Agenda item

[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 work.  In response, the Patient Services Manager confirmed there were four members of staff who worked in the Bereavement Office but they were not all full-time.  She did not believe they were short of staff.  On average there were seven deaths a day at Newcross Hospital.  Delays in obtaining Doctors were sometimes caused due to a Doctor having worked nights, or a Junior Doctor being on their study day.  The Trust had a target within their policy of issuing a Medical Certificate of Cause of Death within 72 working hours of the patient dying.  Regular audits were completed and up to 90% of certificates were issued within 72 working hours.  Those that hadn’t been issued within 72 working hours were generally deaths which had been referred to the Coroner.    

The Head of Public Service reform stated that given there was a statutory target of certifying a death with the Registration Service within 5 calendar days, whether the Patient Services Manager thought a RWHT Trust target of issuing the Medical Certificate of Cause of Death within 72 Working Hours was appropriate.  The Patient Services Manager responded that she was aware of the 5-calendar day statutory deadline for the registering of a death.  The Trust used working days as the Bereavement Office was not open at weekends.  She understood the difficulty of the statutory deadline counting weekends and Bank Holidays as part of the five days. 

A Member of the Panel asked if the Bereavement Leaflet given to relatives of the deceased contained reference to the “Rapid Release Policy.” The Patient Services Manager responded that there was no reference to the policy within the Bereavement Leaflet.  People tended to find out about the policy by talking to the nursing staff on the ward.  Cllr Khan commented that he was not aware of the “Rapid Release Policy” at the RWHT.  He was aware of Birmingham’s and other areas, having worked in Funeral Services in the past.  He asked if it was available to view online, as he thought it needed more publicity.  Dr Parkes responded that it was an internal policy, which he was sure could be made available to the Panel.  The Panel recommended that more publicity be given to the “Rapid Release Policy” at the RWHT and desired to receive assurances that it was up to date and working effectively.

A Member of the Panel commented that it was important to record patients’ medical notes accurately to ensure there was a good audit trail, to help ensure the prompt issuing of the Medical Certificate of Cause of Death and assist during Coroner referral cases. 

A representative from Sandersons Funeral Services commented that the area which they often received a delay was with receiving the correct documentation for a cremation, which was often received after the Medical Certificate of Cause of Death.  It was distressing to families when they could only give a timeframe of when the cremation would be, rather than a fixed date.  He asked if there was any way for the Medical Certificate of Cause of Death, to be completed together with the Cremation forms.  The Patient Services Manager responded that from the 1 December 2018 that would be normal practice at the RWHT.  From this date there would also be a new Bereavement Centre at Newcross Hospital, which would have a Registrar desk and Medical Examiners staff.  There would also be waiting and meeting rooms.  The Medical Examiner would scrutinise the patient file, which she thought would arrive quicker to the Office than at present.  The family would be offered the opportunity to question the Medical Examiner about the care of the deceased.  The process would be more streamlined than previously.  A Member of the Panel remarked it was important to communicate the changes to all relevant stakeholders. 

A Member of the Panel asked how many Medical Certificates of Cause of Death were completed by the RWHT with 24 working hours of the patient being deceased.  The Patient Services Manager responded that she believed it was in the region of 50-60%.  Approximately 92% of certificates were completed within 72 working hours.  Members asked for the RWHT Audit information on the time taken for the issuing of the Medical Certificates of Cause of Death to be provided to the Panel.  

A Member of the Panel asked if there were times in the year where there were more deaths at the Hospital and therefore more demand on Bereavement Services.  The Patient Services Manager responded that there was always an increase in deaths during the winter months.