The Economist’s data team has today published a blog post called “How much would you pay to keep using Google?” Unusually for The Economist, the headline isn’t really an accurate representation of the contents, which actually discuss research findings related to the amount people would have to be paid to give up using search engines in general.

But the original question got me thinking. A couple of years ago, I’d have responded with a fairly substantial sum. These days, I’m not so sure. I wonder what that says about the state of the company?

Google used to be the only decent search engine. That is no longer true. A couple of years ago, I decided to see if it was possible to go all-in on Bing. Ironically, this was somewhat inspired by Matt Cutts, formerly of Google, who gives himself 28-day challenges to test assumptions and better himself. Surely, I reasoned, it can’t be as bad as people make out, nor as bad in daily use as an occasional search to try it out makes it seem. I switched my default search engine to Bing in Chrome and on my mobile.

And do you know what? The vast majority of the time, it is perfectly competent. On very rare occasions when I’m struggling to find something I also try searching on Google: I’d say 75% of the time, I also fail to find what I’m looking for there. I’d also say, without any proper data to back up the assertion, that Bing’s results seem less replete with spammy useless links than Google’s. And Bing’s rewards scheme buys me an occasional coffee. I don’t think I’d pay for Google search.

But of course, Google provides more than just search. Would I pay for other components of their offer?

Would I pay for Gmail? There are perfectly decent alternatives to Gmail, and I rarely use my actual Gmail address but forward stuff to it from elsewhere, so redirecting future mail wouldn’t be a problem. Moving the archive would be a pain. I’d probably pay a small fee—a pound a month?—just to avoid the hassle.

One service I would definitely pay for is Google Maps. I use Google Maps every day and have not found anything that can even begin to compete. Back in December, Justin O’Beirne wrote a great essay on Google Maps’s moat—the content and time barrier which keeps it well ahead of competitors. On these terms, I guess Google Maps is probably the most “valuable” bit of Google to me.

Google Drive is great, but OneDrive is pretty great too. Chrome is my current default browser, but I’d happily switch to Firefox. Google Calendar is actually quite irritating (especially since ‘quick add’ was removed) and I use it only because it’s handy. I like my Android phone, but I’d get by on iOS. I’d be sad to lose my Chromebook, but Windows laptops aren’t quite the horror shows they used to be.

I enjoy watching occasional Youtube videos, but I wouldn’t really miss them if I couldn’t watch them any more. I use Google Photos, but I also upload all of my photos to other cloud services, at least in part because I don’t trust Google not to shut down Photos when it turns its attention elsewhere (à la Google Reader or Google Notebook, both of which closed while I was an active user).

More recent Google developments (Home, Assistant, Allo, Duo, Now) have totally passed me by.

Jeff Jarvis used to talk about “livin’ la vida Google” to describe his complete immersion in the Google universe. A couple of years ago, I’d have put myself in a similar category, but no longer. I am only one person, and I’ve no idea how ‘typical’ I am in this context, but I wonder if my change in behaviour represents a wider portentous shift for Google’s fortunes?

The photo at the top was posted on Flickr by Sigurd Magnusson, and is reproduced here under its Creative Commons licence.

A couple of years ago, I wrote a post for the Fuse Open Science Blog about the system failures which lead to patients ‘inappropriately’ presenting at A&E, and how this is often blamed on patients who are expected to self-triage with a high degree of accuracy. I’ve thought of this today because it popped up in my Facebook ‘memories’.

This has prompted a couple of completely disconnected thoughts.

My first thought is that what I wrote then remains true today, and has become even more relevant with ever-increasing pressure on NHS Trusts. Effective triage of patients to the ‘correct’ NHS services is a nut that remains stubbornly uncracked.

More money has been ploughed into putting GPs in A&E departments, despite mixed evidence on cost and patient throughput. Some companies are experimenting with triage chatbots for the NHS which feels to me like an unlikely solution to the problem of sorting acutely unwell patients. The NHS Choose Well campaign keeps steaming ahead at various levels of the NHS as though doing more of the same will result in a completely different outcome.

Anecdotally, clinical colleagues tell me that last winter was ‘better’ than others in recent years, in as much as A&Es were over-filled with patients who should be there rather than patients who shouldn’t be there. Of course, that means departments are more pressured. Perhaps the fear of long waits and ‘chaos’ puts off ‘inappropriate’ attendees. I’m certain that it puts off some ‘appropriate’ attendees and that this will, at least in a very small way, have contributed to excess winter deaths for 2017/18.

My second—unrelated—thought is that I have absolutely no memory of writing or publishing that Fuse article. I mean, I know I wrote it, but I have no memory of constructing it, or of looking up the stuff about Joseph Hodgson and drawing a parallel between misuse of historical charitable hospitals and the modern NHS.

I’m always bad at remembering things I’ve worked on in the past, but to have such a complete absence of any memory for something I wrote (and clearly put thought into) only 24 months ago is remarkable even for me.

I can only assume I was knackered when I wrote it… which would also explain the slightly crap call-back pun in the last line. I can see what I was trying to do, but reading it now, I think it slightly missed the mark.

The picture at the top is a cropped and edited version of a photo published on Flickr by gwire. I’m using it under its Creative Commons licence.

When people who otherwise know me and Wendy very well come round to our house, they not infrequently express surprise at newspapers lying around the place. But, whatever others might think, both Wendy and I like a print newspaper. For both of us, the serendipity of newsprint is inspiring: we often find our views challenged by a newspaper presenting something that we hadn’t previously considered, or highlighting an alternative angle on something we thought we knew. This is the newspaper playing the role of an anti-Facebook: not presenting us with stuff we are likely to like, but instead presenting us with stuff which is well outside our field of knowledge and experience.

On top of this, there happens to be a large overlap in the Venn diagram of good journalists and journalists employed by print news organisations. So as well as reading print newspapers, I also subscribe to a number of digital versions of newspapers from the UK and the USA, often to follow specific journalists. There are some journalists whose byline on an article means it’s worth reading, even if it’s about something I would never normally be interested in: Will Storr is an example. There are some journalists who are so expert and well-connected in their field that their byline means an article will provide new insight into a topic: Tim Shipman is an example. There are some journalists who understand the value of explaining the significance of a story, don’t cry wolf, and aren’t afraid to explain that the frontpage splash is really not a big deal in the grand scheme of things: Matt Chorley is an example. And, at the other end of the spectrum, one quickly gets to know the bylines to avoid, the journalists who will almost certainly have failed to understand the material they are covered, whose work will almost inevitably contain at least one major error of fact: it seems rude to give an example.

Another advantage of traditional print is that it is slow. Breaking news frequently demands our attention but is rarely worthy of it. The implications of news are rarely understood at the moment it breaks, not least as so little is generally known. Speculation is often worse than unhelpful, separating fact from fiction is rarely possible in the moment, and vacuous commentary often precedes facts. Farhad Manjoo’s article for the New York Times this week discussed relying solely on print newspapers for news and was particularly clear on this. Delayed Gratification is even better than newspapers for this: it presents news on a three-month delay, allowing much fuller analysis and discussion than anyone could hope to achieve in the first three minutes.

Of course, both me and Wendy also regularly read news online and on our phones. We don’t exclusively read newspapers. But I think, for both of us, they form an important part of our news ‘diet’.

I was set thinking about all of this after seeing a data story by Kirby Swales in April’s Prospect. Swales’s suggestion is that the BBC News website has essentially cannibalised the tabloid newspaper market (perhaps the reason the BBC feels it necessary to write full articles on a reality star’s Instagram post and ‘listicles’ about Twitter storms). To me, the biggest surprise in that data is that less than half the adult population of the UK regularly reads news online.

I don’t really have a point to make in this post. I suppose I’m just musing without conclusion that I like newspapers, their circulation is falling, and with ever-more news available online, the proportion of people engaging with it is really quite small. Maybe society is disengaging from journalism. Or maybe habits are changing in less dramatic ways. I don’t know.

The picture at the top is from Jeff Eaton on Flickr and is used here under Creative Commons licence.

Over the past week or so, Cambridge Analytica and Facebook have barely been out of the news. The central thrust of the story is that people consented to share information with Facebook and apps hosted on Facebook, which has then been used to target advertisements. It is claimed that these targeted advertisements influenced the US Presidential Election and the UK’s EU membership referendum. Despite frequent uses of phrases like “hack” and “data breach” in the news coverage, none of this actually involved anything other than use of information for which people had given consent—but the consent may not have been truly informed consent, because people simply clicked “Agree” without reading. (This old story, in which users of free wifi universally agreed to hand over their eldest child in exchange for internet access, feels relevant here.)

To anyone interested in technology, nothing in this story is particularly surprising, and I think its fair to characterise most of the tech press as struggling to cover it. Even Carole Cadwalladr, the journalist credited with highlighting this story, reportedly sees herself as a feature writer who translated something well-known among the well-informed into a story with mass appeal, rather than uncovering anything new.

To me, that the adverts on Facebook feeds are not randomly chosen seems self-evident. And yet, there is plenty of evidence that many people don’t even recognise adverts in their Facebook feeds, let alone wonder how they were chosen. The coverage of Cambridge Analytica seems to suggest that many users are agape at the revelation that Facebook adverts exist and are targeted at users. In some quarters, the anger at Facebook is offset by the fact that the service is free to use and “has to make money somehow”.

If I were an investor in Sky, I would be worried right now. Unbeknown, I suspect, to the vast majority of its users, Sky targets TV ads via a platform called AdSmart. Sky boxes download adverts overnight and then play back commercials targeted at households in ad breaks. Or, as they put it,

With Sky AdSmart different ads can be shown to different households watching the same programme.

Sky uses an enormous amount of probabilistic data on subscriber households to enable this targeting, including everything from household income, the age of cars owned by household members, the month of renewal of insurance policies, the pets owned by householders, whether subscribers are pregnant, and even the compass direction in which the householder’s garden faces. Sky promotes this to advertisers as an

in-depth knowledge of Sky households … There are thousands of combinations to choose from when selecting the audience that sees your ad. Households can be selected based on factors such as age, location, life style or even if they have a cat … allowing advertisers to cherry-pick their audiences.

If people don’t expect targeted advertising on a platform where they proactively share much of their life, then I suspect that they are even less expectant of being profiled and targeted with advertising while they are catching up on the latest soaps. While folk post about their cats on Facebook with alarming frequency, I think many people would be upset to learn that Sky knows whether they own a pet, let alone that this knowledge is used to show them relevant TV ads. And, of course, users pay Sky hefty subscription fees each month, negating the “has to make money somehow” mitigation.

Nobody can claim that Sky is anything other than open about AdSmart, and I am quite certain that they will have legally compliant consent from subscribers as part of the terms and conditions of their service. But all of that is also true of targeted advertising on Facebook. To me, AdSmart feels intuitively like a programme ripe for “exposure” through a talented journalist like Carole Cadwalladr. While the press has less of an incentive to attack Sky than it does to attack Facebook, I would be worried if I were Sky.

The picture at the top is based on an original posted on Flickr by Sarah Joy. I’ve modified it and used it here under its Creative Commons licence. The Sky AdSmart picture in the middle is a promotional image owned by Sky Group, used here under the ‘fair dealing’ exception to copyright law.

There is much made in the press today of a change to the Clarence House website. A passage which explained that the Duchess of Cornwall plans to use the novel title Princess Consort, rather than Queen, when the Prince of Wales accedes the throne has been “quietly removed” (The Telegraph). The press extrapolates from this that Prince Charles “plans to go back on his word and make the Duchess of Cornwall queen” (The Times). This is certainly a reaching stretch of a journalistic conclusion, but the coverage has caused me to reflect a little on the situation.

Is there really a decent argument for the Duchess of Cornwall being anything other than Queen? Regardless of whether she chooses to style herself as such, Camilla will be Queen. In the same way, the Duchess is currently Princess of Wales, even if she chooses to style herself with a lesser title.

But let’s assume for a second that madness prevails, and someone wishes to make an argument for the Act of Parliament which would be required to stop the Duchess becoming Queen, and all the comparable legislation in the nations where Charles will be King. There appears to be no basis for doing this: the common argument mostly boils down to “the public won’t accept it” and “people disapprove of her private life”. The whole point of the monarchy is that such things don’t matter. We don’t get to choose our monarchs or their spouses: provided they are eligible to accede their positions, then accede them they do. If there were a public desire to be picky, then the problem is with the monarchal system, not the individual.

To me, the more persuasive argument is a constitutional one: now that the constitutional principle of primogeniture has changed to favour the firstborn regardless of sex, it’s no longer logical to assume that the role of King is superior to the role of Queen. There should, therefore, be gender equality in terms of the title given to the spouse of the monarch: either the spouse of a Queen should be called a King, or the spouse of a King should be called the Princess Consort (or Queen Consort). To my mind, the latter is the better solution, otherwise we would need to invent another adjective to distinguish the member of the royal couple with the inherited position and constitutional power. It would also be the clearer solution in the case of a monarch with a same-sex spouse acceding the throne.

The catch with my constitutional suggestion is that it really ought to have been sorted when the constitutional changes to primogeniture were approved by Parliament (and equivalent bodies in other nations). However, the problem was sidestepped, along with a host of other gender-related problems. For example, the honorary title bestowed to the spouse of somebody in receipt of a duchy is ‘Duchess’ if the recipient is male and the spouse is female, but zip if the recipient is female and the spouse is male. It’s therefore hard to argue that the status of duchies is equivalent between the sexes.

And the problem with sorting any of this out is that one quickly ends up questioning why such an archaic system survives at all. Only a minority of people may support abolishing the monarchy, but surely an even smaller minority would support creating one if it didn’t already exist.

No doubt harming my credentials as a liberal-leaning millennial, I have to admit that I don’t know my own mind on the future of the monarchy. I vacillate between thinking “of course the monarchy is anachronistic, undemocratic and should be abolished”, “of course the monarchy is anachronistic and undemocratic, but it’s mostly harmless, might do so some good, and no other option looks much better”, and “of course the monarchy is anachronistic and undemocratic, but it would be madness to abolish a long-standing and proven check/balance on our system of government”. In retrospect, I’m surprised to see how unequivocally positive I was about the wedding of Charles and Camilla at the time.

So, in order to avoid complicated and unpredictable questions, it seems to me that the most likely option is the fudge that has been already proven: Camilla will be Queen, but she’ll call herself something else… which is what the Clarence House website said all along.

For the last couple of days, the news has been dominated by the story of Sergei and Yulia Skripal, who fell ill in Salisbury a few days ago. The police are investigating this as attempted murder via a nerve agent, and there is much suspicion that the Russian state may be behind the crime. (One of the stranger things about delaying posts for a year is that you’ll know how this all turned out—I don’t!)

Many people are drawing comparisons between this case and the Alexander Litvinenko affair of 2006. There are two really great bits of writing on that affair which are well worth reading, and this seems as good an opportunity as any to recommend them again.

The first is a fantastic long-form article called Bad Blood by one of my favourite journalists, Will Storr. This is particularly good for setting Litvinenko’s murder in the historical context of murders of Russian dissidents, and—like everything Will writes—has fantastic prose. Re-reading this again today, I note that Will talks briefly about using nerve agents absorbed through the skin as a murder weapon, which would fit neatly with the public statements about the Skripal case so far. Will originally wrote this for Matter, a start-up by another favourite journalist of mine, Bobbie Johnson, concentrating on publishing long-form journalism. Matter has since ‘pivoted’ into Matter Studios, “a multi-platform content studio and incubator”, whatever that is.

The second is Guardian journalist Luke Harding’s extraordinary book, A Very Expensive Poison. This is one of the most arresting non-fiction books I’ve ever read. Harding gives a clear, detailed and compelling account, including all of the cack-handed bungling which humanises the Litvinenko affair and makes it that much more horrific. Harding also dives deeply into the investigation of the murder and the judgement of the subsequent public enquiry. It’s an absolute must-read.

On the other hand, absolutely not worth reading is this, by a pre-clinical medical student who thought he knew something about radiation, but clearly didn’t.

The rather lovely photo of magnolia blossom at the top (which was taken in Salisbury) is by rachelgreenbelt, edited and used under Creative Commons Licence.

I found this Aoen essay by Mark Polizzotti very interesting. He talks, with enormous knowledge and experience, about the art of translating texts and what the ultimate goal of translation should be.

I read quite a lot of books in translation, not least because English is the only language I can read to any reasonable level of competence. When I really enjoy a translated book, I often wonder whether I would have liked the original to the same degree. I also sometimes find myself wondering whether particular annoyances in translated texts are attributable to the original author or to the translator.

The article reminded me of my amazement a couple of years ago at Megan McDowell’s masterful translation of Alejandro Zambra’s Multiple Choice, a book with only a very small number of words, all clearly carefully chosen to have multiple layered meanings. I’ve no idea how McDowell approached the task, but the result is astounding.

There were three paragraphs towards the end of Polizzotti’s article which I found particularly interesting:

At its best, translation exposes us to minds and voices able to stir in us a particular sense of delight or kernel of insight, a shiver of discovery that would be available nowhere else – minds and voices that are truly unique, that have something to say that is dissimilar from what anyone else has to say, in any language. Such minds and voices are exceedingly rare, and we cannot afford to be ignorant of a single one of them. They are the reason that humans have hungered after stories since consciousness began. We are as enriched by having come in contact with them as we are unwittingly impoverished by having forgone or been denied that contact.

For this reason, translation is often cited as a preventative against cultural atrophy and homogenisation. If done well, the translation of a foreign work is uniquely positioned to usher in viewpoints different from what we see at home and make them resonate in another context, giving them a new and vibrant voice that they would not otherwise have had. What this means, somewhat paradoxically, is that translation in the best of cases not only bridges distances but, even more so, safeguards them – not by keeping cultures at a safe remove, but rather by helping ensure that the contact produces sparks rather than suffocation.

In our increasingly interconnected world, it is tempting to posit the end of national and cultural boundaries. But there’s another aspect to it, and it has to do not with the repressive aspect of boundaries but with their utility, for boundaries can also be guardians of difference. The flip side of heightened familiarity, of potentially infinite contact (including, of course, the kind of contact made possible by translation), is the erosion of diversity. Just as the notion of barriers can call to mind a vast gulag of barbed wire, so their absence can as easily conjure an endlessly uniform expanse. The diffusion of ideas, the intellectual and aesthetic free-for-all of arts, literatures, philosophies and viewpoints ricocheting throughout the world, could bring one of the greatest revitalisations in the history of humankind, a new Renaissance. Or it could lead to the blandest global monoculture we’ve ever known.

I hadn’t previously considered translations of books as having the potential to break down cultural barriers to the extend that ‘it could lead to the blandest global monoculture we’ve ever known’. I wonder if the language barrier, and the fact that we are reading a translation and hence having slightly different experiences, is at least slightly protective.

But then, I suppose the same argument could be made for anything: there are mild differences in the taste of Coca-cola around the world as a result of different recipes and manufacturing processes, but no-one could deny that product’s contribution towards a bland global monoculture.

Something to think about!

When people accuse politicians of lying, I generally roll my eyes. Almost a decade ago, I laid into my local MP for sending me an inaccurate letter. Guido Fawkes picked it up and called the poor guy a moronic liar. The episode was a whiny hurling of personal insults that achieved nothing of value. I still slightly regret it.

And these days, too often people choose to quote politicians out of context, wilfully misunderstand their position, or turn slips of the tongue into conspiracy theories. I have no interest in any of that.

And yet. And yet. And yet, I have noticed a lot of inconsistency in Government statements on the Junior Doctors’ Contract dispute. I’m not accusing anyone of lying. I’m not even accusing anyone of being deliberately misleading. I’m just highlighting statements which, as far as I can see, don’t match one another.

Look through the list yourself. Check out the sources. Draw your own conclusions.

There will be no imposition.

Source: Government statement in response to petition, 21 March 2016

There has been no change whatsoever in the Government’s position since my statement to the House in February … We are imposing a new contract, and we are doing it with the greatest of regret.

Source: Jeremy Hunt, speaking in Commons debate, 18 April 2016

Is it really the Government’s position that “no imposition” and “we are imposing a contract” mean the same thing?

No trainee working within contracted hours will have their pay cut.

Source: Jeremy Hunt, speaking in Commons debate, 11 February 2016

No one will see a fall in their income if they are working the legal hours.

Source: Ben Gummer (Parliamentary Under Secretary of State for Health), speaking in Commons debate, 21 March 2016

Is it the Government’s position that “contracted hours” and “legal hours” mean the same thing? Or did Gummer choose to to undersell the Government’s own guarantee on 21 March?

It will actually cost us more. If you’re going to ask more doctors to work at weekends, you’re going to have to pay more.

Source: Jeremy Hunt, on The Andrew Marr Show, 7 February 2016

[We have agreed] the cost neutrality of the contract

Source: Jeremy Hunt, in letter to Professor Dame Sue Bailey, 5 May 2016

Does the government consider “cost neutrality” and “it will actually cost us more” to have the same meaning?

What we do need to change are the excessive overtime rates that are paid at weekends. They give hospitals a disincentive to roster as many doctors as they need at weekends.

Source: Jeremy Hunt, speaking in Commons debate, 13 October 2015

What we’re actually doing is giving more rewards to people who work the nights and the more frequent weekends.

Source: Jeremy Hunt, on The Andrew Marr Show, 7 February 2016

Was the Secretary of State mis-speaking when he said that the contract reduced excessive overtime rates at weekends, or when he said that the new contract increased them?

Certain features of the new contract will adversely impact on those who work part-time, and a greater proportion of women than men work part-time; women, but not men, take maternity leave and some aspects of the new contract have certain adverse impacts regarding maternity; certain features of the new contract will potentially adversely impact on those who have responsibilities as carers.

Source: Government Equity Analysis of new contract, published 31 March 2016

Shorter hours, fewer consecutive nights and fewer consecutive weekends make this a pro-women contract that will help people who are juggling important home and work responsibilities.

Source: Jeremy Hunt, speaking in Commons debate, 18 April 2016

Is it the Government’s position that it got its own Equality Assessment wrong when it concluded that it discriminated against women?

No doctor will ever be rostered consecutive weekends.

Source: Jeremy Hunt, speaking in Commons debate, 18 April 2016

Good practice guidance will be published in the near future to support employers, including guidance on rotas and scheduling, and will make clear that, where possible, routine rostering of consecutive weekends should be avoided.

Source: NHS Employers, 31 March 2016

Does the Government consider that “ever” and “where possible” mean the same thing?

We will make the NHS more convenient for you. We want England to be the first nation in the world to provide a truly 7 day NHS.

Source: Page 38 of the Conservative Party Manifesto, 2015

There is concern that the government may want to see all NHS services operating 7 days. Let me be clear: our plans are not about elective care.

Source: Jeremy Hunt, speaking in Commons debate, 25 April 2016

Were the Conservatives up front about not including elective care in their plan to make the NHS more convenient with a truly 7 day service?

Source: First line of the first page of the Conservative Party Manifesto, 2015

The first line on the first page of this Government’s manifesto said that if elected we would deliver a seven-day NHS.

Source: Jeremy Hunt, speaking in Commons debate, 25 April 2016

Will Hunt correct the Parliamentary record for misquoting his own Party’s manifesto?

It is now not possible to change or delay the introduction of this contract.

Source: Jeremy Hunt, in letter to Dr Johann Malawana, 19 April 2016

We will pause introduction of the new contract for five days from Monday should the Junior Doctors’ Committee agree to return to talks.

Source: Jeremy Hunt, in letter to Professor Dame Sue Bailey, 5 May 2016

Is Hunt claiming to have achieved the impossible? Or was was his earlier statement erroneous?

Images used under by or by-sa licence as appropriate. Sources (in order of appearance): Ted Eytan, Roger Blackwell, University of Salford Press Office, Garry Knight, Ted Eytan (again), Garry Knight (again), NHS Confederation, Roger Blackwell (again). Thank you all!

Marc Bolland stepped down as Chief Executive of Marks and Spencer today, after his fifth consecutive Christmas of disappointing sales. Among the reasons M&S has cited each year for its disappointing sales:

2015: Unseasonably warm weather
BBC News, 7 January 2016

2014: Unseasonal conditions
The Independent, 8 January 2015

2013: Exceptionally unseasonal weather
The Telegraph, 9 January 2014

2012: Mild, wet weather
The Guardian, 8 January 2013

2012: Mild autumn weather
The Guardian, 10 January 2012

If they were genuinely surprised by the ‘mild’ weather five years in a row. perhaps they would have been better off sacking the weatherman than the CEO?

There are roughly half a million beds in residential or nursing care homes in the UK.¹ Private providers operate almost all of these beds (90%) though the sector isn’t particularly lucrative: the average operator draws a profit of less than £5 per resident per day. Most beds are funded either in full (40%) or in part (10%) by local authorities. The NHS pays for a few (5%).

Central Government funding to local authorities was cut by 25% per person over the period of the last Government, though these cuts were not uniformly distributed across the country. This came on top of smaller reductions in funding over the previous five years. As a result, local authorities had much less to spend on social care. The number of day care places plummetted by 50% over a decade. About 20% fewer people received local authority funded care in their own home. And, partly as a result of this, the number of older people in residential or nursing care homes rose by more than 20%.

Over the next five years, we will see a perfect storm in social care for elderly people. The number of people aged over 75 is predicted to grow from 5.3 million today to 6.1 million in 2020 (a virtually unprecedented rate of increase, almost double what happened over the last five years). Yet Central Government funding to local authorities is to be cut further. Funding is being reduced while demand is predicted to increase more than ever before.

The burden will fall on the NHS, as it is in NHS beds that people often wait for care home places. The absurdity of this is that the average per-night cost of staying in an NHS hospital is three times greater than the average care home cost.

Yet there is another insidious factor imposed by Government which will push this situation from ‘substantial problem’ to ‘perfect storm’.

Most workers in residential and nursing care homes are paid minimum wage. By 2020, this will rise fromt £6.50 to £9.

Few could argue with giving hard-pressed workers a living wage. But given that average care home profits are less than 21p per patient per hour, care homes cannot maintain their current charges while increasing staff wages by £2.50 per hour. Yet they cannot raise their fees because Government cuts mean that local authorities can’t pay.

So what happens when care costs increase and funding decreases? First, care is cut: HC-One, Britain’s third-largest care home provider, is already training carers to take on highly skilled tasks which were previously done by more experienced and expensive nursing staff. But, since the cost of those carers is also increasing rapidly, this is only a stop gap solution. As Southern Cross, previously the UK’s largest care home provider, showed in 2011: care home providers can and will collapse.

As care home companies collapse, the supply of care home beds collapses with them. More elderly people get ‘stuck’ in NHS beds, at much greater cost to the taxpayer, and much greater risk to their own health.

And, to add extra thunderbolts to the storm, the number of NHS beds is decreasing rapidly: by nearly a quarter over the last ten years, with no sign of slowing. In this context, an increase in elderly people needlessly occupying NHS beds due to a lack of social care will cause the NHS to grind to a halt.

The underlying problem here is that the Government fails to understand that protecting NHS funding does not protect NHS services. Health and social care are two arms of the same beast: cutting one leaves the other with more to do. Yet the long-term solution isn’t obvious: there are limits to the burden of tax people are willing to carry to fund health and social care services.

The forecast is for bigger storms ahead.