The National Association of Funeral Directors (NAFD) is delighted that a Bill on death certification has been included in the Scottish Government’s legislative programme for 2010-2011 and that, following consultation, plans for a unified system of death certification in England and Wales are moving forward.

The Health (Certification of Death) Bill will introduce a new single system of independent, effective scrutiny applicable to deaths in Scotland that do not require a Procurator Fiscal investigation. The Scottish Government wants to see improved quality and accuracy of Medical Certificates of Cause of Death (MCCD) forms and to ensure that, through better public health information, public health resources are directed where they are needed most.

Key proposals in the Bill include removing the existing cremation forms and fees (currently £147.00 for independent administrative checks by two separate doctors) and the introduction of Medical Reviewers. Located within Healthcare Improvement Scotland, the Medical Reviewers will scrutinise a random sample of forms, carrying out comprehensive checks of all paperwork associated with the death, speaking to the certifying doctor, other relevant healthcare staff and the family or carer of the deceased, and reviewing other evidence as required.

Medical Reviewers will scrutinise cases put forward for review by interested parties who have concerns about a Medical Certificate of Cause of Death form and those where issues have arisen in connection with, for example, a hospital or practice. They will work with NHS boards, the Royal Colleges and NHS Education for Scotland to improve the quality of education and training on death certification for medical practitioners and other staff involved in the death certification process, and will review national and local death statistics produced by a proposed new national statistician for Scotland

Following the public consultation on death certification earlier this year, the Scottish Government has made it clear that it intends to introduce a 'modest fee” to cover the cost of the new system. This element is currently under discussion and the Scottish Government will confirm its position shortly.

In a debate in the Scottish Parliament on September 8, Stuart McMillan MSP, co-convenor of the Cross Party Group for Funerals and Bereavement, said: “I look forward to the Bill coming on to the agenda of the Cross Party Group over the coming months. It is an important Bill. We have only to consider its application to every Member in the Chamber and everyone in the public gallery. Every person has to die at some point. It is a fact of life that we all will die.

“There is a serious point to be made. Dealing with death is a most difficult time for families. As they come to terms with what has happened, they are hit with different bills and do not know what they are for. Bringing together charges is a positive step forward, whether a burial or cremation is involved. Improvements in information gathering and the utilisation of information are also important. Those two important measures will make better the lives of the families of those who have passed away.”

Death certification developments in England and Wales

The NAFD is also pleased to report that plans for changes to the system of death certification in England and Wales are also progressing. The UK Government’s response to the Shipman Inquiry led to the publication of a Consultation on Improving the Process of Death Certification which outlined a programme of work to develop a rigorous and unified system of death certification for burials and cremations in England and Wales.

Now enabled by provisions in the Coroners’ and Justice Act 2009, the programme will:

• improve the quality and accuracy of MCCDs
• introduce a single system of effective medical scrutiny which will apply to all deaths that do not require a coroner’s post mortem or inquest
• provide better information on cause of death to strengthen local clinical governance and public health surveillance

Led by the Department of Health, the programme will need to achieve these outcomes without imposing undue delays on bereaved families or unacceptable burdens on medical practitioners or others involved in the process, and must ensure that the new system is transparent, proportionate, consistent and affordable. The programme is working with a wide range of stakeholders, including the National Association of Funeral Directors, to design, test and pilot the proposed new system for death certification and is continuing to work with the Coroners’ Unit at the Ministry of Justice and the General Register Office to prepare the necessary legislation.

There will be further public consultations in the third quarter of 2010 regarding policy for the new process and, in the first quarter of 2011, to obtain feedback on the actual regulations.

Overall, the NAFD has welcomed the changes and says they should mean funeral directors spend less time arranging the completion of forms. The fact that funeral directors will receive notification of the confirmed cause of death is a positive step and one that should help meet health and hygiene requirements.