Austerity, welfare reform, and deaths

The suggestion that people in the UK have died, and are dying, because of government policies is sometimes dismissed as extreme. But in the face of growing evidence, it would seem more extreme to deny the possibility.

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The Institute and Faculty of Actuaries cannot, by any stretch of the imagination, be considered an extreme organisation. However, the institute’s Continuous Mortality Investigation (CMI) unit has revised life expectancy figures for the UK because of the rise in deaths in recent years. In April 2017, Stephen Caine, a senior consultant at the actuarial firm Willis Towers Watson, said: “Until recently, mortality rates in the UK were falling at an impressive pace. Since 2011, these improvements have stalled. An unprecedented uptick in the number of people dying in the UK each year has led to the CMI’s latest model revising down the projection of how long we will live.”

CMI executive committee chair James Tair said: “The slowing raises important questions about contributing factors. Indeed, our analysis of pensions data implies that the causes could be more complex and stratified than the pure life expectancy figures, that only consider population data in aggregate alone, would suggest.”

In November 2017, a paper published in the British Medical Journal explored a possible contributing factor for this “unprecedented uptick in the number of people dying”..

The paperEffects of health and social care spending constraints on mortality in England: a time trend analysis began by setting out its purpose: “Since 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.”

The researchers found, “This study demonstrates that recent constraints in PEH and PES spending in England were associated with nearly 45,000 higher than expected numbers of deaths between 2012 and 2014. If these trends continue, even when considering the increased planned funding as of 2016, we estimate approximately 150,000 additional deaths may arise between 2015 and 2020. Combining these projected excess deaths and the observed deaths prior to 2015 translates to around 120,000 excess deaths from 2010 to 2017. Contemporaneous reductions in life expectancy and excesses in measures of preventable death both validated our mortality findings.”

For many people with a disability or long-term illness, a combination of austerity and welfare reforms have been found by the United Nations to represent ‘grave and systematic’ violations of their human rights, resulting in a ‘human catastrophe’.

It is not possible to put an exact figure on the number of people whose deaths have been hastened by the government’s decisions, but to suggest that none have died is simply untenable. There are the thousands who have died after being found fit for work when they patently were not. There is no way to prove direct causation, but for a seriously ill or disabled person, to face the prospect of ‘seek work or starve’, as many have done, can have a disastrous effect on mental and physical health.

An academic study found the reassessment of long-term Incapacity Benefit claimants (implemented by Chris Grayling against expert advice) was associated with 590 additional suicides.

And surely nobody can deny the individual deaths which coroners have directly linked to the assessment process. The deaths of Michael O’Sullivan Nicholas BarkerTim Salter and others.

In services which protect the public, cuts can also have fatal consequences. The Fire Brigades Union recently reported that fire deaths in London increased by 40 per cent in 2016. A union spokesperson said, “Station closures and fewer fire engines mean it is taking longer for fire crews to make it to the incident scene. This means they arrive after the fire has become more intense, when the possibility of rescuing victims becomes fainter and the work far more dangerous. Critically, overworked firefighters are now struggling to provide the preventative fire safety work which has historically driven down the number of fatal fires.”

It seems unlikely that there is absolutely no connection between cuts to police budgets, a drop in the number of police officers, and the subsequent rise in violent crime, which had previously been on a downward trend. In 2017  homicides in England and Wales leapt from 574 the previous year, to 723. Following a spate of fatal stabbings in London, a former police officer appeared on television to say that Theresa May had “blood on her hands” because police budget cuts meant that “There are too few police officers to keep the public safe and she is ignoring it.”

In prisons, where the state surely has a solemn duty to keep the people it detains safe from harm, frontline prison officer numbers in England and Wales were cut by 30 per cent between 2010 and 2013. The most recent figures for deaths in prison are for 2016, and reveal “a record level of 354 deaths in prison custody, up 97 from the previous year… There was a record high of 119 self-inflicted deaths, up 29…The rate of self-inflicted deaths has doubled since 2012.”  Even the Ministry of Justice itself has tentatively acknowledged that staff cuts were a factor in making prisons less safe.

Since 2010, the number of households in temporary accommodation has increased by more than 60 per cent, and since March 2011 the number of people who sleep rough has risen by 134 per cent. This increasing homelessness has been authoritatively linked to welfare reforms.

In September 2017 the National Audit Office said, “it appears likely that the decrease in affordability of properties in the private rented sector, of which welfare reforms such as the capping of Local Housing Allowance are an element, have driven this increase in homelessness.”

Also in 2017 the highly respected Homelessness Monitor concluded, “There is little doubt that the absolute shortage of genuinely affordable housing for low income households in large parts of the country continues to be intensified by welfare policy.”

We know that homelessness and rough sleeping have a terrible impact on health. Unfortunately the government does not collect figures on the number of people who die whilst homeless, but last year, in Brighton alone, 17 rough sleepers died, with an average age of 46. It seems entirely reasonable to assume that a rise in the numbers of people homeless and sleeping rough would mean a rise in the numbers of people who die such a death.

And so it goes on. In the face of such evidence, to deny the possibility that some deaths are due to government policies would seem to be an extreme position.

Bernadette Meaden

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