Hansard

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.