Introduction

One long-standing concern of critical gerontology has been to unmask policy assumptions relating to older people and to draw out their often negative practical implications (Townsend, 1981a, 2006). This chapter is located within this tradition by focusing on the recent Green Paper on Independence, well-being and choice (DH, 2005a). As suggested in the title, the whole emphasis of the Green Paper was on empowerment through choice with the Preface from the Prime Minister stressing how the proposals were “an important part of our commitment to renew and modernise all our public services so they are centred on the needs and wishes of the individual” (p 1).

However, this chapter challenges the assumption that the proposals in the Green Paper will lead to the type of services in adult social care that older people want. Instead, a mixture of historical and contemporary perspectives are used to argue that the overall direction of government policies towards older people is leading to a re-medicalisation of later life. It concludes by updating the ‘story’ through an analysis of whether or not the White Paper on community health and social care services (DH, 2006a) is likely to halt this drift to re-medicalisation.

The whole terrain of health and social care continues to change at speed (DH, 2006a; Wanless Report, 2006). However, these new developments need to be subject to a rigorous analysis that gets behind surface platitudes and explores the real implications for older people. This helps us to see that all societies are faced with policy options. Some of these push us towards a holistic and positive approach – such as the vision outlined in the recent work of the Social Exclusion Unit on ending inequalities in later life (ODPM, 2006). However, the central argument of this chapter is that the dominant policy thrust is in the opposite direction and represents a re-medicalisation of later life.

What do older people want?

This chapter is underpinned by a critique of central government in which it is argued that their health and social care policies are leading to a re-medicalisation of later life that does not reflect what older people want.