Fifteen years on from the dawn of austerity in the UK, the consequences of prolonged and aggressive cuts to public spending are written, not just in balance sheets, but in the lives and deaths of hundreds of thousands. Framed in the wake of the 2008 financial crash as a necessary belt-tightening exercise, austerity was sold to the public as a path to fiscal recovery. Instead, it has delivered a generation of flatlining life expectancy, deepening health inequality, and an NHS left to stagger under the weight of demand, underfunding, and political negligence. From the outset, austerity was a political choice rather than an economic inevitability. Economists, public health experts and international organisations including the IMF warned that cutting spending during a period of economic fragility would risk worsening recession and hurting the most vulnerable. Yet the UK government pressed forward. Local authority budgets were slashed. Welfare spending was frozen or reduced. Public health funding was gutted. The NHS received the lowest increases in real-terms spending since its inception. And the consequences were swift.

Between 2010 and 2020, life expectancy growth in the UK came to a halt. For some groups, it reversed entirely. According to a landmark analysis by the Institute of Health Equity, England witnessed the first fall in life expectancy since at least the turn of the 20th century, with the poorest communities hit hardest. For women in the most deprived areas, life expectancy fell by more than six months. Meanwhile, the gap in healthy life expectancy between the richest and poorest widened significantly, now stretching to nearly two decades. These trends are not mere statistical aberrations. They represent a quiet crisis, largely overlooked in mainstream political discourse, but well documented in academic literature and epidemiological studies.

A study led by Oxford and Liverpool Universities, published in the Journal of the Royal Society of Medicine, attributed nearly 330,000 excess deaths between 2010 and 2019 to austerity policies, specifically to cuts in health, social care, and welfare services. It pointed to a significant correlation between funding reductions and increased mortality rates, particularly among older adults and disabled individuals. The authors called the rise in mortality “both avoidable and unprecedented in modern times.” Behind those numbers are deeper stories of degradation. Social care for older adults was among the first casualties of local government cuts. Councils, facing devastating funding shortfalls, tightened eligibility criteria and outsourced care to the private sector, often prioritising cost-cutting over quality. As a result, many older people were left without the support they needed to live independently or safely. Hospital discharge became more dangerous. Delays mounted. Preventable admissions increased. And the NHS, lacking the buffer once provided by community care, was forced to absorb the fallout.

The NHS itself, while spared outright cuts, endured a decade of chronic underinvestment. Funding rose at a fraction of the historical average: just 1.4% annually in real terms compared to the long-term trend of 3.6%. Staffing shortfalls grew critical. By 2019, there were over 100,000 unfilled posts in the NHS, including more than 40,000 nursing vacancies. A survey by the Royal College of Midwives found that just 6% of midwives believed their units were safely staffed. General practice fared no better, with GP numbers falling per capita as demand soared. The promise of 5,000 new GPs by 2020, repeatedly touted by successive Conservative governments, was quietly dropped.

Waiting lists ballooned. Ambulance response times deteriorated. Cancer referral targets were routinely missed. And crucial early detection services, from cervical smear tests to diabetic eye screenings, experienced drop-offs in both funding and uptake. The ripple effects of underfunding played out in A&E departments across the country, where patients waited on trolleys for hours, even days, and in mental health services stretched far beyond their limits.

Perhaps most disturbingly, austerity created the conditions for what public health professionals have termed the “epidemic of despair.” Drug-related deaths reached record highs, with mortality rates from opiates, alcohol, and suicide rising sharply, especially among middle-aged men in post-industrial towns. These deaths, reminiscent of the American crisis of “deaths of despair,” are not random. They are the result of policy frameworks that disinvest in communities, remove safety nets, and erode hope.

Children did not escape unscathed. Cuts to child mental health services, youth clubs, school nurses, and family support units created a vacuum in early intervention. Childhood obesity rates climbed. So did hospital admissions for eating disorders and self-harm. Public health initiatives aimed at smoking cessation, teen pregnancy prevention, and immunisation campaigns were decimated, ironically saving little, while contributing to long-term cost burdens. Austerity was also a geographical inequality machine. The North of England, already lagging in health outcomes, saw sharper declines than the South. Deindustrialised cities with higher poverty rates and greater reliance on public services bore the brunt of cuts. These regional health disparities, entrenched by a centralised political system and reactive health funding formulae, are now among the worst in Europe.

Economically, the irony is painful. The short-term savings achieved through budget cuts have been dwarfed by the long-term costs of worsening health. Sickness-related work absence, long-term disability claims, and mental health-related unemployment have all risen. According to the Resolution Foundation, ill health is now a leading cause of economic inactivity among working-age adults in the UK. The government, meanwhile, faces soaring costs in welfare and healthcare for conditions that might have been prevented or mitigated with earlier intervention and social support.

The COVID-19 pandemic laid bare the fragility left behind by austerity. The UK entered the crisis with fewer doctors, fewer hospital beds, and a less resilient social care system than most comparable countries. The uneven distribution of deaths, highest in deprived areas, was no surprise to those who had studied the public health legacy of the 2010s. And now, in the cost of living crisis of the 2020s, food bank usage, energy poverty, and child malnutrition are again on the rise, signs that we are replaying, not learning from, the past. Despite all this, austerity remains a term seldom uttered in political manifestos. The Labour Party has shifted its rhetoric to “fiscal responsibility.” The Conservatives maintain tight spending rules. And while there is growing consensus among economists and public health experts that austerity was a policy error, this has yet to translate into meaningful change.

What would accountability look like? At the very least, it requires naming the crisis for what it is: a preventable, policy-driven public health disaster. It also means investing heavily in public health infrastructure, reversing cuts to local authorities, restoring real-terms funding to the NHS and social care, and integrating health impact assessments into fiscal decision-making. Beyond money, it demands a paradigm shift: that government budgets are not mere economic tools but expressions of moral and political priorities. A healthy society cannot be built on scarcity. The consequences of austerity are not confined to spreadsheets or debate stages; they are found in funerals held too soon, diagnoses delivered too late, and ambitions curtailed by chronic illness. The UK’s health has paid the price for political decisions made in the name of economic prudence. The only question now is whether we learn from the past, or allow its damage to define our future.