NHS still ageist after all these years

In his book The Age of Aging, the influential economic adviser George Magnus cites JK Galbraith’s theory of the “still” syndrome, in which questions such as “Are you still working?”, “Are you still taking exercise?”, “Are you still drinking?” are raised by younger people to remind older people that they will soon depart from activities that society considers normal.

Galbraith recommended using the retort “I see you are still rather immature”, but his still syndrome is alive and well in Britain today.

Although most people claim to have a positive attitude to people over 70, the government’s equalities review found that, scratching below the surface, people over 70 were seen as friendly but incapable and often the subject of pity. When health professionals do not check their responses to older people, the effects can be devastating.

Age discriminatory rules persist in many health services. Services for older people with mental health needs are under-resourced and not joined up across health and social care. At the age of 65, people may be transferred from “adult” mental health services to services for “older people” even when their needs have not changed.

Such blind age restrictions mean older people are less likely to have access to talking therapies, out of hours services or innovative services developed for younger adults, such as crisis resolution. The relatively high suicide rate among people over 75 clearly shows the need for better mental health services for older people, yet the national suicide prevention strategy does not focus on this need.

In acute healthcare, despite the 2001 national service framework for older people promising that NHS services would be provided “regardless of age on the basis of clinical need alone”, ageist attitudes and rules prevail. Research suggests that treatment for minor strokes is covertly rationed for people aged over 80 and doctors are less likely to refer angina suffers to see a specialist or have tests if they are over 65.

There has been some progress. Age Concern’s Hungry to be Heard campaign highlighted the scandal of malnourished older people in hospitals, and through the Care Quality Commission the issue of nutrition looks set to become a registration requirement for all health and social care organisations.

Legal challenge

Some ageism could be immediately addressed by changes in policy; some relating to change in practice may take a little longer.

Health organisations must start planning for government action on age discrimination beyond employment.

For while the Health Bill, announced in the Queen’s Speech in November, has rightly been the focus of much debate, the Equality Bill, which did not receive as much commentary, will have far reaching benefits for older people, the main adult users of the NHS. Government intends to use it to introduce regulations to outlaw unjustified age discrimination in the provision of all goods, facilities and services - including in the public sector. It has also pledged a public sector equality duty that includes age equality.

When age discrimination regulations and the new public sector equality duty become law, age based rules and practices in healthcare will no doubt be reviewed. If there is a good clinical reason and an objective justification for age restrictions on certain treatments or services, they will remain. But the challenge to the Department of Health and all healthcare workers will be how they can ensure the health service responds properly to the views and needs of older people.

With the legislation, the idea that patients are “too old” to access health services such as rehabilitation or consultant referrals could be legally challenged. Many patients will not want the hassle of pursuing legal avenues, but they will have the right to challenge ageist assumptions.

Some may question whether a legislative approach is best. But both Age Concern and Help the Aged believe changing the law is important. In equality areas such as race and gender, changing the law has helped to change practice and, in turn, attitudes. A change in the law would also give older people a greater sense of entitlement to all health services that improve their quality of life.

Older people should have the chance, along with all other patients, to ask questions, exercise real choice and expect equal treatment, to challenge the “still” syndrome with the answer: “I am still here, still enjoying life, still entitled to the same care as anyone else and I still want you to treat me equally!”