International Longevity Centre UK (ILC) – Written evidence (INQ0079)

About ILC

1. The ILC is the UK’s specialist think tank on the impact of longevity on society, and what happens next. We believe society has to adapt now so we can all enjoy the benefits of longevity.

2. We work with central government, local government, the private sector, and professional and academic associations to provoke conversations and pioneer solutions for a society where everyone can thrive, regardless of age.

Introduction

3. ILC believes that in order to deliver on the Government’s pledge to add five years of healthy life expectancy to people’s lives, there needs to be a greater focus on the prevention of ill health right across the life course.

4. In our digital age, technology will undoubtedly have a role to play in this. Recent decades have seen a number of technological innovations to help us age better, which can be built upon.

5. However, ILC believes that while technology can be an enabling factor in supporting health promotion, it is by no means the magic solution for the challenges of ageing. More needs to be done to understand the current shortcomings of our health and social care services; to evidence which technological innovations work; to overcome regulatory barriers to innovation and to address structural inequalities within the system.

Increasing healthy life expectancy: The importance of prevention in an ageing world

6. There is already a consensus that preventing disease and limiting long-term illness and disability are both good for our health and will play an important role in supporting the economic sustainability of health systems. But translating that consensus into sustained action can be challenging.

7. ILC has launched an international programme of work exploring “Prevention in an ageing world”[1] which seeks to reframe the discourse around prevention and to promote preventative interventions right across the life course.

8. Our initial analysis has shown that in 2017 alone, 27.1 million years were lived with disability due to largely preventable diseases. This number is projected to rise by 17% in the next 25 years. As such, to deliver on the pledge to add five years of healthy life expectancy to people’s lives, Government will need to put prevention right, front and centre of its industrial strategy.

9. A person’s health is influenced by a number of factors. There is strong evidence of the social determinants of health. As far back as 1842, Edwin Chadwick highlighted a 30-year variance in the life expectancy of men in the poorest social classes and the gentry. He also found a North-South health divide. These inequalities continue today.[2]

10. A recent report by Professor Les Mayhew for ILC[3] found that over the last century, whilst adult life expectancy in the UK has been growing, improvements have not been equally shared between its citizens, with significant inequalities in life expectancy between rich and poor areas, urban and rural districts, genders and socio-economic groups. This gap is slowly widening over time resulting in greater inequality.

11. However, while it is pivotal to address social determinants of health, healthcare systems should not seek to “pass the buck” about their responsibility for prevention and public health, as they have a key role to play in delivering on the government’s pledge to add five additional years of healthy life expectancy for all.

The role of technology in supporting healthy ageing

12. Through improved screening, personal monitoring as well as better use of technology to support the development of, access to, and uptake of preventative medicine across the life course, technology could play an important role in supporting prevention across the life course.

13. Technology has the potential to improve mobility, increase independence in the home and reduce loneliness and isolation. The entries received to the Innovating for Ageing awards[4], launched by Just Group and ILC in 2018 showcased the range of innovations that are already seeking to promote healthy ageing, including:
1. Echo, a free NHS medication management app for carers[5];
2. Move It or Lose It, an online exercise programmes to help older people to lead more active and healthy lives[6];
3. Map A Nurse, a nurses-on-demand service that allows users to book same-day home visits by nurses.[7]

14. ILC recently published a report, which highlighted some of the ways in which technology can overcome the barriers to vaccination, including:[8]
1. The US-based healthcare transport company Circulation that leverages ride-sharing services such as Uber and Lyft to take patients to healthcare appointments.[9]
2. A postage-stamp-sized nanopatch with thousands of tiny spikes on its surface, which can be used as an alternative to the needle for delivering vaccination.[10]
3. A digital necklace, which stores a wearer’s medical history, including vaccination records. The necklace has been found to be five times less likely to be displaced than a paper record and has successfully increased vaccination coverage.[11]

15. There is also increasing exploration of financial incentives, monitoring and gamification. For instance, the use of the augmented reality game Pokemon Go had a short-term impact on the number of steps taken by users of the game.[12]

16. There are undoubtedly technologies which will help us age better. But technology is not a magic solution for the challenges of ageing. Government reports over the past 15 years have promised technological solutions to complex problems. Yet these words have so far delivered limited impact.
1. “New service models and technology have an important role in enabling older people to remain in their own homes and avoid unnecessary moves into residential care or hospital” (The Wanless Social Care Review, 2006)
2. “Technology has the capacity to transform the way we offer services and the support that is available to help people with dementia stay in their own homes.” (Department of Health, 2005)
3. “We need to seize the full potential of the advanced application of science and technology to help deliver better later lives.” (Department for Work and Pensions, 2005)
4. Using technology to enable delivery of high-quality support will be a vital element of the future care and support system. (Department of Health, 2009)
5. “Technologies, including telecare and telehealth, also have the potential to save money and improve the quality of care that older people experience, as well as prevent accidents and crises.” (House of Lords, 2013)
6. “Technology can improve connectivity, address health, work and care challenges, and help people unlock the potential benefits of living longer.” (Department of Health, 2014)

17. A greater use of technology has the potential to widen existing health inequalities. The most deprived group of men live nine fewer years than the least deprived. And despite living less long, this group spends more time in poor health.[13] There is a risk that the greater use of monitoring technologies may accentuate the gap in healthy life expectancy because they may be predominantly used by already better-off individuals.

Barriers to technological innovation in care

18. Our regulatory regime is not focussed on innovation: Getting products to market can be challenging. There is no lack of ideas or of innovations. Our recent “Innovating for Ageing” competition attracted over 70 ideas for products and services to tackle vulnerability in later life. However, the UK private market for health and care technologies does not foster innovation.

19. Products are not always well designed. It is important that products and services are inclusively designed.

A recent ILC report found that 82% of over-55s feel their favourite retail brand “doesn’t understand” them and what they need.[14] Looking at housing, there is only enough specialist housing to accommodate for 5% of the over-65 population.[15]

There is an economic case for designing better products and services, as consumers aged 50+ are responsible for 43% of total household spending on consumption[16] and inclusive, easy-to-use products and services have been shown to be more popular among consumers of all ages.

20. Too many people are digitally excluded. In 2018, 5.3 million adults, 10% of the adult UK population, had either never used the internet or had not used it in the last three months.[17] Older people continue to be more digitally excluded than younger people despite progress over the past decade. This prevents too many older people from using online services and mobile apps, putting them at significant social, financial and potentially healthcare disadvantages.

21. We don’t know what works. There is a need for a greater focus on evaluating the impact of technological interventions. Simply delivering a product or service through new technology does not mean that it is better or offers additional value.

Conclusion

22. The Government’s target of adding five years of healthy life expectancy to people’s lives by 2035 is extremely positive but it is also very ambitious. For government to achieve this objective, technology may well play a role, but more needs to be done to ensure better data collection and evaluation of existing services, as well as tackling regulatory, design and accessibility barriers to technological innovation.

23. A greater role for technological innovation in healthcare should also not deter investment from low-tech, evidence-based interventions, such as grab rails and housing adaptions that we already know work well.

24. Getting this right could transform the way we work, live and spend. There is potential of a significant longevity dividend from extending working lives and increasing sustainable consumption. But public policy needs to adapt to deliver this potential. ILC’s Future of Ageing conference will this year focus on how we can realise this longevity dividend.[18] We will publish new analysis which will reveal the potential positive impact of longevity on growth.

September 2019