Exclusive: Public Health England examines older people life expectancy 'alert'

Public Health England confirmed to HSJ it was examining recently released data in response to the concern, but said the figures had “fluctuated” in the past.

An email seen by HSJ, which was sent by Blackburn with Darwen Council’s public health director to others in the region and to PHE, was described as an “alert” and calls for a national review to examine “the causes and developing local/national recovery plans”.

It suggests the fall in life expectancy at 85 could be due to “central government driven reductions in adult social care budgets [which] have reduced or stopped early/preventive interventions for older people”.

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The email from Dominic Harrison said: “It may now be likely that in many [council] areas in the [North West]/England that older people (over 85) are no longer living longer – and that this effect is statistically significant, sustained and (probably) preventable.”

It added: “Actual sustained cohort reductions in life expectancy such as this are now extremely unusual. The fact that we are ‘no longer living longer’ is a public health sentinel alarm.”

Blackburn’s data, analysed late last year, shows a reduction in life expectancy at 85 for both men and women, although this was “more sustained for females”, the email said.

Life expectancy is calculated based on mortality rates over three year periods. It is possible for life expectancy at birth to rise, while life expectancy at older ages falls when mortality rates are falling for younger people and rising for older people.

HSJ analysis of Office for National Statistics figures shows that across England and Wales life expectancy at 85 for women fell between the period of 2009-11 and 2010-12, then again in the period 2011-13 (see graph below and attached). There have been no other falls since at least 2001.

For men, life expectancy at 85 increased for both periods, although by a much smaller amount in each period than at any time since at least 2001.

In summer 2013 HSJ revealed mortality rates among older people had been unexpectedly high from early 2012 to April 2013. The reduction now seen in official life expectancy figures is believed to be linked to the same period of high mortality. Initial figures suggest mortality overall since mid 2013 has not been unusually high.

Mr Harrison’s email, sent last month, said there were “a number of possible explanations” for the fall in life expectancy including reductions in early intervention and preventive social services for older people due to council budget cuts. He suggested this could be the cause both of increased mortality and recently observed increases in emergency hospital admissions.

A further possible reason cited was that “pressure on secondary care services” might have meant “less effective or sustained care for frail elderly (either in or out of hospital)”.

PHE chief knowledge officer John Newton told HSJ: “Although there was a fall in life expectancy at age 85 in 2012, pre-analysis shows there was no further drop in 2013.

“[It is] influenced by many factors and has fluctuated from year to year in the past. However, PHE is currently conducting further analysis of these trends and we hope to make the findings available in the near future.”

A Department of Health spokeswoman said: “The number of people living beyond 85 has been increasing and is expected to increase further over the next few years.”

She highlighted “an extra £1.1bn” the government had given “to councils to help protect social care services this year”; the funds it had allocated to councils for public health; and the “£5.3bn better care fund [which] will focus resources on helping people to live independently which will save money and prevent people from needing more support”.

Faculty of Public Health vice president John Middleton, a former public health director, said the issue “needs to be taken seriously and looked into”. He highlighted the importance of flu vaccination rates and added: “The obvious concern is about shortcomings in social care which is related to the current debate on accident and emergency [demand and pressures].”