The nearness to death effect and why NHS pressures are going to intensify

Since no one at the top, from NHS England to our politicians, appears to want to speak the truth, shall we have a chat as to why NHS capacity pressures keep on escalating?

Figure 1 shows the trend in deaths for males and females in the UK from 1974 to 2017 (Office for National Statistics (ONS), 2018a). Total deaths in males steadily declined from 1974 onward and in females from 1994 onward. The alarming rise since 2011 of nearly 9000 per annum caught actuaries completely by surprise (Jones, 2017a; 2017b).

So, what have deaths to do with capacity pressures? There is a very simple answer: the nearness to death effect. The nearness to death effect has been documented for around four decades and shows that healthcare demand escalates with nearness to death and not with age, per se (Payne et al, 2007). Around half of a person's lifetime hospital inpatient admissions and bed occupancy is compressed into the last year of life (Hanlon et al, 1998). Hence, the marginal changes in deaths are intimately linked to the marginal changes in medical admissions (Jones, 2018a). If you ignore the nearness to death effect, you get the entirely false impression that it is all of those older people consuming the resources.