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Mental Health: Age Discrimination

My Lords, I thank both noble Baronesses for raising this important subject. It is rather humbling to be part of this group from your Lordships’ House who are discussing this, because it seems to me to be a group that understands these issues profoundly. I suspect that many of your Lordships, like me, have personal experience of family members who have experienced these problems. People are bringing a great deal of experience to this debate. I wanted to pick up some points that perhaps go a little wider: how health services are delivered, why we have this problem and what I think those with the political and policy power can do to move it on. I shall make two big general points, which are pretty obvious, and then pick up three more specific points. The two big general points lie behind what has been said but have perhaps not been spelt out quite like this. The first issue—this is not a personal point—is that this is our future; this is what it will increasingly be about in future. We suspect that there will be more older people with mental illness and co-morbidities. That is another big issue, but those co-morbidities can be lost in people’s view of older people with mental health problems. It is our future. It is a growing issue because it will cost us more, whether we plan for it or not—the reality of care will be there. The second issue is also big and obvious: this will grow in political sensitivity. That is partly because we are all ageing and partly because we now have more relatives in their 80s. As the noble Baroness, Lady Greengross, said, we need only to consider the average age in hospital. In my experience in the NHS, when the average age in the entire hospital went above 72, we were in real trouble. That context is fundamental to the future of health services in the country. Let me pick up the three specifics. First, there are some treatments that work, which people do not always realise, and there is a research agenda, which I know that the Government have recently promoted, to find more treatments. That is vital, because there is sometimes a sense of hopelessness when one thinks about the subject as a member of the general public. That research is not just about drugs; it is also about understanding how we deliver services. As the Nuffield Trust brought out very well in its recent study on dementia, that is about understanding the nature of dementia and what it is like from the point of view of the person with dementia. A great body of understanding and research still needs to be developed and given higher priority if ageism and other problems are to be tackled. The other specifics are what my noble friend Lady Murphy referred to as the cultural shift: how do you make change and what are the barriers? I agree that part of it is a leadership issue. It is great to see that a new tsar has been appointed and good to hear the noble Baroness’s comments about the original national service frameworks coming with money. So there is a leadership issue, but there are other issues as well. The first is, simply, that we still have a health service that is just not configured for patients with these sorts of needs. They are similar to a lot of other patients with continuing care needs, but we still have a health system that is based around hospitals and doctors and has funding and payment mechanisms that reinforce the notion that health is about GP referral to hospital, treatment in hospital and going home. There is a fundamental barrier to paying for good mental health services. Incidentally, this is not an argument against payment by results—for a whole range of areas, payment by results seems to me to work very well—this is an argument for finding some other way to pay for another range of services. That is a fundamental cultural problem about health, not just in the UK but in all developed countries. The second point, which came out in what my noble friend Lady Greengross said, is that this is also about people. It is not just about telling the Government and the policy-makers that they should pay more attention to this; it is about staff and how people think. We have all seen elderly patients who have come into hospital with a stroke. You know that they should have had a scan as soon as possible, but they may be there for 48 hours before something happens. Some of that is benign neglect, if I may put it like that. It is not necessarily about money—sometimes it may be misplaced kindness in not intervening—but it happens all the time. The third point, which I stress strongly, is that if the Government—the policy-makers—are going to move this up the agenda, it is not just about more money or more leadership but about staff training. I mean staff training within the specific service but even more within the acute hospital. It is certainly true that 5 per cent of our patients spend 65 per cent of the money and that most of those patients have continuing care needs. One wonders whether 65 per cent of medical education is devoted to people with continuing care issues. I suspect that it is not; I see my noble friend nodding at me. These are big changes. My contribution to this debate is to say that this is real and it is going to get bigger. The political salience will grow. We will be confronted by this more and more. The efforts to solve it are about supporting what the Government have started with their research programme and developing it further; taking further the attempts to change the model of care and service in the NHS more generally so that it accommodates the needs of an increasing number of older people; and pushing forward with the professional bodies and trainers to make some changes in the way that we all, I guess, behave when we work in these services.