House of Lords - Science and Technology

Select Committee on Science and Technology First Report

Ageing: Scientific Aspects

Second Follow-up Report

The Committee's Commentary on the Second Government Response

1. In June 2004 we appointed a Sub-Committee to examine the scientific aspects of ageing. Our report was published on 21 July 2005.[1]

2. On 4 November 2005 we received the Government's response. It was signed, rather to our surprise, by the then Minister of State for Pensions Reform in the Department for Work and Pensions (DWP), a department which had declined to give evidence to our original inquiry. We subsequently sent the response to some of our original witnesses for their views, who without exception shared our disappointment and frustration at the negative attitude of the Government to our recommendations. On 22 March 2006 we published a follow-up report explaining our views. The Government response, and the comments of the witnesses upon it, were appended to the report.[2]

3. The report and follow-up report were debated in Grand Committee on 5 June 2006.[3] In the course of his reply to the debate Lord Hunt of Kings Heath, the Parliamentary Under-Secretary of State at the DWP, said:

"I hear the disappointment with the Government's response to the Committee's report. My noble friend Lord Turnberg described it as defensive; it was not intended to be. It was intended as a positive contribution to the committee and the debate. I assure the Select Committee that the Government take this work seriously. I want to encourage further dialogue between the Government and the Select Committee in this area. I will ensure that we produce a further response to the Select Committee in the light of our discussion today, specifically commenting on the points raised by members of the Committee in the debate and bringing in any other issues that are relevant."[4]

4. In fulfilment of that undertaking, Lord Hunt sent a further response under cover of a letter of 25 July 2006. In that letter he said:

"I hope this further paper conveys more effectively the Government's commitment to increasing our understanding of the issues facing an ageing society, and our desire to maintain and develop dialogue between ourselves and the Committee."

5. This second Government response is printed in the Appendix to this report. We say at once that we welcome it. The Government seem for the first time to be taking the scientific aspects of ageing seriously; they have looked, not just at our recommendations, but at the evidence and the reasoning which led us to make them; and they respond positively to some of them, and to some of the points made in the debate. We can only regret that this was not the response they initially made over a year ago.

6. We comment below on some aspects of this response, including matters highlighted in our first follow-up report.

Healthy Life Expectancy

7. We explained in our original report,[5] and in the first follow-up report,[6] that we doubted whether self-assessment of health was the best way of estimating whether there was in fact an increase in unhealthy life expectancy, and that such self-assessment was made more difficult by the lack of harmonised criteria for measuring healthy life expectancy. We are therefore pleased to see that DWP intend to "explore work with international organisations … to help develop harmonised measures of healthy life expectancy".[7]

8. We also recommended that funds should be made available to the Office for National Statistics to enable it to conduct surveys to assess disability-free life expectancy.[8] DWP say that they will "look to progress" this recommendation.[9] If this means that funds will in fact be made available, this too is welcome.

Stroke

9. Our report underlined that the speed of diagnosis of stroke was an area where major improvements could be made at relatively small cost; it was even suggested to us that there might be a net saving in cost to the public purse, given the likely reductions in the demand for long-term health care as a result of faster initial diagnosis. The National Audit Office (NAO) report, published on 16 November 2005,[10] which we mentioned both in our report[11] and in our first follow-up report,[12] confirms this. It refers to a study which found that "it would cost about £9.9 million a year to provide thrombolysis[13] for [nine per cent of stroke] patients, but would save around £26.4 million a year in care costs, a net saving of more than £16 million a year".[14] The Government plainly have every incentive to take this work forward quickly.

10. The latest response makes the point that access to scanners alone is not enough; the right expertise needs to be available round the clock to interpret the scans. We are told that "all A&E departments have rapid access to [scanners] already, with 217 new and replacement CT scanners installed in the NHS since April 2000". But the statistics from the NAO report, which we quoted in our first follow-up report, and which fully supported the evidence we ourselves received, bear repetition:

"Only 22 per cent of stroke patients in the Sentinel Audit received a scan on the same day as their stroke. Most waited two or more days. For patients who were registered as requiring an urgent CT scan (within 30 minutes), only 30 per cent actually got the scan on the same day."[15]

11. Plainly what is lacking is the expertise to read and interpret these scans, and the Government are right to be looking at training for this. We are encouraged to learn that, from next year, the Picture Archiving and Communication System will enable scans to be read remotely. The NAO report draws attention to a hospital in Melbourne where access by consultants at home to digital scans has contributed to 41 per cent of thrombolysed patients fully recovering from their strokes.[16] We urge the Government to press ahead with this work.

12. We have mentioned the savings in care costs that could be made by improvements in the scanning of strokes. In our report we looked at the cost-effectiveness of treatment;[17] we pointed out that a person or body had little incentive to incur expenditure if the corresponding saving was to accrue to another institution; and we recommended supervision to ensure that only the overall cost to the taxpayer was considered. We are glad to see from the response[18] that steps are being taken to ensure that "those who commission and pay for the community services required as a consequence of a stroke … will be the same people who are commissioning services from hospital Trusts". This should effectively meet our point, but only in the specific context of stroke. Our point was a wider one, and we should be glad to see the principle of reviewing potential overall cost savings, which may result from new preventive initiatives, adopted in a properly co-ordinated way.

Older Drivers

13. Our report considered the possibility that older drivers, rather than having to make an application for their licence to be renewed when they reach the age of 70, should be allowed to decide for themselves at what age they should cease to drive. We pointed to evidence showing that requirements for health and on-road assessment did not necessarily lead to better safety for older drivers.[19] While stopping short of recommending self-regulation, we encouraged DVLA to consider this option.

14. The Government have now explained[20] that an independent review was carried out by a company, Risk Solutions, which was given a copy of our report. DWP officials have explained that the recommendations put forward by Risk Solutions include:

"Change licensing arrangements for older drivers by extending expiry of a car licence to 75 and issuing 5 year licences thereafter. This is on the basis that the occasions on which drivers are asked to make a declaration about their health are increased and that the eyesight and office-based cognitive tests are undertaken at licence renewal."

Cross-departmental groups have been working to prepare a consultation document taking this recommendation into account. We look forward to reading this consultation document when it is issued.

Co-ordination of research

15. Our main recommendation for improving the output of ageing-related research without a major injection of new resources centred on the co-ordination of this research. Here a comparison between the two Government responses gives grounds for cautious optimism.

16. The Government rely, as before, on the Funders' Forum for Research on Ageing and Older People as the body to improve the co-ordination of research. Our report was as critical of the Funders' Forum as of the other initiatives for the co-ordination of ageing research, and we called for the setting up of a new body with the membership, constitution, powers and funding necessary to provide the strategic oversight and direction of ageing research.[21] The Government's first response was to the effect that a new body was not necessary, but that the Funders' Forum had been "revitalised", and would be adequate for the task.[22] As we said in our first follow-up report, this would have been perfectly acceptable if the Funders' Forum was indeed being changed into something resembling the body we recommended; but neither we nor our witnesses could detect any evidence of this.[23]

17. Paragraph 17 of the second Government response states:

"While the Government accepts the criticisms of the past performance of the Forum, we remain of the view that it can be transformed into a body resembling that recommended by the Committee."

We have accordingly looked at this response to see if there are any indications that the Funders' Forum not only can be, but is being, transformed into such a body.

18. The Chairman of the Forum, Michael Lake, is the Director-General of Help the Aged. This organisation, through its Head of Research, was one of the most vociferous critics of the Forum in its original guise. Help the Aged now provides the administrative home of the Forum, which for the first time has "a full-time research programme manager, funded for three years in the first instance, to help develop and support the work of the Forum".[24] The Head of Research manages the programme manager, and the post is funded by some of the larger funding bodies involved in the Forum.

19. Previously, the Forum met so infrequently that it scarcely justified its name.[25] Now the main group is to meet twice yearly, with a smaller business planning group to meet on at least another two occasions. We welcome this. Meetings of the main group, consisting of all organisations funding ageing-related research who wish to join the group, should provide the right strategic direction, while "membership of the smaller business group will be designed to ensure more active participation, especially on the part of the larger funding bodies".[26] The structure of the revitalised Forum seems to us to have the potential ultimately to deliver the active co-ordination of research which all interested parties believe to be so vital.

20. The Government "feel that the Forum should be given the opportunity and support to establish its authority in the ageing-related field, with its achievements being subject to formal assessment after the initial three-year period of investment".[27] We agree. We hope to see the Government providing the Forum and its Chairman with the support they need and deserve for the effective performance of their exacting task. We will be closely monitoring the progress of this urgent work, and hope soon to be hearing from the interested parties that progress is actually being made towards the achievement of the goal of fully co-ordinated research.

21. As evidence that the Forum has "set about [its] task with energy and vigour", the response notes that it has been "collaborating in the launch of the cross-Council New Dynamics of Ageing [NDA] research programme in the autumn".[28] That launch took place in London on 1 November 2006.[29]

22. The only other reference in the response to the NDA is to say that the Government is investing "£3.5 million for a new joint research council initiative on the New Dynamics of Ageing".[30] We are puzzled by the description of the NDA as a "new" initiative, and concerned that these are the only references to it in the response. The NDA was announced in 2004. It is a seven year[31] initiative by five of the UK Research Councils[32] to promote co-ordinated ageing research. At the time our report was published we were highly critical of the serious delays involved in getting this programme off the ground.[33] Now, nearly 18 months later, it appears that out of the many first round applications only two received awards in spring 2006. Eleven preparatory network grants were announced in October 2006, sharing £250,000 of funding; applications for research programme grants are currently invited, with final decisions to be made only in June 2007.

23. It is for the research councils to assess applications for research funding, and to decide which are likely to make best use of funding grants. The Government are not and should not be involved in this. But they should be concerned at the delay in putting taxpayers' money to the use for which it is intended. What seems to us to be missing is the momentum to allow the best research projects without delay to receive the grants which will actually enable them to start their vital work. It is the responsibility of the Government to supervise the research councils. We hope they will be looking to see if the NDA justifies the word "dynamic" in its title.

Conclusion

24. We are grateful to the Minister, and to the Government, for providing us with this further response. In many respects it is a definite step in the right direction. The challenges and opportunities presented by an ageing population require a major Government commitment on many fronts. We believe that the scientific front is one of the most important, and we are glad to see signs that the Government are beginning to recognise this.

1 Ageing: Scientific Aspects, First report, Session 2005-06, HL Paper 20 (hereafter "HL Paper 20"). Back

2 Ageing: Scientific Aspects-Follow-up, Sixth Report, Session 2005-06, HL Paper 146 (hereafter "HL Paper 146"). Back

3 HL Deb., 5 June 2006, cols. GC289-328. Back

4 Ibid., col. GC320. Back

5 HL Paper 20, paragraphs 2.23 to 2.24. Back

6 HL Paper 146, paragraph 11. Back

7 Appendix, paragraph 41. Back

8 HL Paper 20, paragraph 2.30. Back

9 Appendix, paragraph 41. Back

10 Reducing Brain Damage: Faster access to better health care, Report by the Comptroller and Auditor General, Session 2005-06, HC 452: http://www.nao.org.uk/pn/05-06/0506452.htm. See in particular paragraphs 1.16 to 1.22. Back