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Lord Clement-Jones moved Amendment No. 13:

(1) It shall be the duty of any person or body exercising functions or otherwise providing services within the National Health Service to prevent discrimination by reason of age against any class of persons receiving services from the National Health Service except where clinically justified.

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(2) It shall be the duty of any prescribed NHS body to publish an annual statement of the measures they have taken to prevent discrimination on the grounds of age against any class of persons receiving services from the National Health Service."

The noble Lord said: Aficionados of health Bills—that word is not out of place; we have had a health Bill every year since this Government came to office—will recognise that Amendment No. 13 is similar to amendments tabled to each of the previous health Bills. I make no apology for that. One in five of us is aged 55 or over and 42 per cent of NHS resources is devoted to older people. If we do not get our health service right in relation to older people, we are failing horribly not only in human terms but also in the waste of resources.

In the recent past the Secretary of States was quoted as saying,

    "I will not tolerate anything which smacks of age discrimination in the NHS".

But the fact is that this Government, to date, have not done nearly enough to prevent it. Before they came into power in 1997 they promised an investigation into age discrimination in the NHS. The grounds for such an investigation were obvious. It was clear that there had been restrictions on heart bypass operations, heart transplants and cardiac rehabilitation for older people. Kidney dialysis and transplants had been refused to patients over the age of 70 and there are no public health fitness targets for those over the age of 65 in Our Healthier Nation.

That is just a snapshot of some of the problems that could have been investigated at the time. But that inquiry never took place. A succession of reports from voluntary organisations and official bodies since 1997 have shown the presence of age discrimination in the health service. The national confidential inquiry into perioptic deaths in 1999 referred to staff shortages and lack of experience leading directly to the deaths of older people.

An Age Concern survey of 1,000 patients at the end of 1999 found that health was a key concern of older people. But its survey of GPs at the same time found that 77 per cent said that rationing on the basis of age was taking place in the NHS. Another report by Age Concern, Speaking Out, which was published in November 2000, showed that ill-treatment and discrimination against the elderly was still rife at that time.

A report published in 2000 by the Association of Community Health Councils on accident and emergency departments demonstrated horrendous discrimination against older people. Elderly patients are rushed to hospital but are then left to wait on average far longer than younger patients to die on trolleys.

The King's Fund report, Old Habits Die Hard: Tackling Age Discrimination in Health and Social Care, was published earlier this year. So it is not just reports of 1999 and 2000 which illustrate age discrimination; the King's Fund report was published earlier this year. It illustrates the belief of senior managers that age discrimination is endemic in the health service. Three out of four senior health and social care managers

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believe that age discrimination exists in their local services. Help the Aged's recent report, Age Discrimination in Public Policy, is a review of evidence of discrimination and was published this month.

The National Service Framework for Older People by itself is not enough. It is welcome and of course the Government are relying on it as an alternative to legislation. But we need to create a positive legal duty and a positive culture of care. It is not only a matter of resources; above all, it is a matter of respect. That should be enshrined in legislation.

As I have said, we on these Benches have argued on previous occasions, both in respect of the Health and Social Care Act and the Care Standards Act, that such a duty should be on the face of legislation. This Bill presents another opportunity for the Government to accept the need for a clear duty not to discriminate. It is clear that the voluntary approach is not working. Older people are still receiving second rate care. We need to ensure, as a matter of legislation, that training takes place and staff in the NHS recognise the need to comply. I beg to move.

Lord Turnberg: I am sorry that I am unable to support the amendment of the noble Lord, Lord Clement-Jones. I say I am sorry because, in my advancing years, I am second to none in my wish to see age discrimination banished from all walks of life, not least in the health service. So I am right behind, indeed somewhat ahead, of the noble Lord in the principle behind the amendment.

My problem is in working out whether this principle should be on the face of the Bill. I fear that it should not, otherwise we would have to include discrimination on all sorts of grounds—colour, creed, race, religion, all of which are vitally important. Discrimination on any of those grounds is equally abhorrent.

We would have to be clear, therefore, that discrimination of any type is not approved. So, much as I should like to see this provision on the face of the Bill, I regret that I cannot support it.

Baroness Pitkeathley: I too must speak against this amendment, not because I am in any way opposed to age discrimination but for the reasons put forward by my noble friend.

Discrimination of any kind is utterly unacceptable in the NHS. However, amendments to a Bill is probably not the way to ensure that we tackle age or any other kind of discrimination. A framework already exists for tackling this problem in the National Service Framework for Older People. There is already evidence that that is working well for the benefit of older people.

In my prolonged stay in hospital last year, I saw no evidence at all of any kind of discrimination against older people because each patient—at least in my ward in the Middlesex hospital—was treated with dignity, respect and courtesy as well as with clinical expertise, based not on the patient's age but on their clinical

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needs. How that operates in the ward is not by legislation, but by the training, experience and attitude of all staff. Attitudes are set and changed by committed leadership and example and by staff working in a climate which is so respectful of individual patients that discrimination on any ground is simply unacceptable.

Earl Howe: I have a great deal of sympathy with this amendment. The Government's national service framework for older people, published a year ago, was filled to the brim with sound principles and good, sensible practice. It was widely and deservedly welcomed among managers in the health arena, and indeed in social care. Nevertheless, when one speaks to many people in the health service there is a perception that the legacy of ageist attitudes from the past continues to cling on, if only in odd corners.

I admit that evidence of ageism is elusive and anecdotal. But the feeling emerged very strongly from the recent King's Fund study that unless there are the proper resources and support available for managers trying to implement the national service framework, it would be very difficult to promote and foster what is quite a complex policy on as wide and as thorough a basis as is necessary. Rates of progress in implementing the national service framework vary considerably around the country. The King's Fund argued that motivation to tackle age discrimination would be a great deal strengthened by the creation of a legal requirement to promote age equality. One has at least to stop and listen to that view coming from that source.

Against that backdrop it has to be said that there is even the odd Cassandra taking part in this wider debate. Recently, Malcolm Johnson, who is director of the International Institute on Health and Ageing at Bristol University, expressed the view that the Government's pledge to stamp out ageism in the NHS is doomed to failure because of a lack of staff and resources. For example, he has spoken about the low priority generally given to chronic illnesses and the lack of checks and screenings for older people as evidence that ageism in health care is endemic. He was also quoted as saying that the training of most practitioners contains very little about older people and that in the minds of healthcare professionals there is an inbuilt hierarchy of priorities which is hard to shift. Those are the things which he said stand in the way of rooting out ageism.

I do not believe that I would classify myself as quite such a pessimist because I believe that clinicians and managers are much more alive to the issues of discrimination than they perhaps were a few years ago. But I believe that there is still work to do. We need to involve older people themselves in looking at the various policies which have a disproportionate effect on older people and hear what they think about them. We need to examine those specialist services which are aimed mainly at older people and make sure that there are no unacceptable disparities around the country in

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terms of access to treatment and support. Incidentally, I wonder how the new NHS structures will facilitate that process of comparison.

I turn to a particular hobbyhorse of mine. We need to look at hospices and specialist palliative care services, where the degree of public funding has been allowed to slip in recent years to levels that make it very difficult for many hospices to continue functioning. I hope that the Minister will be able to give his own insight into these very important issues.

7.15 p.m.

Baroness Thomas of Walliswood: Perhaps I may make a small additional point. The noble Baroness, Lady Pitkeathley, and other speakers, have referred to the need for equal treatment in the sense of equal respect given to patients of different ages. But that is not necessarily what we are talking about here. On a number of occasions we have discussed in this House the problem of ensuring that older people get the right food when in hospital. It is to that kind of thing as well as to those matters raised by the noble Earl, Lord Howe, that those responsible should direct their attention when spending 75 per cent of the funds directed at NHS secondary care. Their influence could be very strong in ensuring that hospital trusts in particular pay attention to the special needs of older people and not so much to the need for respect.

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