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

Baroness Manningham-Buller Excerpts

Wednesday 20th October 2021 Grand Committee

[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.