Hansard

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.