Excess deaths reach highest level since pandemic peak - how much are NHS failings to blame?

Almost 2,500 more people died in the week to 23 December than expected, 20% more than the five-year average for the same period, new figures from the ONS reveal.

It's the highest number of additional deaths in a week since February 2021, during the pandemic's most deadly period.

There have been over 30,000 more deaths than expected in the past six months alone, equivalent to 1,155 a week.

Even excluding the 8,000 deaths caused by COVID in that period, there are an average of 848 more people dying every week than the average from 2016-19 and 2021 (excluding the pandemic-affected 2020).

Analysis from LCP Actuaries suggests that a significant number of these deaths could be due to the current NHS crisis and delays in emergency treatment.

More deaths at home

Many of the recent excess deaths are occurring at home, as opposed to in hospitals or care homes.

In the week to 23 December, 1,120 more people died at home than usual, 37.5% higher than the five-year average.

In total over the past six months 81,804 people have died at home, 19,270 (30.8%) more than the five-year average from 2015-19. That's a much bigger difference than the change in other settings.

Stuart McDonald, Head of Longevity and Demographic Insights at LCP Actuaries, said that while part of the increase in deaths at home could be attributed to NHS delays, it can also be attributed to patient preference.

"During the pandemic more people decided they wanted to live out their final days at home rather than in hospital where access from friends and family may prove difficult. This trend has continued, supported by the NHS.

"As well as this, working from home has potentially allowed more people to give full-time care to seriously ill relatives instead of requiring care homes or other support.

"However there are more sudden deaths where the fact they are occurring at home is more concerning. Waiting times for Category 2 ambulances - those for things like heart attacks and strokes - have been over an hour rather than the 18 minute target.

"We don't know how many of these additional deaths at home are the 'acceptable' kind led by patient preference and how many are those concerning ones."

The data on where this balance lies doesn't exist as yet, but Mr McDonald said England's chief medical officer, Professor Chris Whitty, was aware of the issue and trying to find out more.

Why are these extra deaths happening?

As well as these potential extra deaths at home, analysis by LCP Actuaries suggested that as many as 500 deaths a week could be caused by delays in A&E.

In November, almost half of people attending major A&Es had to wait more than four hours to be seen - the worst level on record. And more people had to wait over 12 hours to be admitted to hospital after being assessed in A&E than did over 10 years from the start of 2011 to end of 2020.

The LCP's 500 deaths a week are based on an academic study which showed that for every 72 people waiting 12 hours to be admitted to hospital after arriving at A&E, there would be one additional death.

Multiplying this number by the number of waits over 12 hours produces a figure of 497 deaths a week attributed to long A&E waits alone. This is still lower than the total number of excess deaths we're seeing at the moment.

A spokesperson for NHS England told Sky News they didn't recognise the figures: "While services are under significant pressure across the NHS, there are a number of different reasons why we may see higher mortality levels than normal, including from things like inclement weather and rising population numbers."

Rising population numbers are taken into account by the Continuous Mortality Investigation. Instead of using the average from previous years for their baseline, in their calculations they project the number of deaths expected.

Using these figures the number of additional deaths in the week to 23 December would be 2,170 (18%). That's slightly lower than the ONS figure, but still represents a really significant number of people dying in just a week, who would still be alive in more typical circumstances.

Mr McDonald also told Sky News that the figures LCP attributed to A&E delays are likely to be a low estimate rather than too high.

Due to data limitations they didn't include people who waited between four and 12 hours, which the study also suggests leads to extra deaths (although at a lower rate).

And the one in 72 figure they used is for waits of exactly 12 hours. There are likely to be more deaths when people wait longer than 12 hours - of which there have been thousands.

What's happening in other countries?

NHS England chief strategy officer Chris Hopson has pointed out that the UK isn't the only country experiencing a higher number of deaths than normal at the moment.

He said: "We won't know [if delays at A&E are causing the excess deaths] that until we've done the detailed work, which we're in the process of doing."

"We are seeing, like Germany, like Italy, like Spain, we are seeing higher levels of mortality than we would expect. But we know that's due to a number of different factors."

Figures from Our World in Data suggest that other countries have indeed seen excess deaths in recent months, although most not to the same extent as the UK.

The level of excess deaths in Germany remains similar to the UK's, but the likes of Italy, Spain and France have been lower more recently.

Each percentage point difference is equivalent to thousands of additional people dying each year.

The Data and Forensics team is a multi-skilled unit dedicated to providing transparent journalism from Sky News. We gather, analyse and visualise data to tell data-driven stories. We combine traditional reporting skills with advanced analysis of satellite images, social media and other open source information. Through multimedia storytelling we aim to better explain the world while also showing how our journalism is done.

Why data journalism matters to Sky News