Information relating to death by starvation is National Health Service hospitals is not held centrally.

There is no statutory definition of “starvation” in the Health and Social Care Act 2008, or subordinate legislation.

NHS Digital has provided a count of finished admission episodes¹ (FAE) where primary diagnosis² was malnutrition³, by 10 year age bands for the years 2014-15 to 2017-18⁴. This information is provided in the following table.

Source: Hospital Episode Statistics (HES), NHS Digital

Notes:

¹FAE is the first period of admitted patient care under one consultant within one healthcare provider. FAEs are counted against the year or month in which the admission episode finishes. Admissions do not represent the number of patients, as a person may have more than one admission within the period.

²The primary diagnosis is the first of up to 20 diagnosis fields in the HES data set and provides the main reason why the patient was admitted to hospital.

³ICD-10 codes used to define malnutrition are:

E40 Kwashiorkor

E41 Nutritional marasmus

E42 Marasmic kwashiorkor

E43 Unspecified severe protein-energy malnutrition

E44 Protein-energy malnutrition of moderate and mild degree

E45 Retarded development following protein-energy malnutrition

E46 Unspecified protein-energy malnutrition

O25 Malnutrition in pregnancy

⁴HES figures are available from 1989-90 onwards. Changes to the figures over time need to be interpreted in the context of improvements in data quality and coverage (particularly in earlier years), improvements in coverage of independent sector activity (particularly from 2006-07) and changes in NHS practice. For example, apparent reductions in activity may be due to a number of procedures which may now be undertaken in outpatient settings and so no longer include in admitted patient HES data. Conversely, apparent increases in activity may be due to improved recording of diagnosis or procedure information.

NHS Digital has provided a count of finished discharge episodes¹ for in-hospital deaths² where the cause of death³ was malnutrition⁴, split by independent and National Health Service providers for the years 2008-09 to 2017-18⁵. This information is provided in the following table.

Source: Hospital Episode Statistics (HES) data linked to Office for National Statistics (ONS) death registrations data

Notes:

¹A finished discharge episode is the last episode during a hospital stay (a spell), where the patient is discharged from the hospital or transferred to another hospital. Discharges do not represent the number of patients, as a person may have more than one discharge from hospital within the period.

²HES records the circumstances under which a patient left hospital. For the majority of patients this is when they are discharged by the consultant and it is only recorded for the last episode in a spell.

³Cause of death has been obtained through linkage to ONS data. These data do not provide enough information to link the deaths to poor care. It is not possible to determine from these figures how or where the condition originated. There are many explanations as to why someone becomes malnourished: for example they may have cancer of the digestive tract, which means they can not eat properly or can not absorb nutrients; they may have suffered from a stroke or have advanced dementia which can cause difficulties chewing and swallowing; or they may abuse alcohol and so not eat properly. The deceased may have been malnourished before they went into hospital (for any of the reasons mentioned previously), and perhaps only have been in hospital a very short time and the malnutrition may have nothing to do with not being fed properly in hospital. Also, in the majority of deaths in hospitals from falls, it is likely the fall occurred elsewhere, not in the hospital. It is possible that poor care may have been a factor in some of the deaths, but ONS data does not provide enough evidence to draw this conclusion.

⁴ICD-10 Codes used to define malnutrition are:

E40 Kwashiorkor

E41 Nutritional marasmus

E42 Marasmic kwashiorkor

E43 Unspecified severe protein-energy malnutrition

E44 Protein-energy malnutrition of moderate and mild degree

E45 Retarded development following protein-energy malnutrition

E46 Unspecified protein-energy malnutrition

⁵HES figures are available from 1989-90 onwards. Changes to the figures over time need to be interpreted in the context of improvements in data quality and coverage (particularly in earlier years), improvements in coverage of independent sector activity (particularly from 2006-07) and changes in NHS practice. For example, apparent reductions in activity may be due to a number of procedures which may now be undertaken in outpatient settings and so no longer include in admitted patient HES data. Conversely, apparent increases in activity may be due to improved recording of diagnosis or procedure information.

It should be noted that HES include activity ending in the year in question and run from April to March, e.g. 2012-13 includes activity ending between 1 April 2012 and 31 March 2013.

Disclosure Control

In order to protect patient confidentiality '*' appears in the table above for all sub-national breakdowns, where it is possible to calculate a value between 1 and 7 from the data presented. All other sub-national data has been rounded to the nearest 5.

If the national total is between 1 and 7 (inclusive), no sub-national breakdown will be displayed.

If the national total is greater than or equal to 8;

a. Sub-national counts between 1 and 7 (inclusive) will be displayed as ’*’.

b. Zeroes will be unchanged.

c. All other counts will be rounded to the nearest 5.