Changes to death certificates should make things easier for bereaved

It is hoped the new system will provide a better quality of service to the bereaved. Picture: Getty
It is hoped the new system will provide a better quality of service to the bereaved. Picture: Getty
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Move will remove need for other paperwork, writes Paul Cuthell

Across Scotland, a series of roadshows run by the National Association of Funeral Directors and the Scottish Government have been taking place to set out the new death certification process coming into operation on 13 May.

An independent system is being introduced to check the accuracy of a deceased’s Medical Certificate of Cause of Death (MCCD), with the aim of improving the quality of reporting.

The new system, operated by Health Improvement Scotland, aims to improve the quality and accuracy of MCCDs, provide improved public health information about causes of death in Scotland, and ensure that the processes around death certification are robust and have appropriate safeguards in place. It aims to improve communication and information sharing with medical authorities, and will introduce a more consistent level of scrutiny of death certificates regardless of whether the deceased is being buried or cremated. It also ends the requirement for additional crematorium paperwork along with the associated £164 fees families pay to a doctor for completing medical certificates.

From a funeral director’s perspective, the new system allows directors to bring the deceased into their care as soon as the MCCD is issued, and not wait for cremation forms as currently happens. This brings comfort to bereaved families and a smoother transition into the funeral process.

Changes to the death certification and registration process across the UK were proposed as current legislation had not been reviewed for a considerable number of years, and come in the wake of the Harold Shipman scandal. The GP in Hyde, Manchester, was able to murder his elderly patients and cover his tracks by signing their death certificates and falsifying medical records.

While changes to the system have been slow to be addressed in England and Wales, the Scottish Government were quicker in taking action and asked its burial and review committee to look at all issues surrounding death certification for both burials and cremations.

Of the 33 recommendations from the committee, ministers decided to prioritise those on death certification and proposed fresh legislation.

The new regulations apply to only a proportion of the 75 per cent of the 55,000 deaths annually in Scotland which do not require a procurator-fiscal investigation. No cremation or burial can take place without the MCCD being submitted to the registrar, the death being registered and the certificate of registration of death being issued.

To educate and inform relevant parties, the NAFD and Scottish Government have been running a joint awareness campaign, with roadshows across the country. Speakers have included Dr George Fernie, the senior medical reviewer and Sarah Manson, the government project lead on the issue, as well as the NAFD’s Graeme Brown, who has been leading on death certification for the association.

They will finish on 3 June with a presentation to the Scottish Parliament.

The events have drawn audiences including funeral directors, registrars, GPs, mortuary technicians and representatives from the Church, and speakers have included members of the NAFD, the Scottish Government and Healthcare Improvement Scotland, which will be responsible for monitoring and reviewing death certificates. A local registrar has also given a presentation at each venue.

The drop-in sessions have proved very popular and productive, while the responses we have had to the changes in legislation have been varied and widespread, and have been fascinating to hear.

Having been influential within the recent Infant Cremation Commission in providing the industry’s position on a range of important factors around the issue, the NAFD is delighted to be working so closely again with senior decision-makers to help ensure the voice of our members and the wider profession is heard.

Under the new system, a senior medical reviewer will undertake checks on a random number of MCCDs each year. Around 10 per cent of applicable deaths – about 4,000 – will be subjected to a Level 1 check, which involves a medical reviewer assessing the MCCD and speaking to the certifying doctor before authorising the completion of death registration.

A further 2,000 deaths will be subjected to a Level 2 check, which is more comprehensive and also involves the medical reviewer scrutinising medical records and speaking to other relevant people.

Additionally, for up to three years, relatives or others can request an Interested Person’s Review to check the accuracy of the information on the MCCD. All work will be overseen by a national advisory group.

It is hoped the new system, which has been in the offing for a number of years, will provide a better quality of service to and care of the bereaved and wider public through improved and enhanced recording, accuracy and use of cause of death information.

The changes to the system will no doubt be being watched very closely in Westminster, where the government has shown little appetite to consider funding it (as the Scottish Government is here), or even address it, quite possibly because it wants to use Scotland as a testing ground before making up its mind on the best way forward.

Paul Cuthell is president of the National Association of Funeral Directors