The Scottish Government
Tuesday, 7 May, 2013

1. Context and Timescales

You will be aware that work is underway to ensure that the majority of the provisions within the new Certificate of Death (Scotland) Act 2011 come into force by April 2014. This will allow the full national implementation of a new death certification scrutiny process., The new scrutiny process will be undertaken by a group of Medical Reviewers (MRs) employed by Healthcare Improvement Scotland (HIS) and led by a new national Senior Medical Reviewer (SMR)

Following a consultation on the qualifications, training and experience required for the post of SMR, we now wish to seek views on the qualifications, training and experience required for the post of MR. As set down in the 2011 Act Ministers have powers to make regulations under the act to set out the qualification etc requirements for these posts – although we are not required to make such Regulations if we do not wish to do so. We are keen to ensure HIS are able to recruit MRs ahead of the launch of the new system to ensure the service is fully developed and the MRs trained on the new system.

The outcome of this consultation will help shape our views on whether or not a Scottish Statutory Instrument (Regulations) is required and, if so, what should be included in Regulations. We would aim to lay such Regulations in Parliament in time for a coming in force date before the summer.

We propose to conduct this consultation along the same lines as the previous consultation on SMR qualifications etc. The consultation will operate as a two iterations only exercise. All responses to this first iteration must reach us by 7 May 2013.

Once the views have been collated and considered, a second iteration will then be issued for final views, with a projected one week response deadline.

At that point, Scottish Government policy official and solicitors will work together to determine the need for Regulations and, if required, to develop the specific wording of the SSI. In the event that any detailed points of information require to be queried further, we will contact the relevant individuals for this purpose.

2. The Role of the Medical Reviewer

The Medical Reviewer will provide support to Healthcare Improvement Scotland in the development and ongoing delivery of a single system for independent, effective scrutiny of death certification leading to disposal (outwith the Procurator Fiscal service), reporting directly to the SMR.

The current envisaged role of the MR will include:

- Deliver the aims of the Certification of Death (Scotland) Act 2011:

  • Improve the quality and accuracy of the Medical Certificate of Cause of Death (MCCD); and
  • Provide improved public health information and strengthened clinical governance in relation to deaths

- Engage and develop effective relationships with key stakeholders, such as doctors, clinical governance leads and bereavement services in Health Boards, Deaneries and NES, NRS, Crown Office and Procurator Fiscal Service (COPFS), faith groups, funeral directors, registrars, the bereaved as appropriate, etc.

- Provide advice, guidance and support to certifying doctors and registrars in relation to MCCDs
- Involve the SMR in issues which may be challenging
- Work with other MRs, supporting each other to reduce variability and delivering a consistently high quality, person centred service, including peer review
- Act on the outputs and collation and analyses of information contained in the MCCDs.
- Uphold, safeguard and promote the organisation's culture, values and reputation

5. Key Questions

We are happy to accept general comments and views, but you may also wish to consider responding to the following key questions in line with the text above:

  1. Would the long term role of Medical Reviewer be best served by a general or a prescriptive approach to required qualifications, training and experience?
  2. If a general approach is preferred, what key areas would you want to see included (our example suggested senior level leadership, clinical practice, management and communications)?
  3. What specific qualification requirements, if any, should be included and why?
  4. What specific training requirements, if any, should be included and why?
  5. What specific experience requirements, if any, should be included and why?
  6. What other specific requirements, if any, should be included and why?

Comments on
Scottish Government consultation
Death Certification: Secondary Legislation - Medical Reviewer

The Royal College of Physicians of Edinburgh (the College) is pleased to respond to the Scottish Government’s consultation on Death Certification: Secondary Legislation - Medical Reviewer.

The College has the following comments:

  1. Would the long term role of Medical Reviewer be best served by a general or a prescriptive approach to required qualifications, training and experience?

    Initially, a prescriptive approach to qualifications, training and experience may be helpful if this new service is to be established on a robust grounding from its inception and to ensure a cohort of appropriately trained reviewers is in place. This would engender and ensure a mutually high level of respect and cooperation by all those involved in deaths as well as the avoidance of incidents such as those mentioned by Dame Janet Smith in the Shipman Inquiry [2011] Report.

  2. If a general approach is preferred, what key areas would you want to see included (our example suggested senior level leadership, clinical practice, management and communications)?

    If a general approach is preferred, Medical Reviewers would need to have a strong background in the key areas listed above as well as data interpretation. 

    It would also be beneficial for Medical Reviewers to have a working knowledge of:

    1. The laws and regulations relating to cremation and burial in Scotland and in the rest of Britain.

    2. The laws and regulations relating to transfer of bodies to and from Scotland to other countries, including the United Kingdom, inclusive of the role of the H M Coroner in other parts of Great Britain.

    3. The role of the office of Procurator Fiscal in relation to the investigations of sudden and unexpected deaths and to the manner in which Regional Units of this office, which specialise in death investigation, function.

    4. The relevant aspects of the Fatal Accident Inquiries [Scotland] Act [1976] and the Presumption of Death (Scotland) Act 1977 and similar relevant Acts.

    5. The law and regulations concerning deaths from Notifiable Diseases and their reporting.

    6. The role of the Police in the investigations of sudden and/ or suspicious deaths.

    7. The laws and regulations regarding disposal of still births and fetuses.

    8. The post-mortem signs to be expected in suspicious deaths from poisoning, asphyxia and other non-natural causes.

    9. The role of Forensic Physicians/Forensic Medical Examiners employed by the N H S and the Police in relation to their attendance at scenes of sudden death and that of Forensic Pathologists

    10. The current administrative arrangements in cemeteries and crematoria, and in firms of funeral directors.

    11. Knowledge of the different ethnic and religious customs and observances represented in the Scottish population.

    12. The role of bereavement officers and mortuary managers in NHS hospitals.

    13. Aspects of bereavement responses and the involvement of those who assist in bereavement counselling including non-statutory organisations such as CRUSE, Scottish Cot Death Trust.

    14. Aspects of infection control and other public health issues in relation to cadavers.

    15. The formulation of plans in the aftermath of multi-fatality incidents such as major air, rail, road traffic and other accidents, epidemics, etc.

    16. Practical familiarisation with the new forms that will be used.

  3. What specific qualification requirements, if any, should be included and why?

    In addition to a basic medical degree, held for a number of years, with a current licence to practice, ideally a number of Medical Reviewers should have relevant postgraduate qualifications held either in general practice or general medicine or in general pathology or in forensic medicine/pathology.

    It may be a pragmatic response in terms of recruitment and retention to recognise that Medical Reviewers with broad generic medical qualifications and a working knowledge of the points listed in (b) may be required.

  4. What specific training requirements, if any, should be included and why?

    In order to ensure uniformity on a national scale and to enable a dialogue to be established between the various Medical Reviewers and the medico-legal and community involvement in deaths, there could be an initial supervised national comprehensive course, run jointly by the NHS and perhaps one of the Universities, with a final assessment to this course. This would be attended by all prospective candidates and should include an assessment of actual cases.

    A renewal and re-appraisal course should be organised regularly for those in post.

  5. What specific experience requirements, if any, should be included and why?

    Several years’ experience in dealing with the endorsement of the current certification in relation of Medical Certificates of the Causes of Death [Death Certificates] and Cremation Forms, such as Medical Referees to Crematoria, general and forensic pathologists would be useful.

  6. What other specific requirements, if any, should be included and why?

    1. A full knowledge of the current and past legislation and statutory regulations directly related to death certification and registration is essential.

    2. Ideally direct experience in the examination of cadavers to exclude suspicious and unnatural deaths, neglect and abuse.