Claire Rayner: I fear that elderly patients will never be treated fairly by the NHS

'People of 65-plus have been refused stroke rehabilitation and even care in arthritis units'
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The Independent Online
Being old has never been a healthy option, and not because of the sundry ills that flesh is heir to.

Being old has never been a healthy option, and not because of the sundry ills that flesh is heir to. With a modicum of commonsensical self-care you can live your latter years in pretty good nick right into your nineties. And more and more of us are doing precisely that. By 2025 octogenarians will increase by almost half and nonagenarians will have doubled.

The risks come from deliberate neglect of older people's medical needs by younger ones. Too often the elderly are seen as a waste of money. Why cure his illness when he'll just sit around eating you out of hearth and home for longer? This is an attitude that still prevails in countries too poor to be able to afford care for both young and old.

But here in the UK we know better. Don't we?

Actually, no. I can well remember the euphoria that greeted the birth of the NHS back in 1948. I was working in a hospital as a cadet nurse at the time, and heard people talk, often with high emotion, of how marvellous it was to know that from now on we would all be cared for free by doctors from cradle to grave, and need never fear illness again. I was well impressed. I came from the East End, where people never saw doctors unless they were moribund. My first encounter with one was at age four, when I started school and it was obligatory. Before that, we made do with the chemist down the market. He was cheaper. And this in spite of real illness. I later learned that I had had TB for some time in my infant years, but no one knew it.

But to be truthful, it wasn't long before that shiny new NHS slipped into bad habits as far as older people were concerned. When we first got our hands on penicillin, until then used only for the armed forces, we gave it to the young, never to older people, however septic their conditions. Later, when we had dialysis to "wash" the blood of those dying of kidney failure, there were never enough machine hours available to include people over 60. Or even over 50, sometimes.

More recently, there has been rising anger among older people and their families about the ageism that has continued in the NHS. People of 65-plus have been refused not only dialysis and kidney transplants, but also stroke rehabilitation, care in specialist coronary units after heart attack and ­ I kid you not ­ some arthritis units. GPs have been accused of withholding costly medicines from older patients entirely on age grounds, and some have refused expensive investigations such as CAT scans and MRI (magnetic resonance imaging).

Now, at last, a government admits that these allegations are true and intends to do something about it. This week the new National Service Framework for Older People (NSF) was launched as "an ongoing working document", according to John Hutton, the health minister, with a flurry of promises of new money to fund "these tough new national standards that will root out age discrimination".

It all sounds marvellous. Almost as marvellous as the original NHS promises, but I have to admit to some cynicism. Like so many government promises, this one seems a curate's egg. The good parts are very good; the admission that ageism exists is one hell of a first step. So is the work that is to be done on osteoporosis, the bone-crumbling disorder that afflicts three million people (mostly women) and which fills hospital beds with fracture cases, costs the country over £150m annually and causes 40 premature deaths a day.

There will also be special teams to deal with the prevention of falls, a major cause of aged illness, and extra work done for stroke sufferers. There'll be £120m to refurbish the old 30-plus bedded Nightingale wards into bays of four or six, to get rid of the mixed-sex arrangements that so many older people find distressing.

There will be fair shares of investment money into procedures older people need, such as cataract operations (70,000 in the next three years), hip and knee replacements (16,000 ditto), coronary artery clean-outs (3,000) and, according to the NHS plan, another 7,800 nurses, 2,500 therapists and 200 more consultants.

Sitting at the press launch of all these goodies, I found I had entered that last paragraph under the heading "pie-in-the-sky". It sounds great ­ but where are all these people coming from?

Many trusts are struggling with nurse shortages of between 12 to 16 per cent below establishment and no hope of recruiting replacements, because there aren't any available (though agencies seem to be doing quite well). As to the future, it appears that the number of applicants for training is diminishing. So it ain't about to get a lot better.

There is mention of "modern matrons" to provide "leadership" ­ although how they will be able do that to any effect isn't explained. Nor are we told how a new "Health and Social Care Partnership" will operate. At present, many old people find that they slip between NHS provision and social services support, because each section has its own budget and both sides jockey to make the other lot pay. Questions about whether there will be single-stream funding to close that net, as recommended by the Royal Commission on Elderly Care, still go unanswered.

Another omission is any mention of a quiet little scandal uncovered last year by the National Primary Care Research and Development Centre at Manchester University. They found that, in about a third of nursing homes, a fee is paid to GPs to care for the residents. This cost is inevitably passed on to the residents, so that in effect they pay for GP care that the rest of us get free on the NHS. This is appalling ageism.

As Tessa Harding, head of policy at Help the Aged, says, "It's bad enough that older people in care homes are charged for the sort of personal care (washing, feeding, toileting) that hospital patients get free on the NHS. Now it turns out that some of them are also being charged for GP care. From all the Government says in the NSF about their rejection of ageism, this can't be acceptable to them."

So, as I say, a curate's egg. Well done for the good parts, but forgive me and my long memory of past failures if I wait a bit longer to produce hearty cheers. I've been here before.

clairerayner@harrowhill.demon.co.uk

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