The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)
My Lords, this has been an excellent and fascinating debate. I thank the noble Lord, Lord Patel, for his chairmanship of the Science and Technology Committee. I have heard the challenges that he faced. I also thank those noble Lords who sit on the committee and all those who contributed to the report. It was in-depth and covered a range of issues, in the fine tradition of reports from the House of Lords. I remember that when I was a Member of the European Parliament a number of reports from this place were read there. The expertise available here was widely acknowledged.
The report covered a number of issues: the trends and challenges, the science of ageing, lifestyle and environmental factors on ageing, the better use of technology and digital services, and the ageing society grand challenge mission. I will come back to those in more detail.
I also thank all those noble Lords who have spoken today for their knowledgeable and insightful contributions, particularly building on their expertise. I have admired many of them from afar for many years. It is a real privilege to be here in the same debate as them.
Promoting good health, enabling people to live long and healthy lives, and improving the health of the whole population are all something we want, but they are also fundamental aims of this Government. We can do this most effectively by harnessing the incredible opportunities provided through innovation, science and technology, as the noble Baroness, Lady Greengross, and other noble Lords mentioned.
Before I respond to the specific points made today, I will return to one of the points that noble Lords rightfully acknowledged: the impact of the Covid-19 pandemic and the subsequent lockdowns on life expectancy. A number of noble Lords quoted the Office for National Statistics, as well as some interesting pages and websites that we could read to learn more about this. They also highlighted that life expectancy at birth in the UK between 2018 and 2020 was 79 years for men and 82.9 years for women, but this saw a decrease of seven weeks for men with almost no change for women compared with 2015-17. However, the committee report mentions that there has been a decrease for females over the past decade.
One of the Government’s current priorities is to clear the backlog resulting from the pandemic. This report rightly acknowledges the devastating impact of the Covid-19 pandemic and its response on people’s lives in this country, but also how the pandemic has exposed existing health inequalities, which the Government will tackle as part of our levelling-up agenda—as many noble Lords have referred to today.
The Office for Health Improvement and Disparities has been tasked with helping more people to live longer lives in good health and reducing health disparities by breaking the link between someone’s background and their chance of living a healthy long life. As noble Lords are aware—indeed, some have mentioned this—while people are living longer, many suffer poor health towards the end of their lives. A notable statistic is that people in the least deprived areas live in good health for almost two decades longer than those in the most deprived areas. The noble Lord, Lord Patel, and others referred to this statistic.
The Medical Research Council is leading a cross-government programme of research to understand the ageing process better and promote health in later life, but also on how to motivate healthier lifestyles to improve healthy life expectancy. Like many noble Lords, I want to see the MRC rely more on evidence-based research to ensure that targeted interventions work and avoid unintended consequences.
Many noble Lords have shown an interest in the ageing society grand challenge mission for additional healthy, independent years of life while narrowing the gap. The noble Baronesses, Lady Young and Lady Greengross, mentioned this challenge in particular; I assure noble Lords that the Government remain committed to it. One of the most effective ways to increase life expectancy and healthy life expectancy is to prevent people getting ill in the first place. The report rightly lists risk factors, including the impact of smoking and excessive alcohol consumption. The noble Viscount, Lord Hanworth, pointed to the impact of alcohol, when interventions are often focused on other substances, such as tobacco. From looking at the statistics, alcohol not only leads to cirrhosis of the liver but is often responsible for other deaths—drownings, murders, et cetera—so it is important to look at the wider impact of alcohol consumption. We should also look at poor diets, nutrition, obesity, physical inactivity and the environmental factors that affect physical, cognitive and mental health as humans age.
The Office for Health Improvement and Disparities will drive this cross-government effort to reduce ill health. As many noble Lords know, part of the title of this office is about health disparities. It will continue to publish the productive healthy ageing profile, which provides data at national, regional and local levels on a range of indicators, including healthy life expectancy, health behaviours, NHS health checks, employment and housing.
As the Minister for Technology, Innovation and Life Sciences, I am hugely excited by the role that all three will play in our economic recovery from the pandemic, as well as in our long-term prosperity and in improving the health of the nation. The Government’s new innovation strategy, announced in July, sets out our vision to make the UK a global hub for innovation by 2035, not only in digital technology but in the exciting area of life sciences.
The Government’s commitment to innovation also applies to social care. In the September announcement on social care reform, the Government were clear that innovation would play an important part. Therefore, we continue to work with care users, providers and other partners to codevelop the reform plans, and will publish further detail in the forthcoming White Paper.
GPs’ surgeries are the first point of contact for many patients. The pandemic rapidly changed how services are provided, moving to telephone and online to complement face-to-face appointments where necessary. We continue to look at ways to improve the experience, as many noble Lords will remember from the discussion yesterday when face-to-face appointments were raised. The Government are clear that you have to leave it between the patient and clinician but, when a patient requests a face-to-face appointment, there has to be a good medical reason for the clinician to turn it down.
Many noble Lords alluded to technology. I will continue to work with NHSX and NHS Digital to drive digitisation and the sharing of appropriate data across our system of healthcare, from GP practices to hospitals, and to the social care sector to complement the proposed reforms in the Health and Care Bill. The noble Lord, Lord Desai, mentioned the issue of data sharing and making sure it is all there, but there are some challenges, as I am sure the noble Lord will acknowledge. Many civil liberties organisations have expressed concerns, and I have been in contact with a few to pledge that I will discuss how we can make sure that data is safe, and appropriate data is digitised and shared in the most appropriate way, so that patients have trust. We are looking at the development of things such as trusted research environments to make sure that patients are reassured.
I will work across government with the Office for Life Sciences, BEIS, the Department for International Trade and No. 10 to make the UK a location of choice and hub for life sciences, not only in the Cambridge-Oxford-London golden triangle but across the UK as part of the levelling-up agenda.
I will try to address some of the specific points made by noble Lords. The noble Lord, Lord Patel, asked a number of specific questions and I will try to respond to some of them. The noble Baroness, Lady Manningham-Buller, talked about overprescribing. There was an overprescribing review published on 22 September, and I thank Dr Ridge and all those who participated for their diligent work, which produced such a thought-provoking document. It sets out a series of practical and cultural changes, including the better use of technology. I hope that this report will be a call to action for everyone, whether a patient, clinician or healthcare leader, to think about what we can do to take forward this vital agenda.
The Government remain committed to extending healthy life expectancy by five years and I repeat that pledge. To deliver on this commitment we will work with the Office for Health Improvement and Disparities, as I have mentioned previously. The office—I will use its acronym OHID, as I know many in healthcare like their acronyms—will set out its future plans for extending healthy life expectancy, including how these plans will be delivered and, crucially, monitored in due course. In addition, the new health promotion taskforce will drive and support the whole of government to go further in improving health and reducing disparities to tackle many of the factors that are critical to good physical and mental health.
The Government are strongly committed to supporting research into dementia, which a number of noble Lords referred to. UK researchers are at the forefront of global efforts to find a cure or disease-modifying treatment by 2025. Sadly, the response to the prevention Green Paper has been delayed by the need to focus on the pandemic response, but we will bring forward a response to the consultation in due course.
Many noble Lords asked about the levelling-up White Paper, which will be published later this year. It will set out policy interventions to improve livelihoods and opportunity in all parts of the UK, especially to improve health outcomes and reduce the gap in healthy life expectancy. Given the very technical nature of some of the remarks made by the noble Lord, Lord Patel, on the biology of ageing, I hope he will not mind if I respond to these points in writing.
A number of noble Lords raised the issue of technology, including the noble Baroness, Lady Young, and the noble Lord, Lord Mair. Once again, the issue of data sharing came up. We welcome the report’s recognition of the role that technology can play and it is really important to drive this. Part of it is data sharing, and part is making sure that the different parts of our system of healthcare work together and that we can learn from best international practice.
Before I entered this House, I used to do a lot of work analysing technology. One of the things I looked at is how the Japanese decided to respond to the changing demographics of their country. Some countries respond by immigration, but others do not want to respond like that and Japan is one of those that is very sceptical of immigration. Therefore, it is focusing on technology and how to improve the lives of people getting older, whether through some of the technologies that other noble Lords mentioned, such as touch-sensitive items and data communicating with clinicians, or through robots and extraskeletal equipment to allow older people to live a more meaningful life.
The NHS is also supporting many people to stay at home for their healthcare with digital tools and remote monitoring, partly helped by the fact that more and more of the population are buying mobile phones, Fitbits and various digital devices, and are able to provide that data. Once again, we have to be very careful and make sure that the public is onside as that data is shared.
The noble Lord, Lord Mair, also talked about AI and robots. The Government are taking action in this area. In August 2019, the Prime Minister announced a £250 million-boost to AI in the healthcare sector. I have been in very interesting conversations with the NHS AI Skunkworks. It is fascinating to see some of the technology that has been looked at there.
A number of noble Lords also mentioned how we make sure that an ageing population is digitally aware. I worked with a number of local civil society projects in a previous life. One of the interesting projects was where we got younger people to come in and teach older people to use technology. Not only did it give a more meaningful life in many ways to the older people learning technology but it was interesting that quite often some of the young people were from deprived backgrounds—sometimes single-parent families—and they were able to connect with the older person they were teaching. In many cases they found a new mentor or a new role model in their life. It was one of those interventions that helped the elderly people and some of the young people from broken families. We have to look in a more joined-up way at how we can make sure that we help more people that way.
The noble Lords, Lord Mair and Lord Sikka, also talked about the internet. There is something about the essential digital certificates that are being funded for digital entitlement and based on new standards. The Government and Ofcom have agreed a set of commitments with the UK’s major broadband and mobile operators to support vulnerable consumers, not only during the pandemic but as we go forward to make sure there is no real digital divide.
The noble Baroness, Lady Young, and the noble Lord, Lord Browne, spoke about inequalities, as did the noble Viscount, Lord Hanworth, the noble Lord, Lord Davies, and my noble friend Lord Balfe. The Office for Health Improvement and Disparities has said that it is time to shift the centre of gravity for the department and the health system from treating disease to building good health. As many noble Lords have said, we should start this at a young age as effectively as possible.
One of the issues that my noble friend Lord Ridley mentioned is that it is all very well having these health education programmes at a young age, but will people listen then? When I was at school we had programmes about smoking, alcohol and other things. I remember my friends saying that they were never going to drink or smoke, but a couple of years later we were all out partying. When is public education effective? Do you just assume it is at childhood and not again? How do we make sure that it continues throughout one’s life? That is why it is important that public health messages are built on evidence and communicated in a way that appeals to those we are trying to reach.
The noble Baroness, Lady Young, also spoke on various other things about public health. I assure her that regional directors of public health will sit within the Office for Health Improvement and Disparities and will join up at the national and local level.
The noble Baroness, Lady Young, and the noble Lord, Lord Davies, spoke about levelling up. The White Paper will look at how we set out bold policy interventions to tackle a number of different inequalities. As many noble Lords will know, there are multidimensional inequalities and many ways of people identifying, if you like.
A number of noble Lords also spoke about obesity. Many noble Lords will be aware that we published our current obesity strategy in July 2020. This sets out an overarching campaign to reduce obesity by taking forward actions from previous chapters of the childhood obesity plan and setting out measures to get the nation fit and healthy.
This will involve a number of interventions; some of them have been controversial. Some, such as the restrictions on advertising of food high in fat, sugar and salt, both on TV and online, will be progressed as part of the Health and Care Bill. We should be aware of the controversy around some of this and make sure that, when we make these interventions, they are based on evidence, and we are able to review the evidence and bring it back to show what difference it has actually made, rather than just make the intervention, hope for the best and feel good that we have made it. Evidence-based research is very important as we make these interventions.
The noble Baroness, Lady Sheehan, mentioned ethnic-minority inequality, and the Better Health campaign that the Government launched will look at how we focus on those most at risk, including those from specific ethnic-minority communities, those living with long-term health conditions and people over the age of 40 from lower socioeconomic groups, looking at particularly targeted interventions for each of those different minority groups. On long Covid, which she also mentioned, OHID will be looking at a range of factors that impact life expectancy as we look to reduce health inequalities, and that includes some of the issues on long Covid.
A number of noble Lords talked about dementia, and we have been implementing the 2020 challenge on dementia, published in February 2015, to make sure that dementia care, support and awareness of research are transformed. We will be setting out our plans for dementia for England for future years in due course. The noble Baronesses, Lady Young and Lady Greenfield, mentioned dementia research and statistics, and I commit to write to them with more details on the questions they asked, given the time.
I already mentioned that the noble Viscount, Lord Ridley, talked about some of his scepticism of the public health agenda, and I mentioned my experience and that of many friends, but one issue that he mentioned was diagnosis. The work of Genomics England is interesting. As it goes forward, it will be able to identify potential diseases that individuals will face in their life. This is not as easy as it sounds, because it also raises a number of ethical issues. At what point do you notify people that they will suffer from particular diseases? Do you intervene early, or do you wait until a particular age? A number of these issues are incredibly difficult, but we will try to get the right balance.
We talked about research and funding, and the National Institute for Health Research is welcoming funding applications for research in a number of different areas, including those who want to look at the issue of healthy ageing. I hope I have talked in detail about the data strategy, but it will be important that we get there.
I apologise to noble Lords for not being able to cover all the points raised. To finish, I say just that it is an insightful and wide-ranging report, and that the Government remained committed to ensuring that as many people as possible enjoy a long and healthy life, whoever they are, wherever they live and whatever their background.