DEATH CERTIFICATION NATIONAL ADVISORY GROUP – MEETING 10
3 July 2014, 13.00 pm – 16:00 pm - New Register House, West Register Street,
Edinburgh
In Attendance
Members/ Deputies
Dr Iain Wallace
Matthew Armstrong
Salah Beltagui
John Birrell
Gareth Brown
Nicola Livingston
Graeme Brown
Jim Clark
Jane Byrne
David Crawford
Sarah Dillon
Cathy Dunlop
Dr George Fernie
Dr Janice Kelly
Dr Mini Mishra
Caroline McGeachie
Dr Charles Saunders
Dr Jean Turner
David Best
Dr Martin Donnelly
Barry Parker
Medical Director, NHS Lanarkshire (Chair)
NHS Scotland Information Services Division
Muslim Council Scotland (MCS)
Scottish Bereavement Hub
Head of BODDS and Health Protection, Scottish
Government– Deputy Chair
Scottish Council of Jewish Communities (SCoJC)
National Association of Funeral Directors (NAFD)
National Records of Scotland (NRS)
Healthcare Improvement Scotland (HIS)
Crown Office and Procurator Fiscal Service (COPFS)
Death Certification Implementation Team (DCIT)
(Secretariat), Scottish Government
Association of Registrars of Scotland (AROS)
Shadow Senior Medical Reviewer (HIS)
NHS Education for Scotland
Senior Medical Officer, Scottish Government
Healthcare Improvement Scotland (HIS)
BMA Scotland
Scotland Patients Association
Department of Health, Social Services & Public Safety
Northern Ireland
Department of Health, Social Services & Public Safety Dr
Medical and Dental Defence Union of Scotland (MDDUS)
Northern Ireland
Apologies
Ephraim Borowski
Rod Burns
Tracey Gillies
Mark Evans
Brian Gegan
Alison Kerr
Rick Powell
Prof Hazel Scott
Bill Stanley
Dan Wynn
Prof Stewart Fleming
Scottish Council of Jewish Communities (SCoJC)
National Records of Scotland (NRS)
Scottish Association of Medical Directors
Bereavement Co-ordinator, NHS Fife
CRUSE Bereavement Care (Scotland)
Death Certification Implementation Team (DCIT), Scottish
Government
Federation of Burial and Cremation Authorities (FBCA)
NHS Education for Scotland (NES)
Institute of Cemetery and Crematorium Management
(ICCM)
General Medical Council
Scottish Academy
Item 1: Welcome, Minutes of the last meeting and Matters Arising
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1. The Chair extended a welcome to all and noted apologies, in particular, from
Ephraim Borowski for whom Nicola Livingston is deputising. The Chair noted that
Jan Warner had moved to a different post and thanked her (in her absence) for
leading the programme for HIS.
2. The minutes were agreed subject to a change to point 24 relating to a comment
from Cathy Dunlop.
3. All actions were noted as being complete or in progress.
4. Charles Saunders noted the use of switch board numbers for the Dr contacts
section of the Medical Certificate of Cause of Death (MCCD or Form 11). George
Fernie noted that the transition period will be a good opportunity to see how
difficult it is to contact the certifying doctor and noted that individuals with access
to notes such as nurses could also be contacted. However, this would be to
discuss the facts of the case and not to express an opinion.
Item 2 : Updates from UK Administrations
Northern Ireland, England and Wales
5. The group noted the updates provided by Northern Ireland, England and Wales.
Martin Donnelly noted that there would be a Scottish Government representative
on the Northern Ireland short life working group. It was noted that work in
Northern Ireland would not include private healthcare facilities as there are only
two, there will be a separate work strand to include these.
6. Gareth Brown noted cross border transfer and highlighted positive progress with
regard to Ministry of Justice (MOJ) updating their legislation. Bodies travelling
south will receive no additional scrutiny in Scotland and the MOJ will need to
consider whether they wish to introduce any arrangements to provide additional
scrutiny prior to disposal in England or Wales. The Scottish Government’s
position is that the process in place where the death occurs should be accepted
by other UK countries. Martin Donnelly confirmed that this was also the view of
Northern Ireland.
Action – An update on cross border issues will be provided by Scottish Government
at the next meeting.
Item 3 : Health improvement Scotland
7. Jane Byrne presented a joint stakeholder update from implementing bodies and
noted that the updated communications plan had addressed concerns held by
the stakeholder group. The key concern of the stakeholder group, following
appositive qualitative testing, is now related to the transfer of data between
systems.
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8. George Fernie noted an intention to test data transfer between SCI Gateway and
NRS in early August, and challenges are expected and will be dealt with by the
technical teams. It was also noted that the delivery of eCMS was on track.
9. Jane Byrne noted that the recruitment of MRs is planned for August and that a
number of potential candidates have remained on file from the initial recruitment
exercise.
10. George Fernie noted qualitative testing on 100 sequential cases from Edinburgh
and Glasgow was now complete, and in all cases it would have been possible to
asses if the case could be accepted for expedited review. GP practice clinical
records via the SCI Gateway would be required for very few cases.
11. It was suggested that if there was an inconsistency in the MCCD it could go to
the Procurator Fiscal (PF) to decide, however it was made clear that the PF’s
role is not to arbitrate between differing clinical opinions. Registrars can also
raise an issue with the PR as within the current system.
12. David Crawford noted that the new system doesn’t prevent the PFfrom becoming
involved, a reviewer could highlight an issue and encourage the certifying doctor
to report. If a family identified an issue this would fall within clinical governance
guidelines, and there are no time limits. In addition, families could raise
concerns with the GP practice/hospital/Health Board regarding the care of the
deceased.
13. John Birrell drew attention to the guidance in Shaping Bereavement Care and
that it was beneficial for the certifying doctor to discuss the MCCD with the family
and ensure that contact details are provided so if they have further questions
there is someone they can ask.
Item 4: National Records Scotland
14. Jim Clark noted that the MCCD completed the parliamentary process on 20 June
2014. Health Board Local Implementation leads have been asked to nominate a
contact point to receive the new forms. Responses have not yet been received
from Fife, Highland and Western Isles. New forms will be available in mid-July
2014 and sent on to Health Board contacts by the printers. NRS will send new
forms to the independent hospitals directly. Amendments to Form 14 (Certificate
of Registration of Death) will be scheduled when there is a date for the repeal of
the cremation forms.
15. It was noted that testing can be carried out on the registration system from
July 2014 to capture data from the new forms, and with regard to eMCCDs, data
sets have been agreed but there have been initial technical difficulties which are
being resolved. Progress has been made with eCMS and a connection is in
place with work being carried out to establish network connectivity with the NHS
systems. The links between NRS and ISD systems was highlighted as a
potential issue.
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16. Jim Clark noted that NRS have not progressed the procurement of electronic
signature pads as limitations around procurement, distribution and support
arrangements have been identified. Current thinking is to ask Local Authorities to
take this forward individually, partly because this would mean that Local
Authorities would then be responsible for providing their own technical support
and maintenance, simplifying matters greatly for all. The cost is anticipated to be
approximately £100 per device, and with a projected 350 attachment points in
total; the total costs of £35,000, spread over all local authorities, mean individual
local authorities will therefore be well below the procurement threshold. This
should simplify procurement. It was confirmed that NRS is confident that this
could be put in place by Local Authorities from October 2014, when NRS intend
to provide local authorities with full details of the project hardware requirements
(covering signature devices, scanning capability and faxes). Cathy Dunlop
confirmed a preference to have signature pads in place in order to make the
process smoother for the bereaved.
17. Gareth Brown confirmed that the Scottish Government would be happy to
provide funding for the purchase of signature pads if this was necessary to
ensure delivery of the programme. It was noted that the exact same device
would have to be purchased by every Authority.
18. Jim Clark confirmed that NRS have developed a communications plan which is
currently in draft and will be circulated to the stakeholder group at the end of the
week.
19. A discrepancy was noted between the CMO letter and the letter sent to local
authorities. It was confirmed that the CMO letter is accurate as an incorrectly
used form would not be a legal document.
20. Mini Mishra confirmed that the CMO guidance on how to complete the MCCD is
available on the SHOW website and a link to this will be on the MCCD. However,
a link to the updated PF guidance is still required. The CMO letter makes clear
that the current guidance remains and new guidance will be issued later in the
year to take account of the review system, and the link to the updated PF
guidance will be added at this point.
21. Jim Clark noted that NRS has made little progress on the issue of ensuring that
manual offices are legally compliant for April 2015 though some thinking has
been done around how cases in these areas would be identified for review.
Current thinking is that these registrars would contact NRS directly who would
confirm if the case had been selected and at what level, and provide them with
the necessary instructions.
22. Mini Mishra noted that concerns had been raised about the waiting time to see a
registrar had been as much as a week. Cathy Dunlop confirmed that it would
usual in her neighbouring authority to wait 2 days to see a registrar . Graeme
Brown noted an instance where a family experienced a week long wait before
being able to get an appointment with a registrar.
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Action – it was agreed that NRS should monitor this issue regarding registrations,
particularly as this could present a serious issue for faith groups.
Item 5: NHS Education for Scotland (NES)
23. Janice Kelly noted that, concerns had been raised by the bereavement group
that education materials did not address having a conversation with bereaved
families about disposal hazard information (not previously on the MCCD),,
however, it was felt that the education materials could not be too prescriptive
about what doctors say to families. In addition, localities could only change the
contact information and the logo on the NHS material, as NES had the copyright
for the content of the resources.
24. Ian Wallace noted his thanks for the education materials produced by NES which
had been very well received by Implementation Leads.
25. Janice Kelly noted that education materials on the change in MCCD had been
made available, and education materials were being developed for the scrutiny
system. Work is also underway to develop a communications plan.
Action – Mini Mishra confirmed that it will be reiterated via Local Implementation
Leads that completion of the MCCD should be covered as part of induction training.
Item 6: Funeral Industry Subgroup
26. Graeme Brown noted that whilst he had not attended the last meeting of the
funeral industry sub – group he could update from the perspective of the NAFD.
He also noted Rick Powell’s email to the group regarding the MCCD and
implants.
27. Iain Wallace acknowledged the group’s decision to remove the term ‘Fixion nails’
from the MCCD and highlighted that since 2010 doctors have been required to
de- pressurise the nail as soon as it is in place meaning this should be more of a
historical issue, particularly as this type of fixing is not widely used in Scotland.
28. It was noted that the NAFD would be able to contact every funeral director in
Scotland and consider the best way to advise funeral directors would be via a
letter. Communications are intended to begin towards the end of the year with
face to face meetings planned.
29. Gareth Brown noted the core material available on the Scottish Government
website which National Advisory Group (NAG) members should utilise to drip
feed information to their stakeholders. Graeme Brown acknowledged this
material and indicated that it had been used to inform communications. It was
also noted that the Scottish Government would be happy attend any meetings to
present or answer queries on the new system.
30. Mini Mishra sought reassurance that Funeral Directors no longer consider the
review system to present a delay to every funeral and that processes have been
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developed to support funeral directors to mitigate against the risk of delay in any
case. Graeme Brown noted that whilst complete reassurance could not be given
at this stage he was confident that once the new system is in place and people
start working within it there would be few complaints from Funeral Directors.
31. Nicola Livingston asked what action had been taken to mitigate against delays
as were identified by the test site. The mitigation actions were confirmed as the
use of electronic records, including the official contact details of the certifying
doctor on the MCCD and Form 14, and allowing anyone in the team with
knowledge of the patient and / or access to the relevant clinical records to speak
with the MR not just the certifying doctor.
Scottish Government
32. Gareth Brown confirmed the go live date for the new review system would be a
Wednesday towards the end of April (tentative date of 29 April 2015). This will
also be the go live date for a revised form 14. Legislation would be in place by
Feb / March 2015. Most cremations regulations relate to forms to support the
new system Colleagues from HIS will have to design and provide the various
forms (e.g. an Interested Persons review form) or their content by October 2014.
The 1935 cremation regulations will have the appropriate sections revoked as of
the go live date. The remainder of the regulations will stay in place until the
completion of the burial and cremations Bill. Work on this Bill has begun and
public consultation is expected by the end of the year.
Action – HIS to provide the design and content of the interested persons review
form to Scottish Government (SG) by October 2014.
Item 7: Communications
33. Gareth Brown noted that the communications plan had been brought to the
group before but little feedback had been received due to implementation being
some way off at that point. Following discussions with HIS, the plan has been
updated and it is expected that every organisation will have a plan in place
detailing the way it will interact with their professional colleagues.
Action – Every organisation to check and confirm or otherwise regarding its role
detailed on the communications plan.
Action – NES, HIS and NRS to provide their communications plans by the end of
August. Cremation Authorities and Funeral Directors should provide reassurances
regarding planned communications via the Funeral Industry Subgroup by end of
August.
34. Gareth Brown welcomed comments on publications which would require to be
updated and asked that Secretariat is notified of any events which should be
added to the communications plan. He also noted that each organisation should
have a list of where they can get information from.
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35. George Fernie noted that the milestones section of the communications plan had
been incredibly helpful in planning next steps for HIS.
36. Gareth Brown noted that Scottish Government has responsibility for
communicating with the general public and confirmed there would not be a large
scale mass marketing campaign as the new review system will only affect a
small number of people every year, and even fewer people are likely to
experience any delays to funerals. The key point is to ensure that professionals
know what they are doing and have the right information in order that they can
effectively engage with the public as and when appropriate.
37. Salah Beltagui flagged communications as a potential issue for faith
communities as many do not use funeral directors.
38. John Birrell noted publications ‘when someone has died’ and ‘what to do after a
death in Scotland’ will require to be updated. Gareth Brown agreed and noted
that these documents were already identified within the Communications Plan as
requiring update. John Birrell also noted that third sector organisations such as
Marie Curie will have a number of publications to be updated, linking in to the
changes in the above publications. The bereavement hub which is now part of
NES may be able to assist.
Action – Contributions to the communications plan with details of any publications to
be amended should be provided to secretariat by the end of August.
39. David Crawford confirmed that, as the review system excludes those reported to
the PF there would be no need to do anything different to the current system with
regard to the embalming of bodies by funeral directors or for bodies donated to
medical science. The COPFS anticipates that very few deaths will be reported to
them after the funeral, but COPFS will keep this under review.
40. David Crawford updated the group on the introduction of electronic reporting to
the PF by doctors which is hoped to be in place over the next two months. The
PF guidance to doctors is currently being revised and the categories for reporting
tightened. The PF guidance does not mention the review system as it purely
relates to fiscal cases.
41. Mini Mishra noted that it may be helpful for the changes to PF reporting to be
introduced after the introduction of the new MCCD in order to avoid any
confusion amongst doctors. Janice Kelly noted that there was a comprehensive
communications plan in place.
42. Charles Saunders noted that electronic reporting maybe difficult in some areas.
David Crawford noted the benefits of electronic reporting and confirmed that
primarily electronic reporting would be expected. However, it would still be
possible for reporting to happen by phone. Cathy Dunlop noted that registrars
report to the PF via the postal system.
AOB
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43. Martin Donnelly announced that this would be his last meeting with the group as
he would be retiring shortly. He noted that from a Northern Ireland perspective it
has been very helpful to share the learning with this group.
44. Iain Wallace noted that in the run up to implementation it would be helpful for the
group to meet more regularly. It was agreed the group will meet in late August /
Early September with meetings 6 weekly / monthly from then until
implementation. Following a suggestion from Charles Saunders it was agreed
that the meeting dates would all be set at once to enable members to balance
their diary commitments.
Agenda Action Points
Item
Action By
Item 2
1. An update on cross border issues will be provided
by Scottish Government at the next meeting.
Scottish
Government
Item 4
2. NRS should monitor the waiting times for registrar
appointments.
NRS
Item 5
3. Reiterated via Local Implementation Leads that
completion of the MCCD should be covered as part of
induction training.
Scottish
Government /
SMR
Item 6
4. HIS to provide the design and content of the
HIS
interested persons review form to SG by October 2014.
5. Every organisation to check and confirm or
All NAG
otherwise regarding its role as detailed on the
Members
communications plan.
Item 7
6. NES, HIS and NRS to provide their communications
plans to secretariat by the end of August. Cremation
Authorities and Funeral Directors should provide
reassurances regarding planned communications via
the Funeral Industry Subgroup by end of August.
NES, HIS, NRS
and Funeral
Industry
Subgroup
7. Contributions to the communications plan with
details of any publications to be amended should be
provided to secretariat by the end of August.
All NAG
Members
8. Next meetings to be scheduled
Secretariat
AOB
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