An epidemic of ageism in the NHS

`Any caring organisation that can exclude people based on age must have little understanding of humanity's value'
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The Independent Culture
THE OLD jokes are, as everyone knows, the best, and there's no more literal - or shining - example of this than Cary Grant's riposte to a telegram from a journalist asking his age. "How old Cary Grant?" queried the message. "Old Cary Grant fine. How you?" came the instant reply.

The joke is of particular relevance as a counterpoint to the bleakly ageist findings of a new report from Age Concern. For it clearly illustrates that "old" is an epithet that is widely used with warmth to ascribe affectionate familiarity and to assert added, not diminished, value.

Yet while this idea seems at the moment to be particularly unfashionable, it has never been more true. Just as Cary had a spring in his step long after his salad days were over, so do more and more of us. What's more, one of the most striking things about getting older is that you don't feel any different at all; you just start noticing that young people don't make any sense to you any longer. You're never too old; they're just too young. If you're only as old as you feel, then we truly are an infantilised society.

Although it's true that at 37 I'm not yet that well qualified to lead the grey power movement, and that I may be considered something of a whippersnapper to be aligning myself with the tribulations of the "ageing population", I am, of course, not so young that I'm not already discriminated against by the NHS on the grounds of age.

At 37, for example, I'd be routinely turned down for IVF treatment. But maybe I'd feel a little better about that if I could live on, safe in the knowledge that I won't, within only a couple of decades, be all out of luck on the heart transplant front as well.

For among the shock findings of this report, uncompromisingly titled Turning Your Back on Us: Older People and the NHS, is the apparent existence of a national policy to refuse heart transplants to anyone over the age of 60, despite the fact that 66 per cent of those treated in NHS hospitals for heart attacks are over 65.

Certainly it's true that barring from treatment the segment of the population most in need of a certain type of health care is a devastatingly effective cost-cutting exercise. But it rather defeats the object of having a health service at all. What next, I wonder; blanket banning of treatment for ill people? An operating theatre door policy that turns away those who need surgery? Anyway, the timing of this report, on the same day as Help The Aged staged a 24-hour "living poster" in central London to highlight the problems facing the elderly this winter, suggests that there's a culture of neglect against older people in this country that permeates many institutions besides the NHS.

Not that the heart surgery policy is the only one within the NHS that is patently absurd. Although 63 per cent of deaths from breast cancer occur among the over-65s, this is the cut-off point for routine invitations to breast-screening. No woman is denied such preventive checks, but it does seem ludicrous to suggest that while at 55 a woman needs to be reminded that her breasts need a quick zap, this "universal health care" principle suddenly evaporates on her 65th birthday.

As a result of the report, Age Concern has called for the Government to outlaw ageism within the NHS. But the depressing thing is that such discrimination is already officially ruled out in the patient's charter, which stresses that the right to receive health care must be based on clinical need and not any other factor. Surely anyone can see that even in a climate as hard-pressed as the one in which the NHS has to operate, this is the only way to proceed. Of course, a 70-year-old can be a great deal fitter than a 30-year-old, and better able to withstand the effects of invasive surgery. But, instead, youthful whims such as the removal of "psychologically damaging" tattoos are pandered to, while older people have been refused physiotherapy on the grounds that they don't work any more and therefore have no need for a quick recovery.

Even if you were to accept the repellent idea that age alone should dictate your health care rights, 60 or 65 is a pathetically young age to find yourself discriminated against. But the Age Concern report follows up a Gallup poll of 1,600 people over 50, conducted in April, which found that one in 20 felt they had been refused treatment on the grounds of their age and one in 10 felt they had been treated differently after hitting just 50, a time when you may well be a working parent with a couple of teenage dependants.

The follow-up to the Gallup poll, (which is based on the experiences of 1,000 people who responded to Age Concern's appeal for the public and health professionals to come forward with evidence about age discrimination in the NHS) has uncovered some truly vile case studies. Lynne Murrell told of finding her father in soaked pyjamas and with no bedclothes, on a mattress on the floor. But while this kind of neglect is obviously unacceptable, it is a small detail of this case that speaks most tellingly of attitudes in the service to older patients.

A note from one shift to the next saying, "good luck for tonight" had been hung above this patient's bed. The degree of contempt, assumption of intellectual superiority and denial of dignity would be hard to believe, were it not for the fact that it is clear that any caring organisation that can come up with strategies for exclusion based on something as arbitrary as age must have little or no understanding of humanity's value. That is why this report is a wake-up call to all of us, not just for the discriminated- against over-50s. It speaks of a deeper and wider malaise in the NHS than anything we have been aware of so far in the many troubled decades that the service has weathered. Indeed, when Age Concern's director, Sally Greengross, calls for "the Government to act now to halt the spread of the national epidemic of ageism in the NHS", it is impossible to refute her use of the word "epidemic".

As for the Government, though - the Government that made the pre-election promise of an inquiry into ageism but which has as yet done nothing - surely its illogical pride in the youth of its leader and his Cabinet attests that the same alarming cult of infantilism is at work in the offices of power, too. Certainly such a view would seem to be confirmed by the Government's response to the problem. At the moment it is developing the National Service Framework for older people, which, says the Health Minister John Hutton, "for the first time will set national standards for the care of older people, driving up quality". This, surely, is just confirmation that it is all right to have one set of rules for the young and another for the old.

For while there are, of course, particular medical problems that beset us as our bodies age, it cannot be stressed too much that the NHS is a cradle-to-grave service. It should be geared to looking after us throughout our lifetimes, adjusting to help us with problems we come up against as we grow older. Policies that suggest that at a certain point in our lives we become different people, instead of the same people but with changing needs, will continue to foster the idea that older people are a breed apart, found wanting because they, like last season's pashminas, have been around too long to be hip, and too long for that hip operation to pay dividends.

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