Notifications to Care Inspectorate Wales related to COVID-19 in adult care homes: 1 March 2020 to 1 December 2021

In order to improve the timely availability of data related to coronavirus (COVID-19) in adult care homes the Welsh Government and Care Inspectorate Wales (CIW) have agreed to publish provisional counts of the number of adult care homes reporting one or more confirmed cases of COVID-19 and provisional counts of deaths in care homes, based on notifications by care home providers to CIW. This information helps to monitor the impact of COVID-19 and contributes to Wales and UK wide monitoring and decision-making.

This release includes information on the number of adult care homes that reported one or more confirmed cases of COVID-19 in the last 7 and 20 days to CIW. This data shows only the number of care homes that have notified CIW of a confirmed COVID-19 case among their staff or residents and does not show the total number of coronavirus cases for that care home. Since the data shows the number of care homes that reported one or more COVID-19 cases in the last 7 days or 20 days, it does not show whether there is currently an active coronavirus case in the care home. This data is reliant on registered providers reporting consistently and accurately. This data has been collected to inform CIW’s regulatory activities and decisions, and to enable CIW to monitor care homes with outbreaks of COVID-19.

The data included in this release is subject to revisions and previous publications are not revised. The latest figures are the most up to date figures.

• 57 adult care homes in Wales have notified CIW of one or more confirmed cases of COVID-19, in staff or residents, in the last 7 days.
• 166 adult care homes in Wales have notified CIW of one or more confirmed cases of COVID-19, in staff or residents, in the last 20 days.
• CIW have been notified of 12,257 deaths of residents in adult care homes since 1 March 2020. This covers deaths from all causes, not just COVID-19.
• 66.7% of total deaths from 1 March 2020 were for residents in care homes with nursing.
• CIW has been notified of 2,017 care home resident deaths with suspected or confirmed COVID-19 since 1 March 2020. This makes up 16.5% of all adult care home resident reported deaths during this period.
• In the last two weeks, there have been 8 reported deaths of care home residents relating to suspected or confirmed COVID-19.
• There are 1,043 adult care homes and 17 adult and child care homes in Wales.

This section covers the number of adult care homes, and adult and child care homes, that reported one or more confirmed cases of COVID-19 in the last 7 and 20 days to CIW. The data does not show the current number of confirmed COVID-19 cases in adult care homes or whether there is currently an active case in the care home.

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Notifications to Care Inspectorate Wales related to COVID-19 in adult care homes on StatsWales

As at 1 December 2021

• The number of adult care homes which have notified CIW of one or more confirmed cases of COVID-19, in staff or residents, in the last 7 and 20 days generally decreased from January 2021. After an increase in notifications from early June 2021 to mid-September 2021, notifications have generally decreased since mid-September 2021, despite weekly fluctuations.  
• 57 (5.4%) adult care homes notified CIW of one or more confirmed cases of COVID-19, in staff or residents, in the past 7 days. This is a decrease compared to 81 (7.6%) in the 7 days up to 24 November 2021.
• 166 (15.7%) adult care homes notified CIW of one or more confirmed cases of COVID-19, in staff or residents, in the past 20 days. This is an increase compared to 148 (14.0%) in the 20 days up to 24 November 2021.

This section covers the number of deaths of residents in adult care homes, and adult and child care homes, based on statutory notifications by care home providers to CIW.

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Notifications to Care Inspectorate Wales related to COVID-19 in adult care homes on StatsWales

The average of the 2018 and 2019 7 day rolling averages are included as a comparison to the 2020-2021 data.

Daily data is only available from 1 January 2018. Therefore, the average of 2018 and 2019 7 day rolling average begins on 7 January to avoid a misleading decrease in the two year average, where a full week of data was not available.

Main points

• Notifications of deaths in adult care home residents rose sharply from early April 2020 and peaked in early May 2020. By mid-June 2020 notifications had returned to the 2018 and 2019 average, however, they increased again through November 2020 and December 2020.
• From early January 2021, notifications increased but remained below the peak in May 2020. Following this, the number of notifications generally remained below or similar to the 2018 and 2019 average until mid-July 2021.
• From mid-July 2021, notifications of deaths in adult care home residents increased. After a period of reduction during August 2021, they have since fluctuated and have generally remained similar to the 2018 and 2019 average.
• Between 1 March 2020 and 1 December 2021, CIW have been notified of 12,257 deaths in adult care home residents. This covers deaths from all causes, not just COVID-19.

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Notifications to Care Inspectorate Wales related to COVID-19 in adult care homes on StatsWales

A full breakdown of all data from 1 January 2018 can be found on StatsWales. During 2019, care home services were undergoing re-registration with CIW due to new legislation, which introduced a new method of notifying CIW of deaths of care home residents. This may have resulted in some disruptions to notifications being submitted.

Main points

• From 1 March 2020 to 1 December 2021, CIW have been notified of 8,174 deaths (66.7%) with nursing and 4,083 deaths (33.3%) without nursing in adult care home residents.

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Notifications to Care Inspectorate Wales related to COVID-19 in adult care homes on StatsWales

COVID-19 related deaths included in the chart include both confirmed and suspected COVID-19. The care home testing policy was expanded on 16 May 2020 to include tests offered to all symptomatic and asymptomatic staff and residents who have never tested positive for COVID-19 even where the home had not reported possible or confirmed cases. More widespread testing may have resulted in some deaths recorded as non-COVID-19 deaths when previously they may have been recorded as suspected COVID-19 deaths.

From 1 March 2020 to 1 December 2021

• CIW has been notified of 2,017 care home resident deaths with suspected or confirmed COVID-19. This makes up 16.5% of all reported deaths.
• 1,503 of these were reported as confirmed COVID-19 and 514 suspected COVID-19.
• The first suspected COVID-19 death notified to CIW was on the 16 March 2020, which occurred in a hospital setting.
• At the start of November 2020 there was an increase in the number of COVID-19 related deaths notified to CIW. There was a further increase in January 2021 that exceeded the number seen at the end of April 2020.
• Between 27 March 2021 and 21 June 2021, there were no reported deaths of care home residents relating to suspected or confirmed COVID-19.
• In the last two weeks, there have been 8 reported deaths of care home residents relating to suspected or confirmed COVID-19.

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Notifications to Care Inspectorate Wales related to COVID-19 in adult care homes on StatsWales

Source: Notifications of Care Home Resident Deaths received by Care Inspectorate Wales

From 1 March 2020 to 1 December 2021

• 68.0% of suspected and confirmed COVID-19 deaths were located in the care home.
• 30.1% of suspected and confirmed COVID-19 deaths were located in hospital.

The data in this release is based on the date of the notification rather than the date a COVID-19 case has been confirmed or the date of death. CIW notifications of confirmed cases and cause of death are reported by the care home provider. Due to working patterns, there tends to be a lower number of notifications of confirmed COVID-19 cases or deaths during the weekends when compared to notifications for Monday to Friday. There is often a larger number of notifications on a Monday.

The data used for the notifications of cases and the notifications of deaths combines both adult care homes, and adult and child care homes. There are 1,043 adult care homes and 17 adult and child care homes in Wales.

Notifications of confirmed COVID-19 cases in adult care homes

The data presented here is based on the notifications of confirmed cases received by CIW from adult care homes, which relate to their staff or residents. The care home provider only needs to notify CIW of a confirmed case based on a positive laboratory test result. There may be a potential delay between a confirmed COVID-19 case and when the care home providers notify CIW. The number of confirmed COVID-19 cases referred to here is different to the number of new cases published by Public Health Wales. These sources of data are not directly comparable due to differences in timing and the level of validation carried out. Welsh Government publish this data to ensure access to the CIW data is transparent and to provide timely indication of the trends for all notifications of confirmed COVID-19 cases in care homes in Wales. CIW are reliant on providers notifying them consistently and accurately. CIW have requested that providers notify without delay but it is important to note that:

• this data does not tell us the current number of confirmed cases in any one adult care home
• this data is only as accurate as the information submitted by the provider
• providers only informed of confirmed cases from 19 August 2020 onwards

Notifications of COVID-19 deaths in adult care homes

The data presented here is based on the Notifications of Care Home Resident Deaths received by CIW from adult care homes which relate to their residents. The location of death may be in the care home, in hospital or another location. The data is not based on laboratory confirmed tests, and not directly comparable with Public Health Wales (PHW) data. In their rapid surveillance dashboard, PHW include some notifications received from care homes with a positive laboratory confirmed test for COVID-19. These data cannot be added together. Welsh Government publish this data to ensure access to the CIW data is transparent and to provide a timely indication of trends for all deaths to care home residents in Wales, from COVID-19 or otherwise. CIW are reliant on providers notifying and specifying that they are COVID-19 related deaths. The data published by the Office for National Statistics (ONS), which includes all deaths where COVID-19 was a factor according to the death certificate, report higher numbers of deaths related to COVID-19 in care homes in Wales. Welsh Government will continue to work with CIW and ONS to explore the quality of these data.

As at 21 October 2021, CIW published data on deaths involving COVID-19 received from individual adult care homes in Wales between 1 January 2020 and 30 June 2021.

Data included in this release is correct at 23:59 1 December 2021.

Context

In order to improve the timely availability of data on confirmed cases and deaths in care homes caused by the coronavirus (COVID-19), the Welsh Government and Care Inspectorate Wales (CIW) have agreed to publish provisional counts of confirmed cases and deaths in care homes, based on statutory notifications by care home providers to CIW. This information helps to monitor the impact of COVID-19 and contributes to Wales and UK wide monitoring and decision-making.

Relevance

As the independent regulator for care home providers in Wales, providers are statutorily required to notify CIW of deaths to residents. Care home providers are also statutorily required to notify CIW of outbreaks of infectious diseases such as COVID-19. CIW has requested that care home providers to notify it of each confirmed COVID-19 case in residents or staff within the care home, but there is no statutory obligation to do this. In addition, these statistics are used daily for a number of other purposes:

• to provide CIW with intelligence to inform their regulatory activity and decisions
• to understand the impact of the pandemic on care homes
• to support evidence-based advice on future decisions around reviews of lockdown arrangements
• to contribute to Wales and UK wide monitoring and decision-making

Accuracy

From 26 October 2021, the number of notifications of deaths in adult care home residents were revised to reflect the findings of CIW’s ongoing quality assurance. CIW re-categorised the cause of deaths for some residents which resulted in a decrease of 15 suspected COVID-19 notified deaths and an increase of 15 non-COVID-19 deaths between March and April 2020. Revised figures are denoted with an ‘(r)’ on StatsWales.

To ensure accurate reporting of provisional counts of deaths in care homes, based on notifications by care home providers, CIW carried out a detailed review of the data. They found that on a few occasions, some providers had reported duplicate notifications of the same death, either through provider error or in an attempt to provide updates to previous notifications. From 12 October 2021, these duplicates were removed from the published figures. This process resulted in a decrease in the number of deaths of residents in adult care homes, and adult and child care homes (a decrease of 92 non-COVID-19 related deaths and 13 COVID-19 related deaths for the period between 1 January 2019 and 1 October 2021).

Duplicates may still occur as it is possible that providers could continue to report multiple notifications of the same death, however, CIW will conduct regular quality assurance to minimise the impact this could have on the data. If revisions are submitted, revised figures will be published on StatsWales, denoted with an ‘(r)’, indicating that the figure has been revised since the last publication.

From 21 May 2021, CIW changed the day they supply data to Welsh Government on the number of adult homes reporting one or more confirmed cases of COVID-19. Data is now provided weekly on a Wednesday, instead of a Thursday, due to an update in Care Inspectorate Wales’ internal processes. Where we previously reported on the number of COVID-19 cases in the last 7 or 20 days based on data as of the Thursday, we now refer to the data as of the Wednesday.

For consistency with the notifications of cases data, we also moved the latest data for the provisional number of daily deaths in adult care homes to as of the Wednesday, rather than as of the Thursday.

Between 9 April and 21 May 2021, CIW changed the frequency of the data they supply to Welsh Government on the number of adult homes reporting one or more confirmed cases of COVID-19. Instead of daily, data was provided weekly on a Thursday. The reason for making this change was due to there being little change in the data on a day to day basis. This allowed CIW to release some inspector capacity and increase their inspections of care homes. This change only affected the notifications of cases data. Where Welsh Government previously reported on the number of COVID-19 cases in the last 7 or 20 days based on data as of the Friday, Welsh Government reported the data as of the Thursday. Daily data from before 9 April 2021 is still displayed in Chart 1 and provided on StatsWales to give a full picture of the data available. After 9 April 2021, weekly data is displayed which reduced fluctuations in the data, as shown in the charts.

Following Welsh Government guidance issued on 17 December 2020, COVID-19 outbreaks can now be declared as over once 20 days have elapsed since the last affected individual returns a positive test or manifests symptoms. Multi-disciplinary teams must take into account the specific circumstances of individual homes, including the Infection Prevention and Control (IPC) processes that have been applied. In line with this guidance, CIW have revised their daily notifications report to replace the previous 28 day measure to a 20 day measure. This change is reflected in the data presented in this release.

The number of adult care homes in this report fluctuates. This is due to the registration of new care homes and the closure of others. For example, during November 2020, 6 adult care homes were removed and 4 were added. For the notifications of confirmed COVID-19 cases in adult care homes data is collected on a weekly basis via an online form developed and maintained by Care Inspectorate Wales. For the Notifications of COVID-19 deaths in adult care homes data is collected on a daily basis via an online form developed and maintained by Care Inspectorate Wales. The data is validated against previous returns and any significant changes are queried.

Care homes are required to notify CIW of the location of death and cause of death. Prior to 29 April 2020 this was via a free text box and CIW used manual searches on the data to produce summaries by category. From 29 April 2020 the form was amended to include mandatory tick box categories for COVID-19 Confirmed or Suspected and location (hospital, care home, hospice, ambulance, other). Therefore the methodology used to produce these figures changed from 29 April 2020.

In terms of ‘Confirmed’ COVID-19, from 29 April 2020 onwards, this has been provided to CIW by the care home provider by means of an answer to the question: ‘Was the death a result of confirmed COVID-19?’

Prior to this date, the care home provider was not asked this question, therefore, ‘Confirmed’ for these is where CIW’s inspectors have reviewed the free text data provided by the care home provider (on the questions ‘cause of the person’s death, if known and confirmed by a medical practitioner’ and ‘summary of the circumstances leading up to the persons death and all contributing factors’) and determined that it relates to a confirmed case.

In both scenarios CIW are reliant on the care home provider to inform them appropriately of a confirmed case.

Data includes all notifications up to midnight each day.

The COVID-19 cases data covers the number of care homes that have reported one or more confirmed cases, not the number of cases or the number of reports.

The COVID-19 cases data covers residents and staff working at the home.

The deaths data collection covers residents of adult care homes.

Timeliness and punctuality

The notification of deaths data in this release provides data from the 1 March 2020 and onwards, and the same time period two years prior. The notification of confirmed COVID-19 cases data in this release provides data from 16 December 2020 onwards to reflect the change in guidance that occurred on 17 December 2020.

Accessibility and clarity

This statistical release has been pre-announced and then published on the Statistics and Research section of our website. It is accompanied by StatsWales tables to allow users to have direct access to the data that underlies the charts in this release.

Comparability

Data for England was first published on 28 April 2020.

The Chief Statistician has produced a blog of the different sources of data on Coronavirus (COVID-19) related deaths in Wales.

National Statistics status

These statistics are not National Statistics. However, as far as has been practicable, they have been collected and validated in accordance with the pillars and principles within the Code of Practice for Statistics. We continue to develop the data collection and quality assurance process to improve the data.

These statistics have been produced quickly in response to developing world events.

Well-being of Future Generations Act

The Well-being of Future Generations Act 2015 is about improving the social, economic, environmental and cultural wellbeing of Wales. The Act puts in place seven wellbeing goals for Wales. These are for a more equal, prosperous, resilient, healthier and globally responsible Wales, with cohesive communities and a vibrant culture and thriving Welsh language. Under section (10)(1) of the Act, the Welsh Ministers must (a) publish indicators ('national indicators') that must be applied for the purpose of measuring progress towards the achievement of the wellbeing goals, and (b) lay a copy of the national indicators before Senedd Cymru. The 46 national indicators were laid in March 2016.

Information on the indicators, along with narratives for each of the well-being goals and associated technical information is available in the Well-being of Wales report.

Further information on the Well-being of Future Generations (Wales) Act 2015.

The statistics included in this release could also provide supporting narrative to the national indicators and be used by public services boards in relation to their local wellbeing assessments and local wellbeing plans.

Next update

The next release will be at 9.30am Tuesday 21 December 2021.

We want your feedback

We are considering reducing the frequency of some of the COVID-19 related statistical releases, including this publication. We welcome any comments or feedback on how you use these releases, and any changes to them via kas.covid19@gov.wales.

Statistician: Alexandra Fitzpatrick
Telephone: 0300 025 9016
Email: kas.covid19@gov.wales

Media: 0300 025 8099

SFR 382/2021