PHOTO 2 CGMFIf you have ever registered a death of a loved one you will know that it comes at an extremely stressful time, involves an unfamiliar process and you really want it all to go smoothly to get on with funeral planning. To register the death you need a Medical Certificate of Cause of Death (MCCD) – commonly known as a ‘death certificate’.  The death certificate can only be issued by a doctor and this certification registers the death, records information about the death including the cause, and provides a permanent legal record.

This is a vital process and as well as being a legal requirement, it’s one that can provide NHSScotland with accurate information to help healthcare providers plan future services in the most effective.

To help ensure that information is correct, the Death Certification Review Service, (DCRS), run by Healthcare Improvement Scotland, has the primary function of checking a sample of  death certificates  to ensure clarity and accuracy on what caused a death.

I’ve been Senior Medical Reviewer since 2015 and in that time a key focus of our work has been on helping the bereaved by providing greater assurance that the cause of death of their loved one has been accurately recorded. At the same time, our work ensures that the reviews do not cause unnecessary delays to burial or cremation plans. An example of this focus emerged during the current situation with deaths related to ‘flu.

Where a condition may be an acute and serious risk to public health, such as influenza or ‘flu, the law says that certifying Doctors must report the death to the Scottish Fatalities Investigation Unit (SFIU) – a specialist unit of the Crown Office and Procurator Fiscal.

In mid-December 2017 it became apparent that there was an increase in the number of ‘flu related deaths in Scotland.  Healthcare Improvement Scotland noted that the requirement to report these deaths to the SFIU was potentially contributing to further unnecessary delays in processing death certificates and was creating additional work for certifying Doctors at a time when services were especially stretched and also potentially causing delays for bereaved families.

Healthcare Improvement Scotland started to look at how we could help to reduce this pressure and potentially minimise the impact for bereaved families.

We thought we might be able to influence the clinical and legal community to amend this practice and we initiated discussions with the Scottish Government and the Crown Office.

We were keen to explore the basis for the current legislation and to consider the wider impact of it on services and families.  Further discussions with the Scottish Fatalities Investigation Unit and the Deputy Chief Medical Officer (CMO) resulted in a letter to all doctors in Scotland from the Deputy Chief Medical Officer, stating the request to complete an MCCD, but to suspend the additional requirement to also automatically report flu-related deaths to the SFIU.

In a remarkably swift turn of events, this temporary suspension to the SFIU certification process for flu related deaths was facilitated by Healthcare Improvement Scotland within 24 hours of identifying the potential issue.  Facilitating these discussions, resulting in the temporary amendment, and removing an additional layer of administration throughout the system, significantly helped to alieviate pressure on medical staff during the peak winter period.

Respectfully challenging what might otherwise have been viewed as an absolute legal requirement demonstrates the commitment of Healthcare Improvement Scotland and partner agencies such as the SFIU, Crown Office and Scottish Government, to continuously work to improve health and social care services for the people of Scotland.

The temporary suspension of the SFIU reporting requirement is still in place while ‘flu continues to abate throughout the country.


George Fernie is a Senior Medical Reviewer at Healthcare Improvement Scotland.