COVID-19: Type 2 Diabetes

Lord Patel Excerpts

Thursday 21st October 2021 Lords Chamber

[Lord Kamall (Con)]

I thank my noble friend for that question and recognise the work she did with the Centre for Social Justice on this issue. The Government are keen to drive the NHS diabetes prevention programme, which plays a pivotal role in supporting those at risk of developing diabetes. During 2018-19, over 100,000 people took up the programme. In 2019-20, NHS England delivered the long-term-plan target, supporting around 120,000 people on the programme.

[Lord Patel (CB)]

My Lords, does the Minister agree that all those over the age of 40 who are obese, and those who record a high score on the diabetes type 2 assessment, should be offered a blood glucose and haemoglobin A1c test? If he does not agree, can he say why?

[Lord Kamall (Con)]

The Government, in conjunction with the Department of Health and Social Care and many other partners, including Diabetes UK, are looking at the most effective way to tackle diabetes but also to understand the trade-offs that must be made and the balance of considerations. I will write to the noble Lord on the detail of his question.

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

Lord Patel Excerpts

Wednesday 20th October 2021 Grand Committee

Moved by

[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.

--- Later in debate ---

[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.

Motion agreed.

Animal Diseases: Future Pandemics

Lord Patel Excerpts

Wednesday 21st July 2021 Lords Chamber

[Lord Bethell (Con) [V]]

My Lords, my noble friend puts it extremely well. It is exactly that kind of intervention at the front line that can nip infections in the bud, but it is only through international collaboration that we can really tackle the threat of zoonotic infection. The concept of zoonotic tech is not one that I had previously come across, but I will take it away from this debate and have a good look at what more we could do to support it.

[Lord Patel (CB) [V]]

My Lords, one of the key “one health” projects initiated by government has been the target of reducing the prophylactic use of antibiotics in farm animals to help reduce the incidence of antibiotic resistance, thereby helping to treat zoonotic diseases in humans. The Government set targets in 2017 on the use of antibiotics in animals over the next three years. What progress has there been? What other plans are going forward, as the 2017 project has now ended?

[Lord Bethell (Con) [V]]

The noble Lord identifies the threat extremely well indeed. The Department of Health works extremely closely with Defra on this exact point. I pay tribute to both the farming community here in the UK and officials at Defra for their work to encourage farmers to stand back from prophylactic use of antibiotics.

Covid-19: Wuhan Institute of Virology

Lord Patel Excerpts

Wednesday 30th June 2021 Lords Chamber

[Lord Patel (CB) [V]]

My Lords, does the Minister agree that for a better understanding of the current pandemic and future pandemics, identification of the progenitor genome of SARS-CoV-2 is important? We need more data, despite having sequenced more than 1 million SARS-CoV-2 genomes. The escape of pathogens from labs is not new. Examples are smallpox and anthrax, and also SARS, which escaped from several labs in different countries in 2003. Does the Minister agree that we urgently need to address global regulation of labs that undertake gain of function experiments on pathogens?

[Lord Bethell (Con)]

My Lords, I agree with the noble Lord’s appeal for more data—but, candidly, as I know he knows, it is not just quantity of data that we need; it is the right data. Where we are struggling is in getting genomic sequencing of new mutations from the furthest reaches of the virus’s spread. We need a systematic programme around the world that shares the sequences of new mutations with academics who can study and assess them. Without such a systematic programme we are flying blind. That is why we are working on the new variant assessment platform and other pandemic preparedness projects.

Covid-19 Update

Lord Patel Excerpts

Tuesday 29th June 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, the question of prioritisation is one for the Joint Committee on Vaccination and Immunisation. In terms of operational delivery, we have moved to a moment of opening up jabs to all those over 18, and many places do not even require an appointment. Between now and 19 July we are escalating the speed at which we deliver the jab. I encourage all ages to step forward for their first jabs, and those who have an appointment for the second to ensure that they make use of it.

[Lord Patel (CB) [V]]

My Lords, some of the vaccines used in the United Kingdom have been found to be less effective against the beta variant currently spreading in South Africa. What assessment have the Government made of the risk of travellers from South Africa bringing the beta variant to the United Kingdom following the rugby tournament that is taking place there?

[Lord Bethell (Con)]

As ever, the noble Lord is extremely perceptive in his questions, and he is right that as we vaccinate more and more of the population, the risk will become less from highly transmissible mutants and more from those which can somehow escape the vaccine. The South African variant is the one that so far has demonstrated the greatest escapology. For that reason, we are extremely cautious about visitors who may come from areas that have the South Africa variant, including South Africa itself.

Covid-19: Poverty

Lord Patel Excerpts

Thursday 27th May 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, it is a difficult fact that males working in low-skilled elementary occupations, such as security guards, had rates of death more than three times higher than the general population. That illustrates that often those in the most difficult jobs face the greatest threat of infection. The best thing we can do for the economy is to get rid of this virus, for which we need vaccination and testing, and that is the Government’s focus.

[Lord Patel (CB) [V]]

My Lords, following the effects of Covid-19, restoring the nation to good health will require a new social compact, backed by a national cross-departmental health inequality strategy. I am pleased to hear the Minister say that the reduction of health inequality will be in the health Bill, but could he confirm that the legislation will include commitments from other departments and the Government?

[Lord Bethell (Con)]

My Lords, we have provisions for tackling obesity in the health and social care Bill, as the noble Lord knows, but the focus of the cross-ministerial board on health will be to bring together government efforts on not just obesity, but health inequality in the round. The board’s remit has not yet been published, nor has its membership or chairmanship, but I reassure noble Lords that that is coming reasonably soon.

Osimertinib Cancer Treatment

Lord Patel Excerpts

Tuesday 18th May 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I am not aware of a Strepsil shortage in Northern Ireland but I would be glad to write to the noble Baroness if I have any information.

[Lord Patel (CB) [V]]

My Lords, can the Minister confirm that the Northern Ireland protocol runs the risk of medicines not being available, that there will be divergence in the availability of medicines—and, importantly, medical devices—because the approval process might be different, and that the Government are due to report in six months on the effect of that divergence?

[Lord Bethell (Con)]

My Lords, we are watchful of the concerns to which the noble Lord refers but it is our hope and aspiration that there will not be the kind of delays or trouble that he explained. The Northern Ireland protocol means that Northern Ireland will stay aligned with EU rules, particularly for this kind of specific cancer medicine, but that does not mean that there need to be any delays. However, we are watching the situation carefully and the report that he described will give a full account of the problems, if there are any.

Covid-19: Resuscitation Orders

Lord Patel Excerpts

Wednesday 24th March 2021 Lords Chamber

[Lord Bethell (Con)]

I reassure the noble Baroness that there has been a huge amount of stakeholder engagement, with Mencap, Turning Point and others. It is not the role of the CQC to do individual family reviews, but I can reassure her that we have learned important lessons from this process.

[Lord Patel (CB) [V]]

Does the Minister agree that the ministerial oversight committee should also consider looking at end-of-life care?

[Lord Bethell (Con)]

My Lords, yes, I do.

NHS: Staff Numbers after Covid-19

Lord Patel Excerpts

Thursday 4th March 2021 Grand Committee

[Lord Patel (CB) [V]]

My Lords, I recognise that the Government want to address the issue of the NHS clinical workforce. The problem is not the ambition, but in having a clear long-term strategy to achieve this. Does the Minister agree that previous attempts have failed? The intensity and stressful nature of the work related to Covid and other factors, such as the recently announced pension cap, may make retaining staff difficult?

Recent surveys by the Royal College of Nursing, the Royal College of Physicians, the British Medical Association and many others have shown a very high proportion of the workforce are unhappy about their work, with low morale and mental health issues particularly related to Covid. With advances in care, NHS England is likely to require a growth in workforce of 3.2% per year over the next 15 years. That is nearly 650,000 full-time equivalent staff over the next decade. There are also issues about managing the workforce. I hope that through the new NHS Bill we can explore a long-term solution through legislation. Maybe the Minister would welcome that.

Covid-19: Brazilian Variant

Lord Patel Excerpts

Tuesday 2nd March 2021 Lords Chamber

[Lord Bethell (Con)]

The vaccine is absolutely central to our strategy. It is an approach that has proved enormously popular, and I think I speak for a large number of people when I say that defending the vaccine has to be our number one priority. If there were a highly transmissible vaccine-escaping mutation, it would take us back to the beginning of this whole pandemic. That is why we have put in place red list countries and managed quarantine. That is why we are committed to Operation Eagle and the efforts to track down those bringing variants of concern into this country.

[Lord Patel (CB) [V]]

My Lords, the scientists are concerned about the P1 Brazilian variant because of three mutations, one of which is common to other variants, making it more transmissible. One of the others is referred to as the “escape mutation”, which may bypass some vaccine-induced immunity. Does the Minister agree that, apart from the measures the Government are taking of trace, track and isolate and surge testing—which I thoroughly approve of—it is important to continue genomic sequencing, at scale, of Covid cases to detect variants that may arise and to monitor and study post-vaccine immune response? That would enable us to modify the vaccines to boost the immune response and deal with the variants.

[Lord Bethell (Con)]

The noble Lord is entirely right. Our commitment to genomic sequencing, which has lasted for years, has put Britain in great shape to be able to do the sequencing necessary to track these variants. We are doing more sequencing than any other country. But as the noble Lord knows, this is detective work, and it is extremely complex. While the 484K mutation might be the significant change in both the Brazil and South African variants, it might be one of a great many other mutations in its genomic characteristics. This is the detective work we are doing. I am afraid that it will take some time to get to the bottom of it, and it needs to be complemented by field studies into how the mutation reacts in real life, as well as with antibodies. The combination of immunology, virology, biology and real-world clinical study will give us the insight that we need.