| Previous Section | Index | Home Page |
10.12 pm
The Minister of State, Department of Health (Mr. John Hutton): I welcome the opportunity that the hon. Member for Sutton and Cheam (Mr. Burstow) has provided to the House to discuss an issue that is of very great importance to all of us. I congratulate him on the eloquent and considerably persuasive way in which he made his speech.
The issue is important to us, first, because most of us have elderly relatives, friends and neighbours. Secondly, many of us will, at some stage in our lives, be involved in the care of older people. Last--but not least--we are all getting older, and we are living longer. Already, one in five people in the United Kingdom is over 60. By 2020, we will have the highest percentage of people aged 60 and over in the European Union. It is essential that we ensure that older people are not discriminated against in the national health service and that they do not receive an inferior service simply because of their age. Therefore, services for older people are, and have been, a priority for the Government.
We know from patient surveys, for example, that older people are generally satisfied with the services that they receive from the NHS. However, there are spheres in which standards fall short of those that we should all like. Perceptions of age discrimination affect the confidence that users and carers have in the NHS.
I must emphasise as clearly as I can that any type of discrimination--whether it is on the basis of age, race or gender--is completely unacceptable in the NHS. In fact, discrimination contradicts the ethos and some of the basic principles on which the NHS was established 50 years ago. Action is and will be taken to challenge and correct such practices.
The hon. Gentleman mentioned the recent Age Concern report, "Turning Your Back On Us". The Government welcome publication of that thoughtful report and the contribution that it has made to the debate on the standards of health care for older people in our country. Recently, I had the pleasure of meeting Lady Greengross, the chief executive of Age Concern, and I gave her a very clear undertaking that we wish to work closely with Age Concern and others in addressing the issue of discrimination in the NHS.
Age Concern and others have called for an inquiry into age discrimination in the national health service. The hon. Gentleman repeated that call tonight. I fully understand the concerns that older people sometimes get a poor deal from the NHS. We have recognised those concerns and take them very seriously. In 1997, my right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson), who was then Secretary of State for Health, commissioned the Health Advisory Service 2000 to undertake an investigation into the care of older people in acute wards in general hospitals. He published the report, "Not Because they are Old" in November 1998--the hon. Gentleman might be familiar with it. The report made it clear that older people should receive the same quality of care from the NHS as younger people, based on clinical need, not on their age or where they happen to live. A health service circular was distributed to the chief executives of all health authorities and trusts, together with a copy of the report, requiring appropriate remedial action where the essentials of care were not being provided locally.
The Government followed up the report by putting in hand work to develop a new national service framework for older people, which we will publish later this year. That will be an important landmark for improving quality and equity in health care for older people. The hon. Gentleman asked whether the new national framework would address discrimination. I assure him that a significant section of it will address fair access to NHS services. He also asked whether older people would be involved in the planning and delivery of health care for their age group. We were very lucky to have the active participation of a group of older people and their carers in preparing the national service framework. Older people and their carers have been fundamentally involved in the preparation and development of the standards.
The national service framework will be an important landmark for improving quality and equity in health care. For the first time, it will set national standards and define new service models for the health care of older people. It will include performance measures for monitoring progress. Against that programme of action that we have already taken, a further inquiry into age discrimination in the NHS would not be helpful in solving the problems that older people face or perceive. We need action to tackle the issues. The important task is to concentrate on preparing for the implementation of the new national service framework to deliver higher quality services to all older people based on clinical need.
There are two further arguments to bear in mind on the issue. First, an inquiry along the lines proposed by the hon. Gentleman would almost inevitably take time, posing a real risk of delay in taking the necessary remedial action that he and others are rightly calling for. Secondly, his call for an inquiry rests in part on an assumption that the Government will not act unless such an inquiry finds evidence of unsatisfactory practices. He is looking for a means of forcing us into taking action to address his concerns. Nothing could be further from the truth or more divorced from reality. The Government are already committed to taking action to improve services for older people, as evidenced by the forthcoming national service framework and the development of a range of new intermediate care services designed specifically to meet the needs of frail older people. We have a range of other initiatives under way to improve health care services for older people.
I fully understand the hon. Gentleman's argument, but things have moved on. Now is the time to get to grips with solving some of the problems that he and others have identified, rather than rehearsing the case for an inquiry. We accept many of the criticisms that have been made and think that it is time to take action to address them.
Mr. Burstow: The Minister may have noted from the balance of my remarks that I was looking for action. Since the issue of "not for resuscitation" orders marked on records was highlighted in April, Age Concern has received information on 100 further cases. What action are the Government taking to stamp that practice out so that people are consulted before their records are so marked?
Mr. Hutton: We are very aware of some of the concerns that have been expressed about the policies and guidelines on resuscitation and we are carefully considering those issues to see if there is a need for further action. That is a fair point and we are alert to those concerns. It may be that we will need to return to that general issue. I accept the hon. Gentleman's case that we need to do more to involve older people in the debate about improving services and we are trying to do that in a number of ways. The work on the national service framework has been informed by older people and carers through two groups which we set up to ensure that the development of the NSF was informed by those who matter most--older people and those who care for them. I recently received a joint letter from Help the Aged and the Carers National Association on that point. It states:
- We wanted to write and express our appreciation for the way that older people and carers were involved in the development of the National Service Framework for Older People. We know that it is difficult to get these things right, but felt that their involvement in this case has been real.
We will involve older people in other ways as well. The expert patients taskforce, which is chaired by the Chief Medical Officer and which was established in November 1999, is a partnership of people who are living with chronic conditions, voluntary sector organisations working in this area, health and social care professionals
and carers' representatives. Organisations on the task force include Age Concern, Arthritis Care, the British Diabetic Association, and the Long Term Medical Conditions Alliance, many of which deal with chronic conditions that impact greatly on older people. In developing its recommendations about an expert patients programme, the taskforce has made access issues for older people a key considerationAs I said earlier, the Government intend to publish the national service framework for older people later this year. The NSF will enable us to work towards reducing variations in standards of care, but the volume of services is also important, and the significant investment we are making in the NHS enables us to ensure that we get services which are modern and which will reflect the way society is changing.
Earlier this year, we published for consultation "The National Beds Inquiry". It shows that, by comparison with a number of other European countries, the NHS is a relatively efficient user of beds, with comparatively low bed numbers. However, there is a wide variation in hospital bed usage between health authorities in the NHS. Interestingly, it has not shown any simple link between the number of acute beds, the management of emergencies, and elective waiting times.
All this evidence points to the need to take a whole-systems view of services, a point to which the hon. Gentleman rightly drew attention. Nowhere is that need clearer than in the case of older people. As he reminded us, two thirds of hospital beds are occupied by people aged 65 or over. Since the mid-1990s, half of the growth in all emergency admissions has come from people aged 75 or over, especially for conditions relating to the frailty and infirmity of very old people.
The hon. Gentleman is right to say that those findings require a different approach to the management of care in the NHS. NHS care has traditionally been about dealing with life's incidents, such as heart attacks and broken bones. Now an ageing population and increasing chronic disease means that NHS care has also to be about dealing with life's experiences, such as getting older and becoming frailer.
NHS care must therefore be modernised to reflect changes in society itself. The services that the NHS provides for older people are a vital part of that modernisation. At the moment, for too many elderly people, there is a lack of real choice. Many older people stay in acute hospital beds longer than they need to because they have not recovered enough to go home, but have nowhere else to go. What they need is intermediate care services to provide a new bridge between home and hospital.
Intermediate care will take many forms. Some services will be in specially designated hospital wards run by nurse consultants. Some will be in new facilities in the community, perhaps giving new purpose and life to cottage hospitals. Some will be about improved care services in the home.
My right hon. Friend the Prime Minister, in his speech in the House the day after the Budget, announced a new national plan for the NHS. One of the five key challenges he laid down was about partnership. I shall lead the team that will develop that section of the national plan, and we shall focus on partnership in the health, housing, and social care systems to make all parts of the system work
better together and ensure the right emphasis at each level of care. That is of particular importance for older people to ensure that they receive well co-ordinated care.All those initiatives focus on older people and will help us to build on the achievements and improvements that we have already made. We are making the biggest-ever investment in the history of the national health service, and the recent Budget announcement of real-terms increases of 6.3 per cent annually over the next four years will ensure that that investment takes place.
It is worth bearing in mind that that investment will allow the NHS to grow in real terms by a third by 2004. By any stretch of the imagination, that is a very significant investment in the NHS and its sustainability in the future. I believe that older people will be among the principal beneficiaries of that new investment.
The extra resources present us with a once-in-a-lifetime opportunity to transform the NHS radically. We have made a good start: a record number of hospitals are being built and every accident and emergency department that needs it will be modernised. Waiting lists are coming down. By the end of this year, patients with suspected cancer who are urgently referred by their GP to hospital will be seen within two weeks.
In addition, new chest pain clinics will do the same for patients with suspected heart problems. We are taking action to improve access to cataract surgery. Waiting times for hip and knee surgery--common conditions among older people--are falling. All of those developments are positive and welcome.
As the hon. Gentleman said, older people are the biggest users of health services. We want them to benefit from the new investment in the national health service. We have extended the annual immunisation programme for influenza to ensure that everyone aged 75 and over can have the flu vaccine free of charge. All people aged 60 and over are now entitled to free eye tests, regardless of income or health status. An estimated 5 million older people will have had free sight tests by April 2001.
Those are all very positive developments. They show the Government's commitment to improving services for older people, and disprove the contention that the Government are ignoring issues of age discrimination in the NHS. We are certainly not ignoring those issues.
| Next Section
| Index | Home Page |