Executive Summary:
This consultation sought views on one aspect of the planned changes to the death certification process in Scotland, which will be implemented from spring 2014.
Specifically, it seeks views on the arrangements that should be in place for any rare situations where there is a need and a clear rationale for a funeral to proceed within a specific timescale and where that timescale may not be met if the standard review procedure is followed.
Purpose
This consultation seeks views on the proposals for an expedited procedure for the review of Medical Certificates of Cause of Death (MCCD) under the new Scottish death certification system, which will be implemented in Scotland from spring 2014.
Background
The Certification of Death (Scotland) Act 2011 (“the 2011 Act”) was introduced to update the certification of death process in Scotland. The aims of the legislation are to:
Introduce a single system of independent, effective scrutiny applicable to deaths that do not require a Procurator Fiscal investigation Improve the quality and accuracy of Medical Certificates of Cause of Death (MCCDs)
Provide improved public health information and strengthened clinical governance in relation to deaths
The 2011 Act establishes the role of Medical Reviewer and Senior Medical Reviewer, supported by Medical Reviewer Assistants, whose primary functions are to conduct reviews of Medical Certificates of Cause of Death (MCCDs) expeditiously but thoroughly. They will also have a role in providing training, guidance and support to doctors who certify the cause of death and they will liaise with other persons and bodies with a view to improving the accuracy of these certificates.
The date at which the Act comes into force is the same date at which the new system can start, currently projected for spring 2014.
The Review Process
Under the terms of the 2011 Act, the new review process commences when someone (‘the informant’) visits the registrar to register a death. The registrar will take the informant through the registration process and towards the end of that interaction will check and advise if the MCCD - which contains information relating to the death - has been selected for review. Cases for review will be selected randomly.
It is expected that around 25% of all cases where there is no referral to the Procurator Fiscal will be reviewed every year.
Once a certificate is selected for review the registrar will advise the informant of this and that they will be contacted and/or sent the official extract of death once the review has been completed. The review will be undertaken by one of the nationally-appointed Medical Reviewers. It is expected that reviews will normally take between one to three days. Most reviews will be ‘Level 1’ reviews, which will involve a review of the MCCD and a discussion with the certifying doctor. These reviews are expected to be completed within one working day. A smaller number of MCCDs will be subject to ‘Level 2’ reviews, which will involve a more detailed review of the clinical information surrounding the death and the MCCD. Although Level 2 reviews are more detailed the expectation is still that these reviews will be completed quickly, within three working days at most.
It is anticipated that the system will not affect the vast majority of funeral arrangements, which in Scotland tend to take place 7 days after the death. Additionally, Medical Reviewers will be mindful at all times of the need to minimise disruption to bereaved families and to complete reviews as quickly as possible.
Nevertheless, it is accepted that arrangements should be in place for any rare situations where there is a need and a clear rationale for a funeral to proceed within a specific timescale and where that timescale may not be met if the standard review
procedure is followed.
The 2011 Act provides powers to enable an expedited review procedure in Section 6 (‘Request for review not to stay registration’) and Section 7 (‘Medical reviewer to determine whether review to stay registration’), however neither section
sets out the criteria for determining which cases should be eligible for this procedure, except to say that it will be for the Medical Reviewer to ‘determine whether it is appropriate’. Guidance is therefore required to support the work of the Medical
Reviewers in those rare instances where an expedited procedure may be appropriate. This consultation sought views on the proposed key principles of the expedited procedure, to enable registration to proceed (not to stay registration).
