Changes in nurse numbers are linked to excess death rates – especially in care homes – according to a new study looking at the impact of cuts in health and social care spending on mortality.
The study suggests the squeeze on public finances since 2010 is linked to nearly 120,000 excess deaths in England up to 2017, with the over 60s and care home residents bearing the brunt.
“The number of NHS-qualified nurses is the strongest tested mediator”
Researchers said the critical factor may be changes in nurse numbers and warned there could be an additional toll of up to 100 deaths every day from now on without a major boost in funding that would include investing in more nursing staff.
An annual cash injection of £6.3bn would be needed to close the “mortality gap”, estimated the research team from leading institutions in London, Oxford and Cambridge.
They looked at data on health and social care resources and funding from 2001 to 2014, as well as national statistics on deaths, life expectancy and potential years of life lost.
In what is believed to be the first study of its kind, they compared actual death rates for 2011 to 2014 with those that would be expected before spending cuts came into play – taking account of national and economic factors such as unemployment rates and pensions.
The researchers went on to estimate future death rates up to 2020 and then worked out the health and social care funds needed to close the gap.
They identified spending restraints as being associated with more than 45,000 excess deaths between 2010 and 2014, mostly among the over 60s and care home residents.
“The government must redouble efforts to recruit more nurses”
Every £10 drop in spending on social care per head was linked with five extra care home deaths per 100,000 of the population, their analysis showed, with changes in the numbers of hospital and community nurses being a key factor.
The researchers found that, from 2001 to 2010, nurse numbers rose by an average of 1.61% every year, but from 2010 to 2014 they rose by just 0.07% – 20 times lower than in the previous decade.
“Our study suggests that the number of NHS-qualified nurses is the strongest tested mediator of the relationships between spending, and care home and home mortality,” stated the study paper.
Their calculations suggest around 120,000 excess deaths from 2010 to 2017, with projected death rates up to 2020 equating to 100 extra deaths per day.
The mathematical adds to a growing number of studies in recent years by UK researchers that have identified a link between nurse numbers and patient safety, outcomes and mortality.
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The authors of the new study, who were led by Johnathan Watkins, from the Institute for Mathematical and Molecular Biomedicine at King’s College London, concluded that reduced spending on health and social care was “associated with a substantial mortality gap”.
“We suggest that spending should be targeted on improving care delivered in care homes and at home and maintaining or increasing nurse numbers,” they said in the journal BMJ Open.
Janet Davies, chief executive and general secretary of the Royal College of Nursing, said the study was further evidence of the links between staffing shortages and increased patient mortality rates.
“Despite years of warnings, all parts of the NHS and social care system do not have enough nurses and people, particularly vulnerable and older individuals, are paying the highest price,” she said.
“They stand a better chance of recovery and longer, healthier lives when cared for by degree-trained nurses,” said Ms Davies.
She said the government had allowed “nursing on the cheap”, with hospital wards and care homes increasingly relying on unregistered healthcare assistants, especially at night.
“The government must redouble efforts to recruit more nurses,” she said. “In next week’s budget, the chancellor has an opportunity to change course by investing in health and care services and the professionals who work in them.”