Health: Age of reason

THE VOICE from the couch was granite-edged. "I am sick of the complacent, smug acceptance of the limit on NHS spending. What about the morality of it, the inhumanity of it? Why does no one ever question it?"

It was an item on ageism in the NHS on BBC Radio 4's The World Tonight that provoked this outburst. Two experts were discussing the problem and both accepted the grim inevitability of rationing. This did not endear them to the Voice on the Couch. "Why can't these so-called experts ever consider spending a bit more on the NHS? Why do they always have to accept the status quo?" it said. Much has been written on the subject of NHS ageism in the last few days, since publication of an Age Concern report detailing some pretty nasty examples, and most of it I find alarmingly one-sided. Extra spending - on the elderly, in particular - is a two- edged sword that may bring bad effects as well as good.

In the The World Tonight item, John Appleby, of the Kings Fund, observed that 40 per cent of NHS spending goes on the over-65s, who make up 17 per cent of the population. On those figures alone, therefore, the charge of NHS ageism is hard to make stick.

The Voice chips in here with a tale of a family friend in his early eighties who was still working and leading an active life until he developed a hernia. He was put on an NHS waiting list but the operation was cancelled three times (was this age discrimination?); it was 18 months before he had surgery.

By then he had been forced to give up his daily yoga session, found walking difficult, had lost his fitness - and broke his hip in a fall that cost the NHS thousands to fix (and thousands more in rehabilitation and social care costs). The moral here is that investing in early treatment, besides being better for the patient, can work out cheaper in the long run.

So, yes, let's have prompt treatment for the elderly on the basis of clinical need, the same basis as would apply to any other patient of any age under the NHS. The patients I have in mind - real ones, these - are a man of 73 with heart failure, who was resuscitated against his wishes and kept alive for a final 48 hours in a distressed and distressing state.

Also a woman of 62, who suffered a rare reaction to a drug cocktail she should not have been given, had emergency surgery and then suffered a cardiac arrest but was kept alive for 17 days on a ventilator at the request of relatives before she died of multi-organ failure.

These patients cost the NHS thousands of pounds - well over half the health care resources that the average individual uses in a lifetime. The NHS can be as guilty of doing too much as of doing too little.