Science and Technology Committee inquiry
Ageing society: the grand challenge
In 2017, the Government identified the ageing society as one of the global trends that will transform the future. As part of the industrial strategy introduced under Theresa May, the Government set itself four ‘grand challenges’, one of which was to “harness the power of innovation to help meet the needs of an ageing society”. In 2018, the Government added a specific ‘mission’ to this grand challenge: to “ensure that people can enjoy at least five extra healthy, independent years of life by 2035, while narrowing the gap between the experience of the richest and poorest”.
The House of Lords Science and Technology Committee launched an inquiry into ageing in July 2019, looking at how science and technology could be used to increase health span, mitigate negative effects of ageing and support older people living with poor health. It aimed to assess the feasibility of the Government’s ageing society grand challenge mission, and to understand to what extent developments in science and technology would be important in reaching this goal. The committee published its report in January 2021.
Life expectancy and healthy life expectancy
The committee began its report by looking at recent trends. It found that life expectancy continues to rise, but since 2011 it has risen at a slower rate. According to figures from the Office for National Statistics (ONS), between 1980 and 2018, life expectancy at birth rose from 70.5 to 79.3 for males, and from 76.2 to 82.9 for females. By 2043, the ONS projects life expectancy for males at birth will increase by 3.3 years to 82.6, while female life expectancy is projected to increase by 2.6 years to 85.5.
The committee also looked at ‘healthy life expectancy’, which the ONS defines as an estimate of the number of years lived in ‘very good’ or ‘good’ general health, based on how individuals perceive their health. The committee found that healthy life expectancy is not keeping pace with increases in life expectancy, resulting in a growing period of poor health towards the end of life. For the period 2016–18, males in the UK had a healthy life expectancy at birth of 63.1 years; for females it was 63.6 years. Males would then on average live a further 16.2 years in poorer health, equating to 20.5% of their lifespan. Females could expect to live a further 19.4 years (23.3% of their lifespan) in poorer health. New ONS figures published since the committee report suggest that for births in the period 2017–19, years spent in poor health would equate to 20.7% of a man’s lifetime, and 23.8% of a woman’s. The ONS said that female healthy life expectancy at birth in 2017–19 was the lowest it has been since the time series began in 2009–11.
The committee noted that inequalities in healthy life expectancy are “stark”, with people in the least deprived groups living more than 18 years longer in good health than those in the most deprived groups. The latest ONS figures, published since the committee report, suggest the gap in healthy life expectancy at birth between the most and least deprived areas in England is 19.0 years for men (a slightly larger gap than in the 2016–18 figures used by the committee) and 19.3 years for females (a slightly smaller gap than in the previous figures).
Conclusions and recommendations
Overall, the committee concluded the Government was not on track to achieve the ageing society grand challenge mission to ensure five years of extra healthy life by 2035 while reducing inequalities. It found the Government did not appear to be monitoring progress towards the mission, and it was not clear who in Government was responsible for overseeing it. The committee concluded it was “hard to see how the target could be met without significant changes to the way it is managed”.
The committee also identified the “fragmentation of care” across the health and care system as a contributory factor in many cases to “even poorer health in older age”. It argued the health and care system is not designed to cope with treating people with multiple conditions (multimorbidity). This affects older people as they are increasingly likely to have more than one health condition.
The committee made more than 20 recommendations about better coordinating health services, deploying technology and services more widely to support independent living in old age, making more effective public health interventions, and ensuring the UK plays a leading role in developing new treatments. It summarised the key recommendations as follows:
- The Government, along with NHS England, Public Health England, and other agencies, must prioritise reducing health inequalities. In its response to this report we request that the Government sets out a plan for reducing health inequalities over the next parliament.
- All older patients should have a designated clinician. This clinician would have oversight of the patient’s care as a whole, and should coordinate activity across multidisciplinary teams, which should include members from across the health and social care sectors.
- UK Research and Innovation should commit to funding further research into the biological processes underlying ageing as a priority, in particular to address gaps in understanding the relevance of ageing hallmarks to humans. Research to identify accurate biomarkers of ageing in humans should also be prioritised, to support studies to improve health span.
- The Government should ensure the UK remains a global leader in drug research and development. It should work towards making the UK a more attractive environment for growth capital investment, to stop UK innovations moving abroad after the discovery stage of research.
- The Government should implement a concerted and coordinated set of national policies to support healthy ageing, including: regulatory and fiscal measures, actively to encourage people to adopt lifestyles that support healthy ageing; increasing the reach of the NHS Health Check to those in disadvantaged groups who will benefit the most; and working with local authorities on the funding of local services, housing and infrastructure to encourage and facilitate healthier living across the life-course, including the necessary services to maintain health and independence in old age.
- The Secretary of State for Health and Social Care—along with the senior responsible officer—should produce a cross-government strategy which clearly states how the Government plans to achieve the ageing society grand challenge mission by 2035. The strategy should include a roadmap for how the Government intends to achieve the mission, and should specify the departments responsible for working towards the target.
Impact of the Covid-19 pandemic
The committee explained in its report that it received most of the evidence for its inquiry before the start of the Covid-19 pandemic. However, it found that the pandemic “has shown tragically how poor health makes people more vulnerable to further health risk, and has highlighted the health inequalities associated with deprivation—including for ethnic minorities”. The committee argued the impact of the pandemic on physical and mental health, including the as-yet-unknown longer-term impacts, increased the need for action to encourage and facilitate healthy ageing.
What is the Government doing?
Response published March 2021
The Department of Health and Social Care (DHSC) published the Government’s response to the report in March 2021. Much of the response set out actions the Government was already taking in the fields covered by the committee’s recommendations. The Government emphasised its commitment to tackling persistent inequalities It said that DHSC, NHS England, NHS Improvement, Public Health England and other arm’s length bodies were already prioritising reducing health inequalities, in line with the secretary of state’s existing legal duty to have regard to the need to reduce inequalities between the people of England with respect to the benefits they can obtain from the health service.
The Government pledged to come forward in due course with proposals in response to the feedback received following the ‘prevention green paper’, Advancing Our Health: Prevention in the 2020s, that it published in July 2019. It said these proposals would form “important elements” of its plans to reduce health inequalities over the next parliament and beyond. The Government said again in July 2021 that it would set out its response to the green paper “in due course”, explaining it had been delayed in responding to the consultation because of the Covid-19 pandemic.
In its response to the committee report, the Government argued that the recommendation for all older patients to have a designated clinician had already been implemented, as all registered patients over the age of 75 must be assigned an accountable GP. The Government said it did not support one of the committee’s specific recommendations—that the comprehensive geriatric assessment should be a core part of medical training. The Government argued this would not be relevant to all medical specialties (eg paediatricians, pathologists and radiologists), but it said Health Education England would continue to ensure that geriatric medicine and multimorbidity are addressed in the medical curriculum.
In relation to funding further research into the ageing process, the Government said the National Institute for Health Research (NIHR), which is funded by the DHSC, welcomes funding applications for research into any aspect of human health, including into drugs, both novel and re-purposed, that might target the ageing process. It said several NIHR biomedical research centres undertake research that is “relevant for ageing across a large and varied portfolio”. In terms of ensuring the UK remains a global leader in drug research and development, the Government said it was “committed to bolstering our clinical research environment and positioning the UK to compete in a global market for the placement of clinical trials and investigations”. It pointed to the life sciences industrial strategy, the life sciences sector deal and research and development (R&D) roadmap it had already published, and said it was working on delivering its ambition for R&D spending to reach 2.4% of GDP by 2027/28. The Government has also committed to invest £200m into a dedicated life sciences investment programme delivered through the British Business Bank, intended to support the supply of capital for innovative firms.
Since the response to the committee report was published, the Government has made changes to the strategies and bodies involved in addressing the challenges of an ageing society. Some of these changes have been prompted by the Covid-19 pandemic.
The ageing society grand challenge originated as part of Theresa May’s industrial strategy. Boris Johnson’s Government announced in March 2021 that as part of its plan for post-pandemic economic recovery it was “transitioning” the industrial strategy into a new plan for growth, Build Back Better: Our Plan for Growth, and related strategies. It said it would review the grand challenges as part of its forthcoming innovation strategy.
The UK Innovation Strategy was published in July 2021. In his foreword, Kwasi Kwarteng, Secretary of State for Business, Energy and Industrial Strategy, described the ageing society as one of the largest challenges facing the world. He argued the UK must “be in the vanguard of the response to these challenges”. The innovation strategy did not include specific targets on ageing, life expectancy or health inequalities. However, it explained that the Government plans to establish a new innovation missions programme, which will “build on the success of the Vaccines Taskforce” and “set out a suite of bold new goals responsive to our current priorities”. The document implies that demographic change and public health challenges could be among the areas the missions might focus on. The innovation strategy also identifies seven ‘technology families’ where the UK has “globally competitive R&D and industrial strength”. The Government intends to “focus domestic and international attention on the potential of UK tech in these areas” and prioritise investment. The strategy mentions that several of these technology families (bioinformatics and genomics; electronics, photonics and quantum; and robotics and smart machines) could have health-related applications.
The Government stated in its response to the committee report that a “renewed and refreshed focus on inequalities as part of the levelling up agenda will be a crucial part of the next steps as we emerge from the pandemic”. In his speech on levelling up in July 2021, the Prime Minister referred to inequalities in life expectancy in different parts of the country as a “glaring imbalance” he wanted to address. Michael Gove, the new Secretary of State for Levelling Up, Housing and Communities, made a similar point in his speech to the Conservative party conference in October 2021, saying such disparities were “wrong” and had to change.
Some commentators have been critical of a lack of detail in the Government’s plans for levelling up. For instance, Jo Bibby, director of health at the Health Foundation, said in July 2021 there was “no sign of meaningful action or investment to make […] a reality” of Mr Johnson’s ambitions to address health inequalities and improve healthy life expectancy. She said: “Current plans appear to be partial and fragmented, and many deprived areas where people are likely to have poorest health have not been identified as priorities for investment”. She called for the Government to set clear targets to improve healthy life expectancy and for a regular, independent assessment of the nation’s health to be laid before Parliament. The Government is due to publish a levelling up white paper by the end of the year.
Some of the Science and Technology Committee’s recommendations had to do with making public health advice more effective and clarifying the public health roles and responsibilities of different national and local bodies. Since the committee report was published, there have been institutional changes in public health. From 1 October 2021, Public Health England was replaced by the UK Health Security Agency (UKHSA) and the Office for Health Improvement and Disparities (OHID). UKHSA will focus on fighting Covid-19 and tackling and preventing other infectious diseases and external health threats. OHID’s remit is to provide coordination across central and local government, the NHS and wider society to drive improvements in public’s health. This includes addressing disparities in life expectancy between the most and least deprived areas. Sally Warren, director of policy at the King’s Fund thinktank, has argued that OHID will not be able to succeed by itself, but will need to work across Whitehall and regions and local areas to secure progress on the many wider determinants of health.
Cover image by coombesy on from Pixabay.