APPENDIX 1: GOVERNMENT RESPONSE TO
THE HOUSE OF LORDS DEBATE ON THE SCIENTIFIC ASPECTS OF AGEING
Introduction
1. The recent House of Lords debate on the scientific
aspects of ageing raised a number of particular issues associated
with the ageing process, and the important role that research
can play in developing an understanding of the ageing process.
This drew on the thorough and systematic analysis in the first
House of Lords report, Ageing: scientific aspects, which
clarified areas for improvement and highlighted complex issues
for further work. The debate provided very welcome contributions
to the development of Government's strategy and polices. This
note sets out the Government's response to the main issues raised
during the debate.
The Government's Ageing Strategy
2. The Department for Work and Pensions (DWP) is
responsible for the co-ordination of the Government's ageing strategy,
and as such is concerned with the whole multifaceted nature of
the ageing process. The strategy—Opportunity Age—was
published in March 2005 and sets out the first steps in the development
of the Government's approach to tackling the issues raised by
demographic change. It aims to end the perception of older people
as dependent; to ensure that longer life is healthy and fulfilling;
and that older people can participate fully in society.
3. This substantial government programme is intended
to give a lead to a wide range of players whose support is needed
to effect real change in society as a whole. We have set out a
framework for engaging with them to carry it forward and to secure
the wider cultural changes necessary to transform challenges into
opportunities.
4. Although the strategy is a cross-government one,
the DWP leads on taking it forward. The Secretary of State for
Work and Pensions is the Government's Champion for Older People
and the Minister for Pensions supports him. They are both members
of the DA(AP) Cabinet sub-committee on older people and ageing,
and are advised by a "Partnership Group" made up of
key stakeholder organisations and older people themselves.
5. The effect of central and local Government strategies
on the lives of today's and tomorrow's older people will be measured
using a suite of indicators of older people's independence and
well-being. Opportunity Age indicators are designed to be the
first stage in developing a balanced national assessment of quality
of life for older people. They were published in the Pension Reform
White Paper, "Security in retirement: towards a new pensions
system", published 25 May 2006.
Research co-ordination
6. There was much discussion during the debate regarding
the need for research on ageing to be co-ordinated, during which
it was noted that the findings from ageing-related research would
not just benefit older people, as ageing is a process that affects
everyone all of the time.
7. The Government agrees with the Committee that
ageing research should take a holistic approach to ageing, with
greater cross-fertilisation between the medical, biological and
social sciences. We also recognise the contribution that generic
research on the process of ageing can make to a wide range of
scientific fields of inquiry.
8. To see what more we need to do in this area, we
are in discussion with the Council for Science and Technology,
which is an advisory committee to the Prime Minister, chaired
by Sir David King and Professor Sir Keith Peters, Regius Professor
of Physic at Cambridge University. We will ensure that the comments
of the Select Committee and of its members in the debate will
be fed into those discussions.
9. There is a growing volume of research and analysis
into the implications of an ageing society from universities,
independent think-tanks, international bodies such as the Organisation
for Economic Co-operation and Development (OECD) and through the
activities of local networks. The Government-supported English
Longitudinal Study of Ageing is breaking new ground by showing
us how economic, social and health factors over time interact
to affect the quality of our later life. And wider-ranging research
programmes are being supported by the Research Councils. Awareness
and application of this work can help us take better and more
timely decisions. We recognise that there is more to do, both
in developing new knowledge and in ensuring that existing knowledge
on ageing issues is shared across government and made available
more widely to inform plans and decisions, challenge stereotypes
and change attitudes.
10. Regarding resources for longitudinal studies,
half of the budget for the English Longitudinal Study of Ageing
(ELSA) comes from government departments involved in areas related
to the ageing process, including the Department of Health (DH),
the DWP, Department of Trade and Industry (DTI), Department for
Education and Skills (DfES), and the Office for National Statistics
(ONS). The other half of the funding for ELSA is provided by the
National Institute on Aging (NIA) in the US. Both UK governments
and the NIA have a keen interest in understanding the multifactorial
ageing process and cross-Atlantic comparisons will bring a deeper
understanding to this field.
11. We are investing £4.7 million over 5 years
in ELSA, and £3.5 million for a new joint research council
initiative on the New Dynamics of Ageing. Both will enhance understanding
of the changing meaning and experience of ageing and the complex
interplay of factors (biological, social medical, technological
and economic) that affect the ageing process.
12. The Government accepts that the present level
of co-ordination between research councils falls short of the
desired level. The DWP recognises the importance of research co-ordination
and is determined to take the responsibilities of its leadership
role seriously. It will work collaboratively with DH, DTI and
the OSI to ensure that we produce a cohesive approach. Discussions
have been had with the Government's Chief Scientific Officer,
the DH National Director for Older People and the DWP's Chief
Scientific Advisor, subsequent to the Committees' report, about
the best arrangements for strengthening and sustaining active
cross-government liaison on ageing-related research.
An Observatory and an Office for Ageing
13. In addition, we are taking a number of strategic
approaches to achieving better co-ordination and identifying future
priorities. One of these is to consider the role that an Observatory
on Ageing or an Office for Ageing could play, as part of arrangements
which better integrate research into government for older people.
14. The DWP has carried out a limited informal consultation
with a range of potential users and information and research specialists
within and outside government and drawn some interim conclusions
about a possible Observatory on ageing. The scope of an Observatory
covering medical, technological, social and economic aspects of
ageing would be enormous—yet diffusing information across
and between disciplines would be one of its most useful functions.
The key role for an Observatory, therefore, whether inside or
outside Government, would be to provide a synthesis and publicity
function or portal to existing information repositories, rather
than seeking to duplicate existing bodies. It could also potentially
provide the raw material for the Funders' Forum to consider strategic
priorities for research.
15. The potential role and structure of an Observatory
cannot be considered in isolation from the question of a possible
Office for Ageing and Older People. It could form part of that
Office, be separate from it, or form part of an alternative approach.
We therefore propose to consider further the question of how best
to disseminate information and good practice as part of our review
of the potential need for an Office of Ageing and Older People,
reporting later this year.
16. Complementing our increased investment in science
funding, we have a range of initiatives improving coordination
of research and identifying future priorities. We intend to re-examine
Research Council priorities in the Spending Review, informed by
consultation with a wide range of stakeholders. We will also look
at the role of scientific research in helping address ageing issues,
through the Grand Challenge in DTI's five year strategy and potentially
through a Foresight project.
Funders' Forum
17. Central to this activity, and more effective
co-ordination, is the Funders' Forum for Research on Ageing and
Older People. 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. The Forum has met on several occasions since the publication
of the Committee's report and its members have expressed a clear
determination to address the shortcomings identified and work
more proactively to provide effective oversight and strategic
direction of ageing-related research.
18. The Funders' Forum for Research on Ageing and
Older People (FFRAOP) was established in 2001 to bring together
all of the major funding bodies in order to plan and promote the
development of a co-ordinated approach to research on ageing.
Members include the research councils, government departments
and representatives from the independent sector.
19. Following the Committee's report, changes have
been made to the constitution and operation of the Forum. The
Chair of the Forum and its administrative home will now be provided
by an independent body—Help the Aged—which will also
manage a full-time research programme manager, funded for three
years in the first instance, to help develop and support the work
of the Forum.
20. All relevant UK Departments are represented on
the Forum and particular efforts will be made to establish a strong
working relationship between the Forum and the cross-government
ageing-science group under the lead of the DWP's Chief Scientific
Officer. In addition to direct reporting links between the Forum
and the OSI. Research Council members may also report formally
to the OSI/RCUK Joint Strategy Group, chaired by the Director
General of Science and Innovation. DWP members will also ensure
the Forum is closely linked to the strategic work of the Government's
Champion for Older People. By providing in this way an effective
bridge between the 'science' and 'policy' agendas, the Forum will
be well placed to make a distinctive contribution to the development
of a more coherent and integrated approach across government.
21. One concern of those providing evidence to the
Committee was that the Forum's recommendations are not binding
on the funding or strategy decisions of its members. This would
be difficult, given the diverse nature of the organisations involved
and their differing lines of governance and accountability. However,
it has been agreed that the assumption of membership will carry
with it a responsibility to ensure that the advice and recommendations
of the Funders' Forum are fed directly into relevant strategic
discussions within their own organisations.
22. The Forum has also agreed to meet more frequently
and regularly. The main group will meet twice yearly, with the
smaller 'business planning group' meeting on at least another
two occasions. In order to ensure transparency, one of the two
yearly meetings of the main Forum will be held in public. The
need to achieve a balance between the desire to be inclusive and
guarding against being too large and unwieldy is recognised. Membership
will thus be confined to organisations funding ageing-related
research, but open to all who do so. Membership of the smaller
business group will be designed to ensure more active participation,
especially on the part of the larger funding bodies.
23. Progress has also been made in clarifying the
distinctive role of the Forum. The ageing-related research field
is extremely broad, encompassing many bodies or groups with long
established expertise. In such a context, it is important that
the Forum supplements and reinforces, rather than duplicates,
the work of others. In particular:
- the strategic policy work of the
DA(AP) Cabinet sub-committee and the operation of the proposed
Observatory;
- the scientific input to the Grand
Challenge of population ageing;
- the research programmes supported
by the Research Councils and other funders;
- the capacity-building and research
support activities of the UKCRC and its condition-specific research
networks;
- the learned societies, and the
scientific communities they represent, via the British Council
on Ageing;
- other bodies involved in the better
co-ordination of research activity, such as the Co-ordination
of Research and Analysis Group (CRAG) and the Longitudinal Studies
Advisory Group;
- the ERA-AGE network, funded by
the EU 6th Framework Programme and its work, amongst other things,
on a virtual European Institute for Ageing-related research;
- and perhaps most importantly,
the voices of older people themselves, and/or the organisations
that aim to represent them (only a minority of which are currently
represented on the Forum).
24. The distinctive role of the Funders' Forum will
be to facilitate information-exchange, and collaboration where
relevant, with and between these and other stakeholders, consulting
with them about gaps and opportunities and formulating recommendations
about the overall direction of ageing research.
25. The Forum has already set about this task with
energy and vigour, holding an international seminar for leading
scientists in the field, designed to help set the research agenda
and shape the Forum's 'vision', and collaborating in the launch
of the cross-Council New Dynamics of Ageing research programme
in the autumn.
26. We 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.
Cooksey
27. The Chancellor's announcement of a single jointly
held health research fund will obviously have an impact on ageing
research. The aim of this fund is to maximise the impact of the
MRC's funded medical research and the DH's R&D on health outcomes.
It will build on the UK's world class medical science base and
recent developments such as the development of the UK Clinical
Research Collaboration (UKCRC) and the Government's new strategy
for R&D in England "Best Research for best Health".
It has enormous potential.
28. Sir David Cooksey is leading the review which
will advise Government on the best way to take this forward. As
part of his review he launched a consultation on 4 May—details
of the consultation can be found on Treasury's website—this
will no doubt stimulate what is already a hotly debated issue
in the medical/clinical research communities.
Involving Older People in research
29. The Committee has made a number of very positive
recommendations about ensuring that older people are actively
involved in research, both as participants (subjects) and as stakeholders.
The Government is pleased to report good progress in this respect.
The DH's new research strategy 'Best Research for Best Health'
stresses the importance of placing patients and the public at
the heart of research. Increasingly DH Programmes are involving
service users/carers, or the organisations that represent them,
in every stage of the research process. Older people are actively
involved for example, in the advisory group for the Partnerships
for Older People Pilots (POPPs) evaluation, taking an active part
in the commissioning process and overseeing the progress of the
research. We recognise that such involvement helps to ensure the
relevance of research to the lives of those involved.
30. In addition, we acknowledge the importance of
the Committee's concern that older people are not unnecessarily
excluded from research populations. Best Research for Best Health
sets out a general determination to increase the number of people
who enter multi-centre trials, via a network of clinical trials
units. This is underlined by the Department's Research Governance
Framework which states that efforts must be made in research design
to reflect the full diversity of human society, including factors
such as age, sex and race. One of the impacts of the Mental Capacity
Act has been to clarify the situations under which those without
the capacity to consent, including frail elderly people, may nevertheless
have their needs and experiences included in research studies.
31. We hope this gives a strong indication of the
Government's commitment to supporting high quality research, and
to harnessing the outputs of that research to underpin effective
policy development.
Assistive technology
32. The Committee commented on the role that technology
can play in improving the quality of life of older people and
the assistance it can provide in supporting the mobility of older
people and enabling them to remain in their own home for longer.
The Government recognises that the benefits of research in this
area will not merely affect older people, but will affect other
groups, such as disabled people. Regarding older people and technology,
it is also interesting to note that the proportion of older households
who have access to the internet at home has doubled since 2000
and that 73 percent of older households now have a mobile phone.
33. Prior to the publication in January of the White
Paper "Our Health, our care, our say", DH undertook
a strategic review of assistive technology (AT) in consultation
with key stakeholders. The White Paper outlined pilots covering
one million people, testing and monitoring safety and security
in the home, remote physiology and activity monitoring, and providing
care-related information, for example by telephone and digital
TV.
34. The White Paper "Our health, our care, our
say: a new direction for community services" sets a new strategic
direction for health and social care. It directs organisations
towards providing better prevention services, earlier intervention,
and more support for people with long-term needs and strongly
promotes a "whole system" approach to care that enables
people to live more independently in their own homes.
35. It also highlights the need for more support
for people with long-term conditions to help them manage their
conditions. People with long-term conditions, particularly those
who have multiple conditions, have specialist health and daily
living needs. Many people with a long-standing medical condition
also have other complex needs leading to disabilities that often
require care from other sources, especially social care.
36. There is emerging evidence that targeting these
individuals, putting their needs at the centre of service delivery,
can both improve health outcomes and reduce costs. This can be
achieved by supporting them with improved care co-ordination (through
collaboration and new ways of working across health and social
care) combined with the use of new assistive technologies, adding
value for the individual and the system.
37. For people with complex health and social care
needs the White Paper sets out a plan to bring together knowledge
of what works internationally, with a commitment to new assistive
technologies to demonstrate major improvements in care. This will
include:
- a strong emphasis on patient education
and empowerment
- comprehensive and integrated packages
of personalised health and social care services
- joint health and social care teams
- good local community health and
care facilities
38. The National Service Framework for Older People
includes a commitment to "Developing an approach to telecare
investment to support the promotion of independence of older people
through assistive technologies." This aims to increase the
use of assistive technology to promote independence.
39. The Department of Health has recently announced
a Call for a jointly-funded initiative between DH, DTI, EPSRC
and MRC to pilot Healthcare Technology Co-operatives (HTCs), a
recommendation of the Healthcare Industries Taskforce (HITF) in
their Report 'Better healthcare through partnership: A programme
for action', published in November 2004.
Healthy life expectancy
40. The Government accepts the Committee's point
that the measurement of healthy life expectancy is complex territory
and that the reliance on self-assessed health as the basis for
measuring healthy life expectancy leads to questions as to whether
an increase in the number of years spent in ill-health reflects
a true increase in ill-health.
41. We will:
- explore work with international
organisations, including Eurostat and the World Health Organisation
to help develop harmonised measures of health life expectancy;
- look to progress the Committee's
recommendation that the ONS undertakes further work on the relative
merits of different measures;
- and we will continue to support
research to understand trends and causes.
42. ELSA provides externally assessed biomedical
measures of health status, which will enable comparison with subjective
perceptions of health and well-being and, in time, improve our
understanding of the realities of healthy life expectancy. The
earliest that ELSA on its own can provide reliable trend information,
using externally assessed measures, is after wave 6 has been completed
and analysed (approx 2013). However, ELSA draws its sample from
the Health Survey of England (HSE), and there is a possibility
of linking ELSA data with HSE data. If this was done trend information
about externally assessed health could be provided after the completion
of ELSA wave 4 (2008/09).
Stroke
43. The Government recognises the importance of making
clear progress in improving the treatment of strokes.
44. The National Service Framework for Older People,
which covers stroke, is linked with DH's PSA targets. The specific
PSA target covering stroke falls under objective 1: Health of
the Population:
a) Substantially reduce mortality rates by 2010;
from heart disease and stroke and related diseases by at least
40 percent in people under 75, with a 40 percent reduction
in the inequalities gap between the fifth of areas with the worst
health and deprivation indicators and the population as a whole;
45. Following publication of the National Audit Office
report on stroke in November 2005, Ministers at the Department
of Health announced that an eighteen-month work programme would
commence to produce a new national stroke strategy to modernise
service provision and deliver the newest treatments, once their
safety is proven. One of the strands of that strategy will be
working with expert groups to develop a consensus about how best
to deliver urgent scanning nationally.
46. As was highlighted during the debate, delivering
urgent scanning for stroke patients is not simply a question of
the physical scanners—all A&E departments have rapid
access to these already, with 217 new and replacement CT scanners
installed in the NHS since April 2000. Rather, it is about ensuring
the right expertise is available round the clock to interpret
scans. From next year, the new Picture Archiving and Communication
System will enable scans to be read remotely, greatly aiding urgent
diagnosis. But work on the stroke strategy will need to go further
to develop a consensus about how best to deliver urgent scanning
nationally. DH has already begun discussing with the relevant
professional bodies training and organisation of services to facilitate
urgent access to interpreting the scans.
47. DH is funding a new £20 million Stroke Research
Network (SRN) to improve our understanding of what works and to
drive forward further service improvements. The
SRN will have the central objective of providing a world-class
health service infrastructure to support stroke research, remove
barriers to its conduct and increase participation of people who
have had a stroke, their carers and health professionals in stroke
research.
48. The Committee made reference to a comment by
the Stroke Research Network, which suggested that investments
in stroke units and treatments is undermined by the fact that
the benefits are accrued in community services, but the costs
fall on hospital Trusts.
49. Stroke has significant long-term effects, including
the financial burden of rehabilitation and care, which largely
falls to community and social services. The DH recently published
a white paper, Our Health, Our Care, Our Say: a new direction
for community services, which sets out a number of proposals
to ensure more joined-up care across health and social services,
and shift more services from the acute to the community setting.
The implementation of this white paper will help ensure the right
incentives are in place for all parts of the health and care system.
50. The programme of system reform currently underway
across the NHS will strengthen commissioning of services. DH has
published a Commissioning Framework to set out more detailed guidance.
As part of this, the development of Practice Based Commissioning
will bring commissioning decisions closer to local needs which
will ensure services are better integrated across the whole of
the patient journey. Later in the year, DH will publish further
guidance to strengthen joint commissioning arrangements between
Primary Care Trusts (PCTs) and local government. Increasingly,
these developments will mean that those who commission and pay
for the community services required as a consequence of a stroke,
or a stroke that has not been treated in the most effective way,
will be the same people who are commissioning services from hospital
Trusts. This means that the benefits and the financial costs of
improving acute stroke services will fall to the same organisation.
We will also be publishing a stroke commissioning guide later
in the year to set out how this should work for stroke services.
51. Interventions in the acute sector can also produce
demonstrable benefits to hospital trusts. DH has published a toolkit
that enables Trusts to quantify the impact of making several key
improvements to stroke care in terms of better patient outcomes,
reduced lengths of stay and reduced costs for the Trust itself.
The improvements modelled in the toolkit are stroke units, immediate
scanning and thrombolysis, rapid referral to carotid surgery via
a one-stop TIA clinic, and early supported discharge teams.
52. DH is currently developing a similar toolkit
for PCTs and other commissioners to demonstrate the benefits of
ensuring that the stroke services commissioned and provided are
of the highest quality. The aim is to ensure that all parts of
the system are working together to meet the common goal of improving
the service that stroke patients receive.
53. Further information on the work that DH has underway
on stroke—including the toolkit for hospitals and a new
Strategy currently under development—is available at www.dh.gov.uk/stroke.
54. The Public Accounts Committee published its report
on stroke services on 11th July. DH will be responding to the
report through a Treasury Minute.
Age discrimination
55. The Government recognises that there remains
work to be done to ensure that older people are treated with dignity
and respect. In recognition of this, the NHS's National Service
Framework for Older People includes a commitment to "seek
to challenge deep-seated negative cultural attitudes towards older
people, the root cause of failure to treat older people with respect
for their dignity and human rights."
56. The importance that the Government places upon
tackling ageism is demonstrated by the progress that has been
made in introducing legislation on age discrimination in the workplace.
This is having a positive impact on attitudes towards older people,
with statistics showing that almost 40 percent of jobs created
over the past year have been filled by those over state pension
age.
57. Regarding age inequality in the provision of
goods and services, the recently published indicators of older
people's well-being[34]
that are to be used in measuring progress on the Opportunity Age
commitments includes a section on this area. This is a complex
subject area which the Government is committed to investigating
further, with the intention of adding suitable indicators on this
area to the suite of indicators covering older people's well-being
in the future.
Driving
58. Points were made in the debate in support of
self-regulation in recertification for driving. Following the
debate in the House of Lords, a letter was sent from Lord Hunt
to the Department for Transport (DfT) on 21 June, reiterating
the points raised.
59. The Government recognises that mobility and transport
are crucial in enabling older people to maintain active and healthy
lives and mobility is often described as the key to independence.
The Government also recognises that international research into
the development of screening tools to aid licensing authorities
in making decisions about medical fitness to drive has produced
inconsistent results.
60. In 2005, the DVLA commissioned an independent
review of the medical driver licensing system and the Government
provided copies of the Committee's first report to the company
carrying out the review (Risk Solutions). The preliminary findings
of the review were announced at a conference organised by the
Parliamentary Advisory Council on Transport Safety in February
2006.
61. Following this, DVLA is now co-ordinating a Health
and Driver Licensing Review which aims to identify options for
change to be included in a public consultation later this year.
This process will take account of the recommendations put forward
by Risk Solutions. A number of cross-departmental working groups
have recently met to consider specific aspects of the current
medical licensing process. Their work to prepare a consultation
document will continue over the summer.
Home quality
62. The Committee again indicated their desire for
there to be a regulation in relation to lifetime housing. However,
we feel that the most immediate way to tackle the issue is through
a code for sustainable homes. The code gives developers a non-regulatory
means of improving the sustainability of buildings and aims to
become a single national standard that all developers subscribe
to and consumers demand. A code fits very well with better regulation,
and we see it as a faster way of getting the standard out to developers
than making it part of the building regulations, which was the
original recommendation of the Select Committee.
63. The Government continues to place great importance
on tackling fuel poverty among vulnerable houses. The 2005 Pre-Budget
Report provided an additional £300 million across the UK—a
move which was warmly welcomed by the Fuel Poverty Advisory Committee.
In England this will be primarily through Warm Front—providing
packages of heating and insulation measures to vulnerable households.
In 2005-08, more than £800 million will be spent on the scheme.
This complements Winter Fuel Payments, now worth £200 per
household for those aged 60 to 79 and £300 for those aged
80 or over. And through the Energy Review and Comprehensive Spending
Review we will continue exploring further options to support progress
towards our targets.
Active ageing
64. The Government welcomes the Committee's comments
on active ageing. Healthy ageing is embodied in the National Service
Framework for Older People and the Department of Health's healthy
ageing programme is the vehicle for delivering the older people's
component of the delivery of the White Paper Choosing health.
65. This will be a key component in the delivery
of the cross-government strategy for older people described in
Opportunity Age, which includes a focus on healthy active living.
66. The emphasis here is not just providing services
that increase a person's activity and health but that by promoting
healthy activity we can decrease the pressure on services and
families by reducing impairments and disability in older people.
50 pluses are one of the age groups targeted by the new NHS "Life
checks". This will help people adopt healthy lifestyles before
they reach old age, setting a pattern they will hopefully continue
in retirement.
Conclusion
67. The House of Lords Science and Technology Committee
raised a number of very significant issues, both in their reports
and in the subsequent debate. This response seeks to address these
issues, as a starting point for ongoing discussion, and to demonstrate
the Government's commitment to address the challenges facing an
ageing society. Continuing debate is particularly important given
the complexity and importance of issues such as the measurement
of healthy life expectancy, the provision of stroke services and
the co-ordination of research.
68. The Government acknowledges the magnitude of
the task that faces us. While there is a large body of work already
underway in Government looking at making improvements in a significant
number of areas, we accept that much remains to be done. We are
wholly committed to ensuring that progress continues to be made
in tackling the issues. In particular, the DWP will work collaboratively
with other government departments in working to increase our understanding
of the scientific aspects of ageing. In so doing, the Government
is keen to retain and develop its dialogue with the Committee
as we tackle these critical issues.
34 Published in the White Paper on Pensions Reform,
"Security in retirement: towards a new pensions system" Back
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