Standing Committee E
Tuesday 23 January 2001
[Mr. John Maxton in the Chair]
The Minister of State, Department of Health (Mr. John Denham): On a point of order, Mr. Maxton. It may be helpful to you and the Committee if I say something about the Government amendments that were tabled last night and others that will be tabled later today. The Government need to table a number of technical amendments to clauses that we shall be debating on Thursday. I regret that they should have been tabled so late in the day.
I shall be writing to right hon. and hon. Members today, setting out the nature of the amendments and explaining their purpose. I shall also endeavour to produce by 7 pm a consolidated version of the Bill, so that Committee members can see the amended version. If, on considering the amendments, right hon. and hon. Members wish to propose that the Sub-Committee should meet to consider extended sittings within the timetable, we would certainly consider it.
Mr. Philip Hammond (Runnymede and Weybridge): Further to that point of order, Mr. Maxton. The Minister has outlined a problem that the Committee will face on Thursday. The difficulty is that the Opposition may wish to table amendments to the Government amendments once we have seen them. Would it be possible for you to say whether, in such exceptional circumstances, you would be willing to call starred amendments on Thursday amending the Government amendments that will be tabled later today?
The Chairman: On that last point, it would be a matter that I should have to consider at the time. Obviously, I would not rule it out at this stage.
Mr. Paul Burstow (Sutton and Cheam): I beg to move amendment No. 31, in page 11, line 38, after `run', insert
`or that the body has practised discrimination by reason of age,'.
The Chairman: With this it will be convenient to discuss the following amendments: No. 22, in page 3, line 5, at end insert
`provided that they have not been found to have practised any form of discrimination by age.'.
No 24, in page 6, line 33, at end insert
`provided that the matters referred to in paragraphs (a) and (b) above shall include the measures taken by the authority to avoid discrimination by reason of age.'.
No. 27, in page 7, line 30, after `persons', insert `of all ages'.
No. 28, in page 8, line 24, at end insert
`(f) to ascertain whether the trust has practised any form of discrimination by reason of age.'.
No. 35, in page 56, line 13, at end insert
```discrimination'' includes any form of direct or indirect discrimination. Direct discrimination shall be taken to occur when one person is treated less favourably than another. Indirect discrimination shall be taken to occur where an apparently neutral provision, criterion or practice would put persons of a particular age at a particular disadvantage compared with other persons.'.
New clause 4Age discrimination
`. It shall be unlawful for any body to which this Act applies to refuse or delay any treatment or procedure, or to provide a less favourable standard of care, in respect of any person by reason of his age.'.
Mr. Burstow: As this is my first contribution to the Committee's deliberations, Mr. Maxton, may I welcome you to the Chair and say how pleased I am to be a member of a Committee dealing with such an important subject?
The amendments deal with a crucial aspect of that subjectage discrimination in the national health service. I suspect that all members of the Committee will have received letters of complaint from constituents telling of their personal experiences of the NHS, and that many of those letters will have advanced the argument that, at least in part, age was a determinant of their access to treatment.
Last year, in its on-going campaign to highlight age discrimination, Age Concern published a report documenting the testaments of those who had experienced age discrimination. It also gave statistical evidence to demonstrate that it is not only the public who believe that age discrimination and age-based rationing exists within parts of the NHS but that it is the view also of general practitioners. The amendments seek to provide a definition of age discrimination and to provide that the criteria for making age-based decisions in the health service are taken into account by the Secretary of State in respect of some of his funding decisions.
I was prompted to table the amendment by a letter from a constituent, who wrote to me following her mother's experience of what can only be described as less than satisfactory treatment, which left her in a poor condition. Her ward was not cleaned, and I am afraid to say that the attitude of the staff was all too often unsatisfactory. Assumptions were made that contributed to the unsatisfactory care that she received.
Age Concern would want me to draw to the Committee's attention specific examples that demonstrate a growing concern about age being used as a basis for making decisions within the health service. I believe that the Department of Health some little while ago published research showing that 70 per cent. of renal care units used age as a basis for making decisions on access to their services, which is a questionable practice. Similarly, until recently, breast cancer screening was not available to women over the age of 65. It is hardly surprising that the prevalence of death due to cancer among people in that age group was so much higher; they would have benefited from the screening programme. The NHS plan includes a commitment to deal with that.
Mr. Hammond: It is an important subject, but the clause deals with the Secretary of State's ability to exercise draconian intervention powers. The hon. Gentleman seems suggest that the practices that he refers to are widespread. Under the amendment, the logical conclusion is that the Secretary of State would intervene on a massive scale in the running of a large number of health authorities and trusts. Do the Liberal Democrats want that to happen?
Mr. Burstow: I shall make two points in response to the hon. Gentleman. The first is technical. The amendments do not deal only with the intervention powers under clause 16. The group under consideration includes new clause 4, which provides a definition, and amendments to other clauses. For example, clause 7 deals with other aspects of the implementation of the measure.
On the basis of the growing evidence brought to the attention of the House by Age Concern, Help the Aged and many other charities, the Secretary of State should intervene more aggressively. We know that the Government's long awaited NHS framework for older people has still to be published. Ministers have assured us from the Dispatch Box on numerous occasions that the document will include statements on age discrimination and a policy of zero tolerance. However, none of that places specific requirements in legislation. We tabled the amendments in order to initiate a debate, to probe the Government's intentions and to establish whether the Government are persuaded that providing a legislative basis for equality of treatment in the NHS is the way forward.
I have referred to access to cancer treatment and renal care. Another problem is access to clot-busting drugs, because many of the units that provide those drugs base their decisions on age. When clinicians make decisions about access to treatment, they should set aside the patient's date of birth and make an assessment of that person's clinical needs and whether the proposed treatment will produce a beneficial outcome. They should not base their decisions solely on the patient's age. However, it seems to happen time and again.
I shall put one more piece of evidence before the Committee. In October and November last year, the community health councils published Casualty Watch figures. Those figures are interesting, because they are snapshots of specific days and attempt to show how casualty units perform on, for example, waiting time on trolleys before admission into the hospital and treatment.
The figures include data on people's ages. Analysis of the resultsalbeit from only October and November rather than from a more comprehensive survey, but the figures still cover 16,000 casesmade it evident that there was a significant difference in the length of wait for people aged 20 and 80, for example. There was a 65 per cent. increase in waiting time the older one was. That is unacceptable and questionable practice. It was suggested that the reason was that older people who went to accident and emergency departments might have a more complex range of needs, and so might have to wait longer so that various facilities could be set up for their appropriate diagnosis and treatment. I do not accept the idea that that should lead to a longer wait for such individuals.
In a case last year, about which I am still waiting for a substantive response from the Department, two constituents reported their mother's experience to me. She is a dementia sufferer and is in a care home. She was taken to an accident and emergency department after a fall, and her children reported that the level of understanding and appreciation of the needs of someone with dementia was inadequate. The nature of her condition was not understood, and neither was her resultant need for early attention. My constituents' mother was caused great distress and was discharged before treatment was provided, which was unacceptable.
The amendments are an attempt to add provisions to the Bill for, or at least to force the Government to acknowledge further, an important issue of great concern to many of our constituents, which is that age considerations are an unacceptable factor in treatment and care in the national health service. Too often, they underpin aspects of practice and attitude towards our elders in the NHS. One has only to consider the work of Help the Aged and its campaign for dignity on the ward to be aware of the relevant pressures. The Bill provides an opportunityand it is about timefor such matters to be put on a firmer footing.
I return to the question asked by the hon. Member for Runnymede and Weybridge (Mr. Hammond). If the evidence before us today and supplied to the Department from numerous individual cases and non-governmental organisations can be confirmedI believe that it is reputable and creditablethe Government need to act and to be challenging. They must ensure that they do not simply have policy, but the legal back-up for it to ensure zero tolerance of age discrimination in the NHS.