Chapter 6: The Ageing Society Grand Challenge
350.In this report we have referred to the Ageing Society Grand Challenge, a prominent Government policy on healthy ageing, and the extent to which various sectors might contribute to its mission to increase healthy life expectancy by five years by 2035. In this chapter we assess the challenge, including the feasibility and means of achieving its associated mission.
Feasibility of achieving the Ageing Society Grand Challenge mission
The five-year target
351.The first part of the Ageing Society Grand Challenge mission is to increase healthy life expectancy by five years by 2035; specifically “an increase of five years in disability-free life expectancy at birth for both males and females by 2035 … compared to the UK baseline of 62.5 years for males and 62.1 years for females in the years 2014–16”.583
352.Most witnesses thought that the five-year target was a worthy ambition, but were pessimistic that it could be achieved by 2035. David Sinclair, Director at the International Longevity Centre, thought the target was “laudable and exciting but unbelievably unachievable without major policy change.”584
353.Professor Marmot explained that, even if trends in life expectancy improvement were restored to pre-2010 levels, it would produce an increase in life expectancy of only 3.75 years by 2035. The improvement in healthy life expectancy would be even less, because “the inequalities are bigger and the social gradient is steeper” and so “we certainly would not make [the target] for healthy life expectancy”.585 Indeed, the Marmot 2020 report noted that, for females, healthy life expectancy has decreased since the period 2009–11.586 The Centre for Ageing Better told us that analysis by the Health Foundation suggested that healthy life expectancy would rise by just over a year by 2035 and “it will take 75 years to boost the average number of years that men spend in good health by five years assuming the recent rates of improvements continue.”587
354.A representative from the Department of Health and Social Care agreed that the UK is not on track to meet the target. Rosamond Roughton told us: “We are not on track to achieve [the five-year target] at the moment, and, in fact, we have gone backwards. The ONS publishes annual data and in the data before Christmas [2019] things have got worse.”588 However, Elaine Rashbrook from Public Health England was more optimistic, telling us that “we are moving in the right direction” and that it is “hard to say exactly whether we will [achieve the target], but the ambition is there.”589
355.There was consensus amongst Government officials, and those from organisations that contributed to defining the mission (such as the Centre for Ageing Better), that the target was still worthwhile. George MacGinnis, Challenge Director of the Healthy Ageing Challenge Fund, told us that “regardless of the global trends and the wider influences on the Grand Challenge mission”, the five-year target “remains a worthwhile goal, even if the actual five years looks less deliverable than it did when first devised.”590 Dr Giles said “it is a long shot—it is shooting for the moon—but we might get somewhere towards it.”591
Inequalities in healthy ageing
356.There was even less optimism from witnesses about the feasibility of achieving the second part of the mission: to reduce the gap in healthy life expectancy between the richest and poorest. Professor Marmot told us that reducing health inequalities has not been a priority for Government over the past decade:
“I do not think the Government did enough over the last 10 years. They said that they welcomed my [2010] report and included in the Health and Social Care Act [2012] the fact that health authorities should have regard to the reduction of health inequalities, and I was pleased with that. But they did not do much subsequently. They had other priorities.”592
Professor Marmot did not think the Government was adequately monitoring progress in health inequalities; he said that, in the preparation of the Marmot 2020 report, a representative of a health charity expressed surprised that the Government was not undertaking this kind of analysis themselves.593
357.Dr Anna Dixon, Chief Executive of the Centre for Ageing Better, told us that in order to address inequalities the Government needs to address the wider determinants of health.594 This would mean focusing more on prevention earlier in life, using “bold regulatory action” in areas such as obesity, alcohol and smoking, and “a greater focus on physical activity.” This would necessitate a “redesign of our environment, investment in public transport, and active travel.”595
358.We heard from several witnesses that the focus so far on technology and services in Ageing Society Grand Challenge initiatives may heighten inequalities, if products are not affordable and accessible to deprived groups. Professor Marmot explained that “in general, innovations … tend to get taken up first by people with more education [and] more money”.596 This is also the case for non-technical interventions, such as healthy eating advice:
“If people followed Public Health England’s healthy eating advice, those in the bottom 10% of household income would spend 74% of their income on eating. If you give good advice on what constitutes healthy food, people down at the bottom cannot follow that advice because they do not have enough money to do it.”597
Dr Dixon told us that products and services aimed at increasing healthy lifespan should be “designed frugally to be affordable” and that we should not assume that expensive technologies will eventually “trickle down” and become affordable to everyone.598
359.Despite the focus on inequalities in the mission statement, the Government told us that the mission to reduce inequalities is not solely the responsibility of the Ageing Society Grand Challenge, but is a requirement for public authorities, as set out in statutory duties including the NHS Act 2006 and section 149 of the Equality Act 2010.599
Monitoring progress towards the mission
360.We asked witnesses what data is being used to test whether the mission is being achieved. Elaine Rashbrook said that “a range of metrics is available”, but that there is a need to “[identify] which are the most appropriate to measure progress”.600 Dr Dixon told us that “at the high level the mission is trackable”, as data are available on disability-free life expectancy by socioeconomic group. However, she added that the end of the mission is a “long way into the future”, and:
“the question is how we are going to capture and evaluate the other impacts that we think are so important to the mission that we should be generating along the way. That is where there is a need for us to look at the policy actions that are needed. It would be great if those policy actions were all set out … in a cross-government strategy so it was really clear what each department was going to contribute to those policies, and then we could evaluate the extent to which those policies were having the impacts they specifically wanted.”601
She added that, for the mission, it was important to “ensure the social impacts are sitting alongside these broader economic impacts and capture both those together”, but the current evaluation is “not sophisticated enough” to assess social impacts.602
361.Despite data being available for monitoring progress towards the mission at a high level, it does not appear that this is happening within the Department of Health and Social Care or across Government. When we asked Rosamond Roughton whether there are regular reports to Parliament on progress towards the mission, she said there are currently “no plans” for such monitoring and progress updates.603
362.The Government is not on track to achieve the Ageing Society Grand Challenge mission to ensure five years of extra healthy life by 2035 while reducing inequalities, and does not appear to be monitoring progress towards the mission. It is hard to see how the target could be met without significant changes to the way it is managed.
363.We recommend that the Government review the feasibility of the target to increase healthy life expectancy by five years by 2035, and revise or re-commit to it. The Secretary of State for Health and Social Care should commit to reporting annually to Parliament on progress towards the target. The Government should also revise or re-commit to the target to reduce inequalities and outline measurable targets for the reduction in inequalities it hopes to achieve by 2035.
Responsibility and strategy for Ageing Society Grand Challenge mission
364.Given the lack of progress towards achieving the mission, we were interested in speaking to those in charge of its delivery. We were surprised to learn that there does not appear to be a person or team responsible for progress on the mission specifically, as opposed to the overall challenge. Rosamond Roughton, the Senior Responsible Officer for the challenge, told us that the mission “is the responsibility of the Department of Health and Social Care and the responsibility of the Secretary of State for Health and Social Care”,604 but added:
“The Secretary of State has asked all of us in the department to take some responsibility for the mission. There is not a single person who is just doing the mission. The mission is so big I do not know how you could give it to one person. It requires action across such a wide number of things that it is not a single responsibility … I have other colleagues, other directors in the department, who could equally be sitting here today and telling you stuff about what they are doing and what they are responsible for.”605
365.Rosamond Roughton drew a distinction between the aims of the challenge (to stimulate economic activity) and the aims of the mission:
“The underpinning mission guides all the work across the Department of Health and Social Care, because it goes beyond just looking at ageing … It covers a much wider portfolio than just the economic and innovation stimulation of the Grand Challenge.”606
366.She later told us that there will be initiatives beyond the remit of health and social care which will affect the mission, not all of which will necessarily have an economic benefit to the country. She said:
“That is why the Grand Challenge side of looking at the business end of it is also an important element. However, just doing the business end will not deliver the mission and just doing the mission will not necessarily deliver the economic objectives of the Grand Challenge. I think of them as two very closely overlapping, but not identical, goals.”607
367.The lack of clarity over who in Government is responsible for the mission specifically—aside from ministerial oversight by the Secretary of State—and its apparent separation from the team managing the challenge, was concerning to other witnesses. Professor Mariana Mazzucato, Professor in the Economics of Innovation and Public Value at University College London and Founding Director of the UCL Institute for Innovation and Public Purpose, wrote to us after that evidence session:
“I was concerned to hear from the Senior Responsible Officer for the Ageing Grand Challenge in the [Department of Health and Social Care] that, in fact, there is not an individual or a team within government either tasked with this important mission specifically or coordinating action across government (Question 152). In addition, having reflected on the evidence given on the 3rd March, I am left unclear how the grand challenge for ageing, or the mission itself, is being delivered across government, or where authority and responsibility lie.”608
368.We also heard concern that there is not a coordinated, cross-government strategy for achieving the mission, which may be related to the lack of clarity over responsibility for the mission. The Government’s website lists a range of initiatives associated with the Grand Challenge (Box 1), but it is not clear how they are intended to fit together to achieve the mission.609 Several of the initiatives associated with the Ageing Society Grand Challenge are not specific to healthy ageing or to the aims of the mission. For example, the £210 million investment in the ‘from data to early diagnosis’ Challenge Fund was included as part of a £300 million investment in the Ageing Society Grand Challenge in 2018, but it has a broader focus than conditions of ageing or improving healthy life expectancy.610
Box 1: Initiatives associated with the Ageing Society Grand Challenge, as of 10 October 2020
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Initiative
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Source: Department for Business, Energy and Industrial Strategy, Policy paper: The Grand Challenge missions, Ageing Society: https://www.gov.uk/government/publications/industrial-strategy-the-grand-challenges/missions#healthy-lives [accessed 10 October 2020]
369.Several witnesses called for a cross-government strategy for achieving the mission. The Centre for Ageing Better told us:
“Although it is feasible for the Ageing Grand Challenge to make progress towards this goal, it will require actions across departments, not just [the Department of Health and Social Care]. Despite the Ageing [Society] Grand Challenge, there has yet to be a cross-departmental understanding of what ageing really means for the whole of government and how departments beyond just [the Department of Health and Social Care] play a part in keeping people healthier for longer.”611
370.Dr Dixon expanded on how that coordination should occur:
“The first thing [the Government] needs to do is commit and publish a cross-government strategy on ageing. Many other countries have had and do have ageing strategies. Given the huge demographic challenges we face in this country, along with many others, it seems surprising that we have no cross-government strategy on this issue, despite the fact that some of your colleagues some time ago had called for this in previous Lords Committees.”612
Dr Dixon suggested that responsibility for the cross-governmental strategy could sit in the Cabinet Office.613
371.Professor Mazzucato told us that a 2019 report by the UCL Commission for Mission-Oriented Innovation and Industrial Strategy, co-chaired by herself and Lord Willetts, recommended a cross-government approach to all the Grand Challenges:
“To implement and deliver a mission-oriented industrial strategy, the Government should form multi-disciplinary, cross-departmentally-staffed, boundary-crossing Grand Challenge teams. These must be fully resourced, both in terms of funding but also in terms of leadership, staff, support and analytical capability, with operational autonomy to set their own goals and programmes, as well as senior reporting responsibility within government and the freedom to take initiative in a given challenge area.”614
372.She added that a recent report by the Government Office for Science echoed this, recommending that the Government ensures there is “An empowered and accountable mission leader … appointed by the Permanent Secretary of the lead department” and that “The [mission leader] is directly supported by a … flexible and empowered core team of sufficient critical mass … of no more than 8–10 people … [which] consists of members from the key departments”.615 The Government Office for Science report recommended that a “team is formed solely to deliver the mission and therefore has a lifetime that spans the duration of the mission.”616
373.A cross-government strategy should help achieve the part of the mission on reducing health inequalities. Professor Marmot thought the Prime Minister should be responsible for achieving this part of the mission “because it is cross-government”:
“We said in 2010 that 4% of the NHS budget goes on prevention. That is quite apart from investing in early child development and education. The spend on education went down by 8% per child. If you had health equity at the heart of government, you would never allow the per-child spending on education to go down by 8%. That is why I think it should be the Prime Minister. This should be a corporate issue for the whole of government.”617
374.It is not clear who in Government is responsible for overseeing the Ageing Society Grand Challenge mission, aside from broad ministerial oversight from the Secretary of State for Health and Social Care. We are concerned that this policy has no clear ownership.
375.The position taken by the Government that the challenge and the mission are overlapping but distinct is confusing, and we are concerned that achieving the mission does not appear to be at the core of the Grand Challenge.
376.We recommend that the Secretary of State for Health and Social Care appoints a senior responsible officer for achieving the mission of the Ageing Society Grand Challenge, as this does not appear to be covered by the senior responsible officer for the challenge.
377.We are concerned that there is not a cross-government strategy for achieving the mission. Without one, the Ageing Society Grand Challenge is unlikely to achieve the mission of increasing healthy life expectancy by five years while reducing inequalities.
378.The Government’s statement that the part of the mission pertaining to inequalities is not the sole responsibility of the Ageing Society Grand Challenge is confusing. Other aspects of policy will contribute to this goal, but that does not mean that reducing inequalities should not be at the core of the cross-government strategy for healthy ageing.
379.We recommend that the Secretary of State for Health and Social Care—along with the senior responsible officer—produces a cross-government strategy which clearly states how the Government plans to achieve the Ageing Society Grand Challenge mission by 2035. The strategy should include a roadmap for how the Government intends to achieve the mission, and should specify the departments responsible for working towards the target.
380.We recommend that the cross-government strategy explicitly addresses the issue of reducing inequalities in healthy ageing, without ‘passing the buck’ to wider Government goals or statutory obligations. In producing the strategy, the Government should seek wide input from stakeholders; most importantly, from older people.
586 Institute of Health Equity, Health Equity in England: The Marmot Review 10 Years On (February 2020): http://www.instituteofhealthequity.org/resources-reports/marmot-review-10-years-on/the-marmot-review-10-years-on-full-report.pdf [accessed 7 September 2020]
595 Ibid.
597 Q 195 (Professor Sir Michael Marmot). Professor Marmot was citing figures from the following report: The Food Foundation, Affordability of the UK’s Eatwell Guide (2018), pp 7–8: https://foodfoundation.org.uk/wp-content/uploads/2018/09/Affordability-of-the-Eatwell-Guide_Final_Web-Version.pdf [accessed 30 December 2020]
602 Ibid.
609 Department for Business, Energy and Industrial Strategy, ‘Government announces £300 million for landmark ageing society grand challenge’, (12 March 2018): https://www.gov.uk/government/news/government-announces-300-million-for-landmark-ageing-society-grand-challenge [accessed 14 September 2020]
610 Ibid.
615 Supplementary written evidence from Professor Mariana Mazzucato (INQ0097). See also Government Office for Science, Realising our ambition through science (November 2019): https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/844502/a_review_of_government_science_capability_2019.pdf [accessed 14 September 2020].
616 Government Office for Science, Realising our ambition through science (November 2019), p 83: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/844502/a_review_of_government_science_capability_2019.pdf [accessed 14 September 2020]