Is the NHS guilty of ageism by not giving free personal care for some older people in England?

EDITOR—Scotland's first minister has announced that he intends to implement free personal care in nursing homes for older people by April 2002.1 But the prime minister seems to believe that there are better things to spend money on in the English NHS. He overlooks the fact that the NHS Plan for England explicitly claims that it will eradicate ageism in the NHS.

Older people need personal care, not because they are old but because they have acquired disabling disease in old age. Thus the central tenets of the NHS would seem to be broken if older people do not receive the care they need, just because they are old. If this is a form of rationing then its criteria need to be made explicit. The current position that only care provided by registered nurses will be freely provided by the NHS is an inadequate basis on which to determine need and has all the hallmarks of covert rationing at the expense of a highly vulnerable sector of the community. It is also at odds with the national service framework for older people.2

The British Geriatrics Society believes that older people have the right to expect the best possible care from the NHS and social services. Such care should include appropriate facilities and specialists to treat particular problems, not only acutely but also over the longer term.

Specialists in medicine of old age are key to reducing the costs of long term care:

• Firstly, through leading early and expert interdisciplinary assessment, diagnosis, and treatment to postpone and reduce the burden of need for long term care

• Secondly, by skilled and careful assessment of individual need and other alternatives before any decision is made to enter long term care

• And, finally, when long term care in homes is essential, by detailed evaluation of individual dependency as the basis for NHS funding—which may well include elements of personal as well as nursing and multidisciplinary care.

At present older people are given the impression of being seen more as a nuisance than as rightful consumers. Ageism in health care can be as insidious as racism. Perhaps, when some commentators complain about the problem of what to do about older people they should substitute the words “ethnic minorities” and see if the statement still appears reasonable.

I hope that the government in London will rapidly sort out its apparent internal inconsistency on this crucial issue as it introduces the national service framework.