Is Matt Hancock right to take credit for falling death rates?BMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l5676 (Published 24 September 2019) Cite this as: BMJ 2019;366:l5676
Earlier this month England’s health and social care secretary, Matt Hancock, tweeted about some “terrific news”—death rates were at their lowest level since records began, which he claimed was the result of record investment in the NHS and government policies.1
As part of its new Fact Check series The BMJ looks at the accuracy of the claim.
What was the claim?
Hancock’s tweet linked to Office for National Statistics quarterly data on mortality in England for April to June 2019.2 He wrote, “Terrific news: UK mortality rates down to their lowest level since records began. Yet more evidence that our record NHS investment, prevention agenda and NHS long term plan are yielding real results for people’s health across the country.”
What do the ONS figures show?
In April to June this year the age standardised mortality was 886 deaths per 100 000 population, which ONS said was statistically significantly lower than in the second quarter in all years since 2001, when it was 1195 deaths per 100 000 (Fig 1).
Despite conflating the numbers for England and the UK as a whole, it seems that Hancock was correct to assert that second quarter mortality this year was the lowest on record.
One caveat applying to this figure is that quarterly data are limited by registration delays, which means that they are normally lower than the actual number.
However, the ONS said that “the annual rate of improvement has slowed between 2011 and 2019 with improvements only half that observed between 2001 and 2010.” It added that there was “less stability in trends in deaths between 2011 and 2019 compared with the earlier period.”
What about the effect of government policy?
Hancock’s “record NHS investment” seems to be referring to the government announcement from June last year: that the NHS England budget would increase by £20.5bn in real terms by 2023-24, which it labelled the “biggest ever cash boost for the health service.”3
This was followed in November by the government’s prevention policy, which set out how the government planned to improve healthy life expectancy by at least five extra years (by 2035) and to close the gap between the richest and poorest people.4 The NHS long term plan was then finally released in January 2019, outlining how the extra £20.5bn investment in the NHS budget would be spent.5
This extra funding means that the NHS England budget should have increased by 3.6% this financial year, starting in April 2019. But increasing the NHS budget every year almost always happens, so is this a big deal?
While the £20.5bn is technically the largest single cash budget increase for the NHS, it follows years of slow growth. Between 2010 (when the Conservatives came to power in the coalition with the Liberal Democrats) and 2016 the health budget grew at an average rate of 1.3% a year, whereas the average was 5.6% a year between 1997 and 2010 under Labour governments.6
Furthermore, the health think tank the King’s Fund said that the new funding seemed to be in line with the “minimum increase needed to maintain quality and access to care” rather than improve services.7
The ONS report gave no reason for the mortality reduction. It said it could not comment on whether there was a link between the policies mentioned by Hancock and the figures.
When asked by The BMJ whether Hancock was referencing any evidence, the health department said that he “wasn’t specifically referencing a particular piece of evidence that shows a causal link of the government’s policies to the improvement in mortality.”
What’s the verdict?
There does not seem to be a basis to support Hancock’s claim that the latest quarterly mortality figure in England is “yet more evidence” that the government’s NHS investment, prevention agenda, and NHS long term plan are “yielding real results for people’s health across the country.” Mortality is falling but is continuing a trajectory seen since 2001, when Labour was in power.
This is the first in a new series created with the help of Steven Woloshin, co-director of the Center for Medicine and Media at the Dartmouth Institute for Health Policy and Clinical Practice and director of the Lisa Schwartz Program for Truth in Medicine, who has acted as a consultant. Richard Riley, professor of biostatistics at the University of Keele, has also advised on the series. If you spot any statements you would like us to fact check please email email@example.com