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Excess deaths could be linked to health spending cuts

Study suggests 120,000 excess deaths link to finance squeeze

Adrian O'Dowd

Thursday, 16 November 2017

Cuts to public funding of health and social care since 2010 could be linked to almost 120,000 excess deaths in England, suggests the first study* of its kind published today in the online journal BMJ Open.

People aged over 60 and care home residents have borne the brunt of these cuts and were most at risk, according to the study.

Between 2010 and 2014, the NHS in England had a real-term annual increase in government funding of 1.3%, despite rising patient demand and healthcare costs.

Real-term spend on social care has fallen by 1.19% every year during the same period, despite a significant projected increase in the numbers of over 85s (those most likely to need social care) from 1.6 million in 2015 to 1.8 million in 2020.

Researchers from several institutions including King’s College London, PILAR Research and Education, Cambridge, University College London, Universities of Oxford, Cambridge and the Philippines Manila, John Radcliffe Hospital, and London School of Hygiene and Tropical Medicine analysed nationally available data on population deaths, life expectancy, and potential years of life lost.

They also collected data on health and social care resources and finances from 2001 to 2014.

They then compared actual death rates for 2011 to 2014 with those that would be expected, based on trends before spending cuts came into play, and taking account of national and economic factors, such as unemployment rates and pensions.

The researchers’ analysis of the data showed that between 2001 and 2010, deaths in England fell by an average of 0.77% every year, but rose by an average of 0.87% every year between 2011 and 2014.

The spending restraints were associated with 45,368 higher than expected numbers of deaths between 2010 and 2014 compared with equivalent trends before 2010.

Most of these deaths were among the over 60s and care home residents with every £10 drop in spend per head on social care being associated with five extra care home deaths per 100,000 of the population, the analysis showed.

If these trends continued, even when considering the increased planned funding as of 2016, the researchers estimated approximately 150,000 additional deaths could arise between 2015 and 2020.

Combining these projected excess deaths and the observed deaths prior to 2015 translated to around 120,000 excess deaths from 2010 to 2017.

They found that changes in the numbers of hospital and community nurses were the most relevant factors in the associations found between spend and care home deaths.

From 2001 to 2010, nurse numbers rose by an average of 1.61% every year, but from 2010 to 2014, they rose by just 0.07%, which was 20 times lower than in the previous decade.

They calculated that the funds needed to close what they called a “mortality gap” would be £6.3 billion every year, or a total of £25.3 billion.

This was an observational study, so no firm conclusions can be drawn about cause and effect, but the findings back up other research in the field, said the researchers.

They concluded: “Spending constraints, especially public expenditure on social care, are associated with a substantial mortality gap. We suggest that spending should be targeted on improving care delivered in care homes and at home; and maintaining or increasing nurse numbers.”

* Watkins J, Wulaningsih W, Da Zhou C, et al. Effects of health and social care spending constraints on mortality in England: a time trend analysis. BMJ Open 2017;7:e017722. DOI:10.1136/bmjopen-2017-017722

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