Chamber
Plenary, 26 May 2005
26 May 2005 · S2 · Plenary
Item of business
National Health Service<br />(Age Discrimination)
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.
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.
In the same item of business
The Deputy Presiding Officer (Murray Tosh):
Con
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 ...
Shona Robison (Dundee East) (SNP):
SNP
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 t...
The Deputy Minister for Health and Community Care (Rhona Brankin):
Lab
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...
Shona Robison:
SNP
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 wha...
Rhona Brankin:
Lab
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 ...
Mrs Nanette Milne (North East Scotland) (Con):
Con
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...
Mike Rumbles (West Aberdeenshire and Kincardine) (LD):
LD
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...
The Deputy Presiding Officer:
Con
We now come to the open debate. Time is very tight indeed and I ask members to make speeches of strictly four minutes.
Mr Stewart Maxwell (West of Scotland) (SNP):
SNP
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 ...
Carolyn Leckie (Central Scotland) (SSP):
SSP
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 b...
Richard Baker (North East Scotland) (Lab):
Lab
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...
Christine Grahame (South of Scotland) (SNP):
SNP
Will the member take an intervention?
Richard Baker:
Lab
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 ...
John Swinburne (Central Scotland) (SSCUP):
SSCUP
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 i...
Stewart Stevenson (Banff and Buchan) (SNP):
SNP
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 p...
Jackie Baillie (Dumbarton) (Lab):
Lab
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 wh...
Eleanor Scott (Highlands and Islands) (Green):
Green
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...
The Deputy Presiding Officer (Trish Godman):
Lab
We move to winding-up speeches. I call Donald Gorrie and advise him that he has a tight four minutes.
Donald Gorrie (Central Scotland) (LD):
LD
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 a...
The Deputy Presiding Officer:
Lab
You must finish now, Mr Gorrie.
Donald Gorrie:
LD
That would help to reduce the problem and change people's attitude. They would see how much older people can contribute.
Mary Scanlon (Highlands and Islands) (Con):
Con
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 l...
Rhona Brankin:
Lab
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 ...
Mary Scanlon:
Con
Will the minister give way?
Rhona Brankin:
Lab
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 ...
Christine Grahame (South of Scotland) (SNP):
SNP
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 r...
Stewart Stevenson:
SNP
Surely not.
Christine Grahame:
SNP
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 w...