Feature

’Growing old is like being increasingly penalised for a crime you haven’t committed̵

So wrote Anthony Powell in his novel Temporary Kings — and his words ring true in the wake of revelations that some NHS patients are being denied treatment solely on grounds of age. Here, John Brazier, Paula Jones and Adam Darkins examine aspects of the relationship between elderly people and health care

Older people’s rights to health care are largely ignored. The central question we need to ask is this: are older people getting a fair deal from current health care policy and practice? Many involved in policy would say ‘yes’ because they take up a significant proportion of the nation’s health and community care budgets. But are older people getting quality in health care? Are they getting what they actually need? Is the money being well spent, either in their terms or in anyone else’s? Are we really dealing competently with the complexities of health care in an ageing society? We are not, and we should admit this, without necessarily feeling that it is shameful to do so. Shame lies in denial of the facts, and failure to really seek meaningful change.

Let me elaborate on this. We are indeed facing a wholly new social phenomenon, the ageing society. So we are not equipped to respond to the problem as well as we might wish. But are solutions being sought? We can and should learn quickly. New though it is, the demographic situation is not wholly unexpected. We should have been better prepared to accept the notion of an ageing society. As it is, there is a serious problem of ageism. Old people and their needs are too readily described as a ‘problem’ and a ‘burden’ which they somehow have contrived to create. They are blamed for merely living so long.

Some of the prejudice against older people, in the debate about their rights to health care, is doubtless attributable to scarcity of resources in a recession. But this does not excuse views which are in fact much more fundamental than they might seem. Our unease with older age and ageing is frequently expressed in conscious and unconscious ageism. Professionals must examine their own attitudes. For example, not so long ago a cardiologist defined geriatricians as ‘doctors who are not good enough to be let loose on people who matter’ — a salutary reminder of how negatively older people can be viewed.

Ageism translates into public policy. We see very few references to older people in The health of the nation. There are no specific targets for fitness in old age, and the targets for improving people’s health do not go beyond age 65. They do not reflect any consideration for improving quality of life for older people.

Inadequate resource allocations for care in the community do not contribute to older people’s health, neither do low levels of benefit, poor housing nor VAT on domestic fuel. Indeed it could be argued that the health of older people is being undermined by public policy.

Black and ethnic minority elders are doubly disadvantaged through age and poverty. Most are living on very low incomes, many without even a state pension. Their situation is barely acknowledged in the way policy and practice actually works.

Attitudes and practice prevent older people from voicing and claiming their rights to health care. Older people may too readily accept ageing as a deteriorating physical and mental state. They may feel they do not have a right to express their needs, to receive and give information, and to be full participants in their own health care. Some undoubtedly feel they have less right to care and attention than younger people. This is echoed in the provision of services, for example, in cervical screening not being offered or promoted to older women. Services for older patients are still too often seen as low status by professionals, too many of whom still patronise or infantilise them, and are rarely challenged.

Yet it is possible to identify how policy and practice can change and how we can begin to inject more honesty into the very real and necessary debate about ‘who gets what’ in health care in an ageing society. This issue of priorities has to be determined sensitively with regard to older people, who should be involved in the debate. They have a basic right to this as well as to care and treatment.

Older people have a right to information and the support to use it, or to have others use it on their behalf if they are frail or incapacitated. It is especially important that mentally frail older people’s rights are recognised and considered. Older people need confirmation of their rights and status as citizens for whom services exist — services which they should have the right to influence and choose. This is a point which is too often ignored, and it reduces older people to second-class status within a system on which they so often depend for so much.

This is an edited version of a talk given by Paula Jones and Adam Darkins at the Health Rights AGM.