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Older patients ‘being denied access to NHS’: Royal college urges equal treatment for the elderly

Author: NICHOLAS TIMMINS Health Services Correspondent

‘There is a tendency, a sort of philosophy that permeates the service, which suggests that older people perhaps should be treated in a less fortunate way than younger people,’ Professor Leslie Turnberg, the college’s president, said as the college published a report calling for equity for the elderly in health care.

However, the college also warned that it would be ‘impossible’ for the NHS to provide continuing long-stay care free to all those who would prefer it to paying for their own care in a private nursing home.

The Government urgently needed to clarify the rules about about who qualified for such care and under what circumstances.

For acute hospital care, however, ‘a patient’s need for admission should not become an issue on grounds of age’, the college said.

General practitioners seeking admission for an elderly patient ‘should not be involved in a ‘justification exercise’ in an attempt to secure a hospital bed’.

The college’s report was commissioned 18 months ago before the recent political rows over ‘ageism’ in the health service. It draws attention to the risk that acutely ill older people may be offered inferior treatment if admitted to ‘geriatric’ facilities.

‘The risks are that if you are 65 and one week, rather than 64 and 50 weeks, your treatment might vary because of the simple fact of being a different age,’ Professor Turnberg said.

‘That difference may put the older person at some risk. Whether anyone has died because of that I wouldn’t like to say, because it is hard to find evidence of that. But your risks are increased if you are that much older under those particular circumstances,’ he said.

John Grimley Evans, professor of geratology at Oxford University, said a study three years ago had shown that one in five coronary care units operated an upper age limit, usually 70 or 75, for admission. Forty per cent had an upper age limit for clot-busting drugs when such an approach was ‘illogical’. The drugs were more effective in older than in younger patients.

He said the problem was not new, or unique to Britain. In the United States, studies had shown that older people were much less likely to get good and effective cancer treatment. There was no equivalent data for the UK, ‘but cancer experts suspect the same would be found here if the studies were done’.

The college added that the same quality of care should be available for the elderly, however that care was organised.

‘Bad ethics’ were also creeping into the NHS, Professor Grimley Evans added. ‘People are beginning to suggest that people can be valued according to their life expectancy. So someone of 80 is less valuable than someone of 40 because their life expectancy is lower.

‘That is insidious because that has never been the basis of British society – and it is rather dangerous because the lower social classes have lower life expectancy than the upper, blacks have lower life expectancy than whites, and men have six years’ lower life expectancy than women,’ he said.

The issue that patients should be assessed as individuals and not on grounds of age was one doctors could affect, the college said.

Dr Michael Denham, a consultant geriatrician at Northwick Park Hospital in outer London, said clinicians had succeeded in changing managers’ minds when they had attempted to exclude elderly patients from particular services.

John Bowis, a health minister, welcomed the report. He said the NHS was there ‘to provide services for everybody on the basis of their clinical need – whatever their age’.

Benefits could be axed to fund care for the elderly

Author: By Michael Savage, Political Correspondent

The Conservatives said Labour’s plan would lead to the abolition of the benefits, received by about 2.4 million of the elderly and disabled. The Government also faces a growing backlash from its own party. Roger Berry, a Labour MP and chair of the all-party group on disability, said he would fight attempts to withdraw the benefits. “We need to hang on to those two benefits and I would oppose it if the Government tried to remove them,” he said. “I don’t think they will try to remove them, but I think the elderly and disabled want control over what they spend their money on, which is why we need to keep those benefits.”

Carers questioned a proposal for providing more home care for those most in need, as central planks from the Queen’s Speech appeared to continue to unravel. The English Community Care Association (ECCA) said that there was “no coherent back story” explaining how the plan would be funded.

Andy Burnham, the Health Secretary, accused the Tories of “disgraceful scaremongering” in suggesting benefits could simply disappear. However, he admitted that the Attendance Allowance could be reformed to pay for broader changes in the future. He added that anyone who lost out would be compensated with an “equivalent level of support”.

Mr Brown announced plans for the creation of a National Care Service, to match the NHS, in his Labour conference speech in September. Mr Burnham added that a plan announced in the Queen’s Speech this week to guarantee free home care for about 280,000 pensioners and disabled people most in need of extra aid, at a cost of £670m a year, would be paid for out of his department’s existing budget.

But that was questioned by Martin Green, chief executive of the ECCA, as he gave evidence to the Commons Health Committee yesterday. “There appears to be no coherent back story about how this is going to be funded, what the criteria will be, how it interfaces with other aspects of the social care system,” he said, adding that there needed to be more clarity on “the price to be paid at other parts of the social care budget”.

The Government also came under renewed attack from the Labour peer, Lord Lipsey, a former member of the Royal Commission on Long-Term Care. He said the Prime Minister had pre-empted a long-running consultation on social care in order to win some short term popularity.

“In the middle of the consultation on that, in one of the most disorderly pieces of government I have ever seen in 40 years of political life, the Prime Minister has declared that it is government policy that people with severe care needs in their own home should be paid for in full,” he said. “I think that is a bad policy but I think it is also a bad way to do policy just to find a nice highlight for your Labour Party conference speech.

“What has happened is that into this very complicated but important policy process, has been injected something that is just a bit of a gimmick.”

Payments under threat

£89 a week Disability Living Allowance

A tax-free benefit for those who need help with care or have walking difficulties due to mental or physical disability. Worth up to £89 a week.

Verdict: under threat

£70 a week Attendance Allowance

A benefit handed to those aged 65 or over who need help with care costs. Those who qualify will receive up to £70.35 a week.

Verdict: under threat

£95 a week Incapacity Benefit

Given to those prevented from working due to illness or disability. Payment depends on what effect disability has on ability to work. Worth up to £95.15.

Verdict: safe, for now