1. Improving the Process of Death Certification in England and Wales LRSA - Year Ahead 2011 Conference: 11 May 2011 Simon Bennett, Head of NHS Clinical Governance

2. Improving the Process of Death Certification 2 Overview Objectives and Proposed Changes Coroners and Justice Act 2009 The Coalition Government Medical Examiner Training and Recruitment Piloting Next Steps

3. Improving the Process of Death Certification 3 Objectives To develop and put into practice a new system of death certification in England and Wales that will: improve the quality and accuracy of death certification; introduce a single system of effective medical scrutiny applicable to all deaths that are do not require investigation by a coroner (regardless of form of disposal); increase transparency for bereaved families; provide improved information on cause of death to strengthen local clinical governance and public health surveillance.

4. Improving the Process of Death Certification 4 Summary of Proposed Changes 1.Appointment of Medical Examiners who will scrutinise and confirm the cause of all deaths that are not investigated by the Coroner. 2.Medical Examiner’s Officers will talk with next of kin and others to prepare for scrutiny and, after scrutiny, to advise the confirmed cause of death. 3.Where there is no Attending Doctor the Medical Examiner will scrutinise the death and prepare the MCCD. 4.A single Medical Examiner’s Authorisation will replace the current cremation forms and will apply to burials as well as cremations. 5.Medical Examiners will provide general medical advice to Coroners and their officers and support the training of junior doctors on death certification.

5. Improving the Process of Death Certification 5 Coroners and Justice Act 2009 The Coroners and Justice Bill received Royal Assent in November 2009. Responsibility for death certification transferred to Department of Health Medical examiners to be appointed by Primary Care Trusts in England/Local Health Boards in Wales. A National Medical Examiner to be appointed by the Department of Health to provide clinical leadership.

6. Improving the Process of Death Certification 6 The Coalition Government Support the objectives of reforming the process of death certification and the high level timetable for implementation. Health and Social Care Bill transfers responsibility for appointing Medical Examiners to local authorities. Appointment of National Medical Examiner subject to agreement by the Secretary of State (and possibly Chief Secretary) - in line with all other DH appointments. Opportunity presented by the creation of new Public Health Service [from April 2012] to improve surveillance capacity.

7. Improving the Process of Death Certification 7 Medical Examiner Training and Recruitment The Royal College of Pathologists lead College for Medical Examiners. A detailed training curriculum has been developed. Training to be delivered through a ‘blended approach’ with e-learning supported by face-to-face training. Standard job description and person specification developed. Similar arrangements to be put in place for Medical Examiner’s Officers.

8. Improving the Process of Death Certification 8 Pilot Communities in England and Wales Brighton & Hove Leicester Short term pilot focusing on urgent / out-of-hours scrutiny Inner North London Short term pilot focusing on urgent / out-of-hours scrutiny

9. Improving the Process of Death Certification 9 Key Lessons from the Pilots (to-date) 1.Ward staff, bereavement services and GP practice staff have been able to retain MCCDs until they have been scrutinised and confirmed by a medical examiner. 2.Medical examiners can usually scrutinise a deceased person’s records in 15 – 45 minutes. 3.Workload and availability of doctors to talk with the medical examiner (where required) means that the elapsed time for the scrutiny process is often 6 – 12 working hours. 4.Where there is a need for urgent release / disposal, the scrutiny process can be completed more quickly. 5.The new process works best if doctors ask for advice before they certify the death.

10. Improving the Process of Death Certification 10 Key Lessons from the Pilots (to-date) 6.Doctors are providing positive feedback about the value of the advice & scrutiny. 7.Number of coroner’s post-mortems are not decreasing – however type of post-mortem may be changing.

11. Improving the Process of Death Certification 11 Next Steps Complete development of all e-learning training materials (July 2011 - available to partners from October 2011). Public consultation on regulations (July - October 2011). Appointment of National Medical Examiner - subject to Ministerial approval (April 2012). Regulations laid before Parliament (Spring 2012?). Implementation of reformed process (April 2013).

12. Improving the Process of Death Certification 12 Contact Details & Further Information England DH Programme Leads: Meena Paterson (Legislation) Ruth Benjamin (Stakeholder Communications & Programme Office) Paul Ader (Process Design & Piloting) Website:www.dh.gov.uk/deathcertification Email: DeathCertification@dh.gsi.gov.uk Phone: 0113 254 5813

13. Improving the Process of Death Certification 13 Contact Details & Further Information Wales Welsh Assembly Government Health and Social Care Directorate General: Eleanor Sanders(Implementation Lead) Email: Eleanor.Sanders@wales.gsi.gov.ukEleanor.Sanders@wales.gsi.gov.uk Phone: 029 2082 5182

14. Improving the Process of Death Certification 14 Any Questions?