Dead End in Hillingdon

The Spectator, October 19, 1996 | Go to article overview

Dead End in Hillingdon


At first sight, Hillingdon NHS Hospital Trust's refusal of emergency in-patient treatment to over-75s from outside its catchment area, on the grounds that once ensconced in emergency beds they outstay their medical need, may appear harsh. But at second glance it exemplifies a dilemma increasingly plaguing hospitals as most of us live longer.

Ten per cent of Hillingdon's beds are already occupied by elderly patients who do not need acute treatment but cannot be moved on because they can no longer fend for themselves and have nowhere to be cared for. The average length of stay in its `Care of the Elderly' wards has doubled in recent months.

Hillingdon's predicament is widely shared. This is not a medical but a social problem. Old age cannot be cured. While health and social security belonged in the same department, the scale and nature of the problems were obscured. Government reluctance to confront the full implications of demographic change leaves us ill-prepared.

Residential accommodation for the elderly is systematically scarce. Families are no longer disposed to care for the aged, as they have done throughout most of history. But to keep old people in emergency and acute beds is misuse of resources: it is expensive but gives inferior quality of life. Hospitals cannot be expected to carry the burden of domestic care for the aged at the expense of their proper function, which they strain to fulfil. But who can bear it?

The `Hillingdon problem' has medical, economic, ethical and theological dimensions. Sheltered provision and halfway houses for patients discharged from hospital but not yet ready to attain or resume normal self-care can, at best, only touch the fringe of the problem. The burden of growing numbers of permanently incapacitated people dragging on for decades, deserted by their families or surviving them, needing care simply to go through the day and night, is one which government cannot bear but does not know how to relinquish.

No government can be expected to provide additional resources for domestic care of the infirm aged. Demands on resources come from all sides: education, housing, transport, environment, welfare, pensions. Massively improved care for the aged does not have high priority. Even were budgets expanded, numbers and quality of staffing would present insuperable problems.

In the last resort, the matter is theological. Science, which the Enlightenment apotheosised as guide and benefactor, is morally neutral, and can work as easily for evil as for good. …

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