National Health Service (Age Discrimination)
We move, rather behind the clock, to the next item of business, which is a debate on motion S2M-2861, in the name of Shona Robison, on age discrimination in the national health service.
I thank the many families throughout Scotland that have written to me about the experience of their elderly relatives. It is because of their concerns that the SNP has secured this debate. Age discrimination in the NHS can affect health care in many ways, from explicit age limits for health services to hidden discrimination by professionals with regard to a policy that disproportionately affects older people. However, although those are important matters, I will focus on the needs of vulnerable elderly people in our acute hospitals.
I have heard so many similar stories that it sometimes seems to me that there is hardly a family in Scotland—including my own—that has not had the experience of worrying that the personal needs of an elderly relative in hospital are not being properly met and that their dignity is not being maintained. Over the years, many members will have dealt with cases involving the lack of care of vulnerable elderly people in our hospitals. The question that the Parliament must ask is whether those are isolated cases, involving a breakdown in care and communication that is outwith the norm, or whether there is a more widespread system failure in the care of our most vulnerable elderly people in our hospitals. I believe that the evidence suggests the latter.
The cases of Anne Irons and Prudence Dick, who were both patients in the orthopaedic ward of the Edinburgh royal infirmary, were highlighted by the Edinburgh Evening News. That led to a barrage of similar concerns being raised in the newspaper by relatives. The deaths of those two previously healthy elderly ladies must be a wake-up call to us all. Although I welcome the independent inquiry that NHS Lothian has set up into the standards of care, I recognise that the problem is not confined to Lothian, as was demonstrated by the hard-hitting "Frontline Scotland" programme that highlighted cases of neglect throughout Scotland.
"Frontline Scotland" carried out a survey of 130 care home managers throughout Scotland, asking about the experience of their residents while in hospital. Although the survey was not scientific, its results were startling, showing that 69 per cent of care home residents had experienced serious clinical problems, which were, in essence, the result of a failure to provide food and drink and adequate hygiene. The survey also showed that 74 per cent of care home residents expressed concern that their care needs had not been met and their dignity had not been maintained while they were in hospital. Those care tasks are crucial; they are not a luxury add-on for elderly people. If someone is not fed, their chances of recovery and their ability to fight infection are severely reduced; if someone becomes dehydrated, that can make their dementia worse and lead to bed sores; and if someone's dignity is not maintained, they can lose the will to live. Meeting those care needs is an essential part of the care and treatment that elderly people must receive while they are in hospital.
Most staff in our hospitals do the best that they can. Nevertheless, as in any profession, some health professionals are better than others. We must be honest about that, as James Kennedy of the Royal College of Nursing was on "Frontline Scotland", when he stated that
"in some parts of Scotland, nurses are failing the elderly. Standards of fundamental human care are not being met".
That is a strong statement from someone who represents nurses' interests.
However, I do not believe that the problem lies with individual members of staff, albeit that they can make a difference with individual acts of kindness. The problem is that the system is failing to provide the necessary personal care and dignity to older people within busy acute wards. That is partly a staffing issue—nurses in particular are run off their feet because they have little time and may have had inadequate training to be able to cater for those crucial personal needs. With the radical changes that have taken place in the nursing profession, some nurses might question whether dealing with those needs is a task for them to perform. It might not be, but it is clear that someone must carry out those tasks.
Much can be done to avoid admission in the first place if vulnerable elderly people are treated within the community. I am heartened that Professor David Kerr's report deals with that matter in some detail. However, when bones are broken, some form of hospital care will be required, although we need to consider whether that care should be given in a busy hospital ward. I do not believe that such a ward is the best place for a frail elderly person with a broken bone. Once the bone is fixed, perhaps the patient should be transferred immediately to a rehabilitation ward specifically for elderly people, where the staff have the necessary skills, experience and time to meet the elderly person's needs. Indeed, many of those staff could be care assistants rather than nursing staff.
We also have to ask whether the closure of so many beds for the care of the elderly is wise. The number of geriatric beds has been reduced by more than 31 per cent since 1998. Too often, that means that a more appropriate bed cannot be found for the older person to recover and be rehabilitated in. Moreover, the number of vacancies in nursing care for the elderly has risen. There are no nurse consultants for older people in Scotland, when there should be one in every health board area to provide important clinical leadership in care for the elderly.
Staffing is one factor, but age discrimination is as much about attitudes. Too often, elderly people in busy acute wards are seen to be a problem; they are almost regarded as faceless bedblockers whose presence is to the detriment of more needy cases. Attitudes need to change. That is why we require an independent inquiry. These problems are sensitive and older people and their relatives are often reluctant to complain. An independent inquiry is more likely to elicit responses from elderly patients and their relatives, who are more likely to talk to someone who is not seen to be part of the health service.
I do not want to dictate the terms of that inquiry but I suggest that, as well as assessing the true extent of age discrimination in the NHS, it should consider the real experience of older people in acute wards, how older people can avoid coming into hospital in the first place, what other options are available for older people and whether we have enough beds to care for the elderly in Scotland. It should also examine whether the regulatory powers of the Scottish Commission for the Regulation of Care should be extended to cover care of the elderly in acute hospital beds.
The Executive's amendment welcomes the independent inquiry that was established by NHS Lothian. Does the minister really believe that the problems experienced by older people in Lothian are not being experienced elsewhere in Scotland? She would be most unwise to do so and I hope that she will reflect on that point. We have an opportunity today to send out a message to all those concerned that we acknowledge the problem of age discrimination in the NHS and that we are prepared to do something about it. I urge members to support the motion in my name.
I move,
That the Parliament is concerned about the lack of personal care and attention given to older people in some acute hospitals in Scotland and believes that the Scottish Executive should establish, as a matter of urgency, an independent inquiry into direct and indirect age discrimination within the NHS.
I welcome today's debate on the standards of care for older people in the NHS. We have published standards that are both high and equitable and we all expect them to be applied in practice.
Let me be absolutely clear: discrimination on the ground of age is unacceptable. Care for older people is at the heart of Executive thinking. Whether through flagship policies such as free personal care and free bus travel, or housing and central heating initiatives, we are pursuing a coherent policy to promote a better quality of life, healthy and independent living, active aging, positive attitudes towards aging and active participation by older people in society.
Ever since the chief medical officer produced his "Adding Life to Years" report in 2002, the care of older people has been at the centre of NHS thinking, too. Yesterday's report from Professor Kerr strongly reinforces that message. We have just held an experts symposium to review progress and identify the next steps and, next year, we will develop an overarching framework for the health and community care of older people.
As far as health services are concerned, older people have a central position in our policy development. People's circumstances—age, disability, faith, gender, race or sexual orientation—do not affect the care that is given. Clinical decisions are based on the benefit to the patient as an individual. Indeed, this year, we launched a diversity awareness initiative to remind people of that key principle. None of that suggests that there is a bias against older people in our thinking.
How do we ensure that the highest quality of care is in place in the NHS? That is the challenge that we face. First, we already have clear standards in place for the care of older people in the acute sector and we are about to roll those out for all sectors. All NHS boards must apply those standards. Secondly, NHS Quality Improvement Scotland has reviewed services for older people in relation to acute care, health-care-associated infection, stroke services and food, fluid and nutritional care. It has also published best practice statements on the nutritional care, foot care, ear care and oral care of older people. We are also about to conduct a general review of nursing in the community, which will have a bearing on the effective development of community health partnerships.
I accept, as I am sure the minister does, that there are lots of documents that say what should be done. However, does she agree that the problem is that what should be done is not necessarily what is being done in many wards in too many of our hospitals? What will she do to make sure that it is done?
Clearly, there is no point in having standards if we do not ensure that those standards are met. That is the challenge that we face. NHS QIS was established in 2003 to ensure that those standards are rolled out. Where the NHS QIS inspection process suggests that standards are found wanting, health boards will be required to do something about it.
In the particular cases to which Shona Robison referred, it seems that standards were not adhered to. It is important that an independent review is carried out as speedily as possible. Any lessons that can be learned from that review will be disseminated throughout Scotland. I will also write to health boards to ask them to review their arrangements and reassure me that the standards that have been set for care of the elderly are being applied. I have asked the chief nursing officer to raise the issue with directors of nursing in NHS boards at their next meeting. I welcome what is being done in Lothian—no one is denying that we have lessons to learn.
People rightly have high hopes for their loved ones. Health care professionals have a high sense of personal vocation. We have put older people at the heart of our policy development and we expect the NHS to deliver against those standards of care and support. There will always be lessons to learn and we must be, and are, willing to learn them. However, I absolutely reject the idea of systemic discrimination and failure of care in the NHS. I am acting to ensure that all NHS boards deliver in practice the standards that we have set.
I move amendment S2M-2861.3, to leave out from "is concerned" to end and insert:
"welcomes the work of NHS Quality Improvement Scotland on its 2004 review of older people in acute care and its recommendations on how to improve services; welcomes the independent inquiry set up by NHS Lothian in response to recent criticisms of its standards of care, and welcomes the fact that the Scottish Executive has commenced work on an overarching framework for healthcare and community care for older people in Scotland, having due regard to David Kerr's report on the future of the NHS."
Today's debate comes at an appropriate time in the wake of yesterday's publication of the Kerr report, which indicates a way forward for the NHS for the next 20 years. The NHS of the future is going to have to cope with a greatly increased number of elderly people, many of whom will be very elderly and frail. From 17.9 per cent in 1998, the elderly are expected to make up 24 per cent of the population by 2036. Several of us here, myself included, will be in that group. People are now living longer than at any other time in history. Many are healthy and active well into their eighth or ninth decade and many more are looked after with varying amounts of support in their local communities. By the time that they reach hospital, they tend to be very frail, with the complications of longevity, such as thin bones and dementia.
The people in that section of society, more than in any other, rely on appropriate and accessible health care. However, we know that older people have encountered significant problems with hospital care that range from delays in admission, poorly planned discharge and poor nutrition and hygiene care to the negative attitudes of or poor communication from hospital staff. We have also heard of incidents of abuse of the elderly, which can be physical or verbal or simply a case of failing to treat older people with the dignity and respect that they deserve.
Although the situation in some hospital wards is excellent, that is unfortunately not always the case. Various recent press stories have highlighted examples of the bad situations. I realise that the quality of care for older people in hospital is variable and that problems can occur in almost every aspect of a hospital stay, but patients and their relatives have highlighted several problems again and again. There is often a lack of assistance with eating and drinking. Young and even older members of staff can be abrupt or rude and, in the worst cases, patients' needs are ignored. Particularly vulnerable people such as those with dementia or those from ethnic minorities sometimes receive scant understanding of their needs. Older people often feel that, when decisions are taken about their care or treatment, their opinions are ignored or are not sought. It is all too easy for busy hospital staff to talk over or talk down to a frail elderly patient who might be visually impaired or hard of hearing.
Indeed, I have personal family experience of those problems. My elderly uncle was admitted to hospital for the flimsiest of reasons and was then moved from ward to ward as his bed was required for other patients. He became immobile and picked up MRSA and his discharge was delayed for more than a year. During that time, his wife, who fell and broke her hip when she was visiting the hospital, also had a prolonged hospital stay and, sadly, died very suddenly of an unrelated problem on the day that she was due to be discharged. My uncle eventually settled into a nursing home for a short time; however, he fell there and broke his hip. Because of a delay in treating the fracture, he died of pneumonia. It is a fairly classic tale of inappropriate admission, hospital-acquired infection, bed blocking and postponement of treatment for a hip fracture.
There is no excuse for the incidents of neglect by hospital staff of basic care needs such as eating and bathing that were reported recently in the Edinburgh Evening News. However, as long as we have a situation in which inadequate numbers of hard-pressed staff are being rushed off their feet to chase targets that have been set by central Government, I cannot see how matters can be resolved easily. That said, the hospitals and health boards that are involved should investigate such cases very carefully and take what steps they can to protect patients in future. We welcome the review in Lothian and hope that any lessons that are learned from it will be rolled out across Scotland.
We need to examine the issue of abuse of the elderly, which my colleague David Davidson has suggested to the Health Committee should be considered as part of the forthcoming post-legislative scrutiny of the Community Care and Health (Scotland) Act 2002.
At any one time, two thirds of hospital beds are occupied by patients over the age of 65. A number of them do not need to be there and would be far more appropriately treated in the community. However, wherever they are, they should be treated with respect and dignity at all times. There is no excuse for doing otherwise.
I move amendment S2M-2861.1, to leave out from "and believes" to end and insert:
"believes that the Health Committee should consider the issue of elderly abuse in its post-legislative scrutiny of community care legislation; further believes that any neglect of the elderly reflects the current problems and workforce pressures that the NHS suffers from, and recognises that the NHS needs real reform to alleviate these fundamental problems."
Coming a day after the publication of Professor David Kerr's report, this debate is opportune. After all, Professor Kerr's very first proposal is for
"All NHS Boards to put in place a systematic approach to caring for the most vulnerable (especially older people)"
and those
"with long term conditions with a view to managing their conditions at home or in the community and reducing the chance of hospitalisation"
in the first place.
The Liberal Democrats have already shown their commitment to improving services for older people. The Parliament's introduction of free personal and nursing care for older people implemented a long-standing Liberal Democrat policy; indeed, it is significant that the policy has not been implemented—and in fact has been opposed—by the Labour Government in England and Wales. That successful and popular measure is already benefiting many thousands of senior citizens throughout Scotland.
The care of our older people is rightly at the very top of the political agenda. As far as the Liberal Democrats are concerned, there can be no room for age discrimination in our NHS. If people require treatment, that treatment must be forthcoming. It cannot be right for individuals to be discriminated against because of their age instead of being assessed on their ability to benefit from treatment, and I was pleased to hear what the minister had to say in that respect.
Care for older people already accounts for 40 per cent of health budgets in Scotland, and that figure is set to increase as the population ages. Nevertheless, it is fundamentally and morally wrong for anyone to be prevented from receiving NHS treatment or to lack necessary care or attention because of their age. Such a situation would not be tolerated on grounds of race, colour or creed, and I believe that age should not be a factor in determining the most appropriate form of medical treatment.
I am pleased that NHS Lothian is taking the situation at the Edinburgh royal infirmary seriously and has ordered a full and independent review of the matters that were brought to light in a recent television documentary. The board has acknowledged that there have been failings in certain aspects of care and has made it clear that, as a result, it is reviewing its procedures. That is only right.
Although it is vital that such matters are fully investigated and that steps are taken to ensure that they are not repeated, we must emphasise that in NHS establishments throughout Scotland, health care professionals in all fields treat older people with dignity, compassion and respect. That is exactly as it should be.
As far as the SNP motion is concerned, we have already heard that NHS Lothian has set up an independent inquiry in response to the recent incidents. I also believe that the Executive should be given time to respond to the Kerr report's proposals on elderly care. I do not think that we will support the SNP's call for a public inquiry, because the timing of such a step is completely wrong. As the minister pointed out, it is the job of NHS QIS to ensure that high standards of care are implemented across Scotland.
I find it somewhat bizarre that the Conservative amendment asks Parliament to instruct the Health Committee on what it should or should not examine in its inquiries. Indeed, it is extraordinary that Nanette Milne, who is a member of the Health Committee, has framed her amendment in that way. Such a move is quite unusual and not very helpful.
As I said earlier, the Kerr report's first recommendation refers specifically to older people. I, for one, will do all that I can to ensure that that theme is addressed as the Executive decides how best to take forward the report's recommendations.
We now come to the open debate. Time is very tight indeed and I ask members to make speeches of strictly four minutes.
It is a sad day when, despite the hard work of many decent and caring staff in the service, we have to debate the indignity and lack of care that some older people have suffered and are still suffering in the NHS. Unfortunately, the recent "Frontline Scotland" programme showed that some elderly people in hospital are being denied basic care. We should point out that, in this context, basic does not mean minor; it means something that is fundamental or essential.
Various examples of a lack of respect and a disregard for human dignity have been highlighted. Teeth have not been cleaned; batteries have not been put in people's hearing aids, despite the fact that they have spares in their lockers; and because patients have not been taken to the toilet, they have wet and soiled themselves and have been left in that condition. Such situations are unacceptable and must change.
In recent years, emergency admissions to acute care have increased markedly, particularly in the oldest age groups. In 1981, the annual rate of over 85s who were admitted to hospital as acute care emergency admissions was 200 per 1,000 population. By 1999, that figure had grown to approximately 450 per 1,000 population, and it is continuing to grow.
The rising rate of hospital admissions for elderly people means that age discrimination in the NHS is becoming an increasingly urgent issue that will affect more and more people. However, although it is imperative that the care of the elderly in hospitals is improved, it is also imperative that, instead of simply concentrating on adding years to life, we put in place public health measures now to ensure that the old people of tomorrow have a longer healthy life expectancy.
It is worth mentioning that, according to the "Healthy Life Expectancy in Scotland" report for 2004, poorer people not only die younger than more affluent people but suffer more from ill health and for longer periods. In 2000, healthy life expectancy at birth for the least deprived women was 72.7 years but was only 61.6 years for the most deprived women. That is a difference of 11 years. For men, healthy life expectancy was 73.3 years for the least deprived and 55.9 years for the most deprived—a difference of 17.4 years.
Inequalities in healthy life expectancy are wider than inequalities in life expectancy. Males in the least deprived quintile have a healthy life expectancy at age 65 that is 50 per cent higher than that of males in the most deprived quintile. For those in deprivation category 1 who are aged 65, healthy life expectancy is 14.5 years; for those in deprivation category 5, it is only 9.7 years.
I turn now to nutrition for older people in hospital. On average, older people lose 5 per cent of their body weight during an acute stay. Nutrition is an important part of care in hospital, because malnutrition is linked to a poorer clinical outcome in surgical and medical hospital patients, has a high patient cost and is linked to significantly higher health care costs.
The report to the Executive on the implementation of clinical standards for food, fluid and nutritional care in hospitals recommended that ward staff should take responsibility for assessing the nutritional status of patients on admission and that patients who need assistance should be given the time and support that they need to eat their meals and snacks. I wonder whether the minister can tell us what action the Executive has taken on those recommendations. I am sure that we would all agree that older people in hospital should be able to take their meals and should not suffer the ill effects that come from malnutrition.
Many members have already spoken of their personal experience of elderly relatives in hospital. I, too, have unfortunately had that experience. My grandmother suffered a level of care that was far from perfect; she suffered many of the indignities that we have heard about in the media. We must do all that we can to ensure that everyone who needs hospital treatment is given the dignity and respect that they deserve. I urge all members to support the SNP motion today, to show that we care about the treatment of older people in the NHS.
It is absolutely right that we should have a debate about age discrimination in the NHS. It is well known that the NHS is plagued with inequalities and has been for a very long time.
Like me, other members will have received a briefing paper from Help the Aged. It would be better if this debate and subsequent debates could be held in the context of a well-documented problem, rather than in the context of specific allegations. That does not allow due process and it pre-empts the outcome of any internal investigation. People have the right to natural justice before they are judged in this Parliament. I will therefore concentrate my remarks on the general and well-documented problems.
NHS staff provide excellent care despite the system and despite staff shortages. My amendment—which was not selected for debate—calls for urgent action to respond to the well-documented problems that we are all aware of. That urgent action means increasing staff numbers; it means providing better food; it means allowing more time for people to spend with patients; it means moving and handling equipment properly; it means continuing training; and it means back-filling to allow people to be released for training. Trade unions have been talking about all those problems for years and years.
David Kerr's report proposes a further massive shift to community care. However, we have to consider the proposal in the context of today's reality. People wait far too long for adaptations to their homes, for funding packages and for care home placements. I see that everywhere I go. The Kerr report documents the fact that the proportion of people who are elderly is increasing, yet it claims that it is cost neutral. I do not see how we can plan for more care in the community on the basis of the report.
The problem with nutrition in hospitals is also well documented. The problem is directly related to costs, to the privatisation of catering and to the well-documented lack of dieticians. There are not enough staff on the wards to ensure that meals are taken. Because of the systems used—particularly the privatisation of catering—meals are often too hot, and therefore unpalatable to frail and elderly people, or they are too cold. Frail and elderly people often require special diets, but those meals can be simply unpalatable.
Age discrimination spans several spheres. In my final minute, I want to concentrate on the structural and systemic discrimination that exists. For example, guidelines from the National Institute for Clinical Excellence allow certain medicines to be withdrawn from elderly patients specifically on the basis of age. NHS QIS has, I believe, recommended that that particular guideline be removed, and I want to know whether the Executive will enforce that recommendation.
As we know, knee and other orthopaedic operations are rationed in the NHS on the basis of age. What will the Executive do to stop that practice as soon as possible?
It is right that we are discussing such issues, but I would prefer action to be taken and not to hold more inquiries and more discussions. We do not need any more inquiries, because the problems are well documented. I would like action, and I ask the Executive to respond to the points that I have made.
The provision of a high standard of health care is important to everyone in Scotland but particularly to our older people. The starting point for this debate should be a commitment to an excellent and well-resourced health service that can deliver that quality of care. Labour's track record—not only in this Executive but at United Kingdom level—is of record funding for the health service and of a commitment to a strong and successful NHS.
Of course it is important to highlight examples of age discrimination. Sadly, age discrimination exists in various parts of our society—for example, in employment. The Help the Aged Scotland briefing for this debate highlighted such discrimination; the point was brought home to me when I worked at the charity. Not only Government but society in general should do all that they can to root out age discrimination in all its forms.
This morning we have heard of worrying cases. There have been reports of patients who are not receiving a satisfactory level of care and there have been allegations of age discrimination. Investigations have been launched into those allegations. That is right and proper. Age discrimination must be rooted out. Of course there is no policy to discriminate on the ground of age in our NHS.
Debates such as this must take place in the right and responsible context.
Will the member take an intervention?
I am sorry, but I have only four minutes.
Older people are the most frequent users of NHS services. Day in and day out, hundreds of thousands of older people receive an excellent standard of care from our national health service. Although we have to highlight cases of bad care, it is not right to highlight only those cases, or to allow them to overshadow the very many excellent experiences that older people have of the NHS. I hear about the good experiences every day, and I am sure that others do too. It is unfortunate that those experiences are not talked about more often in this chamber and in the media.
We have taken action to improve services for older people. We set up the care commission to ensure that we had national standards—the first ever—for care for older people in Scotland; we introduced free personal and nursing care for older people; and, in planning for the future of the NHS, we ensured that older people were involved. I see from the Kerr report that Irene Sweeney of the Scottish Pensioners Forum was a member of the advisory group.
It is important to acknowledge, as Help the Aged Scotland acknowledges, that NHS QIS took a strong stand when it said that it
"does not, and would never, exercise age discrimination."
I welcome that. Access to health care services should be based on clinical need and not on age.
The problem with debates that are couched in terms such as those in the SNP's motion is the perceptions that they create. For example, older people often live in fear of crime because of the way in which the issue is covered in the media. However, they are less likely than other sections of society to be the victims of crime. There is a similar issue to do with perception in relation to the health service, and it is vital that older people have the confidence in the health service that they should have. When they go into hospital, not only should they expect to receive a high standard of care, but they should know that they are likely to receive that high standard thanks to the thousands of hard-working people in our health service.
We should not be complacent; we should continually strive to have not a single incident of unsatisfactory care. However, by couching this debate in the terms used in its motion, the SNP is in danger of misrepresenting the NHS and lending ammunition to those who would break it up—namely the Tories. I firmly believe that the best way to fight discrimination against older people is to ensure that we maintain a national health service that is free for all, whatever their resources or needs. We will fight for and defend such a health service, because that is the way to ensure the best care for older people in Scotland, free from discrimination.
I welcome the debate on Shona Robison's motion. Sadly, it reflects the lack of basic respect for the elderly that exists in our society and which manifests itself in many forms throughout the country in this new 21st century.
In my opinion, no one should misconstrue the motion as an attempt to criticise any political party. I believe that it is an honest endeavour to gain cross-party consensus in the Parliament on the need to deal with problems that have been sidestepped or ignored for far too long. I must point out that my speech was written before I had the opportunity to read the ministerial statement that Andy Kerr made yesterday, which addresses many of the problems that I highlight in the rest of my speech and to which many other speakers have referred.
The genuine needs of the most vulnerable people in Scotland have been—and are continuing to be—addressed as a result of such welcome measures as the establishment of the care commission, which is led by Mary Hartnoll. Sadly, it is impossible for the care commission to deliver for the Parliament the level of care to which we all aspire. Although it can carry out checks a few times a year, as the relatively recent exposé by Annie Brown in the Daily Record emphasised, the claims of abuses of basic human rights—such as the right to nourishment and life—which were highlighted by the three deaths of elderly patients in Edinburgh recently show that unacceptable standards of treatment are still being inflicted on some of our elderly citizens in some hospitals and care homes. That should result in an outcry from the public and politicians.
I feel very strongly that an independent inquiry should be set up to ascertain the extent of the problem. Its remit should give the inquiry reporters unlimited access to care homes and—sadly—even hospitals, to ensure that the correct acceptable standards are being applied. We read and hear about starvation in some of those establishments, where assistance is not forthcoming to enable elderly people to eat their lunch or dinner.
Help the Aged has reported that, on average, older people lose 5 per cent of their body weight while they are in hospital—Stewart Maxwell mentioned that issue. That means that someone who weighs 10 stone will lose around half a stone, which is a considerable amount. The organisation believes that that indicates that older people's dietary needs are not being met, which may be a sign of a wider lack of appropriate care and attention. Help the Aged welcomes the commitment of ministers and the chief medical officer
"to make older people the core business of the NHS in Scotland."
However, that commitment was made a few years ago and the relevant policies are still not being implemented to a fully acceptable standard. That is why I support the motion's attempt to empower an independent inquiry to report on the true extent of the problem in 2005 and to give Parliament its urgent recommendations. That said, I welcome and give my full endorsement to what the Minister for Health and Community Care said yesterday in his statement, which was forward looking.
Scotland should be proud of the fact that free personal care is provided in the home and in the community. More people who are being treated in our hospitals could benefit from receiving the same standard of care in their own home, but that would require a vast increase in the number of district nurses, health visitors, chiropodists, physiotherapists and home helps. They should be offered more pay to provide a bit more assistance in the home. As well as being a better option for the patient, that would be far more cost effective than hospitalisation.
To sum up, an independent inquiry should be set up to reveal the true extent of the problem of discrimination against the elderly in the health service. Care in the community services for the elderly should be established and properly funded. We should return to the days of the green ladies and give more responsibility to home helps and their colleagues. The problem is urgent; let us have less self-justifying rhetoric and more positive action.
When we see discrimination against older citizens in the NHS, we often see a reflection of broader, societal discrimination against older people. I make no particular criticism of the Executive's policies on discrimination against older people, but I share with all members a concern about the implementation of those policies and the practices of some people in some parts of the NHS.
One of the most moving examples of the contribution to society that people who are nearing the end of their life can make was the art that Rikki Fulton produced in the final few months of his life, when he was suffering from Alzheimer's, which was auctioned recently. That vividly brings home to us that the fact that someone is decaying in their mental or physical abilities does not mean that the inner person or their ability to continue to contribute to wider society is also decaying.
I was interested to note Mike Rumbles's fervent support for the debate. Of course, he is older than Nicol Stephen, so we can understand why he supports there being no discrimination against older people.
The word "discrimination" has been widely used. Carolyn Leckie's amendment says that
"urgent action needs to be taken to remove all forms of age discrimination within the NHS."
Richard Baker used similar language. Even the SNP motion calls for
"an independent inquiry into direct and indirect age discrimination".
All those references to removing discrimination, including that which is made in the SNP motion, are wrong, in the sense that we want discrimination—we want positive discrimination to support old people's issues. I hope that, as the debate draws to a conclusion, widespread agreement on that will emerge. We are talking about adverse discrimination. We must be careful about the shorthand that we use.
In wider society and in the NHS, we must respect the wishes—both negative and positive—of all our citizens. We should take account both of what they want to happen and what they want to avoid. The NHS is an institution that has power over life and death and over the quality of people's life and the quality of their death. Although I have not yet considered the matter in great depth, I would be most concerned if Mr Purvis's bill were to make health professionals party to anything that would appear to accelerate people's deaths. That issue must be examined.
I have a good story about the care of old people that I will share with members. During her final illness, my late mother-in-law received care in St John's hospital in West Lothian that was exceptionally good, to the extent that she was brought a glass of whisky every night so that she would sleep well. It was indeed the water of life—uisge-beatha.
I am dying; I do not know where, when or how I will die, but I know that I am dying. The old gave us the potential to be what we want to be. We must put service to our elderly before our interests and must ensure that we discriminate in favour of the elderly.
In 25 years' time, there will be more people of retirement age in Scotland than there will be children. The biggest growth will be in the number of people who are over 80, who I am sure will be assisted by the prescription of a glass of whisky every evening.
I begin with that fact because we know that, generally speaking, the older someone is, the more likely they are to suffer from ill health and to end up in hospital. To allow an elderly person to end up in hospital is often the default response; it is not what older people want, it should not be what we want and it is perhaps not what they need. Whenever they are asked, older people tell us that they want to remain in their own homes and be cared for in their own homes for as long as possible. The challenge for us in this chamber is to find alternatives to unnecessary hospital admissions, so that older people can be cared for in or at least much nearer to their own home.
I turn to the issue of care in hospital. Members—not only on the Labour benches but across the chamber—have long believed that older people should be treated with dignity and respect. We should never condone negative age discrimination—direct or indirect—in the NHS.
I want to sound a note of caution, however, and agree with comments that Richard Baker made. We need to set the debate in the context of all the positive work that goes on in the NHS. We must be careful not to convey the impression that the NHS is somehow rife with negative age discrimination. I am sure that the SNP would not want to do that—it is simply not true. As the minister said, there is no systemic failure in the NHS. There are many people in our health service who care—daily and well—for our older people.
That said, we must always respond, and respond robustly, to the genuine concerns of relatives and friends. Those concerns point to a need to raise standards of care, particularly standards that focus on nutrition and personal hygiene. I agree with many in the chamber that those care needs are essential to recovery; they are not an add-on luxury.
It is for that reason that the Executive has moved to put in place a number of different measures. I refer to the clinical standards for our older people in acute care, which have at their core the dignity and rights of older people. I refer also to the NHS QIS 2004 review of older people in acute care and to wider national care standards. Through those measures, we will ensure that the very highest standards of care are delivered to our older people. We need to ensure that the rigorous and professional service standards that are set for our hospitals and care homes are met. I acknowledge that they are being exceeded in many places across Scotland.
I turn to the wider question of care for older people. As the minister said, in 2002, an expert group on health care for older people set out to ensure that they have the health and care services that they need. The group looked beyond hospital care to a much wider set of health care policies that support active aging.
Professor Kerr's report, which was published yesterday, specifically looks at older people and how we can tailor health services in Scotland better to meet their needs. His key conclusion is that the more local the provision, the better it is. Ideally, supporting patients at home will prevent avoidable hospital admissions. In his initial response, the Minister for Health and Community Care committed the Executive to providing just such a service: personal, proactive and co-ordinated care in local communities.
Labour is committed to a better life for older people in Scotland, both now and in the future. We are committed to supporting older people to live healthy, independent lives. A key part of all of that is a recognition that age discrimination is a problem not just in the health service but for wider society. We need to send out a signal that all of us should value older people and that all of us want to support them in continuing to make the substantial contribution to Scottish society that they have made for many years.
Two separate and yet connected issues have been referred to in the debate: age discrimination and neglect of the elderly. As various members have pointed out, there is a bit of a continuum between the two.
I note that NHS QIS says that it will not follow the National Institute for Clinical Excellence's example down south of issuing guidelines that use age as a criterion for whether someone receives therapy. Clearly, some people might not be in a state to benefit from particular treatments, but that is because of their overall clinical condition and not because of their age as such. NICE says:
"where age is an indicator of benefit or risk, age discrimination is appropriate".
I question whether age per se is ever an indicator.
In any case, there is a bit of an issue about what we mean by the word "elderly". After all, some people have to work until they are 70. There is a big variation between older people: some people are quite frail and disabled at 70, whereas other people are perfectly independent and fit and can get on with life by themselves at 90.
The debate was prompted by recent high-profile cases of neglect of the elderly. I do not want to refer to them specifically, but they highlighted the need to give attention to care of the elderly and training. I have a little story to tell in that regard, which shows that the issues are not new and that things have not moved on as they should have done.
About 30 years ago, as a wee medical student, I had a summer job as a nursing auxiliary in a psychogeriatric ward in a hospital in Glasgow. There was nothing particularly bad about the running of the ward—it was fine and the staff were very caring—apart from one part of the day, to which I did not give much thought, having arrived on the ward as a student and accepted the practices that went on. After meal times, we would go round the day room, where the 30 or so patients on the ward were seated, with one washbasin, one bar of soap and one facecloth and wash everybody's hands, one after the other. When one says it now, it sounds disgusting, especially for the person who was the 30th to receive the hand washing, but I did not question it—it was just what we did—until we had an outbreak of scabies. Of course, the infection spread rapidly to all the patients, and the infection control people came down on us like a tonne of bricks. They said that each patient had to be walked to the bathroom and helped to wash their own hands and face, which we saw we should have done, albeit that it was much more time consuming. That was what was done thereafter.
I tell the story because it shows that there have always been issues about the care of the elderly. In that instance, we had not thought about people's dignity. The omission was thoughtless, but no malice was involved. As I said, the ward was very caring.
On the standards of care in the ward, because it was a psychogeriatric ward, many of the patients suffered from advanced dementia. They might have been physically fit—and so, one would have thought, perfectly capable—but they could not sequence their movements to feed themselves. If a patient's food and drink was put down in front of them, they would sit bewildered. One might have come to the conclusion that the patients were not hungry, but staff knew that that was not the case and the patients were fed, even those who appeared to be quite physically fit and able to feed themselves. The staff understood the condition of their patients; they knew what they needed.
From what I hear anecdotally, I think that that is not happening now. Perhaps there is a lack of training for those who do the feeding on the wards, because when I was on that ward, the feeding was done either by trained nurses or by experienced auxiliary nurses. I suspect that that is not the case today.
I think that Stewart Stevenson mentioned the issue of broader societal discrimination against the elderly. We have a society in which many of the changes that have been made have not been elderly proofed. An elderly person who wants to make a complaint about their gas or electricity bill is likely not to be able to write a letter, which is what that generation likes to do. They will probably have to make the complaint by phone—pressing all the buttons and so forth—which is quite stressful and difficult for an elderly person to do, especially one with a hearing impairment.
In a number of ways, we make things unfriendly for the elderly—perhaps inadvertently—and that problem is reflected in the NHS. Training issues are involved and specific training on the needs of the elderly should be made available. I ask the minister to address those issues.
We move to winding-up speeches. I call Donald Gorrie and advise him that he has a tight four minutes.
I apologise for missing the first part of the debate. The pressure on members in trying to get agreement on amendments to legislation is unrelenting. There are timetables and we just have to go along with them. However, the speeches that I heard made a good contribution to the debate.
The particular cases in Lothian are being investigated. Obviously, they are unfortunate, but any large system fails, just as we all fail at times. The cases are not typical, but a wider issue is involved, which concerns not just the health service: attitudes, which other members have mentioned. In many quarters, a patronising and dismissive attitude is still taken towards older people. There is also a feeling that older people do not count as much as other people do. Like all other prejudice, whether on the ground of gender, race, religion or whatever, we must combat that attitude. Older people need to be accepted as people with a full contribution to make and as people who need full attention, just like anyone else. All of us must fight to improve people's attitudes in that regard.
Keeping older people out of hospital has also been mentioned and is a goal towards which all of us should aim. The partnership Executive has achieved a certain amount: we have introduced free personal care and put more effort into care at home. However, much more thought and effort must go in to support that. As other members said, we need the necessary technical support and qualified nurses, home helps or whoever to help older people to continue to live in their own home and live a decent sort of life. That is essential. In addition, residential care that is outwith hospital has to be adequately paid for. That issue has never been fully grasped.
We should pay more attention to ensuring that older people have more activities to take part in that keep them busy, entertained and active. It is often quite hard for older people to take part in activities, perhaps because they are widowed or live alone. I am sure that at election time we have all experienced calling on somebody who clearly has not spoken to anyone for a long time. We perform a good social deed by having a long chat with such people.
We can make more use of older people with young people; they often have a good rapport. I had a relation who at the age of 80 spent many hours listening to primary pupils doing their reading and telling them stories. As well as having youth cafes we can have older people's cafes. Many churches have them, but we could encourage them by supporting places where people can have a good, cheap meal and social contact. If we develop more social contact and activities for older people, and mix them with people of other generations, we will give them a much happier life and will save ourselves a lot of money in the health service and other services. We will do everyone a great favour if we mobilise communities to support their older people better. I hope that we can attend to that in many different ways through local authorities, voluntary organisations and other bodies, and give older people—
You must finish now, Mr Gorrie.
That would help to reduce the problem and change people's attitude. They would see how much older people can contribute.
It is sad indeed that we are discussing problems relating to the elderly, given the number of debates that we have held in the Parliament and the amount of legislation that we have passed in the past six years. I agree with Eleanor Scott that we are discussing two issues today. Age discrimination occurs when elderly people are bypassed for surgery or care in favour of younger people. In addition, we have been examining the alleged abuse and neglect of elderly people.
I support Nanette Milne's amendment to extend the Health Committee's investigation into community care legislation. As others have said, problems in the provision of community care by councils ultimately cause problems in hospitals. The bed blocking—or delayed discharge—figures are higher now than they were in 1999, although it is important to put on record the fact that the figures also include people with mental health problems and other disabilities.
The Kerr report appears to acknowledge and address the needs of elderly people. We have debated care of the elderly and passed legislation to set up the care commission, yet the problems that have been outlined today have not improved as expected or intended. The Parliament does not hold local authorities to account on implementing legislation. When did any of us last hear our local councillors take responsibility for bed blocking?
The Kerr report recommends that more care be provided in the local community, and I make no apology for saying, "Why not start with podiatry checks and, if appropriate, a care plan?" Healthy feet keep elderly people mobile and independent, improve their circulation and aid social inclusion. If we continue to cut back and neglect podiatry or chiropody care and treatment, more elderly people will continue to end up in hospital following a fall, spend months in hospital waiting for care in the community, and become more frail and dependent on care and support.
On the vulnerability of our elderly folk, only last week, a middle-aged professional person attended my surgery to make awful complaints about her mother's care in hospital, including about a lack of food and hygiene—we have heard such complaints today. She felt not just upset but guilty that she was letting down her mother after all that she had done for the family. Once I listed all the complaints, the constituent said, "Now you won't use my name, will you? My mother is scared she'll get picked on." After discussion, she asked me to do nothing, as she had already raised the issues in the ward and, if I wrote in, they would know who had complained. Once again, alleged abuse and neglect passed off without investigation and, sadly, are more likely to continue in future.
If we are serious about ensuring that elderly people get appropriate care and treatment in accordance with their needs, we must ensure that all care homes cater for residential and nursing care, in line with the intent of legislation; we must not have elderly people languishing in residential care when they need nursing care following the likely and predictable deterioration of their condition. Given that the remit of the care commission—which I commend; it is doing a good job—covers care homes for the elderly, should not it be tasked with ensuring that high-quality care is provided while people are waiting for care in the community?
I support the amendment in the name of Nanette Milne.
We have all listened carefully to the debate. The issue is emotive and hugely important and, as I said in my opening speech, there is absolutely no room for complacency. I do not think that anybody in the chamber is complacent.
The caring professions must care. It is our job to ensure that they have the support that they need to do that. I believe that we offer that support, and that our NHS staff are an enormous pool of talent and are committed to the care of their patients, whether young or old. If there are shortcomings to address, that is the positive context in which we must view them.
We offer wide-ranging support. The core business of the NHS is heavily geared towards the care of older people. I accept Stewart Stevenson's comment that that must be so. I mentioned some of the key performance targets, such as hip surgery within 24 hours. Conditions that require that surgery mainly affect the elderly, so that is hugely important. Targets matter because they drive the behaviour of health boards and deliver real results for older people as a consequence.
There are many initiatives that I did not mention earlier, perhaps because they are not the core business of the NHS, but which have been referred to by many as contributing to the health of older people. That is true of community care, where there is a range of initiatives to deliver better outcomes for older people. I take issue with Mary Scanlon. Since the action plan on delayed discharge was implemented, the number of older people who are retained in hospital has reduced drastically.
Put that all together and it makes for behaviours and initiatives that are specifically designed to give older people the best possible treatment and care as close to their own home as possible; it is not a sign of discrimination or a lack of care.
Will the minister give way?
I am sorry, but I do not have time.
Let me respond to some specific points that were raised in the debate. Shona Robison referred to "Frontline Scotland" and care homes that are unhappy with NHS standards of care. We need to ensure that we have standards of care across the NHS and into community care. The care commission, NHS QIS and the social work services inspectorate are co-operating to develop uniform standards and inspection arrangements for all care settings in the NHS, homes and the community.
Shona Robison also referred to the reduction in the number of geriatric beds. That does not mean that there is less care; it means that there is a different balance of care. That is quite right, and is referred to by Professor Kerr in his report. However, we need to ensure that we get the balance of care absolutely right.
Several members referred to nutrition in hospitals. Let us be clear: nutrition is an integral part of care. NHS QIS standards are in place and are being reviewed in 2005-06. All health boards should be implementing them.
Carolyn Leckie referred to the number of nurses in Scotland. Out of the four UK countries, we have the highest number of nurses per head. We will have 12,000 nursing students by 2007, and we are on course to meet our nurse recruitment target. She also referred to the NICE consultation, and claimed that NICE is in favour of age discrimination. NHS QIS has said that any such statement is not relevant to Scotland and that it will not exercise any age discrimination here in Scotland.
I am obviously not able to refer to every point that has been raised in the debate. As I have said, we will be developing an overarching framework for the health care and community care of older people over the next year. I very much welcome any lessons that we can learn from the debate. I particularly welcome the ideas and positive suggestions that many members have advanced this morning. We must always improve and seek to improve.
The range of activity that we already have in place, the independent review that was initiated by NHS Lothian and our own plans for developing an overarching framework mean that there is no place for the SNP's suggestion of an independent national inquiry. That would simply be a distraction from the huge task that is in hand.
First, I make it clear that Ms Robison has given her excuses to the Presiding Officer for not being here for the conclusion of the debate.
I preface my main remarks with a recognition that the vast majority of staff in our hospitals are decent, caring people, who frequently work under pressure and in understaffed conditions. That hits home most when older people are involved. They require that most precious commodity of all: time—time to help them with their meals; time for staff to toilet them; and time to stop and talk. That has been recognised by many members, including Stewart Maxwell.
I acknowledge what Carolyn Leckie said. The debate is not an attack on staff in hospitals; however, it is about what is happening to some—to many—of our people. This is where I take issue with some of what the Deputy Minister for Health and Community Care said, although I acknowledge and welcome the comments that she has made and the steps that she is taking following the two tragic cases that we have been discussing. I cannot agree that the problems are not systemic. I simply do not know whether what happened to Mrs Dick and Mrs Irons is or is not part of something systemic. There are too many such examples. I will not go through the case of my own mother, which I covered in a members' business debate, but just about everybody sitting in the chamber has an example to give. It is when a tragedy takes place that we focus on the issues. People are being neglected: they are unable to feed themselves and they are not being looked after. Their cases might not become tragedies, but they are being treated in that way because they are elderly, and people do not have time to look after them.
I will put the matter into context. I say to Richard Baker that there are, indeed, instances of direct discrimination. He said that there is no such policy, but there is. Historically, clinical trials and medical research tend to exclude older patients, yet they can be given medication that has not been tested on them. Screening programmes for breast cancer apply to women aged between 50 and 70, who are called regularly, but after the age of 70, women are not called and must apply, despite the fact that the chances of developing breast cancer increase as women get older. Help the Aged's very helpful briefing paper states:
"One estimate has suggested that 1500 lives could be saved annually if the programme was extended to older women".
Therefore, there are policies that directly affect older people.
I want to concentrate on the indirect discrimination that has been described in some speeches. The use of the term "bed blocker" stigmatises older people. They are talked about as if they are a category, like furniture. In fact, older people are individuals. They are as quirky as Mike Rumbles.
Surely not.
They are as quirky as Andy Kerr and they are as different as Stewart Stevenson. By the way, he has now delivered his 200th speech. I do not know whether to weep or laugh at that. I have not been here for them all, thank goodness.
Stereotypes are being made. That is a cultural issue, which is why I am summing up for the Scottish National Party today. This is not just a health issue; it is a cultural issue that applies to all manner of services.
The list of issues goes on. One is mixed accommodation. I understand that the Deputy Minister for Health and Community Care has put money towards getting rid of mixed-sex accommodation. I do not know what has happened in that regard—perhaps the minister will tell us. If she cannot do so today, she might be able to write to us another time and explain what has been done. What could be more humiliating for older men and women than having to share wards? It is appalling.
Sometimes, a nurse will come along and immediately call somebody by their first name—it can be a simple thing like that. Some older people like to be called by their full name and might not have asked to be called by their first name, yet a nurse will come along and say, "How are you, Jeannie?" and the person will get upset. There is a discourtesy in that. That can be even more the case among older people from ethnic minorities, who might not have the best command of English. They can find themselves more isolated, and their age will make that even more difficult.
Jackie Baillie said that hospital can be the default response. Admissions can often follow a fall in the home, for example a fall from a stepladder, because no home help comes in who can change the light bulb or reach up to the high cupboard, or a fall in the bath, which would not have taken place if a walk-in shower had been fitted. If we made some progress on the provision of aids and adaptations through social work services, fewer older people would be admitted to hospital.
The best medicine for us all in hospital, whether we are young or old, cannot be found in a bottle. It is not medication. It is called TLC—tender, loving care. That is what our older people require.