Excess Death Trends

Caroline Johnson Excerpts

Tuesday 16th January 2024 Westminster Hall

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

This is a very important debate and I will try to make my speech as short as possible. I congratulate the hon. Member for North West Leicestershire on raising this issue and on his determination to highlight the challenges that we are facing. On the one hand, we might have expected that the pandemic would shorten the lives of a number of our more frail citizens and thus have expected a fall in deaths post-pandemic, and we saw that. The ONS reported roughly 608,000 deaths in England and Wales in 2020, 586,000 in 2021, and 577,000 in 2022—that was higher than 2019 when there were about 531,000 deaths, so that does warrant further inspection. We expect a fluctuation year on year, and we also expect the total number of deaths to increase year on year as the population increases and ages. We therefore look at the five-year average, and currently we are using 2017, 2018, 2019, 2021 and 2022 because of the outliers in 2020. Even then, it is unlikely that we will be exactly at the average, and we would expect some years to be higher or lower.

The ONS monthly mortality analysis shows that, in 2022, there were 32,000 more deaths than the five-year average, and in January to July 2023, there were 21,809 more. That equates to an annualised figure of around 37,000, but the figures appear to stop in July 2023. Would the Minister advise as to why the data series has been discontinued? It would be helpful if it were not. However, those are raw numbers and we must be cautious because, as the population ages and increases, so will the number of deaths. The ONS therefore uses the age-standard mortality rate, which has fluctuated month on month but is actually down for both 2022 and 2023 when compared with the five-year average. Overall, when adjusted for age and population size, the number of deaths is not excessive, given what we would expect.

We need to look further at the trends on age and the causes of death to see a fuller picture. Others will no doubt speak of rising cardiovascular disease in men, the late presentation of cancers or the rise in liver disease, but as a consultant paediatrician, I would like to focus on children. The National Child Mortality Database collates data on children’s deaths from nought to 18. Its latest bulletin from March 2023 shows that there were sadly 3,743 deaths to the end of that month, which is an increase of 8% on the previous year. Would the Minister comment on what investigation she is doing into the cause of that increased mortality and what is being done to prevent further deaths? The purpose of the child death overview panel is to investigate those deaths, but the average investigation is taking 392 days, with less than half completed in 12 months and a significant fall in the number being completed in 12 months. What is the Minister doing to improve that process?

One particularly distressing feature of child death data is that suicide or deliberate self-harm was a primary cause of death of children between 10 and 17 years, and looking at the data, it is getting much worse with children between 10 and 14. I understand that the Government are aware of those figures and are investing in mental health for children and improving online safety. I would be grateful if the Minister elaborated further on the steps they are taking to support children and prevent further tragedies.

[Sir Gary Streeter (in the Chair)]

Order. The hon. Member is running out of time.

[Dr Johnson]

I will finish on this point. One reason why I get exasperated with the covid inquiry is that there seems to be too much focus on who said what to whom—did someone swear, did the actors like each other? I am not that interested. I want to know what lessons can be learned. Was lockdown useful? Was getting children out of school useful? Was the vaccine a suitable thing to give to children or not, particularly if they had had covid before? Those are the answers that we need.

--- Later in debate ---

[Maria Caulfield]

Not for the moment; let me respond to as many points from hon. Members as I can.

There is an increase in excess deaths. A number of factors contribute to that. We take that seriously, and monitor it constantly. Looking at the past year, for example, there was a high flu prevalence last winter, when there were still ongoing challenges relating to instances of covid-19 and a strep A outbreak, particularly among children. Those had an impact. Statistics from the Office for Health Improvement and Disparities showed that last year, there were almost 26,400 excess deaths in England, and of those excess deaths, 7,300 were due to acute respiratory infections, including flu and pneumonia.

Last winter, the number of positive tests for flu peaked at 31.8%—the highest figure in the last six years. There are schools of thought on that; one is that when people were locked down, they were not exposed to flu for a couple of years, so their immune systems struggle to cope. We have learned those lessons, and that is why, this year, we have brought forward our flu vaccination programme. We have successfully vaccinated over 17.6 million people since the campaign started in September. It is still early in the winter season, but—touch wood—we are seeing fewer admissions from flu and covid than we did last year. We are learning lessons from those excess deaths.

There are also excess deaths from cardiovascular diseases; that was pointed out during the debate. The figure is 6% higher than expected in England, with almost 13,500 excess deaths attributed to cardiovascular disease. Lockdown did have an impact on that. We know that people were not getting their cholesterol tested or their blood pressure checked, and were still smoking. Antihypertensives and statins were not being prescribed. Again, we have taken action. As my hon. Friend the Member for South West Bedfordshire (Andrew Selous) pointed out, we are supporting local authorities to resume normal NHS healthcare checks; between April and June last year, the highest number of checks were offered since the programme began in 2013. We are investing £17 million in innovative new digital health checks, to be rolled out this spring, that will deliver an additional 1 million checks in the first four years. We have a £10 million pilot to deliver up to 150,000 cardiovascular disease checks in the workplace, with free blood pressure checks being rolled out in community pharmacies to people over 40, and we are investing £645 million to include blood pressure checks in our community pharmacy facilities. That is in addition to the work the Prime Minister announced on a smoke-free generation, which will be debated further, through which we want to see smoking rates further reduce.

I turn to the elephant in the room—covid vaccines—because the hon. Member for North West Leicestershire and other hon. Members have raised concerns about their safety. It is true that Office for National Statistics data, published only in August, shows that people who have had a covid-19 vaccine have a lower mortality rate than those who have not been vaccinated. My hon. Friend the Member for Bosworth (Dr Evans) and the hon. Member for North West Leicestershire are absolutely correct that a high number of people who were vaccinated appear in the excess death population, but when 93.6% of the population have had at least one dose of a covid vaccine, there will be a high number of vaccinated people in the excess death numbers. That is prevalence, not causality. It is important that we look at the causes of excess deaths and tackle them.

[Dr Caroline Johnson]

The Minister is saying that the number of people dying who are vaccinated is higher than the number of people who are not. That is to be expected because they are more likely to be older and frailer. Does she have any data that are adjusted for age and frailty—to say whether the vaccinated population are more or less likely to die?

Gender Recognition

Caroline Johnson Excerpts

Wednesday 6th December 2023 Commons Chamber

[Kemi Badenoch]

The hon. Gentleman is quite right to raise that issue. That is why I mentioned the work that we are doing on clarifying the difference between sex and gender. As I said, these terms were used interchangeably when we originally legislated in the House, which has created confusion in terms of understanding.

Public authorities should aim for clarity in what they do. Many organisations, particularly hospitals, think that removing the term “women” is more inclusive. It really is not—it is excluding. I would gently say to them that if they are using phrases such as “chest feeding” or removing words such as “mother” from paperwork and forms, they are not helping. They are making things worse and they are creating confusion. I am going to work with public authorities. The Minister for Women is also a Health Minister. We take this issue very seriously, and we will see what more we can do to provide clarity. Providing clarity is the key point.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

Women’s participation in sport is significantly lower than men’s. We need to encourage more girls and women to participate in sport because it is good for their long-term health as well as their mental wellbeing. We have heard stories—and I have heard stories in my constituency—of women and girls being put off sport by the presence of males for safety, privacy or fairness reasons. What is the Secretary of State doing to encourage girls to participate in sport and to protect integrity, fairness and privacy in women’s sport?

[Kemi Badenoch]

This is something that I have said it is crucial that sporting bodies understand. They are responsible for managing the rules in this space, and quite a lot of them have updated their guidance to reflect that, but not all of them. Young women in competitive sports should not have to silently accept that biological men will always beat them and take their chances to win gold. Generations of women before them have worked really hard to ensure that women have a place in sports and that those who excel are rewarded for that and are recognised.

The Equality Act 2010 is not a barrier to fair sport for women. It permits it, and it even requires it, so I shall work with my colleagues in the Department for Culture, Media and Sport—the Minister for Equalities is a DCMS Minister—to ensure that fair sport is a right that every woman and every girl can enjoy.

Artificial Intelligence and the Labour Market

Caroline Johnson Excerpts

Wednesday 26th April 2023 Westminster Hall

[Mick Whitley]

The hon. Member makes a good point. When it comes to AI, all workers need protections.

Research by PricewaterhouseCoopers suggests that AI will be responsible for 46% of the UK’s long-term output growth. It promises job creation in sectors such as health, education, and science and technology. At the same time, it threatens devastating job losses in sectors such as manufacturing, transport and public administration. Some 7% of all UK jobs could be automated away within the next five years, and as many as 30% could disappear within 20 years.

The last time we experienced systemic economic displacement on anything like that scale was during the deindustrialisation of the 1980s and 1990s. The architects of that policy believed that nothing should be done to support those communities that carried the cost of the economic and social fallout, the legacy of which my constituency of Birkenhead continues to live with to this day. They followed the ancient mantra that the strong do what they can and the weak suffer what they must. We must not repeat that mistake again. I have called today’s debate to make an urgent plea for a rights-based and people-focused approach to artificial intelligence, and for a process that puts the voices and interests of workers at its heart. In this new machine age, we must assert more than ever the fundamental right of all people to a basic level of economic security and dignity at work.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

The hon. Gentleman makes an interesting point, much of which I support. It is not controversial to suggest that the NHS would benefit from more doctors or that digital tech has the potential to improve people’s lives. The Health and Social Care Committee has been looking at both of those issues. As part of one of its inquiries, the Committee went to San Francisco about a month ago to look at how AI can help in medicine. We found that computers can be taught to read mammograms of breast screening tests. That means that, rather than having to be read by two independent doctors, the mammograms can be read by one doctor and one computer. Apparently, the process is more accurate than one involving two computers or, indeed, two doctors. Therefore, AI has the potential not just to cause the workforce issues raised by the hon. Gentleman, but to benefit areas with workforce shortages.

[Mick Whitley]

I thank the hon. Member for those points. I have already said that we must embrace AI and what it does for us. We are not here to stop progress, but my point is that the Government need to build in regulatory rights and protections.

The benefits of this new technological revolution must be shared by everyone, not just an elite few. I do not claim to have the answers to a challenge of such enormous magnitude—I look forward to hearing hon. Members’ thoughts in a few moments’ time—but a starting point must surely be guaranteeing support to those sectors and communities that will be most affected by the threat and reality of economic displacement. That means strengthening our collective social security net and seriously considering the role that a universal basic income might play in ensuring a decent standard of living in a labour market increasingly characterised by job scarcity. It means investing in skills and lifelong learning, ensuring that workers whose employment is lost to AI have the opportunity to find well-paid and similarly rewarding work.

In any democracy we have to recognise that technology is never ideologically neutral. Every technological system reflects the interests and biases of its creators and funders. Our challenge is to ensure that AI technologies reflect a multiplicity of voices, including those of workers, and not just in their application but in their conception and design as well. I hope we will continue to discuss how we can achieve that.

A people-focused approach to AI must also mean doing more to guarantee the rights of those workers who are already working alongside artificial intelligence and related technologies in their workplace. The AI working group set up by the Trades Union Congress surveyed thousands of workers in producing its report on the worker experience of AI and associated technologies. It shows vividly how workers are increasingly managed by machines, how their rights and autonomy are being steadily eroded, and how automated processes often perpetuate human prejudice when making decisions on employees’ performance, hiring and promotions.

The Government’s response was set out in the Department for Science, Innovation and Technology’s recently published AI White Paper, which advocates a light-touch approach and effectively leaves the market to regulate itself. Although Ministers have devised five fundamental principles that should inform the adoption and use of AI in workplaces, they do not intend to place those principles on a statutory footing. Instead, the implementation of those principles will be left to underfunded and overstretched regulators, such as the Information Commissioner’s Office and the Equality and Human Rights Commission.

That contrasts starkly with the models adopted by other developed economies. The European Union’s Artificial Intelligence Act is likely to be one of the most comprehensive pieces of legislation ever passed on this subject, while California—the very centre of global technology innovation—is preparing to implement measures to protect the privacy and civil liberties of workers. These measures include a new office for AI, with the authority to guide the development of new automated systems, as well as statutory restrictions on the use of automated decision making in the workplace.

The proposal set out by the TUC’s AI manifesto, copies of which I have brought to Westminster Hall for Members today, involves taking a very different position from that taken by the Government. Building on the existing framework of equalities legislation, it calls for a rights-based approach to manage the transition to AI that would strengthen equality protections, guarantee workers the right to human contact and require a human review of high-risk decisions that have been automated, and protect the right to disconnect for all workers. It is also absolutely right to acknowledge the need to listen to workers—their voices and their experiences—in managing this transition. It is essential that we recognise and value the role of trade unions as a vehicle for getting those voices heard.

It is for those reasons that the manifesto proposes a statutory duty for employers to consult trade union representatives before adopting AI and associated technologies. It is also why the manifesto urges employers to agree collective agreements with unions to govern the use of AI in the workplace.

Last December, when I questioned the then Business Secretary—the right hon. Member for Welwyn Hatfield (Grant Shapps)—on the merits of introducing a statutory duty to consult, he expressed interest and offered to meet me to discuss it further. I think the Minister present today will remember that, and I am interested to hear whether he and the new Business Secretary share the right hon. Gentleman’s interest.

Finally, the manifesto emphasises the fact that workers’ participation can be achieved only if workers understand the processes and technologies at work. In environments in which decisions are increasingly dictated by machines, people need to know, more than ever, what data is being held on them and how it is used.

I am aware that time is short and I look forward to hearing other hon. Members’ contributions. I will conclude my remarks by saying that on 17 May I will introduce a ten-minute Rule Bill that builds on the TUC’s important work and which I hope will bring us a bit closer to the rights-based approach I am advocating and which we urgently need. I ask any colleagues interested in supporting that Bill to speak to me after this debate.

Oral Answers to Questions

Caroline Johnson Excerpts

Tuesday 7th March 2023 Commons Chamber

[Neil O’Brien]

As I just said, we are driving forward all that work through the major conditions paper. In addition, we have the Start for Life programme, with another £300 million to improve young people’s start in life. We are absolutely committed to tackling health disparities and driving forward work on all fronts.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

Vaping was designed as a stop-smoking device for adult smokers, but the flavours, colours and disposable vapes have become a fad for children, encouraging those who have never smoked to take up vaping. What are the Government doing to prevent that?

[Neil O’Brien]

My hon. Friend is quite right. It is something that we are looking at very closely, as she knows from previous conversations. While vaping can be an aid in quitting smoking—it helped about 800,000 people to do so last year—we must stop its use being driven up among children.