The government and the “societal benefits” of care

Zoe Wyrko is a Consultant Geriatrician at Queen Elizabeth Hospital Birmingham and is the workforce planning lead for the BGS. She tweets at @geri_babyshutterstock_147407087

I like to think that as a jobbing geriatrician I have a fairly pragmatic attitude towards guidelines. I know that they exist, but I also know that they are not always directly applicable to a frail older person with multiple morbidities, so I’ll look at what they say with a hint of scepticism, and use them when they help me to provide the best care. Extrapolating from this, I tend to see NICE as an organisation that is more for other people than me. I know that the work they do is vital in standardizing care, bringing together groups of experts to decide on treatment pathways and helping to make decisions on which drugs to give when. I have even attended a stakeholder group for the preliminary stages of the guidance they are planning to issue for social care.

This week however, a statement made by Sir Andrew Dillon, head of NICE, has made me sit up and pay attention. It seems we should be afraid… very afraid. As part of the austerity and financial cuts affecting the NHS in England, NICE is consulting on an update to its methodology for assessing drugs. According to articles published in newspapers recently, the Department of Health have requested the institute to make judgements on the ‘wider societal benefit’ of medicines before recommending their use. Thankfully, Sir Andrew has rejected this proposal, and in an interview with The Times explained that this approach would leave older people at risk as they would be discriminated against, and not receive treatments because of the perception of poor value for money. To summarise, younger people have earning potential therefore if they are treated and can return to work they will put money back into the economy via taxes and national insurance, whereas older people take more from society than they can return. He stated “we’re really concerned that we don’t send out the message that we value life less when you’re 70 than we do when you’re 20.”

This discriminatory, blinkered view emanating from unnamed government ministers makes me angry and also very worried. Although the suggestions have been rejected this time, it is likely that this subject will recur. The Equality Act 2010 legally protects people from discrimination in the workplace and in wider society, and specifically states that people cannot be discriminated against because of age. One of the effects of this act is to allow people to continue working past the traditional retirement age if they wish, rather than being forced to relinquish their employment because they have passed an arbitrary birthday. These people will still be paying tax. Many older people who are already retired pay tax on their pensions and investments. It also cannot be forgotten that during their working lives, older people have paid tax and national insurance into the system, and probably ‘claimed back’ relatively little healthcare during that time.

But after all, this is potentially a way of saving significant money from both the health and social care budgets. Don’t use treatments that can prolong life – and I obviously don’t need to elaborate on the hard, economic benefits. It makes me shudder to think about it, and I hope you are of the same opinion. So what next? What other reasons will be used to ration healthcare in the future? Replace ‘age’ with any of the other characteristics described in the equalities act perhaps…?

I understand that the drug assessment methodology will be out to consultation in the near future, and the BGS will be putting in a response (as it does for all significant work like this). Don’t forget the three core principles of the NHS – it meets the needs of everyone, it’s free at the point of delivery, and it’s based on clinical need not ability to pay. We may have a very important fight on our hands.

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