Deaths in care homes are reported, but the specific source you refer to in your question only counts deaths that occurred in hospitals. These are the statistics which are reported daily by the Department of Health.
The reason deaths outside of a hospital setting, including those in care homes, are not being included in the day-by-day statistics published by the DoH is because as they don't occur in a clinical setting, it may take a while for the cause of death to be determined by a doctor. This time lag is exacerbated by the current crisis, and may take even a couple of weeks. Specifically in care homes, where residents are likely to have a variety of underlying health issues, it will often be difficult to determine the cause of death; whether or not the disease was actually COVID, and if this was the primary or secondary cause of death. This time lag makes it unhelpful to report this data daily, as it is unlikely to give a true picture of the number of daily deaths.
The Director of Health Protection for Public Health England, responded on this matter during a daily coronavirus briefing on April 14th:
Laura Kuenssberg (BBC): If I could ask the medics, can you, from as soon as you possibly can, start including the numbers of deaths in
care homes and in the community in these daily statistics, so people
can have a true picture of what’s going on?
Yvonne Doyle (PHE): Thank you, Chancellor. Thank you, Laura. Yes. So, the deaths in out of hospital, we, the Office of National Statistics
do actually collect total deaths, and we’ve had a download of that
today. But Laura, we are working with the ONS to actually speed that
up, so that we do get quicker information.
As you know, the daily deaths we would very much like to have, it’s a
bit more complicated for care homes, because although over nine out of
10 deaths sadly do occur still in hospital, in the community there’s a
range of places where they occur including in care homes, but not just
there. In hospices, and at home, indeed, as well.
In these very dispersed systems, we just need to be absolutely clear
that the cause of death that is attributed is correct. That is what
takes time on the death certificate to get right. But we would like to
have much more rapid data, preferably on a daily basis. And that’s
what we’re working towards.
Later in the same conference, Paul Brand of ITV made a similar point, which led the panel to provide a bit more of an insight into their reasoning:
Paul Brand (ITV): We’ve been filming today at a care home in Gateshead where they feel as if the residents they’ve lost to COVID-19
are being forgotten. Given that data does exist, however imperfect it
may be, wouldn’t it just be more respectful to include those deaths in
your own statistics?
Rishi Sunak (Chancellor): In terms of the data, there’s absolutely no
desire not to respect what’s happening in care homes and to provide
that data. As Yvonne could talk about in a second, we’re actually
working with the ONS to speed up the publication of that data. In
terms of the data that we publish every day and make decisions on, I
think there, there is a question about making sure we have a data set
that is consistent and accurate and timely, and I think there is just
a logistical challenge in being able to collect that data and then
make decisions based on it, but Yvonne can maybe elaborate on that
point.
Yvonne Doyle: Thank you, Chancellor. So absolutely. I would very much
like to have the best possible data on a daily basis, and the care
sector is very much seen as part of the health and care family. They
are the front line, and we’re very familiar with that sector through
our local work and through our national work with local government and
with the local response forums, Then local resilience fora. We work on
the outbreaks, which is even more important to discuss in a sense than
anything else at the moment, where we have a number of outbreaks in
care homes, and there is very active input there to ensure that the
damage and the harm to people is mitigated. So we work very actively
with the care home sector, but it is a very dispersed sector.
Stephen Powis (National Medical Director for England): I would also say that the reason that we can provide the data very quickly
from hospitals is because there are fewer hospitals compared to care
homes, so we’re working with a smaller number of organizations. But
because our hospitals are very used to the process of supplying data
to NHS England on a regular and even on a daily basis, that is
something that they do during normal times for all sorts of data. We
in the hospital sector have a have an infrastructural basis to get
that data rapidly, and of course the patients that we report from
hospitals are those that we know have been tasted as positive. Again,
that is different from in the community where doctors are registering
deaths based on a probable diagnosis and not necessarily on a tested
diagnosis, so there are key differences in the two sets of data and
how they are collected.
Rishi Sunak: Yeah. Paul, just to put some context around Steve’s point, there are a couple of hundred NHS trusts with an existing
consistent system for providing data. There are tens of thousands of
social care settings that one needs to collect data from, and that’s
the challenge that Steve is talking about.
Brand then brought up the case of France which you mentioned, where they suddenly introduced care home deaths into their statistics. He asked whether this indicated that it would be fair to include care home data in the daily deaths announcement. Yvonne Doyle responded:
Happy to discuss that. Indeed, different countries report in different
ways, and one of the issues that we’ve noticed is sometimes the way
those data are presented can cause quite a surprise in the system.
Recently, there was quite a large inject of data from care homes in
France. It made the data look as if there was an alarming increase in
deaths on that day. It wasn’t actually the case. It demonstrates
exactly the challenge of getting this right day on day, and we’re very
much learning internationally. We’re in touch with all our European
neighbors to learn the best we can do.
In conclusion, then, the data around deaths outside of hospitals, including care homes and cases in the community is being recorded by the Office for National Statistics, and can be found here. Specifically with regard to deaths in care homes, there are issues with reporting including the lack of a centralised reporting system, the number of social care providers compared with the number of hospitals, and the fact that doctors will be basing their diagnosis of cause of death on a probable, rather than a confirmed diagnosis. This means that this data is rather less accurate than deaths recorded in hospitals, and also includes a significant time lag. The government, along with PHE and the NHS seems to have decided that including this data in the reported daily death statistics would be a mistake, and could lead to inaccurate conclusions being drawn. They point to the very issue you draw attention to in your question: altering the way statistics are reported would lead to an anomalous increase in the reported deaths. According to the government briefing, however, steps are being taken to receive and record this data more quickly, perhaps on a daily basis rather than a weekly basis as it is currently.
