Age equality in UK healthcare policy and decision-making: a scoping review

Age equality was enshrined in UK law by the Equality Act of 2010, which defined age as a protected characteristic and age discrimination unlawful, unless objectively justified. To date relatively little attention has been paid to how this legal requirement is interpreted and applied in healthcare. Such a lack of clarity raises significant legal and ethical questions regarding how age affects access to and provision of care. This scoping review aims to address this gap. It examines how age and age groups are considered in healthcare policies and decision-making processes and how age equality duties are understood and implemented in practice.

The scoping review draws on national and regional policy and decision-making documents, and relevant academic literature. It has two main objectives: first, to examine the explicit and implicit ways age influences healthcare provision. Second, to assess how different age-groups are represented or omitted in healthcare decision-making processes that determine access to care. Attention is given to age-based distinctions and omissions, their stated justifications or their absence in policy, and healthcare decision-making.

Our findings indicate that despite legal protections, age equality is not yet consistently embedded in healthcare policy or practice with significant unresolved ethical tensions in approaches to age-equality. We identified gaps between stated policy commitments and implementation, limited attention to age-related inequalities and little clarity on when such inequalities may constitute inequities or raise concerns about unlawful discrimination. These include a lack of evidence for systematic monitoring of age-related inequalities and potential inequities, and lack of practical guidance to support healthcare decision-makers in meeting their equality duties.

It remains unclear whether and how key ethical tensions in the pursuit of age equality are resolved by decision-makers. To support a more consistent and transparent approach to age equality in healthcare, efforts should focus on strengthened decision-making processes and clearer operational guidance. The routine use of age-sensitive equality impact assessments across services could enable a more systematic identification of age-related health inequalities and inequities that may be overlooked across the lifecourse.