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 will be the basis for the detailed standard operating procedures set out by implementing organisations and, in particular, Healthcare Improvement Scotland.
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 MCCDs, 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, Local Authority registrars, Cremation and Burial Authorities, Funeral Directors and NHS for Education Scotland.
1.2 The Functions of Death Certification
1.2.1 Death certification serves a number of functions. A Medical Certificate of Cause of Death (Form 11 or "MCCD"), provided to the best of the medical practitioner's knowledge and belief, is a statutory requirement set out within the
Registration of Births, Deaths andMarriages (Scotland) Act 1965 ("the1965 Act") of any registered medical practitioner who was in attendance to the deceased during their last illness. It 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 person reporting the death ("the informant") is given the Certificate of Registration of Death (Form 14 or "death certificate"), which includes information given by the certifying doctor. This allows the funeral to go ahead and the informant to settle the deceased's estate. It also provides the informant with their own permanent record of how, when and why their relative died. This can contribute to information about family medical history, which may be important for their own health and that of future generations.
1.2.3 Information from death certificates 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. Death certificate 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, to families and to Scotland as a whole.
1.3 Background to the Certification of Death (Scotland) Act 2011
1.3.1 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;
In brief, this involved replacing the system in which all cremations incurred scrutiny, costing the bereaved family circa £170 in fees, but where there was no equivalent cause of death scrutiny of burials. The replacement system randomly scrutinises a percentage of all deaths (other than those already scrutinised by the Crown Office Procurators Fiscal and stillbirths) regardless of whether burial or cremation 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 supported by medical reviewer assistants. The primary functions of medical reviewers are to conduct expeditious but thorough reviews of Medical Certificates of Cause of Death (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 persons and bodies with a view to improving the accuracy of these certificates. The senior medical reviewer, with input from others, will develop 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 will improve our public health information. Additional analysis and statistical measures will also assist in identifying and monitoring trends and, together with other available information from organisations such as National Records of Scotland (NRS) and NHS National Services Scotland Information Services Division (ISD), highlight issues to be addressed at individual, regional and national level.
Email: Sarah Dillon