TWENTY YEARS AGO we used to laugh at my late mother-in-law’s rooted conviction that hospitals were a horror. “You go in them places, you’ll not come out.” It was, we thought, a poorhouse race-memory, a quotation from her own mother who lived before the health service and modern medicine. She got her wish and died at home. However, if she were alive to say it now, it would be harder to laugh. Things are not good for the elderly and ill.

Five years ago the Government launched a ten-year plan to improve health services for the age group which uses two thirds of hospital beds and 43 per cent of the NHS budget. At the halfway mark a report is in from three government inspectorates not given to exaggeration or alarmism: the Healthcare, Audit and Social Inspection Commissions. Here are some words from that report: “Patronising and thoughtless . . . inferior treatment . . . failing to take needs seriously . . . ageist attitudes . . . insensitive . . . unfair . . . disrespectful”.

And here are some examples: mixed wards still persist, with consequent misery to a modest generation; there are repeated and bewildering moves between wards for non-clinical reasons; old people have meals whisked away before they can finish them; there are dirty wards, urine bottles not emptied, nights in corridors. Mental health services are insufficient and even basics like foot care are inadequate. Liaison between services is poor. There have been improvements — explicit age discrimination is reduced in stroke care and hip replacement — but not one NHS trust or local authority inspected reached all the Government’s milestones. More old people are being “supported” to stay in their own homes — but there the ending of out-of-hours care by GPs causes problems. One person related a call on Saturday night that produced nothing till the next day when a doctor turned up with no notes and unable to help.

Well, we are all used to NHS Direct and locum services; but if you are old and ill and alone it is positively dangerous. Especially while trusts are closing the local hospitals which provided “stepdown” beds for patients discharged from acute care: there will be ever more vulnerable people relying on the impersonal, mechanistic systems that replace a familiar doctor after 5pm. And every week individual horror stories surface: bedsores, malnutrition, the 93-year-old woman in Wales who was dumped at the wrong house by an ambulance driver despite her protests, presumably because he cheerily assumed she was gaga. She broke her leg trying to escape.

Balance is necessary, but it is good that the report is strongly worded; government claims of perpetual sunshiny improvement need damping down. Liam Byrne, the Health Minister, spoke brightly about the “web of care” and claimed progress, while Age Concern’s director trumpeted that old people are treated as “second-class citizens” (which again is not entirely true, since all of us know of cases and places where they are treated just fine.)

But the interesting focus is how far the problem seems to be less about resources than about attitudes and respect. The report’s emphasis was on the low degree of human dignity offered by medical and care establishments to old people who “find it difficult to challenge ageist attitudes . . . their reluctance to complain can mean that nothing changes”. That strikes a familiar note. Perhaps it is because we have not really grown used to modern longevity, our own or other people’s, but certainly doctors and medical personnel who are not especially interested in gerontology do tend to shrug off things that go wrong with people after 70. “What do you expect, at your age?” Patients themselves tend to take this fatalism with a resigned shrug, because they don’t expect much either.

Which is daft. Nobody gets through old age unscathed and free from aches, but nearly everything can be improved and many things cured almost as readily as they would be in a 45-year-old. Neglect is not only inhumane but economically silly, because it accelerates complete dependence, but examples of a neglectful attitude proliferate.

Here is a small but classic one. An old friend in his mid-eighties, hitherto exceptionally active and adventurous, was observed limping when we met him a year ago. I inquired and he said he had severe pain in his heel but his doctor just told him to take painkillers, which he dislikes. Having had a spell of similar pain myself some 40 years younger, I asked whether anyone suggested shoving supports in his favoured casual shoes — the most commonplace cause of heel pain being flattened or “pronated” arches.

His doctor had neither suggested this, nor referred him to a physio. You can imagine the thought process: “He’s old, so he limps and aches, surprise surprise. Give the old beggar a paracetamol, get him out of here.” I gave our friend a pair of my own off-the-shelf arch supports to try, with rapid results. A year later he walks fine. The impulse to go round and shake his GP was overwhelming.

But not, of course, for him: old people, as the report suggests, mostly don’t like to grumble. Let the self- obsessed young and the sporty-forties complain at every gym twinge: if someone over 70 starts they instantly cast themselves as a grumpy old trout. So “Lucky to be still alive at all, really”, they murmur, and fail to claim their right to reasonably comfortable feet, teeth, spectacles, bed or whatever.

And, human nature being what it is, only the squeaky wheel gets the oil. Staff take advantage of elderly quiescence and resignation to whisk away food, shuttle patients between wards, ignore both their reasonable wishes and their urine bottles or grudge giving two minutes’ thought to the sudden lameness of a fit human being just because he happens to have turned 80. This must stop. Life has grown unnervingly long, so we must declare a national Grumble for your Grandad Week. Mere self-interest demands it: might as well change the culture now, because we’ll all get there eventually.

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