Care for the Elderly (Hansard, 19 January 2000)

§ Baroness Seccombe
asked Her Majesty's Government:
Whether present levels of care for elderly people in the National Health Service are adequate.

§ The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath)
My Lords, the Government are committed to a programme to ensure fair access to consistently high standards of care across the NHS. For older people, we are currently engaged in identifying where improvements are needed.

§ Baroness Seccombe
My Lords, I thank the Minister for that Answer. But does he agree with what I perceive to be a frightening practice of asking elderly patients entering hospital whether they wish to be resuscitated in the event of their heart stopping?

§ Lord Hunt of Kings Heath
My Lords, the noble Baroness raises an important question concerning the information which is made available to patients and the desires that patients are able to express about the treatment that they are to receive. It is right that we should listen to what patients say in those circumstances.
I suspect that the noble Baroness raises a wider issue concerning the withholding of treatment and she will know that BMA guidelines are available which make a thoughtful and useful contribution. At the end of the day those matters lie within the clinical responsibility of clinicians. At times they have to take extremely difficult decisions and it behoves us all to support them in that.

§ Lord Clement-Jones
My Lords, I am sure that the Minster will agree that the availability of high dependency and intensive care beds is of crucial importance to the care of older people. Indeed, they claim to have increased the numbers of high dependency and intensive care beds. Why is it, therefore, that they have held back the results of their own internal review into those beds? Is that the Government engaging in deceit or is it the product of ignorance?

§ Lord Hunt of Kings Heath
My Lords, it is neither. We have indeed set up a national beds inquiry to look at the NHS as a whole to see whether the distribution and number of beds are appropriate and adequate to the needs of the health service. My understanding is that work on that inquiry is still ongoing but is nearing completion. We should certainly hope to publish the results shortly.
1117 As regards the noble Lord's suggestion concerning the number of intensive care beds and high dependency unit beds which are available, I reiterate the point that the Government have already made. We have made available 100 extra beds this winter.

§ Baroness Masham of Ilton
My Lords, does the Minister agree that there is a place for community cottage hospitals in the nursing of elderly people near their homes when they have conditions such as chest infections and flu, as has been experienced lately? Does he agree also that some elderly people become confused? It is difficult to nurse them and nurses should be trained to give a little more TLC to those who are elderly.

§ Lord Hunt of Kings Heath
My Lords, nurses do a magnificent job. While we are committed to improving the education, development and further education of nurses, we owe a lot to them and the contribution they make, often in difficult circumstances. I am surprised that the noble Baroness did not invite me to visit a community hospital, as she usually does on these occasions. I acknowledge the enormous contribution that they can make. Where they have the support of local primary care groups, GPs and other staff, they also have a valuable contribution to make.

§ Baroness Miller of Hendon
My Lords, will the Minister return to the first answer he gave to my noble friend regarding the question that is sometimes asked of elderly people when they go into hospital? I understand that the Minister cannot discuss personal cases, but will he accept my assurance that my mother was not simply given advice? When she arrived in the A&E department, after having been told that she had not suffered a heart attack, she was asked whether, if her heart stopped during her overnight stay, she wished to be resuscitated or whether she should be left. Does the Minister agree that that is a frightening question to ask an elderly lady? Does he accept also that, after protesting in writing, I received a letter from the hospital to say it was national policy to ask that question?

§ Lord Hunt of Kings Heath
My Lords, I am always prepared to investigate individual issues and will be happy to do so in this case. I am not aware of a national policy as to how these matters should be approached and am prepared to look into that, though I am surprised by what the noble Baroness was told.
Delicate issues surround this area which have to be dealt with sensitively. That is why the BMA guidelines on the withholding of treatment are an important contribution to that debate. It is right also that every adult with the mental capacity to make their own treatment decisions should have the right to refuse medical treatment if they so wish. However, the question as to how they discuss that with clinicians must be handled with care and sensitivity.

§ Lord Harris of Haringey
My Lords, is my noble friend satisfied with the progress made in the 1118 elimination of mixed wards for older people? Is he confident that that progress will be maintained in the future in the light of the review that he mentioned in his Answer to the initial Question?

§ Lord Hunt of Kings Heath
My Lords, I am aware that for older people, as well as for most patients in the NHS, mixed sex wards have proved to be wholly unacceptable. We are committed to ensuring that those wards completely disappear by 2002 and are working towards that.

§ Earl Russell
My Lords, when the Prime Minister at the weekend said that he would bring health service funding up to the level of the European Union, was that a promise or an aspiration?

§ Lord Hunt of Kings Heath
My Lords, the Government gave a clear commitment in their manifesto to increase investment in the NHS in real terms year on year and put that money towards patient care. That is what we have done. The Government acknowledge that levels of investment and intervention are not up to the levels of our European neighbours. The Prime Minister clearly signalled his readiness to tackle that and honour the commitment made. Already next year the proportion of national income spent on the health service is set to rise to 6 per cent for the first time ever.

§ Baroness Strange
My Lords, is the Minister aware that in England and in Scotland, and possibly also in Wales, elderly patients occupy hospital beds because they are not able to afford nursing home fees and there is currently not enough money to service them in their own homes?

§ Lord Hunt of Kings Heath
My Lords, I am aware of those problems. That is one of the reasons why the Royal Commission on Long-term Care was set up. We are considering its recommendations and the financial implications of those recommendations.
A number of factors lead to difficulties of discharge of patients from hospital, partly to do with problems in ensuring that the right community services are available. The co-operation now taking place between the NHS and local government is bearing considerable fruit. From April of this year the use of pooled budgets and new flexibilities will lead to improved co-operation and enable us to ensure that the services required in the community are available. Thus some people will not to have to go into hospital in the first place; but those who do will be able to be discharged as soon as they are able.