Ageing: Science, Technology and Healthy Living (Science and Technology Committee Report)

Lord Desai Excerpts

Wednesday 20th October 2021 Grand Committee

[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.