DEATH CERTIFICATION NATIONAL ADVISORY GROUP – MEETING 15
17 March 2015, 10.00 am – 1:00 pm – St Andrews House, Regent Road,
Edinburgh
In Attendance
Members/ Deputies
Dr Iain Wallace
Salah Beltagui
Ephraim Borowski
James Blackburn
Rod Burns
Jane Byrne
Sarah Dillon
Rick Powell
Prof Stewart Fleming
John Birrell
Donald Henderson
Medical Director, NHS Lanarkshire (Chair)
Muslim Council Scotland (MCS)
Scottish Council of Jewish Communities (SCoJC)
National Association of Funeral Directors (NAFD)
National Records of Scotland (NRS)
Healthcare Improvement Scotland (HIS)
Death Certification Implementation Team (DCIT)
(Secretariat), Scottish Government
Association of Registrars of Scotland (AROS)
Shadow Senior Medical Reviewer (HIS)
Death Certification Implementation Team (DCIT) Scottish
Government
Healthcare Improvement Scotland (HIS)
Senior Medical Officer, Scottish Government
BMA Scotland
Institute of Cemetery and Crematorium Management
(ICCM)
Federation of Burial and Cremation Authorities (FBCA)
Scottish Academy
Scottish Bereavement Hub
Deputy Director, Scottish Government
Apologies
Matthew Armstrong
Jim Clark
Dr Barry Parker
Dr Jean Turner
Dr Janice Turner
Prof Hazel Scott
Dan Wynn
Tracey Gillies
NHS Scotland Information Services Division
National Records of Scotland (NRS)
Medical and Dental Defence Union of Scotland (MDDUS)
Scotland Patients Association
NHS Education for Scotland
NHS Education for Scotland (NES)
General Medical Council
Scottish Association of Medical Directors
Cathy Dunlop
Dr George Fernie
Sarah Manson
Caroline McGeachie
Dr Mini Mishra
Dr Charles Saunders
Bill Stanley
Gareth Brown
David Best
Graeme Brown
David Crawford
Carol Lawrence
Head of Health Protection, Scottish
Government– Deputy Chair
Department of Health, Social Services & Public Safety
Northern Ireland
National Association of Funeral Directors (NAFD)
Crown Office and Procurator Fiscal Service (COPFS)
National Services Scotland (NSS) IT
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Item 1: Welcome, Minutes of the last meeting and Matters Arising
1. The Chair extended a welcome to all, in particular Donald Henderson Deputy
Director for Public Health in Scottish Government and James Blackburn,
deputising for Graeme Brown. Apologies were noted by the group.
2. Following minor changes the group approved the minutes from the previous
meeting for publication.
Item 2 : Updates from UK Administrations
Northern Ireland, England and Wales
3. The group noted the updates contained in paper 1. Sarah Manson confirmed that
a letter on cross border arrangements has been issued to the other
administrations. She added that SG would continue to work with the Funeral
Industry Subgroup to refine practicalities for inclusion in Industry guidance.
Item 3 : Health improvement Scotland
4. Sarah Manson noted that from an IT perspective the position was much more
positive than the last meeting. She confirmed that UAT 2 had been signed off
however functionality between HIS and NRS is not complete though resolutions
are in place and will hopefully resolve this. Carol confirmed that there were no
barriers to implementing the paper based MCCD process for 13 May 2015.
5. Jane Byrne updated that the MR training week ran last week and an additional 5
prospective MRs were to be interviewed at the end of the month. The majority of
medical reviewer’s assistants have now been recruited and will take up post on 1
April 2015. HIS will undertake a further recruitment exercise to fill any remaining
posts. Dr Mishra asked whether the recruitment and selection process for MRA’s
had raised any gender equality issues. HIS confirmed that all the successful
candidates competent for interview were female on this occasion. Caroline
McGeachie confirmed that the whole death certification review team will meet on
21 April.
6. Jane Byrne confirmed that HIS have developed a standard operating procedure
for the manual process, in the event of IT failure.
7. Caroline McGeachie noted that the outcomes chain work plan is in development.
8. On communications Jane Byrne noted that HIS were in the process of finalising
the Interested Persons and Deaths Abroad leaflets and were keen to ensure that
they mirrored the design developed by the SG. The HIS briefing noted had
received 600 hits to date. It was also confirmed that questions on deaths abroad
will be added to the Q & A document before 13 May 2015.
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9. Caroline McGeachie confirmed that the procurement tender for a post mortem
service will issue on Friday 20 March 2015. 5 providers have been asked if they
wish to submit a bid.
10. George Fernie confirmed that there continues to be good communication with the
LIGs. Dr Mishra added that it would be helpful for LIGs to outline that getting the
MCCD immediately after death is not always possible and develop clear
communication processes in each Board area for explaining this to the bereaved.
11. George Fernie noted that during a recent meeting with Imams in Glasgow the
CMO position was reiterated and it was clearly explained that this was the best
way to obtain quality public health information.
12. It was highlighted that in secondary care it may be possible for a member of the
team to complete the certificate which would minimise any unnecessary delay.
However it was highlighted that in primary care, weekends and bank holidays
could cause delays of up to 5 days before the MCCD could be issued. It was
agreed that this would cause an unacceptable delay for the bereaved from
faith communities who require a burial as quickly as possible in order to
allow the grieving process to begin.
13. The group discussed the issue of the provision of MCCDs in out of hours
(weekends and public holidays). It was agreed that a short life working group
should be formed to identify a solution as a matter of urgency – Action
14. Cathy Dunlop highlighted the issue of durations routinely being left blank or
incorrectly completed. Mini Mishra confirmed that durations would be required
wherever possible to assist accurate coding within NRS. Regarding small
amendments, such as common abbreviations, it was agreed that registrars could
make the change based on a discussion with the doctor or a member of the team
with the confirmation email received after registration has completed.
15. Jane Byrne noted that RCGP had requested a one page on what the changes
mean for doctors and highlighted concerns raised that some Doctors may not use
the existing Q and A document to find what was relevant to them. George Fernie
noted that local areas may develop their own document as a need had been
identified. Sarah Manson highlighted that the request came from a point of no
information and that better sign posting may be required. Sarah Manson agreed
to discuss with Rob McPhail, HIS Communications officer outside the meeting.
Item 4: National Records Scotland
16. Rod Burns stated his agreement with the earlier assessment of the progress
made with IT. He acknowledged that there are a number of oustanding issues to
be resolved.
17. Rod Burns confirmed that forms 6, 8 and 14 were finalised and acknowledged
some issues in ensuring that the form 6 was WHO compliant. It is anticipated that
the forms will be laid on 23 March and in to force on 13 May. It was understood
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by the group that printing would begin prior to the conclusion of the parliamentary
process.
18. Rod Burns announced that NRS resource had been made available and work
has begun on the scoping , testing and development for digital signature pads.
Testing has already begun with the Local Authorities who have pads in place. In
addition 2 – 3 authorities have carried out testing and achieved functionality.
Notwithstanding local configuration issues the group were provided with
assurance that the pads would be in place for 13 May.
19. Rod Burns provided the group with reassurance that the majority of local
authorities have now carried out assessments on the anticipated need for out of
hours services. He confirmed that the majority consider what they have in place
to be adequate and will monitor regularly. A letter from NRS and SG will be
issued requesting that all authorities requesting a regular review of the out of
service and requests made to it – Action
20. Rod Burns confirmed that 21 of 32 local authorities have supplied invoices for
the IT equipment purchased.
21. Rod Burns informed the group that registrar training was on going and positive
with secondees expected to assist with the development of the guidance. This
was acknowledged as an on-going action. He added that planning for the
manual process was underway.
22. Rod Burns acknowledged that the NRS Business Continuity Plan remains
outstanding but will be available soon.
23. Dr Mishra noted that it would be helpful to have sight of registrar guidance as
soon as possible in order to ensure that it is aligned with CMO and Funeral
Industry Guidance. Rod Burns indicated that a first draft of guidance will be
available week commencing 23 March.
24. Dr Mishra highlighted the issue with the spelling of still birth on NRS forms. Rod
Burns agreed to check this with lawyers to see if it could be changed.
25. Rod Burns agreed to check with Jim Clark whether the randomisation function
has been included in end to end testing. He also confirmed that plans to test on
19 April were still on track.
26. Rod Burns stated that a paper will be drafted outlining the process for the printing
and distribution arrangements for the manual process, which will be shared with
SG.
27. Sarah Manson sought clarity that registrars guidance included information for
registrars on amendments required out with the review service. Rod Burns
agreed to check and confirm.
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Item 5: NHS Education for Scotland (NES)
28. The Chair noted apologies from NES and highlighted the importance of their
attendance at the next meeting.
29. Charles Saunders noted that training for non-trainees had not yet been received.
He also suggested that doctors in secondary care would not access the video
resulting in a risk of doctors supervising juniors having little information on the
changes. Dr Mishra confirmed that there would be a transcript of the video as
well as a summary sheet available. She added that this could be made available
as soon as possible. The Chair added that whilst people can’t be forced to read
the summary there is an expectation around professional responsibility.
30. Following a query from John Birrell it was confirmed that the local implementation
groups would continue to run after 13 May 2015 though they may need to adapt
to include other aspects of bereavement.
Item 6: Funeral Industry Subgroup and Item 7: Scottish Government Update
and Communications
31. Sarah Manson noted that the Funeral Industry Subgroup have had productive
discussions around cross border issues and a number of examples have been
produced for the industry guidance. This will be circulated to the NAG for
information when ready.
32. It was noted that the final 3 NAFD roadshows had been held, from these events
the subgroup will develop a set of Q & A which will be available on the NAFD
website. Sarah Manson also highlighted a very positive event held with a number
of Imams and funeral facilitators in Glasgow arranged by NHS GG&C local
implementation group. She added that Funeral Industry Subgroup member
Khurram Mustaffa had also been doing a lot of engagement with other mosques
to raise awareness of the new system.
33. John Birrell highlighted engagement with the legal profession, Sarah Manson
noted she had contacted the law society but not received a response. John Birrell
agreed to provide contacts. - Action
34. Sarah Manson confirmed that on the legislative side the remaining SSIs are
scheduled to be laid on 23 March and will be in place for go live on 13 May 2015.
Statutory guidance is currently being developed to support the legislation.
35. Sarah Manson thanked the group for their comments on the information leaflets,
with the design for these being finalised. She confirmed that the public
information leaflet , will be provided to the bereaved along with a copy of ‘when
someone has died’ and would be available to Boards in mid April. Existing
distribution channels would be used for this.
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Procurator Fiscal E1 Form
36. Sarah Manson made the group aware of proposals made by the Crown office to
change the arrangements from the current E1 authorisation to cremate form to an
opt in system. The group discussed the proposal highlighting a number of areas
of concern. Sarah Manson agreed to feedback the groups significant
reservations to David Crawford.
AOB
37. Ephraim Borowski raised concerns regarding the robustness of out of hours
registrar services. A number of authorities confirmed they would provide a phone
number but there would be no guarantees that the number would always be
answered. He also noted that a small number of authorities were still to respond.
Rod Burns offered some assurance that Chief registrars had assumed
responsibility for the phones used in providing an out of service and added that
the provisions would be reviewed. Ephraim Borowski emphasised that demand
for out of hours services could not be based on the old process given that burial
prior to registering was not required.
38. Sarah Manson confirmed that outstanding responses will need to be chased and
noted that the term ‘emergency’ needs to be defined in order to ensure that it is in
line with the requirements around advance registration. She agreed that in some
areas there remains a concern with the understanding on how the new
arrangements will impact registrar services.
39. The group discussed the possible impact local authorities with limited out of
hours services will have on those better provided for. Rod Burns confirmed that
while, NRS would have a list of all out of hours contacts, there is not a national
service. Local authorities remain best placed to assess and address local needs.
The Chair added that it would be helpful if all local authorities could have their out
of hours numbers clearly displayed on their website.
Date of Next Meeting
8. The date of the next meeting is 14 April 2015.
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