Most people would agree with Jeremy Hunt that isolation and loneliness are bad things and that we should try to make sure that older people (and everyone else) do not suffer from them. So far so good. The rest of his comments on elder care - that British families should follow the example of people in Asia by taking in elderly relatives - are rather off the point.
Older people in Asian countries do not automatically live with their children. Circumstances differ in different countries, and particularly in urban and rural areas. China, the country he singles out, is the site of headlong health and social change. Roughly half the population now live in cities and one of the big issues in policy is managing the movement of younger people as to cities in search of work.
Migrants may send money back to their parents, but are not there to provide care and companionship. In practice it is more likely that the parents back in the village care for their grandchildren, while their children work in the factories of the Pearl River and Shanghai.
Notwithstanding questions about how his proposal would fit with elderly parents who may need special care and other government policies around working hours and who in the family would take on this responsibility, if you really want to address the problems of frail older people, the last thing you would do is cut budgets.
Much social care is funded by local government. Local government budgets have suffered precipitate cuts, some 30% of their 2010 budgets will be gone by the 2015 election; and about two-thirds of that to be delivered by the end of this year, according to analysis by the Institute of Fiscal Studies.
The allocation formula for these budgets has been rejigged (essentially by removing the needs element) so that cuts in local government spending as a whole hit poorer areas in cities and in Labour-held local authorities in the north and Midlands much harder than Conservative strongholds in shire counties.
Social care spending is a major element in these budgets. It has been relatively well protected, as local authorities cut back libraries, transport and roads, planning and less essential services. Nationally, the social care budget has remained roughly flat, but the proportion within that going to elder care has fallen from 36% to 32%. After all it’s tragedies in child protection that really hit the headlines.
These cutbacks are harshest in the poorer areas. A recent Candesic report points to a drop of 9% between 2010-11 and 2011-12 in the north-west, with a further 7% cut expected in the current year. In the north-east, corresponding cuts were 13% and 2%. By contrast, spending is roughly flat in the south-west. In the south-east, spending fell by 7% in 2011-12 but will recover by 3% in the current year. In London the cut was 2% last year and 5% this year.
Spending on older care has always been too low. The numbers of older people and the proportion of very old who are likely to have greater care needs is rising rapidly as the population ages. The cuts have accelerated the pace of innovation in elderly care services as local government desperately strives to deliver services to more people with less money.
One outcome is that managers become keener on home care (where someone visits the older person in their home), because it’s cheaper than residential accommodation – but Jeremy Hunt is against this, because people may become isolated.
One way to deal with isolation and loneliness would be to give more older people the option of living with others – but of course Jeremy would then have to find the money available to support a decent standard in care homes.