Paying for care….

It seems as hard as we look, whether a government official, a civil servant, professor of economics or the everyday person in the street, the elusive remains out of reach.

The elusive I speak of is the holy grail solution to the huge and widening gap between the finances available, and the costs of the growing need in the adult health and social care system.

During some discussions with various people over the past few weeks and months, it seems the solution to a problem that has been long in the making, is no closer to us, and the stark reality dawns with blinding reality.  There is no magic money tree in the PM’s back garden, nor is there a sufficient dividend in Brexit, or any other fish juggle that politicians would have you believe.  The reality is, it will be for a generation to suck it up, and pay into a solution which will replace solid foundations in our health and social care systems for the future generations that follow us.

We have to accept, that the new normal will be to pay for the care we want to receive, whether that care is delivered by private companies, or the third sector providers, the costs will need to be met, and we all need to start to take that on board.

I guess for those accessing the system now, its too late, and they are going to have to draw on the ever decreasing funds available, but for me, my generation, and those that follow, we need to tackle the situation with robust honesty, and resolve in our heads that we need to put more in, if we ever expect to draw out of the system.

Suggestions have been mooted, late last week, from MP’s tasked with looking into this issue, that a new National Insurance Premium, or some sort of care bond might be the solution, forced upon those aged 40 plus for example,  much like the Auto-Enrollment pension was forced upon everyone a few years ago, ensuring that payments are made into a ring fenced pot, which will boost the budget in the hardest hit areas of health and social care funding.  I am not opposed to the idea, of course no-one likes to pay more “tax”, of course they don’t, but we do seem to have been able to wrap our heads around the need to make provision for our later lives by way of a pension, so why not apply the same thought process to care funding?

Someone has to pay it, the government cant or won’t from current budgets, those who can afford it pay for it now, via private providers, so is it a huge leap to expect the rest of us to think the same way, and stump up for the later life care that we will surely feel that we deserve?

I don’t have the answers, and as I said, from what I can see and read, nor does anyone else.  But it does seem obvious from where I am sitting and working, alongside older people struggling to meet the private costs of care, and being dissatisfied with what the state can afford to provide, that we have to accept that the solution might be that we all need to pay a little bit more each month, through NI, TAX or another scheme of deduction, so that we, and those that follow don’t have the same worries and fears.

Would it really be that bad to have a little less each moth now, with a certainty of comfort and care as we get much older? A bit like a saving scheme if you will, putting a little bit by each month.

I guess attitudes to paying for care need to change, and I think we have a duty to try to change attitudes sooner rather than later.  Each new service that is created within our local Age UK, here in Medway, is created on the basis of full cost recovery.  We calculate the total costs of the service, and break that down into a unit cost, so that we can have a clear and robust pricing policy.  Our services all, with the exception of one remaining contract, generate their own income, sufficient to cover all costs, and make a small contribution to the centre of the organisation, to pay for the people behind the scenes that keep the wheels turning.

In our local community, people are used to this way of social business, finding a provider of the services you need, asking about the price, and making their own assessment based upon quality, reputation and affordability.   It seems increasingly accepted, that this is the way forward, and it is a way that puts our customers in charge.  If services don’t meet their expectations, they walk away, go somewhere else, they vote with their feet, much like we all do everyday in the high street shops.

So the tide is starting to turn, people are beginning to understand, that they must pay for care, now and into the future.

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If you build it….

Apparently, according Kevin Costner, an old film reference I know, “If you built it, they will come.”

Well it seems that isn’t always the case. The context for adult health and social care is changing so fast, that it’s difficult for slow moving statutory authorities, with hands tied to prevent spending, to match the pace of growing need in many areas of our work.

In 2013/14 Age UK Medway answered a call from the Council, practically begging us to do something to ease the growing burden of need locally for people living with dementia and memory conditions.

We delivered, and delivered fast, and opened a specialist centre for people living with dementia, capable of caring for 32 people per day, and of course reaching out to their carers too.

Just three years on, we look at a centre paralysed by the austerity cuts in the local authority’s adult health and social care budgets, we hear from social workers, terrified to make referrals, due to the impact on the council’s budget, leaving people who most need the support, floundering, reliant on services run by volunteers.

Of course volunteer services are amazing, and they continue to form the backbone of charitable work, but they can never and should never be used to replace professional regulated specialist services.

So the situation is now that there are several “baseball fields” sitting, waiting for the people to come, with an invisible, impenetrable shield around them, created by years of cuts, systematic erosion of social care budgets, guarded by elected officials with outdated views and confused priorities.

If you want to help me break through, for the benefit of every older person that needs our support. Share this.

Feeling the squeeze…

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I read a Tweet last night, yes from time to time, when I have the time, I dip into social media and try to keep pace with the key issues of the local community and National debate, after all, this is the context in which we operate our Charity, and it is the political and financial external context that looms large in our future.  As a charity proud to have already made the transition, much encouraged, from benevolence to commercial minded charity management, we find ourselves in a place where we risk feeling a rather uncomfortable squeeze.

For a few years now, we have amended our cost models, and designed new services to be based upon full cost recovery financial modelling, sensible, given the shrinking statutory pot, and the challenges involved in fundraising for a cause that doesn’t particularly strike many heart strings.

So here we are, a fully formed up SME to all intents and purposes, with charitable aims and values, with a determination to grow to reach more and more vulnerable people in our community.

So here’s the squeeze, because we have learned to charge for services, and perform contracts, and operate in a commercial context, we of course, need to fall in line with all of the relevant laws that govern small business. Including the National Living Wage, auto enrollment pensions, paid travelling time for peripatetic workers, the list goes on.

We hear via Twitter, the news coverage etc, that the country has ambition to have National Living Wage of £10 per hour. Great for our workers in the health and social care sector that really need to take home a level of pay that enables them to have a decent standard of living, great for workers elsewhere in the country who have been paid low salaries for some pretty tough jobs, and what charity CEO would not support that initiative?

The difficulty is, we are operating our charity in a commercial context, where contracts from Local authorities come with fixed costs. over the last 4 years, we have seen an approximate 20-30% increase in our direct costs as a result of these pieces of progressive legislation.  However, the same powers that push up the wage costs, are also reducing the value of contracts, and expecting ever more for their money.

We of course, have responded with increased efficiency, the take up of technology to drive further efficiency and add value to the customer experience, but there is a limit.

The most recent increase to the NLW, due in April 2018, will add £80k to the wage bill, reaching a £10 per hour NLW will add a massive £400k to the bill, if we maintain our staff numbers at the same level, making us completely unsustainable in our current shape.  The level of efficiency needed to re-balance the accounts will see our service provision to older people in the Medway communities cut in half, our staff cut by 50% and give us little opportunity to reach more people in the future.

So who will reach those people? the local council? Doubt it, there isn’t the money. The Government? Same answer. Commercial companies? With the margins that can be derived from health and social care contracts? I very much doubt it, and if anyone does fill the gap, it will be with a reduced standard of service, because quality costs money.

Either local authority contracts need to reflect the rising costs of operating in this environment, by matching cost inflation each year, or something is going to go bang.

Who will look after the older people in our community when every charity, small business and provider of services have locked the door and gone home?

I will just leave this here.

2018 is going to be busy…

My first blog of the New Year, with a commitment to try to blog more frequently, giving the promised insight into our strategic plans and the inner workings of Medway’s largest charity for the benefit of older people.

Those of you who have read my blogs in the past, will recognise a trend of doing new things, launching new programs and projects, growing our charity to reach more people in more ways than before, trying to close the gaps in service provision left by reducing statutory services and creating services which enhance, and compliment existing services to ensure that older people in Medway have the opportunity to love their later lives.

2018 marks the start of our new strategic plan, and sets out over the coming 5 years, some really innovative ways in which we hope to improve our service offer, and reach more people than ever.

Key to the success of this will be our continued growth, particularly into areas which currently do not have Age UK services.  In December 2017, we welcomed 25 staff from a neighboring Age UK (Sittingbourne and Faversham), as we took transfer of the Faversham based homecare service, which serves just over 60 clients.  Now that those staff are in Age UK Medway’s employment, we can start our planned growth of the Faversham services, which, we hope, will spread through Sittingbourne too, connecting with our current homecare border in Rainham.

Later this month, our staff will embark on a series of training sessions to introduce them to our new computer systems, and with new knowledge, we hope to be able to find greater efficiency in the way we work, and maintain our services for older people at a very accessible level in terms of cost.

As the year progresses, we will develop staff in the Faversham based team to recruit more carers and senior carers, so that we can reach everyone in our new area of work who wishes to use our services.

We hope to take new offices here in the Chatham Historic Dockyard too, additional to the ones we currently occupy, which will provide staff here with improved training space and facilities, but also allow us to welcome new staff, for the new services we intend to create in the year.  More on that as we launch the services.  Our growing finance team will be able to relocate into a more suitable space for their confidential work, and the additional space will provide the growth resource we need as we take on the challenges of providing more to a greater number of beneficiaries.

But of course, with every prospect of change, comes challenges, which will need to be overcome. Those challenges will test our staff at every level, and of course give our trustees something to get their teeth into too.

We will sit down next week as a senior team, and begin to finalise the budget for the coming financial year, which at the moment, in its draft stage, looks reasonably healthy, and allows us to fix some of our higher priced services for a year, meaning no cost increases for our customers, which I am sure will be very welcome news.

We will continue to offer our new charity Bursary, for those most in need, and explore new ways of generating income this year, which allow us to continually top up that bursary, again allowing more people in need to benefit from the services Age UK Medway can offer.

The overwhelming challenge for us all, will be finding a way for people to plan for and put money aside for their care needs in the future.  We know that government funding is dwindling, and that people are realising that care must be paid for, but filling the gap now, and creating sufficient funds for future use is a burning issue for charities and local authorities, and this year, Age UK Medway hopes to bring a really credible solution forward, so watch this space.

 

 

At times, its is very frustrating…

It was best intention to use my blog to give a little insight, to anyone interested, into the inner workings of the charity, the challenges we face day to day, the processes and thoughts we work through and overcome to bring our services to those who need them the most.

As it has turned out, the complexity and pressing nature of the day to day job has meant that my blog posts have been less frequent than I would have liked, and often subject focused, rather than a commentary of the behind the scenes.

So I am going to attempt to give a little insight, without compromising any commercial sensitivities, or upsetting any potential or current relationships, of the delicate path that the modern charity is forced to walk, as it makes its way through growth and development and the processes of delivering quality services to those most in need.

It is at all times, the most privileged position to hold, one of CEO of a local charity.  It is without doubt, the most challenging, exciting, empowering and complex role I have ever undertaken, and certainly has continued to surprise and challenge me in equal measure this last 5 years.

I still today, continue to be surprised, particularly at the level of misunderstanding of the concept of charity, applied to our local status, reputation and of course service provision.

A long time ago, when I first entered the sector, it was apparent that the traditional form of charity, the benevolent charity, the charity of giving from donations was slowly dying and making way for a more commercially astute, business savvy charitable sector, charged with the delivery of service contracts, production of outputs and now outcomes, and measuring impact, whilst at the same time meeting regulatory expectations, legislative change, and of course, all of the myriad of hurdles that present every employer in the country.  As a person new to the sector, i could see that, it was evident nearly 20 years ago.

Yet today, our local charity is still met with critique and disappointment, that we employ staff and charge for our services.  surprisingly, and probably the biggest shock to me, is that the critique doesn’t come from our customers and beneficiaries, their relatives and carers, because this cohort of people is grounded in reality and fully expect to pay for services, and in fact relish the opportunity to shift from service user to customer, taking control of their customer experience and speaking out if they are dissatisfied in any way, resolving issues and improving the customer experience along the way.

But that the disappointment and critique in the main come from those who actually ought to be best placed, in a position of oversight and overall responsibility, and having occupied that space for the past 20 years, really should have seen the changes going on around them, and the changes being forced through new laws, more commercial processes applied to local service procurement and of course the micro processes created by their own establishments which have over time, nudged, pushed and forced charities to make the change we have witnessed.

How is it, that people of power, control and influence, occupy a shielded utopia that is so far removed from reality that the impact of their decisions are a) never questioned and challenged and b) so diametrically opposed to the very sector they rely on to deliver services, that their statements grossly offend with a level of ignorance that defies belief?

Imagine the frustration of trying to set a budget for a service which is very much needed, with a growing market, with increasing costs of staff, training, regulation with an ever decreasing income to cover those costs, imagine that business model, imagine that you have 5 or 10 services like that, with the contributions from those services being so small, that the overhead costs of the organisation are only just covered, imagine too that you are charged with growing the provision to meet a rapidly growing need, with no specific additional income other than what you can draw from a competitive market place, imagine the other issues that run alongside, responsibility for an organisation that has become a large local employer, of well over 120 staff, that operated within a tightly regulated environment, CQC inspections, data protection legislation changes, safeguarding, health and safety, etc etc, and imagine all of that in a context where you fully understand that you don’t pay your staff the best salaries in the market place, because you have limited funds, that you certainly cannot compete with other commercial organisations that pay approximately 20-30% higher salaries for equivalent posts

Imagine how you might feel if those people of power and control made a very public statement about “charities paying Chief Executives over inflated salaries” and “Charities have grown fat on the Government purse”

I can tell you that the level of frustration is enormous, hearing statements like that, underline that the new charity sector has so much work to do, to change the false perception of charities locally, and probably nationally too.  Hearing statements like that, from people who are clearly ill informed or ignorant, perhaps both, feels like they are personally attacking me, my staff and volunteers, despite all of the amazing work we do, and have done in the community for such a long time.  It uncovers my most protective instinct, to stand at the front of my team and my customers and to shout back on behalf of us all.

If you ask our customers, they know the truth, they understand the amazing work we do, the huge contribution we make to the local economy, local employment, excellent service provision, and they value the way in which we continue to strive to make our services the very best value for money that we can.

It is, at times, very frustrating indeed, to be party to all of the good work happening within charities locally, and yet party to the nonsensical statements made about local charity and have to sit tight and reserve comment for when I have calmed down a bit and considered my response.

It is my comfort to know, that those people making the most preposterous statements will of course come full circle, because time is unstoppable, and they will become old.

Perhaps they might even need a local charity like ours.  Lets hope the future charity sector locally has withstood the onslaught of unfair critique, or it might not have survived to support those who shouted such nonsense.

Strategic thinking and planning…

So as we head toward the end of the current financial year, its time to apply my brain to the possibilities that the next financial year could bring, as well of course as the challenges.

There are a few things happening in the world of charities that we need to consider over the coming year/18 months, and ensure that we are in a good place to adapt to the changes ahead, and adapt to ensure our place in the future as an organisation that can, and will, deliver excellent quality services to its beneficiaries.

Sometimes, being a charity has confines, confines to the structure and set of the organisation that mean we have to say no to opportunities to do more work for older people, and that is something that we need to plan to address in the coming months.

Our charity was borne out of a merger, between two former Age Concerns, closely followed by a re-brand, in line with the national re-branding to Age UK. and our structure has remained tightly focused on charitable activities, and supports that very well. however, times they are a changing, and whilst there will always be a need for charitable services, the traditional reliable funds to charities from local authorities and central government are on the very rapid decline.

In order to ensure we can maintain services in a competitive market place and continue to grow to meet the growing level of needs, we will need to become, in part, something else.

Over the next few weeks, I will be speaking to legal professionals in order to determine the best structure for a new entity, a wholly owned trading subsidiary. The trading subsidiary will allow us to grow services which operate a full cost recovery model to take customers from areas very close to, but outside of the Medway area, and allow us to expand, where there is a need, and a gap in provision, into neighbouring areas.

This isn’t a strategy to goose-step into other charities territory, but one that allows us, by mutual agreement, to bring services into areas where there is an identified need, and other organisations are unable to provide adequate provision.

Its a strategy that gives us a solid commercial base, and an entity that allows us to take up work, that we are able to deliver, but to other groups of customers outside of our traditional “Older People” demography.  It will allow us to operate commercially, and generate income for the charitable arm of the new structure, so a win win for the charitable services, and the community of Medway and beyond,who seek to use our services and expertise.

Once this has been achieved, and I have time framed this for the first quarter of the new financial year, opportunities for the future will become immediately available. These, we anticipate, will include a dramatic expansion of our hot meal delivery service, expansion of the use of our transport fleet to potentially include a rural transport service, expansion of our home care services across a wider geography, and eventually, potentially within the next 18 months, our first venture into residential services.

As firm believers in supporting our customers through their entire journey, it seems negligent of us not to be able to offer the end stages of care, whether through short term respite or full residential services, our customers deserve the highest quality services, and services provided by people they have a relationship of trust with.

So to planning…….

 

Setting the budget is like juggling frogs….

So I have just had sight of the 4th draft of the organisations budget for the coming financial year. We are predicting a loss, of something in the region of 45k.

Its never a comfortable position as CEO, to go to the Board of Trustees and ask them to sign off such a budget, but given the current climate, and the changes we have needed to adapt to this year, overall, its not a bad result.

The context of our predicted loss next year, is complicated, and since September last year, when the process began, has been constantly changing, throwing up unpredictable challenges and barriers to achieving a bottom line break even budget.

We have cleared several hurdles along the way, increasing National Living Wage, a new method of payment that assures our community workers of clarity of pay for time travelling between calls, a big reduction in local authority funding, a predicted drop in attendance at our day centers, introduction of a new software system to drive future administration efficiency and quality improvements, capital plans to replace vehicles in our ageing fleet and enhance services with modern equipment which better meet our service users needs.

With every twist and tun to the process, we have seen a swing in the bottom line from small surplus to large deficit, back to smaller surplus, and back again to the deficit we believe will be about right, based upon some very conservative estimations in the figures.

As each decision we take impacts in our numbers, the ability to keep a clear head and hold nerve through the process is not unlike learning a circus skill I would imagine, though instead of objects of constant shape and size to juggle, imagine juggling something as animated as a troop of frogs.

The challenges within our sector, charity, or voluntary organisations are constantly evolving and often present so many options it is hard to plan ahead with any certainty.  It is that backdrop of uncertainty that forces charity leaders to develop a very unique set of skills, the ability to manage change in a fast paced environment, have oversight of complex and interwoven finance models, an understanding of the impact of change and rapid development, the ability to find efficiency where others may overlook, and drive disproportionate value from every public pound spent.  A skill set that could have a dramatic positive effect in a statutory context.

Perhaps as the Voluntary and Charity Sector weathers this storm, and comes out of the other side, intact, and in good shape to meet the challenges of the future, and delivers quality services for our beneficiaries, the statutory bodies will be bold enough to ask, “How on earth did you do that? And we will be happy to show them.

 

 

Changing times….

As I write my blog today, I am conscious that I have not updated readers for a while on the mechanical goings on in the charity itself, more posting poignant messages relating to seasonal issues and celebratory thoughts of good partnership and collaborative efforts.

This in the main, is due to a level of uncertainty about the future, financially, the future for our charity and others seems to be put at some risk.

Our local authority is making swinging cuts to health and social care budgets, among other cuts, and next year, Age UK Medway will feel the biggest and more definite pinch to date.

Historically, two of our main services, our Day Centres for the frail elderly, have been part funded through a grant, given by the local authority, and it is this grant, that from next year, will cease.  This poses a problem, in terms of raising the funds to continue to open the day centres for the 90 or so people we see each day, but also to the charities cash flow.

over the past weeks, the trustees, and senior team have wrestled with the solution, considering many options, including closure, but we have reached a conclusion that we keep both day services running, and provide an element of financial security for the charity going forward.

As a charity, we have tended to shy away from charging service users the full costs of our services, but we are now forced into facing the brutal facts, that unless we recover the full costs of the services through our charging, we cannot continue to provide the services.

Year on year, for the past few years, the whole charity sector, us included, have sustained real terms cuts to funding, absorbing inflation each year, and the increases to our costs, without any increase in funds from local authority grants of contracts, and the cost rises have been significant.  with the introduction of the National Living Wage, and auto-enrollment pensions, our staff costs alone, have increased by over 20% in the last 4 years. we have of course also seen the same inflation that very household in the country suffers with, the costs of our food, energy and fuel.

However, as bitter as this pill might be to swallow, there is a silver lining for the charity, in the form of complete financial control and independence, from April 2017.

In 2012, our income was balanced across two main streams, earned income, money we raise through activities and charging, and contract grant income, and the balance was 70/30, placing the charity in a position of reliance upon local authority grant for its financial health.

Today, our position is somewhat different, with our turnover being balanced 80/20 but now in the opposite way, significantly less reliant on the grants, and with 80% of our income through our own activities and charges.  this latest change, forms the final 20% of our turnover, allowing us to bring the last part of financial control, in house, under our own guidance and management, creating a charity that is 100% self reliant to generate its income, control its costs, raise its funding and set its own strategy to meet the needs of older people in Medway.

That is no small achievement, and we hope that this places us at the heart of our beneficiaries considerations when they look to purchase services of high quality and good value.this is the world we now operate in, a world where people will increasingly have to pay for their own care and support, but be able to shop around and buy the services they want.

Of course as a charity, we don’t need to return huge profits to shareholders, and breaking even, covering our costs, is our main aim. So we can pass on any value we can create through our efficiency, directly to our customers.  It gives our customers real control over our services too, and gives them more inclination to ask for services to be designed to meet their needs, because they are the paying customer.

Its been a difficult couple of months sorting all of this out, agreeing our costs, and beginning the process of communicating with our customers, but I think it will pay dividends in the end.  We now have a charity that is completely independent, and better able to do exactly what we set out to do in the beginning, to create services of care and support for the older people of Medway. We will be here for the next generation as a result of our independence, and financial security, and we will continue to serve our beneficiaries as we have for the last 42 years.

Something I have been reminded of these last few months, is that change is constant, and in every change, and challenge, there is opportunity. You just need to look for it.

 

 

Its getting cold out there…

As the winter months approach, we are well ahead in terms of planning our charities response to the possible bad weather, with 4×4 vehicles on stand by to ensure that care gets to those people who might become isolated due to snow and closed roads.

But there is some planning that we can all do at home to ensure that the older people in our community are looked out for too.

Think about the people in your area, your street, particularly the older neighbours, and take some time to help out where you can. there are lots of practical things you can do, call in and ask if there is any shopping needed, your going anyway, whats an extra bag to you?

Ask if the heating is working ok? and make sure they have what they need to keep warm, maybe offer a few extra blankets from your cupboard?

If you are out clearing your car of snow, clear the path to your neighbours door too, it might make the difference between them getting out or not.

Having a big dinner this weekend?  Is there a spare chair at your table for your elderly neighbour? Don’t leave them sitting in alone watching TV, invite them to join you.

If you see your elderly neighbours out and about, wish them a Merry Christmas, and ask them if there is anything they need? Give them your number, tell them to call you if they get into difficulty.

There are many excess winter deaths each year in this country, many of which can be prevented, with a few kind words, and extra blanket or a hot meal. if you are going to give something this Chrustmas, make it a worthwhile gift of kindness in your community, it costs nothing, and would be so gratefully recieved.

 

Happy Christmas everyone, and here’s to a good New Year, for all of us.

 

 

Saying it, doesn’t always mean its true

Yesterday the Chancellor responded to criticism of the Autumn Statements omissions on social care with a denial that social care was in crisis.  On that basis then, are we to believe that the crisis we have seen unfolding over the past 5-10 years hasn’t in fact worsened? Hasn’t reached a point that the NHS is buckling under the extra pressure caused by ineffective care at home provision, the poorly funded social care sector, the year on year erosion of contract prices offered to social care providers by our local authorities?

Of course it doesn’t.  Just like when children are told off, or told they have got something wrong, and they cover their ears and tell you they are not listening, this seems to be the approach of the people charged with the leadership of this country, and sadly, we seem to be reluctant to do or say too much about it.

The truth is that unless the health and social care sectors are given significant investment, we face a countrywide, paralysing inability to care for our older population.

The costs of care provision  have been driven up by new legislation, auto enrollment pensions, the National Living Wage, all impacting heavily in a market which already ran to very tight margins, margins so tight that we all recognise the result, poor care, customers short changed.  Care costs money, its very simple economics, and spending now to save in the future is the only way to effectively manage a growing need.

Care staff need to be trained, and trained to a high standard. They need support, effective management, and the chance to continue to learn new skills and improve practice. this cannot be achieved on a shoe string budget.

Many care providers are leaving the market place, because there just isn’t the money in local authority contracts to sustain the business. this just adds to the pressure on remaining providers to do more, with less, and even less the following years and so on.  If that isn’t a crisis, I don’t know what is.

Be under no illusion, whatever the government of the day is telling you, the facts are all around, we deal in the facts everyday. there is not enough money in social care, to care for those that need it now, and certainly not enough for those who will need it tomorrow.

We all have a responsibility to make our local councils and central government listen, they are, after all, answerable to the people who elect them. If they are ignoring us at the dispatch box, we should ignore them at the ballot box.