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Spike in excess deaths linked to NHS and local authority spending cuts

Austerity to health and social care services may be responsible for 30,000 excess deaths in 2015

Ingrid Torjesen

Friday, 17 February 2017

Failures in the health and social care system in England and Wales linked to disinvestment are likely to be responsible for a spike in excess mortality during 2015, suggests an analysis* published in the Journal of the Royal Society of Medicine.

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.

For the analysis, researchers from the London School of Hygiene and 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 and 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 emphasised: "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.


* Hiam L, Dorling D, Harrison D, McKee M. Why has mortality in England and Wales been increasing? An iterative demographic analysis. Journal of the Royal Society of Medicine, February 2017

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