It’s unclear exactly how NHS England plans to save 500,000 lives

“The NHS Long Term Plan, published today, will save almost half a million more lives with practical action on major killer conditions and investment in world class, cutting edge treatments including genomic tests for every child with cancer.”

NHS England, 7 January 2019

Last month many media reports focused on the announcement from NHS England that its new ‘Long Term Plan’ will save around half a million lives.

The Long Term plan sets out the direction the NHS intends to take in England over the next ten years in order to have a “service fit for the future”. It also sets out how the NHS plans to use the £20 billion in extra funding it will receive over the next five years—which we’ve written about here.

It’s unclear how exactly NHS England calculated the figure of half a million lives saved and we’ve asked them a number of times, for more information. There are a lot of things we don’t know for certain about it: for example it’s unclear what time period these lives will be saved over—while the time span of the plan is ten years, the lack of detail on the calculation means we don’t know specifically. We also don’t know whether there is any margin of error on the figure, or exactly how these lives will be “saved” (beyond a few general examples such as early cancer detection).

We think important policy announcements like this should be based on published, clearly explained figures so that everyone can see how they’re calculated, and assess whether public bodies are achieving the goals they’ve set out.

What do we know about how these 500,000 will be saved?

Not very much.

In its public announcement of the plan, NHS England did provide some additional detail on how it proposes to save these 500,000 lives. It said “the latest technology, such as digital GP consultations for all those who want them, coupled with early detection and a renewed focus on prevention to stop an estimated 85,000 premature deaths each year.”

Chief Executive Simon Stevens specified that new treatments and testing services “will mean three quarters of cancer patients are diagnosed early, when the condition is easier to treat, up from half at present, saving 55,000 lives a year.” That alone might seem to get us over the half a million mark, if you add it up over the ten years—but as we’ll explain, it’s more complicated than that.

Mr Stevens added that: “Around 23,000 premature deaths and 50,000 hospital admissions will be prevented over the next decade by putting over 100,000 patients with heart problems through a healthy living and exercise programme every year.”

The plan itself also says that the NHS will look to halve maternity-related deaths by 2025.

When we asked NHS England for more detail about how the calculation was done and what the component parts of it were, it told us that: “The calculations were made based on new and expanded services which the plan will bring into place—mainly new cancer treatments with earlier diagnosis and interventions to catch more strokes, heart attacks, respiratory problems.”

That didn’t make things much clearer, so we’ve asked them again for more information. We are awaiting a response.

What don’t we know?

Firstly, it’s unclear what time period these 500,000 lives will be saved over—as the NHS says itself in the plan, not all of the goals it sets are meant to be fulfilled within ten years, some are over a shorter time frame. The lack of detail also means we don’t know if any of the goals will take longer to achieve.

To put the target in context, there were just under 500,000 deaths registered in England in 2017. The health think tank Nuffield Trust says that, based on official figures from the Office for National Statistics (ONS), around 110,000 deaths in England a year are “avoidable”, either through better quality healthcare or healthier public behaviours.

Secondly, NHS England makes no mention of how definitive this number is—is it a best estimate with a wide margin of error around it, or is NHS England fairly certain it can save this many lives through the measures planned over the next ten years?

Thirdly, as we’ve mentioned already, bar a few specific examples we’ve no indication of how the Long Term Plan will save all of these lives and of the conditions and diseases it plans to tackle in order to do so.

And finally, it’s not apparent from the information published what NHS England actually means when it says it will ‘save’ these lives.

How you define a ‘life saved’ can affect the numbers

It may seem counterintuitive, but talking about ‘saving a life’ can mean very different things depending on how you define it.

The Nuffield Trust has also been looking into this and got a bit more detail from the NHS about its calculations. It says that “NHS England focus on those that are alive, counting the number of times a life is saved, whereas ONS focus on those that have died and instead count how many of these deaths could have been avoided.”

For example a person who is prevented from dying from two separate illnesses in the same year would count as one avoided death based on the ONS’ definition. But for the NHS, this could count as two lives saved.

The method you choose can impact the overall number you end up with. NHS England says improvements in treatment and testing will save the lives of 55,000 cancer patients a year, but the ONS estimated that around 38,000 cancer deaths in England were avoidable in 2016.

This also raises the question of how much longer a patient might be expected to live after their life is counted as ‘saved’, and from what point in time you measure this. The Nuffield Trust says: “NHS England also count people who survive for five years after diagnosis of cancer as being lives saved. But not all these people, sadly, will live much longer. Performance against this measure could improve purely through earlier diagnosis without actually prolonging lives although, of course, earlier diagnosis can contribute to better outcomes.”

We think it’s inappropriate and unhelpful for organisations like NHS England to use figures that aren’t in the public domain. Figures like these should be published in full so that anyone can check where they’re from, how they’re calculated, and whether public bodies are meeting the goals they’ve set out. Public bodies shouldn’t be asking anyone to take their word for it on something so important.