Chronicle of the forgotten

Britain: I hate that television advertisement in which Michael Winner deliberately crashes his huge Rolls Royce into a brand…

Britain: I hate that television advertisement in which Michael Winner deliberately crashes his huge Rolls Royce into a brand new Mercedes - not that I have any particular sympathy for expensive cars, their owners or the insurance business. What nags is its underlying morality: the suggestion that we can now do anything we want so long as we have money to settle the mess.

It haunts me, too, because I seem to become that silly woman standing on the sidelines mouthing clichés about fairness and decency until humiliated into silence by the repeated instruction to "Calm down, dear, calm down!"

As an Irish person who moved to London 30 years ago, I praised the huge range of care services available to all. And I shall never forget how Thatcherism dismantled them one by one. So I had my first baby in a filthy, once-famous hospital which closed within the year, lost every battle as a parent governor in schools which were spinning into chaos, watched playgrounds decay, playing fields get sold off, centres for young and old people disappear, council housing rot, hospital beds vanish, prison numbers soar and beggars become part of the streetscape.

After 17 years, the government changed. But eight years on with New Labour, any hope of reversing the trend seems to be fading fast. More money is being poured into the old system, but it is only glue, sticking together the pieces of something for which nobody can quite remember a shape.

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More and more, as we protest about the latest failure of our social services, we are encouraged to shrug and leave it to the experts, to admit that today's "conflicting and complex moral and financial arguments" are just too difficult for words. Rabbi Julia Neuberger has no such problem. Her Manifesto insists we must stay involved, that the true "test of a civilised society" is in its treatment of those in need at the moment of crisis: the old, the mentally ill, the young and vulnerable, prisoners and immigrants. And she knows what she's talking about. As someone who has laboured long on boards and committees which attempt to deal with such problems, she is uniquely qualified to point out the increasing shortcomings of an ageing social service under strain. More, as a religious leader, her work raises the moral questions implied by failure to deliver. Many of them will echo through Irish society, too.

Grappling with issues such as euthanasia, health spending, the quality of social workers and suitable back-up systems, Neuberger shows how the "moral state" of care is moving away from what was once considered common humanity. "Kindness is not what we value most, nor does it drive the system. If it did, the services would look quite different and respond to what the users say they want." That word, "kindness", comes as a surprise amid a flood of hard-headed statistics and bleak case studies. In fact, it has a curiously old-fashioned ring, a Judaeo-Christian concept no longer valued in our increasingly secular world.

And despite the fact that other words such as "liberal" and "socialism" have been reconstrued into woolly-mindedness at best, Neuberger sticks to those values. She insists the faults in the system must be fixed. As she says, a kindly society benefits even the most selfish.

Most of us will have aged parents and grow old in our turn, nearly every family experiences mental illness and, although we may hope never to suffer imprisonment, homelessness, delinquent children or statelessness, it would be reassuring if the caring professions still treated their clients as individuals rather than boxes to be ticked - just in case.

Too often, though, Neuberger describes their problems without offering a solution. Yet the politicians' tendency to shave services from the most feeble voices in society is an Irish problem, too.

Every half-prosperous country has its share of illegal drugs, violent crime and unplanned immigration, so it would be interesting to read more about what our European cousins are doing. The description of an unusual New York hostel for the mentally ill or an Assertive Community Treatment team there which insists that homeless ex-cons continue to take their medication on the street is not much help. Americans - carers and their clients - seem more ready for "tough love" than do people on this side of the Atlantic: a point made by Neuberger herself in her sympathetic view of many case histories she cites, including the British mental patients who have been released into the void called "care in the community" and "do not want to be bullied by hostel workers into taking their medication".

Care for the individual, Neuberger argues, is being eroded by work overload and budgets. But is more being lost in the cracks? As the word "society" morphs into "community", the good-neighbour dream of a multi-ethnic Britain seems to have been reinterpreted. Almost every questionnaire I am asked to fill - government or care service - checks my ethnic identity. The plan is to design services for my "community". Fine if I liked St Patrick's Day parades. But care users have complained that carers misdiagnose or fail to understand their needs. So, an ethnic balance among care staff is promised, leaving key posts unfilled, workers over-promoted or bodged in from different systems overseas. Unsurprisingly, as many of the case histories cited here show, the practice adds to strain and has caused tragedy.

Neuberger makes a strong case for raising qualifications and pay levels, but surely understanding starts with language? A recent social evening spent with four consultant psychiatrists in London - only one of whom spoke good English or fully understood what I was saying, let alone each other - demonstrated to me what many patients put up with.

With this manifesto, Julia Neuberger's voice will be heard at the centre of every argument. It should echo far beyond the UK, putting down a marker for any country which considers itself civilised and any government which claims to care.

Let's hope they listen.

Aisling Foster is a novelist and critic

The Moral State We're In: a Manifesto for a 21st Century Society By Julia Neuberger HarperCollins, 347pp. £16.99