• There were 5.4 per cent more deaths in England in Wales in 2015 than in 2014 – the biggest year on year increase in several decades
  • Many of the deaths were during winter in early 2015
  • Potential causes include public spending cuts and constraint, problems with flu vaccine, and random fluctuation from year to year
  • Experts call for investigation by chief medical officer

Public health experts have called for investigation after statistics showed the biggest increase in the national death rate for several decades in 2015.

Preliminary figures indicate there were 5.4 per cent more deaths in England in Wales in 2015 than in 2014, and 6.3 per cent more than the average of the preceding five years.

The Office for National Statistics figures suggest the crude death rate – not adjusted for changes in the population age profile between years – increased by 4.9 per cent on 2014.

The increases in both the number of deaths and crude death rate are the biggest for many years. Similar increases appear to have taken place in the early 1950s and the late 1960s.

Much of the increase in deaths took place in the first months of 2015. The spike in deaths during winter 2014-15 has previously been identified by national officials and partly attributed to flu and ineffective vaccines.

However, public health experts told HSJ this did not adequately explain the growth in 2015, and similar patterns in recent years. A report published by Public Health England last week found that a large number of areas had seen falls in life expectancy for some groups of older people in 2014, in contrast to growth at a national level. There were also unexpected surges in deaths among older people in 2012 and 2013. Those years saw smaller increases in the overall death rate.

This chart shows the annual crude death rate over the past 30 years to 2015:

The reasons for the increase are not known and a wide range of factors have been floated by public health experts. They include the impact of a rapidly growing older population; older people returning to England; random fluctuation; weather; flu; cuts to care, support and health services; the economic downturn; high pressure on NHS services; an unidentified infection; and complex past changes affecting the health of the current “cohort” of older people.

Dominic Harrison, an honorary professor at Central Lancashire University and Blackburn with Darwen’s public health director, who was a member the advisory group for the PHE report on older age life expectancy, told HSJ the changes were a “strong and flashing amber warning light [that] something is making the population more vulnerable to avoidable death”.

He said it may be due to cuts and constraint on health and care spending.

“One of the things this data may be telling us is it is just not possible… to contain costs, improve quality, reduce inequality and improve outcomes within such a rapidly diminishing resource envelope,” he said. “We need to understand exactly what is happening if we are to prevent it continuing.”

Another adviser on the report, Danny Dorling, professor of geography at Oxford University and an expert on inequality, said: “When people study 2015 [and take into account population changes] it is quite possible this will be the biggest rise [in deaths] since wartime.” He said he did not believe it was explained by flu or ineffective vaccines, and there were many possible reasons, including the impact of funding constraint, other policy, and the economic downturn. He called for the chief medical officer to investigate.

King’s Fund senior fellow for public health and inequalities, David Buck, said there were multiple possible causes. He said: “PHE really needs to get behind this and investigate more thoroughly as guardian of the nation’s health.”

He said this needed to include looking at links to cuts to services, particularly social care, which had not been examined in the PHE report.

Periods with large numbers of deaths are sometimes preceded or followed by stretches with fewer than normal. This chart shows a rolling 24 month total of deaths and indicates that the combined total over 2014 and 2015 was high.

PHE chief knowledge officer John Newton said: “We have been monitoring changes in life expectancy and mortality in England… We find the statistics for older people fluctuate quite a bit from year to year and around the country. There is often no obvious pattern to this but it is clearly important to keep a close eye on the trends and consider a range of possible explanations.

“In 2015, the monthly death figures suggest that cold weather and flu may have played a part in the high numbers of deaths in the early part of the year. Especially given that A(H3N2) was the dominant subtype circulating last flu season in the UK. In any flu season dominated by an H3 subtype, unfortunately we can expect the burden of illness to be seen in the elderly and therefore a relatively high overall mortality. Changes in the population over time can also have some surprising effects on these statistics for technical reasons. It is important to keep an open mind.”

This chart shows how the increase in deaths, compared to the average of the past five years, was spread through 2015:

This chart shows the annual change in the number of deaths from 1935 to 2015:

This chart shows the number of deaths each year from 1935 to 2015: