Certification of Death (Scotland) Act 2011 Statutory Guidance

Part 1 - Introduction

1.1 Purpose and Legislative Basis

1.1.1 This Scottish Government Guidance sets out some of the key operational principles for the purposes of the Certification of Death (Scotland) Act 2011 (‘the 2011 Act’). This Guidance is the basis for the detailed standard operating procedures set out by the implementing organisation Healthcare Improvement Scotland (HIS). This is statutory guidance under section 22 of the 2011 Act.

1.1.2 In particular, this guidance focuses on what the senior medical reviewer and medical reviewers must have regard to in delivering the independent scrutiny of medical certificates of cause of death (MCCD), or in otherwise delivering their statutory functions. As such, it also necessarily incorporates some of the key functions that are required to be undertaken by others in support of this work, including National Records of Scotland (NRS), local authority registrars, burial, cremation and hydrolysis authorities, funeral directors and Public Services Delivery Scotland (PSD Scotland).

1.2 The Functions of Death Certification

1.2.1 Death certification serves a number of functions. As set out in section 24 of the Registration of Births, Deaths and Marriages (Scotland) Act 1965 (‘the 1965 Act’) provision of a MCCD (also called a Form 11) is a statutory requirement of any registered medical practitioner who attended the deceased during their last illness, or if there was no such medical practitioner in attendance during the last illness, then of any medical practitioner who has access to the relevant clinical records of the deceased. The medical practitioner must state to the best of their knowledge and belief the cause of death. The MCCD provides a permanent legal record of the fact of death and enables the family to register the death and arrange disposal of the body.

1.2.2 When a death is registered, the registrar gives the person reporting the death (‘the informant’) the Certificate of Registration of Death (Form 14). This form allows the funeral to go ahead.

1.2.3 Information from MCCDs is used to measure the relative contributions of different diseases to mortality in Scotland. Statistical information on the underlying causes of death is important for monitoring the health of the population; designing and evaluating public health interventions; recognising priorities for medical research and health services; planning health services and assessing the effectiveness of those services. MCCD data is extensively used in research into the health effects of exposure to a wide range of risk factors through the environment, work, medical and surgical care, psychosocial, and other sources.

1.2.4 Timely, clear and accurate completion of MCCDs is therefore helpful to individuals, families and Scotland as a whole.

1.3 Background to the Certification of Death (Scotland) Act 2011

1.3.1 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 are not reported to the Procurator Fiscal;

This involved replacing the system in which all cremations incurred scrutiny, costing the bereaved family around £170 in fees, but where there was no equivalent cause of death scrutiny for burials. The replacement system randomly scrutinises a percentage of all deaths (other than those which are reported to the Crown Office and Procurator Fiscal Service (COPFS)) and stillbirths regardless of whether burial, cremation or hydrolysis is involved. The bereaved do not pay any scrutiny fee under the new system.

• Improve the quality and accuracy of Medical Certificates of Cause of Death (MCCDs);

This is undertaken by a small team of statutory medical reviewers under the management of a statutory senior medical reviewer, and all of whom are supported by medical reviewers’ assistants (MRAs) who are the administration team and are not medical practitioners themselves. The primary functions of medical reviewers are to conduct timely but thorough reviews of MCCDs. They also have a role in providing education, guidance and support to doctors who certify the cause of death and they liaise with other people and stakeholders with a view to improving the accuracy of certification. The senior medical reviewer, with input from others, has developed national standards for the operation of the system, supported by quality assurance activities such as audits, case discussions and peer review, to ensure consistency in the processes and minimise unnecessary delays due to the scrutiny.

• Provide improved public health information and strengthened clinical governance in relation to deaths

Over time, improvements in the accuracy of MCCD information has improved our public health information. Additional analysis and statistical measures also assist in identifying and monitoring trends and, together with other available information from organisations such as National Records of Scotland (NRS) and Public Services Delivery Scotland, highlight issues to be addressed at individual, regional and national level.