Many people today are not only growing older but stay fitter for longer than ever before. This was one of the factors we considered last week at our College Strategic Thinking Day. The day aimed to consider what our priorities should be over the next 5 years. The aging population was a recurring theme in understanding what these might be. For example, the number of people aged 65 and over is expected to rise by 65% (to almost 16.4m) over the next 25 years. Life expectancy when the NHS was created was 66 for men and 70 for women. Today it is 78 and 82 respectively. At aged 65, men will live an average of 18 more years; women 21.
According to a report published last week by the Royal College of Surgeons and Age Concern, (thank you Norman and Michelle) the NHS has not always kept pace with these changes and there have been a number of concerns raised over the quality of care offered to older people. In the UK age discrimination is illegal but the report suggests that decisions over whether older people are put forward for surgery might still be subject to the age of the patient rather than actual need.
For example, whilst the incidence of breast cancer peaks in the 85+ age group, the surgery rate peaks for patients in their mid-60s and then declines sharply from the age of 70. People over the age of 65 make up the majority of recipients of joint replacement surgery. However, the rate of elective knee replacement and hip replacement surgery for patients in their late 70s and over has dropped sharply and consistently over the last 3 years. 10000 men a year die from prostate cancer and the incidence of the disease increases with age. Overall 50% of men who develop the disease will die as a direct result of it. But surgical treatment rates for the disease do not match the number of new cases being diagnosed amongst the older population. Emergency surgical procedures are increasing for hernias in older people, while the planned surgery rates fall sharply once a patient is aged 75 or over.
Of course there are many reasons why these apparent discrepancies might be occurring, and it’s clear the fault does not lie with surgeons per se, other decisions makers might also have a role to play, particularly those responsible for primary and community care services. Likewise, the older person themselves might want to exercise some choice as to whether they want surgical treatment or not.
People need information to make choices however. It has been said that the rise of social media has led to the growing empowerment of us all, and the 'nowhere to hide' culture of the Twitterati has raised expectations of quality, and growing intolerance of poor service. And there are many people like my parents (older people in their own right) who regularly use their iPads to access information about all aspects of their life. However, such access can be a mixed blessing. The instant access to others offered by Twitter, Skype and FaceTime is the new technological tyranny. Orwell probably had it right.
At the other end of the age spectrum I was interested to read last week that university students in classes that use Twitter average 10% grade points higher than those who don’t. 98% of students own some kind of digital device, and 8% of students use social networking sites to contact their lecturers. 50% of students believe that tablets will replace text books completely within the next 5 years. When at our College Strategic Thinking Day I shared this information and asked who, that morning had used Twitter and tweeted someone – there were only 2 of us who had, Moira and me. Made me think.
The other thing that made me stop and think last week was the publication of the challenging report from the Prison Reform Trust and INQUEST entitled Fatally Flawed. This report used the the story of Joseph Scholes to explore the way in which the UK criminal justice system treats young people. Joseph was just 16 when he died at Stoke Heath Young Offender Institution in 2002. Despite much public outcry, no public inquiry was ever undertaken. Since Joseph died on 24 March 2002 to the day this report was published last week on the 24 October 2012, 9 children and 191 young people aged 24 and under have died in prison.
We have to do better for both the older and younger people in our society.