I was shocked, not at all surprised and guiltily elated by the health service ombudsman's findings of official NHS neglect and failure to care for elderly people. Ann Abraham's report - and the observations in her eloquent introduction - should be a wake-up call. She told it from her vantage point. From my ground-level perspective on the edge of our revered healthcare system, the NHS seems, bluntly, no longer fit for purpose for older people.
I'm not a medical professional. As a specialist exercise instructor, I work with older people who still live independently, but most of whom are at risk of falling and injuring themselves. None of my clients is at death's door, but all are living lives made increasingly complicated by the combined effects of ageing, disease, disability and treatment. It's a new kind of normality and one that could easily be yours or mine some day. This generation's experiences of their unanticipated extra decades carry urgent cultural and structural messages for the future of healthcare.
Among this generation of over-70s, I see a culture of low expectations about what the health service can do for them. This is paradoxical, because they consume truly vast amounts of their own and the NHS's time visiting GPs: undergoing scans, investigations, procedures; awaiting diagnoses; tracking down specialists' reports; getting new medications; coping with the side-effects of medications; switching medications and so on.
Retirement, for many, has turned into a full-time occupation of chasing after their own illnesses. And yet they routinely tolerate poor outcomes, continued decline in their quality of life and, above, all, long-term, low-level pain.
To me, it's unacceptable that an 83-year-old should have been in pain ever since his knee replacement 10 years ago, but he just shrugs his shoulders: "What can you do?" he says. I am surprised that no one has suggested investigating another client's horribly locking and painful knee joint. "They say it's probably arthritis," she explains, accepting this bog-standard non-diagnosis as incurable fact.
I am puzzled when a GP orders a breathless 89-year-old patient urgently to the hospital for a heart scan, but two weeks later, still breathless, the patient is none the wiser. "Should I ring them?" she asks me, tentatively. Another client seems grateful when telling me that her GP has at last confirmed her spinal fractures; she'd been in pain for two years with all the classic osteoporotic signs but no hint of an investigation until we encouraged her to pursue it.
Acceptance of what the NHS does, or doesn't do to them, is wholly characteristic of today's elderly people and those low expectations without doubt contribute to mediocre and inadequate responses throughout the system.
One manifestation of this is the way old people are treated like old bangers: rust-boxes full of dodgy components that need sorting. Another is a straightforward refusal to hear or see the obvious - from a hand tremor or unsteady gait to a repeated specific complaint or non-specific need just to talk.
One GP took time out a while back to ring me and hurl abuse down the phone after I'd written advising him of how he could refer his patient to a falls-prevention class (because she'd asked me to). His argument, minus the expletives, was that I knew nothing of his patient and how difficult she was. He didn't mean complex. He meant troublesome, awkward, demanding, contradictory. He put the phone down on me.
And it seems like the entire NHS is so rushed off its feet that no one, ever, stops and explains anything. It's one reason why my clients, to a person, would endure almost any amount of pain rather than go into hospital and face certain death. They know nothing of how depression can affect their cognitive function, the crucial role of Vitamin D, or how they can get temporary respite from their nagging back pain, but they know all about hospital superbugs.
I could go on but it starts to feel like telling tales out of school. I know how much this kind of criticism will infuriate good, even wonderful, health professionals. But it's time to stop explaining away horror stories such as Ann Abraham's, or the litany I hear in my work, as aberrant incidents. The ombudsman said clearly: "These are not exceptional or isolated cases."
It seems to me that the NHS, every bit as much as schools, falls back on an "excuses culture", failing to address the bigger issue: that where older people are concerned, our professional carers simply do not care enough.
I am not referring here to compassion, important though that is, but the highest possible quality of professional care. To deliver that will require one paramount structural change. It is absurd to believe that GPs can serve us from cradle to grave, given how incredibly complicated every one of us becomes beyond midlife - physically, mentally and emotionally.
We need a new breed of "geriatrician GPs" whose clear role is to "see the person" and help each individual to maintain the best possible quality of life for the longest duration. These super-doctors would absolutely have to be like old-fashioned ones in the sense of establishing and maintaining a long-term relationship with their patients, for how else can you treat the whole person? Every older adult would graduate five years before retirement, say, from their standard GP to senior GGP.
I would like to see their clinics boosted by an army of multi-skilled, soft-tissue therapists to tackle all those misdiagnosed "frozen" shoulders and "arthritic" joints; to provide serious and, where necessary, extended rehab after joint surgery; and to deal with all that unnecessary low-level pain that blights daily life for so many.
Never again will elderly people be as easily mollified as they are now. The sixtysomethings are forewarned: they know there's another 25 to 30 years ahead of them and their expectations of healthcare and its ability to deliver technological fixes are, if anything, likely to be sky-high. This might force care standards up, but it might just blow the budgets first.
So another cultural shift is called for: all of us need to understand that maintenance of body and mind is a personal responsibility that accompanies the privilege of longevity.
Rather than whiling away anxious years of our lives in NHS waiting areas, or relying on ever-more intricate pharmacological cocktails, we need to fill our retirements with productive, sociable, meaningful activity - the best-value prophylaxis yet invented against an interminable twilight of medical dependency.
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