Deaths in the care sector, England and Wales: 2020

• In England, there were 155,376 deaths of care home residents in 2020 (wherever the death occurred); this is an increase of 18.5% compared with 2019 (131,149 deaths) and 18.3% compared with the five-year average between 2015 and 2019 (131,384 deaths).

• In Wales, there were 8,236 deaths of care home residents in 2020 (wherever the death occurred); this is an increase of 20.3% compared with 2019 (6,849 deaths) and 17.0% compared with the five-year average between 2015 and 2019 (7,041 deaths).

• Taking into account the population size and age structure, age-standardised mortality rates (ASMRs) in England, for male and female care home residents, were statistically significantly higher in 2020 compared with the five previous years (11,193.3 deaths per 100,000 male care home residents, and 7,918.8 deaths per 100,000 female care home residents); ASMRs were statistically significantly higher for male compared with female care home residents in 2020.

• In Wales, male care home residents had statistically significantly higher ASMRs in 2020 compared to the previous five years (9,381.4 deaths per 100,000 male care home residents) whereas females had statistically significantly higher ASMRs in 2020 (6773.9 deaths per 100,000 female care home residents) compared with 2017 only; ASMRs were significantly higher for male compared with female care home residents in 2020.

• The North East continues to be the region of England with the highest ASMRs (11,245.9 deaths per 100,000 care home residents) and London was the region with the lowest (8,307.1 deaths per 100,000 care home residents); this difference was statistically significant.

• Dementia and Alzheimer disease was the leading cause of death in both male and female care home residents in England (accounting for 26.0% and 34.3% of deaths respectively) and Wales (26.6% and 35.4% respectively) in 2020; COVID-19 was the second highest leading cause of death in both male and female care home residents in England (17.8% and 14.2% respectively) and Wales (19.1% and 14.0% respectively).

• The majority of deaths of care home residents occurred within the care home in both England (86.6%) and Wales (83.5%).

The format of this publication has been changed to focus on headline figures and trends. This is so that we can prioritise the publications of the most time-sensitive data and analysis. This publication will return to its regular format for 2021 data next year. Read more in our update on release plans and statistical products.

We are currently working towards badging these as National Statistics and welcome comments regarding any additional data that could be included in future publications. If you have feedback, please send an email to social.care@ons.gov.uk.

For a full explanation of the methods used to produce this release, including further methodology guides, please see Measuring the data from our previous publication.

The term "care home residents" used in this publication refers to all deaths where either (a) the death occurred in a care home or (b) the death occurred elsewhere but the place of residence of the deceased was recorded as a care home. The figures should not be confused with "deaths in care homes" as reported in other publications, which refers only to category (a). When interpreting these mortality statistics, please note that:

• death statistics are compiled from information supplied when deaths are certified and registered as part of civil registration, a legal requirement

• summary figures published in the release include analysis of causes of death by broad disease groupings (a list of these is available in Section 10 of the User guide to mortality statistics)

• figures in this release are presented for England and Wales separately because of the devolved nature of adult social care

• the data in this publication cannot be compared with the 2020 coronavirus (COVID-19) data presented in the Deaths involving COVID-19 in the care sector article or the Deaths registered weekly in England and Wales, provisional dataset (including care home resident deaths dataset) because of differences in the data presented

Rates

There is currently no up-to-date measure for the size of the care home population. Therefore we have used 2018-based population projections for communal establishments for England and user-requested 2018-based population projections for Wales. We have applied a care home resident proportion using the 2011 Census data from Nomis to ascertain an estimated care home population for England and Wales. Age-standardised mortality rates (ASMRs) are used to allow comparisons between populations that may contain different proportions of people of different ages. The 2013 European Standard Population is used to standardise rates. In this release, we have adjusted the monthly ASMRs to allow for comparisons with annual rates.

Experimental Statistics

These statistics are designated as Experimental Statistics. Experimental Statistics are those that are in the testing phase, are not yet fully developed, and have not been submitted for assessment to the UK Statistics Authority.

Collaboration

In the development of this bulletin, we have worked closely with partner departments across government including the Care Quality Commission (CQC) and the Care Inspectorate Wales (CIW).

Care Quality Commission (CQC)

The CQC is the independent regulator of health and social care in England. Notifications about deaths in care homes must be sent to the CQC without delay using the CQC Provider Portal and they are typically provided within two to three days of death. The data provided by the CQC are counts of deaths each day of care home residents who died in care homes, by date of notification. More information on the data provided by the CQC can be found in our joint transparency statement.

Notification forms ask service providers about the person who died, including their characteristics. However, these questions are not marked as mandatory and so we may not get all providers answering them, which would render the dataset incomplete. Therefore, Office for National Statistics (ONS) death registration data for characteristics of care home residents have not been compared with 2020 CQC data because of the degree of missingness within the death notification data.

Care Inspectorate Wales (CIW)

In Wales, the Welsh Government publishes the number of deaths of registered adult care home residents notified to the Care Inspectorate Wales (CIW).

Data are collected on a daily basis through an online form that is developed and maintained by CIW. The data are validated against previous returns and any significant changes are queried. Data include all notifications up to midnight each day. The data collection covers residents of adult care homes.

The ONS uses a broader definition of care home residents than that used in the CIW data.

Coding of deaths

Deaths are cause coded using the World Health Organization’s (WHO) International Classification of Diseases, 10 edition (ICD-10). Deaths are coded to ICD-10 and a single underlying cause derived using Multicausal and Unicausal Selection Engine (MUSE) (IRIS version 5.5). Cause of death reported here represents the final underlying cause of death for those aged 28 days and over. This takes account of additional information received from medical practitioners or coroners after the death has been registered.