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Baroness Finlay of Llandaff: I wish to speak very briefly to this amendment because it highlights an extremely important issue, which is that discrimination against any group cannot be condoned in any way. Sadly, with limited resources, there is always some form of rationing. But it really must not be at the expense of any single group.
Perhaps I may take up the point made by the noble Earl, Lord Howe. The hospice service is now providing a core service to patients, which relieves the NHS of some statutory functions, yet it does not even receive 50 per cent funding for the core service delivery of specialist palliative care. It is not frills in the service, but core care for people in need. It is worth remembering that money spent on small items—such as ensuring that patients have the dentures they need, as these are rapidly realigned if they do not fit; that they have the mobility aids that they require installed in their own homes to allow them to get home—could result in cost savings at the end of the day rather than increased expenditure.
Therefore, I suggest that the spirit of the amendment is excellent but, sadly, it addresses age only. There are many other groups within our population who have disabilities of different kinds and who also experience a degree of discrimination or who believe that they are discriminated against. Possibly, the proposed patients' fora and the community health councils, which I am delighted to say we are retaining in Wales, should be charged with ensuring specifically that this type of discrimination does not occur.
Baroness Carnegy of Lour: When the Minister replies can he answer one question for me? In a number
of GP practices I know, when one telephones for an appointment one is asked for one's date of birth. Is that usual and what is the reason for it?
Lord Hunt of Kings Heath: From nodding heads around the Chamber, apparently it is quite usual for some practices to ask for that information. I do not know the reason for it. It may be sought as part of the identification. Quite often one is asked for a date of birth, along with the postcode, for identification purposes. I cannot supply any more information on that.
This is a very important debate. Noble Lords have debated the issue of discrimination against older people in the health service on a number of occasions. However, I say to the noble Lord, Lord Clement-Jones, who a few minutes ago was an arch de-centraliser, now in a very centralist directional mode—
Lord Clement-Jones: But the noble Lord realises that on devolution of any kind national standards are of great importance.
Lord Hunt of Kings Heath: I am glad for that support of government policy. This is a very important matter. I believe that the government's approach, which is essentially through the national service framework which many speakers have mentioned, is the right way forward. That framework sets out a number of standards for older people. The first states,
- "NHS services will be provided, regardless of age, on the basis of clinical need alone. Social care services will not use age in their eligibility criteria or policies to restrict access to available services".
We have recently completed an analysis of the audits of age-related policies required by the framework. That has shown that age-related policies are normally based on clinical evidence. In nearly all other cases reviews of the policies are being undertaken or action has already been taken.
Noble Lords have referred to the excellent King's Fund report on age discrimination, and as was recognised in that report, there is little consensus or clarity on the meaning and consequences of age discrimination. I have no doubt that more work needs to be done as the NSF programme develops. Guidance was issued to inform the age-related audits of written policy in the National Health Service. Additional tools need to be developed to assist in the auditing of policies
on implicit age discrimination and on the national benchmark of access to the services and treatment that are important for older people.Age discrimination is complex and cannot be addressed overnight. It may manifest itself in a number of different ways—I agree with the noble Lord, Lord Clement-Jones on this. Those ways might include low overall rates of provision of those interventions that are relatively more important for older people, such as hip and knee replacement, cataract surgery, occupational therapy, chiropody, community equipment, assistive technology, hearing aids and National Health Service dentistry, to acknowledge the comments made by the noble Baroness, Lady Finlay. Age discrimination may show itself in low relative rates of access of older people to specialist services compared with younger people or refusal of particular treatments, such as revascularisation or expensive drugs. There may be low referral rates to particular services or, indeed, unthinking or insensitive treatment from individual members of staff. We would all have to acknowledge that there are examples of that within the National Health Service. I should make it clear that the aim of the national service framework is not to favour older people over other age groups but to ensure that they are treated as individuals. Some progress has been made.
The noble Baroness, Lady Thomas, talked about the issue of food in hospitals. I well recognise that that has been an issue both in terms of the nutritional value and whether older people actually eat enough. Past evidence has shown that they do not. There is also the matter of how meals are organised on the ward and whether nursing staff monitor that individual patients are either feeding themselves or are given assistance if necessary. We are making progress. The chief nursing officer has written to individual nurses to remind them of their duties in that respect. The work that we are doing on a national menu will improve the overall substance and nutrition of the food provided in the National Health Service.
The work on phasing out mixed-sex wards again is an example of responding to issues raised by older people. We published new guidance on resuscitation policy and we have said that decisions not to resuscitate should be made on a case-by-case basis. A blanket do-not-resuscitate policy based on a specific patient group such as older patients is unacceptable. The health service recognises that surgery is becoming safer and new techniques and treatments mean that more people can receive treatment, including older people for whom surgery may not previously have been an option.
When breast-screening programmes were first set up in 1988 evidence suggested that older women would not accept screening invitations, so they were not included in the routine recall programme. Government-funded pilot studies have now shown that extending routine invitations for breast screening to women aged 65 to 69 is both feasible and cost-effective. Noble Lords will know that we are extending the programme as a result.
More generally, the noble Earl, Lord Howe, raised the question of how to involve older people in decisions about their treatment and, more generally, in ensuring that the National Health Service is fully aware of their needs. Patient forums are one way of ensuring that, close to where services are provided, there is input from older people and others to ensure that some of these issues are raised.
On the matter of hospices and special palliative care, I acknowledge their vital role and the partnership required between the National Health Service and the independent care sector. Noble Lords will know that we have made various announcements in the past few months concerning the provision of extra resources and by encouraging the health authorities locally to develop palliative care policies in which independent care provision becomes fully part of the overall strategy and policy of that area.
To answer the question asked by the noble Baroness, Lady Carnegy, it has been confirmed that date of birth is always requested for identification only and not for any other reason.
In conclusion, I echo the points made by my noble friends, Lord Turnberg and Lady Pitkeathley that there is all-round support for the intention behind the amendment, but I do not believe that legislation is the right route. We are making progress; there is a lot to do, but the national service framework provides the best vehicle for doing so.
Lord Clement-Jones: I am grateful for the support—at least for the intention behind the amendment, as the Minister put it—and for the fullness of the Minister's reply.
I confess to being slightly disappointed at the response of the noble Lord, Lord Turnberg, to the amendment. It is one of those tuppence coloured, penny plain issues. If I offer penny plain, which is the age discrimination issue, that is far too narrow; so it is not comprehensive enough in its anti-discrimination provisions. If I offer the tuppence coloured, which is a general duty of equity within the health service, that is far too blanket in its nature and could be shot down for being too vague and covering far too wide a group of patients. I do not think that one would win in that kind of argument, so I shall not base too much credence on the fact that a legal duty is an inappropriate way of proceeding.
I ask those who are not in favour of a legal duty to say what they would do if I were to come back in a year's time, when I am sure we will have yet another Government health Bill, and say that the national service framework has not been working. Will the Minister say when he believes evidence of compliance will be made available under the NSF? He said that the health service would be monitoring compliance and it is therefore incumbent on Ministers to produce that evidence regularly and say when it will be available.
I take as my model—a campaigning model to some degree—the noble Lord, Lord Morris of Manchester. He has no hesitation in bringing forward a proposition time and time again—in fact, every six months. I am being moderate in introducing mine only once a year.
The noble Lord, Lord Morris proposes compensation for haemophilia patients who contract hepatitis C—and quite rightly. I am confident that noble Lords who are sceptical of imposing a legal duty will eventually realise that the national service framework is not enough. Let us see how the national service framework will work in practice and monitor compliance.
The Minister himself does not appear to be too confident. He referred to "some progress", which is not a resounding accolade for progress on the national service framework.
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