Trends in excess deaths

Excess deaths are typically measured as the difference between the observed number of deaths within a period compared with the five-year average.

Data on excess deaths is routinely published by the Office for National Statistics (ONS) within their deaths registered weekly in England and Wales publication.

The Office for Health Improvements and Disparities (OHID – part of the Department of Health and Social Care) also publish information on excess mortality, including:

• Excess mortality in England (post pandemic method), last updated 21 March 2024;
• Excess mortality in England and English regions, last updated 20 February 2024;
• Excess mortality: bespoke analyses, last updated 12 October 2023.

Details of excess deaths and age-standardised mortality rates were also published in the ONS Monthly mortality analysis. This series was discontinued in August 2023, but some more recent updates have been provided in response to Parliamentary Questions.

The table below shows excess deaths in England and Wales between January 2020 and September 2023. Details are also shown for the age-standardised mortality rate (ASMR) and how this differs from the five year average rate. The ASMR shows the number of deaths per 100,000 age standardised population so it takes into account changes in the size and structure of the population.

Because the population is both growing and ageing, it would be normal to see an increase in the number of deaths. Comparing the ASMR allows us to see whether the increase in deaths is higher than we would expect, given demographic changes.

Over the period shown in the table, the majority of quarters have a relatively high number of excess deaths as well as an elevated ASMR. For the most recent quarter ending September 2023, the number of deaths in England and Wales was 2.1% above the five-year average but the ASMR was 4.7% below the five-year average.

Source: ONS mortality data as provided in HL36, 21 November 2023

A debate on excess deaths and policy implications took place in the Commons on 24 January 2023; the Health Minister, Maria Caulfield, responded on behalf of the Government. The Minister said that excess deaths data showed that causes of death from conditions such as ischaemic heart disease (otherwise called coronary heart disease) had contributed to excess deaths in England in the past year. Ms Caulfield did not directly respond to a question asking if she would commit to an investigation on the cause of excess deaths, but said:

We are seeing an increase in excess deaths in this country, but we are also seeing that in Wales, in Scotland, in Northern Ireland and across Europe. There is a range of factors. As we saw, there was an increase in December in the number of people being admitted with flu, covid and other healthcare conditions. That was seen not just in this country, but across Europe.(see HC Deb, 24 January 2023, c845)

The Government responded to a PQ in January 2023 asking, with reference to OHID’s data on excess mortality, if it had made an assessment of trends in the causes of excess deaths over winter 2022/23, and if it would publish a list of the principal causes of excess deaths to date:

Excess deaths are the difference between the actual registered number of deaths and the expected deaths based on data for previous years. There are a wide range of estimates from different bodies including the Office for National Statistics and the Office for Health Improvement and Disparities (OHID), using different methodologies. The OHID estimates of excess mortality published on 12 January 2023 use the trend in mortality rates from 2015 to 2019 to estimate expected deaths. They adjust for population growth and ageing. This provides further insight on the causes of death driving the excess mortality over 2022. It is likely that a combination of factors has contributed to excess deaths over winter 2022/23, including high flu prevalence, cold weather, the ongoing challenges of COVID-19 and health conditions such as heart disease and diabetes (PQ 125400, 20 January 2023).

In another PQ response on excess deaths, the government referred to its forthcoming Major Conditions Strategy which will address conditions that contribute most to morbidity and mortality in England:

[…] On 24 January 2023, the Government announced that it will publish a Major Conditions Strategy and an interim report will be published in the summer. The strategy will set out a strong and coherent policy agenda that sets out a shift to integrated, whole-person care. The strategy will tackle conditions that contribute most to morbidity and mortality across the population in England including, cancers, cardiovascular disease, including stroke and diabetes, chronic respiratory diseases, dementia, mental ill health and musculoskeletal conditions. (PQ 187274, 8 June 2023)

The government has also set out the steps it is taking, across the healthcare system, to reduce the number of excess deaths (PQ 191309, 30 June 2023). This includes publication of the NHS delivery plan for recovering urgent and emergency care services (January 2023).

A public e-petition calling on the Government to Launch a Public Inquiry into excess mortality in England and Wales closed on 7 December 2023 with 14,113 signatures. The Government had responded to the petition in July 2023, noting that the UK Covid-19 public inquiry was underway, that it had “no plans for a further public inquiry” and that the government was “taking steps to reduce excess deaths”. The full response is available on the petition page.

The Health Minister, Maria Caulfield, responded to Andrew Bridgen’s adjournment debate on Trends in Excess Deaths on the 20 October 2023. The Minister reiterated points made in earlier debates and PQ responses that a “combination of factors” had contributed to the “increase in excess deaths, including, in the last year, high flu prevalence, the ongoing challenges of covid-19, a strep A outbreak and conditions such as heart disease, […] diabetes and cancer” (HC Deb, 20 October 2023, c567).