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Understanding 'excess deaths' - and their cause

Nurses on the picket line outside University College Hospital, London, on 18 January. Photo Workers.

The increasing number of deaths in Britain is a concern. We need to ask why – and recognise that there is no evidence that Covid vaccines are to blame. Quite the contrary…

More than 650,000 deaths were registered in the UK in 2022 – nine per cent more than in 2019. It represented one of the highest levels of excess deaths outside the pandemic in 50 years. These figures should be of concern to workers, and it is right that we should ask why it has happened.

The term “excess deaths” can sound like a heartless description but it is an important statistical term that deserves to be better understood. At any given time of year there will be a “usual” or expected number of deaths – “excess deaths” means numbers above this level.

When the figures came out in January there was a surge of social media activity blaming the rise on the Covid vaccine. While it is perfectly reasonable to think a new factor may have triggered a rise, assertions need to match the evidence – and there is no such evidence for a vaccine effect.


The government may be pleased about the focus on vaccines as the cause of increased deaths, because that obscures more worrying trends which need attention.

The rise in cardiac problems has been highlighted by some as evidence that Covid vaccines are driving the rise in deaths. But this conclusion is not supported by the data. It is true that in rare cases (mostly not fatal) one type of Covid vaccine has been linked to a small rise in cases of heart inflammation and scarring (pericarditis and myocarditis).

Yet this particular vaccine side-effect was mainly seen in boys and young men, while the excess deaths in the UK are highest in older men – aged 50 or more. Likewise close analysis of the figures for the first half of 2022 actually showed that unvaccinated people were more likely to die than vaccinated people.

So what is causing the excess deaths?

First, there is evidence that crucial aspects of health care have been omitted, compounded by lack of emergency care when the consequences of that omission occur, such as a heart attack or stroke.

“The scale of long waiting times for Emergency Care…is associated with patient deaths.”

It was always a worry that restricting access to NHS health care during lockdown would result in the neglect of patients who needed treatment for other reasons. The extent of that neglect was revealed by a major British Heart Foundation study published in January 2023.

As a result of the huge reduction in diagnosis, monitoring and treatment of high blood pressure and high cholesterol, nearly half a million people in the UK missed starting on medication to help prevent heart attacks and strokes.

The authors of the study show that, alarmingly, the detection of high blood pressure and high cholesterol have still not returned to pre-pandemic levels.

We learn from this that in our rush to prevent deaths from a new infection, our actions raised the risk of dying from the more well-known killers of undiagnosed high blood pressure and high cholesterol.

It is clear that emergency planners thinking about the next pandemic should be prioritising how the routine screening for high blood pressure and high cholesterol can be maintained in a pandemic period.


The second major factor which may be contributing to the national excess deaths figures is the waiting time to be seen in an emergency – the result of acute pressures on the NHS. Added to the increased risk of heart attack and stroke is the risk of not being seen in a timely manner when that particular medical emergency strikes.

Speaking on 12 January Dr Adrian Boyle, President of the Royal College of Emergency Medicine (RCEM), said: “December’s performance figures are truly shocking, more than 50 per cent of all patients facing waits over four hours and nearly 55,000 patients facing 12-hour waits from the decision to admit. 12-hour waits from decision to admit obfuscate the truth and are only the tip of the iceberg, we know the reality is far worse. We know that the scale of long-waiting times for Emergency Care is causing harm to patients and is associated with patient deaths.”

The reason that the RCEM uses the phrase the “tip of the iceberg” is that the current 12-hour performance figures published by NHS England are measured from when the decision to admit the patient was made rather than their time of arrival at the Emergency Department. Although data on time of arrival is collected throughout England, there has been no indication of when this data will be published.

In their effort to better understand these long waits masked by the decision to admit metric, the RCEM submits monthly Freedom of Information requests to NHS England and NHS Digital in its campaign on the extent of extremely long stays in emergency departments in England.

Focusing on the shortcomings of the NHS as a cause of rising deaths could obscure other, more fundamental, problems. The health of a nation does not rely on its health service – rather it relies on good nutrition, good housing and so on. Poverty is the big killer and there is clear evidence to link life expectancy to it.

Data from the Office for National Statistics show that men born in the poorest areas of England and Wales are now expected to live almost 10 years less (73.5 years in the period 2018 to 2020) than those in the richest areas (83.2 years), and women eight years less (78.3 versus 86.3).

When the Health Foundation published a major new study into health inequalities in 2022 its director, Jo Bibby, commented:

“The NHS wasn’t set up to carry the burden of policy failings in other parts of society. A healthy, thriving society must have all the right building blocks in place, including good quality jobs, housing and education. Without these, people face shorter lives, in poorer health. This has a big economic impact, with many older workers now leaving the labour market due to ill-health.”

The study found that a 60-year-old woman in the poorest areas of England has a level of “diagnosed illness” equivalent to that of a 76-year-old woman in the wealthiest areas, according to new research by the Health Foundation. For 60-year old men in those areas it was not quite as bad: the equivalent was to a 70 year-old in the wealthiest areas.

The squeeze on real incomes has pushed more people into those “poorest” groups with the consequence of increasing sickness at an earlier age.

Behind the “excess deaths” headline is a chain of causes – first, poverty causing greater ill health. Add to this serious ill health not being detected and treated. And then when an emergency occurs, there can be life-threatening delays in treatment.

NHS action

Industrial action by NHS staff has brought the problem out in the open and into the public domain for at least one of the steps contributing to excess deaths – the delays in emergency treatment.

The action of staff in different parts of the service was originally over a pay dispute. But it has given them a platform to discuss and explain the patient safety issues which are daily occurrences. One of the greatest ironies of the paramedic dispute is that the safety measures staff have negotiated have actually made it easier for the service to prioritise life-threatening cases during strike days compared with non-strike days.