exceed the supply.

And how on earth do we find the money? That of course will be our money taken in taxes (or savage cuts elsewhere). With the tax take at a 70-year high already, finding the sums involved without destroying the economy is impossible.

Moreover, there aren’t going to be enough people of working age to provide the care whilst simultaneously running a thriving economy. Without that, there won’t be revenue to pay for any decent public services.

What’s to be done? Option 1 is to let our politicians keep on passing the parcel, hoping the music stops on someone else’s watch. That way lies disaster; one day (soon) we’ll wake up to an utterly broken health/social care system.

Option 2 is to start asking some very tough and difficult questions. This will be painful on many levels. For example, why should the prudent saver have their money taken in taxes, to pay for the person who partied like there’s no tomorrow? Should we regulate social care like healthcare, driving up the cost? Is quality of life more important than quantity? I don’t believe in assisted dying, but I do sometimes wonder if modern medicine has failed to get the balance right, between good life and long life.

Fundamentally, do we demand that the state takes responsibility for every aspect of our lives, or do we accept our own responsibility as individuals and families? The former implies a socialist utopia that has never worked anywhere. Costs and demographics mean that young workers won’t have anything like the lifestyle their parents and grandparents enjoyed.

The latter requires the state to encourage saving (with certainty that it won’t be plundered in the future), and to support families, so that we really do create “resilient communities”. The big challenge is providing a genuine safety net, that doesn’t get exploited.

Fifty-one years after John Pitman asked the question it’s time to start coming up with serious answers.

If we don’t go with small reactors, we face some hard choices...

Patrick O’Brien ('It's time to pump the brakes on reintroduction of nuclear energy to Trawsfynydd', Frankly Speaking) is right to highlight the risks of nuclear fission. Sadly, I only get 600 words in Right Field, so it is difficult to explore all the issues. But it is worth noting that we do have a long experience of SMRs in Royal Navy Nuclear Submarines — and in the US they have also been used in large surface ships too — with a sound safety record.

The modern SMRs are designed with decommissioning in mind, something that didn’t happen with earlier reactors.

If we don’t go down the SMR route, then we have tough choices. Current renewables are unpredictable. We don’t have population scale battery storage. Nuclear fusion has been “ten years away” since the late 1970s. Tidal is attractive but we haven’t seriously looked at it yet.

So either the lights go out (bad choice), or we stick to fossil fuels of which LNG (Pembroke Power Station) is the least-worst option. I can live with that, but then there’s no point in beating ourselves up over becoming carbon zero by an arbitrary point in time.

Dismissing SMRs is fine, so long as we are all happy with the alternatives. But we have to find practical solutions and fast.

You can contact Patrick directly at [email protected]