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

Baroness Walmsley Excerpts

Wednesday 20th October 2021 Grand Committee

[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.