Television Reviews: Goldring: The Age Of Rationing and End Of An Illusion

"HEALTH IS A lottery... How well or how badly do the wrinklies come out of it?" The tone was unmistakable - peremptory, impatient with mollifying conjunctions, happy to include a little jolting insult in the phrasing. Thought you might fall asleep, did you - this being a documentary about National Health Service policy? Not when Nanny Goldring is on your screens, at least not if you know what's good for you. In Goldring: The Age of Rationing (Sun C4), the first of two documentaries for Channel 4's "Cradle to Grave" season, the wrinkly with attitude began on a personal note - the story of her own treatment after a stroke had left her marooned on her kitchen floor for four days. Her experience of the NHS had been excellent: "If you gave my stroke team a three-legged horse, they would train it to win the Cheltenham Gold Cup," she said gratefully. But her point was that this was as much an accident of fortune as the original attack had been. In another area, she might have had very different treatment, indeed, she might have been deemed too old to merit the best care.

Frankly, you would only make such a judgement about Mary Goldring if she was unconscious - because, if she was awake, you wouldn't dare. Here, she tore into various examples of ageism in the NHS - from the fact that women above 64 aren't automatically called for breast screening, even though they are far more likely to die from the disease, to the equally harsh discriminations made against older heart patients, who may have expensive interventions withheld (unless they kick up a fuss). This is a problem of success, not failure - when you saw an 84-year-old man having open-heart surgery, you were watching a procedure that would have been unthinkable when the Health Service was set up. And Goldring's personal stake in the matter seemed to me to have clouded her usually pin-sharp vision - in particular, when it came to the decisions such advances force on a finite budget. "The idea that a young life is worth more than an old life is obscene," she concluded, with real fury in her voice. But is obscene really the right word for this widespread cultural prejudice (surveys show that even old people subscribe to it)?

It seems more likely that it recognises a crude biological calculation - young people are more likely to be raising children, for one thing. I hope that when I am 75, I won't casually be regarded as too old for an urgent operation, but I hope, too, that I might be open to the suggestion that a mother of two young children should precede me in the queue. But Golding's argument that such assumptions should be transparent and open to debate is incontestable and was pursued further in the second of her two films, last night's End of an Illusion (C4). There, she examined the problems generated in keeping a promise of comprehensive treatment made more than 50 years ago - when the number of treatments available was a fraction of what they are now. "Ministers have made it very clear that rationing does not exist in the NHS," said one Health Service Sir Humphrey, making it equally clear by his tone of voice that he could not be held responsible for the truth content of this dogma.

Unfortunately, such prevarications - as endemic in hospitals as certain types of bacteria - are difficult to square with waiting lists so long that you may die before you reach the head of the queue. But Goldring also usefully questioned the way in which waiting-list length had become a crude measure of success. Because a flat figure of 18 months has been applied to all operations, some people wait in considerable pain while the merely inconvenienced are dealt with. Alter that political rule, said one surgeon, and waiting lists for serious operations could be halved.

In this programme, Goldring also approvingly reported on heart specialists who were applying a kind of informal triage system - only giving patients expensive diagnostic treatment if they scored more than 40 on a home-made scale of urgency. I suppose this isn't entirely incompatible with a demand for better treatment for older people, but it didn't seem impossible that rationing of expensive procedures might fall a little more heavily on the elderly than those in the middle of life. Goldring's central point holds good, though. The ideology of comprehensive care now needs a Zimmer frame to get about - and lying about it won't do anybody's health any good.