Martin Bright
The Guardian


On a bleak September day three-and-a half years ago, my 88-year-old grandmother, Irene Emmings, lay fighting for her life in a Bath hospital. After suffering a stroke, she had been rushed into the accident and emergency department where doctors stabilised her condition. At this point, she was abandoned by a system that had lost the will to care.

After hours on a trolley in a corridor, she was eventually placed on a mixed ward where nurses had no idea that she needed a drip to help her diabetes or drops for her glaucoma. For five days, she was left without food or drink because a speech therapist was unavailable to test her swallowing reflex. 

Things were little better when she was eventually transferred to a women's geriatric ward. On one occasion, relatives found her with her head on a pillow sodden from a leaking drip and on another lying in her own faeces. Unable to speak, in her desperation, she left notes by her bed about the neglect and abuse she had endured. She wrote of how telephone calls from relatives were left unanswered as the phone was left ringing all night and how staff tried to force-feed her through the nose without her consent. 

What she didn't know was that doctors had written 'Do Not Resuscitate' on her file; if she had had another stroke or heart attack, the hospital would not have tried to save her. 

When this newspaper published details of her experiences, we thought it was an extreme case, but the response from hundreds of readers showed that her treatment was horribly and scandalously unexceptional. The 'Dignity on the Ward' campaign which followed, backed by Help the Aged, led the then Health Secretary Frank Dobson to intervene directly. He promised immediate reform of the way older people were treated. In an article in  The Observer, he pledged to establish a National Service Framework for an end to ageism in hospitals. 

Last week, to the joy and genuine surprise of campaigners for older people, the framework appeared, backed by £120 million to refurbish wards for older people. Dobson's successor, Alan Milburn, has called it a 'radical blueprint' and for once those tired words appear to be borne out by the document. By the end of 2004, the NHS will undertake an additional 70,000 cataract operations, 16,000 hip and knee replacements and unclog 3,000 arteries - all on patients over 65. 

Most profoundly, the framework commits the NHS to provide care 'regardless of age and on the basis of clinical need alone'. By October, all hospitals will be expected to end rationing on the basis of age, a welcome return to the founding principles of the health service. 

But behind the scenes, the health professionals and charities which backed the Dignity on the Ward campaign are worried. Where will the extra nurses come from to care for the 88-year-olds who no longer have 'Do Not Resuscitate' written on their files? Who will pay for the doctors to carry out thousands of extra operations? 

A devastating report published on the Department of Health website last week outlined the monumental nature of the task ahead. The Standing Nursing and Midwifery Advisory Committee said that over-65s were still being denied the basic rights to privacy and independence. It also voiced 'great concern' at persistent negative attitudes to older patients, the motivation behind  The Observer 's new campaign - the Elderly Abandoned. 

Alan Milburn knows that it will need far more than a lick of paint on geriatric wards to improve conditions   for older patients. Last week's report made it clear that the NHS was still 'failing far too often to meet their basic needs for food, fluid, rest activity and elimination [going to the toilet]. Their psychological, mental health and rehabilitation needs are often ignored... it remains the case that staff lack the basics - clean bed linen, pillows and dressings - to allow for the humane treatment of older patients.' 

We should not belittle the genuine attempt at reform represented by the National Service Framework, but many specialists now believe ageism is so entrenched that it will take more than a blueprint, however radical, and a set of targets, however ambitious, to transform the culture of a lack of respect for the elderly. 

It is a sign of how far we have drifted from the idea of universal health care that the Secretary of State needs to make a public statement that older patients in the NHS should have equal rights. Two-thirds of those using the NHS are over the age of 65. Instructing hospitals to take their needs into account is not far removed from telling those who run Disneyland that it would be good if they catered for the needs of children.

Reprinted with kind permission of Guardian Newspapers Limited