Over 60s and care home residents most at risk; changes in nurse numbers may be key

The squeeze on public finances since 2010 is linked to nearly 120,000 excess deaths in England, with the over 60s and care home residents bearing the brunt, reveals the first study of its kind, published in the online journal BMJ Open.

The critical factor in these figures may be changes in nurse numbers, say the researchers, who warn that there could be an additional toll of up to 100 deaths every day from now on in.

They estimate that an annual cash injection of £6.3 billion would be needed to close this ‘mortality gap.’

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

And real term spend on social care has fallen by 1.19 per cent 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, say the researchers.

While this mismatch in supply and demand and the funding gaps facing services have been well quantified, the potential impact on population health remains unclear.

To try and address this, the researchers mined nationally available data on population deaths, life expectancy, and potential years of life lost. And they 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.

They categorised their findings by age, place of death, and the local government area in which the death occurred, and used these to estimate future death rates up to 2020.

Finally, they looked at the health and social care funds that would be needed in addition to those already budgeted by the government as of 2016 to close any gaps in death rates.

Analysis of the data showed that between 2001 and 2010, deaths in England fell by an average of 0.77 per cent every year, but rose by an average of 0.87 per cent every year between 2011 and 2014.

The spending restraints were associated with 45,368 excess deaths between 2010 and 2014 compared with equivalent trends before 2010.

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

These associations remained after further detailed analysis and taking account of global and national economic factors.

Changes in the numbers of hospital and community nurses were the most salient 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 rose by just 0.07%–20 times lower than in the previous decade.

On the basis of the trends between 2009 and 2014, the researchers estimate that an extra 152,141 people could die between 2015 and 2020, equivalent to nearly 100 extra deaths every day.

The funds needed to close this ‘mortality gap’ would be £6.3 billion every year, or a total of £25.3 billion, they calculate.

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

The study has several policy implications, as it indicates that lower spend on health and social care is “associated with a substantial mortality gap,” they explain.

Universal coverage is undoubtedly important, they write, but it has to be properly financed if it is going to improve health. And the excess deaths among older people and care home residents make a strong case for targeted interventions, they add.

“This includes funding increases in social care, in addition to maintenance or rises in nursing numbers aligned with demand,” they conclude.

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