Overview
In order to improve the timely availability of data on deaths in care homes caused by the coronavirus (COVID-19), the Office for National Statistics (ONS) and the Care Quality Commission (CQC) have agreed to publish provisional counts of deaths in care homes, based on statutory notifications by care home providers to CQC.
The figures will be published as part of the ONS’s weekly deaths release, and will include:
total count of deaths in England per day, where the death was in a care home and was notified by the care home operator as involving COVID-19
count of deaths in care homes by local authority in England per week, divided into all deaths and deaths notified as involving COVID-19
Description of the data source
CQC collects data on deaths of care home residents under Care Quality Commission (Registration) Regulation 16. The intention of this regulation is to ensure that CQC is notified of the deaths of people who use services so that where needed, CQC can take follow-up action.
Notifications include the death of a person using a service if either of the following has happened:
- the person died while a regulated activity was being provided
- their death may have been a result of the regulated activity or how it was provided
Notifications about deaths must be sent to CQC without delay. Notifications are typically provided within two to three days of death, with low levels of reporting at the weekend and high levels on the first working day of the week. All providers must send their notifications directly to CQC.
Providers must use forms provided by CQC to make notifications under this regulation. Providers can notify CQC using the webform on the CQC Provider Portal or using the MS Word form on CQC’s website and returning this via email.
On receipt of the notification, CQC’s National Customer Service Centre staff key in the main fields from the form into internal systems and make the full form available to their inspectors. If providers submit a blank form or one that is deemed insufficiently complete, CQC will contact the provider to obtain the essential missing information.
Adult social care providers who notify CQC of a death tell CQC of deaths of those who use their service regardless of where the death occurs, including hospital. The notification forms ask the provider to tell CQC about the place of death. Note, as described in the Technical definitions section, the data used in this release are for deaths of care home residents that occur in care homes only.
In analysing the deaths notifications data, CQC analysts clean the data extracted from CQC systems, including removing records where there are duplicate notification IDs. Once analysed, checks are made on the analysis undertaken following CQC’s standard quality assurance processes.
Previously published data
CQC has not previously published deaths notifications data.
Technical definitions
The information notified to CQC includes the date of death, place of death, and (from 10 April) whether the death was a result of confirmed or suspected coronavirus (COVID-19). The inclusion of a death in the published figures as being the result of COVID-19 is based on the statement of the care home provider, which may or may not correspond to a medical diagnosis or test result, or be reflected in the death certification.
The weekly published figures will be organised by date of reporting. There is no validation built into the quality of data on collection. Fields may be left blank or may contain information that is contradictory, and this may not be resolved at the point of publication. Most pertinent to this release are place of death and whether the death was as a result of confirmed or suspected coronavirus.
For notifications received between 10 April and 24 April, place of death was missing in 16.5% of notifications (9.7% for notifications that stated confirmed or suspected coronavirus). Where the tick box stating whether the death was as a result of confirmed or suspected coronavirus is not completed, the assumption made is that they were non-COVID deaths.
The published figures will include deaths of care home residents in care homes with nursing (nursing homes) and care homes without nursing (residential care homes), who die in the care home. The figures will also show, separately, the potential additional deaths in care homes if all notifications with place of death not stated were assigned to care homes. CQC is also notified of deaths of clients of home care services, who may die in hospital or in their own homes. The latter are not included so that the figures are clearly understood as referring to residents of care homes.
For breakdowns by local authority (LA), care homes are allocated to a lower tier LA based on the address of the registered location.
Comparison with other sources of data
The main differences between the CQC data, ONS death registrations and other published sources of data on deaths involving COVID-19 are summarised in Table 1.
| DHSC COVID-19 (as published on GOV.UK) | ONS COVID-19 deaths registered | ONS COVID-19 death occurrence (actual date of death) | Care Quality Commission deaths in care homes (date of notification received) | ||||
|---|---|---|---|---|---|---|---|
| Coverage | UK (however we only include England and Wales breakdowns for comparable coverage with ONS data). | Registrations in England and Wales. In discussions with devolved nations to create UK estimates in the near future. | Registrations in England and Wales. In discussions with devolved nations to create UK estimates in the near future. | Deaths notifications received by providers of CQC registered locations in England. | |||
| Inclusion | Deaths in hospitals. | Any place of death, including Nursing homes. | Any place of death, including Nursing homes. | Deaths in care homes. | |||
| Deaths where patient has been tested for COVID-19. | Deaths where COVID-19 has been mentioned on the death certificate. | Deaths where COVID-19 has been mentioned on the death certificate. | Deaths where the care home provider has stated COVID-19 as a suspected or confirmed cause of death on the death notification. | ||||
| Timeliness | Provided daily but not officially registered. Data are provided to NHS-E directly by hospitals. | Weekly registrations are 11 days behind because of the time taken to register, process and publish. | Weekly registrations are 11 days behind because of the time taken to register, process and publish. | Daily deaths notifications by date of notification. These take on average 4 days to receive and process. | |||
| Data only published once confirmed family have been notified of death. | Registered in the week ending the 10 April 2020 (Week 15) | Deaths which occurred in Week 15 but were registered up to 18 April 2020. | Data published weekly by ONS. Deaths which were notified to CQC between 10 April and 24 April 2020. |
Download this table Table 1: Definitions of COVID-19 deaths between different sources
.xls .csvFigure 1 shows a comparison of ONS and CQC number of deaths of care home residents in all places of death, including hospital, between 1 February and 10 April 2020.
For the ONS it shows the number of deaths of care home residents, by date of death, occurring up to 10 April and registered up to 18 April. The date of death is as written on the death certificate. Death registration data are incomplete for some time after the date of death. The number of deaths based on date of registration is also provided for comparison. For CQC it shows the number of deaths of care home residents by date of notification up to 10 April 2020. The date of death is based on the date that CQC’s National Customer Service Centre received the notification. This is because the date of death field is not sufficiently complete. Using date of notification allows for a timelier view of the change in number of deaths notifications received, recognising the limitation that it is not a direct comparison.
Seven-day running averages are used to smooth the cyclical nature of both series across a week.
These figures relate to all deaths of care home residents, rather than deaths involving COVID-19. However, the close match between the two data series suggests that they are comparable. It is therefore likely that notifications to CQC are a good proxy for registrations of deaths in care homes and provide a timely indicator of change in the numbers.
The CQC series lags the ONS series by two days, in line with the two to three-day lag CQC see between date of death and date of notification. The difference in deaths for the final dates shown in Figure 1, where the ONS series shows lower deaths, is because of the time it takes for deaths to be registered.
When comparing figures on deaths involving COVID-19, it should be remembered that the opinion of care home providers on cause of death in the notification to CQC may differ from death certification based on the medical judgement of the certifying doctor.