A controversial aspect of the Health Bill, currently at committee stage in the House of Lords, is the treatment provided by the NHS to those aged 75 or over.
The NHS Outcomes Framework, used by the newly created NHS Commissioning Board to drive future health improvements, introduces a distinction between those under and over 75. One of the five domains of the framework is preventing people from dying prematurely. Three of the improvement areas in this domain (tackling deaths from cardiovascular disease, respiratory disease and liver disease) focus on only those under 75.
When you combine this with the health benefits measure used by the National Institute for Health and Clinical Excellence (NICE) the concern rises further. NICE uses a quality-adjusted life year (QALY) to measure the health benefits delivered by a given treatment regime. In simple terms, with the same end result the QALY measure is higher the younger you are. The result of this is that as you get older your chances of qualifying for treatment go down.
I question the rationale for introducing age into these measures. Baroness Bakewell concisely summed up the issue in the Lords recently: “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.
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.”
Baroness Bakewell also quoted a recent report commissioned by the Department of Health, which 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”.
The Health Bill would put a duty on the NHS Commissioning Board and the 10,300 GP practices they will control in April 2013 to follow this framework. Ten million of the population are now over the age of 65, all of them registered voters. It would be wise for the Secretary of State for Health, Andrew Lansley, to think carefully before potentially consigning such a group to the scrapheap. Age inequality in the NHS, as well as being morally wrong, could become a major vote loser for the conservatives for generations to come.
By Jon Davies| Righttrack’s Digital Marketing Manager
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