Health and Social Care Bill
Baroness Bakewell Excerpts(12 years, 5 months ago)
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Baroness Bakewell
“( ) how effectively the NHS services meet the needs of the older population”
Baroness Bakewell
My Lords, I rise to speak to Amendment 150B and 320ZB. As with the others that I have proposed to this Bill, my amendments are all associated with one running theme: meeting the needs of older people. First, I propose that the annual report of the NHS Commissioning Board should be measured by how effectively it meets the needs of older people. Thus, I am separating out a particular cohort of people for whom particular attention needs to be made. Why do I do that? It must surely be obvious every day that we read the papers and every occasion when stories run in the media of inappropriate treatment of older people in hospitals, care homes and nursing homes. They are not getting the treatment that they should and the public know this and care about it.
My major amendment stands aside from the many other amendments to this Bill so far that have dealt with new structures, responsibilities, commissioning and safeguards. The purpose of this amendment is to test views on the creation of a role of commissioner for older people. There are many reasons why such a post becomes increasingly pressing. You may well be familiar with them. First, there are the demographics. The statistics are familiar and frightening. There are 10 million people now over 65 in the UK. By 2034, 23 per cent of the population will be over 65. Of them, 3.5 million will be over 85. Such proportions of the population will constitute by far the highest percentage of users of healthcare and specifically of social care in this country. Old age is not a condition you cure. We are not hoping that old people will get better. Scientific advances will not find miracle cures that reduce the incidence of old age. Medical science will paradoxically be increasing the numbers in this cohort. This change constitutes one of the largest challenges that developed societies have to face. The situation is the same in Japan, America and Canada. This is where the human race is going. I feel that there is little appreciation of the scale of what it is to meet those needs.
All the detail and complexity of this Bill and the debates that we are having about it concern the replacement of one complex structure of the NHS with another. We have been debating in detail the network of relationships between the NHS Commissioning Board, the CCGs, HealthWatch England, the CQC, the local HealthWatch organisations and the role of Monitor. All this abundance of well intended organisational ways of meeting the needs of patients does not take on the bigger picture facing the future.
The old are a different cohort. We will all one day be patients. Before that, as people age they become needful of different provisions of social care. Social care is in the title of this Bill. They will need meals on wheels, transport provision, adapted housing and all the things that provide for a living that, while not being an illness, is not as independent as it once was.
Such a commissioner for the old already exists. Such an independent statutory body with an overview of all people aged 60 and over was created in Wales in 2006. It exists to promote the interests of older people and improve their lives. Among the crucial things its first commissioner, Ruth Marks, does is to promote awareness and challenge age discrimination. She also offers ongoing assistance for older people who contact her with problems. She is often dealing with complex issues that involve all the various public bodies and that individuals cannot cope with. In the commissioner, they have one person that they can turn to to help them through this web of public bodies. This unique help, individual to individual, through the complex world of health and social care provision, seems to me to be of overriding merit and appropriate in the discussion of this Bill. Northern Ireland also has such a figure, known as the Older People’s Advocate, currently in the person of Dame Joan Harbison. We already have a Children’s Commissioner, created by the Children Act 2004. This could act as a template for a commissioner for the old—to hear and then promote the views and concerns of individuals and to involve them in the discharge of the health service function.
In 2008, I was invited by the Government Equalities Office initially to be a champion, which I thought was bit aggressive; then I was invited to be an ambassador, which sounded rather diplomatic; and I volunteered to be a voice. Not only because I am a broadcaster, I thought that people want a voice and they know what it means. When Harriet Harman asked me to do this, she nodded in my direction and said that of course it was uncharted waters. Indeed it was. Neither of us realised what the reaction would be. I was inundated with complaints of every conceivable kind. Health sometimes, hospitals often, pensions frequently, but also things like the closing of public loos or ex-pats in Spain worrying about their heating allowance.
Some of them were very strange requests indeed—how would I get people’s savings out of the Icelandic financial system? I had to respond by sorting out the networks of support that exist—Citizens Advice Bureaux, Age UK, MPs and local authorities. It was a rigmarole of roundabout ways in which people could have a satisfactory answer to their personal problem.
Time has moved on. My role was a part-time, amateur job. We are now into the serious matter of considering the old. Old age now has a high profile. The newspapers are on board. The media follow such stories. We owe to them the revelation of the many scandals that exist. Architects are concerned and interested in designing lifelong homes. The co-housing movement is on the go. Martha Lane Fox is campaigning to get the old on the internet. There is a multiplicity of age-related websites. You can adopt a granny. You can adopt an old person’s garden. There are thousands of such websites but none of them answer the single requirement to have one person who is on your side. The Liberal Democrat conference in September debated such a policy motion, calling for a commissioner for the old. This is an idea whose time has come. I beg to move.
Baroness Finlay of Llandaff
My Lords, I apologise to the House for missing the noble Baroness, Lady Bakewell’s opening remarks. I simply point out that we have an Older People’s Commissioner for Wales, Ruth Marks. In March 2010 she led an inquiry into care in hospitals, called Dignified Care? By November this year, she was satisfied that the 12 recommendations from its in-depth and hard-hitting report had been met. She is now using her powers to drive forward additional adult protection legislation and a nursing home review. It is only with legal powers and leadership that we can really turn care round. I believe that such a post is more than cost-effective. I really recommend that the Government look hard at having an older people’s commissioner for England because we know that there is a big problem there. Such a post will more than save its cost.
Baroness Bakewell
I thank the Minister for that detailed response to the amendment. I also thank my noble friends for drawing attention to what is going on in Wales and in Newcastle, for mentioning the issue of older carers, and for discussing the nature of this particular group. Everyone in the population, we hope, will one day belong to that group. It is not an exclusive cohort.
I think that there is a small point of philosophical difference here. This forest of a Bill bristles with well-meaning organisations that are listening, speaking, consulting each other and offering clinical leadership. It is dense with such things. What it does not have is the single sapling of a commissioner standing alone in the desert and speaking for us, not us talking about them. To that extent, I think that the debate has been particularly fruitful. I hope to continue discussions with noble Lords, and with that in mind, I beg leave to withdraw the amendment.
Funding of Care and Support
Baroness Bakewell Excerpts(12 years, 5 months ago)
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Baroness Bakewell
I, too, support the Dilnot recommendations and ask for a White Paper in the new year and action from the Government. I thank my noble friend Lady Pitkeathley for bringing forward the debate. I am sure that we will learn many intricacies, given the expertise in the House.
I will explain from my own experience why this is so important. I recently made a “Panorama” that told the story of someone in her mid-50s who had moved into the family home to care for her mother. Her mother's health deteriorated and she went into a care home. The family home had to be put up for sale and the dutiful daughter was left without either a home or an inheritance. These stories have proliferated in the media and have outraged people who wonder how such things are allowed to happen.
Before the Dilnot commission, there was a very unattractive political skirmish when the previous Government proposed a tax on an individual’s estate. It was denounced in the press and elsewhere as a death tax, and the proposal died. This proposal must not die. It has to be faced. It deals with issues of death and inheritance. Perhaps that is why we have shirked it and spoken less absolutely than we need on the matter. The old fear loss. They fear the loss of their contemporaries. They fear the loss of their capabilities, and they deeply fear the loss of their home and their savings. They fear these things more than other generations that have not got there yet, but such worries impact on the health and well-being of an older generation, and that is a consideration for the health of the nation generally.
There are several popular misunderstandings about this situation that get perpetuated by the press—I am sorry if I am guilty of that, and I hope I am not. When I go to make programmes, people often say to me, “I’ve paid taxes all my life. Why am I not cared for when I am old?”. This refrain has given it a very high profile in the media. It was always understood that the National Health Service provided, as the phrase had it, from the cradle to the grave—to the grave, not to the old people’s home. Social care was mistakenly seen as part of that contract with the state, and it still is. Social care, housing, feeding and dressing were things that, as citizens, we have paid for all our lives, but when it comes to being frail, as well as old, we need help in them, so they bridge a social convention—that we pay for housing, food and health—and the medical convention of the National Health Service. We are back to: “I paid taxes all my life”.
Dilnot’s most high-profile recommendation is that there should be a cap on an individual’s contribution to social care of somewhere between £25,000 and £50,000. This is high-profile because it strikes at this very unease felt by a generation of older people who, I have to say, have assets. We are asking taxpayers to fund the safeguarding of those assets. It is a long explanation to make that plausible to people who do not have such assets and wonder why people better off than themselves are asking people in the lower tax range to fund them. We are a property-owning democracy. Citizens are motivated throughout their lives to own their home and, what is more, it is a widely held impulse and part of our culture to have something to pass on to our children. Whether we approve of that or not is not germane to this argument. It is a widely held cultural belief.
Dilnot seems to me to walk a tightrope in asking that care is funded by a shared responsibility between the individual and the state. That is a new and understandable contract. It is as fair as can be devised and honours the aspirations of as many citizens as possible. Adjacent to this proposal are recommendations urging people to plan early in their lives and to be informed of the financial packages that are on offer to meet the sums they could be called on to pay, but the central proposition is a good one. I urge the Government and the Minister to move on this.
Health and Social Care Bill
Baroness Bakewell Excerpts(12 years, 6 months ago)
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Lord Warner
My Lords, I support the amendments of the noble Lord, Lord Patel. I draw the Minister’s attention to the noble Lord’s great expertise, of which I am sure he is aware, in the area of setting standards for good clinical outcomes. He has done this in Scotland and the Committee should take careful note of the amendments that he has proposed and which I strongly support. I shall not go over again the ground that the noble Lord has covered, but he has made a compelling case for tidying up the wording of the 2006 Act in the areas that he has suggested.
Amendment 109 is in my name and that of the noble Lord. The words that it would add to new Section 13E(3) are very important to patients. Good and speedy access to services is essential to good outcomes, but it is an issue with which the Conservative Party has played fast and loose in its efforts to distance itself from targets. In doing so, it may have made itself popular with the NHS but it has rather lost sight of the importance that access to services has for patients in terms of their view of the way in which the NHS treats them.
Good and speedy access is critical to good outcomes, and nowhere is that more apparent than in cancer services, which is why a lot of effort was put in by the previous Government, with experts in cancer, to devise the targets that were produced in this area. I am not trying to make a party political broadcast on the success of Labour’s access targets, although the temptation is enormous, but to bring out the key difference in approach to access between many parts of the Chamber and the Government Front Bench. I suspect that when the Minister comes to reply, I will get a little lesson on the lines that access is a process and what we should concentrate on is outcomes. I suspect that his brief will tell us a lot about that particular issue.
I suggest that there is a different way of looking at this. Access is not just a process issue because it incorporates one of the requirements for good outcomes. Of course, no one, least of all me, is suggesting that we should be against trying to define outcomes or measuring performance in achieving those outcomes. Some of us have spent the best part of our working lives trying to deal with the subject of outcomes in a whole range of public services. But we usually struggle, as I suspect this Government will, to define the outcome appropriately and to find an appropriate measure. Often we have to wait an indecently long time for the outcome to become apparent. We are often forced back onto proxies, which usually look much more like outputs than outcomes. Performance measures on access are a good example, not least because without speedy access patients are unlikely to get good outcomes.
It is also important that we have speedy access in order to ensure that diagnosis takes place, particularly in areas such as cancer. That is why targets were used by the previous Government to drive improvements to access. One reason why they got involved in the issue of targets and access was the great public concern in the 1990s about the length of time people had to wait before they could get access to services. I am not making a party political point, but trying to get across to the Benches opposite that patients take this very seriously. They judge the NHS to a great extent on whether they can get access to services in a timely way. It is worth bearing in mind that the previous Government's targets were actually less demanding than some of the views that patients had on how long they should wait to get services. Patients were much more demanding than the NHS targets that the previous Government set for the NHS in this area.
A Nuffield Trust comparative study of access targets in north-east England and the lack of them in Scotland revealed that the English experience was better for patients both in terms of speedier access and of efficiency and cost. It also showed that targets were indeed often unpopular with NHS staff. But if we are to make a choice between popularity with NHS staff and popularity with patients, I know which side of that argument I would prefer to be on.
I know that the Government have begun to retreat, to some extent, on the issue of abolition of targets, but we need to keep speedy access to services high on the NHS agenda, particularly as the NHS moves through a period of considerable challenge. Our five little words in Amendment 109 would help to do that, and I hope that the noble Earl will feel able to accept them.
Baroness Bakewell
I support Amendment 18B, which is also included under the heading,
“Duty as to improvement in quality of services”,
of the proposed new Section 1A to the 2006 Act.
I speak on behalf of particular interest group: the old. I declare an interest. I was for 18 months the government-appointed Voice of Older People. The interest group for which I speak is large and growing larger. Some 10 million people are now over 65 in the UK. In 2034, 23 per cent of the population will be over 65 of whom 3.5 million will be of the older old—over 85. That age, 85, is significant to the amendment. The amendment is to new Section 1A(3), proposed in Clause 2, dealing with the Secretary of State’s duty to seek continuous improvement in the outcomes, and it lists the relevant outcomes to be measured: effectiveness, safety and quality. We have already heard from the noble Lord, Lord Patel, and others about the important amendments to that.
Amendment 18B seeks to add a fourth consideration—and a rather odd one—which is that,
“These outcomes should not exclude sections of the population due to age”.
That phrase sits uneasily here—it would sit uneasily anywhere—because it is not of a kind like any other. However, it is important for the many people who will be numbered in the data on which outcomes are based—or, rather, not listed in the data.
The NHS Outcomes Framework 2011/12, which sets out outcomes and corresponding indicators, states:
“Where indicators are included which can be compared internationally, levels of ambition will work towards the goal of achieving outcomes which are among the best in the world”—
a laudable aim indeed. However, the document goes on later to state:
“Current data collections are limited in the extent to which this is possible … We recognise that there are certain groups or areas which the framework may not effectively capture at present, simply because the data and data collections available do not allow outcomes for these groups to be identified”.
In the document’s charts that show the overarching indicators, it is clear that many of the indicators stop at the age of 75. The indicators specify the mortality rates from cardiovascular disease, respiratory disease and liver disease. Thus, the data on deaths from such causes over the age of 75 are not monitored under the outcomes framework, despite the fact that life expectancy is far higher than 75.
It is also clear that many of the data are under development. I understand that, and there is work to be done. As the document states:
“This is the first NHS Outcomes Framework and … it is intended to signal the direction of travel for the NHS”.
The direction of travel for the population of this country is to have a much higher percentage of older old people. We already have more than 12,000 centenarians. Throughout debates on this Bill, I will be pressing for considerations of age to be written specifically into its provisions.
Why do we need to be so explicit? Surely we are all citizens, we are all taxpayers and, in the end, we are all patients. That is of course the reasonable case, but that is not how care is experienced. A recent report commissioned by the Department of Health concluded:
“Evidence of the under-investigation 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 frailty, co-morbidity and polypharmacy we must conclude that ageist attitudes are having an effect on overall investigation and treatment levels”.
That was in a report published for the Department of Health. To give just a simple anecdotal example from broader practice, although the risk of breast cancer increases with age, the general-practice reminders that are sent out to women to invite them to mammograms stop once a woman reaches the age of 70.
My amendment seeks to make clear, and even overemphasise, that all outcomes include all sections of the population. Prevailing attitudes to the old require that to be spelled out in the Bill.
Lord Kakkar
My Lords, I support Amendments 15 and 19, in the name of the noble Lord, Lord Patel, to which I have added my name. In so doing, I speak as a practising clinician and I wish to emphasise the wise point made by the noble Lord, Lord Patel, about the need to ensure that the Bill describes important facets of what needs to be achieved to improve culture within the NHS.
At Oral Questions today, we heard a discussion about hydration policy. Clearly, in a healthcare system, it is important that the culture is appropriate. Therefore, an emphasis on specifying “health outcomes” and “clinical quality standards” is also important because that will drive a cultural emphasis on the fact that improvement of health is the purpose of the Bill. The failure specifically to recognise, on page 2 in line 17, the issue of outcomes being specifically those of health, and in line 27 the quality standards to be specifically those of clinical quality, is potentially an important failure that should be recognised. I hope that in responding to this debate the Minister can confirm that with the emphasis on health outcomes and clinical quality standards, the purpose of the Bill will be emphasised in the language used in the Bill.
Baroness Bakewell
“( ) These outcomes should not exclude sections of the population due to age.”
Baroness Bakewell
My Lords, I thank the noble Earl for his thoughtful consideration of my amendment. Because this is so impending a situation, it has to be taken on board for the future. The noble Earl spoke about having data that were robust in terms of verifiability and about evidence for the over-75s being harder to come by. However, life expectancy in this country is 84 for women and 79 for men, so there are data somewhere. I reiterate that there is a growing groundswell of concern, evident in newspapers when the story goes wrong, about the National Health Service failing older people, and I am sure that the Minister is as keen as I am to see that end. I beg to move.
Earl Howe
My Lords, I completely understand the points that the noble Baroness has made and I am sure that there is general sympathy in this Committee for the issues that have been aired through successive reports. I refer not just to the Care Quality Commission’s findings but to those of the ombudsman relating to care for the elderly in both the NHS and care home settings. The noble Baroness should be in no doubt that this is very high on the Government’s list of priorities but, as she recognised herself, there are particular obstacles that we have to overcome before we can move forward in the way that she has indicated and that we all want.
Health and Social Care Bill
Baroness Bakewell Excerpts(12 years, 7 months ago)
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Baroness Bakewell
My Lords, it is the genius of this country that in recent history it has enacted concepts of major significance in human progress. The Reform Act 1832 transformed our democratic process. The Education Act 1870 inaugurated an era of universal state education. In 1929 the creation of the BBC set the global template for world public service broadcasting. In 1946 the National Health Service was just such a bold and significant leap forward. As we consider how it might be improved, we need to bear in mind what we are changing: one of the finest, most highly regarded and valued institutions of British life, with a global reputation. The enduring essence of the NHS must not be yielded up to the transient imperatives of an external free market.
We must examine this Bill in the light of this conviction. We in the Lords enjoy the privileged opportunity of safeguarding what is so widely cherished. We must be vigilant to deliver improvement without sacrificing the underlying principle, that the NHS belongs to the people and is there to serve their interests.
We must also bear in mind that this Bill is not needed. There is no call for it throughout the country. Levels of satisfaction with the NHS were high and improving. Commissioning improvements were already under way under the last Government. No such proposals as now face us were spelled out in any party manifesto, nor in the coalition agreement. This Bill is in breach of a basic democratic contract.
What is more, many elements of the Bill are already being implemented before the Bill has been enacted. On 19 July Andrew Lansley let slip—it was a good day to bury bad news—that from next April £1 billion worth of NHS services, including wheelchair provision for children and a range of talking therapies, will be opened up to competitive bids from the private sector. The reputable Daily Telegraph blogger, Max Pemberton, who is also a doctor, called it,
“the day they signed the death warrant of the NHS”.
Such changes are already in progress. This, when the Bill is not yet enacted, is surely constitutionally dubious.
The National Health Service is the victim of its own success. It has kept people healthier for longer and, together with science and public hygiene, delivered a population living years longer than in 1948. Meeting the needs of an ageing population is the biggest challenge that lies ahead. The old are not well served by current provision, or by the proposed changes.
We have before us already a comparison between the NHS and private provision in this country: healthcare for the old is provided by the NHS; social care, the care of the frail and failing, provided in their homes or in care homes, is subject to the market. For social care, either the state pays for the private provider or individuals and families do. We have already seen two things happen when private finance buys too far into care. First, the service itself can be deficient and the monitoring is poor. Local authorities putting out tenders for care services too often chose the cheapest on offer, risking low standards provided by a shifting population of carers on the minimum wage and with inadequate training. There is already evidence of this happening. Secondly, the care of the elderly becomes a market commodity. The company that first invests moves on and others move in to asset-strip the enterprise for their own gain; then they too move on.
The story of Southern Cross shocked us all. The 33,000 old people in the care of the former company that ran some 750 care homes have been passed from hand to hand. The homes themselves were owned by the Qatar Investment Authority, which charged exorbitant rents to Southern Cross and salted away its profits in the Isle of Man and the Cayman Islands. Southern Cross could not sustain its business model. A Unison report in June 2011 assessed that the care industry was worth £4 billion to private equity investors, but it is considered by them a high-risk investment, with many investors inclined to resell at the highest price in the shortest time. That is what Blackstone Equity had done with Southern Cross. The care of the frail and the needy is far from their first priority. The old are seen as a resource to be milked for profit.
The old are not well served by this Bill and yet they are overwhelmingly the most frequent users of NHS services. Patients over 65 account for 60 per cent of admissions and 70 per cent of day beds in NHS hospitals. Following the recommendations of the Dilnot inquiry into how to pay for social care, the NHS Commissioning Board should now call for a fundamental review of how the NHS assesses, prioritises and commissions health services to meet the needs of an ageing population, and what place competing private providers will have.
Private providers have long had a place in the NHS and are important to it and its commissioning process, but let us not go down the American route. A Harvard-led study found that 62 per cent of all bankruptcies in the United States in 2007 were due to medical bills, an increase of 50 per cent in six years. Most of those affected were well educated middle-class home owners. Astonishingly, three-quarters of them had had their finances destroyed by medical costs even though they had insurance. The latest figures from the World Health Organisation suggest that the US spends 2.4 times more on health per person than in Britain, yet British men live on average two years longer and British women one year longer than in the States.
The NHS has been doing much that is right for 60 years. Every institution can be improved, monopolies can get complacent, and people want choice. However, that does not mean switching the fundamental principle on which this great institution was built. It belongs to the people of this country and they do not want it run on a competitive model.
Care Homes
Baroness Bakewell Excerpts(12 years, 11 months ago)
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Baroness Bakewell
To ask Her Majesty’s Government what steps they are taking to protect the interests of residents of care homes, such as those operated by Southern Cross.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, the Government will take whatever action is necessary to protect the welfare of care home residents. Southern Cross has plans in place to restructure its business and is keeping the Government updated on progress. We will continue to keep in close touch with the situation and will work with local authorities, the Care Quality Commission and others to ensure that there is an effective response, which delivers protection to everyone affected.
Baroness Bakewell
I thank the noble Earl for that information. Given the latest revelations that Southern Cross traded the care of older people for short-term profit and that the Care Quality Commission so woefully failed to come to the help of suffering people in a home in Bristol, can I urge him to take the most urgent steps as soon as possible to relieve the suffering of people who are old, frail and dependent, and who are suffering much neglect?
Earl Howe
My Lords, I am sure the noble Baroness’s concerns will be echoed throughout the House. We have seen distressing reports in recent days of the treatment of certain patients in private hospitals, but the worry over Southern Cross relates much more to its financial situation and the future of its residents. I can assure the noble Baroness that we are taking this situation very seriously. We are in touch, as I have said, with all the relevant parties—and have been for the last several months. We are making sure that everybody is aware of their responsibilities in this area, not least towards the residents concerned. As regards Southern Cross, we are now in a critical period when restructuring is being explored, and we wish those efforts well.
Health: Polymyalgia Rheumatica and Giant Cell Arteritis
Baroness Bakewell Excerpts(13 years, 1 month ago)
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Baroness Bakewell
My Lords, there was a tale told when I was first an advertising copywriter of a beggar sitting beside the road with an empty hat at his feet and a placard that read, “I am blind. Please help”. An advertising man took the placard and amended the message to, “It is spring. I am blind. Please help”. According to legend, the hat was soon filling with coins. It is spring: please help.
I support my noble friend’s idea that there needs to be much greater awareness of giant cell arteritis in the community and among GPs. I do not have medical expertise, alas, and I am grateful not to have had the tragic experience of the noble Lord, Lord Black, with the death of his mother.
The added words were meant to bring home to all those who passed by just how terrible the affliction of blindness is. It is not only the buds on trees and the dancing daffodils that the blind cannot see—they cannot see the faces of those they love; they cannot easily move around the world, crossing roads, using the tube; in their own homes they cannot trace the multitude of things mislaid daily in life, they cannot read, watch television, cook or look out for domestic hazards such as gas taps left on and rugs awry. The sum total of all such difficulties is a life vastly curtailed from a life lived with full sight. That, as we have heard from the noble Lord, Lord Wills, is the predicated outcome for some 3,000 patients a year who suffer giant cell arteritis. The examples I have given were among the main problems that arise for older women. I understand that women over 50 are particularly vulnerable to giant cell arteritis.
In supporting my noble friend in urging the Government to take action, I want to describe a confluence of social circumstances that converge on the group most at risk from the threat of blindness. First, they are for the most part older patients. It is generally recognised that people of an older generation are often more tentative in their relationship with their GPs than younger, more assertive, generations. Older people turn up and describe their symptoms and, all too often, get from their doctors a response that amounts to little more than, “Well, what can you expect at your age?” It is the way in which society colludes to groom older people to expect their lives to be winding down. We do it far too often, far too early, and often with far too little medical authority. It is an expensive and depressing form of ageism, somehow implying to older patients that their aches and pains are of less significance than they were when they were younger.
I am careful to say “implying” because no doctor would articulate such a thought outright, but in the mood and way older patients are often treated, the “What can you expect at your age?” mentality can discourage them from pressing more insistently for the medical treatment they need and which would avoid their symptoms developing further. Nowhere is this more evidently the case than with giant cell arteritis.
The second circumstance that increases the chances that giant cell arteritis could be overlooked is that the symptoms are so humdrum: headaches, sudden onset headaches, headaches over the temples; loss of appetite, weight loss, depression, tiredness. All these symptoms crop up at every age but are more easily set aside when they happen to older people. What is more, our culture has come to expect the old to be complaining. We made a comedy television hero of Victor Meldrew, and we watch and laugh along with everyone at successive television series based on the notion of “grumpy old”. The old are seen in these images as intrinsically irritable and complaining. It may just be television comedy, lightly meant and not to be taken too seriously, but such regular and amusing stereotypes colour our assumptions, sometimes to a dangerous degree. A patient presenting with a headache might just be one of them, but their complaint might be serious enough to need instant treatment and its neglect could, as we have heard, lead to total blindness that was totally avoidable.
A third consideration, related to all these, is that there is no time to be lost. With immediate diagnosis and treatment with high-dose steroids, and without waiting for a specialist report, the risk of blindness can be averted. Yet this is not how GPs go about their business; it is common practice to listen, weigh up symptoms and then recommend a first-stage range of treatments. In the case of giant cell arteritis, this will be damaging delay. When someone, especially an older person, goes blind, it is not only the individual who is afflicted. The social consequences in the life and care of such a person have a major impact, too, on the lives of their family, on those who have to cope with them, in where and how they live and in planning the social support for their rest of their lives.
It is becoming a truism of our ageing society that one of the most desirable patterns of living longer should be staying healthy for longer—desirable not only individually across a generation but in major financial savings to the state. Already, the system of social care for the old is woefully inadequate, leaving people isolated and neglected because the service is not fit for purpose. My noble friend Lord Wills has already detailed the further financial cost of 3,000 new patients each year suffering from acute blindness. I can suggest only the personal reality of those costs: already-stretched care workers with lists of visits to be made daily rushing in and out of people’s homes, dumping unappetising food on their clients and offering them cursory hygiene and little in the way of friendship. Sometimes an older person may have several different carers coming and going, as the job turnover is high and its wages low. I do not describe such social care to condemn the carers; the system forces such behaviour upon them.
Imagine how much more distressing and isolating it would be to receive such care if you were blind. That level of human misery is avoidable. If the Government take steps now strenuously to urge awareness of giant cell arteritis upon the medical profession, the blight can be averted. We know, as my noble friend has indicated, that raised awareness of symptoms among GPs already reduces the risk of damage caused by strokes. The gap between where we are now and the prospect of saving 3,000 people a year from going blind is a little one. It can be bridged, simply and soon. To do it is within our reach. It is spring.