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

Lord Kakkar Excerpts

Wednesday 20th October 2021 Grand Committee

[Lord Kakkar (CB)]

My Lords, I join other noble Lords in congratulating my noble friend Lord Patel on the remarkable, thoughtful and insightful way in which he chaired your Lordships’ Science and Technology Committee on this inquiry, on the preparation of the attendant report, and, of course, on the way he introduced this debate. In so doing, I declare my own interests, in particular those as chairman of the King’s Fund, of UK Biobank and of the Office for Strategic Coordination of Health Research.

Your Lordships’ Science and Technology Committee identified the profound consequences of an ageing society and demographic in terms of the impacts economically and on the delivery of health services, but also of the broader societal impact. In considering the implications of ageing, we must be clear at the heart of all consideration and the development of any policy that it is the responsibility of society and government to ensure that we continue to deliver support and care for an ageing population compassionately.

We also have to ask ourselves the question, “What is going wrong at the moment?”, particularly in the delivery of health services. The committee was able to receive important evidence in this regard. We heard that the delivery of services is not joined up; we still provide healthcare services in a very disjointed fashion. In so doing, we have a focus on single diseases and single conditions, rather than providing a service for an ageing population where there is capacity to consider multiple comorbidities at the same time and provide interventions that ensure that each of those is addressed meaningfully and in an integrated fashion, so that individuals can maximise the opportunity for improved outcomes and avoid the many deleterious consequences of ill-co-ordinated multipharmacy and multiple ill-co-ordinated interventions.

Her Majesty’s Government will shortly bring to your Lordships’ House the Health and Care Bill. In that Bill there will be the opportunity to look at the way services are delivered. Is it Her Majesty’s Government’s intention that this Bill will provide the opportunity to deliver and address with a potential legislative change the important recommendations in this report that plead for the more co-ordinated and joined-up delivery of care services for an ageing population?

We also received evidence of the remarkable basic science research effort established over recent years in the creation of a new specialty of biogerontology—basic scientists studying the processes of ageing at a molecular and cellular level. That scientific output has identified hallmarks that can be associated clearly at a cellular level with the ageing process, such as telomere attrition, mitochondrial dysfunction and stem cell exhaustion. All this fundamental research provides the opportunity both for novel targets in the establishment of biomarkers that can be used to address, identify and diagnose the ageing process clinically at a much earlier level, and, most importantly, for novel therapeutic targets that will become future interventions and the opportunity for us to target the multifactorial manifestations of the ageing process.

We also heard that the next stages in the development pathway in clinical research in particular are dysfunctional. The current way we regulate clinical trials is to provide regulation to achieve a single treatment for a single disease, rather than undertaking clinical research for the ageing process, which, by definition, affects multiple end organs. We also heard that elderly populations and those with multiple comorbidities are frequently excluded from clinical trials, so much of the evidence generated for potential therapeutic intervention is generated in populations who are not elderly, and we extrapolate from those populations to a highly complicated ageing population. That is why the interventions we offer frequently fail to have the impact we might anticipate or to provide the advantages that so much technology and innovation in healthcare and research could provide. It is essential that the insights, innovations and interventions we will provide to deal with the ageing process and diseases associated with ageing are derived in and from those specific populations, rather than extrapolation.

Her Majesty’s Government have suggested that they will use the opportunity availed by leaving the European Union to look at the clinical trials regulation. Do they intend to look at the regulation to ensure that we can address this major fault in conducting clinical research to address the ageing process, so that we can not only achieve important benefits for those individuals and citizens who will benefit from the research output but have the opportunity to provide for our country to lead in the clinical development of interventions and innovations to address the ageing process?

Finally, we were also able to look at the question more broadly of how the health service can help us to address this important societal and national challenge. One of the important questions is how we are able to mobilise and use data collected within the National Health Service and in many large cohort studies that Her Majesty’s Government and research charities have supported over many years and decades, in terms of generating data to identify novel biomarkers, to establish approaches to appropriate imaging, and to apply emerging techniques of data science to these large cohorts and datasets to help us identify novel biomarkers and accelerate and improve the clinical trials process.

This is a very real challenge and once again Her Majesty’s Government have identified the opportunity to look at the general data protection regulation. Will that opportunity be used to provide for a review that allows us to access and address health data in a responsible and meaningful fashion, of course with appropriate social licence, to ensure that we can drive forward innovation in this important area? It is with data and it will be with innovation that we are able to make a major contribution to the issues identified in your Lordships’ Science and Technology Committee report.