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We write them off as vulnerable, non-sexual burdens – but the elderly are not just a problem to be solved

A new regular column, "Nurse in the City", by Brian Kellett.

Have you heard of the “pink pound”? Of course you have – you read the New Statesman. I’m guessing that you also know about the “grey pound”, the demographic that takes in the elderly of this country.

You will know about the “ticking time bomb” of the ageing population and about how pensions are becoming so expensive that many of us will have to work until we are 68 or older. The elderly are also seen as “bed-blockers” who take up hospital places (though half of their hospital beds have been cut).

As a community nurse in east London, I spend most of my working day seeing people in their homes. You learn quite quickly in this job that the elderly are just as diverse as the rest of us and that it is misleading to refer to them as a homogenous lump. I used to work in various branches of emergency medicine. Back then, I saw patients for a very short time. After many years, I decided that struggling with drunks and dealing with young people who thought that a blocked nose was an emergency worthy of an ambulance were starting to wear a bit thin. Now, I have the time to get to know my patients and they get to know me. In many cases, we are on first-name terms. And each patient is different.

There is a woman I visit who is intensely proud of how clean she keeps her house, despite living on her own and being nearly blind. She has a little rota in her head – on Wednesday morning, she mops the floor (whether it needs it or not); in the afternoon, she vacuums the carpets; on Thursday, she dusts her house from top to bottom, and so on.

Then there is the woman who lives in a very mucky house – the sort of place that has you wiping your feet on the way out – and until recently would refuse all help from us. Finally, she agreed to let some people in to give it a tidy. It’s still dirty but there’s been a big improvement. I like both of these patients equally. They show their independence in different ways; they are quite happy in their way of life.

There are also the sisters who live together and are as thick as thieves (I swear they are conspiring to do something, like in Arsenic and Old Lace) and the woman who was thrown out for marrying a man from India – her family could not stand the “shame”. They drove her not only from her family home but from the village she grew up in.

The elderly, apparently, are nonsexual. Perhaps someone should tell that to the chap who says he enjoys looking at pornography, though “nothing down there” has been working for years, or the other man who has a wife and children but still flirts with me (it probably doesn’t help that I keep insisting on looking at his naked buttocks as part of his care package).

I see atheists, Christians, Muslims, Buddhists, Sikhs and Jews. I see those with pin-sharp minds and those in the midst of dementia. I don’t need anniversaries to remind me of wars because I hear true stories about them on an almost daily basis. As I sit on the floor in front of my patients, bandaging their legs, I hear about how they became friends with German POWs, or how they drank themselves through Italy following their commander, or how they looked after their mates, or how they got to carry the “bastard big gun” because they were the tallest in their squad. For many of them, it was the formative experience of their life, not something simply to be trotted out every 25, 50 or 100 years and “celebrated”.

As I change their catheters, I listen to them talk about their time as union leaders; about strikes and how they did their best for their members. Some of them espouse political views that I disagree with. Sometimes, I nod my head and let it slide; at other times, I’ll have a good-hearted argument.

There seems to be a consensus that the elderly are vulnerable people who get abused in nursing homes, get pensions that are unsustainable, will freeze to death in a cold snap and take up valuable hospital beds, all at the expense of the “hard-working taxpayer”. But what we need to accept is that they are people and not just a problem to be solved.

Next week: Dr Phil Whitaker’s Health Matters

This article first appeared in the 19 February 2014 issue of the New Statesman, The Space Issue

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Air pollution: 5 steps to vanquishing an invisible killer

A new report looks at the economics of air pollution. 

110, 150, 520... These chilling statistics are the number of deaths attributable to particulate air pollution for the cities of Southampton, Nottingham and Birmingham in 2010 respectively. Or how about 40,000 - that is the total number of UK deaths per year that are attributable the combined effects of particulate matter (PM2.5) and Nitrogen Oxides (NOx).

This situation sucks, to say the very least. But while there are no dramatic images to stir up action, these deaths are preventable and we know their cause. Road traffic is the worst culprit. Traffic is responsible for 80 per cent of NOx on high pollution roads, with diesel engines contributing the bulk of the problem.

Now a new report by ResPublica has compiled a list of ways that city councils around the UK can help. The report argues that: “The onus is on cities to create plans that can meet the health and economic challenge within a short time-frame, and identify what they need from national government to do so.”

This is a diplomatic way of saying that current government action on the subject does not go far enough – and that cities must help prod them into gear. That includes poking holes in the government’s proposed plans for new “Clean Air Zones”.

Here are just five of the ways the report suggests letting the light in and the pollution out:

1. Clean up the draft Clean Air Zones framework

Last October, the government set out its draft plans for new Clean Air Zones in the UK’s five most polluted cities, Birmingham, Derby, Leeds, Nottingham and Southampton (excluding London - where other plans are afoot). These zones will charge “polluting” vehicles to enter and can be implemented with varying levels of intensity, with three options that include cars and one that does not.

But the report argues that there is still too much potential for polluters to play dirty with the rules. Car-charging zones must be mandatory for all cities that breach the current EU standards, the report argues (not just the suggested five). Otherwise national operators who own fleets of vehicles could simply relocate outdated buses or taxis to places where they don’t have to pay.  

Different vehicles should fall under the same rules, the report added. Otherwise, taking your car rather than the bus could suddenly seem like the cost-saving option.

2. Vouchers to vouch-safe the project’s success

The government is exploring a scrappage scheme for diesel cars, to help get the worst and oldest polluting vehicles off the road. But as the report points out, blanket scrappage could simply put a whole load of new fossil-fuel cars on the road.

Instead, ResPublica suggests using the revenue from the Clean Air Zone charges, plus hiked vehicle registration fees, to create “Pollution Reduction Vouchers”.

Low-income households with older cars, that would be liable to charging, could then use the vouchers to help secure alternative transport, buy a new and compliant car, or retrofit their existing vehicle with new technology.

3. Extend Vehicle Excise Duty

Vehicle Excise Duty is currently only tiered by how much CO2 pollution a car creates for the first year. After that it becomes a flat rate for all cars under £40,000. The report suggests changing this so that the most polluting vehicles for CO2, NOx and PM2.5 continue to pay higher rates throughout their life span.

For ClientEarth CEO James Thornton, changes to vehicle excise duty are key to moving people onto cleaner modes of transport: “We need a network of clean air zones to keep the most polluting diesel vehicles from the most polluted parts of our towns and cities and incentives such as a targeted scrappage scheme and changes to vehicle excise duty to move people onto cleaner modes of transport.”

4. Repurposed car parks

You would think city bosses would want less cars in the centre of town. But while less cars is good news for oxygen-breathers, it is bad news for city budgets reliant on parking charges. But using car parks to tap into new revenue from property development and joint ventures could help cities reverse this thinking.

5. Prioritise public awareness

Charge zones can be understandably unpopular. In 2008, a referendum in Manchester defeated the idea of congestion charging. So a big effort is needed to raise public awareness of the health crisis our roads have caused. Metro mayors should outline pollution plans in their manifestos, the report suggests. And cities can take advantage of their existing assets. For example in London there are plans to use electronics in the Underground to update travellers on the air pollution levels.

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Change is already in the air. Southampton has used money from the Local Sustainable Travel Fund to run a successful messaging campaign. And in 2011 Nottingham City Council became the first city to implement a Workplace Parking levy – a scheme which has raised £35.3m to help extend its tram system, upgrade the station and purchase electric buses.

But many more “air necessities” are needed before we can forget about pollution’s worry and its strife.  

 

India Bourke is an environment writer and editorial assistant at the New Statesman.