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An apology for absence was received from Cllr Martin Waite.
Declarations of Interest
There were no declarations of interest.
[Dr Julian Parkes will be discussing the role of GPs in the community and the certification process. Note attached].
Dr Julian Parkes GP outlined his experiences of the death certification processes. He stated that Primary care was a list based system meaning that patients were registered with a practice and the practice took responsibility for their patients. The Alfred Squire Road Practice had 8400 registered patients. The average GP in England was responsible for 1850 patients. There were approximately 100 deaths per year from patients registered at the Alfred Squire Road Practice. Deaths in Primary Practice tended to fall into four distinct categories:
1) Sudden death where the patient had not recently been seen.
2) Deaths in Hospital.
3) Deaths at home but expected, the patient was often receiving palliative care for Cancer.
4) Deaths in Compton Hospice or following discharge from hospital to a nursing home, which was not their usual residence.
An audit of deaths in September 2017, over a three-month period, showed there had been a total of 25 deaths, 4 deaths were sudden and unexpected. The breakdown was as follows: -
· 12 deaths occurred in Accident and Emergency or as inpatients at Newcross Hospital and one at another Hospital.
· 2 deaths occurred at Compton Hospice.
· 3 deaths were in a residential or nursing home.
· 8 deaths at home, with 3 of those being sudden and unexpected, with the remaining 5 being on the Palliative Care Register and expected to die.
Dr Parkes commented that it was required by law that a Doctor notified the cause of death and not the fact of death. The specific circumstances of the death would affect whether a GP could issue a Medical Certificate of Cause of Death (MCCD). He outlined the circumstances where a death would have to be reported to the Coroner, as detailed in his written report which had been circulated with the agenda. He also outlined the formal procedures required if a patient was to be cremated.
A Member of the Panel enquired if it was still permittable to write, “old age” on the Medical Certificate of Cause of Death. Dr Parkes responded that Doctors tried to avoid the use of term as much as possible, but there were certain circumstances where it was permissible to still use the term.
Cllr Sohail Khan commented that GPs out of hours availability was vitally important. Contacting a deceased person’s GP out of hours, from experience, he found to be problematic. In response, Dr Parkes outlined that GPs were contracted to work from 8am - 6:30pm, five days a week, excluding bank holidays. There were out of hours GPs or paramedics who could confirm death after the closing hours of the surgery. Normally they would inform the family that they would need to contact the deceased person’s GP surgery during opening hours to arrange for a Medical Certificate of Cause of Death to be issued. An appointment with the Registrar could not be made until they had the Medical Certificate of Cause of Death. An out of hours GP would not be able to issue the Medical Certificate of ... view the full minutes text for item 3.
[Elaine Roberts, Patient Services Manager, The Royal Wolverhampton Hospital Trust]
The Patient Services Manager outlined the internal processes for issuing a Medical Certificate of Cause of Death at Newcross Hospital within the Royal Wolverhampton Health Trust. If a person died on a ward at hospital the deceased’s relatives, if present, would be issued with a bereavement leaflet. The leaflet detailed the processes which needed to take place following a death. They were asked to contact the Bereavement Office on the following working day between 10am - 4pm, so the stages in the formal process could be properly explained.
The Patient Services Manager remarked that the Ward was expected to call the deceased’s GP to notify them of the death, but not the cause of death. A Member of staff from the Ward would then enter the patients administration system and log the patient as deceased. They would then send the patient file to the Bereavement Office. The file would normally be received by the Office on the next working day. Should the person have died on a Friday, it would not normally reach the Bereavement Office until the following Monday. Once the Bereavement Office had safely received the Patient File, they would ascertain which Doctor or Doctors needed to be contacted to complete the Medical Certificate of Cause of Death. If the Bereavement Office knew the patient was to be cremated, they would ask the Doctor to complete the first part of the cremation form at that stage. It was however true to say that at this stage they may had not heard if the patient was to be cremated and families sometimes changed their minds, often due to financial reasons.
The Patient Services Manager stated that once the Medical Certificate of Cause of Death had been completed, the Bereavement Office contacted the relatives to arrange for collection of the certificate. The family could then contact the Registry Office to officially register the death. If the Patient was to be cremated, the Bereavement Office would continue to arrange for the necessary cremation paper work to be completed. The second part of the cremation form had to be completed by a Doctor who had been registered for five years.
The Patient Services Manager stated that the Trust did have a “Rapid Release Policy”, which had been used within the Hospital, it formed part of the “Management of the Deceased Patient Policy.” She had known the “Rapid Release Policy” to be used at weekends. She was happy to circulate the policy to the Panel along with the Bereavement Leaflet. There was always an on-call Director and an on-call Manager working for the Trust, 24 hours a day, 7 days a week, who all knew about the “Rapid Release Policy”. The Patient Services Manager commented that deaths referred to the Coroner would naturally normally cause a delay in the process for families.
A Member of the Panel asked about the number of staff working in the Bereavement Office and if they faced delays in obtaining the appropriate Doctor to complete the necessary paper ... view the full minutes text for item 4.
[Julia Goudman (Business Development Manager – Registrar’s) and Martyn Sargeant (Head of Public Service Reform) will be present. Briefing Note Attached].
The Business Development Manager summarised the points contained in the briefing note that had been distributed. Legally deaths had to be registered within five calendar days, which included Weekends and Bank Holidays. Deaths had to be registered within the District where they occurred. A death had to be registered by a qualified informant who was usually a relative. When a relative was not available they could accept someone who was present at the death, the occupier of the house or an official from a public building where the death occurred, or the person making the arrangements with the Funeral Director.
The Business Development Manager commented that there were a number of reasons a death might have to be reported to the Coroner by the Registration Service. This included if the Medical Certificate of Cause of Death detailed an unnatural death.
The Business Development Manager remarked that in order to register a death the Registrar was required to see the Medical Certificate of Cause of Death from the qualified informant. Once this had been seen and the Registrar was content with the certificate being legally valid, they could issue a form which enabled the burial to take place. If the Coroner had been involved, the Coroner issued a separate form, rather than the Medical Certificate of Cause of Death.
The Business Development Manager detailed the latest statistics on the issuing of the Medical Certificate of Cause of Death and the registration of a death. 69% of Medical Certificates of Cause of Death were currently signed within two calendar days in Wolverhampton. 29% of deaths last year had been referred to the Coroner. 95% of Customers who contacted the Registration Office were offered an appointment within two days. This had slipped in January, due to the high demand for registration appointments. 71% of deaths not referred to the Coroner were registered within five days. The Registration Service performance target was 90%. The Registration Service was facing increased pressure from the Home Office to improve performance in this area. 28% of deaths that were referred to the Coroner, where no post mortem or inquest was required, were registered within five calendar days. Where a post mortem was required, only five per cent of those deaths were registered within seven days.
The Business Development Manager commented that in the last two years there had only been one formal complaint made about the Registration Service. This had been in relation to a customer believing that the Service could not offer an appointment within a reasonable timeframe. They regularly measured customer service satisfaction through surveys. 98% or more of people said they were satisfied with the service they had received from the Registration Service. They had recently been asking a further question to customers, where the registration of the death had taken longer than five days, if they had been happy with the time taken. In September 2018, 94.1% had said they were happy.
A Member of the Panel asked if there had been an increase ... view the full minutes text for item 5.
Coroner Office Experience
[Margaret Collins (Corner’s Lead – Black Country) will be present].
The Coroner’s Lead for the Black Country outlined the Coroner’s Service in Wolverhampton. It was the first time they had been asked to attend a Council Scrutiny Panel. Wolverhampton was one of the four areas covered by the Black Country Coroner, the other three being Sandwell, Dudley and Walsall. On average the Office dealt with 1200-1300 deaths from Wolverhampton per year. It was a small team of ten people, which included the Coroner. Every year they dealt with approximately 4,500 deaths.
The Coroner’s Lead for the Black Country stated that since November 2015, they had introduced a new computer system called “Civica Coroners”. The Coroner, Mr Siddique was appointed in September 2014 and had been very supportive of the move away from paper systems to electronic. A Portal had been added to the system in the latter part of 2016, which led to significant efficiencies. It allowed GPs and Hospital Doctors to report deaths 24 hours day, seven days a week into the Coroner’s system. The Portal was also linked into Funeral Directors and Registrar’s. The introduction of the system had significantly improved efficiency and had revolutionised the way the Coroner’s Office worked. The Black Country area was one of the first Coroner’s areas to go live with the Portal system. There were many Coroner areas in the country still awaiting to launch the Portal system. The Black Country Coroner’s Service was considered a centre of excellence and were regularly consulted about the system.
The Coroner’s Lead for the Black Country remarked that they operated a triage system in the Coroner’s Office. As a death came through into the Coroner’s system, there would be an initial triage exercise. If a death could be actioned quickly, a simple Form A would be issued. The Coroner by law had to investigate all deaths including the simple cases. Some cases required an investigation or an inquest. The Coroner Office Team was split in two different categories, those that dealt with community deaths and those that dealt with inquests. She stated that for all deaths referred to them, they always spoke to the family. This was not the case for all Coroner’s in the Country. She felt it was important as it helped to keep a level of independence to the process.
Cllr Sohail Khan asked about the out of hours repatronisation phone service. The Coroner’s Lead for the Black Country responded that they tried to mirror the service with the Registrar’s, some of which were open 8am-1pm at Weekends and Bank Holidays. The Assistant Coroner’s were available between these times and the four Registration Services that fell within the jurisdiction had their contact details.
Cllr Khan asked if the Coroner’s Service, working alongside Registrar’s, could have an out of hours service (where there were staff in the actual Coroner’s Office) at Weekends and Bank Holidays. There was a discussion about an out of hours service. The Coroner’s Lead for the Black Country said that at the present time they would not be ... view the full minutes text for item 6.
Al-Mu'min Muslim Funeral Services
[Al-Mu’min Muslim Funeral Services - Ash Khan and Mohammed Ishtiaq to present verbal report]
Cllr Sohail Khan stated that in the Islamic faith it was a religious requirement to bury the body as soon as possible. There was an understanding though that the country was governed by laws that had to be followed before a body could be buried. In the Islamic Faith, the Funeral Directors were expected to take 90% of the burden away from families. It was paramount for organisations to work together to ensure a smooth and efficient service for families. He thought it was important for a standardised policy to be in place to help with families who had specific requirements for the deceased. It was important to plan for the future. He had some concerns about the new Medical Examiner Role, which he thought could potentially cause an added delay if a rapid release was required.
A Member of the Panel commented that the Muslim population was increasing and so it was important to ensure that mechanisms were in place to ensure as quick a burial as possible. It was very distressing if families were not able to bury the deceased quickly.
The representative from Al-Mu’min Funeral Services thanked the Registration and Coroner’s Service for their accommodating behaviour in the past. He commented that if processes could be more streamlined in the future, then families would receive a more efficient service from them. He thanked the Panel for the invitation that had been extended to him to attend the meeting.
A Member of the Panel commented that it was important to have an item on burial places in the Wolverhampton area, added to the future Scrutiny Work Programme.
Sandersons Funeral Services
[Verbal Report - TBC]
The representative from Sandersons Funeral Services thanked the Panel for asking them to attend and contribute to the meeting. He commented that they had a good relationship with all the relevant stakeholders. He stressed the importance of the family’s needs. He remarked that in his experience things did not always go smoothly when there was a request by the family that did not fit into normal procedure. There were often delays in faith-based questions and if a repatrionisation was required. It was important to have a cohesive system to ensure that families received an efficient and professional service. Communication was important and people needed to have information available to them so they were fully aware of the polices in place.
Next steps - Recommendations and Agreed Actions
The Health Scrutiny Panel made the following recommendations:
A) That the RWHT circulate the “Rapid Release Policy” to the Panel along with the latest Bereavement Leaflet and the Government Booklet – “What to do after a death”.
B) That more publicity be given to the “Rapid Release Policy” at the RWHT and to receive assurances that it is up to date and working effectively.
C) The RWHT Audit information on the time taken for the issuing of the Medical Certificates of Cause of Death be provided to the Panel.
D) That consideration be given to how communication can be enhanced to relatives of the deceased about the On-Call Registration Service, where a prompt burial is required.
E) That consideration be given to extending the On-Call Registration Service timeframe (currently 8am-9am) at Weekends and Bank Holidays (excluding Christmas Day and Easter).
F) That the Crematorium booking system, waiting times and delays particularly during the winter season, be added as a potential future item to the Health Scrutiny Work Programme.
G) That the Health Scrutiny Panel, working with relevant partners, investigate how the official paperwork processes surrounding death can be made more streamlined.
H) That Registrar’s ensure there is absolute clarity given to a person registering a death, that the date of death used in the register entry can differ to that on the Medical Certificate of Cause of Death, in certain defined circumstances.
I) That a review be completed on the current resources given out to families following a death and suggestions made for improvement, such as a simple one-page flow chart.
J) That an assessment take place in due course, on how the new Medical Examiner Role and new Register Office being implemented from 1 December 2018 at Newcross Hospital, effects the expediency of the formal processes after death.
K) That an item is added to the future Scrutiny Work Programme on burial places within the Wolverhampton area.
Meeting closed at 12:15pm.