1. Improving the Process of Death Certification Local Registration Services Association Conference 11 May 2010, Hilton Deansgate Hotel, Manchester Simon Bennett, Head of NHS Clinical Governance

2. Improving the Process of Death Certification 2 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 not subject to investigation by the 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

3. Improving the Process of Death Certification 3 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.The Medical Examiner’s Authorisation will be transmitted to the Bereavement Office / GP Practice, Registrar, Funeral Director and Disposal Authority.

4. Improving the Process of Death Certification 4 Impact of Proposed Changes Bereaved Families Simpler process. Increased transparency: confirmed cause of death explained and easier to raise concerns. Improved quality of certification. Doctors Access to Medical Examiner to discuss medical cause of death. Improved quality of certification. Less paperwork through removal of Cremation Forms. Funeral Directors Less time / work involved in arranging completion of forms. Notification of confirmed cause of death helps meet health and hygiene requirements. Coroners Fewer investigations / post-mortems where deaths are unnecessarily reported by doctors. Medical advice available from Medical Examiner. Registrars Less paperwork. Easier to proactively monitor and manage workload. No requirement to understand / interpret medical information on MCCD.

5. Improving the Process of Death Certification 5 Issues and Challenges Preventing delays to funerals Arrangements for appointing and employing Medical Examiners - including their relationship to PCTs and coroners Collaboration with the Ministry of Justice to co-ordinate death certification/Coroner reforms

6. Improving the Process of Death Certification 6 Response to Issues and Challenges Preventing delays to funerals Responding by: making provision for the deceased to be buried or cremated before the death is registered maximising the flexibility of the Medical Examiner service through the use of part-time appointments testing different models of service provision - including an ‘Emergency Medical Examiner Service’ training Medical Examiners to understand the needs of different faith communities

7. Improving the Process of Death Certification 7 Continued.. Arrangements for appointing and employing Medical Examiners - including their relationship to PCTs and coroners Responding by: statute creating the role of Medical Examiner requiring functions to be performed independently of PCTs having national/local statutory protocols PCTs involving the coroner in their local arrangements for appointing Medical Examiners Medical Examiners providing general medical advice to the coroner

8. Improving the Process of Death Certification 8 Continued.. Collaboration with the Ministry of Justice to co-ordinate death certification/Coroner reforms Responding by: joint DH/MoJ legislation - Coroners and Justice Act 2009 important roles for National Medical Examiner and Medical Advisor to the Chief Coroner co-ordinating development/implementation plans

9. Improving the Process of Death Certification 9 Overview of Proposed Process This is a high-level process map and is work in progress. It does not cover still births or out-of-country deaths or disposals

10. Improving the Process of Death Certification 10 Overview of Pilots 1. Sheffield (Started March 2008) Initial work as Pathfinder Pilot has provided positive results. A & E Consultant is lead pilot medical examiner. Early scrutiny on ~50 deaths per week at Northern General without any undue delay. Planning work underway with NHS Sheffield to extend pilot to deaths in the community from Jun’10. 2. Gloucestershire (Started February 2009) Pilot focusing on deaths certified by GPs at 6 Practices. Existing pre-scrutiny advice for deaths in hospital being reviewed to assess feasibility of providing advice after scrutiny. Pathology-based pilot medical examiners. Planning work underway to extend pilot (from Jun’10) to evaluate provision of ME-2 to registrar and request for informant to provide a signature confirming discussion of cause of death. 3. Powys (Started June 2009) Pilot focusing on issues in rural / sparsely populated areas. Currently covers deaths in 5 community hospitals and deaths elsewhere that are certified by a limited number of GP Practices. GP-based pilot medical examiners. 4. Essex (Starting January 2010) Confirmatory scrutiny for deaths in Broomfield hospital (from Mar’10) and the deaths in the community around Chelmsford (from Jun’10). 5. Faith Communities (National Pilot – Started July 2009) Work underway to re-engage with leaders of main faith communities and ensure that their concerns are being addressed. Particular focus on the provision of ‘fast-track’ and out-of-hours services.

11. Improving the Process of Death Certification 11 Timetable

12. Improving the Process of Death Certification 12 Contact Details & Further Information DH Programme Manager: Simon Bennett (Head of Clinical Governance - Clinical Quality & Strategy) DH Programme Leads: Ruth Benjamin (Stakeholder Communications & Programme Office) Paul Ader (Process Design & Piloting) Dr Cleo Rooney (Scrutiny, Clinical Governance & Training) Website:www.dh.gov.uk/deathcertification Email: DeathCertification@dh.gsi.gov.uk Phone: 0113 254 5813