People's History of the NHS

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Old Age and the NHS


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Guest encyclopaedia entry by Professor Pat Thane

In 1948 c. 70,000 chronically sick older people occupied beds mainly in former Poor Law hospitals, expected to stay until death, often having suffered strokes or heart attacks. Many more, living at home, were disabled by conditions which were minor and curable for those who could afford treatment or appliances, including bad feet, defective hearing and vision, unable to afford hearing aids, using spectacles inherited from relatives or bought cheaply on market stalls. For example, a woman was bedridden, apparently deaf and thought to be suffering from mild dementia. Once her severe corns were treated on the NHS, the impacted wax removed from her ears and her constipation remedied she was up and active again.[1] Lives at all ages were transformed when the NHS introduced free spectacles and dental care, though few poorer older people still had their own teeth and services needed more by older than younger people, such as chiropody and hearing aids, were introduced more slowly and incurred charges; many older people still lacked them in the 1960s.

The issue of  ‘bed blockers’, as they were described, began to be tackled in the 1930s, when Dr Marjorie Warren found herself responsible at the West Middlesex Hospital for about 700 bedbound old people in large, dismal wards, with poorly trained nurses and largely ignored by doctors who did not expect recovery. Warren had the wards painted attractively, provided dayrooms and activities giving an incentive to get out of bed, seriously diagnosed patient’s conditions and promoted physiotherapy and other forms of rehabilitation, enabling 200 of the initial patients to leave hospital to live with relatives or in care homes. She was early to recognize that diagnosis of older people was difficult because they often suffered from multiple conditions, physical, mental and social, which she learned to disentangle. But, as long remained the case with geriatrics, her innovations were not recognized or well – regarded at her own hospital.

Warren inspired the emergence of geriatric medicine in Britain and, with colleagues in the BMA, urged the nascent NHS to improve medical services for older people, the training of those caring for them and research into their needs. The response was slight, even more for mentally than physically ill people, as younger patients took precedence. Progress was faster in Scotland, led by another individual, W Ferguson Anderson, the first British Professor of Geriatrics in Glasgow in 1964, himself inspired by Warren. Still in 1958 Glasgow teaching hospitals banned admission of patients over age 65. In the 1960s older people still too often received cursory, even cruel, treatment in grim conditions. Doctors attributed symptoms to ageing not to illness, assuming that illness was normal in old age and little in their training suggested otherwise. Anderson’s practice convinced him that very many older people were healthy. To convey greater realism about their needs by 1965 he made geriatric training obligatory at Glasgow. Only in the mid- 1970s did WHO and the BMA urge it in all medical schools, while DHSS began to encourage the formation of geriatric units and specialist consultants, whose numbers slowly grew.

It was recognized before 1948 that older people could maximize their fitness and activity living in their own or their families’ homes, but services, such as district nurses and home helps, grew more slowly and unevenly than for younger people and required means-tested payment. Services improved in the 1970s as did often miserable conditions in care homes following revelations including in Peter Townsend’s survey, appropriately titled The Last Refuge (1964). Integration of health and social care to prevent older people needing so much hospital care has been urged since the 1950s but never achieved. Cuts to local authority services and privatization from the 1980s and, still more severely, since 2010 have caused further deterioration of community and residential services while more people live longer, often suffering multiple complex conditions.

From the 1960s also medical research made breakthroughs especially valuable to older people including cardiac pacemakers, kidney dialysis, from the 1970s cataract, joint and organ replacement surgery, though suggestions continued of age-based rationing of treatment, that younger people received precedence. Older people and their families became less willing to take inferior treatment for granted, more inclined to complain. Yet still, in 1994, the MRC pointed out that older people were persistently excluded from treatment, including for coronary care, from research into the effectiveness of new drugs and treatments and clinical trials and from screening programmes. Women are still routinely called for breast cancer screening only until age 70 despite the fact that breast cancer is more prevalent past age 70. Cuts to NHS services in recent years have often been directed first at services which particularly affect the capacities of very many older people for independent living, including cataract removal and joint replacement.

More people than ever before live longer and also healthier lives, especially the better-off. Between 1981 and 2006 average life expectancy of British men at 65 rose from 13 to 17.2 years, their disability free life expectancy from 7.6 to 12.8 years. Among women the figures were 16.9 and 19.9; 8.5 and 10.6.[2] In 2010 men in Kensington and Chelsea had average life expectancy at birth of 88, those in Tottenham, 71[3]. The changes owe something to improved medical care, more to higher living standards, for those who can enjoy them. The ageing society is often presented negatively as burdening the NHS with excessive costs. Less discrimination against ageing people and more attention to preventive and supportive community services could enable still more to stay healthy longer, demanding less of the NHS and further increasing their already growing contribution to support for their families (e.g. through childcare), to national output and  taxation, hence helping to fund free health care.

PT

Pat Thane is Professor of Contemporary British History at King’s College London and a leading authority on social and welfare history.

Notes

[1] W. Ferguson Anderson and Bernard Isaacs eds. Current Achievements in Geriatrics (London 1964) pp 2.4, quoted in Pat Thane, Old Age in English History: Past Experiences, Present Issues (Oxford University Press, 2000), p. 446.

[2] Office of National Statistics, Statistical Bulletin: Older People’s Day 2010 (accessed 23 Jan 2012).

[3] M. Marmot, Fair Society, Healthy Lives. Strategic Review of Health Inequalities in England  www.marmotreview.org (accessed 2 Jan 2012).

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