Age, equality, and cultural oppression: An argument against ageism

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University.The concept of 'ageism' has often been thought to be of limited moral concern, especially in comparison to other forms of discrimination such as racism and sexism. Nevertheless, there are also those who believe that ageism is morally significant, and there are diametrically opposed views within liberal and egalitarian theory as to whether age discrimination is or is not just. This thesis has two objectives. Firstly, it seeks to overcome the apparent vagueness of the concept that has given rise to such diametrically opposed views concerning ageism by examining exactly what the phenomenon involves. It defines the wrongfulness of much age discrimination as originating in either the nature of the reasons for which people discriminate against the old or the nature of the consequences for the individuals affected. In the course of the thesis I make several important distinctions, the most important of which are between the social and moral worth of a person, and between the synchronic and diachronic interests of a person. These distinctions allow us to distinguish between a culturally oppressive ageism and ageism that is justified by reasons of equality and efficiency. The former is intrinsically morally wrong, the latter extrinsically wrong. The second aim of the thesis is to develop an anti-ageist ethical principle capable of challenging both forms of ageism in a comprehensive way, and which is consistent with a broader liberal egalitarian political theory. This is achieved by drawing on the distinction between the irreducible nature of each person's synchronic and diachronic interests. I have identified the principle that we should protect the synchronic interests of older persons with a democratic social egalitarianism that seeks to equalise the social relations between citizens rather than concentrating upon an equality of distribution. It is in this way that I also connect the debate about the morality (or otherwise) of age discrimination with debates within contemporary liberal egalitarian philosophy

National evaluation of Partnerships for Older People Projects

Executive Summary The Partnership for Older People Projects (POPP) were funded by the Department of Health to develop services for older people, aimed at promoting their health, well-being and independence and preventing or delaying their need for higher intensity or institutional care. The evaluation found that a wide range of projects resulted in improved quality of life for participants and considerable savings, as well as better local working relationships. • Twenty-nine local authorities were involved as pilot sites, working with health and voluntary sector partners to develop services, with funding of £60m • Those projects developed ranged from low level services, such as lunch-clubs, to more formal preventive initiatives, such as hospital discharge and rapid response services • Over a quarter of a million people (264,637) used one or more of these services • The reduction in hospital emergency bed days resulted in considerable savings, to the extent that for every extra £1 spent on the POPP services, there has been approximately a £1.20 additional benefit in savings on emergency bed days. This is the headline estimate drawn from a statistically valid range of £0.80 to £1.60 saving on emergency bed days for every extra £1 spent on the projects. • Overnight hospital stays were seemingly reduced by 47% and use of Accident & Emergency departments by 29%. Reductions were also seen in physiotherapy/occupational therapy and clinic or outpatient appointments with a total cost reduction of £2,166 per person • A practical example of what works is pro-active case coordination services, where visits to A&E departments fell by 60%, hospital overnight stays were reduced by 48%, phone calls to GPs fell by 28%, visits to practice nurses reduced by 25% and GP appointments reduced by 10% • Efficiency gains in health service use appear to have been achieved without any adverse impact on the use of social care resources • The overwhelming majority of the POPP projects have been sustained, with only 3% being closed – either because they did not deliver the intended outcomes or because local strategic priorities had changed • PCTs have contributed to the sustainability of the POPP projects within all 29 pilot sites. Moreover, within almost half of the sites, one or more of the projects are being entirely sustained through PCT funding – a total of 20% of POPP projects. There are a further 14% of projects for which PCTs are providing at least half of the necessary ongoing funding • POPP services appear to have improved users’ quality of life, varying with the nature of individual projects; those providing services to individuals with complex needs were particularly successful, but low-level preventive projects also had an impact • All local projects involved older people in their design and management, although to varying degrees, including as members of steering or programme boards, in staff recruitment panels, as volunteers or in the evaluation • Improved relationships with health agencies and the voluntary sector in the locality were generally reported as a result of partnership working, although there were some difficulties securing the involvement of GP

Exploring experiences of cancer care in Wales - a thematic analysis of free-text responses to the 2013 Wales Cancer Patient Experience Survey (WCPES).

Objectives: To provide the first systematic analysis of a national (Wales) sample of free-text comments from cancer patients, to determine emerging themes and insights regarding experiences of cancer care in Wales. Design: Thematic analysis of free-text data from a population-based survey. Setting and Participants: Adult patients with a confirmed cancer diagnosis treated within a three month period during 2012 in the seven Health Boards and one trust providing cancer care in Wales. Main outcome measures: Free-text categorised by theme, coded as positive or negative, with ratios. Overarching themes are identified incorporating comment categories. Methods: 4,672 respondents (of n=7352 survey respondents) provided free-text comments. Data was coded using a multistage approach; (1) coding of comments into general categories (e.g. Nursing, Surgery etc.), (2) coding of sub-categories within main categories (e.g. Nursing Care, Nursing Communication etc.), (3) cross-sectional analysis to identify themes cutting across categories (4) mapping of categories/sub-categories to corresponding closed questions in the WCPES data for comparison. Results: Most free-text respondents (82%, n 3818) provided positive comments about their cancer care, with 49% (n=2313) giving a negative comment (ratio: 0.6:1, negative-to-positive). 3172 respondents (67.9% of free-text respondents) provided a comment mapping to one of four overarching themes: communication (n=1673, 35.8% free-text respondents, a ratio of 1.0:1); waiting during the treatment and/or post-treatment phase (n=923, 19.8%, ratio: 1.5:1); staffing and resource levels (n=671, 14.4% ratio: 5.3:1); speed and quality of diagnostic care (n=374, 8.0%, ratio: 1.5 : 1). Within these areas, constituent sub-themes are discussed. Conclusions: This study presents specific areas of concern for cancer patients, and reveals a number of themes present across the cancer journey. While the majority of comments were positive, analysis reveals concerns shared by significant numbers of respondents. Timely communication can help to manage these anxieties, even where delays or difficulties in treatment may be encountered. Strengths and limitations of the study: • Provides further detail on closed measures in population-based survey. • Indicates area of concern not addressed by closed measures. • Volume of comments and ratios of negative to positive comments in specific areas indicate areas of particular concern

“No official help is available” - experience of parents and children with congenital heart disease during COVID-19

Introduction: the purpose was to explore the experience, information, support needs and decision-making of parents with congenital heart disease (CHD) during the COVID-19 crisis. Materials and methods: a survey study of parents of children with CHD, children and young people, capturing experiences, decision-making, information and support needs during the COVID-19 crisis. The survey launched for 1 month (9thApril 2020) during the first infection wave in the UK and subsequent restriction of free movement under lockdown rules from March 23rd2020 until May 31st2020. Results: 184 parents and 36 children/young people completed the survey. Parents were more likely to worry about the virus (86.4%) than children/young people (69.4%), whilst (89%) parents were more vigilant for symptoms of the virus vs. children/young people (69.4%). A thematic analysis of the qualitative comments covered 34 subthemes, forming eight-overarching themes: Virus 1)risk of infection, 2)information, guidance and advice, 3)change in health care provision, and 4)fears and anxieties; Lockdown and isolation 5)psychological and social impact, 6)keeping safe under lockdown, 7)provisions and dependence on others, 8)employment and income.Conclusions: there was widespread concern over the virus especially amongst parents. Parents and children/young people however, were frustrated with the lack of specific and paediatric focused information and guidance, expressing disappointment with the adult centric information available. Parents also felt alone, especially with their concerns around the implications of cardiac service suspension and the implication for their child’s health. In order to better support children and their families, resources need to be developed to address families’ and children/young people’s concerns for their health during this pandemic. <br/