While it might be going too far to suggest that those whom the NHS loves die young, there is evidence that the NHS is less interested in the welfare of people over the age of 65 than it ought to be.
“Ought to be”, because old age is the time of life when we are very likely to be sick and in need of medical intervention. The other costly times of life are infancy and, in the case of women, the reproductive years; the costs of old-age care outstrip both of those. Any number of statisticians are making gloomy predictions about how many people will be in their sere and yellow leaf and consequently a burden to the productive young by 2020 or so.
The Royal Commission on the Funding of Care of the Elderly which reported last month came to a different conclusion, though: there is no demographic time bomb of this nature set to overwhelm the NHS. What we shall witness instead, the commission believes, is an extension of enjoyable productive life for more and more people rather than a prolongation of medically expensive dying.
So, why the panic among those who decide who gets what on the NHS? Here are a few alarming statistics:
– Sixty per cent of the people who suffer heart attacks are aged 65-plus, yet 20 per cent of Cardiac Care Units (CCUs) operate age-related admission procedures (that is, they refuse admission to older people).
– Forty per cent of CCUs attach age restrictions to the use of highly effective (but undoubtedly expensive) life-saving thrombolytic (“clot-busting”) drugs, providing them only to younger patients.
– Between 33 per cent and 50 per cent of cardiac rehabilitation programmes have upper age limits on access to their services.
You want more? Consider breast cancer screening. The incidence of the disease rises sharply in women over 65, yet the recall system for mammograms, which are meant to catch the disease early enough for successful treatment, stops at the age of 65. Thereafter, women can only be screened on request.
Even when it comes to the positive business of promoting good health, the government shows scant respect for the elderly. Its green paper Our Healthier Nation, which sets targets for improving health, sets an upper age limit of – you’ll never guess. Yup. Sixty-five years.
The list could go on and on. A Gallup survey for Age Concern last February showed that one million people over 65 had experienced age discrimination in health care. The survey is being repeated this year and will report in a couple of weeks. There is no suggestion in the preliminary findings that there has been any improvement in the situation.
A far more distressing, if less visible, aspect of age discrimination in the NHS is spelled out in detail in a case study included in the report of the Royal Commission on the Funding of Care of the Elderly. Mary is a 70-year-old widow. She lives alone in her own house and suffers a mild stroke, which her GP diagnoses and treats. He arranges for a community nurse to come and look after her nursing needs and for some social service support, too, some of which Mary pays for (her meals on wheels, for example). All is well for a couple of months, but then Mary has a second stroke and this time goes into hospital.
And now things change dramatically. She is refused admission to a stroke rehabilitation unit (too old, according to their policies), though she does improve a little. After six weeks on the ward she ceases to receive most of her state old-age pension. The 64-year-old lady in the next bed and in the same medical situation pays nothing for her care in this NHS hospital, but Mary does – because the state will not permit any individual to benefit twice from its provisions. So Mary’s health care costs her hard cash.
It will cost her more yet. The acute ward she is in needs her bed. There is no longer a suitable long-stay geriatric ward bed for her (over the past couple of decades or so the NHS has been quietly closing them down), and she isn’t able to go home as she has no informal carer (the state’s label for the vast army of desperately hardworking, over-stretched and under-supported friends and family members who provide billions of pounds’ worth of unpaid care). So it’s a nursing home for Mary, in which she will have to pay for all her care – not just her board and lodging but nursing care, too. And when she has used up all her savings, she’ll have to sell her house to pay the nursing home bills. Not until her total financial worth has been reduced to £16,000 will she once again start to receive free NHS nursing care.
The royal commission made various proposals that would, if enacted, right this injustice. At present the government is “considering the report, which will need further debate”.
So, we have in the NHS an institutionalised ageism, which prompts the question: is it justified? And the answer has to be, well, sometimes. Up to a point. Maybe. It’s an area that is misty with complex issues, such as the rights of the individual over those of the mass; the value of life, however painful or limited; the role of “experts”, be they medical, economic, ethical or political; and, very importantly, the attitudes we, as a society, hold about age.
It will take long and careful debate by all of us to come up with a solution to this institutionalised ageism. The government’s attempts to set benchmarks for treatment that will apply to everyone everywhere – the National Institute of Clinical Excellence – will, they believe, resolve many of those problems. I certainly hope so; because unless someone does, soon, hundreds of thousands of us will die, not only unwept and unsung but uncared for.
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