It is no secret that the spread of COVID-19 within the care sector has been the subject of significant media attention and cause for concern amongst those involved with care. But how hard can it be to answer the question: ‘How many deaths on care has there actually been?’ The answer is: it’s all in the detail.
The Office for National Statistics (ONS) reported on 3 July 2020 that for deaths registered between 2 March and 20 June 2020, there were 19,394 deaths of care home residents which involved COVID-19, which represented 29.3% of all deaths of care home residents. The key to interpreting COVID-19 death statistics is understanding how the deaths are classified, and how the ‘subject’ of the statistics is defined. In relation to care homes, the latter variable would be how broadly ‘care home’ is interpreted. Does that include care homes for those other than the elderly, like those with mental or chronic illness? What about those receiving community care? For example, in the above statistic, death of a ‘care home resident’ 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. As this statistic also includes deaths that occurred outside of a care home, we can expect the death rate to be higher than when just looking at deaths within a care home itself. Jurisdiction should also be considered as some death rates include care homes in both England and Wales, and others are limited to those in England.
The ways in which deaths are measured also vary between each statistical study. The above study included deaths involving COVID-19 where the certifying doctor suspected the death involved COVID-19 but was not certain, for example, because a test was not undertaken. Of the 19,394 deaths involving COVID-19 of care home residents, 16,305 (84.1%) were classified as “confirmed” COVID-19 and 3,089 (15.9%) were classified as “suspected” COVID-19. This differs to an additional study by the ONS where a death was recorded if COVID-19 was mentioned anywhere on the death certificate.
There have been further concerns raised in relation to how Public Health England (PHE) is compiling ‘out of hospital’ data. It is suggested that PHE regularly checks the NHS database of patients who have ever tested positive for COVID-19, and then they cross-reference it with the NHS central register to check if any of those patients have died. As Professor Heneghan puts it, according to PHE, no one in England can recover from COVID-19. A patient may be successfully treated for COVID-19, but their unrelated death some two months later will still be counted as a COVID-19 death, because they have previously tested positive.
In addition to the above, the death of care home staff is an entirely different concern, with studies either not including them in their statistics, or omitting whether they are included or not. For example, a joint study between the Care Quality Commission (CQC) and the ONS were only concerned with residents who died in a care home and whose deaths were reported to the CQC. However, the introduction of the Health Service and Social Care Workers (Scrutiny of Coronavirus-related Deaths) Directions 2020 may place more importance on non-resident deaths. The Directions now require deaths of health care workers and social care staff to be scrutinised by Medical Examiners, providing greater safeguards and ensuring referrals of appropriate deaths to the coroner.
With all of the above considered, it may seem as if COVID-19 deaths in care homes are still very much a ‘grey area’. But the ONS have provided weekly COVID-19 death figures which do provide more insight than some of the previously mentioned studies. The figures include deaths where COVID-19 was mentioned on the death certificate and are categorised by the place of death in England and Wales. This is helpfully broken down to include care homes, hospices and other communal establishments, and provides definitions for them all. ‘Care home’ in this study includes homes for the chronically sick, nursing homes, homes for people with mental health problems and non-NHS multi-function sites. Whilst this unfortunately does not improve the death rate (15,216 COVID-19 deaths in care homes between 28 December 2019 and 17 July 2020) it does improve our ability to understand how many deaths have occurred within care homes due to COVID-19, and what exactly that includes.
Compared to the first couple of months of the COVID-19 pandemic, we definitely have more knowledge as to the impact of COVID-19 on the care sector, but there is still a greater degree of certainty to be desired surrounding the death rate statistics. Caution should be taken when interpreting care home data, with particular attention being paid to variables outlined here.
Nicola Howlett, Trainee Solicitor, BLM
 14,045 deaths occurring in care homes which involved Covid-19 between 10 April and 24 July 2020. https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/datasets/numberofdeathsincarehomesnotifiedtothecarequalitycommissionengland