Age Limits on Health Care (Hansard, 16 February 1999)

§ Dr. Vincent Cable (Twickenham)

I beg to move, That leave be given to bring in a Bill to amend the National Health Service (Primary Care) Act 1997 to prohibit the refusal or delay of treatment on the basis of age; and to establish an inquiry into the prevalence of age discrimination in the National Health Service. I recognise that the Bill deals with a sensitive issue, and I propose it because I have been persuaded by organisations directly concerned with the aged—notably Age Concern, which has given me a great deal of help with the Bill—that there is a serious problem. That concern has been echoed by the Royal College of Nursing and the Chartered Institute of Physiotherapists, which also support the Bill.

The problem originates in the fact that we have an aging population, with a growing number of people over 65 using the NHS; they now account for 40 per cent.—and rising—of its budget. The NHS is, and always has been, constrained in its resources. There is growing fear, and evidence, that resources are being withdrawn from patients on the basis of age alone.

I stress that I present the Bill in a positive spirit. I am not here to point fingers or suggest that clinicians are behaving improperly, and I make no implied criticism of the Government or the previous Government. Indeed, the problem arises for positive reasons: because the NHS has been so successful in extending life, a growing number of people encounter the diseases of old age.

There has also been much advance over recent years in the treatment of the elderly in the NHS. I vividly recall one of my first jobs in the mid-1960s, working in the geriatric ward of a mental hospital. It was an horrific experience to see a large circle of old people, mainly ladies, sitting and looking at each other, inert, immobile and effectively waiting to die.

That contrasts with what happens today in the geriatric mental ward in St. John's in Twickenham and, I am sure, in many other places, where there are much better staff ratios and a much more professional and positive approach; it is a different universe. None the less, there is a serious problem, because there is a large gulf between the official policy on age in the NHS and what happens in practice.

The official position, as declared in the ethical statement of the General Medical Council, is that there should be no discrimination on age or any other grounds. That has been repeatedly echoed in the House. The former Prime Minister, the right hon. Member for Huntingdon (Mr. Major), when asked about the problem in 1994, said that it was undoubtedly the policy that the NHS should in no way discriminate on grounds of age. I am sure that the present Prime Minister would say the same.

Unfortunately, there is evidence that a great deal of such discrimination occurs in practice. NHS trusts run cardiac rehabilitation programmes, helping people who have had heart attacks—the same applies to strokes—to become mobile and independent again. I use this example because there is not much research on age discrimination in the NHS, but three recent studies on those programmes have shown clearly that, in 40 per cent. of them, an age bar is explicitly applied. People over 65 or 70—in some cases, 60—are specifically precluded from benefiting because they are too old, and for no other reason.

743 That is not only discriminatory, it is perverse in medical terms. If those people are helped to become more mobile and independent, they are less of a burden on social services when they leave hospital and costs are reduced. We are not talking about high-tech medicine: the programmes are relatively cheap.

Another example of discrimination is more emotive: screening for breast cancer. A great deal of attention has been given to the matter in an attempt to make the screening more comprehensive, but it is still the case that women over 65 are not invited to be screened, despite the evidence that two thirds of the women who die from breast cancer are over 65, and all the medical evidence shows that they benefit just as much as younger women from early detection and treatment. The implicit assumption is that their lives are less worth while.

Another example is more widely recognised. For many years, it was extremely difficult for elderly people to get access to kidney dialysis treatment, although again the medical evidence is that they can benefit from it as much as younger people. The problem has become a little easier, but the most recent evidence that I have seen suggests that only about one in eight of the people recommended for kidney dialysis is able to get access to the treatment.

Alzheimer's disease is a growing problem. At present, about 700,000 people have it, and the total will be well over 1 million in a decade. A chilling statistic is that one in five of people who live through their 70s will contract Alzheimer's disease. The death last week of Iris Murdoch will have reminded people of what the disease does to even the finest brain: sufferers lose their faculties, memory and dignity.

Yet Alzheimer's disease can be stopped. Drugs have been developed that can cure at least half of all cases, but they are being made available in only a relatively limited number of NHS trusts. The reason is primarily one of cost, although that again is a false economy: the £1,000 that a course of the relevant drugs costs is small compared with what people who are allowed to degenerate because of the disease cost their carers in the community.

To round off this list of anecdotes—to which I am sure that all hon. Members could add from their own experience—I shall offer an example that may be more trivial but that illustrates the mentality underlying the problem. Not long after taking office, the Government introduced a consultation paper called "Our Healthier Nation". It was quite enlightened, and was concerned with promoting fitness as a way to prevent ill health. However, it contained no reference to fitness targets for people over 744 65, and I asked a series of questions to find out why. The answers from Ministers revealed a complete lack of comprehension about why people over 65 might want to keep fit. It was assumed that such people were sedentary and that fitness was of no interest to them.

There are two elements to the underlying problem. The first has to do with economics—and rather bad economics at that. Health service trusts and clinicians, being strapped for cash, assume that one way to save cash is to withdraw treatment—especially expensive treatment—from elderly patients. In many cases, that is a false economy, as the costs then fall on carers and local social services departments.

However, the second element of the problem goes beyond economics and might be called a question of ideology, although it does not involve the ideology of left and right. It is the belief that most people share—I do not think that we are especially enlightened in this respect—that we are all entitled to a lifespan of three score years and ten. The belief probably derives from religion.

When my father died, 10 years ago, he had been prematurely evicted from hospital, and I am sure that that is why he died. It caused him to lose several years of doing what he loved most, which happened to be helping the Conservative party. I was angry about my father's premature death, but he was philosophical, saying that he had lived for 70 years and saw no reason to create a fuss. However, I think that he was wrong. Nothing binds us to Old Testament arithmetic: people now can—and should—live much longer. The question is whether they should live longer as fit and well people.

I have introduced the Bill to preclude discrimination in the NHS on grounds of age, to stimulate debate and to promote research on the subject.