SECOND OPINION
deliver services, the NHS is giving second best to people in later life.
This second rate treatment extends to health outcomes. A recent report commis- sioned by the Department of Health con- cluded that ‘evidence of under-investiga- tion and under-treatment of older people in cancer care, cardiology and stroke is so widespread and strong that, even taking into account confounding factors such as fragility, co-morbidity and polypharmacy, we must conclude that ageist attitudes are having an overall impact on investigation and treatment levels’.4
When set in the context of the UK’s com- paratively poor record on mortality rates for older people in many treatable disease areas, for example cancer, this is damn- ing indeed. While we welcome the shift to health outcomes, it is extremely disap- pointing that many of the indicators in the current draft of the NHS Outcomes Framework propose upper age limits even where there is evidence that ageist atti- tudes are having an impact on diagnosis and treatment.
At the same time, we know that other parts of the health service are set up in a way that discriminates against older patients. Many services of primary benefit to older people, such as falls prevention, inconti- nence and audiology, are under-funded and under-prioritised by commissioners.3 We are also aware that older people face discrimination in accessing mainstream services, as for example mental health services. In addition to which, there are simply service gaps for many older people. By failing to adequately commission and
The NHS Outcomes Framework should challenge ageist clinical assumptions not embed them further. Age UK will press to see these age limits removed so people of all ages benefit from the reforms.
These examples highlight a culture of in- stitutional ageism which isn’t always obvi- ous, but is ingrained within almost every aspect of the NHS. These direct and indi- rect forms of ageism are actually condemn- ing older people to early deaths and often extremely poor treatment. To break down
these barriers and to meet the needs of our ageing population, the entire system needs to change. We need a fundamental change in the patient journey which places much greater emphasis on holistic care and the patient’s experience. Training and profes- sional development needs to reflect who the NHS is actually serving. Age UK is also calling for a review of how the NHS assess- es, prioritises and commissions services to meet the needs of people in later life.
The forthcoming reorganisation of the NHS provides an important opportunity to realign our health service to meet the challenges of the next 60 years by putting older patients at the heart of these reforms. As the NHS approaches its 65th birthday, its time it realised that most of its patients already have.
1 ‘Rewarding but not much Kudos: Results of the National
Medical Student Survey on Attitudes to and Perceptions of Geriatric Medicine’. Tim Robbins and Adam Gordon. Responses from 1,562 students from 29 medical schools. 555 (40.6%) respondents would possibly under- take a career in specialty while 92 (6.7%) would probably
or definitely do so. 2
‘Are we teaching our students what they need to know
about ageing? Results from the UK National Survey of Undergraduate Teaching in Ageing and Geriatric Medicine’. Adam Gordon, Adrian Blundell, John Gladman, Tahir
Masud. Published electronically, 5 January 2010. 3
‘Ageism and age discrimination in primary and commu-
nity healthcare in the UK’, Centre for Policy on Ageing, page 67: “The evidence suggests there is under-investment in services that are proportion- ately more important for older
people than younger adults.” 4
‘Ageism and Age
Discrimination in Secondary Care in the UK’, Centre for Policy on Ageing, page 59.
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She said: He was not helped to use a commode and fainted, soiling himself in the process; He was not properly cleaned and his clothes were not changed until she re- quested this the following day; The ward was dirty, including a squashed insect on the wall throughout his stay and nail clippings under the bed; He was left without access to drinking water or a clean glass; His pain was not controlled and medica- tion was delayed by up to 90 minutes; Pressure sores were allowed to develop; No check was made on his nutrition; His medical condition was not properly explained to his family; He was told of his diagnosis of terminal cancer on an open ward, overheard by other patients.
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However, there were a number of service failures during both of his admissions: Mr D’s nutritional status was not proper- ly assessed, while a lack of records meant it was impossible to assess his fluid or food intake; Pain relief for Mr D was not always ef- fective, yet no formal pain assessments were completed; The change of Mr D’s discharge date should have prompted a complete review of his condition, needs and discharge ar- rangements. That did not happen.
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The Ombudsman found that Mr D’s care and treatment fell below reasonable stand- ards in a number of ways, but found no service failure in the time taken to diagnose Mr D’s cancer, nor in the way the Trust communicated the diagnosis to his family.
The Ombudsman praised some aspects of the trust’s discharge planning, like contact- ing Macmillan and district nurses and so- cial services.
The Ombudsman upheld the complaint and the trust apologised to Mr D’s daughter and paid her £2,000 in compensation.
It pledged to review all nursing documen- tation and to introduce a five-day pain management course available to all staff. It also said it would bring in an ‘holistic as- sessment tool’ for the palliative care team to make sure care needs are met.
There are many other stories like Mr D’s, and the Health Ombudsman’s full report, at:
www.ombudsman.org.uk/care-and- compassion/case-studies
national health executive Mar/Apr 11 | 17
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