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Mr. Hopkins: I have listened with great interest to my hon. Friend's speech. I am sure that a century or two ago,
when people were talking about registering voters for political elections as residents of particular areas or towns, all sorts of objections were made as to whether voters could be registered effectively and electoral registers drawn up. Does he agree that such objections represent an attempt to obfuscate a simple process and that, if people are registered on a particular day, the registers would stay in force for a year, just as they do for general and local elections?
Mr. McDonnell: It is interesting that the right hon. Member for Cities of London and Westminster referred to the origins of the City corporation. It was formed in mediaeval times by groups of workers who organised themselves into guilds so that they could exercise their rights of franchise in those guilds. That is not so different from what we request; we want workers to come together in their individual units to form an electoral college, which could organise a ballot to select and elect the voters who would qualify to vote for the City corporation.
With the greatest respect to the hon. Members who have mobilised those arguments, they have been used against every democratic advance made in this country over the centuries and, therefore, they must be rejected. We must say clearly that a compromise is involved if we cannot have full adult suffrage in the City corporation. Involving the work force in managing the City corporation represents a compromise that should be seized upon if it wants to portray itself as a progressive organisation.
No one has argued that there has been any difficulty registering businesses for a vote. What independent supervision of the registration of businesses is there apart from the rating list? It has been argued that ballots of employees could be fixed by moving a desk from one corner to another. The same could apply to businesses. They could build an extension to their office, and by so doing straddle another ward. I do not accept the arguments that have been expounded.
Amendment No. 77 concerns the business college, and provides an opportunity to address the issue raised by the right hon. Member for Cities of London and Westminster about businesses all being the same. In that amendment, I have tried to ensure that the business college represents and reflects the full range of businesses operating in the City. [Interruption.] I can tell from the mutterings that I have lost the House's attention, but perhaps I could draw hon. Members back to examining the critical issue of how to ensure the representativeness in the City of the business community.
Amendment No. 77 tries to establish within the electoral college certain constituencies of interest. I have suggested in the amendment that we should consider the Government's categorisation of business and industry. We could identify within that categorisation certain business operations and allocate them to those categories. If we allow a general franchise of businesses, the finance sector could dominate.
I want the business electoral college to reflect the full range of expertise in the City, so that it can be brought to bear on the management of the City corporation. That would bring benefits. The amendment would not only ensure that the financial sector does not dominate the business electoral college, but would draw in the other expertise to produce a balance. That means the lawyers, the accountants and a range of other facilities.
In our definition of qualifying bodies, we recognised that trade unions could become qualifying bodies because we are now assured that under the legislation they can be unincorporated bodies. That means that if trade unions are not accepted in the employee section, they could be included in the business college, because they are stakeholders.
I have also tried to overcome the problem of the residential vote being swamped. That is our biggest fear about the legislation. I have tried to do that by limiting the number of business voters elected from the business electoral college to no more than 2,000. That would significantly enhance the number of business voters, but would not allow the swamping of the residential vote, which stands at about 5,000 electors, although I am open to correction on that. [Interruption.] We have a real opportunity of establishing a business college that is representative, that will be able to create a business agenda for the City corporation in its own right and independently, reflects the different professions in the City and is not of such a scale, as it is currently, to overrun the residential vote. [Interruption.]
I plead your protection, Mr. Deputy Speaker, from the noise that is emanating from hon. Members. With my amendment, I want to try to tackle some of the abuses that we have described under the previous amendments, and in doing so to ensure that the business electoral college has independent--
It being Ten o'clock, further consideration stood adjourned.
Bill to be further considered on Wednesday 17 May.
CRIMINAL JUSTICE (MODE OF TRIAL) (NO. 2) BILL
- That, during the proceedings on the Criminal Justice (Mode of Trial) (No. 2) Bill, the Standing Committee on the Bill shall have leave to sit twice on the first day on which it shall meet.-- [Mr. Clelland.]
SCIENCE AND TECHNOLOGY COMMITTEE
- That Mr. Nigel Jones be discharged from the Science and Technology Committee and Mr. Paddy Ashdown be added to the Committee.--[Mr. McLoughlin, on behalf of the Committee of Selection.]
Age Discrimination (NHS)
Motion made, and Question proposed, That this House do now adjourn.--[Mr. Clelland.]
10 pm
Mr. Paul Burstow (Sutton and Cheam): There is nothing inevitable about illness and disability in old age. They are not synonymous. That is not to say that an ageing population does not present challenges; it certainly does. By 2031, nearly one in three of the population--some 18.6 million people--will be over 60. It is cause for celebration that, as we age, many more of us will continue to lead active and healthy lives, but it is inevitable that the number of people needing acute and long-term care will increase.
Change is needed in the national health service: a change in culture and mindset, and a change in organisation and practice. The NHS reforms of the 1980s and early 1990s created a breeding ground in which I believe ageism flourishes. More and more older people are being admitted to fewer and fewer beds for shorter and shorter stays; two in three general and acute-care beds are occupied by people over 65; more than half the recent increase in the number of emergency hospital admissions involved older people; and bed occupancy rates have more than doubled over the past 10 years in the geriatric sector.
The first step in eradicating age discrimination in the NHS is an acceptance that ageism exists at all levels of the health service. The Minister will know that the concerns I expressed this evening are echoed by Members on both sides of the House. Indeed, his hon. Friend the Member for Shrewsbury and Atcham (Mr. Marsden) introduced a ten-minute Bill, the Health Care Standards for Elderly Persons Bill, only last month to press the case for an independent national inquiry. I certainly believe that such an inquiry would have a part to play in addressing the concern felt by many outside the House.
As one of the sponsors of the hon. Gentleman's Bill, and as a co-chair of the all-party group on ageing and older people, I believe that the issue needs urgent attention. Both Age Concern and Help the Aged have collected evidence of ageism in the NHS, and the number of cases rose steadily. In its report "Turning your back on us", Age Concern discussed the findings of a Gallup poll carried out in March last year. It found that one in 20 people over 65 had been refused treatment, while two in 20 felt that they had been treated differently since they turned 50.
Even the Department of Health has found evidence of discrimination. A review of renal services revealed that as many as two thirds of kidney patients over 70 had been refused dialysis or transplants. More recently, the spotlight has fallen on the use of "not for resuscitation" orders. The British Medical Journal recently drew attention to a gap between guidelines and practice in the use of such orders. An article in the issue of 29 April refers to an independent review. Following a complaint by the family of an elderly woman who had died in hospital, the review stated:
- It was hard to avoid the conclusion that the treatment plan . . . was to do little more than allow the patient's life to ebb away.
Research has found that more than two out of three patients with NFRs are not involved in making that decision. More worrying still is the finding that labelling patients "not for resuscitation" makes them 30 times more likely to die--and with no say in the decision. That cannot be right or acceptable. I hope that the Minister will be able to say something about what the Government are doing to stamp out such an immoral practice.
The need for action at all levels of the NHS to tackle ageism was brought home to me by the case of Mrs. Marge Terry. When Mrs. Terry, described as an "elderly and alert lady", was admitted to St. Helier hospital last September with breathing difficulties, she had every reason to expect to be quickly discharged and back in her home at Bawtree house, a residential home in my constituency. Mrs. Terry, who was 91-years-old, never recovered. After four weeks and five ward changes, she died.
A catalogue of neglect has prompted Mrs. Terry's daughter, Mrs. Eileen McAndrew, to speak out. During those four weeks, the NHS let Mrs. Terry down. Cleaning was inadequate. Bedside cabinets and tables were left sticky and dirty. Bins were left full to overflowing with tissues and other waste. Her records were not kept properly. Address details were wrong. Her age was recorded incorrectly three times in the same notes. She was left sitting in bed in a nightdress and bedjacket badly soiled with blood.
Mrs. Terry waited four days to see a doctor after developing a serious chest infection and a further two days for an X-ray. Soiled bandages were left lying on her bed. She was given little help with eating and drinking. As a result, food was left to go cold. Staff blamed her for that, describing her as unco-operative. She was even left to take her own medication.
On Saturday 9 October, the hospital phoned Mrs. Terry's daughter to come in as quickly as possible. Sadly, Mrs. Terry died minutes before she could get there.
Mrs. McAndrew put it in the following terms:
- In the four weeks my Mum was in St Helier Hospital, I saw her deteriorate from an elderly alert lady, who used an electric wheelchair and kept me on my toes, to an old frail weak 91 year old going on 100, who kept asking me to take her out of here.
Mrs. Terry was robbed of her dignity. That was clearly not the intention of any of the staff at the hospital, but it was the result. I want the trust to commit itself to a wholesale review of the way in which acute care is provided for older people. I hope that the Minister will ensure that such a review is undertaken.
What needs to be understood in cases such as Mrs. Terry's is that, although the health needs of most older people are the same as everyone else's, the oldest old people often have a complex mixture of problems and
symptoms. A medical profession that is increasingly specialised often poorly meets their needs. What is needed is a people-centred approach. By people-centred, I mean an interdisciplinary team-work approach. Therefore, medical and nursing education needs to take that on board.In the early 1970s, the British Medical Students Association called for a joint core curriculum for all health professionals to achieve just that end, but the opposite has happened. Increased sub-specialisation has created a generation of doctors who are ill equipped to deal with the complex, multiple needs of older people. Reforms to undergraduate medical education are squeezing training in geriatric medicine out of the curriculum altogether.
Last Thursday, my hon. Friend the Member for Richmond Park (Dr. Tonge) highlighted the need for a concerted effort to tackle poor hygiene and cleanliness in our hospitals. With two in three acute beds occupied by people over 75, and the fact that hospital-acquired infections make death as much as seven times more likely, there is a crying need for investment in the cleaning of our hospitals. Saving through cheap cleaning contracts is a false economy as the cost to the NHS of hospital-acquired infections has risen to some £1 billion a year.
Last week, I visited the Florence Nightingale museum at St. Thomas's hospital to mark the 180th anniversary of that great reformer's birthday. When it comes to care and to hospital cleanliness, it seems that many of the hard-learned lessons that Florence Nightingale taught us have been forgotten. She introduced simple hygiene measures, scrupulous cleanliness and effective nurse training. All of that is described in her book, "Notes on Nursing" and in many letters and other writings. She said:
- It may seem a strange principle to enunciate as the very first requirement in a Hospital that it should do the sick no harm.
The key findings of Help the Aged's report were, first, that to create a "positive culture of care" that values older people, the needs of both patients and staff must be addressed. Secondly, staff motivation is central to the delivery of a high standard of care. Help the Aged found that the motivation and morale of staff and their leadership had a direct effect on the quality of the care provided.
The report identified six factors that are essential if we want to protect the dignity and to promote the recovery of older patients: a sense of security, of significance, of belonging, of purpose, of continuity and of achievement. Although, as Help the Aged has acknowledged, those six senses need further refinement, they provide a conceptual framework for understanding what matters to patients.
Help the Aged also identified some basic prerequisites for staff to deliver better services, the first of which is adequate staffing levels. Low staff numbers leads to a lower quality of care, as staff do not have the time--and, often, the inclination--to do what is necessary to provide a positive culture of care. They are simply too busy. The second prerequisite is adequate resources for staff to perform their roles. Effective medicine requires sufficient basic equipment to provide care properly and effectively.
The third prerequisite--it is probably the most important of all--is effective leadership to create "zero tolerance" of bad practice.Clearly, the national service framework for older people, which is expected in July, will be crucial in driving forward change and driving out ageism. I hope that it will incorporate the model described in dignity on the ward. Will the Minister tell the House whether the framework will explicitly challenge ageist assumptions in the NHS and force practitioners to re-evaluate what they do? Will it require older people to be involved in the commissioning and design of services? Will it place multi-disciplinary working at the heart of good patient care? Will it make it clear that there is no place in the NHS for age-based rationing?
I believe that, even when the national health service's national framework is in place, there will be a need to make ageism illegal. Just as the House has legislated to protect the rights of ethnic minorities and disabled people, it is now time for us to protect older people. Outlawing age discrimination would not entail older people receiving treatment that is of no benefit to them or having treatment imposed on them against their will. Anti-discrimination would simply make doctors think more than they do now before refusing treatment for an older person.
What older people need now is tough anti- discrimination legislation, a national service framework that is people-centred and well-resourced, and a change in medical education, that equips our doctors with skills and understanding to work with older people. By ensuring that our health service is fit for older people, we make it fit for everyone. Quite simply, there can be no place for ageist assumptions in the NHS. Ageism must be met with zero tolerance.
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