This year marked the fifth year of Scotland’s Death Certification Review Service, created to ensure the accuracy of death certificates. As the service’s latest Annual Report is published, George Fernie, Senior Medical Reviewer, reflects on the year past and the service’s plans for the future.

I am genuinely delighted to be presenting my fifth annual report for the Death Certification Review Service, a significant milestone. It’s an opportune moment to reflect back on progress made over this period. It’s especially satisfying to consider what has been achieved, particularly when the process and content of the Medical Certificate of Cause of Death (MCCD) has assumed much greater public prominence due to the COVID-19 disease pandemic.

We have attained a reduction in the ‘not in order’ rate, which is the measurement the Certification of Death (Scotland) Act 20113 states best demonstrates the quality and accuracy of an MCCD. Over half of all MCCDs reviewed when the service commenced required some change, compared to now, whereby some NHS boards have a sustained improvement and a ‘not in order’ percentage rate in the ‘teens’.

A conscientious approach

Whilst there remains room for improvement, this suggests we are on the right track.

Had I predicted we would have effected this so quickly, I would have been concerned about over-optimism. However, the conscientious approach adopted by the team who have progressed the reviews in an educative and supportive manner, coupled with a responsive group of certifying doctors in Scotland, have helped us surpass our initial ambition.

We have continued to review MCCDs and improve:

  • quality and accuracy, giving public confidence in the death registration process in Scotland,
  • public health information about causes of death in Scotland, supporting consistency in recording that will help resources to be directed to the right areas in a more timely way,
  • clinical governance, helping to improve standards in reporting deaths across Scotland.

Although quality improvement is the main reason the service exists within Healthcare Improvement Scotland, the fact we have demonstrated sustained improvement over this timespan very much justifies our existence. This is at a time when the importance of the quality and accuracy within MCCDs has attracted great attention due to the consequences from infection by such a devastating Coronavirus.

Last year, we identified some areas we would like to focus on to support the continued improvement of certificates and the review process. I am pleased to report, we have completed some of this work and have made good progress in all other areas.

We have:

  • reviewed how we manage enquiry calls to the service,
  • increased awareness of the death certification review process across Scotland,
  • improved the ‘not in order’ rate in all NHS boards,
  • improved the speed with which the outcomes of cases reported to the Procurator Fiscal are dealt with.

Although there has been a heightened awareness by the team, especially of prescribing issues identified in the Gosport inquiry, no such systematic failings have been identified in Scottish territorial boards, although a watching brief has been maintained.

Public health benefits

Work continues on wider public health benefits where the service has co-operated with Public Health Scotland, particularly in considering the implications from the COVID-19 pandemic.

Analysis of administrative and process errors by certifying doctors and transcription errors by registrars is underway. The main impediment to completing reviews within the service level agreement is the unavailability of certifying doctors. However, the breached rate remains reassuringly low.

We also have new plans for the year ahead. We plan to complete piloting work to introduce the eMCCD into secondary care which will bring a number of benefits to families bereaved, NHS boards and registrars; and work with NHS Boards to reduce the number of clinical errors on MCCDs, including appropriate reporting to the Procurator Fiscal.

I’d like to sign off by thanking the DCRS team for all their hard work and to the NHS in Scotland for their dedication to improving the system. It’s the continued teamwork that will bring about further successes in the years ahead.

George Fernie is Senior Medical Reviewer with Healthcare Improvement Scotland’s Death Certification Review Service.

More information

Visit the Healthcare Improvement Scotland website to read the report.