Researchers exploring why there has been a substantial increase in mortality in England and Wales in 2015 conclude that failures in the health and social care system linked to disinvestment are likely to be the main cause.
There were 30,000 excess deaths in 2015, representing the largest increase in deaths in the post-war period. The excess deaths, which included a large spike in January that year, were largely in the older population who are most dependent on health and social care.
Reporting their analysis in the Journal of the Royal Society of Medicine, the researchers from the London School of Hygiene & Tropical Medicine, University of Oxford and Blackburn with Darwen Borough Council, tested four possible explanations for the January 2015 spike in mortality.
After ruling out data errors, cold weather and flu as main causes for the spike, the researchers found that NHS performance data revealed clear evidence of health system failures. Almost all targets were missed including ambulance call-out times and A&E waiting times, despite unexceptional A&E attendances compared to the same month in previous years. Staff absence rates rose and more posts remained empty as staff had not been appointed.
Professor Martin McKee, from the London School of Hygiene & Tropical Medicine, said: “The impact of cuts resulting from the imposition of austerity on the NHS has been profound. Expenditure has failed to keep pace with demand and the situation has been exacerbated by dramatic reductions in the welfare budget of £16.7 billion and in social care spending.”
He added: “With an aging population, the NHS is ever more dependent on a well-functioning social care system. Yet social care has also faced severe cuts, with a 17% decrease in spending for older people since 2009, while the number of people aged 85 years and over has increased by 9%.”
“To maintain current levels of social care would require an extra £1.1 billion, which the government has refused.”
Professor McKee continued: “The possibility that the cuts to health and social care are implicated in almost 30,000 excess deaths is one that needs further exploration. Given the relentless nature of the cuts, and potential link to rising mortality, we ask why is the search for a cause not being pursued with more urgency?”
“Simply reorganising and consolidating existing urgent care systems or raising the ‘agility’ of the current A&E workforce capacity is unlikely to be sufficient to meet the challenges that high levels of admissions of frail elderly people and others who are vulnerable are likely to present this winter and in future winters.”
The researchers say that there are already worrying signs of an increase in mortality in 2016. Without urgent intervention, they say, there must be concern that this trend will continue.
Commenting on the analysis, Professor Danny Dorling, University of Oxford, added: “It may sound obvious that more elderly people will have died earlier as a result of government cut backs, but to date the number of deaths has not been estimated and the government have not admitted responsibility.”
Why has mortality in England and Wales been increasing? An iterative demographic analysis (DOI: 10.1177/0141076817693599) and What caused the spike in mortality in England and Wales in January 2015? (DOI: 10.1177/0141076817693600) by Lucinda Hiam, Danny Dorling, Dominic Harrison and Martin McKee, will be published by the Journal of the Royal Society of Medicine at 00:05 hrs (UK time) on Friday 17 February 2017.
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