The Birmingham Bereavement Project Dr Dawn Chaplin Project Director

Background to Project (What we aimed to do) 2 year joint funded project UHB/ HEFT /SHA Aim: to develop and test a model of bereavement care across a range of services to provide an integrated and seamless service for bereaved people

The end of life and Bereavement journey

Baseline Activity – ‘Task’ Focussed why we aimed to do it Place of Death Death Certification HMC Register Office Funeral Directors Bereavement Support Focus The living / ill patient Focus Issuing documentation MCCD / Cremation paper return belongings Focus Ascertaining cause of death: natural, unnatural Focus Formal registration of death and issuing application documentation for disposal Focus Arrangement and disposal of deceased person by burial / cremation Focus Support for bereaved person Mixed quality of bereavement information available. No standardised specific training on EOL / bereavement / individual requirements. Little formal training on death certification. Death seen as failure. Bereavement care seen as someone else’s responsibility. General Office / Medical Records Officer ‘add on’ to day job. Little formal customer care. No formal training / pick up on job. Large responsibility: hospital funerals, patient finances, valuables, legal aspect. Seen as paternalistic. Critical. Authoritarian. ‘Something must have gone wrong’. Legal requirements. Document focussed. Drop in Service Variation in service provided. Disposal of deceased remains Not easily accessible. Not readily available. Not known about. Not always appropriate

Conferences Workshops Symposia Partnership Working Research to provide evidence based practice Policies, procedures, standards, legislation Early & Appropriate Intervention Bereavement Support Feedback Centralised Bereavement Care Services Education & Training Effective Communication Consistent & Appropriate Information Co-ordination Compassion Consistency Co-operation Care Faith Advocacy Group HEFT UHB SHA HEFT UHB SHA Voluntary Bereavement Organisations Military Project Military Project Stakeholder Organisations Stakeholder Organisations Education & Training National Working Alliance for Bereavement Written Information Written Information Verbal Information Signposting & Handing Over Bereavement Website & Helpline Downloadable Digital App AR Code Downloadable Digital App AR Code Bereaveme nt Follow Up Service Early Adopter Programme Medical Examiner & Officers Steering Group End Of Life & Bereavement Bands 1-4, 5, 7, 8 Jr Doctor Training with Medical Examiner Virtual World Training Gold Standard Framework Appropriate Environment GHH Bereavement Suite Nurse Led Bereavement Level 4 Service Risk Identification Risk Identification Bereavement Questionnaires Bereavement Questionnaires Complaints Compliments Complaints Compliments Faith Advocacy Groups Voluntary Bereavement Support Organisations Community Support Groups Early Intervention following Complaints Rapid Response Support Team (TRIM) Bereavement Follow Up Service Rapid Referral (Staff & Relatives) CRUSE Bereavement Care Bereavement Care Policy Early Adopter Early Adopter Key Performance Indicators Route to Success When A Person Dies Death Certification Review Personal Care After Death NICE Quality Markers End of Life Care Strategy Bereavement & It’s Impact on the Immune System Development of Bereavement Services in Acute NHS UK Bereavement Research Forum Early Adopter for Improving Death Certification Bereavement in the Abrahamic Faiths Research into Funeral Payment Scheme National Institute for Health Research MEO / ME Function HM Coroner and Coroner Officer Representative SHA / Cluster Representative Faith Advocacy Group Representative Equality & Diversity Representative R&D Lead Bereavement Support Organisation End of Life & Palliative Care Representative Bereavement Lead for Trusts Cemetery & Crematorium Representative (Council) Funeral Director Bereaved Relative (Lay Representative) Clinical Governance Risk Representative Education and Training Lead (Link to Academic Institution) Common Goal / Vision With care and compassion delivering a high quality service to bereaved people Project Director

Pilots and work streams – Outcomes Bereavement care and support (carers and staff) Follow up service Fast track support Community support involvement Military project (Teresa Griffiths) MEO service Training and Education Multi disciplinary/ Multi professional/ Medical Examiner role/

Pilots and work streams – Outcomes New technologies Website and help line Digital Birmingham ‘app’ and QR code virtual training (Maggie and Soulla) Working in Partnership Faith Advocacy Group Local hospice (Nikki and Jo) Cruse and other support agencies Early Adopter working group Child Sudden Death Conference

Pilots and work streams – Outcomes Research and Development Effects of bereavement on immunity; Early Adopter; Development of acute bereavement services in the UK; Research into funeral payment ….and many more opportunities Check list for all service providers Exec summary of the project will be available

Benefits For Bereaved people Better care for dying deceased person and the carers Improved communication with, and feedback from, bereaved carers. People feel ‘listened’ to and their comments acted upon Integrated systems providing the right support at the right time by the right people

Benefits For Service providers Access to appropriate training and education Closer working relationships and two way channels of communication Understanding the significance of each role and associated responsibility along the journey A multi professional forum for bereavement service representatives to inform, support and share good practice

Benefits For organisations Appropriately trained and supported staff Key performance indicators demonstrating that high quality care is being delivered Streamlining existing resources to provide high quality, cost effective, person focussed bereavement care services A model that demonstrates how a seamless system can be implemented and sustained

Next steps Advisory group – with exec level leadership Key is sustainability - Early Adopter Close working relationships will continue National Working Alliance for Bereavement

Coming together is a beginning, keeping together is progress, working together is success Henry Ford

Improving the Process of Death Certification Ruth O’Leary Lead Nurse Bereavement Services

Background Process unchanged since 1935 Shipman Enquiry (2003) Existing arrangements were confusing Inadequate safeguards Government Response – ‘Learning from tragedy, keeping patients safe’ (2007) Consultation on Improving the Process of Death Certification Coroners and Justice Act 2009

Current System Different processes for cremation and burial Coroners Officers / Bereavement Officers provide advice to doctors re cause of death Patients examined for cremation No medical examination for burials Medical Certificates – variable quality of completion Causes of death sometimes imprecise Coroners may not be notified about the right deaths

Reasons For Change Create single unified system To strengthen current arrangements Improve Quality & Accuracy of Causes of Death Provide equity of service – Cremation / Burial Increase communication with bereaved National implementation 2014

Process As part of the Birmingham Bereavement Project Commenced April 2012 UHBFT/HEFT both have centralised Bereavement Service Pilot - ALL deaths Cremation forms still required, legal requirement Introduction of Medical Examiner role – senior doctors Introduction of Medical Examiner’s Officer – Bereavement Officers Training and Education

Medical Examiners (ME) Scrutinises the notes to find Cause of Death Speaks to referring team and check consistency with notes Agrees Cause of Death – referring team completes Medical Certificate (inc Cremation Forms) ME completes forms for Register Office and medical notes Views the patient Ensures Cause of Death is sufficiently precise Authority to challenge doctors / refer to Coroner if appropriate Straight forward Coroners referrals are outside of this process

Medical Examiner’s Officers (MEO) Bereavement Care Officers at UHBFT / HEFT Speak to relatives and co-ordinate process of Death Certification Once determined, will provide relative with Cause of Death Arrange collection of Medical Certificate by appointment

Benefits For Relatives Simpler process Open and honest conversation regarding Cause of Death Easier to Raise Concerns Confirmed Cause of Death Transparency and Understanding of Cause of Death More Engagement with the Family by Medical Examiners Officers Improved Quality of Certification

Findings To Date Beginning of the journey Need to have robust rota of Medical Examiners Cremation Form payments are now used within the new process Relatives value knowing and being able to discuss the Cause of Death No delays in families receiving Medical Certificates Out of hours