Northern Health Science Alliance (NHSA) – Written evidence (INQ0053)

About the NHSA

The NHSA is a partnership of ten research-intensive universities, ten leading research NHS Hospital Trusts and the four Academic Health Science Networks of North England, established to improve the health and wealth of the region by building on an internationally recognised life science and healthcare cluster. The NHSA is working to reduce the dramatic inequalities that exist in health outcomes between the North and other regions of the UK.

The NHSA promotes the combined value of its membership to secure inward investment in the Northern health science cluster as a national asset. The NHSA was identified in both the Industrial Strategy and Life Sciences Sector Deal as a successful exemplar of regional strength in health innovation and as a delivery partner for a northern Sector Deal in life sciences.

Consultation response – Ageing: Science, Technology and Healthy Ageing

Scientific basis

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.)?

1. The scientific enquiry into ageing is advanced and UK researchers have made a lot of progress in our understanding of ageing. However, there is still a lot more work to be done.

2. Individual disease states, such as dementia, cancer and stroke, are more well studied than specific research into longevity and healthy ageing. The focus on these diseases has meant there has been less focus on multimorbidity, public health, prevention and determinants of good health in older age.

3. There has also been a lack of joined up understanding between animal models and humans and the effect their experience and/or current environment has on their medical presentation (either through epigenetics or other behavioural components) or between individual differences and medical (or indeed social) intervention.

4. The evidence we have points to the fact that one size does not fit all. However, the solution lies in systemic and multidisciplinary enquiry, the likes of which have never been supported to do before. It also represents a cultural shift to a new way of working that will allow us a pathway to finding out what will work for whom, eventually lessening the burden on the NHS and patients due to unnecessary and often exploratory interventions by targeting the right care to the right people.

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?

1. What are the practical impediments for this advice being acted on?
2. Are there examples of good practice in the UK/devolved nations, or elsewhere?

5. Although the content of public health advice about healthy lifestyles has a reasonably strong evidence base (given limitations in epidemiological-style designs), we know relatively little about how the style and format of the advice influences its reception, nor how their use impacts (or not) behaviour.

6. Exercise and physical activity are integral to healthy ageing, to slow and/or prevent the development of age-related diseases and disability. Population-level change is hindered by a disconnect between how physical activity guidelines are translated and given meaning in everyday life of people as they age. For example, ‘sit less, move more’ messages may bear little relevance to the rhythms of older adults’ lives. They can also exclude and alienate those who, due to various health conditions and impairments (e.g. vertigo, spinal cord injury) might find themselves seeking, or living with stillness[1].

7. The application of implementation science can be useful here. Previously, healthy lifestyle factors have predominantly been outcomes for physical health, disease and disease risk factors, mental health, wellbeing, and quality of life benefits have been under-emphasised.

8. We also need to gain a better understanding of how inequalities inhibit the most vulnerable groups from being able to and wanting to extend their health span, and the economic costs of these issues to the UK more broadly.

9. There is also little discussion of the importance of healthy lifestyle behaviours for their own sake and there has been a missed opportunity to emphasise the pleasure of these activities as part of public health campaigns[2].

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

10. There remains an incomplete understanding of the behavioural and social determinants of health in old age, and of demographic difference. The UK Prevention Research Partnership is funding research to fill this knowledge gap, but it is likely that more will need to be done to keep up with changes in the environment and our understanding of potential determinants.

11. Large cohort studies are making an excellent contribution to strengthening the evidence base concerning links between behavioural/lifestyle determinants and health outcomes, including here body composition, bone density, and clinical outcomes (fracture)[3],[4],[5]. Much research on physical activity in later life overlooks the everyday experiences of the those over 80 years old.

12. It also fails to consider peoples’ lived experiences of how age intersects with other social characteristics (e.g. race, class, sexuality, gender) and the impact of this on their aspirations and ability to age healthily – often while encountering multiple forms of discrimination[6].

13. This is important because it imposes barriers to the development and successful implementation of good policies on ageing and health; influencing the way problems are framed, the questions that are asked and the solutions that are offered[7]. Diverse quantitative and qualitative methodological innovation in gerontological research is enhancing the quality of knowledge about older adults, health, and lifestyle interact[8],[9],[10],[11].

Technologies

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:

• Digital communications for services, social interactions, etc.
• Devices, machines, etc. for daily living in the home
• Transport, infrastructure, services, etc. for involvement in community
• Accessible public spaces
• Smart homes

14. There are a number of technological innovations in an advanced state of readiness for use with older adults, including: accessible digital platforms for service access and data sharing, home-based technologies focusing on health and safety, and communication support. However, research has shown that translation of these technologies from successful efficacy to final stage effectiveness trials is complicated. Where technology has been trialled in naturalistic settings its uptake and benefits are often disproportionately distributed.[12]

15. Those with complex social and economic challenges may find access to, and use of, technological innovations more challenging. Support must be designed in partnership with the target group. A key issue for technology is that access challenges move beyond the physical and economic and so engaging older adults in lifestyle change (in particular, behaviours that impact on health) requires tailored support.[13],[14] Therefore, there is a need to engage behavioural scientists and older adults in early-stage technological development is important to ensure a co-production approach.

16. Given scarcity in the research literature, it is critical that further work is funded to focus on populations excluded from, or who struggle to engage in, standard technology and community delivered health interventions to try and design and develop innovations that meet the needs and concerns of these groups. Gaps are also evident in the integration of technology to home-based care. Advances here can afford us objective measures of behavioural abilities such as movement, allowing us the ability to greater control and titrate medications most notably for chronic pain for example.

Industrial strategy

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?

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?

17. The UK is a leader and excels in the underpinning of sciences and engineering disciplines required to make a difference in health span. However, more should be done to improve the pathway for scaling up new technologies and ensuring access for older people.

18. Universities are developing excellent evidence-based interventions that they struggle to diffuse to more than one NHS Trust. There is sometimes an issue when technology companies develop solutions to problems but do not think about how older adults can or will use these solutions practically.

19. There is now more dialogue between technology developers and Universities who hold a vast knowledge and expertise in developing both the evidence base, such that the correct solution can be found for a problem correctly identified, but also to involve the target stakeholders in that development. This needs to be the norm as opposed to the exception, but more value must be placed on what Universities have to offer in this.

20. Newcastle University Joint Research Office (NJRO) is an exemplar case study in addressing historical challenges. The team delivers in-house bespoke training and development to new and existing members of staff who are involved in the development, delivery and implementation of experimental, translational and clinical research. Staff in the NJRO work extremely closely with other universities, NHS organisations, government departments and industry. They are involved in national working groups to share best practice, collaborate out-with the partnership and ensure that the clinical research delivered at Newcastle is safe, value for money, of the highest quality and through adoption will make a difference to patient outcomes.[15]

Healthier ageing

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

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?

21. The Government’s aim of providing five more years of independence is more feasible that providing five years of health but increasing the independence of the healthier older population could in turn lead to longer health spans due to factors such as mental health. However, this will only happen if independence does not result in loneliness and an absence of support.

22. In order to pilot implementations in and across communities, greater collaboration is required between academics, local councils, healthcare professionals and industry. This should embed a whole systems approach to ensure older adults are educated and provided opportunities to regularly be active, from community walking to weight training in leisure facilities.

23. Visual perception and motor abilities decline with advancing years. To enable older people to stay in their own homes, modifications must be made to mitigate this. Sheltered accommodation must be designed to conform to what we know about the behaviour of the elderly, for example, their direction of movement under stress, and how they interact with emergency signage (in the case of a fire for example). In short, all organisations need to be involved in supporting the Government’s aim. The way an older person moves is determined by their physical health and how they feel, is as much dependant on their social interactions as it is on the number and type of medications they may be taking.

24. The NHSA believe Public Health England (PHE) is effectively positioned to lead from a national standpoint, building on the development of the consensus statement for healthy ageing and their existing efforts to coordinate national partner organisations. PHE should be supported by the Department of Health and Social Care, to coordinate across relevant Arm’s Length Bodies (ALBs) and ensure Government policy is being shaped to deliver on the Government’s healthy ageing aims.

25. As previously mentioned in order to deliver on the Government’s ambitions at a local population level all organisations involved in frail and elderly pathway delivery need to be involved. This should be coordinated through health and wellbeing boards, which have successfully improved outcomes in health and care within their geographies by uniting clinical, political and community leaders. Healthy ageing should be included within a board’s joint strategic needs assessment; linking the government’s aims to the needs of local populations.

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?

26. Health outcomes, access to, uptake of, and benefits of health service and interventions are disproportionately distributed. It is critical that further work is funded to focus on, and work with, populations excluded from, or who struggle to engage in, standard technology- and community-delivered health interventions to try and design and develop innovations that meet the needs and concerns of these groups.

27. It is just as important to give the elderly consistency in the provision of health services (e.g. a reasonable expectation that they may see the same GP twice in a row) as it is to have consistency of care across conditions and areas.

28. No Grand Challenge would be complete without addressing multimorbidity. We have become condition-siloed where elderly patients can have 6 or more consultants for different conditions. As they see a different GP every time, there is no health professional who can address the needs of that person (as opposed to their conditions).

To what extent could achieving the Government’s aim of five more years of healthy and independent life exacerbate, or reduce, these inequalities?

29. The aim will not be met unless it is met for every part of the UK and every demographic group. Reducing inequalities is essential for the whole country as it benefits the more affluent as well as those with less income and assets.

30. The matter of place-based approaches to population health has been highlighted recently in the national media through the success of one local GP in a small town in the North West of England. Dr Spencer believed the only way to tackle Fleetwood's health problems was to start from the bottom up - not by dictating what needed to happen but by encouraging and supporting residents to take control of their own health, and in doing so, their own lives. It would be for residents to decide how best to improve their health, what would work and what would not. Statistics had shown that residents in Fleetwood could expect to live shorter lives and experience more life-changing illnesses than people elsewhere in the UK, and this is the key to what became known as ‘Healthier Fleetwood’, a movement that offered people the chance to empower themselves and start making positive decisions about their healthcare.[16] Exemplar place-based approaches such as Fleetwood, should be considered for funding and policy support.

31. Harnessing the assets of regional networks offer a novel and critical approach. For example, the Northern Universities Public Health Alliance (NUPHA) was recently launched to work collaboratively across the North in highlighting the vast inequalities that exist within the North itself and between the North and the rest of England.[17] NUPHA is building on the messages of the Due North Report[18], the early work of the Equal North Network[19] and the NHSA’s Health for Wealth report[20].

32. Similarly, the role of Academic Health Science Networks (AHSN) as a driver for innovation scale and adoption is crucial to addressing this challenge. The AHSN Network is uniquely placed as the unifying network of the 15 AHSNs in England to unlock the power of frontline innovation, saving lives and money. On an individual level, the AHSNs (of which there are four in the North of England) bridge gaps and strengthen connections between research, the life sciences industry and healthcare professionals. AHSNs cross traditional sector boundaries and strengthen partnerships with industry partners so that innovative technology can be commercialised and make a difference to more patients more quickly.[21]

20 September 2019