Austerity: Life Expectancy

Louise Haigh Excerpts

Wednesday 18th April 2018 Westminster Hall

[Louise Haigh (Sheffield, Heeley) (Lab)]

I beg to move,

That this House has considered austerity and changes in life expectancy.

It is a pleasure to serve under your chairmanship, Mr Paisley. Life expectancy is the statistical analysis of that most basic feature of health, life itself. Through these linear annals, since the early years of Queen Victoria’s reign, the health and wellbeing of this nation have been catalogued. Life expectancy serves as the statistical testimony of the social history of our country. Through it are revealed the national crises and epidemics, the giant leaps forward in public health and the great workplace, environmental and social reforms that have marked the last two centuries of change.

In the first collection, published in 1841, the English life table gave female life expectancy as 41 years and male as 40. The changes that followed in the subsequent 180 years have seen those doubled. The turn of the 20th century saw a dramatic drop in infant and childhood mortality as sanitation and living standards improved. Improvements in the treatment of infectious disease, the creation of the NHS, the Clean Air Act 1956 and improvements in maternity care, living standards and incomes followed, and with them rises in life expectancy that were sustained for almost a century. Neither wars nor global convulsions could stem the inexorable upward rise.

That was the great era of a remarkable revolution in public health. By 2011, women’s life expectancy had reached 83 and men’s 79. With three months added with each passing year, a little girl born in Sheffield in 2011 had every right to expect to live to be 100 years old. Those assumptions were not based on any great improvements or medical discoveries, but simply on the fact that our health was improving and would continue to do so.

However, since 2011, something unusual and, in modern British history, unprecedented has happened to life expectancy: it has flatlined. For the first time in well over a century, the health of the people of this nation has stopped improving. It is of course axiomatic that life expectancy cannot increase forever, and that a slowdown in growth would eventually occur, but it is the sudden and sustained rise in mortality rates that has so concerned public health professionals and should concern us as parliamentarians.

The period from July 2014 to June 2015 saw an additional 39,074 deaths in England and Wales, compared with the same period the previous year. While mortality rates fluctuate year on year, that was the largest rise for nearly 50 years, and the higher rate of mortality was maintained throughout 2016 and into 2017. Provisional figures on the number of weekly deaths indicate that winter mortality was higher than usual in early 2015, 2017 and 2018.

Those recent trends contrast starkly with the long-term decline in age-specific mortality rates throughout the 20th and 21st centuries. Now, research published in The BMJ has revealed the shocking fact that 10,000 more people died in the first seven weeks of 2018 than in the same period in 2017. The study finds no external factor that might have caused the 11% rise: no unusual cold snap, natural disaster or flu outbreak outside normal expectations. The Office for National Statistics has gone so far as to revise down its official life expectancy projections by almost a whole year, compared with the projections of just two years ago. That means 1 million further earlier deaths are now projected over the next 40 years.

The Financial Times has reported that the deceleration of previous rises in life expectancy has cut £310 billion from future British pension fund liabilities. As Professor Danny Dorling of the University of Oxford has noted, what is happening with life expectancy,

“is no longer being treated as a temporary decline; it is the new norm.”

Dorling and Dr Hiam have looked at other extraneous factors to explain those projections. A rise in birth rates? No—birth rates are falling. More migration? The ONS now projects less inward migration over the next 40 years.

How then to explain an increase of 40,000 deaths on what was projected for this year, and an extra 25,000 deaths for next year? We can only conclude that there has been a sharp deterioration in the collective health of this country. Dominic Harrison, Director of Public Health for Blackburn and Darwen, and an adviser to Public Health England, has said that the figures are a “strong and flashing” amber light that,

“something is making the population more vulnerable to avoidable death.

We know that in some areas the picture is even more concerning, with higher death rates and life expectancy falling. Research has pinpointed 29 areas where we see falling life expectancy for women; chief among them are seaside towns and post-industrial areas.

[Stephanie Peacock (Barnsley East) (Lab)]

I congratulate my hon. Friend on securing this important debate. Barnsley, the area I represent, has one of the lowest life expectancies in the country. Does she agree that post-industrial towns such as Barnsley need more funding and resources to tackle the inequality between north and south?

[Louise Haigh]

I could not agree more with my hon. Friend. She makes an important point, because it is exactly those post-industrial towns and regions that were invested in so heavily under the last Labour Government and have seen a fall in life expectancy over the last seven years.

Regional and class inequalities in health, as we know, are nothing new, but there is a more distinct change now taking place. In my city of Sheffield, the healthy life expectancy for women of 57.5 years has dropped by four years since 2009, while healthy life expectancy across the country has basically held steady. There are already too many areas in our country where healthy life expectancy is unacceptably low. The average baby girl born in Manchester between 2014 and 2016 will live to be 79, but only until age 54 will she be healthy. That is almost one third of her life spent grappling with health issues that will not affect the average woman born on Orkney until she is 71 years old.

[Mr Jim Cunningham (Coventry South) (Lab)]

One of the factors, if not the sole factor, is that when we look at the past recession, most of the burden has been inflicted on women generally. We all know that. That is an anxiety factor, and there are good examples of it. One good example is the women of the Women Against State Pension Inequality Campaign. A lot of them were due to retire and had plans; those plans have gone now, because they will not get their entitlement. There are a number of factors that affect women more than men, particularly during a recession.

[Louise Haigh]

My hon. Friend is absolutely right. It has particularly hit older women, and I will come on to that disproportionate impact shortly.

Something is adversely affecting the health of our population, and as my hon. Friend has just said, none of it is happening in a vacuum. The observation is unavoidable that these patterns coincide with the era of austerity. It is simply inconceivable that the state of our public realm, welfare system, housing, fuel poverty, child poverty and our NHS have nothing at all to do with it. The number of NHS trusts with budget deficits has increased sharply since 2015, as have waiting periods for elective surgery and waits for urgent care. Hospitals are now warning of an “eternal winter”, as records show the number of patients receiving urgent care within four hours fell to a record low in March 2018. Almost half a million patients waited longer than 18 weeks for planned care.

This week, the Royal College of Physicians raised the alarm, writing to hon. Members to tell us that hospitals are “underfunded, underdoctored, overstretched”. That will not be news to anybody who has been anywhere close to the NHS in recent years. However, the shortage of doctors and consultants revealed by the RCP is systematic and shocking; 43% of advertised consultant posts last year in Yorkshire and the Humber were not appointed to. In acute medicine, only five out of 26 posts were successfully appointed to. The RCP concludes that these workforce shortages have direct implications for patient safety. Although our hospitals still provide expert care, relentlessly drawing on the good will of staff—who cannot possibly provide the best possible care when under such pressure—is unsustainable.

Issues within the NHS are being compounded by problems with the provision of adult social care. According to the King’s Fund, in 2016-17 there were 380,000 cases of a delayed transfer of care due to patients’ awaiting a hospital assessment. A similar number were waiting for a place in a nursing home. It is little surprise that the sorry state of our social care system should be linked to a fall in the life expectancy of older women living in the poorest parts of the UK, because that cohort has seen a disproportionate fall in their life expectancy. For the first time, health inequality is rising because the most deprived are suffering with poorer health.

I have often heard it said that the elderly have been protected from the worst ravages of austerity, but the elderly who live in deprived communities have been hit many times over. Relevant to this debate, they have been hit first by the cut in pension credit for lower-income groups and then through the funding pressures on adult social care. Of course, it is in the local authorities serving the most deprived areas that these effects have been felt the most.

[Mr Tanmanjeet Singh Dhesi (Slough) (Lab)]

My hon. Friend is making an excellent speech, especially on the impact on the elderly. However, does she agree that more and more children are now being impacted by austerity? Slough Foodbank has noticed an increase in the number of families attending its food bank, saying:

“When we checked the vouchers, we discovered that there had been an increase of 16% in the number of children we helped in 2017 compared to 2016.”

Does my hon. Friend agree that it is important that child poverty is addressed now? There are lifelong implications for those who grow up in poverty, such as poorer academic results, employment prospects and life expectancy.

[Louise Haigh]

I am glad that my hon. Friend raises that important point, because I am not able to address all the factors behind declining life expectancy. The British Medical Association raised that point this week, saying it is very concerned about the 5 million children growing up in poverty and the implications that that will have in the future on life expectancy.

[David Hanson (Delyn) (Lab)]

I do not want to divert my hon. Friend from the main course of her speech, but she knows that, over the past 30 years, infant mortality has fallen by 60%, yet from 2015 onwards it has risen in England and Wales each year. Holywell Central and Flint Castle wards in my constituency have child poverty rates of 43% and 42%. We have seen an increase of 100 children in poverty in my constituency in the last year. This is a long-term issue, which we need to address.

[Louise Haigh]

My right hon. Friend is absolutely right: these are long-term issues, which need addressing. They are all the more heartbreaking because we have seen decades of progress, and we all assumed that that would only go in one direction; little did any of us imagine that we would see a rise in infant mortality in the sixth-richest country in the world. These figures are, quite frankly, inexcusable.

On social care, care homes in deprived communities often no longer receive enough to cover the costs of care, which inevitably compromises the quality that they are able to provide. For those in such communities who cannot afford private care homes, that reduction of quality, and in some cases the lack of any available residential care at all, has had a punishing effect.

All Members present will have received casework regarding those still in their homes in the community who rely on care packages. Their care is simply unacceptable, relying on care workers who are paid far too little and who often do upward of 25 care visits every single day. There is not a chance, even by unsustainably drawing on the boundless good will of those care workers, that visits could last for 30 minutes, as defined by official guidance. It is beyond the realms of possibility. Those millions of hours of lost contact time for the 470,000 vulnerable—predominantly elderly—people who use home care will have undoubtedly compromised their long-term care and support needs and the management of multiple conditions.

It perhaps should not be a surprise that the rise in mortality and the fall in life expectancy came from precisely that cohort—older women living alone in poorer areas. In many senses, they were the early-warning sign of the deeply troubling trend in increasing mortality. This cohort, more reliant than any other on a functioning, effective, compassionate state providing quality support, have been badly let down in recent years. It should be a source of national shame that elderly women in some of the most deprived areas of our country are living in isolation, not properly cared for, and are losing their lives because the state has not supported them. However, it is not just that cohort of women. Some 7% of the extra deaths in 2016-17 were of people aged between 20 and 60. Almost 2,000 more younger men and 1,000 more younger women have died than would have if progress had not stalled.

I am sure that the Minister cannot look at the evidence presented here today, or at the research undertaken over the past two years, and not want to take steps to tackle those shocking statistics and to prevent those lives from being cut short. It is therefore critical that Ministers and the Government take seriously the fall in life expectancy and the evidence behind the growth in mortality. Up to now, Public Health England has regrettably tried to attribute it to the greater prevalence of flu. However, as Loopstra noted in her report:

“If Public Health England’s attribution of rising mortality to cold weather and flu is correct, then it should lead to an elevation of mortality in regional swathes across the nation. However…trends have varied considerably across local authorities, with no apparent geographic patterning consistent with regional outbreaks.”

The rise in unexpected mortality and the concurrent fall in life expectancy represents a significant moment in the history of public health in this country, yet the Department of Health has so far rejected the call from public health professionals for an inquiry into the sharp rise in deaths. I repeat that call today, and ask the Minister to look very seriously at the evidence presented on the link between life expectancy and austerity.

I will end on the words of Danny Dorling and Stuart Gietel-Basten, who have undertaken so much of the research in this area:

“demography is not destiny. Projections are not predictions. There is no preordained inevitability that a million years of life need be lost…but only through politics comes the power to make the changes that are now so urgently needed.”

The Minister has that power in her hands, and there can be no more pressing question for her than to ask why the citizens of our country are dying sooner than they should. I hope she leaves no stone unturned in pursuit of that answer.

[Ian Paisley (in the Chair)]

I do not intend to put a formal time limit on speeches. However, there are two Opposition spokespersons as well as the Minister, and I would like to start calling the Opposition spokespersons just after the hour, so if Members could speak for about five minutes each, that would be helpful.

--- Later in debate ---

[Louise Haigh]

Could the Minister confirm what the net change in investment in early intervention has been since the Conservatives came to power?

[Jackie Doyle-Price]

I cannot give the hon. Lady that information now, but I will write to her.

Alcohol is a source of poor health outcomes, so we are also doing much to tackle that. I am in dialogue with Members on both sides of the House about supporting the children of alcoholic parents, recognising that they are a particular need group. I thank those hon. Members who have been associated with that.