Will the winter of 2019/20 have unusually high service demand? Part 2: Strategy

Following on from a series of articles in this journal which sought to highlight the role of nearness to death upon the marginal changes in health service demand and costs (Jones 2019a-f), this article will commence with some strategic principles and then move on to the tactical specifics for 2019/2020 winter.

While the ageing population has been increasing health service demand over many years, we need to understand how the less well recognised role of nearness to death may have been acting to influence the trends. To this end, Figure 1 shows the trend in the number of deaths per 1000 population in England since 1968 and the projected trend to 2041.

As can be seen, from around 1980 through to 2011, the number of deaths per 1000 population was steadily declining. This is a very important trend because, in those years, the reduction in deaths over time was acting to offset the effect of the ageing population. Both the ageing population and increased end-of-life demand are now acting to augment the trends towards even higher demand. The trend upward after 2011 partly arises from the post-World War II baby boom, in which the leading edge turned 65 in 2011. In the UK, some 83% of deaths occur above age 65 (Office for National Statistics (ONS), 2018), hence the long-term upward trend after 2020 in Figure 1.