There is tendency to regard the first year of each decade as a milestone and 2030 is no exception; this is the year the sale of petrol and diesel cars will end, wind farms will generate 50GW of energy and one million people in Britain will die. Hold on there, one million deaths in a year? Four hundred thousand deaths in excess of the long term average: even Covid only killed two hundred thousand and took two years to do it. Another pandemic then? An asteroid strike? Or a reinterpretation of an obscure passage in Nostradamus? None of the above I am afraid, just basic mathematics.
During 1947 there were a million live births in the UK.
The average life expectancy of a UK citizen is 83 years.
So, anyone born in 1947, and who survived into adulthood – most of them thanks to the NHS, free school milk and the decline in smoking, is set to arrive at life’s departure gate eight years from now.
Currently 600,000 people die each year, typically 100,000 less than live annual births 83 years earlier. A million deaths and the suddenness with which the annual total increases, will give 2030 a somewhat apocalyptic feel. Even the solemnity of Huw Edwards is unlikely to suffice. The BBC may be forced to bring Orla Guerin back from the Ukraine to read the six-o-clock news.
Twenty Thirty is two general elections and numerous OBR reports away and, for politicians at least, way over the distant horizon. Even so a failure to plan for the looming demographic upheaval will have, or is already having, serious consequences for both Britain’s economy and its health service. Here is some more of that basic maths.
In 2021 there were 624,828 live births, 586,334 deaths (low as covid the previous year had brought some deaths forward) and net migration of 239,000 so the UK population grew by approximately 277,500. On present trends it is unlikely annual live births will increase dramatically by 2030 (they have fallen by around 70,000 each year since 2017). Preventing the UK population shrinking would require net inward migration of 400,000. As well the generation born in 1947 has been supplemented by migrant workers invited to Britain from its former colonies. These migrants fitted the same demographic profile as the 1947 cohort. The prediction of a million deaths might even be on the low side.
Should we worry? Obviously, I do, being one of those set to depart. But surely a few hundred thousand less people on this crowded island would be a blessing. As the population shrinks it will become younger and more dynamic, houses will be cheaper, use less energy and the wealth hoarded for decades by the boomer generation will finally be released. Reaching these sunny uplands however, with the UK’s economy and its health service intact, could prove challenging.
As distant as 2030 may seem, the impact of those impending deaths is already being felt. The care crisis is, to a large extent, due to those of us set to die in 2030, and the early part of the decade that follows, reaching the age of 70 and struggling with medical conditions associated with old age. Of course, Britain has been here before although, apparently, given the current social care crisis, learned little from the experience.
In 1921 there was also a million strong spike in births, members of this generation arrived in A&E to begin their last lap on this planet during the nineteen nineties. This forced the NHS to pivot from a health service which removed tonsils, appendixes and saucepans from children’s heads to one which dealt with conditions which were predominantly terminal. The NHS also had to cope with patients who, instead of going home after treatment, remained on hospital wards because the community care system was creaking under the weight of elderly people needing 24 hour support.
There is no shortage of people claiming to have fixed the great bed blocking crisis of the 1990s; New Labour, which poured millions into healthcare; local authorities who set up joint initiatives with the NHS; the Medtech sector which, despite the ill fated National Program for IT, ended years of under investment in new technology. However, the hubris in the wake of what everyone believed was a job well done created the complacently which has brought us to where we are today. The attitude until recently has been ‘we coped with one influx of elderly patients, bring on the next one.’
In 2003 my company published the first in a series of reports attempting to detemine the extent to which the health crisis of the 1990’s went away on its own and the pressure on the NHS eased because the elderly patients that caused it had departed. Unfortunately, as any engineer knows, problems that go away on their own tend to come back on their own.
For the past two decades the NHS and Britain’s social care system has benefitted from a hiatus in live births between the mid 1920s and early 1940s. This breathing space has now come to an end and the folly of not using it to improve the resilience of the NHS and Britain’s social care service is becoming all too apparent. And, once again, poor data has fed this complacency.
The first bed blocking crisis was caused by an influx of ailing seventy year olds that seemed come from nowhere. True, there was that 1 million spike in live births in 1921 but then came the second world war. Of the 880,000 people killed during the conflict those who died abroad were omitted from records of deaths in the UK. On the other side of the balance sheet were refugees from Eastern Europe who remained in Britain after the conflict. There was also a reliance on a steady increase in life expectancy to push any care crisis into the future – something which obviously could not continue indefinitely. Eventually a wave of elderly people who had disappeared from government records magically reappeared. Two decades on and history may be about to repeat itself.
The longer one studies the Office of National Statistics demographic data the more perplexing the gap between live births and deaths becomes. In the absence of a war, with annual net annual migration from the UK around 100,000 between 1947 the mid-1970s and negative since, why is the gap between live births and deaths so high? Only during two years, 1976 and 1977, were deaths in the UK higher than births. Why then have the million people born in 1947, seem to have disappeared from healthcare planners computers? Are we, again, clinging to the belief that increased life expectancy will push an inevitable NHS capacity crunch into the future?
Death is a taboo subject, especially for a generation that, like Roger Daltrey, initially hoped to die before it got old, but then changed its mind and, taking its lead from Keith Richards, came to regard itself as immortal. During the Covid epidemic, when the number of deaths was a nightly feature on TV news it was easy to gain the impression the NHS was doing quite well until the epidemic. Low mortality rates during the previous decade suggested a cure for death might be just around the corner – perhaps there was something scientists at Astra Zeneca and the Medical Research Council were not telling us. A comforting thought for us seventy-year-olds but disastrous if our politicians are also in denial.