Healthcare Rights for Older People (Hansard, 17 March 1997)

§ The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege)
My Lords, the Government do not intend to institute an independent inquiry because it is not and never has been government policy to withhold medical treatment on the grounds of age. Health Ministers have made it clear that whatever the age of the patient, there are no exceptions to the fundamental principle that the NHS is there to provide services for everyone on the basis of clinical need.

§ Lord Stallard
My Lords, I thank the noble Baroness for that reply. Is she aware that the research recently done by the national Nursing Times and Age Concern shows a completely different picture? Although the research is still not complete, they have proved that 20 per cent. of coronary care units operate age related admission policies and 40 per cent. restrict the giving of clot busting drugs to older people. Sixty-three per cent. of deaths from breast cancer are in women aged 65 or over, yet it is the older women who are not being given the same facilities for screening as younger ones; those at most risk are not allowed to be screened. Two thirds of kidney patients between the ages of 70 and 79 are not accepted for life saving dialysis or for transplants, and the president-elect of the British Geriatric Society has been quoted as saying that older people are under-researched, under-diagnosed, under-valued and sometimes over-drugged. Does not that give the lie to what the Minister said in relation to the Government's picture? And does it not mean that we are well overdue for an independent inquiry into the situation of discrimination against older people in hospitals?

§ Baroness Cumberlege
My Lords, no. When one looks at the resources that are put into services for elderly people, we have seen an increase in the number of consultant geriatricians, community nurses and home helps; around 40 per cent. of the hospital and community services are for people aged 65 and over. However, we agree that age should not be an indicator of quality of life or of intellectual prowess—one only has to look at your Lordships' House to see that. But clinical decisions must take into account the likelihood of a person recovering and their strength to withstand an operation.

§ Lord Milverton
My Lords, is my noble friend aware that, from my experience and from visiting hospitals while I was a parish priest, I cannot agree that there is any discrimination against older people? That did not appear to be the case on my recent visit to hospital for a fractured 652 kneecap, nor does it appear to be true that if one had a clot, one would be discriminated against by not being given the treatment for that.

§ Baroness Cumberlege
My Lords, my noble friend is right that if one looks at the operations that affect elderly people, particularly hip operations and cataracts, in each of the years before the reforms around 50,000 people had a hip replacement; yet last year alone 62,500 people had the operation—that is 12,900 more than in the years before the reforms. The situation with cataracts is even more pronounced. It would be wrong therefore to say that elderly people are not receiving treatment. My figures prove that they are.

§ Baroness Farrington of Ribbleton
My Lords, when the Minister says that a specific number of elderly people have been treated, are the Government referring to the individual people who have received treatment or, as is their policy, to the number of patients who have to return because they are sent home too early and therefore appear as new patients in the statistics?

§ Baroness Cumberlege
My Lords, the technical term is "finished consultant episode". That is often difficult to say on these occasions. In relation to cataracts, it is likely that the figures refer to individual people who have had an operation on one eye and may have to come back for treatment to the other eye. The same applies to hips.

§ Baroness Jay of Paddington
My Lords, is the Minister aware that the authoritative report referred to by my noble friend in his original Question includes therapies such as rehabilitative care, chemotherapy, palliative chemotherapy for people in the later stages of cancer, and so forth? They are not simply statistics about operations which can be referred to in this simple numerical way. Is the Minister aware that her Answer is slightly surprising because it throws scepticism on the report of an extremely authoritative body? If such decisions are being taken within the health service—and the report indicates that they clearly are—who takes them and at what level? Is this a policy decision or a complete fragmentation of the health service where all these decisions are taken by local trusts on a business basis rather than on the basis of any national criteria of care for elderly people?

§ Baroness Cumberlege
My Lords, the Government are clear that it is clinicians who should take decisions about clinical treatment. In May 1992 the General Medical Council made clear to general practitioners and doctors throughout the service that it was unacceptable to discriminate against any patient. It is right that consultants should take those decisions. The last thing we want is managers or lay people taking clinical decisions.

§ Baroness Jay of Paddington
My Lords, I must come back to the Minister and ask: is she concerned about what appear to be inappropriate clinical decisions being taken by doctors in relation to old people?

§ Baroness Cumberlege
My Lords, that is a matter for professional bodies.

§ Baroness Robson of Kiddington
My Lords, does not the Minister agree, for all her statements that there is no 653 lack of care for the elderly, that treatment varies enormously from district to district? It depends on where one happens to live whether a certain treatment is available. Can the Minister envisage, in the same way as parents move house districts where there is a good school, the whole of the elderly population moving into a district where the care is better.

§ Baroness Cumberlege
My Lords, the Government are fair in their allocation of resources to different health authorities. It is then up to the health authorities to decide how to spend those resources. In relation to general practitioners treating elderly people, we have weighted the system so that general practitioners receive a high capitation fee for elderly people. We have tried all those mechanisms. But I come back to the point that in the end it must be for consultants to make clinical decisions. It would be wrong if they did not take into account people's likelihood of recovery, their strength to withstand an operation or the quality of their life afterwards. That is extremely important. If the quality of life is not improved, then the treatment may be an unkindness.

§ Lord Stallard
My Lords, will the Minister accept that her replies today will be read with dismay by those taking part in serious research? They have already uncovered serious complaints which should be investigated. Even at this late hour, on the eve of a general election, cannot the Minister say something constructive as to how this Government intend to deal with those complaints rather than simply dismissing that serious research?

§ Baroness Cumberlege
My Lords, this Government have put more resources into the health service than any other government. What is more, they have made a pledge that for five consecutive years, if re-elected, they will increase the budget of the National Health Service. That is a pledge that the Opposition cannot match.