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
Focus
The living / ill
patient
Place of Death
• Mixed quality of bereavement
information available.
• No standardised specific
training on EOL / bereavement
/ individual requirements.
• Little formal training on death
certification.
Focus
Issuing documentation
MCCD / Cremation paper
return belongings
HMC
Death
Certification
• General Office /
Medical Records
Officer ‘add on’ to day
job.
• Little formal customer
care.
• No formal training /
pick up on job.
• Death seen as failure.
•Bereavement care seen as
someone else’s responsibility.
Focus
Ascertaining cause of
death: natural, unnatural
• Large responsibility:
hospital funerals,
patient finances,
valuables, legal aspect.
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
Register Office
Funeral
Directors
Bereavement
Support
• Seen as paternalistic.
• Legal requirements.
• Critical.
• Document focussed.
• Authoritarian.
• ‘Something must have
gone wrong’.
• Drop in Service
• Variation in service
provided.
• Disposal of deceased
remains
• Not easily accessible.
• Not readily available.
• Not known about.
• Not always appropriate
National Working Alliance for Bereavement
Stakeholder
Organisations
Education & Training
Co-ordination
SHA / Cluster
Representative
Common Goal / Vision
Jr Doctor Training
with Medical
Examiner
Project
Director
With care and compassion
delivering a high quality service to
bereaved people
Bereaved Relative
(Lay
Representative)
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