Scotland is witnessing a concerning uptick in ‘avoidable’ deaths. With an increase of 4 per cent on the previous year, there were almost 18,000 preventable deaths in Scotland in 2021. As the rising pressures on the NHS continue to expose cracks, this week’s report on avoidable mortality from the National Records of Scotland does little to diffuse concerns.
Things don’t look much rosier when Scotland is compared to the rest of the UK. Although no British data for avoidable deaths in 2021 has been made available yet, historically Scotland has seen the highest rates of avoidable mortality in the UK over the last 20 years. Using the latest comparable data for England and Wales, this trend continues: Scotland is predicted to once again outdo both countries.
In 2021, 63,587 deaths were registered in Scotland. Of these, 17,862 were considered avoidable. Breaking this down further, 12,752 deaths were considered preventable – meaning that public health interventions could have helped stop these deaths – and 5,110 were seen to be as a result of a treatable cause, meaning that earlier treatment and secondary prevention could have helped save these lives.
Who died prematurely? After adjusting for age, death rates were almost twice as high in males than in females, with the most common causes being cancers and cardiovascular disease, such as stroke or high blood pressure. Deaths caused by Covid also saw a rise on figures from the previous year, however these only make up a small proportion of the overall total.
Unsurprisingly, avoidable deaths in people from the most deprived areas were highest, pointing to the striking health inequalities that remain in Scotland. Some 40 per cent of the most deprived Scots saw a marked increase in avoidable death rates last year, while there was a limited change in the least deprived areas. Glasgow had the highest figures recorded, at 600 per 100,000 people, whereas East Dunbartonshire, on the outskirts of Glasgow and yet significantly more affluent, had figures nearer 200 per 100,000 people. Julie Ramsay, head of vital events statistics at the NRS, reiterated this: ‘Avoidable mortality doesn’t impact everyone equally. The rate of avoidable deaths in the most deprived areas was over four times the rate of those in the least deprived.’
What caused these deaths? Cancer has long been Scotland’s leading cause of death. The report's findings confirm cancer is once again the primary contributing factor to Scotland’s avoidable deaths. It also shows that this trend has remained steady for the last twenty years. There remain concerns, however, that the impact of the Covid pandemic is still masking true cancer rates in Scotland. During the pandemic, screening invitations were significantly reduced, screening programmes themselves were paused while waiting times for crucial scans escalated. Ultimately this results in later diagnosis of disease, and delayed treatment times – and avoidable deaths. As Public Health Scotland emphasised, the drop of cancer diagnoses in 2020, with almost 3,000 fewer people being diagnosed, was a result of under-diagnosis, not a decrease in people developing cancer. Again, Scotland’s deprivation levels need to be scrutinised more closely: health inequalities are extremely pronounced in cancer care. Figures released by Macmillan Cancer Support last month found that cancer patients in Scotland’s most deprived areas are 74 per cent more likely to die from the disease. The Scottish government acknowledged the statistics but last month reported that ‘actions to tackle health inequalities in relation to cancer are showing progress’.
Unsurprisingly, avoidable deaths in people from the most deprived areas were highest, nodding to the striking health inequalities that remain in Scotland.
Avoidable deaths caused by alcohol and drugs increased for the ninth year in a row, amidst the worst drug death crisis Scotland – and indeed Europe – has ever seen. Last year, there were 2,641 avoidable deaths from alcohol and drug-related disorders. This year, Dundee emerged as the drug deaths capital of the developed world, as my colleague Michael Simmons reported in July. The findings coincide with the ongoing battle between drug reform campaigners, desperate for more funding and alternative methods of rehabilitating drug users, and the government. During their first 12 years in power, the SNP cut funding for drug and alcohol services by 53 per cent. What followed was a 160 per cent increase in drug deaths. While discussions about more radical methods of tackling Scotland’s rising drug deaths have been the focus of discussions between the Scottish government and drug reform campaigners, the country’s drug death figures remain stark.
Deaths from Covid meanwhile make up only a fraction of the avoidable mortality figures. This fits with reports that excess deaths from non-Covid causes have seen a significant rise since the pandemic. Paul Gray, the former CEO of NHS Scotland, said the NHS was bound to be overwhelmed regardless of the pandemic. Speaking at first minister’s questions, Paul O’Kane, Labour’s public health spokesman, said: ‘Smokescreen excuses of Brexit and Covid don’t wash. The first minister slashed training places for nurses and midwives back in 2012 when she was health secretary. The Scottish government missed its own target of recruiting 700 new student nurses this year.’
O’Kane’s comments come as Scotland’s largest nursing union, the Royal College of Nursing, has voted to go on strike for the first time ever in disputes over pay, after recently rejecting the Scottish government’s revised pay offer. John Swinney, deputy leader of the SNP, recently dashed hopes when he announced that there is no money spare for public sector pay rises, telling the BBC that ‘I have nowhere else to go to fund pay deals other than what the government offers’. The strikes are expected to take place before Christmas; their potential impact is likely to be catastrophic.
Can the NHS really cope with losing more staff, if even temporarily? The hospital system is becoming increasingly bunged up by A&E wait times at one end and bed-blocking at the other. The bed shortage feeds into the much bigger and more concerning staff shortage problem, where pay disputes and poor working conditions mean staff morale is at ‘the lowest level it has ever been’, according to BMA Scotland chair, Dr Iain Kennedy. But more than that, avoidable deaths rates are being directly impacted too. Two deaths in one month have been blamed on staffing issues at Glasgow's flagship Queen Elizabeth University Hospital. These are two of 336 incidents that have occurred in the Glasgow health board area between July and August that have been attributed to poor staffing levels of ‘an inappropriate skill mix’, as a recent Freedom of Information request revealed. As a result, the number of patients waiting at the end of each month for treatment has been steadily increasing since 2020 for both inpatients and outpatients.
As pressure mounts, the cracks in the system continue to widen. The latest figures on 2021’s avoidable death rates simply quantify the impact of these issues on the health service. The NHS is fast approaching breaking point.
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