Grand Committee
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Arrangement of Business
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The Deputy Chairman of Committees (Baroness Fookes) (Con)
My Lords, Members are encouraged to leave some distance between themselves and others and to wear a face covering when not speaking. If there is a Division in the Chamber while we are sitting, this Committee will adjourn as soon as the Division Bells are rung and resume after 10 minutes.
Ageing: Science, Technology and Healthy Living (Science and Technology Committee Report)
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Lord Patel
That the Grand Committee takes note of the Report from the Science and Technology Committee Ageing: Science, Technology and Healthy Living (1st Report, Session 2019-21, HL Paper 183).
Lord Patel (CB)
My Lords, it is a great privilege to open this important debate on the Science and Technology Committee report Ageing: Science, Technology and Healthy Living. I thank the Minister for making time to respond to the debate. I am hoping that, being new in the post, he might have a more positive response to the conclusion of the report than the one we got from the Government.
It is a compliment to the committee and its report that so many notable noble Lords are taking part in the debate. I thank them all and look forward to their contributions. I sincerely thank all the committee members. I could not ask for a more committed, passionate, understanding, gentle, malleable and only occasionally challenging committee—or maybe not. I thank them all for their hard work and tolerance.
The committee was fortunate to have talented, hard-working committee staff: our clerk, Dr Simon Cran-McGreehin, policy analyst Dr Amy Creese, and committee operations officer Cerise Burnett-Stuart. I thank them for their hard work in running the committee and producing the report. The committee was well advised and supported by our specialist adviser, Professor Janet Lord, professor of immune cell biology and director of the Institute of Inflammation and Ageing at the University of Birmingham. On behalf of the committee, I thank her for all the help and advice she gave us.
We started our inquiry in July 2019 but had to delay concluding evidence sessions and publication because of the pandemic. It has already become clear that those who are old, who suffer from multiple comorbidities and who are socially deprived will pay the highest penalty as a result of Covid-19, compared to the young and healthy.
The background to our inquiry was a government publication in November 2017 naming an “Ageing Society”, as one of four “Grand Challenges” of the industrial strategy. It committed to
“harness the power of innovation to help meet the needs of an ageing society.”
In 2018, the Government announced that the mission of the ageing society grand challenge was to:
“Ensure that people can enjoy at least 5 extra healthy, independent years of life by 2035, while narrowing the gap between the experience of the richest and poorest.”
The aim of our inquiry was to understand to what extent developments in science and technology related to ageing will be important to reaching the goal of the Government’s grand challenge of an ageing society.
We also considered how current public health policies and co-ordination of healthcare for older people may contribute to years spent in poor health. Demographic projections suggest that, by 2035, 7% of people—some 5 million of the population—will be aged over 80. Life expectancy continues to rise, but the rate of rise is slowing. There is a strong link between deprivation and life expectancy. Males in the least deprived areas live nine and a half years longer than those in the most deprived areas. For females, the gap is 7.7 years. A more important measure than life expectancy is healthy life expectancy. The average age of healthy life expectancy in England is 63 years, with males spending a further 16 years—20% of their lifespan—and females 19.4 years, which is 23.3% of their lifespan, in poor health.
Inequalities in healthy life expectancy are even starker than those for life expectancy. The difference of 18.3 years in healthy life expectancy between the least deprived and most deprived is striking, with 70.6 and 52.3 years of healthy life respectively. Prioritising reducing health inequalities will have huge gains for health and for the economy.
Data from deaths from 2003 to 2018 show that that one-third of the deaths in England are attributable to social inequality. The King’s Fund report of September 2021 says that the Government have
“failed to make significant progress in reducing inequalities”.
While there is clear understanding of the lifestyle and environmental factors throughout life that correlate with good health, interventions in public health do not seem to be effective. Public health interventions need to find ways to motivate and to facilitate change to a healthier lifestyle, particularly for those living in deprivation and suffering the worst health. A child in year 6 from one of the most deprived areas is twice as likely to be obese compared to a child from a well-off area.
Ageing is a major risk factor for a wide range of diseases. Older people often have more than one health problem, often referred to as multimorbidity. Some 14 million people in England have two or more health conditions and 4.7 million have more than four health conditions. The health system currently fails these people for lack of co-ordination of care, with polypharmacy and overprescribing adding to their misery and making them sicker. The report indicated ways of reducing overprescribing, particularly in older patents with multi- morbidity.
I am pleased to see that the report on overprescribing from the Chief Pharmaceutical Officer confirms our views, with one in five admissions to hospital of the over-65s and 6.5% of all hospital admissions related to overprescribing. The Government did not accept our recommendations to help reduce the problem. When will the Government publish their response to the Chief Pharmaceutical Officer’s report and the implementation plan?
From a biological perspective, ageing is the result of an accumulation of a wide variety of molecular and cellular damage over time that leads to decreased physical and cognitive function, increasing the risk of illness and death. A recent animal study suggests that an ageing immune system may play a critical role in diseases related to age. The timing of these changes is not fixed, hence a person’s biological and chronological age can be out of step. Genetics, lifestyle and environmental factors may all have a role. Ways to measure how well a person is ageing will help science to develop understanding of the biological effects of ageing and how they can be modulated.
Understanding the biological pathways that lead to multisystem ageing will help us to discover new diagnostics and technology. Cellular senescence and deregulated nutrient sensing are two good examples of hallmarks of ageing. Understanding biological processes opens up the potential for developing new therapeutic interventions that could reduce or even reverse biological ageing and decrease the risk of developing disease. For example, targeting senescent cells which cause inflammatory changes in tissues leading to disease may allow us to develop senotherapeutics. Some repurposed drugs have already shown promise in mitigating age-related tissue damage.
Despite my enthusiasm for speaking more about the science related to ageing, there are several eloquent speakers taking part in today’s debate who have greater knowledge than I do and can—and I hope will—say more. The recent government report Life Sciences Vision identifies two key areas for research that relate to ageing. The first is improving translational capabilities in neurodegeneration and dementia. No doubt my noble friend Lady Greenfield may have more to say on that. The second is research into better understanding of ageing-related pathways. It is suggested that funding should come from partnership with industry. What plans do the Government have to implement those proposals? Our report recommended increased funding for ageing-related research and better co-ordination. I am pleased that UKRI has taken some recent initiatives in funding such research, but who will provide the necessary co-ordination, for which our report indicated a need?
I now come to the ageing society grand challenge and the mission of extending healthy life by five years by 2035. Our single conclusion in the report was that the Government are not on target to deliver on it, with lack of leadership and lack of a clear plan being major barriers. Different government departments had a role, but no one had responsibility for leadership or co-ordination. I hope that the Minister can confirm that the Government are still committed to the ageing society grand challenge of extending healthy life expectancy by five years. If that is the case, who will lead on it? When will the Government publish a detailed plan with timelines to achieve it? Who will independently monitor progress and will Parliament be able to review progress on a regular basis?
Any plans to extend healthy life expectancy cannot succeed without also addressing inequalities in health outcomes. The Government had said that they would publish their response following the end of consultation on the prevention Green Paper to address health inequalities. When will they publish their response? The Government are to publish the levelling-up White Paper by the end of the year. Will the White Paper address the issues related to inequalities in health and the means of reducing them?
In conclusion, research to better understand the biology of ageing, developing technologies, diagnostics and treatment for age-related diseases and keeping people healthy longer are the themes that our report tried to address and to suggest possible solutions to. Although the Government’s initial response was disappointing, there are now some positive signs and promise of more, so I remain hopeful.
I end with a plea to the Minister. I know that he will have a long brief to read out in response to today’s debate. My plea to him is to leave some time to answer the questions raised by noble Lords today and not just read the brief. If he does that, he will make himself very popular. I beg to move.
Baroness Young of Old Scone (Lab)
My Lords, when I first came to this House, the doorkeepers told me that this was the best elderly daycare centre in London and that it would give me another 10 years of life expectancy, so this is an apt report for your Lordships’ House. I join my former colleagues on the Science and Technology Committee in thanking the noble Lord, Lord Patel, for his chairmanship of this important inquiry and echo his thanks to the staff, who supported us splendidly.
It is clear that improvements in healthy life expectancy have stalled. On average, about 20% of our lives is spent in poor health. The gap in life expectancy between the rich and the poor has widened even further.
I want to pursue three areas this afternoon. The first is to touch on technological support for older people to help to improve the quality of their lives. The second is to focus on the root causes of increases in years of ill health and disability—the root cause is indubitably poverty and deprivation—and to explore what the Government’s levelling-up agenda must do to tackle them. The third is the importance of integration of action across all policy areas nationally and locally and how the recent changes in responsibilities for prevention of ill health will work out.
I have some lasting impressions of the committee’s work. First, the foundations for healthy old age are laid down from our youth onwards. We need to focus on how people can be healthier throughout their entire life course and not try to put a sticking plaster on the situation once old age is reached. Secondly, there is a pronounced societal difference in healthy life expectancy, which is highly correlated with deprivation and ethnicity. The difference in healthy life expectation between the least and most deprived is nearly 20 years. Poverty and deprivation are the root cause of unhealthy ageing. That is totally unacceptable in a civilised society. However, perhaps my most abiding memory was that we convened a panel of elderly people to help our deliberations only to find that Select Committee members were generally older than the elderly people.
I will raise three issues directly with the Minister. The first is the role of technology in enabling healthier ageing. There are many technologies, such as digitally based products and services such as fall trackers, medication monitors and digital befrienders, and other newer technologies such as robots and digital surveillance programs, all of which could help to support older people, improve their quality of life and allow them to maintain a more independent existence. But provision is low and the poorer and more deprived simply do not get access to such help. That gradient will increase with new technologies becoming more and more available. That has to change. What plans does the Minister have to accelerate not only the pace of technological development but, more importantly, the uptake of those technologies?
Secondly and most importantly, let us not be in any doubt that the root causes of unhealthy ageing are deprivation, unemployment, poor education and housing, lack of opportunity and unhealthy diet and lifestyles, including smoking and alcohol. Tackling these root causes sounds just the thing for the Prime Minister’s levelling-up agenda. Sustained action is needed over a lengthy period, with co-ordinated efforts between national and local government.
Cutting the income of the poorest by removing the £20-a-week universal credit payment does not fit that bill, nor does a spending review and Budget in the next few weeks that has been trailed as the ultimate austerity measure by the Chancellor, who seems increasingly out of love with his boss’s objectives. We are facing another version of the TB-GBs—I will leave your Lordships to fill in whatever acronym you would like for the new Chancellor versus Prime Minister tension. We need not a focus politically on the red wall seats and town centre tart-ups but a sustained attack on inequality and lack of opportunity wherever it occurs.
It is only three years since the Government set themselves the target of five extra years of healthy life by 2035, but that target is already being airbrushed out. Its future is unclear from the Government’s response. Can the Minister confirm whether, in his view, the ageing society grand challenge will survive the proposed review that will be undertaken and whether the five extra years will still be a target? If the target has gone within three years of being established, how confident can the Minister be that the sustained approach required to tackle poverty and deprivation will not be as ephemeral? We no doubt await the White Paper on levelling up later this year, but it would be good to get a feel from the Minister now.
My third point is about the importance of integration of action to promote healthy living across all departments and many policy areas, such as work and education, transport and housing, air quality, local environment quality et cetera. Public Health England, which was responsible for co-ordination on prevention and health promotion, has gone and the Office for Health Improvement and Disparities was launched only at the beginning of this month. I understand that there is to be a cross-government ministerial board on prevention to drive forward a co-ordinated government approach on the wider determinants of health. How often has this ministerial board met and what has it done so far?
The local effort is to be driven by local directors of public health. I will pay a small tribute to those incredibly important people. They are currently up to the neck in Covid and before the pandemic were definitely below the salt for esteem and resources in local authorities. Can the Minister tell the Committee in detail how the Government will ensure that local directors of public health will be given the position, authority and resources to do this co-ordination job across many policy areas on a local level?
We hear much about the pressure on the NHS these days. Much of that pressure is due to those substantial years of poor health that, on average, many people experience. The Government need to see the challenge of healthy ageing as an issue of economics and of health service sustainability, but above all as an issue of equity.
Baroness Sheehan (LD)
My Lords, I also thank the noble Lord, Lord Patel. I joined the Science and Technology Select Committee just in time for the inquiry that led to this report, so was able to appreciate the consummate ease with which he chaired the complex scoping exercise and then of course the inquiry itself. I add my thanks to the clerks for their hard work and dedication. My remarks today will focus on the impact of the Covid pandemic on the fundamentals of the Government’s two-tier grand challenge strategy to, first, increase healthy independent living by five years by 2035 and, secondly, narrow the gap between the richest and the poorest.
Like all developed countries, the population of the UK is ageing. The report tells us that we will see a 51% increase in people aged over 80 to about 5 million from 2018 to 2035, and all the while the working-age population remains static. It was against that backdrop that in 2017 the Government named our ageing society as one of the four grand challenges in the now sadly abandoned industrial strategy. Between 1980 and 2018, life expectancy at birth rose to 79.3 years for males and 82.9 years for females. However, healthy life expectancy—the number of years for which a person is expected to live in good health without disability—has not improved at the same rate; it stands at 63.1 years for males and 63.6 years for females.
It will come as no surprise, given the heavy mortality rate due to Covid last year, that the ONS reports that, for the first time in four decades, life expectancy for men in the UK has fallen. Life expectancy for women remains unchanged. Are the Government assessing the impact that long Covid may have on healthy life expectancy? On the last page of their response to the report, the Government seem to imply that the ageing society grand challenge will no longer be identifiable as such in the more nebulous plan for growth, under the “build back better” soundbite that replaces the more solid industrial strategy. I hope that the Minister can offer reassurance that this will not be the case, and in particular that R&D funding into the science of ageing and support for SMEs at the cutting edge of technological innovation to aid independent living will be protected from any cuts to the promised £22 billion per annum investment in R&D. I would appreciate it if he could refrain from listing the Government’s historic support, as was the case in their response to the report, and instead tell us their future plans.
I turn to the second tier of the grand challenge: narrowing the gap between the richest and the poorest, which stands at nine and a half years for life expectancy and, distressingly, almost 20 years for healthy life expectancy. That will have been exacerbated by the country’s recent experience of those who bore the heaviest toll in lives lost during the pandemic. Covid hit the poorest hardest and, within that, hit people from ethnic minorities even harder. The report’s first recommendation is that the Government, along with NHS England and the erstwhile Public Health England, “prioritise reducing health inequalities” between the least deprived and most deprived areas, and asks that they set out a plan to do so over the next Parliament. In response, the Government in effect say that we will get the report due course when they come forward with proposals in response to the prevention Green Paper. What is the progress to date on that response?
My final remarks will focus on obesity, which is closely linked to deprivation. Food loaded with cheap harmful additives is leading to an increased number of lives lost and points to a failure by successive Governments to act on the prevention agenda by promoting healthier diets and a more mobile lifestyle. Frankly, it is a disgrace that poorer people have little choice but to buy food that is poor in nutrition and positively harmful to their health.
The experience of the pandemic illustrates starkly that the Government have not curbed the appetite of the food and drink industry to maximise profits at the expense of the health of their customers. Cheap and addictive additives such as sugar, salt and hydrogenated fats in heavily processed foods—to boost flavour and shelf life—have wreaked immeasurable harm on the population at large. Will the emphasis that the Government propose to place on prevention include tackling the food and drink industry’s role in increasing obesity? Will they, for example, extend the sugar tax to foods and drinks that are high in added cheap sugar? Trans fats, a form of processed hydrogenated cooking fats, have been identified as one of the most dangerous food additives. Are the Government rethinking their reluctance to introduce curbs on their use, if not their total ban?
Our report points to the damage that a lack of movement does to our bodies, let alone a lack of physical exercise. The sedentary lifestyle of a couch potato is one that will lead to an end of life riddled with multiple morbidities and a carrier bag full of drugs to treat symptoms of each disease, as well as drugs to counteract side effects. The Government have failed to provide central oversight of the volume or interactivity of these drugs. GP oversight is proving inadequate, to the detriment of the patient and NHS finances. I hope that the Minister will give us greater cause for confidence than the Government’s written response.
Baroness Greenfield (CB)
I thank the noble Lord, Lord Patel, for the opportunity to consider how we might enhance the prospect of a long and healthy life. Accordingly, I declare an interest as founder and CEO of Neuro-Bio Ltd, a biotech company developing an innovative treatment for dementia, specifically Alzheimer’s disease. As the noble Lord correctly predicted, I will focus most of my comments on that subject.
Alzheimer’s is a neurological condition characterised by memory loss, disorientation and general cognitive impairment. It is a disease typically, though not exclusively, of older people. One in six over the age of 80 have dementia, a condition that affects as many as 70% of residents in care homes. The spectre of Alzheimer’s is one of the cruellest potential scenarios awaiting us in later life. While heart disease and cancer are serious, often disabling and sometimes terminal, you can still reminisce over old photographs and spend meaningful and precious time with your grandchildren. These life-enhancing moments are gradually closed off to an individual with dementia.
Despite hearing from witnesses from both Alzheimer’s Research UK and the Alzheimer’s Society, there seems to be no substantive discussion in the report of the very real threats that Alzheimer’s currently poses to enjoying a healthy older age. It is cited as the most common cause of death for women, then flagged in relation to air pollution and reported as mitigated by cognitive reserve. That is three mentions of one of the most important issues related to ageing and its potential alleviation by science.
The Alzheimer’s Society’s website reports facts and figures that are truly concerning. First, there is the societal impact of dementia as one of the main causes of disability later in life. There are currently around 850,000 sufferers in the UK; this figure is projected to rise to 1.6 million by 2040. This year, 209,600 people are expected to be diagnosed with dementia; that is one person every three minutes.
Secondly, there is the economic factor. The total cost of care for people with dementia in the UK is £34.7 billion. This is set to rise sharply over the next two decades to £94.1 billion by 2040.
Thirdly, there is the impact on carers, in addition to the financial and mental health repercussions of perhaps giving up a job to care for a loved one. On more than one occasion, I have heard this daily existence described as a living death.
Since these problems are not raised in the report, it is unsurprising that there are no recommendations specifically to resolve them. I want to make a few suggestions for brief consideration here. The only successful way to combat Alzheimer’s disease will be to devise an effective treatment. In turn, this is dependent on gaining insight into the underlying brain processes. Further research, both basic and translational, is thus essential.
However, dementia research is desperately underfunded. For every individual living with the condition, the annual cost to the UK economy is more than £30,000, yet only £90 per patient is spent on research. Five times fewer researchers choose to work on dementia than on cancer. Yet if we could come up with a means of delaying the onset by five years, the number of deaths from the condition would be halved, saving 30,000 lives a year.
Admittedly, various recommendations in the report are concerned with drug development in a more general sense in relation to older people. However, sadly and strangely, no specific issue is raised in relation to improved therapies for Alzheimer’s disease. An obvious and predictable recommendation would be to make more funds available for research, be they from public, private or philanthropic sectors.
Just as important, but much less obvious, is the question of how such resources should then be deployed. Currently, the majority of funding is directed at just one strategy to combat the histological marker in the brain—amyloid—as it is a frequent feature of Alzheimer brains. However, drugs designed to antagonise amyloid at best only slow down the progression of the disease. There is increasing doubt that it is the primary cause of the neurodegenerative process. The report could have highlighted the lack of success of current treatments and thus argued the case for promoting initiatives pursuing innovative lines of inquiry. In this way, we could truly understand the degenerative mechanism in order to intervene with a successful pharmaceutical strategy.
The hunt for an anti-Alzheimer’s drug that actually works is far from straightforward. As yet, there is a no accepted narrative for how and why neuronal loss starts, nor for—of equal importance—how it is perpetuated for decades before the classic profile of cognitive impairment presents. Unless and until we understand what is happening in the brain for this period, we will only ever be able to deal with downstream symptoms, such as amyloid accumulation, rather than halting cell loss by intercepting the driver of the disease.
The second reason for failure to date is the lengthy time window of 10 to 20 years between the onset of cell loss and the eventual presentation of cognitive impairment. Any treatment initiated at this late stage is comparable to closing the stable door after the horse has bolted, as the pernicious cycle of cell loss would have been under way for decades. Analogous to the measurement of cholesterol for detecting cardiovascular problems, we need a routine blood test, say, that would enable easy screening to determine whether the degenerative process was already in train, even though the person may feel perfectly fine at the moment. Imagine if we had a blood biomarker indicating early on that degeneration had already started, well before the behavioural symptoms of Alzheimer’s were apparent. Imagine if we had a drug that stabilised cell loss and halted neurodegeneration. If such a drug were taken before the symptoms became apparent, those symptoms may never arise—not a cure in the literal sense, but effectively just that.
What is stopping us developing such a biomarker and such a drug? We need to facilitate more innovative lines of research and challenge existing dogma. Admittedly, there will be false dawns and blind alleys. There will be risks to take and cynicism to overcome, but that is the only way we will ever develop an effective treatment for Alzheimer’s disease. The American physicist and philosopher Thomas Kuhn famously argued that science does not evolve gradually towards truth but has a paradigm; that is, it has an accepted approach that remains constant until anomalies start to accumulate, and accumulate to such an extent that it is finally accepted that established thinking cannot explain the phenomenon in question. A completely new theory must then be conceived—a paradigm shift. If we are to understand and tackle this devastating condition successfully, we are long overdue for such a shift in our thinking.
Alzheimer’s disease is not an inevitable consequence of ageing, but it is a disease of old age. In my view, the report has missed a golden opportunity to draw attention to its current impact and future threat. Most importantly, it has missed the opportunity to promote new strategies to consign dementia to being a disease of the past. Only when this happens will we be able to have justified confidence in an old age that is not only able-bodied but clear-minded.
Viscount Ridley (Con)
My Lords, it is an honour to follow that eloquent speech from the noble Baroness, Lady Greenfield, and her strictures are well made. I begin by commending the noble Lord, Lord Patel, not only on securing this debate but on steering the committee through a vital and largely virtual piece of work. He did so with charm, wisdom and not a little fierceness when necessary.
The main issue that our report grapples with, as others have said, is the gap between health span and lifespan. We are spending longer living, but even longer dying. We would all like to live lives of perfect health until, one day, we drop dead, but it does not happen that way and the gap is not closing. I am horrified to hear the statistics from the noble Lord, Lord Patel, and that, as a 63 year-old, my health span is coming to an end. By largely or partly exterminating the quick killers, such as smallpox and heart attacks, we have left ourselves with slower killers, such as cancer and Alzheimer’s.
The first thing to say is that this is a problem born of success. The defeat of premature mortality is a spectacular triumph of modern medicine and we should not forget that. In my lifetime, global life expectancy has increased by about five hours per day; it has gone from 49 to 71. Let us not be so keen to complain about the failure to defeat the morbidities of old age that we forget to celebrate these unprecedented achievements. I am not wholly convinced that better leadership and accountability by government on the grand challenge would necessarily have made a big difference in the last few years.
As the noble Lord, Lord Patel, said, the central issue with which we grappled was how to close the gaps between health span and lifespan and between rich and poor. There are four possible ways to do it: we can teach young people not to get into unhealthy habits, such as obesity and lack of exercise, which will make them unwell in old age; we can learn to treat people’s illnesses better when they get ill in old age; we can diagnose illnesses better and earlier, as the noble Baroness said; or we can do research into the underlying mechanisms of ageing in the hope of finding preventive therapies. Today, I argue that, from what I heard in the inquiry, the first and second suggestions are unlikely to work very well; the third and fourth may be much more important.
I am a little cynical about public health advice to the young as a cure for old age. In the report, we say that
“a life-course approach to healthy ageing is to be commended”
and that
“There are advantages to adopting healthy lifestyles earlier in life.”
But we lament that
“We heard differing views on whether young people tend to engage with the issue of healthy ageing”,
which is a bit of a euphemism, yet we recommended
“regulatory and fiscal measures, actively to encourage people to adopt lifestyles that support healthy ageing”.
That would all be great, but do we really think that we can tell the young that they must drink in moderation now to prepare for a sedate old age, free of illness, or that they will believe that we can deliver that promise? After all, lots of us adhere to Hunter S Thompson’s advice, even in middle and old age:
“Life should not be a journey to the grave with the intention of arriving safely in a pretty and well preserved body, but rather to skid in broadside in a cloud of smoke, thoroughly used up, totally worn out, and loudly proclaiming ‘Wow! What a Ride!’”
We sort of admit in this report that solving the problem of the gap between health span and lifespan through public health advice is not working but say that we should do more of it.
On treating people’s illnesses better, we rightly focused on multimorbidity. One doctor treats one symptom, another treats another and the fact that the patient has five things wrong with him at the same time either is ignored or, worse, leads to multiple medications that interfere with each other. “Polypharmacy” was a word that I learned during this inquiry.
I like to think that we can reform healthcare in such a way as to do better at this, but it will be a Sisyphean task, because the rise of multimorbidity is, to some extent, an inevitable consequence of defeating premature mortality. Someone with multiple organs failing at once is simply expressing their biological sell-by date. It is an interesting fact that when supercentenarians—people older than 110—die, they generally just fade away with no particular cause. The machine just stops. Even cancer cells struggle to keep going in their elderly bodies.
By the way, an even more interesting fact is that, while the number of people reaching 100 goes up and up all the time, the number reaching 115 remains extremely small and has hardly changed in decades. There really is a sell-by date on human life. Jeanne Calment, who is the only person to get past 119 and supposedly died at the age of 122 in the 1990s, had probably swapped her birth certificate with her mother’s, we now think. There is currently one 117 year-old and one 118 year-old woman alive in the world and no man older than 113, I think. For those worried about pensions, it is a good thing that we just ain’t going to live to 150—not without genetic engineering, at least.
That leaves diagnosis and research. I genuinely think that the best thing we can do for the elderly and the best way to help to close the gap of social inequality is to diagnose people’s ailments sooner. It disappoints me that this country does not seem as keen on early diagnosis as other countries sometimes are. As for research, like the noble Baroness, Lady Greenfield, I am convinced that Britain, with its terrific bioscience expertise, has a great opportunity to make a huge contribution to the underlying science of ageing. Therein we might find a way to treat people either with senolytic drugs or with telomerase to give them the bodies of 40 year-olds in their 80s, followed by a sudden death at 110. That seems a noble goal, which the Government should heartily embrace. In his reply, will the Minister tell us what the Government are doing to support ambitious research into both the mechanisms of ageing and the value of early diagnosis?
Lord Browne of Ladyton (Lab)
My Lords, it is an honour to follow the noble Viscount, Lord Ridley. I am pleased to accept his advice that, before we address the challenges, we should celebrate the achievements of medical science. If he will excuse me, I will take some time to reflect on some of his other advice, and I will certainly not introduce him to my sons until I have worked out what the implications might be.
It was a privilege and an education to have been a member of the Science and Technology Select Committee while it was carrying out this inquiry under the expert chairmanship of the noble Lord, Lord Patel. I associate myself with his words of recognition and thanks to the committee staff and our expert adviser, and I thank him for his impressively comprehensive introduction of a complex report in an accessible way. I do that principally because I will use it as reason for concentrating on one aspect of the report, which was raised both by my noble friend Lady Young of Old Scone and the noble Baroness, Lady Sheehan—the impact of inequalities. Over the months during which we took evidence, we found that inequality was the most significant challenge.
Our committee heard evidence from many witnesses to support the finding set out in the first conclusion of our report, which is that inequalities in healthy life expectancy remain stark. People in the most deprived groups on average spend almost 20 years longer in poor health than those in the least deprived groups. There are also shockingly large differences in healthy life expectancy among ethnic groups. The evidence that we received more than justified our recommendation that the Government prioritise reducing health inequalities and our request that they set out a plan for reducing health inequalities over the next Parliament—a request with which they respectfully declined fully to engage. There is hope yet. The Government, via the Minister, have been invited three times to engage with this issue, so it will be interesting to hear his response.
Our relatively short paragraphs on inequality disguise the scale of the evidence that we received of the all-pervasiveness of its effects on longevity and healthy living and the degree to which it repeatedly raised its head in our evidence sessions. In our report, the word “inequalities” is used 77 times.
We conducted our inquiry largely over the course of the pandemic, during which there has been a growing awareness of the degree to which poverty and the underfunding of public health have been associated with a large and unequal mortality caused by Covid-19 across the whole UK. However, before the pandemic, in many communities both life expectancy and, in particular, healthy life expectancy had begun to decline after a period of improvement. Hitherto, this decline in longevity was explained by growing unemployment or the replacement of long-term secure jobs by largely insecure and low-wage employment because of de- industrialisation and changes in the economy of the UK in the latter part of last century. Largely, these trends resulted in greater loss of good economic opportunities and jobs in the north as opposed to London and the south-east, where the burgeoning service economy and education opportunities gave young people, including some from poorer areas, a better chance to succeed in that changing environment.
However, during the period of austerity, these long-term changes were worsened by a deliberate decision to reduce social support, welfare payments and funding to local government and public services. By 2018-19, one in five people in the UK, including many in work, was living in poverty and many still are—in fact, those numbers are increasing. Like the changes in the economy, these austerity cuts had a greater impact in the poorest communities, making the effects of the loss of secure employment worse. Poverty and reduced funding of this nature were reflected in increased unhealthy and harmful behaviours, such as poor nutrition, alcohol use and smoking, and less provision of or use of preventive healthcare and, consequently, increased mortality.
Pedantically—and I hear this said regularly—it is correct that healthcare spending was affected less by austerity than other sectors. There has been an annual 1% to 3% increase since 2010, but it has been insufficient to keep up with the increasing demands of an ageing population. This imbalance has led to longer waiting times for primary and specialist care and, once again, the most significant effects have been in deprived areas. The real-term cuts in public health spending have also been larger in the north and north-east, where life expectancy lags.
To make matters worse, helping people to stop smoking and health checks, which affect diseases with substantial contribution to mortality inequalities, had greater than average funding cuts. To arrest and reverse this trend of falling life expectancy, we need economic and social policies that specifically address inequalities, supported by greater investment in public health and healthcare in the communities with the lowest healthy life expectancies.
Despite the terms of the Government’s response to the committee’s recommendations, thus far the post-Covid “build back better” agenda does not explicitly address equity. The levelling-up funding plans to address these regional inequities, particularly in the so-called left-behind districts, appear to be focused on investment and infrastructure. At best there has been a limited specific focus on areas such as child poverty, public health or high-skilled education.
An awareness of place is crucial to tackling inequity. It is regrettable that place-based improvement in northern cities, for example, remains limited to local action facilitated by devolution in cities such as Manchester, and community resilience, well-being and regeneration initiatives. Without additional resources for education, employment and health, these positive steps will prove insufficient to address this issue. To reverse the decline in longevity in many of our communities, health equity needs to be a key outcome of policy.
The date set for the publication of the spending review, 27 October, is the opportunity for the Government to provide at least some certainty on these important areas of spending and investment, including those identified in this report. It could also be the foundation for at least the outline of a coherent plan for reducing health inequalities over the next Parliament, as recommended in this report.
Lord Mair (CB)
My Lords, it was a privilege to have been a member of this House’s Science and Technology Select Committee under the excellent chairmanship of the noble Lord, Lord Patel. I too thank him for his leadership in our inquiry on ageing and the production of our report. Our report highlighted that people are living longer but, regrettably, many of the extra years are spent in poor health and in difficult conditions. Today I will focus on the role of engineering and technology in improving the situation and how it can enable people to live independently in their homes for longer in old age.
Our committee concluded that technologies and related services have an increasing role in helping people to live healthily and independently in old age. This was referred to by the noble Baroness, Lady Young of Old Scone. These include assistive technologies, which can compensate for declining ability and help individuals to cope better with their environment, making it possible to extend independent living. They also include medical technologies, which can improve health and capability.
I will first address assistive technologies that can provide the ability for independent living, which is especially important. Remaining in one’s own home and community is vital to many older people and can contribute to an improved sense of health and well-being. To this end, there is considerable potential for smart homes, with technologies in the home such as sensor networks, motion sensors, infra-red cameras and even robots.
Today’s internet of things makes the possibilities of the smart home much more easily attainable. Wireless monitoring devices can be placed around the home to monitor the individual’s daily activities. Monitoring could be done directly, by devices that monitor gait, breathing or speech, for example, or indirectly, by devices that monitor the use of the fridge or utilities such as electricity and water, for example. Data can be accessed by formal and informal carers, who can make real-time care decisions to help the elderly person.
However, although such smart homes can promote independent living and safety, there are two important issues. The first is privacy: how would an elderly person react to being constantly monitored in their home? The second is the possible risk that such technologies, by making the elderly person more capable of being on their own, could even promote further loneliness and social isolation. Impressive as these new technologies and services are, there is a need for more research to understand whether they would be acceptable to the user and whether they would in fact make a real difference to older people’s lives.
There is also the important issue of digital service provision for older people. We heard evidence suggesting that only around 60% of one-person households, where the person is over 65, have broadband. This widespread lack of broadband connection is likely to become less of an issue with the advent of 5G. Nevertheless, we recommended that the Government ensure internet access for all homes so that older people can access services to help them to live independently and in better health. Lifelong digital skills training is needed, so that when people enter old age they will have the ability to use the available technologies to their benefit. The Government’s recent introduction of a new entitlement for adults with few or no digital skills to undertake specified digital qualifications, up to level 1, is to be welcomed.
I will now address medical technologies. Our committee received evidence that wearable and implantable medical devices have an increasingly important future for the ageing population. Miniaturised devices applied to the skin or implanted into the body can allow precise and timely interventions to improve healthcare while reducing the number of medical appointments. For example, people with diabetes can use implanted technology to monitor blood glucose levels and deliver insulin. Devices monitoring other important health indicators, such as blood pressure and skin temperature, are also envisaged. More futuristic are exciting engineering developments in the field of microrobotics that may enable very local drug delivery or other treatments, such as microsurgery, within the body. There are also non-invasive surgical techniques, “robotic” implants, ingestible robots, in-body sensors for monitoring purposes, implanted drug delivery systems such as insulin pumps, and many others.
In the light of the evidence that we received, our committee concluded that the use of wearable and implantable technologies for monitoring health conditions and administering treatments is likely to become increasingly common. Such technologies have the potential to provide more precise and timely treatment and could well contribute to better health and greater independence in old age.
Our committee recommended that the Government support the deployment of technologies that contribute to healthier and independent living. Our universities and industries are world leaders in science and engineering and are consequently well-placed to undertake the necessary R&D. UKRI is making significant investment in early-stage technologies to support the ageing society grand challenge through the healthy ageing challenge. It is to be hoped that the forthcoming spending review and Autumn Budget will continue to support and indeed increase this UKRI funding that is so vital for our ageing population.
My final remarks relate to the mission of the ageing society grand challenge announced by the Government in 2018. This was eloquently addressed by the noble Lord, Lord Patel, in his opening speech and by the noble Baroness, Lady Young of Old Scone. The Government’s mission was to
“ensure that people can enjoy at least 5 extra healthy, independent years of life by 2035, while narrowing the gap between the experience of the richest and poorest.”
Technology can undoubtedly contribute to independence and social connectedness in old age. However, even with the rapid engineering advances that we are seeing, it seems unlikely that technology can add five years of healthy and independent living by 2035. Moreover, there is a risk of new technologies actually widening the health inequalities gap in old age, due to barriers to uptake being more prevalent in disadvantaged groups. We heard from several witnesses that technologies and services may heighten inequalities if products are not affordable and accessible to deprived groups. The Government will need to take the necessary steps to make these new technology tools ubiquitous and beneficial for the whole population in old age. Can the Minister comment on this and indicate how the challenge will be met to avoid the inequalities gap potentially increasing?
Viscount Hanworth (Lab)
The Science and Technology Committee’s report on ageing was written before I joined the Committee. I have no hesitation in declaring that it is an excellent report. It is lengthy and comprehensive and it contains numerous important recommendations.
The report has disposed of the optimistic belief that citizens of affluent societies can look forward with equanimity to the prospect of increased longevity. However, in comparison to the experience of Britons 100 years ago, the average lifespan has already increased markedly. A century ago, average life expectancy at birth for men was 48 years, whereas for women it was 54. By 2015, life expectancy for a man was 79 years and for a woman it was 83 years. It should be noted, however, that it can be misleading to compare average lifespan statistics then and now. The earlier figures are affected by a higher frequency of infant mortality and death in childbirth, both of which have been radically reduced.
The process of increasing longevity has slowed and there is little prospect of further significant increases at the top end of the range. Nevertheless, there remains considerable scope for reducing the incidence of premature death associated with social deprivation. The prospects of a morbid senescence, in which people suffer from the ailments of old age, have increased disproportionately. Both the duration of that period of affliction and the incidence of the associated ailments have increased markedly. Although it should be possible to delay the onset of the diseases of senescence and to mitigate their effects, they will not be eliminated. As the report observes, few of these ailments are liable to be eliminated by natural selection, since they occur mainly after the age of reproduction.
The report also revealed the wide differences in health and longevity among individuals in different socioeconomic circumstances. The expected duration of a healthy period in life—the health span—for those in the most affluent areas is 18 years longer than for those in the most deprived areas. Those in poverty suffer more from the ailments of old age. If there is a realistic prospect of increasing longevity on average and of reducing ailments, it must be by addressing these inequalities.
The statistics of disease and mortality recorded 100 years ago are dramatically different from the modern statistics. The Office for National Statistics has a web page titled “Causes of Death over 100 Years”, which shows the top causes of death by age and sex from 1915 to 2015. The incidence of mortality through infectious diseases has been radically reduced over that period. Until after the Second World War, infections were generally the leading cause of death for young and middle-aged males and females. During the second half of the 20th century, polio, diphtheria, tetanus, whooping cough, measles, mumps and rubella were all virtually wiped out, largely as a consequence of childhood immunisation. Meanwhile, from 1945 onwards, heart conditions became a leading cause of death for middle to older-aged males, followed by cancer. A similar trend, occurring at older ages, has been seen in women during that period, while younger to middle-aged women have more frequently died of breast cancer.
The committee’s report remarks that modern medicine is still dominated by the objectives of defeating single diseases and single ailments. To be more appropriate to treating an ageing population, it should be addressing what is described as multimorbidity, which is the state of having two or more long-term medical conditions. Coronary disease, hypertension—or high blood pressure —diabetes, dementia and strokes are all highly correlated in the aged cohorts; that is to say, they occur together, but they are being treated as if they were isolated ailments.
The experience of death and the social attitudes towards it have changed markedly over time. In predominantly rural communities, the realities of birth and death, witnessed in both the animal and the human populations, are liable to be part of everyday experience. These experiences are curtailed in urban populations.
In late Victorian times, the decline in premature mortality was accompanied by a curious side-effect, which was the ritualisation of death. This can be witnessed by visiting the cemeteries that date from then that accommodate lavish funereal monuments. In London, the Brompton, Highgate and Abney cemeteries are prime examples. Later, when cremation became an acceptable means of disposing of bodies, the memorialisation of the dead was much diminished. The incidence of mortality per head has been much reduced by the increased longevity that we have witnessed in the past 100 years. Nowadays, death is marginalised. It is no longer ever-present in our consciousness. I suggest that this marginalisation has had some deleterious consequences.
Although we are aware that the population has aged, we have been unwilling to face the consequences. Our provision of care for the elderly has not adapted to these circumstances and it has become seriously inadequate. We are frequently surprised and resentful when relatives die. Many appear to believe that death occurs only through medical negligence or malpractice. Doctors are fearful of being blamed for the death of relatives and they seek to indemnify themselves against complaints by asking relatives to assent to “do not resuscitate” orders.
The report is replete with recommendations of what should be done to reduce the impact of the diseases of senescence. It emphasises the well-known circumstances that undermine health in later life. Foremost among these are smoking, alcohol consumption and obesity, but only the first of these has been consistently targeted by public health campaigns. Much less has been done to address alcohol consumption, obesity and the lack of physical exercise. It is notoriously difficult to change human behaviour merely by exhortation and there has been political resistance to the interference of what has been described as the “nanny state”.
The recommendations of the committee’s report are too numerous to recite, but some of them are striking and should be remarked on. The report declares that the piecemeal approach to the problems of ageing needs to be replaced by a co-ordinated approach that addresses the complex and interrelated problems. Patients are often prescribed a multiplicity of drugs, with little attention given to the potential for their damaging interactions or to the harm caused to a patient by a pharmacological overload. It has been recommended that ageing people should be assigned to a designated clinician who has a complete oversight of their care.
The report calls for further research into the processes and problems of ageing and asserts that not much is fully understood yet. It calls for fuller and more enduring longitudinal studies. However, cross-sectional studies are needed that would highlight the disparities in health that are attributable to the inequalities in our society. The Covid pandemic has revealed the health hazards associated with social and economic deprivation and the stark differences in health and mortality between ethnic groups. Surely the most effective means of promoting good health in an ageing population is by striving to achieve a just and equitable society.
Lord Davies of Brixton (Lab)
My Lords, it is a pleasure to take part in this debate. We most certainly owe the noble Lord, Lord Patel, and his committee a big vote of thanks for their excellent report. I am only sorry that I was not here to participate.
As an actuary, life expectancy is my subject and I hope that I will be forgiven for emphasising aspects of how the issue is discussed. A crucial distinction, which needs to be understood in such discussions, is that between period and cohort life expectancies. It is not that one is right and the other wrong, but it is important to understand the distinct roles that both play in such discussions.
Period life expectancy is defined as the average number of additional years a person can be expected to live for, if he or she experienced the age-specific mortality rates of a given era in the current time period, for the rest of his or her life. The latest figures from the ONS are based on the experience of people for the three years 2018 to 2020. If you want to compare current mortality experience with that of the past—the experience of 2018 to 2020 with that of 20 years previously—the period life table is the one that you want.
In contrast, cohort life expectancy makes allowances for mortality improvements by combining observed and projected changes in mortality into future years. A cohort refers to a group of people with the same year of birth. For example, if someone is aged 18 in 2018, they were born in 2000 and would therefore be part of the year 2000 birth cohort. It has to be accepted that estimating future changes in mortality is difficult, but to ignore them would be even worse. Over many years, we have seen consistent improvements: people are living longer. However, the report points out that the rate of improvement has slowed in the last decade. While there are no uncontested explanations for this slowdown, I, along with many other practitioners, have no doubt that austerity has played a key role. In any event, this is a subject worthy of further study.
The report also points out the gross differences in life expectancy by social circumstances—one might even say class. But it is not the absolute level that differs by social circumstances; it is the rate of improvement. The wide differences that we see in rates of improvement are as much or more of a cause for concern as the current position. As has been mentioned, we await the levelling-up White Paper and it will be judged by how effective we think it is at addressing these issues. Can the Minister give us any reassurance that this will be a headline in the White Paper?
I come back to period and cohort life expectancies. Period life expectancies are based on solid data: we actually know how many people died in a particular period and what the population was. Cohort life expectancies depend on the exercise of some judgment about what changes in life expectancy are to be expected in future—over a period of many years, in the case of young people. However, if you want to know how long someone is expected to live—so that you could, for example, advise them on how much they need to save for retirement—you really need to use the cohort expectancy. In the same way, if you want to know what the future population will be then you need to adopt the approach of the cohort and build in allowances for potential improvements. This important distinction appears in the report, with footnotes that provide links to a detailed explanation. However, I am disappointed that the report focuses on period life expectancy. Fortunately, that does not affect its key conclusions, but it would be better to have used the more useful figure.
I am running out of time but want to say something about the impact of the Covid-19 pandemic on life expectancy. Quite understandably, given when it was written, the report itself says little. In any event, it is still relatively early days and the pandemic itself is a moving target. What we can be sure about is that it is here to stay. Every death is a tragedy, and the latest estimate from the Covid-19 Actuaries Response Group—I can recommend its website—is that the pandemic has cost 155,000 lives in the UK. It would be natural to assume, therefore, that this has had an adverse effect on life expectancy, particularly next year when more up-to-date data covering the period of the pandemic will be available. However, as is so often the case, it is more complicated than that, particularly when we come to cohort life expectancies. There are many consequences of the pandemic on future mortality, but not all are necessarily negative. For example, the improvements in hygiene, working from home leading to less traffic and pollution, and the mask wearing have clearly had some success—whatever their effects on Covid-19—in controlling influenza and other illnesses. I am sure that I, along with many others, will maintain these behaviours. We wait to see whether there will be the feared rebound, but the long-term effect will probably be positive overall.
There have also been significant improvements in medical science that might have a substantial effect on future mortality. The pandemic has spurred scientific innovation and collaboration from immunology and vaccine science through to new approaches to the collection and processing of health data and the organisation of healthcare. In particular, it has catalysed research and medical advances. RNA therapies are being harnessed to develop vaccines for personalised cancer therapy, infectious and autoimmune diseases and other disorders, not least cystic fibrosis and haemophilia. Work was already under way, but there is no doubt that Covid-19 has brought forward the time when these new treatments will be of value and extend human life.
I mention these positive effects not to make light of a pandemic where every death is a tragedy. However, it sets the Government a higher target: are they prepared to take advantage of these advances and deliver not just for those in the lucky groups who gain from improvements but across the board, focusing on those with fewer social advantages?
Lord Kakkar (CB)
My Lords, I join other noble Lords in congratulating my noble friend Lord Patel on the remarkable, thoughtful and insightful way in which he chaired your Lordships’ Science and Technology Committee on this inquiry, on the preparation of the attendant report, and, of course, on the way he introduced this debate. In so doing, I declare my own interests, in particular those as chairman of the King’s Fund, of UK Biobank and of the Office for Strategic Coordination of Health Research.
Your Lordships’ Science and Technology Committee identified the profound consequences of an ageing society and demographic in terms of the impacts economically and on the delivery of health services, but also of the broader societal impact. In considering the implications of ageing, we must be clear at the heart of all consideration and the development of any policy that it is the responsibility of society and government to ensure that we continue to deliver support and care for an ageing population compassionately.
We also have to ask ourselves the question, “What is going wrong at the moment?”, particularly in the delivery of health services. The committee was able to receive important evidence in this regard. We heard that the delivery of services is not joined up; we still provide healthcare services in a very disjointed fashion. In so doing, we have a focus on single diseases and single conditions, rather than providing a service for an ageing population where there is capacity to consider multiple comorbidities at the same time and provide interventions that ensure that each of those is addressed meaningfully and in an integrated fashion, so that individuals can maximise the opportunity for improved outcomes and avoid the many deleterious consequences of ill-co-ordinated multipharmacy and multiple ill-co-ordinated interventions.
Her Majesty’s Government will shortly bring to your Lordships’ House the Health and Care Bill. In that Bill there will be the opportunity to look at the way services are delivered. Is it Her Majesty’s Government’s intention that this Bill will provide the opportunity to deliver and address with a potential legislative change the important recommendations in this report that plead for the more co-ordinated and joined-up delivery of care services for an ageing population?
We also received evidence of the remarkable basic science research effort established over recent years in the creation of a new specialty of biogerontology—basic scientists studying the processes of ageing at a molecular and cellular level. That scientific output has identified hallmarks that can be associated clearly at a cellular level with the ageing process, such as telomere attrition, mitochondrial dysfunction and stem cell exhaustion. All this fundamental research provides the opportunity both for novel targets in the establishment of biomarkers that can be used to address, identify and diagnose the ageing process clinically at a much earlier level, and, most importantly, for novel therapeutic targets that will become future interventions and the opportunity for us to target the multifactorial manifestations of the ageing process.
We also heard that the next stages in the development pathway in clinical research in particular are dysfunctional. The current way we regulate clinical trials is to provide regulation to achieve a single treatment for a single disease, rather than undertaking clinical research for the ageing process, which, by definition, affects multiple end organs. We also heard that elderly populations and those with multiple comorbidities are frequently excluded from clinical trials, so much of the evidence generated for potential therapeutic intervention is generated in populations who are not elderly, and we extrapolate from those populations to a highly complicated ageing population. That is why the interventions we offer frequently fail to have the impact we might anticipate or to provide the advantages that so much technology and innovation in healthcare and research could provide. It is essential that the insights, innovations and interventions we will provide to deal with the ageing process and diseases associated with ageing are derived in and from those specific populations, rather than extrapolation.
Her Majesty’s Government have suggested that they will use the opportunity availed by leaving the European Union to look at the clinical trials regulation. Do they intend to look at the regulation to ensure that we can address this major fault in conducting clinical research to address the ageing process, so that we can not only achieve important benefits for those individuals and citizens who will benefit from the research output but have the opportunity to provide for our country to lead in the clinical development of interventions and innovations to address the ageing process?
Finally, we were also able to look at the question more broadly of how the health service can help us to address this important societal and national challenge. One of the important questions is how we are able to mobilise and use data collected within the National Health Service and in many large cohort studies that Her Majesty’s Government and research charities have supported over many years and decades, in terms of generating data to identify novel biomarkers, to establish approaches to appropriate imaging, and to apply emerging techniques of data science to these large cohorts and datasets to help us identify novel biomarkers and accelerate and improve the clinical trials process.
This is a very real challenge and once again Her Majesty’s Government have identified the opportunity to look at the general data protection regulation. Will that opportunity be used to provide for a review that allows us to access and address health data in a responsible and meaningful fashion, of course with appropriate social licence, to ensure that we can drive forward innovation in this important area? It is with data and it will be with innovation that we are able to make a major contribution to the issues identified in your Lordships’ Science and Technology Committee report.
Lord Winston (Lab)
My Lords, it was a huge pleasure to have the noble Lord, Lord Patel, as our chairman yet again for this inquiry, which was conducted with some challenging difficulties that were faced. He was, as usual, remarkable in his leadership and what we did. As the noble Lord, Lord Browne, and others have just emphasised, the findings show very clearly that the biggest single problem with ageing in the UK is widespread deprivation, which means that the Government are failing to reach their targets of trying to extend longevity.
There are many processes that we looked at which are associated with ageing. Multimorbidity, of course, is one of the key issues, where these processes between organs have a connection and are often responsible for what is happening. Unfortunately, there are not enough specialists doing regular connected medicine. This is one of the things that needs to be looked at in the health service. How many geriatricians who are specialised are available for this service in the United Kingdom at present? Do the Government feel that, given the manifestations of ill health, which are so interconnected, there should be more people of this kind? Perhaps that could be confirmed at the end of this debate.
An important aspect of this report was the science behind ageing. It is complex and surprising. I remember 35 years ago in my own lab we found that a human embryo, just three days after fertilisation, showed processes of ageing and that cells were changing and being destroyed. As we age, that process is not so efficient, so abnormal cells often appear in the adult human.
The committee identified a wide range of other mechanisms, including mutations in mitochondria—the battery packs of nearly every individual cell—which are an important aspect of ageing, the shortening of chromosomes, changes in DNA and in its repair, the loss of stem cells and, importantly for many of us in this Room, the process of inflammation, to which older people are much more susceptible. These and other issues are reported in the excellent chapter 3 of the report. I recommend that people read it because one of the most important aspects is changes in the immune system; of course, this aspect has been absolutely relevant during the Covid pandemic. We learned a great deal more about ageing, rather supporting some of the things we have been looking at. It turns out that these things are critical in all aspects of ageing in nearly all tissues and most organs, but they are not understood.
I should declare an interest that I have not declared before and which is not listed in the committee’s report: that of my own recent experience. Before the pandemic, I knew that I had cataracts in both eyes. An optician did not see anything else wrong with my eyes. I was therefore happy to continue reading on my computer without thinking about it, and I felt that my general processes were not impaired when I was doing stuff in Parliament; of course, your Lordships may have other views of my efficiency in that respect. I found that, while reading continuously on my computer, I was able to see films and re-read Dickens, Hazlitt, Hardy and many other authors. I did not really read newspapers.
In the past few weeks, however, I have suddenly found that I cannot read newsprint and am increasingly unable to read a printed book. In fact, I cannot read a printed book. I also cannot see road signs—I do not drive, obviously—and I do not recognise people. At the recall of Parliament, the only way I could identify noble Lords—even those on the same side of the division between the two major Benches as me—was by the sound of their voices. I realised that something was seriously wrong, particularly when I looked at my computer and saw that horizontal straight lines were no longer straight but wavy and often changed; I also saw black spots, of course, and colours such as green and red were all rather entrancing but very different. It seemed that something rather serious might be going on.
Of course, not being able to recognise your Lordships by sight and not being able to read a speech is really a blessed relief. I must say, if a few more noble Lords were in the same position, it might be quite good for the Chamber, but there we are. Unreadable speeches are not a great thing. At least when the noble Lord the Whip comes to say that I have been conducting myself too long, I will not recognise what is happening and so can go on wittering in this way.
I rapidly turned to Moorfields hospital and was very fortunate to meet Professor Adnan Tufail. He happens to be a notable international expert in retinal disease—oddly enough, particularly in my rare manifestation of age-related macular degeneration, which is quite common. My condition—seeing as I have not written a speech, I say this for the purposes of Hansard, because I like to tease them—is called reticular pseudodrusen age-related macular degeneration. Unfortunately, it seems to be a rare genetic kind of this disease and is particularly aggressive. Anyway, I was immediately sent for treatment by Professor Tufail, who was amazing. I had a treatment that noble Lords may have seen in “Un Chien Andalou”, a surreal 1929 film by Buñuel, where things are injected directly into the eye—although in my case, it was a monoclonal antibody, not a knife. It was done efficiently and without pain, but that treatment will have to be continued for some time.
To cut a long story short, I went to the lab and was able to see exactly the problems that they face. They are doing a huge amount of research at Moorfields—it is internationally recognised—and so many of the chemical processes that they are looking at, which are extremely complex in the eye, particularly in the retina, are exactly the same processes in the rest of ageing.
Multimorbidity with eye disease is one of the problems because people who are really short-sighted tend to fall down and break limbs, and are much more likely therefore to have other health problems as a result. Some become isolated, of course, and may not be able to get their brain in motion; dementia is therefore much more likely.
This is a massive problem because age-related macular degeneration, which may in different circumstances be very different, is still the commonest cause of blindness in the United Kingdom. We are not doing a great job, particularly among deprived people who, unlike me, do not have access to medical care in the same way because they are not medically qualified. What number of age-related macular degenerations are seen in the United Kingdom? What is the possible cost of this, both with and without treatment? How might we do something about this?
There is a real need to do more research. I must say, I found that there was very little public research at Moorfields. It was mostly from venture capital and other commercially derived areas. This is not good for widespread research, which can be immediately available to medicine. I commend Tufail’s team for carrying on. Finally, how much money is available from the Medical Research Council for retinal disease and cell therapies to treat those diseases?
Lord Sikka (Lab)
My Lords, it is an honour to follow the noble Lord, Lord Winston. I wish him a speedy recovery. I congratulate the noble Lord, Lord Patel, and members of the Science and Technology Committee on producing this thorough report. I urge the Government to adopt all its recommendations.
Technology plays a great role in every walk of life. However, it must not be a substitute for caregivers or human interactions. We have already seen that face-to-face appointments to see GPs are becoming rare. In online appointments, patients are expected to describe their medical condition. This is impossible to do with any degree of certainty, especially when patients have not encountered a similar health problem before. Technology can be a boon but it can also damage your health; just ask anyone addicted to online gambling, for example, hence the need for regulation.
That said, people’s welfare requires that they must have access to digital technology. However, that access is constrained by institutionalised inequalities. About 1.5 million homes in the UK do not have internet access at the moment. Around 20% of children did not have any access to a device for online learning while schools were closed recently. Those without access to the internet are most likely to be people aged over 65 or households with low incomes or financial vulnerability. Free broadband was a radical Labour policy at the last general election and would have helped many to benefit from the digital revolution. The Government have already plagiarised many of Labour’s policies and revarnished them; I urge the Minister to do the same with the broadband policy.
The noble Baroness, Lady Young, and the noble Lord, Lord Browne, indicated that economic inequalities are a key determinant of healthy life expectancy, but the Government’s policies have accelerated those inequalities and denied millions of people good food, housing, education, internet and participation in democracy to inform policies that can improve their lives. Even before Covid, 14.5 million people were living in poverty. The poorest 50% of people in the UK have just 9% of its wealth and 42% of all disposable household income is in the hands of 20% of people, while only 7% of it goes to the lowest 20%. Some 18.4 million individuals have an income less than the income tax threshold of £12,570. Only 58% of the adult population pays income tax because the other 42% is too poor. Some 6.2 million people have an income of less than £8,844. With such an economic predicament, a large number of people cannot easily access technology and harness its benefits, yet the Government continue to neglect this challenge. Hopefully the Minister will explain why they are so committed to hurting the poorest and most vulnerable people in our society.
Income tax is payable on incomes above £12,570, but the new Johnson tax—a 1.25% hike in national insurance—applies to incomes above only £8,844. As has already been mentioned, universal credit has been cut, and the average state pension is only around £8,000—about 25% of average earnings—which is the lowest in the industrialised world. Some 2.1 million retirees live in poverty. It is estimated that around 3 million people in the UK are undernourished, and 1.3 million of them are retirees. Every year, around 25,000 of them will die because of the cold and related problems. Nearly 6 million people are awaiting hospital treatment in England and there is no relief in sight.
On top of that, the Government have adopted regressive taxation policies. Even before Covid, the poorest 10% of households paid 47.6% of their income in direct and indirect taxes, while the richest 10% paid only 33.5%. I hope that the Minister will be able to tell us how he is going to address that situation, because the redistribution of income and wealth is the key to unlocking the door to healthy life expectancy—but Ministers do not utter the “R” word. None of the Ministers at the annual Conservative Party conference mentioned it; hopefully the Minister will put that record right.
On several occasions, the Government have published impact assessments of their policies, but I am yet to see an assessment that explains the impact of their policies on women, senior citizens, children or other marginalised groups in our society. Nothing is said about the impact of matters such as the suspension of the triple lock, the cut in universal credit, the new Johnson tax, wage freezes and cuts in public services on inequalities or healthy life expectancy. Late last year, the 107-page Budget document said absolutely nothing about these things; indeed, the word “women” appeared in it only three times. Can the Minister give an undertaking that, from now on, all government policies will be accompanied by an assessment of their impact on women, senior citizens, children, marginalised groups, inequalities and healthy life expectancy?
Finally, I want to say a few words about the pharmaceutical industry. Two issues have a direct relevance to this debate. First, the pharmaceutical industry has been profiteering through drugs pricing, thereby depriving many people of vital medicines that affect the quality of their lives. Secondly, the pharmaceutical industry does not have the zeal of people like Edward Jenner to eradicate anything; it increasingly creates dependency. You can see that people are dependent on drugs for blood pressure, asthma, cholesterol and many other things because the industry wants more customers. Indeed, some of these drugs themselves have side-effects that affect quality of life, but it seems to me that the drugs industry is off the Government’s radar. Its business model must be examined.
Lord McColl of Dulwich (Con)
My Lords, I have been given permission to sit while giving my speech because I am having great difficulty with my vision. First, I thank the noble Lord, Lord Patel, for initiating this discussion on the report on ageing. The report makes the apt point that, although life expectancy is increasing,
“the UK has seen low rates of life expectancy increases compared with most European and other high-income countries.”
With any medical condition, we must focus first on diagnosis, secondly on aetiology and, thirdly, on treatment. Well, the diagnosis is clear: the people of the UK are the most unhealthy in Europe. Seventy one per cent of those aged over 30 are obese or overweight. When I first mentioned that statistic last year in the Chamber, it was dismissed by a prominent politician as being over the top. I was not over the top; I was just dealing with facts, truth and science.
As the noble Baroness, Lady Sheehan, mentioned, obesity leads to widespread disease, including type 2 diabetes, hypertension, strokes, heart attacks, dementia and many other conditions that cause premature ageing, morbidity and death. The fat in the gross excess of fat cells leaks out, impairs the immune system and leaves the polluted body susceptible to very many diseases, especially infections such as Covid-19. The countries with the highest prevalence of obesity are the ones with the greatest incidence of Covid-19. So when the Prime Minister was accused of being responsible for 130,000 deaths, it was a false accusation. The aetiology of obesity epidemics is simply that people are putting too many calories into their mouths. Therefore, the treatment is, first and foremost, to get obese people to put fewer calories into their mouths. In fact, the Prime Minister was the first national leader to advocate eating less in order to reduce the obesity epidemic. He showed the way by losing three stone himself and coined the phrase, “Don’t be fatty at 50”.
Before we focus on complex solutions, we must first ensure that we have mastered the simple ones. It is not the case that eating less is impossible; what is impossible is to go on eating too much and remain healthy. There is no doubt that eating less requires effort and, for some, it is very difficult indeed, but the effort pays off in terms of morbidity, mortality and improving the quality of life in old age.
It was said that one group of people suffered more from Covid because of poverty and government cuts. Then an honest commentator pointed out that this particular group of people is more likely to suffer from heart attacks, strokes, type 2 diabetes and hypertension, but no one had the courage to say that the cause of those four conditions was mainly obesity. The critics say that they were obese because they could not afford the right food, but they would not be obese if they ate less of the wrong food.
Elements of the scientific world and some authorities have confused the public by mixed and inaccurate messages—for instance, that physical exercise is the answer to the obesity epidemic. The scientific institution known as NICE has maintained for years that all the calories we eat are used up on exercise, but surely one of the 500 employees of NICE could have gone to the gym, exercised for half an hour on a machine and seen how few calories they expended. On average, approximate intake of adults is 2,000 to 2,500 calories a day, which means that a person would have to exercise for four or five hours every day to burn up the calories they ate. This would increase their appetite and their calorie intake. I should emphasise that physical activity is essential for good health but is not an effective way of reducing weight.
There should be a clear message to the public that obesity is a disease that destroys the human body slowly and, as people get older, produces an enormous amount of suffering and death. The Department of Health has not always been helpful, in that it advocated a low-fat diet—but it is fat that acts as a brake, limiting the amount we eat. We clearly need to limit the amount of saturated fat, but unsaturated fat is fine. As fat leaves the stomach it goes into the duodenum and releases hormones that act on the stomach, delaying its emptying, thus giving an early sensation of fullness and satiety. After the fat has been emulsified and absorbed, it moves down the small intestine and normal service is resumed by the stomach. This is a beautiful mechanism that limits the amount we eat but, not surprisingly, the food industry dislikes it.
In the 1970s, Professor John Yudkin of London University set out clearly in his research that fat was not the problem; the problem lay in sugar. The food industry not only deliberately demonised fat but demonised Professor Yudkin. It was influential in his dismissal from his university post. The food industry advocated a low-fat diet, which is not only tasteless but bad for sales. It therefore added large quantities of sugar to the diet, and so the rot set in, with increasing obesity leading to the obesity epidemic.
Whole milk used to play an important part in limiting how many calories people ate. Skimmed milk was an industrial by-product which was at first discarded, then fed to animals and later to humans. The Department of Health has not helped matters by continuing to advocate a low-fat diet. It told GPs not to call patients obese because it was judgmental; it does not seem to realise there is a distinct difference between being judgmental and making accurate diagnoses.
The committee’s report focuses on the cure for the lifestyle choices of an ageing population, but prevention is better than cure. We could save millions from untimely deaths and billions in expenses if we focused on prevention. The struggle to keep an ageing population healthy has no greater challenge than this: the problems posed by bad choices. What is the Government’s role? It is not to tell people what to do. Instead, it is to honestly present them with the facts and the truth, and encourage them to make the right choices to grow older unhindered by increasing morbidity and mortality.
Lord Crisp (CB)
My Lords, I am not a member of the committee so it gives me great pleasure to say that I thought this was a really excellent report. The science was fascinating and it was very readable as well. I almost thought I understood most of it, which was gratifying. It deserves a wider audience for bringing it all together in the way that it does. It is also a privilege to follow on behind a distinguished doctor and to be followed by a distinguished nurse; I suppose that is the right place for somebody whose background is in health management.
I want to pick up three points. Two of them are about the Government’s response and the other is about something specific within the committee’s report. As a health manager, perhaps the right place for me to start off is with that nexus of issues that noble Lords have talked so much about: the multimorbidity, the unplanned cocktail of drugs that people are taking and the lack of co-ordination. Very interestingly, there was also the point that the noble Lord, Lord Kakkar, picked up about older people not being included in drug trials. Indeed, as the report said, there was no real research being done on ageing in general, as opposed to the more specific points as a whole.
This area of co-ordination and oversight of what is happening with old people’s medication and their health is vital. I am not sure the committee’s recommendations were strong enough—other things could be there—but, frankly, the Government’s response was bland, as if to say: “Yes, you have already got a designated clinician.” I do not know if many older people know that, and I speak as somebody with a 97 year-old father-in-law. The truth is that it is left to the family. It is left to the individual, the family, the carers, the friends, and so on. That is another manifestation of inequality, because of access to having people who can help you.
I liked the point made by the noble Lord, Lord Kakkar, that maybe this can be picked up in the forthcoming Bill or the debate in the House about it. But I would like to ask the Minister if he recognises that there is inadequate co-ordination and oversight of older people’s health and medication. Will he ensure that the department and the NHS do more to address this?
My second point refers to the committee itself. The whole document treats older people as a problem and a burden, but what about the contribution and value that they—or perhaps we—bring to society? One may say that is not within the scope of what the committee was looking at, but I have seen a lot of evidence that having a meaning and purpose in life is good for your health. However, being undervalued and seen as helpless—as most of us are reduced to being helpless when in the health system—or not being in control, which is a vital part of one’s health and self-esteem, is bad. We should not forget that whole range of issues. They are susceptible to good evidence, good policy and good thinking that recognises the role and contribution of older people. There is an admirable focus in the report on the causes of ill health, but there needs also to be thought about the causes of health. There needs to be more research in that area.
I shall also pick up a point that the noble Viscount, Lord Ridley, raised, even though he is not in his place. I do not disagree with him on the importance of research but this is about research and society; it is not one or the other but both. Research is vital but he caricatured public health as being about advising young people to do healthy things. That is not often going to work; I suspect I agree with him. Having said that, just by chance this morning I was on a webinar Zoom call with Everton Football Club, which is doing remarkable things to teach young people about health using that very strong force of role models, so that area is not a guaranteed failure.
A good public health approach is much more about enabling people to have a good life, in the sense of making sure that they are secure. Love comes into this, as does education, opportunity and all the things that enable people to be all they can be. It is what Aristotle referred to as eudaimonia and is normally referred to as human flourishing. The public health aspect of dealing with inequalities, but going wider than that, is really important. This committee is right to have picked up both the biological science in research and the society aspects.
Let me pick up one final point. In its last chapters— I think it is recommendations 20 to 23— the report presses the Government on how serious they are about this challenge and how determined they are to do it. Have they got somebody in charge of it? Is there going to be the impetus, energy, support and mobilisation to make something happen? Those are really important issues. Again, I thought the government response on this was bland, at best. There was no indication of the energy and importance of this issue in the way that it needs to be taken forward. Will the Minister reassure the Committee that it is not only about whether the grand challenges are going ahead in this form, but that these issues around health, ageing, science and technology are to be picked up in the appropriate fashion?
Baroness Watkins of Tavistock (CB)
My Lords, it is an honour to follow the noble Lord, Lord Crisp, and a pleasure to speak in this debate on the report of the committee chaired by the noble Lord, Lord Patel, who has been my mentor since I entered this House and encouraged me to speak today. He introduced this debate so effectively and outlined the challenges that face society in relation to ageing.
Many noble Lords have developed and will continue to develop the important themes of science and technology research investment as an essential building block in developing treatments, AI and robotics to assist people in older age and to target specific illnesses through effective new drugs. I intend to discuss the challenges and opportunities outlined from social care and a “happiness and health” perspective in later life.
The report notes that the proportion of the UK population that is older than 80 is expected to increase from 4.9%, or 3.3 million people, in 2018 to 10%, or 7.6 million people, by 2065. The Chief Medical Officer for England, Professor Chris Whitty, explained to the committee that it is anticipated that older age groups will be
“highly concentrated … in places where delivery”
of care and health services
“is more difficult than it is in cities.”
I recently attended a lecture that he gave at the University of Plymouth. He outlined the particular challenges of reaching people in rural communities and seaside towns, where many young people leave for work but return to retire, leaving a very small young workforce pool to provide paid care work to support older people.
This morning, the current challenges of providing enough care workers to support people as they come out of hospital were made clear by several speakers on the “Today” programme, including Vic Rayner, chief executive of the National Care Forum. There is insufficient modern accommodation, particularly in the social housing sector, to provide supportive living in a cost-effective manner to older people. Yet there is huge opportunity to build units with appropriate technology to enable more independent living, even for people who have multiple morbidities.
I am amazed that it is now possible to wear a watch with a tracking device that records a person’s whereabouts and, if their routine changes, enables alerts to a central hub and/or a named relative or carer within seconds. As a district nurse in the 1970s, I had to return to base to phone a patient I was worried about. If they did not answer, I had to go back to see them. Think of the difference for district nurses today because of mobile phones and modern technology. In addition, Housing 21 and Bath University work to link innovative engineering to do what appear to many to be simple interventions, such as a kettle that can never boil dry, due to a switch-off mechanism, or baths and showers that control the water temperature so that people cannot scold themselves when bathing. People can therefore stay independent.
Can the Minister please explain how the Government intend to promote investment in social housing that will meet the needs of the most deprived older people, so that they can live healthier, more independent lives? The boom of such housing available to those who can afford to buy age-specific homes of this kind illustrates that many older people enjoy living in such communities and are often less lonely as a result. Will the Government also invest in research designed to identify the potential benefits of such interventions on a longitudinal basis to provide data to inform future investments for older people?
I turn from housing as a key social determinant of health to the NHS and social care. Loneliness is a risk factor for both physical and mental health, as is adequately detailed in paragraph 34 of the report. What role should the NHS and care services play, possibly through social prescribing, to reduce extreme loneliness in old age? In the village where I live, the local post office and shop have just closed and, other than school transport, the bus operates twice a day—that is, two buses one way and two back, without a timetable focused on getting people to and from work. There is no bus that enables a 10 am departure and a return before 4 pm, so that someone of 70 years old can use their pass to go to the nearest town to shop, visit the library and perhaps have coffee. These are real issues for people, yet here in London I can pretty well go anywhere anytime. Could further investment in transport from central and local government overcome these issues and thus promote the health of older people?
Can the Minister explain whether Health Education England is exploring the need for specialist health and social care workers to work with older people? There are few Admiral nurses to support people with dementia, yet this is the highest cause of death in women and the second-highest cause of death in men in England, as illustrated by table 1 in the report. The report also highlights the need for more regular medication reviews for people as they get older and the fact that Age UK reported to the committee that
“care packages can only focus on the essentials such as meals and toileting, without any time for help with mobility”.
That is a damning indictment of our individualised care interventions. The noble Lord, Lord Kakkar, outlined the need to provide co-ordinated, compassionate care. It is essential at the moment, let alone in the next 20 years.
Promoting independence is vital if people are to live longer, healthier, happier lives in old age. I suggest that the recommendation outlined in paragraph 275 of the report—
“that the Government clearly defines the roles and responsibilities for healthy ageing among national and local government and their agencies”—
is as essential as blue-skies research. The report clearly outlines the differences in life expectancy between different socioeconomic and ethnic groups. Why is my life expectancy estimated to be nine years longer than that of someone living nine miles away from where I reside, in the most deprived ward of Plymouth?
Finally, can the Minister comment on whether the ageing society grand challenge needs revision, or is to be completely reviewed from the current term, to ensure
“that people can enjoy at least five extra healthy, independent years of life by 2035, while narrowing the gap between the experience of the richest and poorest”
and enable all older people to have high-quality support and care in the last five years of their lives, as necessary, to reduce loneliness and thus promote health and happiness irrespective of income? The new social care levy could, I argue, be used in part to achieve this aim.
Lord Desai (Non-Afl)
My Lords, this is a very good report, as many noble Lords have said. There is not much I can say in any kind of expert way, so I will follow the model of the noble Lords, Lord Davies and Lord Winston. The noble Lord, Lord Davies, talked about the report from his own professional side, while the noble Lord, Lord Winston, told a lovely personal story. I will do those two things because it will be more helpful.
First, as an economist, I was involved in measuring human welfare. Twenty years ago, I was involved in inventing the concept of human development. At that time, life expectancy was popular among economists. However, I discovered that it is not a good measure of what we really want to measure because, once a country has taken care of infant mortality and under-five mortality, life expectancy rises. After that, it slows down and does not actually indicate anything much except that the death rate in older people also slows down slightly.
I always say that if I move from a country with a lower life expectancy to one with a higher life expectancy my health does not improve. How is my health condition to be measured? I think the report has an angle on that which is: how many years do I have left to live? I thought I had invented a new concept about potential lifetime. What is the potential lifetime of any person? Your age-dependent life expectancy minus your age is how many years you have left to live. One of the things we ought to look at is whether that measure should be more easily available as an indicator.
On a personal level, what is my condition? I may be 50, but my multimorbidities make my potential lifetime shorter. The idea of healthy years of life left has less utility as a group measure than if you could measure it individually, as I am sure we can. We need better measures of what we are trying to measure—not so much ageing, but healthy living as you get older and how many years of that you have to deal with.
About six months ago all my underlying conditions, as they are called, flared up and I became an ageing person, as it were. At least two hospitals are currently looking after me. One is King’s College Hospital near where I live and another is the Tessa Jowell. I am very well looked after.
What is very interesting about my experience—and I think it was partly inactivity during the pandemic that finally got me—is that, until then, my overworked GPs were not able to tell me what was happening with me. When I went to the GP, which I did not do very often as I knew how burdened they were, my GP had no time. It is a group practice and no GP had, until now, ever introduced themselves to me or asked my name—but they know my name. They have five minutes, if that. They stare at the computer and look at what medicines I get and give me some medicine. No GP ever told me what the medicine does for me. It is just “take this”. It is one of those things that happens. They know what they are doing and I presume that, as they know, I do not need to ask. It would only waste their time.
The report says something about how care is episodic. As a patient, I would like to have an assurance that somewhere is a portfolio of all my conditions from the first time I saw a GP until now, which the GP can access. If that was the case, then at some stage somebody would tell me why I have got to where I have, what I have done wrong and what I could do further. It is not that they cannot do it; they just do not have the time. We are living with an extremely underfunded National Health Service and, while it is doing marvellous work without a doubt, there are limits to what a human being can do in a day.
It is an unfair contrast but, when I grew in India—no doubt we were paying for the GP and were slightly better off—my mother would go to the GP and say: “Now listen, this boy has got such and such. Last time you gave such and such medicine. Can you give something else?” The GP would then have a nice, long chat. Obviously, I was lucky. I was richer, but my family was not very rich, believe me.
When my multimorbidities caught up with me again, I was in India, and I had an amazingly detailed explanation of what was happening to me and why, and which morbidities were interacting with each other. It is not possible to get that sort of thing. Can we somehow make lives easier and give GPs the technical apparatus so that they can quickly see how to improve the care of an individual patient, especially elderly patients who have more complications?
We also know that these conditions are exacerbated by income inequalities, where you live and so on. This happens all the time. Whenever there is a crisis, I could tell you who would suffer most—the elderly, women, ethnic minorities and others in a postcode lottery. In the 2008 financial crisis, the same people suffered, because of the economic conditions. All I can hope is that we improve the support that clinical people have to take care of us as well as possible.
We should also do something about inequalities. Last week, in your Lordships’ Chamber, we had a lot of discussions about the cut in universal credit, pension problems and so on. As the Government are levelling up, they should try to reduce inequality as much as possible.
Baroness Manningham-Buller (CB)
My Lords, I join my colleagues in thanking the noble Lord, Lord Patel, for his wonderful leadership of our committee and his patience under provocation from Zoom, not to mention committee members. Listening to the evidence of this inquiry was sobering. There has been virtually no progress in reducing the UK’s stark health inequalities, and years of unhealthy living before death have lengthened. The NHS is not structured to tackle multimorbidity and much has to be done to cope with an ageing population, let alone meet the aim of the grand challenge, whether or not it survives in those terms. Of course, there are lots of societal and economic issues as well as health issues.
Many of the things I thought of saying before this evening have already been covered, so I will focus first on the costs of this. I know that Governments, in looking at the recommendations of Select Committees, react when we recommend that a lot more money should be spent —and indeed there are such recommendations, including extra funds for research or certainly refocusing them. But the committee also felt there were plenty of opportunities to save money while—this is most important —putting the patient first. With the opportunity to save substantial NHS funds, the cost of not doing so is vast.
Like the noble Viscount, Lord Ridley, I had also not heard of polypharmacy, but we heard evidence of too many patients taking a cornucopia of medicines—maybe as many as 20 drugs, often more than necessary, without proper recognition of the side-effects and their interaction with each other, for example, and their propensity to cause falls in some cases and lead to a poorer quality of life.
In my experience, GPs have little time to conduct detailed drug reviews, however much they wish to. I note from the Government’s reply that they were reinstituted in July 2020. Understandably, GPs are also often reluctant to delete from a list a drug that has been prescribed by a specialist consultant, and the advice that you get from pharmacists varies. I strongly echo the request from the noble Lord, Lord Patel, for a proper plan to deal with this very expensive issue, about which the evidence we heard accords with a more recent review by the Chief Pharmaceutical Officer. Apart from saving and helping patients who are confused by this array of drugs—I have spent the last few years dishing out dozens to my husband—it could also save millions.
My second point is that the NHS is simply not structured or geared for multimorbidity. Expertise and specialities continue to narrow. We need those—geriatricians and others—who can take a broader view of a patient’s whole requirements. Until fairly recently, in my GP surgery there was a sign instructing patients in the waiting room to raise only one issue with the doctor per visit. I recognise the time pressures that led to that stricture, but it was very unsatisfactory. Patients should not have to edit what to mention and what to suppress. To ask them, in effect, to decide what their main problem is themselves through self-diagnosis, and to make journeys that may be long and expensive, particularly in rural areas—as the noble Baroness, Lady Watkins, said, we heard about Chris Whitty’s view that the elderly are moving out of cities and are more difficult to reach—for multiple visits is expensive and unreasonable. It is also inefficient and potentially dangerous, as the complaints they have may well be linked. I should like to hear from the Minister how he believes that the NHS can adapt to gear itself to the reality of patient need in multimorbidities on the scale outlined. As many other Peers have mentioned, much greater co-ordination is needed, and efforts are to be made where possible to avoid patients having to trek to different appointments on different dates and in different places.
My final point is about research, on which many others have spoken. The demands on UKRI are high, and recent cuts to its budget damaging, but there is still too little focus on each end of the life course. That runs from conception, where, as we know, many health problems arise—the noble Lord, Lord Winston, mentioned this—to the final years, with some focus on the causes of ill health, as the noble Lord, Lord Crisp, suggested. Government should consider how to stimulate research at both ends: reproductive health and ageing health. These areas do not currently have much appeal for researchers; they are less well funded than other areas of medical science.
Whether or not the grand challenge survives—and I hope its aim does, whether or not it is relabelled or ditched for whatever reason—my main hope is that the Government produce a coherent and consistent plan to address the multiple problems from our ageing society, including health inequalities. These problems are not reducing; they are becoming more acute. I hope the Minister will be clear about when we might see such a plan.
Lord Balfe (Con)
My Lords, I thank the noble Lord, Lord Patel, for his excellent report. It is a report I will not be getting rid of; it will stay on my shelf. That puts it in distinguished company, because it means that it is one that has been not only worth reading but worth keeping and referring to in future. The noble Baroness, Lady Young, said that this was the best old people’s home. When I came here, I was told it was the second best, but that there were no vacancies in Buckingham Palace.
I am very pleased that people are living beyond 80, particularly because I am now in my very late 70s and I look forward to joining them, but we need to remember that it is important to keep people alive, or to help them stay alive, in a way in which they can enjoy life, not as people struggling from day to day. We have the challenge not only of longevity but of helping people to contribute to society and to be able to be a useful part of it.
My first point is this: we are very lucky that we are in the House of Lords and have plenty to do. However, in the community in Cambridge that I live in, I see many people who could contribute a lot to society but somehow or other there is no structure for them to do so. Indeed, in many ways, there is almost a feeling that they are not quite wanted and are part of a generation that has gone. We must first look at changing our attitudes and realise that many people can contribute at many levels, and that that also helps to keep them healthy and on top of things.
I would distinguish between the changes that we have seen and which have contributed to the lengthening of people’s lives. Some of them are what I would call national changes, and some are individual ones. During my lifetime, we have seen the advent of the National Health Service, which has certainly helped a lot of people to live longer because those who cannot afford or do not see doctors have been able to access medical care.
We have also seen a number of incidental changes, which are now almost forgotten. For instance, I advise those noble Lords who have few weeks spare to read Chips Channon’s diaries. You will read about a London where fog was so dense that you could not see in front of you. Now, we have made marvellous steps in the reduction of pollution. You will read about a London where the amount of alcohol consumed—particularly in this place, incidentally—was prodigious. Nowadays that has gone down, which has contributed to change. You will read about a London where people bought each other a cigarette case for Christmas as a matter of course. How many cigarettes do you see now? Not many, quite rightly. We have made a lot of changes as a society. I say to the Minister that part of the department’s strategy must be to make it unacceptable for certain behaviours to take place at all. I am not going to start a debate on them, but there are areas where we need societal shifts to make it clear that certain types of behaviour are no longer accepted.
We also need to look at individual behaviour. One thing that has not been mentioned is class, although we have of course mentioned poverty. The fact of the matter is that the middle class is, and has always been, very good at looking after itself. One thing we have to spread is the inquiring nature of the middle class. Its ability to get the best out of society for itself must be extended. You cannot get hold of people and say, “Here is a social worker, we are going to make your life better”. Fundamentally, people have to change the way they look at society and make their own life better. For some years, I was the president of the British Dietetic Association. Dietitians will tell you that the biggest difficulty they have—or one of the biggest—is getting the intellectual case across. I hear what my good friend and doctor, the noble Lord, Lord McColl, has to say, but one of the biggest difficulties in persuading people not to put those calories into their mouths is persuading them that it is actually the wrong thing to do.
This is where the food and drink industries have a part to play. I am afraid that we have to get a bit tough with them. If any noble Lords wish to go across the road to Tesco and have a look at the meal deal on display, they will see that, if they have a Tesco card, they can get various commodities quite cheap. There are special offers and, of all those commodities—I went and had a look at them today before this debate—not a single one would be classified as healthy eating. They are all high in hydrogenated fats or are straightforward sweets, sugar and chocolate. The voluntary approach is not going to work. I think that the department would find that it had the country behind it if it took a tough line with the food and drink industry. Incidentally, I am a vice-president of the Food and Drink Forum, so I have some dealings with the industry. I listen carefully to all it says and believe about 5% of it—and I am a generous sort of person.
I also point out to the Minister the difficulty in getting things done. The noble Lord, Lord Rooker, and I have been campaigning for years—he has done most of the work, to give him his credit—for the addition of folic acid to bread. It has taken years and years. The Minister is going to have to be tough with the industry.
My final point is that there is a need for a better science of geriatrics. Most general practitioner services do not have a doctor who specialises in the elderly. They need it, but we also need more in the way of literature and publications that will help elderly people to know how to help themselves—in particular to tackle the polypharmacy case, because it could be tackled much better if people knew that they needed some help.
Baroness Greengross (CB)
My Lords, I thank the noble Lord, Lord Patel, for his opening remarks and for highlighting the important issues raised in this report. I also thank the many noble Lords who have spoken this afternoon. Ageing is an area I have worked in for most of my adult life. I am grateful for the work done by the committee on these important topics, and for it inviting me to speak to Members on the issues raised.
I declare my interest in the register as chief executive of the International Longevity Centre UK. In its 2020 report, Health Matters: Why We Must Commit to Delivering Prevention in an Ageing World, the ILCUK warned that the average number of years people will live in poor health is set to increase by 17% over the next 25 years. We know that the 2019 Conservative Party manifesto made a commitment to ensure that people lived at least five extra healthy and independent years of life by 2035. The report we are discussing has a similar goal of wanting an increase of five years in disability-free life expectancy at birth for both males and females by 2035.
Sadly, in many parts of the UK, we are in fact going backwards in terms of healthy years lived. Sir Michael Marmot’s 2020 report for the Institute of Health Equity found that, for the first time in a century, life expectancy had fallen for women in the poorest communities in the UK. Overall, we have seen low rates of life expectancy increases compared with most European and other high-income nations, which is very sad news to read. Further, Sir Michael’s report found that, since 2010, the percentage of life spent in ill health has increased for both men and women.
Given this, to achieve the 2035 goal stated in the Science and Technology Committee report and the 2019 Conservative Party manifesto, there will need to be significant investment to stop health inequality and support people to live longer lives free of illness and disability. Do the Government still stand by their manifesto commitment of five extra healthy and independent years of life by 2035? If so, given the recent evidence of increased health inequalities throughout the UK, what will they do to address this?
Another area of the report that I am very interested in is the section on housing and the built environment. Paragraph 287 states:
“A basic requirement of independent living is the ability to move around the home and undertake the tasks of daily life. However, we heard that many homes are poorly suited to life in old age.”
According to the charity Habinteg, only 9% of homes in England are suitable for people living with disabilities.
I have for a long time been a supporter of housing with care, where older people can enjoy independent living in a community setting where care and support can be provided if needed. Yet only 0.6% of the over-65s in this country live in housing with care settings—about one-tenth of the levels seen in countries such as the US, Australia and New Zealand.
I agree with the report’s recommendations that the Government should use planning rules to ensure that homes and communities are accessible for people with limited mobility and adaptable as their needs change with age. Promoting housing with care and using planning laws to ensure that developers are able to build these sorts of living situations would be an extremely effective way to achieve this recommendation.
I conclude by once again thanking the noble Lord, Lord Patel, for the opportunity to debate this report today. Longevity and technology change are both transforming the human life course in profound ways. The Covid-19 pandemic has in many ways accelerated some of these changes in technology and highlighted the health inequalities that still exist. This report makes a number of important and timely recommendations to which I hope the Government will give serious consideration.
Baroness Walmsley (LD)
My Lords, it is a pleasure to begin the winding speeches on behalf of the Liberal Democrat Benches, not least because we have just had 19 excellent speeches. Indeed, the level of agreement about the relevant issues indicates to me that the Science and Technology Committee had a lot of the right answers, and I make no apology for repeating some of them in a few minutes.
First, I thank the noble Lord, Lord Patel, the committee staff, our witnesses and, in particular, the medical experts on our committee who helped me to understand some of the more scientific elements of what we were hearing. As a member of the committee, I enjoyed it very much. I found it interesting but also important because in the introduction to the report on ageing we pointed out that by 2035 there will be some 5 million people over 80 and I will be one of them—in fact, I will be over 90 if I live that long, so I have a vested interest in the Government’s response to this report. In welcoming the noble Lord, Lord Kamall, to his new Front Bench role, I hope he is going to give me some comfort at the end of this debate.
As the noble Viscount, Lord Ridley, emphasised, we can thank medical science for the fact that we are living longer. The doctors and scientists are keeping us alive, but we have to ask ourselves: for what quality of life? That is why the Government issued their grand challenge of five more years of healthy life by 2035, while narrowing the gap between rich and poor. I welcome that, but is it achievable? That is what the committee set out to discover.
We heard that although average life expectancy in the UK has continued to increase year on year, although recently at a slower rate, healthy life expectancy has not kept pace. Indeed, there is a widening gap between the two, and between rich and poor. People are living longer—although women in the lowest 10% demographic group are not—but many of those extra years are spent in poor health, with multiple diseases that can mean a person spending half the week visiting several different departments in their local hospital.
The health and care system is not designed for people with multimorbidities, as the noble Baroness, Lady Manningham-Buller, just said, nor for early diagnosis in many cases, as mentioned by the noble Viscount, Lord Ridley. We therefore recommended that older people should have a designated medical professional to integrate their care and smooth out the bumps in the availability of treatment; the noble Lords, Lord Crisp and Lord Kakkar, recommended this too. The Government say that it is already happening, but not according to the evidence we heard. We think it could save money in the end, as well as providing a better service for older people.
However, there is something to be thankful for, although the noble Lord, Lord Kakkar, pointed out the problems with the clinical trials regulation. Our report outlines considerable progress in researchers’ understanding of the biology of ageing, and we reported on the work on new therapies and repurposed drugs to tackle age-related diseases. We urge the Government to continue to support this work, but believe that the “R” of R&D is often better supported than the “D”. More effort thus needs to go into developing the discoveries of our scientists here in the UK, to avoid the benefit going to companies and patients abroad.
Age-related diseases do not just happen as soon as you turn 60. We heard evidence of the lifelong lifestyle and environmental factors that correlate with health in old age. This is particularly relevant to the second part of the grand challenge mission: to narrow the gap between rich and poor, as many noble Lords have mentioned. We concluded that this knowledge should be used by public health authorities and national regulators to help individuals to understand and make use of it but, critically, to enable them to do so.
However, no matter how healthily a person lives through life, inevitably they will become frail in old age, even if relatively fit, because of the cellular and molecular changes referred to by the noble Lord, Lord Patel. Most people would rather live safely—significantly, he also used the word “independently”—in their own home when they get old. They would of course be happier in their own community and, as the noble Lord, Lord Crisp, said, in control. This would also be cheaper for the health and care services and it is where home care comes in. Sadly, we know about the pressures on that, as well as on residential care, but the recent government announcement of an increase in national insurance contributions will do little for social care. Staff shortages and poor pay and working conditions mean that many old people, who would be better off at home, are kept too long in a hospital bed which could better be used to clear the backlog of procedures resulting from the pandemic. This illustrates the spider’s web of linked policy areas.
We heard encouraging accounts of where technology can help older people look after themselves, to ensure that they are safe and well, but many older people do not have the digital skills needed to operate these aids. They also cost money, which again is a challenge to achieving the second part of the mission: narrowing the gap between rich and poor. The availability of technological solutions should not further add to health inequality by being available only to the better off and digitally savvy. Do the Government have a plan to avoid that happening?
As the noble Baroness, Lady Watkins, said, loneliness can be a negative factor in well-being, as we have seen during the pandemic, when many people living alone have suffered mental health challenges. The internet can provide some communication but only if you have a connection, so this depends on the availability of decent broadband and a costly device, as well as the skill to use it. I join the noble Lord, Lord Mair, in asking: what are the Government doing to make sure older people are not left out of the digital age?
We heard from civil servants and Ministers that there is enthusiasm for achieving the grand challenge, but we came to the conclusion that this is unlikely. Why? It is partly because the progress towards achieving the challenge is not being monitored, while there is no road map to ensure the actions needed happen in a timely way. Achieving such a goal would have required a two-pronged approach: action to pick the low-hanging fruit—better support and joined-up health services for older people—alongside a prompt start on the long-term actions which can prevent many age-related diseases through lifelong strategies.
I repeat my noble friend Lady Sheehan’s question: has the grand challenge mission been ditched, diluted or incorporated into something else? Prevention of age-related illness is not just a matter of information and education about how to live a healthy life. Many people know exactly what they should be doing yet lack the resources to do it, such as enough income to buy healthy food and keep their home warm. But it also requires government to look at the lived environment and pressures under which people live. Examples of these are tackling our polluted air, which causes 40,000 extra deaths every year, enough income to keep the home warm and dry and the availability of nutritious food near to where people live, rather than high streets full of cheap fast-food takeaways.
The Institute of Health Equity recently reviewed the Marmot report 10 years on, and it emphasises that health and life expectancy follow the social gradient. It is abundantly clear that the challenges are worst in certain groups, so interventions to prevent the diseases of old age should be prioritised in the poorest groups if levelling up is to mean anything at all across all constituencies, not just the former red wall.
When all is said and done, what became obvious to me was that we should not start action on healthy old age when we are old; we should start when we are children. That would help us all and protect the NHS. The noble Baroness, Lady Young of Old Scone, commented on that, and I very much agree. The widening gap between rich and poor among older people living with multimorbidities says it all. Clearly, although we can mitigate the ill effects of an unhealthy old age with all the technical solutions we have recommended, such as research into the diseases of old age, repurposed drugs, technological aids, co-ordinated medical treatment and oversight—I recommend the sort of electric hob that turns itself off when you remove the pan, which is much safer for old people—in the end and over the longer timescale, it is the socio-economic factors that will have the greatest effect in giving us all more years of health at the end of life. I look forward to the Minister’s reply.
Baroness Thornton (Lab)
I do not think you need to be old. I have one of those magic hobs myself.
Almost every noble Lord here today can declare an interest in this debate, because we all—possibly excepting the Minister, who is quite a youngster in this Room—have a direct, personal interest in the recommendations and actions arising from this important report, presented by the noble Lord, Lord Patel. I join in the congratulations and applause directed at the noble Lord, who chaired this investigation, and his committee, many members of which have spoken today. They must have worked hard, in unusual and challenging circumstances, to produce this excellent report. I add my congratulations to all noble Lords who have spoken in the debate, and thank the Library and many other organisations for the briefing provided.
The challenge, of course, is what happens next; it always is. It is ensuring that change and progress results from the committee’s labours and deliberation. The Minister’s job today is of course to convince us that these many excellent recommendations will not be consigned to the long grass or worse, because of the blandness—in the word of the noble Lord, Lord Crisp—of the Government’s response.
I was impressed by two things about this report in particular: first, that it linked the socioeconomic factors with the scientific ones; and, secondly, that its clear recommendations provide a pathway—a route map, as the noble Baroness just mentioned—which, if followed and implemented, would lead to significant improvement in the lives of many of our fellow ageing citizens. Although there is not much to celebrate about the ongoing pandemic, the timeliness of the committee’s deliberations meant, as the noble Lord, Lord Patel, said in his opening remarks, that it became clear that the old, those suffering from multiple morbidities and the socially deprived would pay the highest penalty as a result of Covid-19, compared with the young and healthy.
This links to the Government recognising in November 2017 that ageing was one of the great challenges of their industrial strategy; in 2018, they announced the ageing society grand challenge. Indeed, the NHS’s long-term plan accepts that the NHS has a key role to play in ensuring that the extra years of life are spent in good health, while research into the effects of Covid on older people’s lives recognises, as do organisations such as Age UK, that we have a major challenge. Now, we have the Government’s commitment to levelling up, which of course includes looking at the inequalities in our ageing population and the huge differences in life expectancy in different and sometimes neighbouring communities, to which many noble Lords referred.
A combination of all those things suggests, therefore, that this report and its recommendations provide the Minister and his colleagues with a huge and important agenda. Many noble Lords have made those links; this report does the same. My noble friends Lord Browne and Lord Hanworth, and the noble Baroness, Lady Watkins, all addressed this issue.
The Government have said that addressing health inequalities will be at the core of their levelling-up agenda, and the Prime Minister has acknowledged that healthy life expectancy needs to improve. However, as yet, there is no sign of meaningful action or investment to make this a reality. The current plans appear partial and fragmented, while many deprived areas where people are likely to have the poorest health have not yet been identified as priorities for investment. I suspect that my noble friend Lord Davies could give the Government a hint or two on the methodologies that they might use.
In her excellent book, The Age of Ageing Better? A Manifesto for our Future, Dr Anna Dixon says:
“Few of us think of ourselves as old, whether we’re 60, 70 or 80.”
We are privileged here because age discrimination does not really feature in your Lordships’ House. When we hear of an ageing society, we are not experiencing care homes full of people staring at a TV screen. We are generally not bed-blockers, nor do we generally suffer from the loneliness described by this report. In fact, we think of our fellow Peers with value. We think of them bringing wisdom, enlightenment, humour and commitment to the work that we undertake in this place, even at some very great ages.
Yet we are all ageing, of course. It is a natural biological process. I think about my own background: my aunts and uncles come from a working-class family in Yorkshire, where the heavy load of working in the building trade and factors such as diet, smoking, drinking and pollution weigh heavily. All of my mother’s 10 siblings died before the average age you would have expected them to live to, and all of them died of heart disease, stroke or lung cancer. Among my contemporaries from school in Yorkshire, I am the only one who still has a full-time job; they have all retired, apart from one farmer. I intend to keep working full-time as I contemplate the future. We need to celebrate the long-term lives that we experience.
People in England can now expect to live far longer than ever before, but these extra years of life are not always spent in good health, as described in this excellent report, with people developing conditions that reduce their independence and quality of life, as my noble friend Lady Young said. I read with great interest the science bits of this report, and I particularly enjoyed the briefing I received from the British Society for Immunology about the report itself. It is worth looking at that brief, which states:
“It is well established that the immune system changes as we get older. The balance between immune activation, regulation and resolution can be altered as we age, resulting in inadequate protection against infection, along with a greater risk of inflammatory disease. As with many aspects of the human body, there is no one ‘cut off’ point for this to occur but instead it is a gradual process.”
However, the Covid-19 pandemic highlighted the relationship between ageing and the progression of our immune systems as a part of our natural life. My noble friend Lord Winston talked about the complexity of ageing. I wish him well with the challenge that he is facing.
I particularly liked recommendation 7:
“We recommend that UK Research and Innovation commit to funding further research into the biological processes underlying ageing as a priority, in particular to address gaps in understanding the relevance of ageing hallmarks to humans. Research to identify accurate biomarkers of ageing in humans should also be prioritised, to support studies to improve health span.”
This is the recommendation that the British Society for Immunology focused on. It makes the point, which other noble Lords have made, that the scientific understanding of the way in which many drugs interact with the immune system in older people is lacking, often because of a dearth of this age demographic in clinical trials. I found the Government’s response to that recommendation particularly weedy. They need to think about the teeth that the MHRA and other bodies need to ensure that clinical trials have the right demographics.
There are 20-odd recommendations in this report and that is the one that I have chosen to highlight, but the Government have to implement a concerted and co-ordinated set of national policy responses to support healthy ageing. That has to include regulatory and fiscal measures encouraging people to adopt healthy lifestyles. The Government have to have a plan. The response that we have had so far is not a plan. There needs to be a plan and a timetable. As the noble Lord, Lord Crisp, said, the Government need to show how serious they are about this matter.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)
My Lords, this has been an excellent and fascinating debate. I thank the noble Lord, Lord Patel, for his chairmanship of the Science and Technology Committee. I have heard the challenges that he faced. I also thank those noble Lords who sit on the committee and all those who contributed to the report. It was in-depth and covered a range of issues, in the fine tradition of reports from the House of Lords. I remember that when I was a Member of the European Parliament a number of reports from this place were read there. The expertise available here was widely acknowledged.
The report covered a number of issues: the trends and challenges, the science of ageing, lifestyle and environmental factors on ageing, the better use of technology and digital services, and the ageing society grand challenge mission. I will come back to those in more detail.
I also thank all those noble Lords who have spoken today for their knowledgeable and insightful contributions, particularly building on their expertise. I have admired many of them from afar for many years. It is a real privilege to be here in the same debate as them.
Promoting good health, enabling people to live long and healthy lives, and improving the health of the whole population are all something we want, but they are also fundamental aims of this Government. We can do this most effectively by harnessing the incredible opportunities provided through innovation, science and technology, as the noble Baroness, Lady Greengross, and other noble Lords mentioned.
Before I respond to the specific points made today, I will return to one of the points that noble Lords rightfully acknowledged: the impact of the Covid-19 pandemic and the subsequent lockdowns on life expectancy. A number of noble Lords quoted the Office for National Statistics, as well as some interesting pages and websites that we could read to learn more about this. They also highlighted that life expectancy at birth in the UK between 2018 and 2020 was 79 years for men and 82.9 years for women, but this saw a decrease of seven weeks for men with almost no change for women compared with 2015-17. However, the committee report mentions that there has been a decrease for females over the past decade.
One of the Government’s current priorities is to clear the backlog resulting from the pandemic. This report rightly acknowledges the devastating impact of the Covid-19 pandemic and its response on people’s lives in this country, but also how the pandemic has exposed existing health inequalities, which the Government will tackle as part of our levelling-up agenda—as many noble Lords have referred to today.
The Office for Health Improvement and Disparities has been tasked with helping more people to live longer lives in good health and reducing health disparities by breaking the link between someone’s background and their chance of living a healthy long life. As noble Lords are aware—indeed, some have mentioned this—while people are living longer, many suffer poor health towards the end of their lives. A notable statistic is that people in the least deprived areas live in good health for almost two decades longer than those in the most deprived areas. The noble Lord, Lord Patel, and others referred to this statistic.
The Medical Research Council is leading a cross-government programme of research to understand the ageing process better and promote health in later life, but also on how to motivate healthier lifestyles to improve healthy life expectancy. Like many noble Lords, I want to see the MRC rely more on evidence-based research to ensure that targeted interventions work and avoid unintended consequences.
Many noble Lords have shown an interest in the ageing society grand challenge mission for additional healthy, independent years of life while narrowing the gap. The noble Baronesses, Lady Young and Lady Greengross, mentioned this challenge in particular; I assure noble Lords that the Government remain committed to it. One of the most effective ways to increase life expectancy and healthy life expectancy is to prevent people getting ill in the first place. The report rightly lists risk factors, including the impact of smoking and excessive alcohol consumption. The noble Viscount, Lord Hanworth, pointed to the impact of alcohol, when interventions are often focused on other substances, such as tobacco. From looking at the statistics, alcohol not only leads to cirrhosis of the liver but is often responsible for other deaths—drownings, murders, et cetera—so it is important to look at the wider impact of alcohol consumption. We should also look at poor diets, nutrition, obesity, physical inactivity and the environmental factors that affect physical, cognitive and mental health as humans age.
The Office for Health Improvement and Disparities will drive this cross-government effort to reduce ill health. As many noble Lords know, part of the title of this office is about health disparities. It will continue to publish the productive healthy ageing profile, which provides data at national, regional and local levels on a range of indicators, including healthy life expectancy, health behaviours, NHS health checks, employment and housing.
As the Minister for Technology, Innovation and Life Sciences, I am hugely excited by the role that all three will play in our economic recovery from the pandemic, as well as in our long-term prosperity and in improving the health of the nation. The Government’s new innovation strategy, announced in July, sets out our vision to make the UK a global hub for innovation by 2035, not only in digital technology but in the exciting area of life sciences.
The Government’s commitment to innovation also applies to social care. In the September announcement on social care reform, the Government were clear that innovation would play an important part. Therefore, we continue to work with care users, providers and other partners to codevelop the reform plans, and will publish further detail in the forthcoming White Paper.
GPs’ surgeries are the first point of contact for many patients. The pandemic rapidly changed how services are provided, moving to telephone and online to complement face-to-face appointments where necessary. We continue to look at ways to improve the experience, as many noble Lords will remember from the discussion yesterday when face-to-face appointments were raised. The Government are clear that you have to leave it between the patient and clinician but, when a patient requests a face-to-face appointment, there has to be a good medical reason for the clinician to turn it down.
Many noble Lords alluded to technology. I will continue to work with NHSX and NHS Digital to drive digitisation and the sharing of appropriate data across our system of healthcare, from GP practices to hospitals, and to the social care sector to complement the proposed reforms in the Health and Care Bill. The noble Lord, Lord Desai, mentioned the issue of data sharing and making sure it is all there, but there are some challenges, as I am sure the noble Lord will acknowledge. Many civil liberties organisations have expressed concerns, and I have been in contact with a few to pledge that I will discuss how we can make sure that data is safe, and appropriate data is digitised and shared in the most appropriate way, so that patients have trust. We are looking at the development of things such as trusted research environments to make sure that patients are reassured.
I will work across government with the Office for Life Sciences, BEIS, the Department for International Trade and No. 10 to make the UK a location of choice and hub for life sciences, not only in the Cambridge-Oxford-London golden triangle but across the UK as part of the levelling-up agenda.
I will try to address some of the specific points made by noble Lords. The noble Lord, Lord Patel, asked a number of specific questions and I will try to respond to some of them. The noble Baroness, Lady Manningham-Buller, talked about overprescribing. There was an overprescribing review published on 22 September, and I thank Dr Ridge and all those who participated for their diligent work, which produced such a thought-provoking document. It sets out a series of practical and cultural changes, including the better use of technology. I hope that this report will be a call to action for everyone, whether a patient, clinician or healthcare leader, to think about what we can do to take forward this vital agenda.
The Government remain committed to extending healthy life expectancy by five years and I repeat that pledge. To deliver on this commitment we will work with the Office for Health Improvement and Disparities, as I have mentioned previously. The office—I will use its acronym OHID, as I know many in healthcare like their acronyms—will set out its future plans for extending healthy life expectancy, including how these plans will be delivered and, crucially, monitored in due course. In addition, the new health promotion taskforce will drive and support the whole of government to go further in improving health and reducing disparities to tackle many of the factors that are critical to good physical and mental health.
The Government are strongly committed to supporting research into dementia, which a number of noble Lords referred to. UK researchers are at the forefront of global efforts to find a cure or disease-modifying treatment by 2025. Sadly, the response to the prevention Green Paper has been delayed by the need to focus on the pandemic response, but we will bring forward a response to the consultation in due course.
Many noble Lords asked about the levelling-up White Paper, which will be published later this year. It will set out policy interventions to improve livelihoods and opportunity in all parts of the UK, especially to improve health outcomes and reduce the gap in healthy life expectancy. Given the very technical nature of some of the remarks made by the noble Lord, Lord Patel, on the biology of ageing, I hope he will not mind if I respond to these points in writing.
A number of noble Lords raised the issue of technology, including the noble Baroness, Lady Young, and the noble Lord, Lord Mair. Once again, the issue of data sharing came up. We welcome the report’s recognition of the role that technology can play and it is really important to drive this. Part of it is data sharing, and part is making sure that the different parts of our system of healthcare work together and that we can learn from best international practice.
Before I entered this House, I used to do a lot of work analysing technology. One of the things I looked at is how the Japanese decided to respond to the changing demographics of their country. Some countries respond by immigration, but others do not want to respond like that and Japan is one of those that is very sceptical of immigration. Therefore, it is focusing on technology and how to improve the lives of people getting older, whether through some of the technologies that other noble Lords mentioned, such as touch-sensitive items and data communicating with clinicians, or through robots and extraskeletal equipment to allow older people to live a more meaningful life.
The NHS is also supporting many people to stay at home for their healthcare with digital tools and remote monitoring, partly helped by the fact that more and more of the population are buying mobile phones, Fitbits and various digital devices, and are able to provide that data. Once again, we have to be very careful and make sure that the public is onside as that data is shared.
The noble Lord, Lord Mair, also talked about AI and robots. The Government are taking action in this area. In August 2019, the Prime Minister announced a £250 million-boost to AI in the healthcare sector. I have been in very interesting conversations with the NHS AI Skunkworks. It is fascinating to see some of the technology that has been looked at there.
A number of noble Lords also mentioned how we make sure that an ageing population is digitally aware. I worked with a number of local civil society projects in a previous life. One of the interesting projects was where we got younger people to come in and teach older people to use technology. Not only did it give a more meaningful life in many ways to the older people learning technology but it was interesting that quite often some of the young people were from deprived backgrounds—sometimes single-parent families—and they were able to connect with the older person they were teaching. In many cases they found a new mentor or a new role model in their life. It was one of those interventions that helped the elderly people and some of the young people from broken families. We have to look in a more joined-up way at how we can make sure that we help more people that way.
The noble Lords, Lord Mair and Lord Sikka, also talked about the internet. There is something about the essential digital certificates that are being funded for digital entitlement and based on new standards. The Government and Ofcom have agreed a set of commitments with the UK’s major broadband and mobile operators to support vulnerable consumers, not only during the pandemic but as we go forward to make sure there is no real digital divide.
The noble Baroness, Lady Young, and the noble Lord, Lord Browne, spoke about inequalities, as did the noble Viscount, Lord Hanworth, the noble Lord, Lord Davies, and my noble friend Lord Balfe. The Office for Health Improvement and Disparities has said that it is time to shift the centre of gravity for the department and the health system from treating disease to building good health. As many noble Lords have said, we should start this at a young age as effectively as possible.
One of the issues that my noble friend Lord Ridley mentioned is that it is all very well having these health education programmes at a young age, but will people listen then? When I was at school we had programmes about smoking, alcohol and other things. I remember my friends saying that they were never going to drink or smoke, but a couple of years later we were all out partying. When is public education effective? Do you just assume it is at childhood and not again? How do we make sure that it continues throughout one’s life? That is why it is important that public health messages are built on evidence and communicated in a way that appeals to those we are trying to reach.
The noble Baroness, Lady Young, also spoke on various other things about public health. I assure her that regional directors of public health will sit within the Office for Health Improvement and Disparities and will join up at the national and local level.
The noble Baroness, Lady Young, and the noble Lord, Lord Davies, spoke about levelling up. The White Paper will look at how we set out bold policy interventions to tackle a number of different inequalities. As many noble Lords will know, there are multidimensional inequalities and many ways of people identifying, if you like.
A number of noble Lords also spoke about obesity. Many noble Lords will be aware that we published our current obesity strategy in July 2020. This sets out an overarching campaign to reduce obesity by taking forward actions from previous chapters of the childhood obesity plan and setting out measures to get the nation fit and healthy.
This will involve a number of interventions; some of them have been controversial. Some, such as the restrictions on advertising of food high in fat, sugar and salt, both on TV and online, will be progressed as part of the Health and Care Bill. We should be aware of the controversy around some of this and make sure that, when we make these interventions, they are based on evidence, and we are able to review the evidence and bring it back to show what difference it has actually made, rather than just make the intervention, hope for the best and feel good that we have made it. Evidence-based research is very important as we make these interventions.
The noble Baroness, Lady Sheehan, mentioned ethnic-minority inequality, and the Better Health campaign that the Government launched will look at how we focus on those most at risk, including those from specific ethnic-minority communities, those living with long-term health conditions and people over the age of 40 from lower socioeconomic groups, looking at particularly targeted interventions for each of those different minority groups. On long Covid, which she also mentioned, OHID will be looking at a range of factors that impact life expectancy as we look to reduce health inequalities, and that includes some of the issues on long Covid.
A number of noble Lords talked about dementia, and we have been implementing the 2020 challenge on dementia, published in February 2015, to make sure that dementia care, support and awareness of research are transformed. We will be setting out our plans for dementia for England for future years in due course. The noble Baronesses, Lady Young and Lady Greenfield, mentioned dementia research and statistics, and I commit to write to them with more details on the questions they asked, given the time.
I already mentioned that the noble Viscount, Lord Ridley, talked about some of his scepticism of the public health agenda, and I mentioned my experience and that of many friends, but one issue that he mentioned was diagnosis. The work of Genomics England is interesting. As it goes forward, it will be able to identify potential diseases that individuals will face in their life. This is not as easy as it sounds, because it also raises a number of ethical issues. At what point do you notify people that they will suffer from particular diseases? Do you intervene early, or do you wait until a particular age? A number of these issues are incredibly difficult, but we will try to get the right balance.
We talked about research and funding, and the National Institute for Health Research is welcoming funding applications for research in a number of different areas, including those who want to look at the issue of healthy ageing. I hope I have talked in detail about the data strategy, but it will be important that we get there.
I apologise to noble Lords for not being able to cover all the points raised. To finish, I say just that it is an insightful and wide-ranging report, and that the Government remained committed to ensuring that as many people as possible enjoy a long and healthy life, whoever they are, wherever they live and whatever their background.
Lord Patel (CB)
My Lords, I will not keep you longer than half an hour. I am joking, of course. First, I thank the Minister very much for his response. I teased him to start with not to read his brief, but to try to answer the questions and, I have to admit, he attempted to answer the questions raised by all noble Lords. On those that he was unable to answer, he promised to write, and I thank him for that.
He confirmed that the grand challenge of adding five years to healthy life expectancy by 2035 is still government policy, but did not say who is in charge, who will monitor and who is going to report on progress to Parliament. At least this gives the Science and Technology Committee the opportunity, in a couple of years maybe, to review it and see what progress we have made, so he has been warned. He had better be on your guard, as we or some people might come back to him.
He answered the questions, but there was still a lot of “in due course”, so we will look forward to the reports that we will receive in due course. I wrote down at least five that he mentioned and I particularly look forward to the levelling-up White Paper, which is coming, because a lot of issues about inequalities need to be addressed. Once the NHS Office for Health Improvement and Disparities is established—it uses the word “disparities”—I hope to see a plan of how it will go about its task of reducing disparities.
I thank all noble Lords who took part today. All the speeches were excellent. I thank all my colleagues on the committee, because the attendance of Members, past and present, was spectacular, as were their speeches. I was also impressed by others, who were not part of the committee and by their backgrounds—economists, engineers, neuroscientists, those with decades of experience of the ageing process, nurses, accountants and an actuary. You suddenly start measuring your life’s limits. I did not declare an interest, as other noble Lords did, about their age or illnesses. I am 16, going on 83, and I intend to be 17 sometime. I thank noble Lords and beg to move.