Effects of health and social care spending constraints on mortality in England: a time trend analysis

Abstract

ObjectiveSince 2010, England has experienced relative constraints in public expenditure on healthcare (PEH) and social care (PES). We sought to determine whether these constraints have affected mortality rates.MethodsWe collected data on health and social care resources and finances for England from 2001 to 2014. Time trend analyses were conducted to compare the actual mortality rates in 2011–2014 with the counterfactual rates expected based on trends before spending constraints. Fixed-effects regression analyses were conducted using annual data on PES and PEH with mortality as the outcome, with further adjustments for macroeconomic factors and resources. Analyses were stratified by age group, place of death and lower-tier local authority (n=325). Mortality rates to 2020 were projected based on recent trends.ResultsSpending constraints between 2010 and 2014 were associated with an estimated 45 368 (95% CI 34 530 to 56 206) higher than expected number of deaths compared with pre-2010 trends. Deaths in those aged ≥60 and in care homes accounted for the majority. PES was more strongly linked with care home and home mortality than PEH, with each £10 per capita decline in real PES associated with an increase of 5.10 (3.65–6.54) (p<0.001) care home deaths per 100 000. These associations persisted in lag analyses and after adjustment for macroeconomic factors. Furthermore, we found that changes in real PES per capita may be linked to mortality mostly via changes in nurse numbers. Projections to 2020 based on 2009-2014 trend was cumulatively linked to an estimated 152 141 (95% CI 134 597 and 169 685) additional deaths.ConclusionsSpending constraints, especially PES, 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.

Navigating environmental constraints to injection preparation: the use of saliva and other alternatives to sterile water among unstably housed PWID in London

“…Drugrelated deaths in the UK are higher than any European Union (EU) country; in the year before Britians exit they accounted for one third of all reported in the EU country and, in the year prior to Britain's exit, accounted for a third of all reported in the EU [5]. In an austerity context, where health harms are exacerbated by cuts to social and health services [6]-particularly among a growing homeless population [7]-services must innovate to reach those most at risk. To do so effectively, it is essential that interventions are informed by an in-depth understanding of current constraints to safe injecting practices and how environments can be modified to facilitate or protect against health harms.…”

Why is life expectancy in England and Wales ‘stalling’?

“…Other research has found a link between cuts in payments to pensioners and mortality29 and delay in National Health Service discharges and mortality 30. Most recently, research implicated ‘spending constraints’ as contributing to 45 368 (95% CI 34 530 to 56 206) extra deaths from 2010 to 2014, compared with pre-2010 trends, predominantly in people aged over 60 years and living in care homes 31. Correlation is not proof of causality, as all epidemiologists know.…”

Food banks and the production of scarcity

“…Cuts have hit the poorest people and places hardest, re-enforcing classed, gendered, and racialised inequalities at a range of scales. Documenting some of their most "vital" effects, Watkins et al (2017) have estimated that between 2010 and 2014 cuts to health and social care spending alone were associated with 45,368 more than expected deaths while, with food prices rising seven times faster than average household incomes, by 2014 8.4 million people in the UK were experiencing food insecurity (End Hunger UK, 2018;Taylor & Loopstra, 2016). The number of food banks has also expanded dramatically, from 56 Trussell Trust food banks providing a three-day supply of food to the equivalent of 40,989 people in 2009-2010, to more than 2,000 Trussell Trust and independent food banks providing in excess of 1.6 million food parcels in April 2019 (Butler, 2017(Butler, , 2019.…”