What’s the most shocking thing about the chart shown in Figure 1 below, copied from this week’s ONS Weekly Deaths report? It shows the number of excess weekly deaths by place of occurrence, which ONS report from time to time, usually buried in the midriff of the report. For some, the most shocking thing might be the peak in hospital excess deaths in Spring 2020, or in the 2020/2021 winter. For others, it might be the exceptional care home peak that occurred in March and April 2020, a peak Dr No has written about before. But in each of these two settings, the peaks have been offset somewhat by other periods when the number of deaths fell below the number of expected deaths, based on the 2015-2019 average. Perhaps the most shocking thing instead is the consistent excess mortality for deaths occurring in the home. These average out at 891 excess deaths every week over the 76 weeks covered by the chart. For hospitals, the same average is 248, and for care homes it is 312 excess deaths.

Figure 1: Number of excess deaths by place of occurrence, England and Wales, registered between 7 March 2020 and 20 August 2021. Source: ONS (see text for link)

Since more people live at home than in hospital or a care home, we might expect there to be more home deaths, and so more excess home deaths when there is an excess. So let us instead look at the number of excess deaths for each setting as a percentage of the expected number of deaths for the setting, based on the 2015-2019 five year average number of deaths, using the underlying data, which can be found here. What we find remains shocking. For home deaths, over the period covered by the chart, there were 38% more deaths than expected. For hospitals, on the other hand, it was a paltry 5%, while for care homes it was 14% more than expected. These simple sums confirm what our eyes suggest us when we look at the chart: there was a consistent, and as it turns out disproportionate, rise in the total number of excess deaths occurring at home, compared to the rises in hospital and care home excess deaths. 

Getting on for a fairly consistent almost one thousand excess deaths every week since March 2020 is shocking. Apart from the covid wave peaks, and the bank holiday troughs, week in, week out, hundreds more people died at home than expected. In neither last summer nor this one was there any let up. There was no lull in the cull; instead, the excess deaths just kept on rolling in to ONS, who counted them all, week in, week out, and plotted them on this chart. Even more shocking, the great majority of these excess deaths were not covid deaths, because covid’s lethal scythe hardly touched the home.

Although not shown on the chart, the weekly data for the chart includes both all cause deaths and  ‘deaths involving covid’ for each setting. If we assume — a rather reckless assumption — that all covid deaths are excess deaths, then, by simply subtracting the total of these home ‘deaths involving covid’ from the total number of excess home deaths, we can arrive at a figure for the number of non-covid excess deaths. From the total of 67,687 excess home deaths for the period covered by the chart, we subtract a total of 8,197 ‘deaths involving covid’, leaving 59,490 excess deaths not involving covid. To the extent that the reckless assumption is indeed reckless — some of the ‘deaths involving covid’ were going to happen anyway, and so are part of the expected number of deaths, and so are not excess deaths — then, for each such expected death, we remove them from the subtraction. If, for example, 4,000 of the ‘deaths involving covid’ were expected, in the sense they were going to happen anyway, then we would only subtract 4,197 covid deaths from the 67,687 total excess deaths, leaving 63,460 excess deaths not involving covid.

Overall, excess deaths at home rose more sharply than in any other setting, and furthermore, the great majority of excess home deaths were not covid deaths. If they, by ONS’s own reporting, are not covid deaths, then something else caused those excess deaths. Whatever it is, it has remained pretty constant throughout the period covered by the chart, including during summer months, when, extreme heat waves excepted, excess deaths normally decline. What can possibly have changed around March last year, and remained pretty constant over the last 18 months, that might account for the week in week out relentless toll of excess deaths at home?

Something may emerge when we get full cause of death data, which won’t be until well into next year, but Dr No doubts anything obvious will stand out. No single explanation will emerge, instead we are likely to see across the board rises in common causes of mortality, including potentially avoidable causes of mortality, rather than an epidemic of this or that. Nor can we seek clues from those who died, for they are no longer with us, but we might get hints from relatives of those who died. In the absence of any other obvious persistent explanation, Dr No has to conclude that by far the most likely cause of these excess home deaths is the government’s reckless ill thought through policies of hard hitting emotional messaging and lockdown. Large swathes of the population were literally scared witless, and in their witless state — which is still widely in evidence even today — they stayed locked down, even when they could and should have sought medical help. Put simply, those who stay at home, die at home.                                            


  1. Tish Farrell Reply

    More very useful analysis, Dr. No. Though I’m not surprised about the number of home deaths. I just want to scream and scream.

    In fact the longer this goes on the more one starts to deny one’s own capacity for rational response. The last time I wrote to my ever-junta-supporting MP Mr Dunne I believe I remarked if SARS CoV2 is so lethal (according to gov-speak, if not its own website classification for this disease) what kind of government sends (apparently infected) test-positive people home to self-isolate WITHOUT medical treatment? Isn’t this some kind of weird/immoral Russian Roulette – either recover or get ill enough to require hospital treatment, by which time the outlook for some of the latter may be very poor. Obviously most of the home self-isolating either got better or weren’t actually ill. Not surprisingly I did not get a response to this particular question. The cull is very useful isn’t it – whatever the cause – e.g. state pensions saved etc

  2. dearieme Reply

    “The cull is very useful isn’t it – whatever the cause – e.g. state pensions saved etc”

    I’ve never found that argument persuasive. It’s a Conservative government – culling the old is culling their own voters. And it’s not as if politicians pay pensions out of their own pockets.

    • Tish Farrell Reply

      I take your point, dearieme. All the same, I made my comment on the basis of a shocked comment from an accountant friend last year who had totted up the amount saved back then. The prospect of our aging population creating huge future demands on creaking NHS provision must also be a massive headache for the system? The baby-boomers will be increasingly in that category over the next couple of decades. According to gov. figures for last year over a third of the population was over 50 and more than 75% of 50-70 yr olds were in active employment and so not drawing pensions until later.

    • Frogge Reply

      You assume that the government is conservative. Its behaviour indicates otherwise.

      NHS data is always suspect as data accuracy is a function of board requirement, and board requirement is determined by DOH

  3. dr-no Reply

    It is hideous to contemplate any government culling its own citizens, and on balance it seems more likely (but of course not certain) that the excess deaths came about as a result of collateral damage from ill conceived policy driven on the one hand by panic – ‘something must be done’ – and the even more ill conceived decision to let the SPI-B behavioural loons and numerologists out of their playpen. It wasn’t just the lockdown that kept people at home, indeed there have been long periods with no formal lockdown. it was also the pervasive projection of and then internalisation of fear by large swathes of the population. A normally sensible in his mid seventies friend on many years of Dr No’s readily admitted he decided not to go to A&E despite early symptoms suggestive of a heart attack. He was one of the lucky ones: a few days later, he was persuaded to attend, and tests showed a recent heart attack. Curiously, his symptoms started about three weeks after his first covid vaccination. No Yellow Card has been filed, as far as Dr No is aware (though of course there is no reason why he should know, if the treating doctor did nonetheless file one).

    This post was partly inspired, if that is the word Dr No is looking for, by his weekly supermarket shop yesterday. Medium size Sainsbury’s in a lower middle class area. Most of the shoppers, perhaps three quarters, were wearing masks, and from time to time made those odd jerky movements we see when people perceive someone has got too close to them. This wasn’t ‘protect others’ behaviour, it was ‘protecting self’ behaviour. The all looked terrified. Even the masks couldn’t hide that, you could see the fear in their eyes. It was only the 10% of non-masked shoppers who actually looked normal and were happy to smile at a stranger that stopped Dr No from going insane and screaming ‘what the hell are you all playing at?’.

    dearieme – given the cull may not be deliberate policy, it might nonetheless be considered by some as ‘very useful’ in that one of the biggest problems facing this, and indeed any government, is how to pay for social care. It is yet again in the news again, with our old friend and erstwhile one time SoS for Health JC (C is a four letter word ending in t, not a five letter one ending in t) dreaming up new names for a social care tax. Social care is a huge headaches for the Tories, because, one way or another, tax of one form or another will have to be levied (let’s forget silly notions of private solutions, social care is a problem that needs a national level solution) and tax increases are (a) anathema to Tories and (b) potent vote losers. So no harm in having a few OAPs fall off their perches early. It might mean a few less voters, but it also means less spending on social care. The really cynical might even be tempted to ask: what’s an OAP voter really worth?

  4. Tom Welsh Reply

    The essential fact that I glean from your excellent article, Dr No, is that during what was made out to be a terrible pandemic the NHS and most people associated with it instinctively protected themselves and their organisation rather than helping their patients.

    That is fully in line with Jerry Pournelle’s Law of Bureaucracy, which states that

    “In any bureaucracy, the people devoted to the benefit of the bureaucracy itself always get in control and those dedicated to the goals the bureaucracy is supposed to accomplish have less and less influence, and sometimes are eliminated entirely”.

    The NHS may have been inspired by fine ideals and great hopes; but the means by which it was implemented have utterly confounded its purpose. It was set up by politicians for politicians, through the means of bureaucracy and administration. The administrators, whom a naive outsider would suppose almost wholly unnecessary, have gradually taken over until the whole huge Tower of Babel is almost entirely concerned to protect itself. Patients can go die elsewhere and take their filthy diseases with them.

    • Tom Welsh Reply

      To put it another way, to my mind the NHS itself has become a cancer that grows and feeds itself by sucking away the lifeblood of the nation and its people.

  5. Alice Reply

    When shopping in a small Sainsbury’s I and one check out assistant, a young woman, were the only free people. One elderly man wore a mask just over his mouth, to stop him accidentally lambasting unmasked shoppers that he’d sniffed out, perhaps?

  6. dr-no Reply

    Tom – Dr No remains committed to the founding principles of the NHS, which can be very simply stated: (1) treatment on the basis of clinical need (as opposed to patient’s fancy) and (2) funded out of general taxation (and so free at the point of delivery, only very minor co-payments tolerated). Hidden in both is the idea that a patient is a patient, not a customer, consumer, client, service user, chancer, punter, freeloader, or whatever alt-NHS term is currently in vogue. Both are also the only rational and humane way to run a modern health service.

    After that, it gets complicated. Although Dr No worked in the NHS for most of his professional career, he was not a career NHS doctor, for many reasons, with a major one being a chronic awareness of the NHS’s failings. A number of these have been documented in posts over the years, mostly on the old blog.

    It was, at least to Dr No, entirely predictable that the NHS would react to the pandemic as it did. A good few years ago, the RCPsych (Royal College of Psychiatrists) and it’s ‘stakeholder partners’ developed something they called ‘New Ways of Working’, which Dr No dubbed ‘New Ways of Putting Your Feet Up’, on account of the fact the general idea was that community psychiatric nurses would do most of the work on the ground, leaving consultants to look after the more complex cases, an activity known in the field as putting your feet up. GPs and non-psychiatric consultants have followed the trend, with a proliferation of noctors (nurses pretending to be doctors) and poctors (pharmacists pretending to be doctors). It was entirely predictable that the pandemic would usher in a new round of new ways of working, with further and better new ways of putting your feet up. A new development in the pandemic was that nurses and other non-medical staff also found new ways of putting their feet up; only they got bored, and so filled their time posting those ludicrous tik-tok videos that still make Dr No shudder.

    But the malaise is not universal. There are countless NHS staff who have worked superbly throughout. Dr No’s own experience in recent years has been excellent 90% of the time. Only this week, he had a hospital appointment, but in keeping with new ways of putting your feet up, he was seen by a noctor rather than a doctor. Happily, Dr No is a doctor, so there was a doctor in the room after all, even if he was also the patient, and he was able to guide the noctor gently in medical ways. He is acutely aware this is a tremendous privilege: the vast majority of patients do not have this option.

    Which brings us back to something we have discussed before: the NHS works best when sensible doctors and nurses (real nurses, not noctors) are in charge. Not the deranged public health doctors and the coercive healthists, but the Dr Finlays, and dare we say it, even the Lancelot Spratts of bygone days; and traditional matrons rather than modern matrons. The cancer in the NHS isn’t the sound core of sensible clinical staff, it is instead the managers, including those who manage from Westminster, and those clinical staff who have gone over to the dark side, and now see themselves as managers as much as clinicians. The NHS works best when management is conspicuous by its absence, and the sensible doctors, nurses and patients go about their business of diagnosing and treating illness and injury, and alleviating suffering. Pournelle’s Law of Bureaucracy is very pertinent: when the managers take over, you have a bureaucracy, and so your choice of quote applies perfectly.

    In passing, Dr No knows the BMA and many individual doctors opposed the introduction of the NHS, and had to be ‘persuaded’ by various bribes to accept the NHS, including the infamous ‘stuffing their mouths with gold’. It doesn’t look good with hindsight, but we have to remember the real concern of doctors at the time was loss of professional independence, even though in reality they lost very little – that would come much later, when Batman and Mrs Hacksaw put their boots and heels in. Doctors of Dr No’s generation (qualified 1982) and the immediately preceding ones ‘never had it so good’, but it has gone downhill since, and by and large because of one thing, management interference.

    The other hugely damaging influences have been the changes in medical education and regulation. These are tightly linked, because they both come under what Dr No calls the General Turkey Council. MMC (Modernising Medical Careers, or as it is better known, Mangling Medical Careers) spelt the end of traditional medical education, by replacing the pursuit of excellence with the pursuit of quotas, among many other misfortunes, not least the destruction of the traditional firm. Regulation went really bad the day revalidation was introduced, a long delayed but nonetheless knee jerk response to Shipman. The twin evils of revalidation are that firstly, it assumes incompetence until proven otherwise, which damages professional ethos and morale), and secondly (this is related, and is actually the greater evil), it removes the locus of professional control from the internal (the doctor learns internally what makes good practice, and then practices it) to the external, the rules and regulations imposed in ever vaster numbers by the General Turkey Council. The net effect is to impoverish the doctor. No longer a self-regulating practitioner, he becomes a pawn in the General Turkey Council’s game, incapable of independent self-regulation – which is pretty much the defining feature of any true profession.

    We have to accept that they days of the golden era are never to return. But that does not mean giving in to the new ways. Instead, we fight back in ways that we can. Dr No’s blog is written by Dr No as a way of saying ‘no’ to the absurdities and excesses of the new ways, wherever they may be, and Bad Medicine is a broad enough umbrella to cover a lot of ground, from dodgy research to coercive healthism, and much more besides. As patients we can do out bit, by insisting on sensible, patient focused clinical care, rather than managed care, even if this is easier for some to do than others. Our votes are less useful, because all political parties want to manage the NHS their way, and we know that any form of external management is poison to a sensible NHS. If there was a ‘Leave the NHS Alone’ party, that would be the one to vote for, but it would never get a single seat, let alone a government.

    Not for the first time, Dr No appears to have covered more ground than he meant to when he started writing this reply…

  7. Tom Welsh Reply

    I am sorry if my comment provoked Dr No; let me hasten to add that we seem to be very much in agreement. (Although Dr No has the twin advantages of being a doctor and having worked in the NHS. I haven’t even been seen or treated by the NHS for a good many years, which I hope to extend until one day I drop stone dead without warning).

    “Dr No remains committed to the founding principles of the NHS…”

    I can’t say that I am committed to those principles, as I have seen how they worked out in practice. However, I can commit myself to them in exactly the same way as I am committed to the principles of Jesus Christ and the founders of the Communist movement – even though I am agnostic and have never been a communist or a political socialist.

    The principles are fine – the devil is in the details, and especially the management. Unfortunately almost all politicians seem dedicated to the principle that they should lay down broad goals, and it should then be the task of unnamed inferiors to realise those goals in practice. Of course that never works, except in the sense that it gives the politicians an excuse when the goals are not met.

    “There are countless NHS staff who have worked superbly throughout”.

    I do not dispute that. But surely it hardly matters, when all those excellent well-intentioned people must do the bidding of the minority of cancer cells – or be fired.

    “The NHS works best when management is conspicuous by its absence, and the sensible doctors, nurses and patients go about their business of diagnosing and treating illness and injury, and alleviating suffering”.

    Exactly so! Unfortunately, ever since its inception the NHS has seen political styles of management steadily encroaching from the top down, and eating away the structure as they go. Today I read on “Lockdown Sceptics” that even top NHS management is now hearing from the media of vital decisions affecting the health of millions, and the work of themselves and their employees, without ever being consulted let alone informed. The cancer has almost run its course; now medical decisions about the health and treatment of patients (and the healthy too) are made by cabinet ministers – or rather their unelected, often anonymous “advisers” – rather than doctors, nurses, or even NHS administrators.

    Incidentally, the very word “noctor” contains within itself its own devastating refutation. “Doctor” (“teacher”) comes from Latin “docere”; whereas “nocere” means to harm or injure. So “noctor” would perhaps be a better term for qualified doctors who persuade their patients to allow themselves to be injected with mRNA and other dangerous concoctions.

  8. dr-no Reply

    Tom – Dr No wasn’t in any way provoked, he just wanted to establish his position, and yes, we both agree on many points: ‘devil is in the detail’ <=> ‘after that, it gets complicated’ etc and of course our views on management interference.

    One of the reason for objecting to the current iteration of political interference (the current NHS bill) is that it will foster managed care, which is truly actually much worse than it sounds. At some point Dr No needs to get round to doing a post on the implications.

    Dr No unsurprisingly knows that doctor comes from the Latin for teacher, but he failed to make the nocere connection, well spotted!

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