Queen’s Speech

Lord Rees of Ludlow Excerpts

Thursday 9th January 2020 Lords Chamber

[Lord Rees of Ludlow (CB)]

My Lords, the Government’s rhetoric indicates a welcome willingness to contemplate radical initiatives in research and education. That is especially crucial if we are to confront the energy challenge. The Climate Change Act’s 2050 target is indeed daunting. We need not just to decarbonise existing levels of electricity production, but to treble production, to energise electrically powered transport and heating and for electrolytic production of hydrogen and hydrocarbons needed for long-distance aviation. We need innovation to get and store energy more efficiently from sun, wind and tides, and, given our traditional expertise in nuclear energy, to investigate fourth-generation concepts, such as small modular reactors, which could prove cheaper, more flexible and safer than existing nuclear reactors. The potential pay-off from fusion in the long term is so great that it is worth developing prototypes.

Climate change is potentially a threat to national security, so combating it deserves the scale of sustained effort that we commit to our national defences. This require large-scale, long-term, mission-driven efforts in institutions like those that we have for defence R&D. In the United States, two successive Energy Secretaries, both, amazingly, world-class physicists, advocated establishing new national laboratories to spearhead energy innovation, along the lines of Los Alamos. That is what we need here: institutions, with long-term missions, devoted to a national goal, crucial amplifiers of product-driven research in industry and journal-driven research in universities. For decades we have had the Culham laboratory for fusion research. The newly funded Faraday centre for battery development is welcome, but it should be the nucleus of a broader and larger venture to address other energy technologies, especially those where it is realistic for the UK to achieve a lead—and for computational modelling, too.

Real breakthroughs are needed in energy generation, storage and smart grids to meet the 2050 targets, but there is a stronger motivation. We produce only 1% of global CO₂ emissions—itself not crucial—but we produce more than 10% of the world’s high-impact research. If a scaled-up and wisely prioritised programme led to cheaper carbon-free generation, India and other vast developing markets could leapfrog directly to clean energy rather than building coal-fired power stations. Our efforts could thereby make far more than a 1% difference to the world, and to our national economic benefit. It would be hard to conceive of a more inspiring challenge for young scientists and engineers or a better investment in the UK’s future than devising clean and economical energy systems for the world. Likewise, incidentally, we can contribute disproportionately to another global challenge, sustainable food production, if we expand and deploy our world-leading expertise in genetics and plant science.

This leads to my final point. Our idealistic younger generation need the requisite expertise, which is why it is good that the Government have responded to the Auger report’s recommendations about 16 to 19 year-olds’ further education. That report suggested reforms of higher education as well. To promote lifelong learning, it recommended that everyone should be entitled to three years’ support, to be taken at any stage. This would encourage flexibility and would mean, for instance, that those who leave university for any reason after two years are not tainted as wastage, but can get some certificate of credit and an entitlement to return and upgrade later in life. In his previous role, the Minister supported such reforms, so will the Government implement that part of the Augar report?

A key mantra for this country should be, “If we don’t get smarter, we’ll get poorer.” With bold reforms to our education, and our innovative approach to R&D, we could aspire to contribute far more than our pro-rata share to solving global challenges and enhance our economy as well.

End of Life Care

Lord Rees of Ludlow Excerpts

Tuesday 14th March 2017 Lords Chamber

[Lord Rees of Ludlow (CB)]

My Lords, I add my thanks to the noble Baroness, Lady Finlay, for introducing this debate with such authority on an issue of inescapable relevance to us all.

We already have some options. We can ask not to be resuscitated if we have heart failure; we can decline invasive cancer treatment. We can legally formalise such wishes via an advance decision to refuse treatment, or via lasting powers of attorney. It is dismaying that only 4% of people who should take such measures have actually done so, and of course this has to be done before they lose the capacity to make choices for themselves.

A clear signalling of our wishes for end-of-life care will become even more important as medical science advances, creating, in consequence, a widening gulf between what could be achieved by extraordinary measures and the way in which most of us would prefer to end our days. This leads me to a parenthetic comment prompted by the short debate only last week on assisted dying. That debate focused on those who, even with the best palliative care, spend their last days in a predicament where they feel that life is no longer worth living.

I realise that this is viewed as a separate issue and that many people are deeply opposed to legalising assisted dying, but there will be an increasingly fuzzy boundary between assisted dying and the consequences of having signed a directive to refuse treatment. There will be cases when doctors will be prevented from acting even in cases when they feel confident that they could achieve genuine improvements in someone’s quality of life. The blurred distinction between killing and letting die is familiar to anyone who has had courses in philosophy and ethics.

Paragraph 13 of the end-of-life care review urges that,

“by the end of 2019, every local area should establish 24/7 end of life care for people being cared for outside hospital, in line with the NICE quality standard for end of life care, which supports people’s choices and preferences”.

The Government’s response, as far as its sentiments go, ticks all the right boxes. However, what causes anxiety is the gap between the aspirations and what can realistically be provided in a policy regime where austerity and the small state are the mantras, and where the demands are growing because more people are surviving to an advanced age with consequent more complex needs. What is surely uncontroversial is that far more resources should be deployed to care properly for those nearing their end, either in hospices or at home.

If we were in Japan, we would hear futurologists extolling the role that robots will play in caring for the old. Automatons can indeed help with household tasks and with mobility. As the noble Baroness, Lady Lane-Fox, has emphasised, digital technology is of crucial value. However, let us not kid ourselves that they are an acceptable substitute for genuine carers—real human beings, with empathy and time to talk with, and comfort, those who are dying. Robots may surpass humans in precision surgery and medical diagnostics, but they will never replace humans as carers. Even if a vulnerable person—say, with advanced dementia—is comforted by a machine or even a soft toy, their human dignity is being betrayed if that is all they have. We would be short-changing the old if we offered them just a mechanical simulacrum of sympathy.

Not only are there now too few jobs for carers, but these jobs are poorly paid, insecure and carry low status. This is surely a signal that we need a change in public attitudes, in the deployment of funds and in the labour market. We are told that workers in whole segments of the economy will be displaced by automation. Huge numbers of people, mainly themselves in middle age, may become less employable in traditional economic roles. However, many of them will have just the qualities needed to be excellent carers. That is why there needs to be a policy rethink, leading to innovative ways of funding in both the public and charitable sectors an expansion of upgraded, esteemed and secure employment for carers so that we can all feel confident, when our time comes, that we will have access to the support, both physical and spiritual, that is now available only to some.

Drug-Resistant Infections

Lord Rees of Ludlow Excerpts

Thursday 15th September 2016 Lords Chamber

[Lord Rees of Ludlow (CB)]

My Lords, this timely debate is a chance to congratulate the noble Lord, Lord O’Neill, on the excellent series of reports that he has produced. We should surely also use this opportunity to acclaim Dame Sally Davies, the Chief Medical Officer, who espoused this cause early on and has probably done more than anyone else to raise ABR issues on the political agenda, not just in the UK but worldwide.

Antibiotic resistance is growing so fast that 700,000 people already die each year from untreatable infections. The pathogens such as typhoid which once succumbed swiftly to penicillin and other antibiotics now fight back; they are becoming killers again. Just this year, doctors have noted the emergence of resistance to colistin, which is the last line of defence against some very resistant bacteria. There is real worry that within a decade, transplants and even orthopaedic operations will become hazardous because of the intractable risk of infection, so ABR is a global threat that hangs over us. The O’Neill report emphasised that by 2050, 10 million lives a year and a cumulative $100 trillion of economic output might be at risk due to the rise of drug-resistant infections, unless we can develop new drugs and make more prudent use of what we have.

My comments will focus on avoiding the overuse of drugs. I have zero expertise in medicine—my scientific field is space research and astronomy—but I have become a small-time crusader for the AMR cause, for reasons that I will explain by offering a bit of history from 300 years ago.

In the 18th century, the most pressing scientific challenge was measuring time and determining longitude at sea. In 1714, the Government set up what was in a sense the first scientific quango: the Board of Longitude. The board established the first challenge prize: a reward of £20,000, a huge sum in those days, for the first person to devise a way to determine longitude, with specified precision. Famously, it was John Harrison, a working-class Yorkshireman and an outsider, who triumphed with his marine chronometer, an extraordinary high-tech artefact of its era.

In the 300 years since, this initiative has been emulated by many challenge prizes. One, for instance, was the stimulus for Lindbergh’s transatlantic flight. More recently, the American government agency DARPA has sponsored competitions for driverless vehicles and for robots that can do complex tasks in hazardous environments. The California-based XPRIZE foundation promotes privately sponsored prizes. It aims to revitalise,

“markets that are currently stuck due to existing failures or a commonly held belief that a solution is not possible”.

As the current Astronomer Royal, I thought that the tercentenary of the Longitude Prize was worth celebrating with a national prize to address a contemporary challenge. Government support was forthcoming and allowed a reward of £10 million. Nesta, which has established expertise in this area, agreed to oversee the administration of the prize and has done a splendid job.

What should the challenge be? There is no manifest number one problem, as there was in the 18th century. A committee I chaired came up with a list of six possible challenges. All were presented on BBC TV and in the press, after which there was a public vote. The most popular choice was a project to tackle antimicrobial resistance.

A well-designed prize must meet several criteria. It should engage many contestants and, ideally, unleash investment amounting to far more than the prize itself. It must not require huge facilities accessible only to big battalions. Success must require genuine breakthroughs but be credibly achievable within five years. It should be configured, as was the original Longitude Prize, so that intermediate steps towards the target may get a reward. For an individual, a university group or a small company, the prize money is a significant incentive; if a big company wins, the publicity is more important. Either way, all have a motive to participate.

Of course, £10 million is a trivial sum compared to what is needed for developing new drugs, but there are bite-sized challenges relevant to AMR where it is an appropriate incentive. The target our expert advisers chose was to devise cheap, accurate, rapid and easy-to-use point-of-care kits to test for bacterial infections. These kits might be a strip of sensitised paper or a lab on a chip combined with a smartphone app, and they must be capable of being used anywhere in the world to identify the nature of someone’s infection. This would reduce the overuse or misuse of antibiotics and thereby help ensure that the antibiotics we have now will be effective for longer. The O’Neill report argued that currently, more than half of prescriptions for antibiotics may be unnecessary or inappropriate and that developing a globally available test will be part of the solution to keeping these drugs viable for another generation.

The prize has attracted more than 150 registrations and remains open for more. Entries are whittled down by an expert panel. Many were clearly not credible, and some entrants are encouraged to team up with others. Entries have come from many countries, but to be eligible they must involve a UK company or institution and carry out manufacturing and/or design of the winning solution in the UK, or lab test or showcase the winning solution in the UK.

This year, incidentally, the Americans launched a challenge prize with similar goals and a similar scale of jackpot, although with a US focus. That prize will concentrate on the 18 identified bugs that pose special health threats in the US, but it is being co-ordinated with ours. The American prize has set a maximum time of 90 minutes for its test to be used and to give results, which is appropriate for use in out-patient and in-patient settings, including pharmacies. The Longitude Prize has set the time limit at only 30 minutes, as we are looking for a test that will work in the field, in all health settings, including where antibiotics can be bought over the counter.

Those of us involved in these prizes welcome the fact that the O’Neill report highlights the importance of rapid diagnostics. We hope the Longitude Prize will help to speed up existing work in this area and generate some novel ideas. Moreover, a feature of prizes is that they can attract public interest. Nesta has been working hard on this in the UK, even developing a computer game based on the principles of antibiotic resistance to illustrate the science.

If overprescription of antibiotics were the only problem, it would be challenge enough. But of course, it is already much worse than that, because in the US, China and many other countries, as the noble Lord, Lord Lansley, indicated, antibiotics are being used for animals in a prophylactic context. I gather that the EU is banning this, and we hope that that will be followed.

Finally, it is worth noting that this challenge is clearly one that must be tackled globally. It therefore tends, rather like climate change in a way, to slip down the agenda compared to more parochial issues. It is also rather like climate change in that, although it is important now, it is going to be even worse in the future, so the benefits of action will accrue even more to the next generation than to us. For that reason, in order to ensure it does not slip down the agenda, the public need to keep up the pressure. The O’Neill report included a global awareness campaign as one of its priorities, and I echo the view expressed already by the noble Lord, Lord Lansley, that the forthcoming UN meetings will offer a boost to this cause.