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.”
Responding to the analysis, Chairman of the LGA’s Community Wellbeing Board, Cllr Izzi Seccombe, said:
“We would urge government to urgently review the evidence behind this analysis. If correct, it would clearly reinforce the desperate need to properly fund social care.
“Genuinely new government money is now the only way to protect the services caring for elderly and disabled people, and ensure they can enjoy dignified and healthy lives, live in their own community and stay out of hospital for longer.
“Social care faces a funding gap of £2.6 billion by 2020, while councils’ public health budgets, which fund vital prevention work that keeps people well and out of hospital, have been cut by £530 million over a five year period.
“Councils, care providers, charities and the NHS are all united around the need for central government to fully fund adult social care. This is essential if we are to ensure people can live independent, fulfilling lives, as well as alleviating the pressures on the NHS.”