It is, apparently, the second best-known contemporary poem, though few know who wrote it, or can remember much beyond the opening lines:
When I am an old woman I shall wear purple
With a red hat which doesn’t go and doesn’t suit me…

It was written by Jenny Joseph when she was 29 – she is now 84, by the way, and you can see her reading her poem at https://youtu.be/8cACbzanitg.

Since it is my birthday today, it seemed a good time to look at how we imagine our old age will be when we are still young. I have reached an age which, as a child, I thought was officially Very Old. It seemed to me that men as old as I am were just biding their time till the Grim Reaper called – after all, two of my grandparents didn’t make it to this age.

Without wishing to become drawn into political argument, it is clear from the speeches and writings of Nye Bevan that when he was crafting the NHS he had an idea of old age in mind. By providing care that was free at the point of delivery he wanted to remove any disincentive to ask for help early. That much we all know; but it is often forgotten that he thought the more important part of the work he was doing was the arrangements he made to put public health medicine on a sound footing, because ultimately he hoped to contain demand by improving the health of the whole population. In Bevan’s model, people would not necessarily live longer, but they would have a better quality of life. In fact, since 1900 we have added about seven years of adult life expectancy, but those are not usually seven good quality years. The pattern has increasingly become one of progressive and prolonged frailty requiring high levels of care, and that is why most health economies have been working hard on trying to manage (and postpone) that frailty.

It also explains why this year’s Pharmacy Management National Forum is focussing on frailty.and long term conditions. We hope that good evidence-based treatment of all age groups will help us to arrive at our later years in better health with less need of a high level of intervention.

I was also fascinated to learn of The Red Hat Society, an organisation devoted to helping women enjoy fun and fitness, which takes its symbol from the poem. Avoiding frailty matters to our patients, and to the NHS. Both will have a much better future if we can improve our care, and we look forward to hearing on 16th November of the initiatives that pharmacy is developing to do just that.