Tag: Danny Dorling

Health cuts most likely cause of steep rise in mortality, government in denial

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Government denies that NHS and social care cuts may have caused 30,000 excess deaths in England and Wales 2015.

An unprecedented rise in mortality in England and Wales, where 30,000 excess deaths occurred in 2015, is likely to be linked to cuts to the NHS and social care, according to research which has drawn an angry response from the government.

The highly charged claim is made by researchers from the London School of Hygiene & Tropical Medicine, Oxford University and Blackburn with Darwen council, who say the increase in mortality took place against a backdrop of “severe cuts” to the NHS and social care, compromising their performance.

(The report can be accessed here: Why has mortality in England and Wales been increasing? An iterative demographic analysis.)

The Department of Health (DH) responded by accusing the authors of the paper and accompanying commentary, published in the Journal of the Royal Society of Medicine on Thursday, of “bias”.

The researchers ruled out other possible causes of the increase, including cold weather, flu and the relatively low effectiveness of the flu vaccine that year, noting that fatalities from the virus rose “but not exceptionally”.

After examination of NHS performance data for the period, which shows the service missing almost all its targets, they concluded: “The evidence points to a major failure of the health system, possibly exacerbated by failings in social care.”

The rise in deaths from 2014 to 529,655 in 2015 was the biggest in percentage terms in almost 50 years and the mortality rate was the highest since 2008. The excess deaths were largely among older people who are most dependent on health and social care, the authors said. 

See: Excess deaths per month in 2015 compared with 2006-2014

The research further warned that the “spike” was showing signs of becoming an established pattern, with provisional official weekly mortality data from 2016 showing deaths from October onwards increasing by 7% compared with the five-year average.

While accepting their findings would generate controversy, the authors expressed surprise that the rise and the reasons for it had not previously been scrutinised.

Professor Danny Dorling from the University of Oxford said: “It may sound obvious that more elderly people will have died earlier as a result of government cutbacks, but to date the number of deaths has not been estimated and the government have not admitted responsibility.”

The researchers observed that the increase in mortality came as waiting times rose in A&E departments – despite unexceptional attendances – for admissions, diagnostic tests and also consultant-led care. Ambulance response times also increased as did operations cancelled for non-clinical reasons. Staff absence rates rose and more posts remained empty as staff had not been appointed.

The authors said health service austerity had been exacerbated by £16.7bn of cuts to the welfare budget and a 17% decrease in spending for older people since 2009, while the number of people aged 85 and over had risen almost 9%.

See: Age-standardised death rates per 100,000 population for all ages

Barbara Keeley, the shadow social care minister, said: “The Tories have created a crisis in social care. They have cut billions of pounds from council budgets and care is suffering as a result.

“In the March budget, the government must provide extra funding urgently and deliver a sustainable settlement to deal with the crisis in health and social care.”

The Liberal  Democrat leader, Tim Farron, called it “a national scandal that in one of the richest countries in the world, vulnerable older people are missing out on the services they need and may even have died due to poor care”.

The report’s co-author, Dominic Harrison, the director of public health at Blackburn with Darwen council, said the research “raises a red flag that is telling us that the health and care system may have reached the limits of its capacity to safely and effectively care for the population that funds it. Our analysis suggests that the most likely cause of that failure, when all other possible explanations have been excluded, is insufficient resources and capacity”.

The paper will make uncomfortable reading for the government at a time when it is under substantial pressure to boost spending for both the NHS and social care amid fears they are at breaking point.

See: Number of patients spending more than 12 hours from decision to admit to admission

A Department of Health (DH) spokesman described the study as “a triumph of personal bias over research”. He added: “Every year there is significant variation in reported excess deaths, and in the year following this study they fell by nearly 20,000, undermining any link between pressure on the NHS and the number of deaths. Moreover, to blame an increase in a single year on ‘cuts’ to the NHS budget is arithmetically impossible given that budget rose by almost £15bn between 2009-10 and 2014-15.”

The fall the DH refers to is the reduction in excess winter deaths, which compares those between December and March with those in the rest of the year. Excess deaths over the year are measured relative to the average in recent years.

Harrison said the point the authors were making was that in months such as January 2015, which saw a spike in deaths, there was an insufficient service response to a surge in demand. He termed this a “fail event” and warned there could be recurrences over the next five years without a rise in funding. He added that preliminary figures pointed to a possible significant increase in excess deaths last month.

“I have few doubts that our findings will be strongly contested,” he said. “This report has been published in good faith in a peer-reviewed academic journal by senior health professionals who are concerned to understand the causes of avoidable death in the population – precisely so that we can avoid it happening again.”


From The Guardian, 17th February 2017

 

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Public health experts from Durham University have denounced the impact of Margaret Thatcher’s policies on the wellbeing of the British public in a comprehensive study which examines social inequality in the 1980s.

The study, which looked at over 70 existing research papers, concludes that as a result of unnecessary unemployment, welfare cuts and damaging housing policies, the former prime minister’s legacy includes the unnecessary and unjust premature death of many British citizens, together with a substantial and continuing burden of suffering and loss of wellbeing.

The research shows that there was a massive increase in income inequality under Baroness Thatcher – the richest 0.01 per cent of society had 28 times the mean national average income in 1978 but 70 times the average in 1990, and UK poverty rates went up from 6.7 per cent in 1975 to 12 per cent in 1985.

Baroness Thatcher’s governments wilfully engineered an economic catastrophe across large parts of Britain by dismantling traditional industries such as coal and steel in order to undermine the power of working class organisations, say the researchers. They suggest this ultimately fed through into growing regional disparities in health standards and life expectancy, as well as greatly increased inequalities between the richest and poorest in society.

Professor Clare Bambra from the Wolfson Research Institute for Health and Wellbeing at Durham University, co-author of the research report, commented:

“Our paper shows the importance of politics and of the decisions of governments and politicians in driving health inequalities and population health. Advancements in public health will be limited if governments continue to pursue neoliberal economic policies – such as the current welfare state cuts being carried out under the guise of austerity.”

Thatcher’s policies  have been condemned for causing “unjust premature deaths.” Cameron’s policies are even more class-contingent and cruel.

I think there is a growing body of empirical evidence which indicates clearly that Conservative governments are much worse for public health, prosperity and wellbeing than unemployment. (From: Conservative governments are bad for your health.)


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The Government’s brutal cuts to disability support isn’t ‘increasing spending’, Chancellor, but handing out tax cuts to the rich is

Chancellor George Osborne

 

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Source: Hansard

Context

Many of us recognised in 2012, when the welfare “reforms” and other cuts to public services that support the poorest citizens were forced through parliament despite considerable opposition, using only the “financial privilege” of the Commons as a justification, that the Conservatives are on an ideological crusade, which flies in the face of public needs, democracy and sound economics, to shrink the welfare state and privatise our essential services.

In a wealth transfer from the poorest to the very rich, we have witnessed the profits of public services being privatised, but the losses have been socialised – entailing a process of economic enclosure for the wealthiest, whilst the burden of losses have been placed on the poorest social groups and our most vulnerable citizens – largely those who are ill, disabled and elderly. The Conservative’s justification narratives regarding their draconian policies, targeting the poorest social groups, have led to media scapegoating, social outgrouping, persistent political denial of the aims and consequences of policies and reflect a wider process of political disenfranchisement of the poorest citizens, especially sick and disabled people.

That the cuts are ideologically driven, and have nothing whatsoever to do with economic necessity, was demonstrated only too well by the National Audit Office (NAO) report earlier this year. The NAO scrutinises public spending for Parliament and is independent of government. The report indicates how public services are being appropriated for purely private benefit.

The audit report in January concluded that the Department for Work and Pension’s spending on contracts for disability benefit assessments is expected to double in 2016/17 compared with 2014/15. The government’s flagship welfare-cut scheme will be actually spending more money on the assessments conducted by private companies than it is saving in reductions to the benefits bill.

From the report:

£1.6 billion
Estimated cost of contracted-out health and disability assessments over three years, 2015 to 2018

£0.4 billion
Latest expected reduction in annual disability benefit spending.

This summary reflects staggering economic incompetence, a flagrant, politically motivated waste of tax payers money and even worse, the higher spending has not created a competent or ethical assessment framework, nor is it improving the lives of sick and disabled people. Some people are dying after being wrongly assessed as “fit for work” and having their lifeline benefits brutally withdrawn. Maximus is certainly not helping the government to serve even the most basic needs of sick and disabled people.

However, Maximus is serving the private needs of a “small state” doctrinaire neoliberal government, and making lots of private profit whilst it does so. The Conservatives are systematically dismantling the UK’s social security system, not because there is an empirically justifiable reason or economic need to do so, but because the government has purely ideological, anticollectivist, antidemocratic, profoundly uncivilising prescriptions and longstanding prejudices.

Last week I wrote about the £30 a week Employmen Support Allowance (ESA) work related activity group (WRAG) cuts, which the Government have forced through the legislative process, despite meeting with widespread opposition, the government claim that it is their financial privilege to do so. Yesterday I wrote about the brutal cuts that are planned for Personal Independence Payments (PIP) for sick and disabled people, which are aimed at saving money by reducing eligibility for the support. The cut, it is estimated, will affect at least 640,000 disabled people by 2020, who may lose up to £150 a week. This is money that provides essential support for people who need help to prepare food, use the toilet or dress themselves, amongst other things, and to maintain a degree of dignity and independence.

The cuts to ESA and Personal Independent Payments (PIP) take place in the context of a Tory manifesto that included a pledge not to cut disability benefits. In fact in March last year, the Prime Minister signalled that the Conservatives will protect disabled claimants from welfare cuts in the next parliament (this one). Cameron said the Conservatives would not “undermine” PIP, which was introduced under the Coalition to save money by “targeting those most in need.” Now it seems those most in need are not the ones originally defined as such.

At the time he told BBC Breakfast: “We’ve replaced one benefit – Disability Living Allowance – with a new benefit – Personal Independence Payment – it’s working well, it is also going to lead to some savings over time and we haven’t created that benefit in order to undermine it. We want to enhance it and safeguard it.”

Semantic thrifts: being Conservative with the truth

Only a Conservative minister would claim that taking money from sick and disabled people is somehow “fair,” or about “helping”, “supporting” or insultingly, “incentivising” sick and disabled people who have already been deemed unfit for work by their doctors and the state via the work capability assessment to work.

The Tories all too frequently employ such semantic shifts and euphemism – linguistic strategies – as an integral part of a wider range of techniques of neutralisation that are used, for example, to provide linguistic relief from conscience and to suspend moral constraint – to silence both “inner protest” and public objections – to the political violation of social and moral norms; to justify acts that cause harm to others whilst also denying there is any subsequent harm being inflicted; to deny the target’s and casualties’ accounts and experiences of political acts of harm, and to neutralise remorse felt by themselves or other witnesses.

Media discourse has often preempted the Conservative austerity cuts, resulting in the identification, stereotyping and scapegoating of the groups in advance of the targeted, discriminatory policies. Media discourse is being used as a vehicle for the government to push their ideological agenda forward without meeting legitimate criticism, public scrutiny and without due regard for essential democratic processes and safeguards.

The five neutralisation techniques identified by Gresham Sykes and David Matza are: denial of responsibility, denial of injury, denial of victims, appeal to higher loyalties, and condemnation of condemners.

The really critical part of Sykes and Matza’s argument is that rationalisations precede immoral, cruel or controversial acts and are a key factor in making deviant behaviour possible (amongst delinquents, the mafia or Conservative ministers). As such, the rationalisations betray intent.

The cuts of £120 a month to the disability benefit Employment Support Allowance  are also claimed to be “fair.” and “supportive.” Though I have yet to hear a coherent and rational  explanation of how this can possibly be the case. Ministers claimed that people subjected to the ESA Work Related Activity Group cuts could claim PIP if they required support with extra living costs, but now we are told that PIP is to be cut, too.

Osborne’s techniques of neutralisation: calling a cut “increased spending”

The chancellor has defended his decision to use the cuts in disability benefits to fund tax breaks for the wealthy. On the Andrew Marr show yesterday, he was questioned about his decision to cut PIP, currently made to over 640,000 disabled people in a bid to save at least £1.2 billion. Many severely disabled people are facing a cut of up to £150 a week under the new reduced eligibility assessment criteria.

Controversially, the cuts to disability benefits will fund tax cuts for the most affluent – the top 7% of earners. The Chancellor is set to raise the threshold at which people start paying 40p tax, in a move that will probably see  many wealthier people pulled out of the higher rate of income tax, in the coming budget. Mr Osborne says he wants to “accelerate progress” towards the Conservative’s manifesto pledge of raising the threshold for the 40p rate to £50,000 in 2020, it is understood. The average annual income in the UK is around £27,000. 

Andrew Marr said: You’re taking money out of the pockets of some of the most vulnerable people in this country, disabled people. These are the people who can least afford the sacrifice, the people with the weakest shoulders.

And you’re changing the rules to hit them. Is that really your priority?”

Osborne ludicrously claimed that the Conservative government was “increasing spending on disabled people”, he said: “Controlling welfare bills is part of what you need to do if you’re a secure country confronting the problems in the world.”

But as Marr pointed out, the cuts to ESA and PIP show an intended substantial reduction on government spending to essential support for disabled people.

From January 2017, the cut to PIP is likely to hit sick and disabled people who face fundamental barriers to health and essential basic care. The cut, it is estimated, will affect at least 640,000 disabled people by 2020.

Andrew Marr went on to say: “At the same time as you’re raising thresholds to help middle-class tax payers, it’s going to seem a very callous set of priorities.”

However, Mr Osborne maintained that the brutal and uncivilised cuts were “necessary to improve the economic conditions in the UK”. He said: “Yes, times are tough. The fiscal situation is a difficult one. All Western countries are not productive enough.”

You can see the interview here:


Austerity and premature mortality

Since 2011, a year after the government began their austerity programme, mortality rates have increased rapidly. Advisers to Public Health England (PHE) have warned that the 4-year trend may be the worst since World War II.

Data from the Office of National Statistics shows a 5.4% (27,000) increase in deaths in the past year alone, prompting calls for an urgent investigation. The year-on-year rise, to a total of 528,340 deaths, is the highest since 1968.

PHE said the elderly were bearing the worst of Tory austerity cuts, with women suffering disproportionately, though this is partly because they live longer, however, it is also due to a growing crisis in the NHS and cuts to social care. Professor Danny Dorling, from Oxford University, an advisor to PHE on older age life expectancy, said:

“When we look at 2015, we are not just looking at one bad year. We have seen excessive mortality – especially among women – since 2012.”

Figures show that the number of deaths had been falling steadily until 2011, a year after the government began their austerity programme, when deaths rates began to increase rapidly.

Professor Dorling cited Tory austerity as the biggest cause:

“I suspect the largest factor here is cuts to social services – to meals on wheels, to visits to the elderly.”

Empirical research published two years ago demonstrated the high a cost the country paid in terms of health and wellbeing for the Thatcher administration’s economic and social policies. The study, which looked at material from existing research and data from the Office for National Statistics, illustrates that Thatcherism resulted in the unnecessary and unjust premature deaths of British citizens, together with a substantial and continuing burden of suffering and a widespread degradation of wellbeing. Co-author and researcher Professor Clare Bambra from the Wolfson Research Institute of Health and Wellbeing said that deaths from violence and suicide all increased substantially during the Thatcher era in comparison with other countries. Regional inequalities in life expectancy between north and south were also exacerbated, as were health inequalities between the richest and poorest in British society.

Professor Bambra also says that the welfare cuts implemented by Thatcher’s governments led to a rise in poverty rates from 6.7% in 1975 to 12% by 1985; poverty is well known to be one of the major causes of ill health and mortality. Income inequality also increased in the Thatcher period, as the richest 0.01% of society had 28 times the mean national average income in 1978 but 70 times the average by 1990. Other research (The Spirit Level) indicates that income inequality is internationally associated with higher mortality and morbidity.

Welfare reform minister, Lord Freud, refused to monitor the number of people who take their own lives as a result of the £120-a-month cut planned for those people in the work related activity group (WRAG), claiming employment and support allowance from April 2017. Concerns were raised in the House of Lords last week, when Baroness Meacher, amongst others, warned that for the most vulnerable, the cut was “terrifying” and bound to lead to increased debt.

Condemning the truly callous and terrible actions of the Treasury, she urged ministers to monitor the number of suicides in the year after the change comes in, adding: “I am certain there will be people who cannot face the debt and the loss of their home, who will take their lives.”

Many people have died as a consequence of the welfare “reforms.”

Not only have the government failed to carry out an impact assessment regarding the cuts, Lord Freud said that the impact, potential increase in deaths and suicides won’t be monitored, apart from “privately” because individual details can’t be shared and because that isn’t a “useful approach”.

He went on to say “We have recently produced a large analysis on this, which I will send to the noble Baroness. That analysis makes it absolutely clear that you cannot make these causal links between the likelihood of dying – however you die – and the fact that someone is claiming benefit.”

Actually, a political refusal to investigate an established correlation between the welfare “reforms” and an increase in the mortality statistics of those hit the hardest by the cuts – sick and disabled people – is not the same thing as there being no causal link. Often, correlation implies causality and therefore such established links require further investigation. It is not possible to disprove a causal link without further investigation.

Whilst the government continue to deny there is a causal link between their welfare policies, austerity measures and an increase in premature deaths and suicides, they cannot deny there is a clear correlation establised, which warrants further research and political accountability.

Then they came for the ESA Support Group …

Despite the fact that this government face a UN inquiry into grave and systematic abuses of the human rights of disabled people, the blatant attacks on a social group with legally protected characteristics continues and the Conservatives continue to target disabled people for a disproportionately large and unfair burden of austerity cuts.

A government advisor, who is a specialist in labour economics and econometrics, has proposed scrapping all ESA sickness and disability benefits. Matthew Oakley, a senior researcher at the Social Market Foundation, recently published a report entitled Closing the gap: creating a framework for tackling the disability employment gap in the UK, in which he proposes abolishing the ESA Support Group. To meet extra living costs because of disability, Oakley says that existing spending on PIP and the Support Group element of ESA should be brought together to finance a new extra costs benefit. Eligibility for this benefit should be determined on the basis of need, with an assessment replacing the WCA and PIP assessment. The Conservative definition of “the basis of need” seems to be an ever-shrinking category.

Oakely also suggests considering a “role that a form of privately run social insurance could play in both increasing benefit generosity and improving the support that individuals get to manage their conditions and move back to work.”

I’m sure the private company Unum would jump at the opportunity. Steeped in controversy, with a wake of scandals that entailed the company denying people their disabilty insurance, in 2004, Unum entered into a regulatory settlement agreement (RSA) with insurance regulators in over 40 US states. The settlement related to Unum’s handling of disability claims and required the company “to make significant changes in corporate governance, implement revisions to claim procedures and provide for a full re-examination of both reassessed claims and disability insurance claim decisions.

The company is the top disability insurer in both the United States and United Kingdom. By coincidence, the  company has been involved with the UK’s controversial Welfare Reform Bill, advising the government on how to cut spending, particularly on disability support. What could possibly go right?

It’s difficult to see how someone with a serious, chronic and often progressive illness, (which most people in the ESA Support Group have) can actually “manage” their illness and “move back into work.” The use of the extremely misinformed, patronising and very misleading term manage implies that very ill people actually have some kind of choice in the matter. For people with Parkinson’s disease, rheumatoid arthritis, lupus and multiple sclerosis, cancer and kidney failure, for example, mind over matter doesn’t fix those problems, positive thinking and sheer will power cannot cure these illnesses sadly. Nor does benefit conditionality and being coerced into work by callously insensitive and medically ignorant assessors, advisors and ministers.

The Reform think tank has also recently proposed scrapping what is left of the disability benefit support system, in their report Working welfare: a radically new approach to sickness and disability benefits and has called for the government to set a single rate for all out of work benefits and reform the way sick and disabled people are assessed. 

Reform says the government should cut the weekly support paid to 1.3 million sick and disabled people in the ESA Support Group from £131 to £73. This is the same amount that Jobseeker’s Allowance claimants receive. However, those people placed in the Support Group after assessement have been deemed by the state as unlikely to be able to work again. It would therefore be very difficult to justify this proposed cut.

Yet the authors of the report doggedly insist that having a higher rate of weekly benefit for extremely sick and disabled people encourages them “to stay on sickness benefits rather than move into work.”

The report recommended savings which result from removing the disability-related additions to the standard allowance should be reinvested in support services and extra costs benefits – PIP. However, as outlined, the government have ensured that eligibility for that support is rapidly contracting, with the ever-shrinking political and economic re-interpretation of medically defined sickness and disability categories and a significant reduction in what the government deem to be a legitimate exemption from being “incentivised” into hard work.

The current United Nations investigation into the systematic and gross violations of the rights of disabled people in the UK because of the Conservative welfare “reforms” is a clear indication that there is no longer any political commitment to supporting disabled people in this country, with the Independent Living Fund being scrapped by this government, ESA for the work related activiy group (WRAG) cut back, PIP is becoming increasingly very difficult to access, and now there are threats to the ESA Support Group. The Conservative’s actions have led to breaches in the CONVENTION on the RIGHTS of PERSONS with DISABILITIES – CRPD articles 4, 8, 9, 12, 13, 14, 15, 17, and especially 19, 20, 27 and 29 (at the very least.) There are also probable violations of articles 22, 23, 25, 30, 31.

The investigation began before the latest round of cuts to ESA and PIP were announced.

 

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Reverse the ESA disability benefit cut: sign the petition

Extend the PIP consultation & stop cuts to supporting terminally ill & disabled: sign the petition

 

Related

A tale of two suicides and a very undemocratic, inconsistent government

Paternalistic Libertarianism and Freud’s comments in context

Let’s keep the job centre out of GP surgeries and the DWP out of our confidential medical records

Conservative governments are bad for your health

Research finds strong correlation between Work Capability Assessment and suicide

Benefits Assessor: How Long Are You Likely To Have Parkinson’s?

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