HM Government – Written evidence (INQ0023)

 

A Cross-Government memorandum prepared by:

Department of Health and Social Care (DHSC);

Department for Business, Energy & Industrial Strategy (BEIS);

Department for Work and Pensions (DWP);

Office for Life Sciences (OLS);

NHSX; and

Public Health England (PHE).

 

Scientific Basis

  1. How complete is the scientific understanding of the biological processes of ageing and their epidemiologies (including the relative roles of genetics, epigenetics, lifestyle, environment, etc.)?

 

UK Research and Innovation (UKRI) is best placed to comment on the completeness of the scientific understanding of the biological processes of ageing and their epidemiologies. UKRI is providing additional written evidence in response to this question.

 

The ageing population is one of the major challenges of our time. As part of our Industrial Strategy’s Ageing Society Grand Challenge, we have set a mission to ensure that people can enjoy at least five extra years of healthy independent living by 2035, whilst reducing inequalities between the richest and the poorest.

 

This is a complex mission that will require Government to work with academia, industry and civil society to develop an evidence-based understanding of individuals and populations; links between lifestyle and health outcomes; the role of technology and innovation; and the scientific understanding of the biological processes of ageing and their epidemiologies. We have made significant investments to address this including funding for cutting edge research facilities and to foster international collaboration, support postgraduate training, public engagement, knowledge transfer, and other core research activities. Our support for research and innovation is aimed at maximising health and supporting businesses to improve productivity and growth by realising the potential of new technologies and helping to develop new commercial ideas.

 

UKRI delivers a large proportion of public research and innovation activity and in 2019/20, received an allocation of £7.2 billion from the government. As part of this, UKRI supports the wider delivery of the Ageing Society Grand Challenge, which contributes to its four pillars of the Ageing Society, as explained in Q11. Some examples that support the development of our scientific understanding of the biological processes of ageing and their epidemiologies are included below:

 

 

  1. How firm is the scientific basis for public health advice about healthy lifestyles as a way to increase health span, including physical health and mental health?

 

How firm is the scientific basis for public health advice about healthy lifestyles as a way to increase health span, including physical health and mental health?

Evidence set out in our Prevention Green Paper[1] suggests there are four factors that shape our health: the services we receive; the choices we make; the conditions in which we live; and our genes. The relative contribution made by each is less clear but is likely to vary from person to person and from disease to disease.

 

Figure 1: Determinants of premature mortality and their contribution (left)[2]
Figure 2: Estimated impact of determinants on health status (right)[3]

Two pie charts that present the contribution of health determinants to overall population health from two studies.

The Life Course approach[4] acknowledges that what happens at one life stage has an impact on later life. For example, receiving a good education is likely to increase opportunity for a better job, with the chance to build financial security throughout life. Having a good start in life can lay the foundations for good physical and mental health throughout life and there is good evidence for interventions that support behaviours, and to a lesser degree, social determinants, across the life course[5].

 

Risk factors like obesity, smoking and physical inactivity place us at higher risk of both early death and ill-health/disability[6]. Public health interventions over the past decades have led to significant improvements in the nation’s health. For example, we now have one of the lowest smoking rates in Europe with fewer than 1 in 6 adults smoking. However, other major challenges such as obesity and clean air, will continue for the next decade. Taking on a personalised prevention model and incorporating prevention in the NHS Long Term Plan, will allow us to build on the more traditional public health interventions and rise to these challenges.

 

Public health advice and standards issued by Public Health England (PHE) and The National Institute for Health and Care Excellence (NICE) to inform commissioners, providers and the public are supported by considered assessments of the available scientific evidence. Examples of good practice are given later below.

 

A recent Lancet[7] article highlighted that the strongest evidence for changing health behaviours and reducing inequalities is for fiscal and economic interventions that reduce the affordability of tobacco and alcohol, with growing evidence for sugar-sweetened drinks. There is also promising evidence for fiscal and economic interventions that incentivise walking, cycling, and public transport and disincentivise driving. There can be a role for public information in support of fiscal and economic interventions, for example raising public awareness of financial incentives and disincentives. We know the things that kill us (such as cancer, heart disease and stroke) are not always the same as the things that make us unwell. Some of the most common causes of ill-health are: joint, bone and muscle problems, depression and anxiety, long-term conditions like asthma and diabetes[8]. However, much premature ill-health and disability can be prevented, and there are actions we can take to increase our chances of living longer, healthier lives. Some health conditions we are born with and cannot avoid. Where this is the case, the priority is supporting people to enjoy a good quality of life and to live well.

 

The DHSC-funded National Institute for Health Research (NIHR) supports a significant and diverse portfolio of research activity that aids our understanding of ageing; for example the NIHR School for Public Health had a programme of work on Ageing Well which worked to develop an integrated public health approach to optimise health in older age groups. It included projects on developing age friendly cities, inequalities in healthcare and outcome and strategies to improve uptake of healthy behaviours to support healthy ageing. For example, one study produced an evidence-based evaluation tool for age-friendly initiatives that can be adapted to different contexts which can be used by a steering group of city stakeholders in collaboration with researchers to evaluate or plan local initiatives. Its use in Liverpool has provided insights that informed the city’s age-friendly policy and practice.

 

Good health is much more than the absence of illness. It's a state of wellbeing that includes our mental as well as our physical health. Parity of esteem was enshrined in law back in 2012. This requires the NHS and local authorities to consider the 'whole person', and their mental and physical health needs as equally important. Poor mental health is the second most common cause of years lived with disability in England [9]. The most common conditions are depression and anxiety, which make up the majority of mental health cases[10]. Approximately 1 in 4 people report living with a mental health issue[11]. Incidence is highest in the working-age population, and higher in women than men[12]. Other groups at greater risk include: those living on low incomes, people with problem debt, and those identifying as lesbian, gay, bisexual, or transgender (LGBT)[13]. Mental health problems can have a broader impact on society. Poor mental health at work costs the UK economy between £74 billion and £99 billion per year[14]. Mental ill-health is also associated with lower life expectancy, with some conditions associated with reductions in life expectancy of 10 to 20 years[15].

 

We need to lay the foundations for good mental health across all parts of our society. This is because the circumstances we're born into – and the conditions in which we live – all have a major bearing on our mental health. We need to take urgent action to tackle the risk factors that can lead to poor mental health, such as adverse childhood events, violence, poverty, problem debt, housing insecurity, social isolation, bullying and discrimination. We also need to invest in the protective factors that can act as a strong foundation for good mental health throughout our lives, such as strong attachments in childhood, living in a safe and secure home, access to good quality green spaces, security of income, and a strong set of social connections[16].

 

Interventions to promote good mental health and reduce some of the impacts of poor mental health which impact on health span are underpinned by evidence[17] and include but are not limited to, school-based programmes to prevent bullying and initiatives to prevent depression and workplace programmes to promote mental health. PHE supports action on three key overlapping areas of public mental health across the life course[18], including mental health promotion, prevention of mental health problems and suicide prevention, and improving lives, supporting recovery and inclusion of people living with mental health problems.

 

In addition, loneliness is increasingly recognised as an issue affecting health span and can affect anyone and have a significant impact on physical and mental health. The Government published the first cross-government Loneliness Strategy - A connected society: A Strategy for tackling loneliness – laying the foundations for change[19] on 15th October 2018. The Strategy brought together government, local government, public services, the voluntary and community sector and businesses to identify opportunities to tackle loneliness and build more integrated and resilient communities. The Government’s £11.5 million Building Connections fund, launched in July 2018, will stimulate innovative solutions to loneliness across all ages, backgrounds and communities. A range of local projects funded through the Loneliness Strategy will help to build evidence on what works to address this issue and will be measured through the new Public Health Outcomes Framework measures for loneliness[20].

 

What are the practical impediments for this advice being acted on?

 

Influencing individual behaviour is complex and requires action at three levels to promote healthy behaviours and increase healthy life span:

 

One of the challenges in shifting population level behaviour is the appropriate translation of evidence into practice. The All Our Health Framework[21] provides a practical resource for health and care professionals to use their knowledge, skills and relationships to improve health outcomes and reduce health inequalities. PHE has published a Menu of Preventative Interventions[22] to support local health and care planning. With financial constraints in local authorities there is a need for greater diversification of resources in line with the diversity of the ageing population. PHE has published a Productive Healthy Aging Profile[23] to summarise the data available, and support commissioning decisions in localities across England.

 

Social attitudes in relation to ageing need to change. By thinking that ageing will be a negative process, people may have a more pessimistic view of their own future and expect to face difficulties in their daily lives and relationships as they age. This then manifests itself as stress, depression and anxiety[24]. In autumn 2019, PHE, in partnership with the Centre for Ageing Better, is publishing a consensus statement on healthy ageing, which aims to challenge ageism and shift the perception of ageing towards being more positive.

 

Examples of good practice

 

The public health advice issued by PHE is based on the scientific evidence (both clinical and epidemiological) and is robust. Research indicates that the impact of general advice at population and individual level is mixed. There is a strong evidence base, grounded in behaviour change theory to support interventions for unhealthy behaviours[25] [26]ranging from population-wide public health campaigns to individual-level behaviour change interventions. There is also an emerging evidence base supporting behavioural and social science approaches to behaviour change[27] and a recognition that commercial factors, such as sophisticated advertising and marketing techniques can influence individual behaviour.[28] Examples of good practice from PHE include:

 

 

 

 

Local area examples of good practice

 

 

 

 

 

 

 

 

  1. Which developments in biomedical science are anticipated in the coming years, in time to contribute to the Government’s aim of five more years of healthy and independent life by 2035? Research areas may include:

 

 

The NIHR invests in early translational research infrastructure based in NHS/University partnerships and the NIHR Biomedical Research Centres (BRCs), which have a substantial portfolio of world-class early translational biomedical research to support the development of new, ground breaking treatments, personalised medicine, drug repurposing, diagnostics, prevention and care of patients. Several NIHR BRCs undertake research that is relevant for ageing across a large and varied portfolio. For example:

 

 

Multimorbidity has been defined recently in an Academy of Medical Sciences Report, Multimorbidity: a priority for global health research,[45] as the co-existence of two or more chronic conditions, relating to either physical health or mental health. Multimorbidity is now the norm among older people in the UK. There are structural and cultural barriers facing multimorbidity research and the NIHR is working with other funders (Academy of Medical Science, the Medical Research Council and the Wellcome Trust) to overcome these and support the research needed to better understand the trends, clusters, mechanisms and causes, burden, prevention and management of multimorbidity. The NIHR has developed a strategy which sets out actions to foster a change in NIHR culture and practices to promote and enable multimorbidity research; in order to fund the right people, collaborations and research to generate an evidence base for improved health and care.The government sees treating multimorbidity as a key area for advancement in the next five years and is working with the sector to scope potential projects in this area.

 

To develop our understanding of the biomedical science of ageing NIHR is also working with other research funders, including UKRI, the UK Dementia Research Institute and Dementias Platform UK. DHSC is sponsor of the £250m international Dementia Discovery Fund, aiming to find new life-changing treatments. NIHR and the Economic and Social Research Council (ESRC) are also co-funding a joint £12m research initiative on dementia care, prevention and technology.

 

Through the initiatives set out in the Life Sciences Strategy, Government is developing new industries in the fields of early disease detection and genomics, digital technologies and data analytics, and advanced therapeutics, which are revolutionising healthcare and contributing to the Government’s aim of five more years of healthy and independent life by 2035. We are on the cusp of a genomic revolution in healthcare. As we have highlighted in the Prevention Green Paper, we predict the 2020s to be the decade of proactive, predictive, and personalised prevention. This means targeted support, tailored lifestyle advice and personalised care – all of which will support and enable people to increase their health span.

 

In diagnostics, we have already led the way globally with initiatives like the 100,000 Genomes Project – the largest national sequencing project anywhere in the world. This saw around 25% of patients with rare diseases receive a diagnosis for the first time, and for some conditions a diagnosis rate as high as 60%. Building on this success, earlier in September, the Government also launched the world’s largest genetics project, the £200m whole genome sequencing project, which will examine and sequence the genetic code of 500,000 volunteers at the UK Biobank. Furthermore, the Genomic Medicine Service in the NHS will be the first of its kind in the world to integrate whole genome sequencing into the healthcare system. It aims to deliver equitable access to genomic testing to help more accurately diagnose disease and personalise treatments and interventions.

 

By 2035, we therefore expect the use of genomics to be fully embedded in diagnosis and treatment of disease and better enable longer health spans. However, we also expect emerging genomic technologies, such as polygenic risk scores (PRS), to have matured and play an important role in disease prediction and prevention. Ongoing research on PRS gathers information from population genetic risk to predict an individual’s risk of many common diseases that can affect healthy ageing, such as cardiovascular disease, cancer, diabetes, inflammatory diseases, Alzheimer’s disease and many mental health conditions. PRS are also likely to be able to predict other clinically relevant effects such as response to therapy and adverse drug reactions.

 

The clinical implementation of this approach will be pioneered at scale in the new Accelerating Detection of Disease (ADD) challenge. As part of the Industrial Strategy’s second Life Sciences Sector Deal, government announced a major new commitment of up to £79m ISCF Wave 3 funding for the ADD Challenge, with an expected sector investment of £160m, to address the early detection of disease in individuals before any symptoms present. This has the potential to transform the way people are treated, improve the health-span of the population and save many thousands of lives.

 

The programme aims to recruit up to five million healthy participants into a world-leading research cohort in order to shed new light on the detection and treatment of common diseases. A key part of the ADD challenge will be to offer as many participants as possible their PRS. Individuals will volunteer their genetic information, which will be used in accordance with relevant legislation, regulation and good practice guidance on use of data, in order to develop and improve the evidence base for the use of PRS.

 

The goal of the ADD challenge will be to support research, prevention and treatment across major chronic diseases, including cancer, dementia, heart disease and mental health conditions. The project will seek to enrol under-represented groups, such as ethnic minorities, to enable a better understanding of disease and preventative measures for every individual in society and reduce existing health inequalities. The project brings together the NHS, industry and leading charities including Cancer Research UK, the British Heart Foundation and Alzheimer’s Research UK. It will be the largest ever study of its kind, collecting a broad range of data from healthy volunteers over many years.

 

As part of the Industrial Strategy, NHSX is leading work to use data, AI and innovation to deliver the AI & Data Grand Challenge’s mission to transform the prevention, early diagnosis and treatment of chronic diseases by 2030. Using AI and data, there is an opportunity to accelerate medical research in early diagnosis, leading to better prevention and treatment of disease. Within 15 years better use of AI and data could result in over 50,000 more people each year having their cancers diagnosed at an early rather than late stage.

 

Government also recently announced an investment of £133 million in healthcare innovation, including life-changing treatments for arthritis and cancer and for pioneering gene-based therapies for diseases including dementia and Parkinson’s. This funding will unlock new treatments that allow people to lead healthier and longer lives.

 

 

  1. How complete is the understanding of behavioural determinants and social determinants of health in old age, and of demographic differences?

 

Evidence set out in our Prevention Green Paper [46] suggests there are four factors that shape our health: the services we receive; the choices we make; the conditions in which we live; and our genes. The relative contribution made by each is less clear but is likely to vary from person to person and from disease to disease.

Figure 1: Determinants of premature mortality and their contribution (left)[47]
Figure 2: Estimated impact of determinants on health status (right)[48]

Two pie charts that present the contribution of health determinants to overall population health from two studies.

 

The Life Course approach[49] acknowledges that what happens at one life stage has an impact on later life. For example, receiving a good education is likely to increase opportunity for a better job, with the chance to build financial security throughout life. Having a good start in life can lay the foundations for good physical and mental health throughout life and there is good evidence for interventions that support behaviours, and to a lesser degree, social determinants, across the life course[50].

 

As we get older, the steady accumulation of a lifetime of advantages or disadvantages, results in unequal levels of health, wealth, happiness and security in later life. In terms of unequal levels of health, evidence and analysis shows that populations living in disadvantaged circumstances are more likely to have multiple risk factors (for example, poor diet, lack of physical activity) leading to unhealthy behavioural determinants and as a result, experience multiple morbidity in old age. These demographic differences are evident in the 19-year gap in healthy life expectancy experienced between those living in the most and least deprived areas in England[51]. PHE has published a toolkit[52] for place-based approaches to tackle inequalities.

 

In terms of behavioural determinants, an estimated 40% of ill health in England is explained by known risk factors[53]. We have some good evidence on the relative contribution or attributed risk for some behavioural determinants and causes such as tobacco. The data tells us that smoking is one key contributory health risk behaviour and there is a clear social gradient in smoking prevalence[54]. In 2016, 27.2% of adults in the most deprived decile smoked, compared with 7.9% of those in the least deprived decile. Prevalence of smoking is also higher among those who work in routine and manual occupations compared with those in managerial and professional occupations[55].

 

Social gradients can also be observed in levels of adult health risk behaviours such as the percentage of people physically inactive in the least and most deprived deciles in 2017/18 (16.8% - 30.6%), overweight or obese (56.4% - 67.4%), and meeting the recommended ‘5-a-day’ on a ‘usual day’ (45.7% - 60.2%)[56]. There is also a social gradient in the rate of hospital admissions for an alcohol related condition and an increasing trend in admissions for those aged 65 and over.

 

The percentage of disability-adjusted life years attributable to the top known risk factors are shown below for England in 2017 (Global Burden of Disease):

 

 

Social determinants include social, cultural, political, economic, commercial and environmental factors that shape the conditions in which we live and work. These social determinants affect our access to quality of housing, and our home environment plays a crucial role in helping us remain healthy, active and independent in later life. There is a consensus that wider determinants such as social, economic and environmental factors are important. However, there is limited evidence on their relative impact, for example, how important housing is relative to education or tobacco use.

 

However, we do have a good understanding on some specific wider determinants and there are multiple studies on the impact of specific factors on health in isolation.

 

Some examples of specific determinants include:

 

 

Technologies

 

  1. What technologies will be needed to facilitate treatments for ageing and ageing-related diseases, and what is their current state of readiness? For example:

 

To further boost NHS research in developing new medical technologies the NIHR has invested in 11 NIHR Medtech and In vitro diagnostic Co-operatives (MICs). These provide expertise in the NHS to work with industry to develop new healthcare technologies and provide essential evidence to help with the adoption of in vitro diagnostic tests by the NHS. The NIHR Trauma MIC, for example, has been working to provide information from patients on the use of a prototype device for the minimally invasive delivery of Osteospheres. This technology provides a novel treatment which could repair and regenerate new bone tissue for osteoporotic patients at risk of bone fracture.

 

The NIHR also invests in the NIHR Innovation Observatory which aims to supply timely information to key policy and decision makers and research funders within the NHS about emerging health technologies that may have a significant impact on patients or the provision of health services in the near future. The NIHR Innovation Observatory produces briefings and alerts that provide information on a single technology and horizon scanning reviews and pipeline analysis reports. The Innovation Observatory has published a range of reviews of relevance to ageing, including those focussed on cancer and palliative care, technologies for hearing loss, Parkinson’s and urinary and faecal incontinence.

 

A notable innovation is Technology Integrated Health Management for dementia (TIHM) – part of Wave 1 of the Test Beds programme and involving over 1,400 participants. The intervention aims to improve the lives of people with dementia and their carers by using ‘Internet of Things’ technology to provide real-time information about their daily activities. The technology includes GPS trackers, door and electricity monitors, motion sensors and vital sign readers. These products are supported by AI and machine learning. If a significant deviation in participant behaviour is identified, then a healthcare professional is immediately alerted who can then decide what type of support or treatment each individual needs.

 

TIHM developed by the Surrey and Borders Partnership has now received class 1 medical device certification and is soon to be piloted in other NHS trusts, including Birmingham and Middlesex. This is part of TIHM’s wider strategy to commercialise their innovation and to help more dementia patients to live independently for longer.

 

Advances in bioinformatics and genomics are already starting to improve patient care. Many patients in the 100,000 Genome Project with an undiagnosed rare disease have benefited from diagnosis (approx.1 in 4) and up to 50% of cancer patients received actionable findings to improve their treatment or offer participation in novel clinical trials. Linking and correlating genomics, clinical data and data from patients facilitates routes to new treatments, diagnostic patterns and information to help patients make informed decisions about their care.

 

Cell and gene therapies are a type of precision medicine which involves extracting cells, protein or genetic material (DNA) from the patient (or a donor), and altering them to provide a highly personalised therapy, which is re-injected into the patient. Cell and gene therapies may offer longer-lasting effects than conventional medicines. They have the potential to address complex diseases for which there are no effective treatments. They are part of a shift in healthcare towards precision medicine and will be an important factor in increasing a healthy lifespan.

 

To date only a few products have been licenced for use in patients. The majority of therapies are still under clinical trial studies to make sure that they will be safe and effective. However, we are already seeing examples of some technologies being developed and deployed within the NHS. For example, the NHS Test Beds programme brings together NHS, industry and academia to test new technologies in real-world settings including those that monitor health conditions and provide personalised advice. Over £16M of government funding has been provided to support the Test Beds programme to date.

 

Government also recently announced an investment of £133 million in healthcare innovation, including life-changing treatments for arthritis and cancer and for pioneering gene-based therapies for diseases including dementia and Parkinson’s. This funding will unlock new treatments that allow people to lead healthier and longer lives.

 

 

  1. What technologies will be needed to help people to live independently for longer, with better health and wellbeing? What is the current state of readiness of these technologies, and what should be done to help older people to engage with them? For example:

 

What technologies will be needed to help people live independently for longer, with better health and wellbeing?

 

As the TIHM example in Question 5 illustrates, technology can help support people to live in their homes or communities for longer and stay connected to family, friends or wider support networks. There is a wide variety of technology available and each individual will have different technology requirements to enable them to live independently for longer with better health and wellbeing depending on their circumstances and personal needs.

 

1.7 million people in the UK are already supported by technology enabled care such as telecare and personal alarm systems. Innovations in assistive technologies are enabling more people, whatever their circumstances, to remain independent and fully engaged in their home life, careers and communities. In addition, society is increasingly embracing apps, wearables and the internet of things and the use of technology in all settings is becoming more and more common.

 

Technology can improve the timeliness and accuracy of communication between the person and their carers, enable operation of common devices within the home with ease and simplicity, or measure activity, status, critical statistics and whereabouts of an individual in a non-intrusive way. Opportunities range from low to high technological initiatives, simple adaptations include handrails to help prevent falls while, at the opposite end of the spectrum, the influence of Artificial Intelligence and robotics is growing.

 

NIHR is funding increasing research on social care, alongside UKRI and ESRC, to find out how to maximise independence. The UK Dementia Research Institute (UKDRI) has a major programme of research on dementia care and technology, including for example 'smart home' technology to enable people to live more independently for longer. This includes the new NIHR Applied Research Collaboration Wessex on and ‘Ageing and Dementia: supporting independent living for people with complex health needs’ which begins in October 2019.

 

An expanded list of examples of the types of technology that can support people to live independently for longer with better health and wellbeing is included below:

 

What is the current state of readiness of these technologies?

 

Many of these technologies are already in use and some are widely available in the consumer market. For example, HeartFlow is a non-invasive cardiology diagnostic tool which reduces unnecessary invasive testing. Through government and NHS support it has been adopted across 34 NHS sites, with over 3,000 scans analysed saving the NHS an estimated £700,000. Alongside Heartflow 11 other products are being supported by up to £2 million from the Accelerated Access Collaborative (AAC) and Academic Health Science Networks (AHSNs) to increase their use, potentially benefitting up to 500,000 patients and saving the NHS up to £30M. Others, though developed and available, are less commonly used. Still others, such as robot companions; augmented reality to assist in dementia care; or machine learning and artificial intelligence are at earlier stages of development.

 

The spread of these technologies is at an early stage. There are a range of initiatives to improve adoption and scale up.

 

There are a number of other innovative pathfinder projects already underway to demonstrate the benefits of using technology to improve health outcomes (see Annex A).

 

While technology is proven, scale-up of benefits do not always happen as approaches have been developed locally. NHS Digital launched Digital Social Care in June 2019 to support the care provider sector to work together to improve the digital maturity of the care sector as a whole, through developing a capability framework and guidance on how to buy and manage technology products.

 

NIHR supports a range of research into technologies that aim to help people live independently for longer. For example, NIHR is funding increasing research on social care, alongside UKRI and ESRC, to find out how to maximise independence. The UK Dementia Research Institute (UKDRI) has a major programme of research on dementia care and technology, including for example 'smart home' technology to enable people to live more independently for longer.

 

The NIHR Mindtech MedTech Co-operative is supporting work on a study Brain+ D Detect-Prevent to investigate the potential of digital apps for cognitive training (often known as brain training) for Alzheimer's Disease.

 

The new NIHR Applied Research Collaborations (ARCs) will also be undertaking high-quality applied research focused on the needs of patients and support the translation of research evidence into practice in the NHS, public health and social care. A number will be supporting relevant research activity, such as the NIHR ARC Wessex with a Research Theme on ‘Ageing and Dementia: supporting independent living for people with complex health needs’.

 

What should be done to help older people engage with them?

 

The decision by people, including older people, to accept and engage with an assistive technology is complex and individual. Some older people are technology enthusiasts, others will be deeply suspicious.

 

If the technologies described above are to be used at scale, the priority should be minimising as many potential barriers whilst ensuring people have choices. This will require action to overcome supply side barriers, which limit the provision of useful technologies. However, barriers which depress demand, such as low public awareness or suspicion of technology, are equally important to address. If people have had little exposure to technology, they may feel uncomfortable relying on it to provide important aspects of their health and social care. There are a range of initiatives to improve awareness and mitigate these concerns.

 

Over the past five years Government has supported almost over 1.3million people to engage with digital technology and develop their digital skills in community settings, through the Future Digital Inclusion programme, which is delivered through the 3,000 Online Centres Network. Further, around 3,000 libraries across England provide a trusted network of accessible locations with trained staff and volunteers, free Wi-Fi, computers, and other technology as well as Assisted Digital access to a wide range of digital public services where individuals are unable for whatever reason to access these services independently.

 

Some specific examples of actions needed to enable older people to better engage with these technologies are included below in Question 8.

 

In October 2018 The Department of Health and Social Care published ‘The future of healthcare: Our vision for digital, data and technology in health and care’ where we set out how we can take best advantage of technology and innovation to improve how we deliver both health and care and to improve the experience of individuals. Government has since created a new joint unit - NHSX - which brings together the technology leadership from across the Department of Health and Social Care, NHS England and NHS Improvement, and will lead the digital transformation across the NHS and social care. A key role of NHSX is to put in place the foundations to enable an adult social care sector which embraces innovation, where tech developers understand the standards required to access the market, where providers have the right infrastructure in place to take advantage of technology, and where individuals are best able to identify and choose the assistive technology they need. This work will contribute to the ability of older people to engage with these technologies.

 

 

  1. How can technology be used to improve mental health and reduce loneliness for older people?

Digital technology can play an important role in bringing groups of people together to create meaningful connections. Technology can be used to improve mental health and reduce loneliness for older people in a variety of ways by connecting them with friends, family and caregivers or by providing closer links into their communities. Loneliness affects many older people: 34% of older people feel lonely sometimes or often[63].

 

There are some good examples of technology being used to reduce loneliness for older people. For example, as part of the Liverpool City Council testbed, a communication device called Paman is being tested. Paman is a portable, one-way 4K video and two-way audio device which provides service users with a link to a local pharmacist who can see them and give advice on medication. It gives a better quality of care than sending in carers who are not medically trained. The pharmacist knows the medical history and what has been prescribed to the service user and can build a better relationship. Initial results have seen treatment compliance improving from 55% to around 97% and evidence of service users feeling more connected to their communities.

 

Another technology being trialled as part of the Liverpool testbed is Push to Talk. This communication tool is designed to bring companionship and reduce loneliness. At the press of a button, a wireless call is triggered to the Push to Talk network over the user’s landline phone and connects them to someone else who wants to chat. Tablet based quiz games are also being trialled to reduce loneliness in the Liverpool testbed enabling easy to play video games and quizzes to be played simultaneously with users from their own homes or from day care centres, again reducing the feeling of isolation and connecting people with their communities.

 

Digital infrastructure is also a vital underpinning, and Government recognises the power of digital inclusion in bringing groups of people together as a tool to create meaningful connections.

 

The GovTech Fund includes a competition, launched in July 2018, which makes funding available to start-ups to explore how digital technologies can help tackle rural loneliness.

 

DCMS has also launched a Digital Inclusion Innovation Fund, which allocated £400,000 across 3 projects focusing on two of the most digitally excluded groups - older and disabled people. The fund will also be looking at how digital inclusion can help tackle loneliness amongst these often isolated cohorts, particularly in geographically isolated areas. In Uttlesford, rural West Essex, the Smart Homes project was allocated funds to train older people to use Smart Tech in their homes. These ‘Digital Boomers’ in turn invite their older peers into their homes for informal social events and coffee mornings to introduce them to this new tech and how it can benefit them. Digital buddies, younger ‘digital natives’, are also embedded into the programme for longer-term support. The social (and inter-generational) learning element of this project could make a significant impact into tackling loneliness and reducing isolation amongst older people.

 

NIHR funds a number of research projects exploring the potential effect of loneliness and social isolation. Studies range in their focus, from specific vulnerable groups such as the elderly, those with mental health conditions or learning disabilities to the wider impact of social isolation and loneliness on an individual’s physical and mental health and well-being. For example, a current trial is testing an intervention to improve the physical and mental health outcomes for people who may be isolated due to a range of physical, psychological and social factors. Other studies, whose primary focus is not loneliness or social isolation, explore the effects of these within a broader context. For example, a current study is researching the specific late effects of chemotherapy (such as hearing loss) and the associate impact on quality of life, including social isolation. In another example, researchers based the NIHR Wessex CLAHRC are looking to help support older people who may feel that they are lonely by connecting them with what’s around them in their community, using a web-based tool called GENIE.

 

The NIHR established the Older People and Frailty Policy Research Unit in January 2019; this is a collaboration between academics from the University of Manchester, Newcastle University and the London School of Economics. The unit aims to produce timely, high quality research evidence to help Ministers and policymakers to make informed decisions about the lives of older people. The NIHR Older People and Frailty Policy Research Unit will carry out a rapid evidence synthesis to examine effective and cost-effective interventions to promote and sustain social connections in the elderly; and what resources are required to implement effective and cost-effective interventions. This will help guide commissioning decisions and shape future research priorities. This evidence review will focus on older people identified as being, or at risk of being, socially isolated and/or lonely and include interventions aimed at reducing or preventing loneliness or social isolation, including those which rely on technology.

 

NIHR also invests significantly in Mental Health research. This includes research infrastructures that focus on mental health research, such as the NIHR Mindtech MIC, the NIHR Oxford Health BRC and the NIHR Maudsley BRC. In addition, a number of NIHR supported centres, facilities and collaborations have dedicated mental health themes such as the ‘Mental Health and Technology’ research theme within the NIHR Nottingham BRC, which is exploring development of new technologies to transform mental healthcare.

 

 

  1. What are the barriers to the development and implementation of these various technologies (considered in questions 5-7)?

a)   What is needed to help overcome these barriers?

b)   To what extent do socio-economic factors affect access to, and acceptance of, scientific advice and use of technology by older people and those who care for them?

 

The UK has a world-leading health service and a strong regulatory environment, with a global reputation for research and innovation. We boast four of the world’s top ten biomedical universities, and our scientific research accounting for 18% of the most-cited publications in life sciences. Through the implementation of the Life Sciences Industrial Strategy, we are continuing to build on these strengths to ensure we continue to develop the technologies needed for healthy ageing. These actions are set out in our response to question 10.

 

However, this doesn’t always translate into patients being able to access the best new treatments, including those that support healthy ageing, at the speed or to the level we would hope for. There are a number of recognised barriers which exist at various stages in the product development pipeline. The Government is already acting to tackle a number of these across all technologies, implementing the ambitions set out in the life science industrial strategy and Accelerated Access Review (AAR)

 

Ensuring Access to finance for small-medium innovative Life Sciences companies

 

The Life Sciences Industrial Strategy (LSIS) and HM Treasury’s Patient Capital Review identified that despite a history of great UK science, it has historically been challenging to scale life sciences businesses in the UK because of issues in accessing the right sort of finance, particularly a lack of available ‘patient’, or long term, capital as a barrier to growth for innovative companies. In response, HM Treasury published an action plan to release over £20bn of patient capital investment by 2027. This includes the establishment of the £2.5bn GBP Patient Capital Fund. The Office for Life Sciences is also developing a complementary programme to address sector specific issues in accessing finance. These include a lack of specialist investing expertise in the sector. Again, the Office for Life Sciences’ aims to identify opportunities to develop this specialist talent pool, working in close partnership with the private investment community.

 

Barriers to Implementation

 

In 2016, the independent AAR was published. The report identified several barriers to implementing new innovations. These were:

i)                   fragmentation across the system, i.e. lack of join-up between partners in bringing new treatments to market,

ii)                 a lack of effective demand signalling, and horizon scanning to develop and identify the key technologies that would transform the NHS, and

iii)               a lack of government support on the adoption of new technology into the NHS.

 

To address these issues, the government has established and expanded the Accelerated Access Collaborative (AAC), which brings together leaders from across government, the NHS and industry to tackle barriers to patient access. The AAC partners have set out an ambitious set of priorities to deliver a wide-ranging set of improvements to the innovation ecosystem, including:

 

 

These improvements have already begun to translate into real examples of faster adoption of the best new innovations, including those which support healthy ageing and the treatment of age-related diseases. For example, the AAC is providing bespoke support for 12 key products which have the potential to benefit up to 500,000 patients and save the NHS up to £30m by increasing their use.

 

One of the 12 products receiving support is HeartFlow, a new technology which helps clinicians diagnose coronary heart disease without invasive surgery. The product benefits frail patients by greatly reducing unnecessary invasive testing and providing peace of mind through improved diagnosis. Through government support it has been adopted across 34 NHS sites, saving the NHS an estimated £700,000 or £214 per patient.

 

Public involvement in research is defined as research that is carried out ‘with’ or ‘by’ members of the public rather than ‘to’, ‘about’ or ‘for’ them. It is an essential part of the process by which research is identified, prioritised, designed, conducted, evaluated and disseminated. Since its inception in 2006, the NIHR has been ground-breaking in that it has funded and supported expertise to advance, promote and support the engagement, involvement and participation of patients, carers and the public – improving the reach, quality and impact of its research.

 

The NIHR Older People and Frailty Policy Research Unit will carry out a rapid evidence synthesis to look at whether digital technologies improve access to health and social care across age groups; and what the characteristics are of effective digital interventions which increase access for older adults. If the evidence allows, it will look to see if there are differences across the older age population according to socio-economic status. The aim is to help identify any gaps in current digital intervention approaches, and to provide a better understanding of the utilisation of these interventions by older people and the extent and nature of support needed for further implementation of policy goals to improve access to health and care technology for older adults.

 

The key barriers to the development and implementation of assistive technologies include:

-          Consumer awareness and demand for products and services

-          Interoperability of systems and data across health and care

-          Access to infrastructure for individuals and in health and care organisation, including broadband and 5G to help more people be able to access new technologies and so that technologies can use fast, reliable broadband to send and share data

-          Digital skills awareness and training for individuals and across the health and care workforce.

We are making progress in supporting improvements in these areas. Through the Ageing Society Grand Challenge we are fostering new partnerships with industry and driving better consumer awareness to support the development of inclusive, functional and aspirational products that people actively want to buy. As set out in the Government's Vision for Digital, Data and Technology for Health and Care published in October 2018 we are supporting the social care sector to embrace new technology in line with the wider principles of increasing interoperability, data sharing, innovation and improved security.

 

 

Industrial Strategy

 

  1. What opportunities are there for industry in the development of new technologies to help increase health span? In which areas of medical research and technology development does the UK excel?

Through the Industrial Strategy there are several opportunities for industry in the development of new technologies to increase health span, and many of these build on areas of research and development in which the UK has strengths.

 

The Industrial Strategy sets out the Government’s long-term plan to boost productivity. This includes a focus on Grand Challenges in Artificial Intelligence and Data Economy, Clean Growth, Future of Mobility and Ageing Society. These are society-changing opportunities and industries of the future where the UK can build on its strengths and lead the global technological revolution.

 

The UK population is ageing but we often talk about ageing populations as a problem leading to increasing costs for health and care services. For the individual, we assume getting older means frailty, decline and inactivity. The reality is that living longer is an opportunity and our focus now should be on ensuring we are matching longevity of life with improved quality of life. We must also think about what it means to be an ageing society, and so there are implications for everyone and not just the ageing population.

 

This is why the Government has chosen an Ageing Society as one of its four Grand challenges in its Industrial Strategy. This is an area where we need to think through the opportunities for economic growth that are prompted by these demographic changes

 

Delivering this Grand Challenge will require many interventions, across many agencies, from health and care, to housing and work, at a national and a local level. We want people of all ages to lead fuller, healthier and more active lives; we also want to support a new generation of businesses to thrive in the growing global market for products and services that support healthy ageing. There are huge opportunities: the over-50s account for 76% of the UK’s financial wealth and nearly half of all consumer spending. In 2015, there was an estimated baseline value of €3.7 trillion for Europe’s Silver Economy, primarily comprising private expenditure by older people (50 plus) on various goods and services, from housing to recreation. This shows there are significant markets for well-designed products and services in the areas such as connected health, tourism and smart home solutions[64].

 

To meet our ambition to become​​ the world's most innovative economy, we are driving change by increasing public investment in R&D, by ensuring the UK is the best place for innovators, and by using the Grand Challenges to drive partnerships between the best scientific and business talent across the UK. So far, we have allocated £2.4bn to strategic research programmes through the Industrial Strategy Challenge Fund. This includes investing £197 million for first-of-a-kind technologies for the manufacture of medicines to accelerate patient access to new drugs and treatments; £98 million to stimulate well-designed innovations to support healthy ageing; £210 million in Data to Early Diagnostics and Precision Medicine. Other initiatives that support industry opportunities include: allocating nearly £1.2bn of funding to the Catapult network to help businesses transform high potential ideas into new products and services and raising the main rate of the R&D tax credit to 12%.

 

The AI & Data Grand Challenge is also supporting the development of technologies to help increase health span. The UK has been a global top three participant in the development of AI technologies in the last decade. AI adoption has the potential to contribute £200bn or 10% of UK GDP by 2030. In May 2018 we announced the first mission for this Grand Challenge: “Use data, Artificial Intelligence and innovation to transform the prevention, early diagnosis and treatment of chronic diseases by 2030”.

 

In December 2018, we announced five Centres of Excellence in digital pathology and imaging with AI, supported by an initial £50m Industrial Strategy Challenge Fund investment. The Centres’ work will lead to more intelligent analysis of medical imaging and pathology data, and the development of new innovative ways of using AI to speed up diagnosis of diseases; improve outcomes for patients; and free up more NHS staff time for direct patient care. A further £50m from DHSC will be made available through an Innovate UK led competition this Autumn.

 

Success in this mission is one of a number of steps towards saving lives and increasing NHS efficiency by enabling earlier diagnosis and reducing the need for costly late stage treatment. The opportunity - working with academia, the charitable sector, and industry and harnessing the power of AI and data technologies - is considerable. It should lead to a whole new industry of diagnostic and tech companies which would drive UK economic growth.

 

Through the implementation of the Industrial Strategy more broadly we are continuing to support our strengths in innovative research, including committing to increased funding for scientific research, with a stated aim of R&D being 2.4% of GDP by 2027.

 

We are driving change by ensuring the UK is the best place for innovators and using the Grand Challenges to drive partnerships between the best scientific and business talent across the UK. So far, we have allocated £2.4bn to strategic research programmes through the Industrial Strategy Challenge Fund. We have also allocated nearly £1.2bn of funding to the Catapult network to help businesses transform high potential ideas into new products and services and raising the main rate of the R&D tax credit to 12%.

 

We are building on the UK’s position as a strong and growing global hub for life sciences with close to a quarter of a million jobs in the sector and almost £74bn in turnover annually, making it a crucial pillar of the UK economy. The sector has a history of high performance, with turnover and employment growing by 3% and 8% respectively between 2009 and 2018 and turnover growing by almost £1b (£0.8bn) in the last year alone.

 

The UK also has four of the global top ten biomedical universities in Oxford, Cambridge, Imperial and UCL, and a strong life sciences cluster in the South East of England in the ‘Golden Triangle’.

 

UK public and private research institutions are world-renowned with a strong legacy of ground-breaking research and draw significant investment. These institutes continue to support innovative developments, with the Lab for Molecular Biology receiving both the 2017 and 2018 Nobel Prizes in Chemistry, and with the Wellcome Sanger and The Francis Crick institutes continuing the work started by their namesakes.

 

The Life Sciences Sector Deals also continue to deliver improvements to our clinical research offer including:

 

 

The Government’s partnership approach with industry and academia through the Life Sciences Industrial Strategy and the Sector Deals has allowed the UK to convert its expertise into world leading programmes that support increasing health span. Particular areas of opportunity include data, genomics, and advanced therapies.

 

The UK has arguably the best quality patient data in the world, providing rich, whole life scale data for approximately 65 million people. By establishing NHSX, Government is committed to supporting access to this data for research which will support biomedical discovery science. The Office for Life Sciences’ Digital Innovation Hubs programme is aiming to establish centres that are being primed to facilitate commercial access to high quality, curated data sets on specific diseases. NHSX's work to deliver the Early Diagnosis Mission and establish an AI lab will also support work with industry to put the UK at the forefront of the use of AI and data in early diagnosis, innovation, prevention and treatment.

 

We also believe that Advanced Therapy Medicinal Products (ATMPs) are a key growth area for the future. In the first Life Sciences Sector Deal, the government committed £162m to develop the manufacturing infrastructure for innovative medicines and enable small and medium-sized businesses to produce advanced therapies. This enabled the creation of two new national centres and three Advanced Therapy Treatment Centres. We also invested £12m on the expansion of the Cell & Gene Therapy Catapult Manufacturing Centre in Stevenage. By building on our existing infrastructure supporting cell and gene therapy, these investments will make the UK a uniquely attractive location for complex medicines manufacturing and support our ambition to become a leading hub for advanced therapy manufacturing. Companies are recognising this, and the recent ‘Leading Innovation: The UK’s ATMP Landscape’ report states that ‘the UK is the leading source of innovation and development of ATMPs in Europe’, with 24% of ATMP developers in Europe headquartered in the UK and rapid growth in the industry since 2012.

 

The UK is a world leader in genomics science and its application to healthcare. Building on recent advances realised through UK BioBank, the clinical implementation of this approach will be pioneered at scale in the new Accelerating Detection of Disease (ADD) challenge, which aims to recruit up to 5 million healthy participants into a world-leading research cohort in order to shed new light on the detection and treatment of common diseases. A key part of the ADD challenge will be to offer as many participants as possible their PRS. Individuals will volunteer their genetic information, which will be used in accordance with relevant legislation, regulation and good practice guidance on use of data, in order to develop and improve the evidence base for the use of PRS.

 

The goal of the ADD challenge will be to support research, prevention and treatment across major chronic diseases, including cancer, dementia, heart disease and mental health conditions. The project will seek to enrol under-represented groups, such as ethnic minorities, to enable a better understanding of disease and preventative measures for every individual in society and reduce existing health inequalities. The project brings together the NHS, industry and leading charities including Cancer Research UK, the British Heart Foundation and Alzheimer’s Research UK. It will be the largest ever study of its kind, collecting a broad range of data from healthy volunteers over many years.

 

 

  1.         What more is required for the UK to benefit from commercialisation of its discoveries and inventions relating to healthy ageing, as envisioned by the Government’s Industrial Strategy?

We recognise the need to be able to capture the value from our science, research and creativity and support innovations that drive our productivity. We want to increase engagement between universities and business, to help ensure that the UK’s excellence in discovery is more consistently translated into its application in industrial and commercial practices, and so into increased productivity. UKRI have primary responsibility for development of policies to support research commercialisation and broader knowledge exchange activities. Recent developments include:

 

  1.   Industrial Strategy Challenge Fund (see question 9).
  2. Development of a Knowledge Exchange Framework to assess university performance in knowledge exchange by Research England. This new framework will encourage effective university external engagement and complement the Research and Teaching Excellence Frameworks. The framework will be augmented by a concordat, which outlines key knowledge exchange principles and implementation advice (including greater transparency on policies and expectations for academics, business and investors).
  3. The £100m Higher Education Innovation Fund Connecting Capability Fund over 2017-21, which supports universities to collaborate together in research commercialisation and working with business, has already leveraged benefits in the life sciences: four of the fourteen projects funded will specifically focus on supporting commercialisation of research in medical technology, advanced therapies, and antimicrobial resistance. Such research areas have high importance to healthy ageing.
  4. Catapult network: The Catapult network is working with industry and universities to support the development and commercialisation of innovative new products and processes.

 

We start from a strong base. UK University research commercialisation is internationally competitive – between 2013-2017, the UK was home to five of the top ten universities in the world by capital raised by their spinout companies, with Cambridge being ranked first in the world. This has been noted in the life sciences context by the House of Lord’s 2018 report ‘Life Sciences Industrial Strategy: Who’s driving the bus?’ which concluded that “The UK was highly praised… for business-university collaboration” and performs well at translating basic research into innovation.

 

Research England has recently published independent advice from Mike Rees on UK University Investor Links in July 2019. This concluded that there is positive momentum in the UK system and that policies are having a positive impact. The advice says that the UK ecosystem is developing but it is not consistent or being leveraged to the full and includes a note of concern about introducing new initiatives as opposed to focusing and streamlining.

 

The 2018 House of Lord’s report ‘Life Sciences Industrial Strategy: Who’s driving the bus?’ noted that despite successes in commercialisation, more could be done to support early-stage spin-out life sciences companies and identified gaps in funding for such companies. For instance, a 2017 report by the Association of the British Pharmaceutical Industry identified insufficient venture capital investment in early stage companies, due to the high risk at this stage.

 

Acknowledging the importance of venture capital in company growth, including ‘academic capital’ - funds that focus on commercialising academic research - the Office for Life Sciences are leading a programme of work to further address issues faced by innovative small-medium life sciences companies in accessing the finance and support they need to grow.

 

Finally, through the Ageing Society Grand Challenge we want to lead the world in the development of health and care products and services that support better ageing; taking measures to reframe the market for age-related products and services to unlock domestic and global market opportunities

 

We have identified several demand and supply side barriers that mean there is still a dearth of products and services in the consumer market that meet the desires and aspirations, as well as the needs, of an older population.

 

We need to do more to challenge the deep-rooted stereotypes around ageing and to ensure the diverse needs of older people are recognised. Too many products for older people are designed in a way which is “medicalised” and stigmatising – for instance, unattractive grab rails. There is also a strong association of ageing with ill health and decline, by both producers and consumers, leading to a focus on products and services focused on treatment and management of severe declines in capacity, rather than prevention or earlier mitigation. We need to move from a medical dependency market, to a mainstream consumer market by taking a more inclusive approach to designing products, services and technologies for older people. The concepts are simple, but at the heart of the work is a deep and serious engagement with individuals about what they want, need and desire.

 

Finally, we need businesses and innovators to understand the market opportunity and not equate ageing with the very old who have care needs, but rather with the larger number of ‘healthy or the wider population’ who may want different products and services.

 

 

Healthier Ageing

 

  1.         How feasible is the Government’s aim to provide five more years of health and independence in old age by 2035?

a)   What strategies will be needed to achieve the Government’s aim?

b)   What policies would be required, and what are their potential costs and benefits?

c)    Which organisations need to be involved?

d)   Who should lead the work?

 

How feasible is the Government’s aim to provide five more years of health and independence in old age by 2035?

 

The Industrial Strategy set four Grand Challenges to put the country at the forefront of the industries of the future. They are areas where the best from public and private sector will come together to respond to seismic global trends, build on existing UK strengths and embrace the technological advances, so we can take advantage of new markets, improve people’s lives and the country’s productivity.

 

The Ageing Society Grand Challenge (ASGC) looks to harness the power of innovation to help meet the needs of an ageing society. In 2015, there were around 901 million people aged 60 years and over worldwide, representing 12.3% of the global population. By 2050, it will have increased to 2.1 billion or 21.3% of the global population[65].

 

To galvanise activity, we are taking a new mission-oriented approach. We are working with industry and society to set bold, targeted goals to focus national efforts on solving the most intractable problems within our Grand Challenges and exploiting the biggest opportunities. Missions are a different ​way of doing policy. We are aiming for transformational, not incremental, change, driven by innovation, and delivered with business and wider society, with goals that inspire people. ​

 

In May 2018, we announced the ASGC mission: “Ensure that people can enjoy at least five extra healthy, independent years of life by 2035, whilst narrowing the gap between the richest and the poorest”. This is defined by an increase of five years in disability-free life expectancy (DFLE) at birth for both males and females by 2035 (which would be based on data covering the period 2033-2035), compared to the UK baseline of 62.5 years for males and 62.1 years for females in the years 2014-16.

 

DFLE is a measure of the average number of years a person can expect to live without a limiting longstanding illness or disability. This includes physical or mental health conditions or illnesses that are expected to last 12 months or more, and when taken singly or together, substantially limit the ability to carry out normal day-to-day activities. It is calculated by combining survey data on the prevalence of limiting longstanding disability or illness with measures of current mortality. It is averaged over a three-year period and calculated separately for males and females. DFLE is a National Statistic, produced independently by the Office for National Statistics (ONS). It is available for the constituent countries of the UK at local authority level and by national deprivation deciles.

 

In terms of setting the ambition of 5 extra years by 2035, we have been deliberately ambitious. Past data shows that in the period of greatest improvement (2000-2010), there was an improvement in DFLE at birth of around four years for men and two year for women. The analysis we have completed indicates that 5 extra years by 2035 is a reasonable target, but it is at the upper end of what we have seen delivered historically or in other countries and will require sustained effort not only from government and the health and care system but across all of society.

 

Since the launch of the Ageing Society Grand Challenge mission, the mission has been recognised and amplified by a number of organisations that are also looking to make significant changes in the healthy ageing area including the Centre for Ageing Better and the all Party Parliamentary Group on Longevity. The mission is also at the heart of the recently published prevention Green Paper, Advancing our Health: Prevention in the 2020s.

 

  1. What strategies will be needed to achieve the Government’s aim?
  2. What policies would be required, and what are their potential costs and benefits?
  3. Which organisations need to be involved?
  4. Who should lead the work?

Foresight’s Future of an Ageing Population report [66] set out how demographic change will affect the whole country and highlighted the importance of a co-ordinated response not only between Government departments, due to the inter-connectedness of policies affected by ageing, but also collaboration across national and local government, industry, businesses, civil society and with citizens.

 

There is already significant work underway across Government in response to the demographic trends from improving labour market participation among older workers to promoting active travel.

 

Through the Ageing Society Grand Challenge, led by the Department of Health and Social Care, we want people of all ages to lead fuller, healthier and more active lives; whilst supporting a new generation of businesses to thrive in the growing global market for products and services that support older people. These could be anything from home appliances like eye-level ovens and walk-in showers, to the use of new technologies such as AI and robotics.

 

We have identified where we can supplement this existing activity and will focus on these four pillars to deliver the mission:

 

 

In developing our approach to mission delivery, we are considering the following key principles.

 

This is not just about supporting older people. We are taking a whole life course approach which focuses on how everyone extends healthy life expectancy, mirroring the focus of the Prevention Green Paper.

 

We need to shift perceptions of old age to create a more positive narrative around longevity. The current ‘narrative of decline’ around growing older characterises older people as frail, ill and dependent. These negative perceptions are solidified by the portrayal of older people in the media, such that the European Social Survey found people aged 70 and over are perceived as contributing relatively little to the economy and a burden on health services[67]. Negative perceptions can precipitate a reluctance to prepare and therefore failure to adapt to an ageing society. Shifting the public’s perception of older people is crucial to ensure that civil society understands living longer will affect us all and we need to improve quality of life to match this. Building on the concept of a ‘100 year life’, civil society must start to treat ageing as an opportunity as opposed to a challenge.

 

There are major opportunities for technology and innovation to influence how we age. To make an impact across the population we need to focus very strongly on design and be able to articulate a solution’s benefit which resonate positively with people (e.g. smart homes to support convenience rather than assistive technology).

 

We must target inequalities as part of the work, being clear that regardless of socio-economic status, everyone benefits from the opportunities longevity and new technologies and innovations provide. There is significant variation in how the regions are ageing and the resulting demands for product and services and local industrial strategies present an excellent opportunity to address inequalities.

 

Delivering the mission will require complex systems thinking across a number of policy areas across Government including housing, place, financial support, workforce as well as health and care. It will require working with data and technology, local industrial strategies and behaviour change sitting across the whole.

 

The ASGC team in DHSC is leading this Grand Challenge, works closely with several Government departments on this cross-cutting agenda. For example, we are working with BEIS, which leads on the Clean Growth Grand Challenge and the Ministry of Housing, Communities and Local Government, which leads on housing policy, to launch a new design and innovation competition later this year that will support both the Clean Growth and Ageing Society Grand Challenges. This will prototype the homes of the future - built to a standard suitability for changing needs across a lifetime whilst also being environmentally sustainable.

 

We are building UK business awareness of the longevity economy and age- diverse workforce and recently announced Andy Briggs as the Business Champion for the Ageing Society Grand Challenge and the establishment of the UK’s Longevity Council which will provide independent advice to the Secretary of State for Health and Social Care on the implications of demographic change for the UK and help deliver the Grand Challenge.

 

We have invested in the UK Longevity Ecosystem providing £40m jointly with Newcastle University for a new National Innovation Centre for Ageing (NICA) to develop innovations that support healthy ageing, and are investing £98m in innovation and technology to support healthy and independent living through the ISCF Healthy Ageing Programme. NICA is a key delivery partner to the Ageing Society Grand Challenge.

 

We are supporting local places through Local Industrial Strategies to address the opportunities and challenges of an ageing society and building research and innovation collaborations with international partners.

 

 

  1.         To what extent are inequalities in healthy ageing, as well as differences in acceptance of technologies, a barrier to achieving the aims of the Government’s Ageing Society Grand Challenge?

 

It is important to recognise that the mission to reduce inequalities, and improve health, is not simply through the Ageing Society Grand Challenge. The requirement for public authorities to do so is set out in statutory duties as below:

 

We want everyone to have the same opportunity to have a long and healthy life, whoever they are, wherever they live and whatever their social circumstances. Reducing health inequalities requires systemic action within the health and care system, across government and at the local level to:

 

We know there is a clear social gradient to healthy life expectancy. People in deprived areas tend not only to live shorter lives, but they also spend more of those years in poor health. For example, women living in the 10% most deprived areas can expect to live 18 fewer years in good health than those in the 10% least deprived areas[70].

 

Inequalities also exist across a range of other dimensions, including ethnicity, gender, sexuality and having a disability. The underlying causes of these inequalities often cluster together, with people experiencing 'multiple disadvantage'. There are also certain groups who experience poorer health outcomes than the wider population, such as people sleeping rough, leaving care, and offenders in prison or in the community.

 

Research by The King’s Fund in 2012 showed that unhealthy behaviours cluster in the population[71] and that in 2008, people with no qualifications were more than five times as likely as those with higher education to engage in all four poor behaviours[72]. These unhealthy behaviours are tobacco use, alcohol consumption, unhealthy diet and lack of physical activity. This is important because having three or four of these behaviours increases the risk of early death and disease, thus affecting health span.

 

In addition, we know that we should be investing in our health throughout life – from early years, through to older age. But some people find this easier than others. Not because of innate differences in their decision-making, skills or values, but due to differences in the circumstances they are born into and the conditions in which they live. We believe that everybody has the right to a solid foundation on which to build their health. Nowhere is this clearer than the early years.

 

This is why, to help deliver the Ageing Society Grand Challenge mission, we have:

 

 

  1.         What would be the implications of a paradigm shift to people leading healthier lives for longer, and spending less time suffering ill health? For example:

 

As we set out in the Industrial Strategy, there are significant opportunities for the UK from an ageing society. Through the Ageing Society Grand Challenge, we are using the power of innovation to meet the needs an ageing society and to put the UK at the forefront of these industries of the future.

 

Whilst it is not always possible to predict the future, we know from the demographic data that the UK population is ageing, and this provides both challenges and opportunities for individuals, services, society and the economy. It is likely we will see rising levels of obesity, mental illness, age-related conditions like dementia, and a growing, ageing and diversifying population, often living with multiple, long-term conditions such as diabetes, asthma and arthritis. The UK’s workforce will be more multi-generational, older and with higher levels of female participation[73][74].

 

The Ageing Society Grand Challenge mission is for everyone to enjoy five extra healthy, independent years of life by 2035 while reducing the gap between the richest and poorest. This is a stretching ambition. It will need government to work in partnership with industry, academia and the third sector. But achieving it will transform ageing in the UK – from something people fear into something we all celebrate. If we take action:

 

 

 

 

18 September 2019

 

ANNEX A – Examples of innovative pathfinder projects already underway working to use technology to improve health outcomes

 

 


ANNEX B – Implementation in the Health System: Accelerated Access Review & Collaborative

 

The UK has a world-leading health service and a strong regulatory environment, with a global reputation for innovation. However, this doesn’t always translate into patients being able to access the best new treatments at the speed or to the level we would hope for.

 

In 2016, the independent Accelerated Access Review (AAR) was published. The report identified several issues that needed to be tackled if we were to increase, or speed up, patient access to new innovations. These issues were defined as: i) fragmentation across the system, i.e. lack of join-up between partners in bringing new treatments to market, ii) a lack of effective demand signalling and horizon scanning, and iii) government support overly focusing on the development of health products, rather than supporting their implementation.

 

The Government published its response to the AAR in 2017, which included key commitments to improve patient access. Since its publication, we have made a host of key improvements to NHS and patient access to the best new technologies and treatments, including:

 

 

These improvements have already begun to translate into real examples of faster NHS adoption of the best new innovations, including those which support healthy ageing and the treatment of ageing related diseases. For example:

 

40

[1] CO and DHSC. Advancing our health: prevention in the 2020s. 2019. https://www.gov.uk/government/consultations/advancing-our-health-prevention-in-the-2020s/advancing-our-health-prevention-in-the-2020s-consultation-document

[2] Adapted from McGinnis J., Williams-Russo P., Knickman J.R. (2002) 'The case for more active policy attention to health promotion'

[3] Canadian Institute of Advanced Research (2002), quoted in Kuznetsova, D. (2012) 'Healthy places: Councils leading on public health'

[4] PHE. Health Matters: Prevention – a life course approach. 2019. https://www.gov.uk/government/publications/health-matters-life-course-approach-to-prevention/health-matters-prevention-a-life-course-approach

[5] PHE. Expanded Interventions Table for Health Matters Prevention: a Life Course Approach. 2019. https://app.box.com/s/cp00ik11ac0d52rz6y2onffo10f8zi8m/file/459568258055

[6] "Institute for Health Metrics and Evaluation (IHME). GBD Compare. Seattle, WA: IHME, University of Washington, 2015. Available from http://vizhub.healthdata.org/gbd-compare (viewed 19/06/19)

Bull, FC. and the Expert Working Groups (2010) 'Physical Activity Guidelines in the UK: Review and Recommendations'

[7] Marteau, T.M. et al. Increasing healthy life expectancy equitably in England by 5 years by 2035: could it be achieved? The Lancet, 2019. Vol 393, issue 10191. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31510-7/fulltext

[8] Steel, N. et al (2018) 'Changes in health in the countries of the UK and 150 English Local Authority areas 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016'

[9] Institute for Health Metrics and Evaluation (IHME). GBD Compare. Seattle, WA: IHME, University of Washington, 2015. Available from http://vizhub.healthdata.org/gbd-compare (viewed 19/06/19) Percentage of total years lived with disability in England by level 2 cause (all ages, both sexes) - 2017

[10] NHS Digital (2015) 'Health Survey for England 2014'
NHS Digital (2016) 'Adult Psychiatric Morbidity Survey: Survey of Mental Health and Wellbeing, England, 2014'
This estimate reflects the balance of evidence across both the Health Survey for England and the Adult Psychiatric Morbidity Survey.

[11] NHS Digital (2015) 'Health Survey for England 2014'
Please note that these are self-reported diagnoses of mental health issues. The 2014 Adult Psychiatric Morbidity Survey further shows that 1 in 6 adults had a common mental disorder. This covers depression, generalised anxiety disorder (GAD), panic disorder, phobias, obsessive compulsive disorder (OCD), and common mental disorders not otherwise specified (CMD-NOS).

[12] NHS Digital (2015) 'Health Survey for England 2014'
NHS Digital (2016) 'Adult Psychiatric Morbidity Survey: Survey of Mental Health and Wellbeing, England, 2014'

[13] NHS Digital (2015) 'Health Survey for England 2014'
NHS Digital (2016) 'Adult Psychiatric Morbidity Survey: Survey of Mental Health and Wellbeing, England, 2014'

Chakraborty, A. et al (2011) 'Mental health of the non-heterosexual population of England'. Journal of Psychiatry, 198, 143–148.

[14] Department for Work and Pensions and Department of Health and Social Care (2017) 'Thriving at work – The Stevenson / Farmer review of mental health and employers'

[15] Chesney, E., Goodwin, G.M. and Fazel, S. (2014) 'Risks of all-cause and suicide mortality in mental disorders: a meta-review' World Psychiatry 13:2.

[16] Department of Health and Social Care (2014) 'Annual Report of the Chief Medical Officer 2013 - Public Mental Health Priorities: Investing in the Evidence'
Royal College of Psychiatrists (2010) 'No health without public mental health'

[17] PHE. Commissioning Cost-Effective Services for Promotion of Mental Health and Wellbeing and Prevention of Mental Ill-Health. 2017. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/640714/Commissioning_effective_mental_health_prevention_report.pdf

[18] PHE. Collection: Public mental health. 2018. https://www.gov.uk/government/collections/public-mental-health

[19] DCMS. A connected society: a strategy for tackling loneliness. 2018. https://www.gov.uk/government/publications/a-connected-society-a-strategy-for-tackling-loneliness

[20] PHE. Public Health Outcomes Framework. https://fingertips.phe.org.uk/profile/public-health-outcomes-framework

[21] PHE. All Our Health: about the framework. 2015. https://www.gov.uk/government/publications/all-our-health-about-the-framework

[22] PHE. Local health and care planning: menu of preventative interventions. 2016. https://www.gov.uk/government/publications/local-health-and-care-planning-menu-of-preventative-interventions

[23] PHE. Productive Healthy Ageing Profile. 2019. https://fingertips.phe.org.uk/profile/healthy-ageing

[24] Ipsos Mori and The Centre for Ageing Better. The Perennials: The future of ageing. 2019. https://www.ipsos.com/sites/default/files/ct/publication/documents/2019-02/ipsos-perennials.pdf

[25] University of Wisconsin-Madison Population Health Institute. 2016. County Health Rankings & Roadmaps Model [Online]. Wisconsin-Madison: UWPHI. http://www.countyhealthrankings.org/our-approach; PGP - https://www.gov.uk/government/consultations/advancing-our-health-prevention-in-the-2020s/advancing-our-health-prevention-in-the-2020s-consultation-document 

[26] National Institute for Health and Clinical Excellence. Behaviour Change: Individual Approaches. Public Health Guidance 49. 2014. https://www.nice.org.uk/guidance/PH49

[27] PHE. Improving people’s health: applying behavioural and social sciences to improve population health and wellbeing in England. 2018. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/744672/Improving_Peoples_Health_Behavioural_Strategy.pdf

[28] Pearson-Stuttard, J., Murphy, O. & Davies, SC. 2019. A new Health Index for England: The Chief Medical Officer's 2018 annual report. Lancet, 393, 10-11.

[29] PHE. Models of delivery for stop smoking services: Options and evidence. 2017. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/647069/models_of_delivery_for_stop_smoking_services.pdf

[30] NICE. Workplace policies for Smoking Cessation. 2006. https://www.nice.org.uk/guidance/ng92/evidence/workplace-policies-for-smoking-cessation-pdf-4788923442

[31] NICE. Alcohol-use disorders: diagnosis and management. 2011. https://www.nice.org.uk/guidance/qs11

[32] PHE. Guidance: Alcohol commissioning support 2019 to 2020: principles and indicators. 2018. https://www.gov.uk/government/publications/alcohol-drugs-and-tobacco-commissioning-support-pack/alcohol-commissioning-suport-pack-2018-to-2019-principles-and-indicators#effective-population-level-actions-to-reduce-alcohol-related-harms

[33] NICE. Behaviour change: individual approaches. 2014. https://www.nice.org.uk/guidance/ph49/chapter/1-Recommendations

[34] NHS. NHS Health Check. 2019. https://healthcheck.nhs.uk/

[35] Alageel, S., and Gulliford, M. Health checks and cardiovascular risk factor values over six years’ follow up: Matched cohort study using electronic health records in England. PLOS Medicine. 2019. https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002863

[36] NHS. NHS Health Check e-bulletin – July 2018. https://www.nhshealthcheck.nhs.uk/nhs-health-check-e-bulletin-july-2018/front-page/nhs-health-check-e-bulletin-july-2018.

See also: PHE. NHS Health Check. 2018. https://fingertips.phe.org.uk/profile/nhs-health-check-detailed

[37] PHE. All Our Health: personalised care and population health. 2019. https://www.gov.uk/government/collections/all-our-health-personalised-care-and-population-health

[38] Leeds Health and Wellbeing Board. Falls Preventions, the Leeds Approach. 2017. https://www.yhphnetwork.co.uk/media/1112/a-physical-activity-approach-in-making-leeds-fall-proof.pdf

[39] PHE. Health Inequalities in ageing in rural and coastal areas. 2019. https://www.gov.uk/government/publications/health-inequalities-in-ageing-in-rural-and-coastal-areas

[40] Food for Life. Older People. 2019. https://www.foodforlife.org.uk/older-people

[41] NIHR. Ageing programme. 2019. https://sphr.nihr.ac.uk/category/research/ageing/

[42] Amsterdam. Amsterdam Healthy Weight Programme. 2019. https://www.amsterdam.nl/sociaaldomein/blijven-wij-gezond/amsterdam-healthy/#h4833d5da-5599-40a8-8f60-1bd352624c3b

[43] Centre for Active Design. 2019. https://centerforactivedesign.org/

[44] Heart Foundation. Healthy Active by Design. 2018. http://www.healthyactivebydesign.com.au

[45] The Academy of Medical Sciences. Multimorbidity: a priority for global health research. 2018. https://acmedsci.ac.uk/file-download/82222577

[46] CO and DHSC. Advancing our health: prevention in the 2020s. 2019. https://www.gov.uk/government/consultations/advancing-our-health-prevention-in-the-2020s/advancing-our-health-prevention-in-the-2020s-consultation-document

[47] Adapted from McGinnis J., Williams-Russo P., Knickman J.R. (2002) 'The case for more active policy attention to health promotion'

[48] Canadian Institute of Advanced Research (2002), quoted in Kuznetsova, D. (2012) 'Healthy places: Councils leading on public health'

[49] PHE. Health Matters: Prevention – a life course approach. 2019. https://www.gov.uk/government/publications/health-matters-life-course-approach-to-prevention/health-matters-prevention-a-life-course-approach

[50] PHE. Expanded Interventions Table for Health Matters Prevention: a Life Course Approach. 2019. https://app.box.com/s/cp00ik11ac0d52rz6y2onffo10f8zi8m/file/459568258055

[51] PHE. Health Matters: Prevention – a life course approach. 2019. https://www.gov.uk/government/publications/health-matters-life-course-approach-to-prevention/health-matters-prevention-a-life-course-approach

[52] Public Health England. Tools to Support ‘Place-based approaches for reducing health inequalities’.2019. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/825133/Tool_A.pdf

[53] Public Health England. Strategic Plan for the next four years: better outcomes by 2020. 2016. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/516985/PHE_Strategic_plan_2016.pdf

[54] Health Profile for England: 2018, Public Health England https://www.gov.uk/government/publications/health-profile-for-england-2018/chapter-5-inequalities-in-health

[55] Office for National Statistics. Adult smoking habits in the UK: 2017. 2017. file://ims.gov.uk/data/Users/GBBULVD/BULHOME30/SBodanis/Downloads/Adult%20smoking%20habits%20in%20the%20UK%202017.pdf

[56] Productive Healthy Ageing Profile, Public Health England https://fingertips.phe.org.uk/profile/healthy-ageing

[57] BRE (2016) The cost of poor housing to the NHS https://www.bre.co.uk/filelibrary/pdf/87741-Cost-of-Poor-Housing-Briefing-Paper-v3.pdf

[58] Productive Healthy Ageing Profile, Public Health England https://fingertips.phe.org.uk/profile/healthy-ageing

[59] https://www.ageing-better.org.uk/news/work-and-health-later-life

[60] Centre for Ageing Better. Volunteering for a better later life, 2017. https://www.ageing-better.org.uk/news/volunteering-better-later-life

[61] Productive Healthy Ageing Profile, Public Health England https://fingertips.phe.org.uk/profile/healthy-ageing

[62] PHE (2018) Health Profile For England
https://www.gov.uk/government/publications/health-profile-for-england-2018/chapter-6-wider-determinants-of-health
Cutler and Lleras-Muney (2006) Education and health: evaluating theories and evidence
https://www.nber.org/papers/w12352.pdf?new_window=1

[63] ILC (2015) The links between social connections and wellbeing in later life

[64] European Commission. Silver Economy Study: How to stimulate the economy by hundreds of millions of Euros per year. 2018. https://ec.europa.eu/digital-single-market/en/news/silver-economy-study-how-stimulate-economy-hundreds-millions-euros-year

[65] PHE, Health inequalities: place-based approached to reduce inequalities. 2019. https://www.gov.uk/government/publications/health-inequalities-place-based-approaches-to-reduce-inequalities

[66] Government Office for Science. Future of an Ageing Population. 2016. https://www.gov.uk/government/publications/future-of-an-ageing-population

[67] European Social Survey. Ageism (ESS4 2008). 2008. https://www.europeansocialsurvey.org/data/themes.html?t=ageism

[68] NHS. National Health Service Act 2006. 2006. http://www.legislation.gov.uk/ukpga/2006/41/pdfs/ukpga_20060041_en.pdf

[69] UK Public General Acts. Equality Act 2010. 2010. http://www.legislation.gov.uk/ukpga/2010/15/section/149

[70] The Health Foundation. Creating Healthy Lives. 2019. https://www.health.org.uk/sites/default/files/upload/publications/2019/Creating%20healthy%20lives.pdf ONS. Health state life expectancies by national deprivation deciles, England and Wales: 2015 to 2017. 2019. https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthinequalities/bulletins/healthstatelifeexpectanciesbyindexofmultipledeprivationimd/2015to2017

[71] The King’s Fund. Clustering of unhealthy behaviours over time: Implications for policy and practice, 2012. https://www.kingsfund.org.uk/publications/clustering-unhealthy-behaviours-over-time

[72] The King’s Fund. Clustering of unhealthy behaviours over time: Implications for policy and practice, 2012. https://www.kingsfund.org.uk/publications/clustering-unhealthy-behaviours-over-time

[73] DWP. Fuller Working Lives: evidence base 2017. 2017. https://www.gov.uk/government/publications/fuller-working-lives-evidence-base-2017

[74] Government Office for Science. Future of an Ageing Population. 2016. https://www.gov.uk/government/publications/future-of-an-ageing-population

[75] NHS Digital, Hospital Accident and Emergency Activity, 2018.

[76] ONS, UK Health Accounts: 2016, 2018. This is a UK-wide figure and includes government and non-government expenditure.

[77] Department for Work and Pensions. The macroeconomic impact from extending working lives. 2011. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/214392/WP95.pdf