More than 2000 deaths were attributed to the August 2003 heat wave in England and Wales. We analysed excess mortality in southern England during the heat wave by place of death. Excess mortality was 33 per cent in those aged 75 and over and 13.5 per cent in the under 75 age group during the 10 day heat wave. Among those aged 75 and over, deaths at home increased by 33 per cent and deaths in nursing homes increased by 42 per cent. Around one quarter of the heat wave attributable deaths occurred in care homes, but this is likely to be an underestimate as some residents may have been admitted to hospital before death. There is a need for further research to assess the risk of heat-related mortality in hospital in-patients and the residents of care homes in order to improve prevention strategies.