Victims Of Socialism

Deadly Rationing: The gatekeeper for Great Britain's national health care system is denying cancer patients drugs that would extend their lives. Why? Because the medication is considered too expensive.

What's a life worth? Apparently not much in Great Britain. The National Institute for Health and Clinical Excellence, the government agency that decides which treatments the National Health Service will pay for, has effectively banned Lapatinib, a drug that was shown to slow the progression of breast cancer, and Sutent, which is the only medicine that can prolong the lives of some stomach cancer patients.

Banning beneficial drugs due to cost is nothing new in Britain. NICE, which has to be one of history's most ironic acronyms, forbade the use of Tarceva, a lung cancer drug proven to extend patients' lives, and Abatacept, even though it's one of the only drugs that has been shown in clinical testing to improve severe rheumatoid arthritis. Once again, we have to ask: Do we really want to use the British system as the model for a U.S. health care regime?

Promises of an effective, cost-effective health care system operated by the federal government are cruel fabrications. The British system shows that the state makes a mess of health care. So does the Canadian plan, which is plagued with unhealthy and often deadly waiting times for treatment.

The Swedish government system is no better. It also refuses to provide some expensive medication and, inhumanely, refuses to let patients buy the drugs themselves. Why? According to a Journal of American Physicians and Surgeons article, bureaucrats believe doing so "would set a bad precedent and lead to unequal access to medicine." Like Canadians, Swedes are subjected to long waits. They also have denial-of-care problems that sometimes lead to death.

A reasonable person would see the record of repeated failures in government-run medicine as evidence that such a system is not sustainable. Yet every central planner thinks he or she - or his or her immediate group - is smart enough to correct the flaws of socialist programs and therefore has the moral authority to force others to participate in his experiments. It is the same thinking that will move a person to say we are the ones we've been waiting for.

Medicine needs experimentation to progress. But experiments need to stay in the laboratories, not spread to the domain of public policy. Americans are not lab rats. They deserve to be treated with dignity and not shoved aside as expendables to be sacrificed in deference to a sacred totem of the political left.

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Why does the NHS hate the elderly so much?

One day, when I was touring a North London hospital, I stopped in horror in front of an old lady in a blue bed jacket. Her face was a mass of bruises. I assumed she'd been brutally mugged, but the matron I was shadowing looked embarrassed. The old lady was, indeed, a victim - but of the NHS and its dreadful treatment of the elderly. First, a wrong prescription from her GP had left her so dizzy that she had tripped over and broken her hip. Then she had fallen out of her hospital bed and bashed her face.

I asked why the NHS bed lacked the cot sides available in private hospitals. 'We believe physical restraint is inappropriate to our patients' dignity,' reproved the matron. It is a case that sums up why the NHS is failing our elderly through misdiagnoses, ignorance and a culture that neglects and even despises them, putting Government targets over compassion and common sense.

I remembered that poor bruised woman when I read the horrific results this week of the Healthcare Commission's investigation into conditions at Staffordshire General Hospital. Hundreds of patients there, most of them elderly individuals who in any civilised society would expect to be treated with dignity, respect and compassion, may have died because of 'appalling' care, the commission suggested. The litany of complaints from families of the hospital's victims should shame us all: patients so thirsty they were forced to drink out of flower vases; wards described as war zones; people given wrong medication or none at all while others had to lie in soiled sheets and sick people left in A&E for hours, covered in blood and without pain relief. True, the problems did not apply exclusively to the elderly, but they were by far the most numerous among patients to be treated with such callous disdain.

And perhaps the most disturbing fact is that, far from being an isolated incident, if you are old and a health service patient anywhere in the country, you suffer more than any other patient.

Why does the NHS seem to hate the old so much? A recent survey of 201 doctors by the British Geriatrics Society found that seven out of ten specialists believe the elderly are less likely to receive a proper diagnosis and essential treatment than younger patients. Almost half believe the health service is 'institutionally ageist' and more than half admitted they were worried themselves about how the NHS would treat them in old age.

Most staff strive to treat patients with care and skill and there is a huge number of them whose dedication and professionalism we can only admire. But I spent a year researching a report on the NHS and I witnessed how the service betrays the elderly at every level. It sees neither they nor their most common illnesses as a priority. This is extraordinary because the elderly are the core business of the NHS. They occupy nearly two-thirds of general and acute hospital beds and account for half of the recent growth in emergency admissions.

And Britain is getting older. By 2025, the number of people over 80 will have increased by about 50 per cent. But simple demographics aside, it seems almost beyond comprehension that those who enter the NHS, those who choose a career caring for others, are actually denying civilised treatment to an entire swathe of the population. Surely we should, as a society, care properly for those who in earlier years have nurtured us and who now need our help. What kind of people have we become that we simply discard our elderly as an inconvenience because they get in the way of Government cost-cutting and performance targets?

As in other areas of political life, Government policy in the NHS has placed the emphasis on vote-winning targets such as waiting times and extended surgery hours for GPs. This has been at the expense of the patients who most use the NHS and are the least able to protest - the elderly. The problem is well known. A staggering 1,600 health service managers in a major national survey, reported in the Journal of the Royal Society of Medicine, believe that the elderly have benefited least from Government reforms.

But common conditions in old people - osteoporosis and incontinence, for example - still don't attract the Government's attention and spending. Meanwhile, free breast screening stops at 73, despite powerful evidence that it should continue for much longer, and anyone suffering from mental health problems is refused specialised treatment after 65.

It is not all the Government's fault. Discrimination against the elderly is prevalent throughout the medical profession. 'Old people deserve proper diagnoses and treatment,' says Dr David Oliver, a senior lecturer in elderly care medicine. 'But they are just not getting it.' Many doctors will blame symptoms such as confusion and falling on old age. But, in fact, points out Dr Oliver, acute confusion can be brought on by a change in the patient's circumstance, a bladder infection or a new medicine - and not always age at all.

Medical staff are often not helped by their training. Despite the increase in elderly patients, half of medical schools lack a geriatric medicine department. Doctors and nurses get only four or five weeks' training in caring for the elderly. As Dr Oliver says, old people are 'core users of NHS services, but they are still not high up on the agenda'. Nor are they popular with many members of medical staff. In surveys for the Royal Society for Medicine, medical students declare openly that they do not wish to work with old people. But the sheer number of old people using the NHS means that most of them will have to. How many of us want to be cared for by a doctor who has little or no interest in our ailments?

General neglect on the ward is another major problem. People in their 70s and 80s come from a generation that respects authority and hates to complain. And in a busy hospital, the quiet old lady in the corner can be safely overlooked. In a corridor of an A&E department in a London teaching hospital, I came across one old lady lying on a trolley. She had arrived at 10.30pm the previous evening and it was now lunchtime the following day. 'It's very hard on the bones,' she said, trying to smile. 'I wouldn't recommend it.' She had not been given anything to eat. 'And I haven't had a wash either. Of course, they try their best,' she said. A few hours later I returned. She was still there, but a nurse had brought her a blanket. Every time she turned over, however, it fell on the floor.

The old-fashioned matron used to be the patient's advocate. She had the power to oversee all elements of a patient's care, and take responsibility for their well-being. But the modern matron, an invention of the current Government, lacks clear authority at ward level. Some, through sheer force of personality, do an excellent job. But too many fail to ensure that even basic care is provided - and it is the elderly patients who suffer. Busy ward staff don't consider helping an elderly person to eat a priority - and so six out of ten older people are at risk of becoming malnourished while in hospital.

Patients complained to me all the time about the food. In one ward, I saw an old man wearing an oxygen mask and sitting in bed staring disconsolately at a wash bowl sitting on a bedside table covered in detritus. Next to the wash bowl lay his uneaten breakfast. A nurse, who should have helped him to wash and eat, had simply abandoned him. Indeed, many of the nurses I saw seemed indifferent or helpless. And the fact that so many of our elderly are going hungry on our wards, unnoticed, is an appalling indictment of the NHS and its attitude to the old.

No one is asking that old people should get privileged treatment. But they should get their fair share of resources and care. As the case of Staffordshire General Hospital shows all too graphically, this simply is not happening.

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