About a third more deaths in England are occurring at home than before the Covid-19 pandemic, data has revealed, with the majority down to causes other than the coronavirus.
In April, the UK government launched a campaign to encourage people who were unwell to seek medical attention, amid alarm that A&E attendances had plummeted. But the latest data, which extends into mid-September, suggests those with life-threatening conditions are still shying away from hospitals.
Figures from the Office for National Statistics (ONS) show that even after the peak of the first wave of Covid, deaths at home were higher than the five-year average, with about a third more deaths registered – a proportion has remained largely steady since mid-June. Deaths at home have also remained elevated in Wales.
With other data from the ONS revealing that the total number of deaths in England and Wales fell below the five-year average over the summer, although it has since risen again, the data appears to highlight a change in where people die.
Sarah Caul, the head of mortality analysis at the ONS, said that while deaths in hospitals and care homes had fallen to below the five-year average after rising during the peak of the Covid outbreak, deaths at home remained well above this bar.
“We have seen an overall increase of deaths as well as a redistribution of various causes of death,” she said.
“For instance, while deaths of heart disease are below average in hospital, it has been above average at home. It’s a similar picture when looking at prostate cancer for males, and dementia and Alzheimer’s disease for females..”
The data shows that between the weeks of 28 December 2019 and 11 September 2020 there were 108,842 deaths in private homes in England – 25,472 more than the five-year average over that period. The majority of the excess was down to deaths among those aged 70 to 89 years, with men accounting for a greater proportion of excess home deaths than women.
The rise in the number of home deaths began in late March: by the week of 3 April, more than 3,600 deaths were recorded in home settings in England, compared with a five-year average of 2,209. But an excess remains: in the week of 11 September, 2,901 deaths were recorded as occurring in private homes, compared with a five-year average of 2,129.
The rise in home deaths does not appear to be directly down to Covid-19; it is instead a result of conditions ranging from breast cancer to cerebral palsy. Even at its peak during the week of 24 April, only 411 of the 4,529 deaths recorded to have occurred at home in England were caused or involved coronavirus.
The ONS team report that since the week of 14 March, deaths from dementia and Alzheimer’s disease have risen by 79% in private homes in England compared with the five-year average with 2,095 extra deaths, while diabetes deaths at home have risen by more than 85%, with 595 extra deaths. Deaths at home from cardiac arrhythmias during this period rose by 105%, with 446 excess deaths.
For both men and women the leading cause of death among those who died at home was coronary heart disease.
Dr Katherine Henderson, president of the Royal College of Emergency Medicine, said the figures were sad and alarming. “Patients who need urgent care must seek it from our hospitals where they will receive it,” she said.
Prof Sir David Spiegelhalter, chair of the Winton Centre for Risk and Evidence Communication at the University of Cambridge, said the number of deaths at home was holding steady at about 400 a day for England and Wales – about a third higher than before the pandemic.
“Non-Covid deaths in hospital have correspondingly declined, suggesting most of these deaths would normally have occurred in hospital, and people have either been reluctant to go, discouraged from attending or the services have been disrupted,” he said.
Spiegelhalter added the data did not reveal whether lives could have been saved if those taken ill had gone to hospital rather than stayed home
“Crucially, the ONS data cannot tell us about the quality of these deaths, particularly in terms of the end-of-life care provided to the patients and the support for their families,” he said.
