Comparison of weekly death occurrences in England and Wales: up to week ending 15 May 2020

• Deaths registered weekly in England and Wales, provisional: week ending 15 May 2020

• Where to find statistics on UK deaths involving the coronavirus (COVID-19) and infection rates by country

• This article accompanies the Weekly deaths release for the week ending 15 May 2020 and explains the differences between various data sources that report on coronavirus (COVID-19) deaths.

• A total of 41,220 deaths involving COVID-19 were registered in England and Wales between 28 December 2019 and 15 May 2020 (year to date).

• In England, including deaths that occurred up to 15 May but were registered up to 23 May, of those we have processed so far, the number involving COVID-19 was 40,096; the comparative number of death notifications reported by the Department of Health and Social Care (DHSC) on GOV.UK was 30,753 and NHS England numbers, which are deaths in hospitals only, showed 24,787 deaths.

• In Wales, including deaths that occurred up to 15 May but were registered up to 23 May, of those we have processed so far, the number involving COVID-19 was 2,007; the comparative number of death notifications reported by the DHSC on GOV.UK was 1,191 and Public Health Wales (PHW) numbers, which come from the same source as the DHSC figures but are continuously updated, showed 1,207 deaths.

• In England, the number of deaths involving COVID-19 in care homes that were registered by 15 May was 11,096, while in Wales the number of deaths was 548.

• The Care Quality Commission (CQC) provides numbers of deaths involving COVID-19 in care homes in England that were notified between 10 April and 22 May, which showed 10,636 deaths, of which 870 occurred in the week up to 22 May.

• The Care Inspectorate Wales (CIW) provides the number of deaths involving COVID-19 in care homes in Wales that occurred between 17 March and 22 May, which showed 427 deaths, of which 35 occurred in the week up to 22 May.

Figures 1 and 2 show the cumulative numbers of deaths relating to the coronavirus (COVID-19) for England and Wales respectively, by day up to 15 May 2020, allowing comparison between:

• the daily death counts released by the Department of Health and Social Care (DHSC) on GOV.UK
• the reconciled data by date of death released by NHS England and Public Health Wales (PHW)
• Office for National Statistics (ONS) death records by date of registration
• ONS death records by date of death

Numbers produced by NHS England and PHW are the numbers supplied to the DHSC but based on date of occurrence rather than date of notification.

Figures 3 and 4 are for England only and include numbers of deaths provided by the Care Quality Commission (CQC) for deaths involving COVID-19 in care homes. Figure 5 is for Wales only and compares deaths in care homes as reported by the Care Inspectorate Wales (CIW) and the ONS.

Difference between ONS, DHSC, NHS England and PHW figures

The DHSC release daily updates on GOV.UK counting the total number of deaths reported to them among patients who had tested positive for COVID-19, regardless of place of death. This covers all deaths reported up to 5pm the day before in England, Wales, Scotland and Northern Ireland wherever they occurred, if known to the public health agencies. To allow comparison with the ONS figures, only the numbers for England and Wales are shown in this article.

NHS England provides the data on deaths in hospital in England and PHW provides data on deaths in Wales that feed into the GOV.UK figure. NHS England and PHW also publish continuously updated series by date of death as opposed to date of notification.

The ONS provides figures based on all deaths registered involving COVID-19 according to death certification, whether in or out of hospital, for England and Wales. We also provide the figures by date of death (occurrence). More information can be found in the Measuring the data section of our Weekly deaths publication.

The DHSC number of deaths reported by 15 May 2020 where the person tested positive for COVID-19 and died in hospital and elsewhere was 30,753.

The current DHSC figure reported is 8,438 fewer than the 39,191 death registrations involving COVID-19 reported by the ONS for the same period. Both data sources have some delay from date of death to reporting.

The number of deaths occurring by 15 May and registered by 23 May was 40,096, which is 9,343 higher than the current DHSC reported number. This is because the ONS figures for occurrence are based on date of death while the DHSC report on date of notification. The next section looks at DHSC numbers based on date of death, which are more in line with ONS occurrences.

The NHS England numbers by date of death, which come from the same source as the DHSC's numbers but are continuously updated and based on deaths in hospital only, showed 24,787 deaths by 15 May. This is 5,966 fewer than the current DHSC deaths and 15,309 fewer than the ONS figures for England by date of death.

The number of deaths reported by PHW to the DHSC by 15 May was 1,191 for Wales (Figure 2). This number is 769 fewer than the 1,960 death registrations involving COVID-19 reported by the ONS for the same period. Both data sources have some delay from date of death to reporting.

The number of deaths in Wales occurring by 15 May and registered by 23 May was 2,007, which is 816 higher than the DHSC reported number. This is because the ONS figures for occurrence are based on date of death while the DHSC report on date of notification. The next section looks at DHSC numbers based on date of death, which are more in line with ONS occurrences.

The PHW numbers by date of death, which are the same source as the DHSC's numbers but are continuously updated, showed 1,207 deaths by 15 May. This is 16 more than DHSC deaths for Wales but 800 fewer than the ONS figures for Wales by date of death.

The difference between the NHS England and PHW figures, and the ONS figures by date of death, is because of the wider coverage of the ONS figures, including deaths outside of hospital in England and those where COVID-19 was reported on the death certificate but there was no positive test. Looking at the year to date, 34.9% of deaths in England and Wales registered by 15 May 2020 involving COVID-19 occurred outside of hospital (14,403 deaths).

Deaths in care homes

On 15 May 2020, we released Deaths involving COVID-19 in the care sector, England and Wales: deaths occurring up to 1 May 2020 and registered up to 9 May 2020, which looks at deaths of care home residents. The following section looks at deaths that occurred in care homes.

To improve the timely availability of data on deaths in care homes caused by COVID-19, the ONS and the Care Quality Commission (CQC) have agreed to publish provisional counts of deaths of care home residents in care homes in England, based on statutory notification by care home providers to the 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 and 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. The data are from 10 April 2020 when the CQC introduced a new method to understand whether COVID-19 was involved in the death.

A death involving COVID-19 is based on the statement from the care home provider to the CQC: the assessment of whether COVID-19 was involved may or may not correspond to a medical diagnosis or test result, or be reflected in the death certification. More information on the data provided by the CQC can be found in our joint transparency statement. As with ONS registrations, reduced numbers of notifications occur on the weekend.

On 10 April 2020, the first day when data were collected using the CQC’s new method of identifying deaths involving COVID-19, there were 106 deaths of care home residents in care homes notified to the CQC. From 10 April up to and including 22 May, the latest date for which data are available, the number had increased to 10,636 deaths of residents in care homes involving COVID-19.

Up to 15 May, there were 9,766 deaths in care homes involving COVID-19 notified to the CQC (Figure 4). There were an additional 1,340 deaths of care home residents where the location of death was not stated by the care home provider, shown separately in Figure 4. These deaths may have taken place in a care home, but they could have been in hospital or elsewhere. The ONS has reported that there were 10,188 deaths involving COVID-19 in care homes registered during the same period and 9,749 deaths in care homes occurring in the same period that were registered by 23 May.

The data from the CQC and ONS registrations follow a similar pattern. The difference is likely to be caused by registration delays in the ONS figures or reporting delays in the CQC figures. It takes around two to three days for the CQC to be notified of a death, while the ONS has to wait until a death is registered to be included in the statistics, which can take longer. On average, for deaths occurring in March 2020, there was a delay of four days between a death occurring and being registered. ONS death occurrences are higher than the CQC figures as these numbers are based on the date of the death rather than date of notification.

An important difference between the two sources is that the ONS reports deaths where COVID-19 was mentioned on the death certificate, while the CQC notifications rely on the statement of the care home provider that COVID-19 was suspected or confirmed. The CQC does not hold person-level information that allows a direct comparison between the two sources and so an accurate effect of different reporting criteria cannot be determined.

In Wales, the Welsh Government publishes the number of deaths of care home residents involving COVID-19 notified to the Care Inspectorate Wales (CIW). Figure 5 shows the number of deaths notified to the CIW from 17 March 2020 (the first notification) that occurred in care homes and where suspected or confirmed COVID-19 was listed as the cause of death by the service provider.

Including deaths notified to the CIW up to 22 May, there were 427 deaths where the death occurred in care homes and COVID-19 was confirmed or suspected. Between 17 March and 15 May, there were 392 deaths notified to the CIW as involving suspected or confirmed COVID-19 and where the death occurred in care homes. This is 156 fewer than the 548 deaths registered as involving COVID-19 and occurred in care homes as reported by the ONS, and 170 fewer than the 562 deaths that occurred between 17 March and 15 May but were registered by 23 May.

It is acknowledged that care homes will be feeling the effects of the deaths of any of their residents including those that died outside of care homes, for example, in hospitals. The ONS, CQC, PHE and CIW are undertaking further work to better understand the total impact on care home residents.

Conclusion

The ONS and DHSC COVID-19 death numbers have different criteria. The DHSC count deaths where a person has been tested positive for COVID-19, while the ONS counts deaths where COVID-19 (including suspected cases) was mentioned on the death certificate, regardless of location. The improvement to the recording of COVID-19 deaths in England by PHE has gone some way in reconciling the differences.

The ONS registration numbers in Figure 1 align more closely to the DHSC-reported number of deaths, as like the DHSC-reported number it is based on the date a death is known (reported) rather than when it occurred. The date of death data from NHS England are closer to the ONS occurrence data as they are both based on the date the person died. The figures published on GOV.UK are valuable because they are available very quickly and give an indication of what is happening day by day. Their definition is also clear, so the limitations of the data can be understood. But they do not include all deaths involving COVID-19, such as those where no test result was available.

NHS England's reconciled numbers by date of death are valuable as they give a good indication of the lags in the daily deaths in hospital reporting process. They allow analysis by date of death to be carried out, which is a better indicator of the growth in the number of deaths.

Numbers produced by the ONS take longer to prepare because they have to be certified by a doctor, registered and processed. But once ready, they are the most accurate and complete information. The ONS provides figures based on deaths registered in England and Wales with COVID-19 (more information can be found in the Measuring the data section of our Weekly deaths publication).

The ONS is now publishing on behalf of the CQC the number of deaths in care homes that are notified to the CQC. This gives a more up-to-date number of deaths in care homes than was previously available. In the CQC figures, a death involving COVID-19 is based on the statement from the care home provider to the CQC: the assessment of whether COVID-19 was involved may or may not correspond to a medical diagnosis or test result, or be reflected in the death certification.

The ONS is also including figures produced by the CIW, which give a more up-to-date figure of numbers of deaths in care homes where COVID-19 was suspected or confirmed as recorded by a clinician.

Coronavirus (COVID-19) deaths

Coronavirus (COVID-19) deaths are those deaths registered in England and Wales in the stated week where COVID-19 was mentioned on the death certificate as “deaths involving COVID-19”. A doctor can certify the involvement of COVID-19 based on symptoms and clinical findings – a positive test result is not required.

More quality and methodology information on strengths, limitations, appropriate uses, and how the data were created is available in the Mortality statistics in England and Wales QMI.

To meet user needs, we publish very timely but provisional counts of death registrations in England and Wales in our Deaths registered weekly in England and Wales, provisional dataset. These are presented by sex, age group and regions (within England) as well as for Wales as a whole. To allow time for registration and processing, these figures are published 11 days after the week ends. Because of the rapidly changing situation, in this bulletin we have also given provisional updated totals based on the latest available death registrations, up to 15 May 2020.

Because of the coronavirus (COVID-19) pandemic, our regular weekly deaths release now provides a separate breakdown of the numbers of deaths involving COVID-19: that is, where COVID-19 or suspected COVID-19 was mentioned anywhere on the death certificate, including in combination with other health conditions. If a death certificate mentions COVID-19, it will not always be the main cause of death but may be a contributory factor. This new bulletin summarises the latest weekly information and will be updated each week during the pandemic.

These figures are different from the daily surveillance figures on COVID-19 deaths published by the Department of Health and Social Care (DHSC) on GOV.UK, for the UK as a whole and its constituent countries. Figures in this report are derived from the formal process of death registration and may include cases where the doctor completing the death certificate diagnosed possible cases of COVID-19, for example, where this was based on relevant symptoms but no test for the virus was conducted. Our figures also include any deaths that occur outside of hospital.

From 29 April 2020, there was a change in the reporting of the Department of Health and Social Care (DHSC) daily coronavirus (COVID-19) deaths data. Prior to 29 April, the daily published counts of COVID-19 deaths for England accounted for deaths that had tested positive for COVID-19 in hospitals only. From 29 April, this data series has been improved by Public Health England (PHE) to include all deaths where a positive test for COVID-19 has been confirmed, wherever the death took place.

The improved data series has been reconciled back to 6 March 2020 when the first COVID-19 deaths were notified. Figures for Scotland, Wales and Northern Ireland had already begun to include deaths outside hospitals, so this change ensured that the UK-wide series has a shared and common definitional coverage. A detailed explanation of the change can be found in our transparency statement. In this report we have included the improved post-29 April England COVID-19 data series in the comparisons. The improved PHE (post-29 April) data series is the series that should now be compared with the Office for National Statistics (ONS) data series.

In contrast to the GOV.UK figures, we include only deaths registered in England and Wales, which is the legal remit of the Office for National Statistics (ONS). Tables 1 and 2 provide an overview of the differences in definitions between sources.

We will publish accompanying articles periodically, giving enhanced information such as age-standardised and age-specific mortality rates for recent time periods and breakdowns of deaths involving COVID-19 by associated pre-existing health conditions.

There is usually a delay of at least five days between occurrence and registration. More information on this issue can be found in our impact of registration delays release.

Our User guide to mortality statistics provides further information on data quality, legislation and procedures relating to mortality and includes a glossary of terms.

Figures are based on the date the death was registered, not when it occurred. There is usually a delay of at least five days between occurrence and registration. More information on this issue can be found in our impact of registration delays release.