How the Moira Anderson Foundation is helping create a new model of care for children affected by abuse – Gillian Urquhart

Posted on August 9, 2019

Gillian-Urquhart-1 Barnahus is a Scandinavian term that most in Scotland will not be familiar with. But that’s all set to change.

The word translates as Children’s House (Barn meaning ‘children’ and Hus meaning ‘house’) and the first Barnahus was founded in Iceland in 1998. Since then many countries have developed their own Barnahus model, most in Scandinavia. Closer to home, an English version of Barnahus called The Lighthouse was launched in London in October 2018.

Since inception in 2000, MAF has supported people affected by Child Sexual Abuse. We were instrumental in forming the coalition group, Justice for Children in 2002. The clear message given by the group 17 years ago was that children should be nowhere near a court building.

So what exactly is Barnahus? In simple terms, it is a concept for a child-friendly centre for victims of abuse. Barnahus provides a home-like setting (safe, calm, welcoming) for children to give evidence and receive therapeutic support after disclosure of abuse. Some models are led from a health perspective and incorporate medical/forensic examinations, while others are more aligned with criminal justice.

As Director of the Moira Anderson Foundation (MAF), I was delighted to have been invited to a Barnahus scoping workshop in June organised by Healthcare Improvement Scotland and the Care Inspectorate. Both these organisations have been commissioned by the Scottish Government to develop quality standards and outline a framework for a Barnahus response to Child Sexual Abuse (CSA) in Scotland. The workshop provided an opportunity for like-minded organisations to get together and discuss how we thought Barnahus could work in Scotland.

The participants all had a good understanding of the model and therefore rich and thought-provoking conversation was able to take place from get-go. Informative presentations were delivered by key stakeholders which aided us in our tasks. We worked to provide the group responsible for developing the standards with a direction of travel. I’m confident we achieved that aim.

Since inception in 2000, MAF has supported people affected by Child Sexual Abuse. We were instrumental in forming the coalition group, Justice for Children in 2002. The clear message given by the group 17 years ago was that children should be nowhere near a court building.

This subject is close to my heart. I have been in court with children/young people and their families and witnessed the accused do their best to intimidate the victim’s family; menacing stares and threatening gestures. I’ve seen supporters of the accused gather at entrances to the court and wait until the victim and their family leaves, making sure their presence is felt. It can be a horribly frightening and harrowing experience for a child/young person to be involved in a sexual abuse court case. Adults struggle to cope with the pressure. Imagine for a second how terrified a young child might feel! The requirement to tell the story of what happened to them multiple times to different people can leave children confused and can impact on their ability to tell a consistent story, it can also re-traumatise. Dealing with cross-examination during the trial is a horrendous experience for a child.

Childhood Sexual Abuse is a public health issue. The more awareness and understanding there is of the subject and the trauma that survivors deal with, the better. MAF has seen a huge increase in referrals in recent times, we see this as a positive: more people are finding the confidence to speak up.

I have been in court with children/young people and their families and witnessed the accused do their best to intimidate the victim’s family; menacing stares and threatening gestures. I’ve seen supporters of the accused gather at entrances to the court and wait until the victim and their family leaves, making sure their presence is felt.

In October 2016 MAF were involved in an event organised by Children 1^st – Justice for Children Conference – Getting It Right For Child Witnesses. The conference examined what Scotland could do to improve the justice system for children and young people. Lord Carloway, who chaired the Evidence and Procedure Review 2015, was a Keynote speaker, as were colleagues from the Barnahus in Oslo. Hearing how the multi-disciplinary approach works in practice terms was very interesting.

Fast forward to 2019 and we’ve seen the Vulnerable Witnesses Bill receive Royal assent in June, there’s no going back! The steps being taken by the Scottish Government are hugely encouraging; there will be obstacles to overcome but nothing insurmountable, there’s proof it can be done.

I look forward to reading the draft standards and for our organisation to continue to support developing the right Barnahus model for Scotland, as part of the wider plan to give children/young people the care and support they need to find justice and healing.

Please contact the project team at hcis.barnahus.standards@nhs.net.

Visit our website to read the scoping report.

Gillian Urquhart is Director of the Moira Anderson Foundation.

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Tagged: children and young people, standards and guidelines

Barnahus – a new model of care and support for children who have experienced abuse – Rachel Hewitt

Posted on August 8, 2019

Rachel-blog According to research by Children 1^st, children who have experienced abuse may have to tell their story to 14 different people before they get the support they need. Sometimes, children and young people have to tell their stories to people from up to nine different organisations—everyone from their schoolteacher to a High Court judge, which potentially adds more traumatic experiences to those they’ve already been through.

To help address this issue, the Standards and Indicators Team within Healthcare Improvement Scotland (HIS) were commissioned by the Scottish Government to jointly develop standards which will outline what a Barnahus model should be like in Scotland.

Like many people, the term Barnahus was relatively new to me before I started to work on the standards project. I’d seen a video on social media of a house in Iceland that was designed to help children feel safe when they’d experienced abuse. It seemed like a brilliant child-friendly idea, but, as with all social media, I flicked past it after watching.

Like many people, the term Barnahus was relatively new to me before I started to work on the standards project. I’d seen a video on social media of a house in Iceland that was designed to help children feel safe when they’d experienced abuse. It seemed like a brilliant child-friendly idea, but, as with all social media, I flicked past it after watching.

Barnahus comes from the Icelandic word for ‘children’s house’. It refers to a European –wide model which has a shared set of principles but can look different depending on the place where it is introduced. In some places, like Iceland, the Barnahus is literally a house, where children and young people are seen in a residential area in a building designed to look like their own or their friends’ front rooms. In other areas it is a wide system of support, advocacy, children’s rights and ongoing support.

What are we doing?

Barnahus represents the next step in a whole system change. Standards are part of the culture of change and early evidence work that can pave way for the future in a real and meaningful way.

We don’t know what a Barnahus model will look like in Scotland yet. The standards we will be jointly developing with the Care Inspectorate will outline a blueprint for how these principles might be implemented alongside our legal system and what this might mean for NHS boards, staff, police, social work, justice, and someone going through this process. The standards will be applicable to any local or national body who might be involved in implementing a Barnahus model in Scotland, whether that is a physical ‘house’ or building, or a network with shared principles, given the geographical difficulties faced by some areas.

This work involves working with people and evidence from health, but also social services, the police, and justice (so I’m learning the intricacies of Scots law), child and human rights (I’m also learning bits of international law) and a whole host of support agencies, third sector organisations, and universal services.

What have we done so far?

On 19 June 2019, we held a day-long engagement workshop at the Raploch Community Campus. Fifty attendees from across a range of sectors, including health, justice, social work, and the third sector, came together to discuss what kind of model they would like to see introduced in Scotland, and what key principles underpinned it. We used the discussion from this workshop to inform what would be included in the standards (this is called the scope).

The discussion on the day was one of the most rich and varied I have ever seen. On my table, representatives from the police, social services, and academia were discussing how to teach children to recognise when they are being abused and feel safe to come forward; meanwhile, on the other side of the room, the justice representatives were engaged in a deep debate about the detail of the UN Convention on the Rights of the Child in relation to forensic interviews.

What have we found from the scoping exercise?

During this exercise, we found that many of the delegates had a shared understanding of what a Barnahus model meant, and in particular that the broad principles of fair justice, positive wellbeing, ongoing support, human rights, participation and child-centred designed were supported by a range of agencies. At the centre of all of this is the child’s needs, choices, and wellbeing. We use the phrase ‘trauma-informed’—for children and young people, this means that people who they come into contact with throughout their journey understand that they have experienced something traumatic, and that they may respond differently or need a different approach.

We found that many of the delegates had a shared understanding of what a Barnahus model meant, and in particular that the broad principles of fair justice, positive wellbeing, ongoing support, human rights, participation and child-centred designed were supported by a range of agencies. At the centre of all of this is the child’s needs, choices, and wellbeing.

What we learnt from this engagement exercise was that the Barnahus standards should stretch out far beyond children and young people who have experienced sexual abuse, to all children and young people who are victims or witnesses of violence. This was a significant step for us as a project team, as it means that not only are we widening the focus of the standards, but one of the recommendations from the report was that we complete a child rights and wellbeing impact assessment for the first time.

What will we do next?

Throughout the standards development process, the joint HIS and Care Inspectorate project team will continue to work with professionals and people with lived experience. A short life working group, known as the standards development group, will be formed to write the standards. The group will be made up of people from a wide range of organisations and sectors, including health, social work and justice, and co-chaired by leads from health and social care respectively. The standards development group will meet on a minimum of two occasions between August 2019 and December 2019.

As project officer on the development of the set of standards, it’s a privilege to be part of such a vital piece of work that will help change the experience of the child protection system for children who have experienced abuse.

In early December 2019, the Barnahus standards will go out for a 12-week consultation. I look forward to welcoming you all to comment, as we work to engage with groups from as far and wide as possible, to help shape the best standards for children in Scotland.

Please contact the project team at hcis.barnahus.standards@nhs.net.

Visit our website to read the scoping report.

Rachel Hewitt is a Project Officer with the Standards and Indicators Team at Healthcare Improvement Scotland.

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Tagged: children and young people, standards and guidelines

How equality and diversity can help create better care for all – Mario Medina

Posted on July 25, 2019

You might think equality and diversity has little to do with health and social care, and that complying with the Equality Act is just a tick box exercise that we all feel duty-bound to comply with. Yet I believe that these two factors are crucial in ensuring Healthcare Improvement Scotland’s work has impact, and that it truly improves health and social care for everyone in Scotland.

Assuming that a programme of work will lead to improvements for all, without trying to really understand the diverse needs of those we want to benefit from the work, can lead to us discriminating against individuals, as well as widening Scotland’s health inequalities gap. Moreover, it can be a sure-fire way to ensure that the aims of the project fall short of our intentions.

Assuming that a programme of work will lead to improvements for all, without trying to really understand the diverse needs of those we want to benefit from the work, can lead to us discriminating against individuals, as well as widening Scotland’s health inequalities gap.

As a health body, the Equality Act requires us to eliminate discrimination, advance equality, tackle prejudice and promote understanding across nine protected characteristics: age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex and sexual orientation. It’s a responsibility that we all share, particularly as each of us has at least five of the nine characteristics. That’s why it’s important to consider the potential impact of our work at the beginning of each project to ensure that it is set up in order to improve care for as many people as possible. To achieve this, a tick box exercise will fail all of us. To really bring about improvements for all of us, equality and diversity have to be factors that we wholeheartedly commit to.

But how exactly do we ensure that a genuine commitment to equality and diversity is built into our work? Let me give you some examples of strategies that have worked for us.

Our Standards and Indicators team considered how the new cervical screening standards might be received fairly by everyone. Potential issues were identified and action taken to engage with different groups who might be impacted, improving our understanding of how to address these issues. Engagement with minority ethnic people identified potential cultural barriers to accessing cervical screening. The standards therefore included a stipulation about the provision of good quality information and strategies that NHS boards can adopt to identify those most unlikely to attend. We also identified issues from the trans community and built that perspective into the standards to ensure assumptions would not be made based on gender when identifying those eligible for screening.

Due to this type of engagement with people whose views are often under-represented in decision-making processes, we were able to design and develop standards with equality and diversity at their heart.

But to ensure we’re factoring equality and diversity into everything we do, we also need to recruit and retain a diverse workforce. We’ve taken a number of steps to improve in this area. We’re part of the Disability Confident scheme, which helps employers recruit and retain disabled people. Each year we complete Stonewall’s Workplace Equality Index (WEI), a tool for employers to measure their progress on lesbian, gay, bi and trans (LGBT) inclusion. During Mental Health Awareness Week, our staff took part in See Me’s Pass the Badge campaign, which encourages people to talk about mental health. We’ve also successfully recruited Modern Apprentices to Trainee Administrative Assistant roles. These actions and initiatives have improved career opportunities for people from a broad range of backgrounds.

Due to this type of engagement with people whose views are often underrepresented in decision-making processes, we were able to design and develop standards with equality and diversity at their heart.

The real evidence of our commitment to equality and diversity came with the creation of the Margaret McAlees Award in collaboration with Unison’s Scottish Health Care Branch. Established in honour of our late colleague Margaret McAlees, a Unison steward renowned for helping advance equality and promoting diversity, the nominations highlighted some of the great work our staff are doing. Our SIGN guidelines development team promoted the rights of young people to be involved in decisions which affect them, and worked to ensure patient versions of guidelines were accessible for them. The team behind our Scottish Patient Safety Programme for Mental Health were nominated as early adopters of a human rights-based approach to their work and for their efforts to tackle mental health stigma and discrimination. The award winners, our Focus on Dementia team, demonstrated a commitment to improving the lives of people living with dementia over and above what could be expected of them, undertaking voluntary work and participating in fundraising events in their own time. This work has improved the wider public’s understanding of dementia and how it affects people’s lives.

As an improvement organisation, we’re always looking to do things better. That’s no different when it comes to equality and diversity. We don’t want to simply meet our duties, we want to exceed them. I’m delighted to be in a position where I can look back on excellent work that is making equality and diversity a key part of what we do, and also to support its further development.

Mario Medina is Equality and Diversity Advisor for Healthcare Improvement Scotland.

More information

Healthcare Improvement Scotland website

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Tagged: equality and diversity, ihub, impact campaign, standards and guidelines

How the Scottish perspective is helping combat antibiotic resistance in Ghana – Jacqueline Sneddon

Posted on July 9, 2019

Antibiotic resistance is a threat on a global scale. Protecting these vital medicines for the future is everyone’s problem, not just an issue for one country or continent. There’s little point in ensuring Scotland or even the UK carefully manages its antibiotic use if other countries don’t do the same. There are no boundaries to spread of resistant bacteria. One of the best ways to safeguard these vital medicines is through cooperation and learning from each other. That’s why I’m passionate about sharing the work the Scottish Antimicrobial Prescribing Group (SAPG) have undertaken over the last decade to safeguard antibiotics – and to learn from others’ experiences.

Antibiotic resistance is a threat on a global scale. Protecting these vital medicines for the future is everyone’s problem, not just an issue for one country or continent. There’s little point in ensuring Scotland or even the UK carefully manages its antibiotic use if other countries don’t do the same.

As part of this cooperative approach, we were recently awarded a global volunteering grant from the Fleming Fund’s Commonwealth Partnerships for Antimicrobial Stewardship (AMS). Our project, which will help develop antimicrobial stewardship in two Ghanaian hospitals, is one of 12 Commonwealth health partnerships supporting national antimicrobial resistance action plans in Africa. At its heart, the project aims to establish antimicrobial stewardship programmes as well as improving infection prevention and control practice, and building capacity and expertise in clinical pharmacy to Ghana. We are being joined on the project by health psychologists from Manchester University’s The Change Exchange, who will help us embed behaviour change within our interventions, ensuring work in both Scotland and Ghana is more sustainable and effective. During our initial scoping visit in May we saw some examples of good practice we’d like to emulate back in Scotland, as well as lots of areas where we could support improvements.

So what did I learn on our first visit? How lucky we are to have free healthcare and comprehensive community services in Scotland. Healthcare in Ghana is funded via a National Health Insurance Card costing $36 per year, covering consultations and medicines. Those without a card can access healthcare on a ‘cash and carry’ basis, paying for consultations and medicines when they need them. There’s also a social welfare system, although it appeared not to be accessed often, and sometimes hospital staff will pay for a patient’s treatment if the family can’t. There’s no community healthcare system, so community pharmacies play a major role in providing advice and medicines; they aren’t allowed to sell antibiotics but many do. Patients requiring medical advice attend a hospital out-patient department akin to our Out-of-Hours service, but they just turn up and wait to be seen. Services open at 6am and patients start queuing at 4am. If patients are admitted to hospital their family must provide much of their daily care, including bathing and feeding.

All government hospitals have Drug and Therapeutics Committees (DTC) and follow the national Standard Treatment Guidelines 2017, a 1400 page book laid out by clinical condition. Medicines guidance is dispersed throughout chapters and finding antibiotic guidance was challenging. Systems and processes within both hospitals were similar to those in the UK, but staff roles differed with less medical staff and nurses taking on what we would consider medical roles.

While our team will train up to 25 professionals in each hospital to deliver a local stewardship programme to ensure safe use of antibiotics, and establish point prevalence surveys to provide data on antibiotic use, our project very much takes a partnership approach. Using a ‘train the trainer’ approach and joint working on data collection will ensure that local staff can sustain stewardship activities after the project finishes.

At its heart, the project aims to establish antimicrobial stewardship programmes as well as improving infection prevention and control practice, and building capacity and expertise in clinical pharmacy to Ghana.

Daniel Afriyie, Director of Pharmacy at Ghana’s Police Hospital in Accra, and Israel Sefah, Chief Pharmacist at Keta Municipal Hospital, are lead partners for the project. The SAPG team, which includes pharmacists, nurses and Infectious Diseases Consultants, will bring leadership skills and knowledge back to their NHS boards through involvement in the project.

Next steps are for Daniel and Israel to visit Glasgow in August, attend a SAPG meeting, visit several hospitals and meet with colleagues at the University of Strathclyde. Our next visit to Ghana in October will focus on delivery of training at each hospital. Meetings with the Ministry of Health and the Pharmacy Department of the University of Ghana are also planned.

I can’t wait to go back and hope by undertaking this work we can make a difference to the global problem of antimicrobial resistance.

Jacqueline Sneddon is Project Lead for The Scottish Antimicrobial Prescribing Group.

More information

Visit the SAPG website for more on the work of The Scottish Antimicrobial Prescribing Group.

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How the patient voice helps identify technologies to stop cancer in its tracks – Claire Donaghy

Posted on July 3, 2019

rptoz Each year more than 3,700 people are diagnosed with bowel cancer, making the disease the third most common cancer in Scotland. It’s also the second biggest cancer killer in the country, with 1,600 dying every year. But it shouldn’t be: bowel cancer is treatable and curable, especially if diagnosed early.

As the Head of Scotland for Bowel Cancer UK, I work to ensure people affected by bowel cancer receive the best treatment and care available. It’s vitally important that any new technology is thoroughly researched and the evidence base reviewed before being introduced to the NHS. The work of the Scottish Health Technologies Group (SHTG) – part of Healthcare Improvement Scotland – ensures this happens, and that’s why I am proud to be involved with them as a Patient Organisation Representative.

To date, I’ve been involved in three different health technology assessments. Each one has been very different but all have the potential to improve the treatment and care people with bowel cancer receive.

To date, I’ve been involved in three different health technology assessments. Each one has been very different but all have the potential to improve the treatment and care people with bowel cancer receive. The first SHTG assessment I was asked to be involved in explored the use of robot-assisted surgery for some patients who have rectal cancer. While SHTG conducted the important task of reviewing the evidence of the technology’s effectiveness by looking at previous studies, they were keen to find out what’s most important to those diagnosed with rectal cancer to ensure their voice also played an important role in shaping the final advice. As a patient group that works closely with patients and their carers, Bowel Cancer UK were ideally placed to help.

In putting together our submission for the review, we wanted to demonstrate what outcomes patients would regard as benefitting them, and what information they would need to make an informed choice about robot-assisted surgery. To do this, we were able to use a combination of our existing knowledge and expertise, as well as gather additional patient views from a short survey we promoted online through our patient forum and social media channels. We found patients wanted fewer treatment-related side effects, faster recovery time and the ability to return to work more quickly. They also valued smaller scars as a result of the surgery, as well as knowing that an experienced team would be undertaking the surgery, plus more information generally about robotic surgery.

These responses helped us provide an informative patient organisation submission, which I presented to the SHTG committee. At the committee meeting itself, I felt the key points I presented were listened to, and that the contribution of Bowel Cancer UK was valued by committee members. The subsequent advice published by SHTG stated that robot-assisted surgery should be considered for some patients with rectal cancer who fit the agreed criteria. In those patients, there is evidence of a clinical benefit as it reduces the risks that come with open surgery.

We’re proud to know that we play a crucial role in shaping the final advice that will influence health policy and decision-making at local and national level that will promote an efficient, safe, sustainable, equitable and high-quality health system for all patients, not just those with bowel cancer.

In addition to the robotic surgery assessment, I’ve also provided peer review comments for two other assessments on behalf of Bowel Cancer UK. The first was to explore the introduction of the use of Colon Capsule Endoscopy for detecting bowel cancer or polyps, and found that this kind of technology may be considered as an option for some patients. The second was the use of PET-CT imaging in patients with anal cancer, which found that such imaging should be considered when assessing the stage of tumours.

We’re proud to know that we play a crucial role in shaping the final advice that will influence health policy and decision-making at local and national level that will promote an efficient, safe, sustainable, equitable and high-quality health system for all patients, not just those with bowel cancer. Working with SHTG to develop evidence and advice like this will help Bowel Cancer UK achieve our vision of a future where nobody dies from the disease.

Claire Donaghy is Head of Scotland for Bowel Cancer UK.

More information

Visit our website for more information on the work of the Scottish Health Technologies Group.

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Why we need to talk about dementia – Cesar Rodriguez

Posted on June 4, 2019

I have always felt very strongly that older people with mental illnesses suffer a double whammy in terms of stigma and discrimination. This is why I believe that it is extremely important to talk about the social changes and awareness required to make sure that older people are seen as a valued asset in our communities. However, it is also important to remember that not all those with dementia are what we may consider to be old. In Scotland there are around 3,200 people under 65 years of age living with dementia.

As a consultant in Old Age Psychiatry and Associate Medical Director for Older People, NHS Tayside, and National Clinical Lead (Psychiatry) for the Focus on Dementia Team, part of Healthcare Improvement Scotland’s ihub, my main interest has always been dementia care.

When my own mother was diagnosed with Alzheimer’s disease in her late-60s, this interest became not just the focus of my working life, but also very much part of my personal life. For the last 16 years, I have been a trustee at the Dementia Services Development Trust. This charity funds projects which aim to improve the experience of those living with dementia.

When my own mother was diagnosed with Alzheimer’s disease in her late-60s, this interest became not just the focus of my working life, but also very much part of my personal life.

The Trust recently funded the production of a short film called ‘We Need to Talk About Dementia, starring two well-known River City actors, Barbara Rafferty and Stephen Purdon. This is a unique project, which aims to aid conversations around some of the most challenging issues people can experience when diagnosed with dementia, and also highlights some of the issues families and carers may face when they are helping to look after loved ones.

Dementia Awareness Week (3-9 June)

During Dementia Awareness Week, (3-9 June), Healthcare Improvement Scotland’s Focus on Dementia team will show the film as part of their awareness-raising activities and to encourage continued conversations about dementia. Staff have been invited along to the organisation’s Glasgow offices (with popcorn!) to see the film, which I also have a small role in.

River City cast help raise awareness

In the film, Barbara Rafferty plays the part of a woman who has downsized her property to pay for her husband’s care home expenses due to the progression of his dementia, the demise of his health and the escalation of his anxiety, frustration and aggression. Stephen plays a painter and decorator who, through talking to Barbara, finds out how her husband’s dementia has impacted all aspects of both of their lives. It raises important issues and encourages conversation around the very real challenges faced by those diagnosed with dementia, and also families looking after loved-ones with this condition.

The film’s producer and director is River City’s Stuart Davids, who left his job to look after his own mother following a diagnosis of dementia. Having no prior knowledge of what dementia was, what care was needed or available, no experience of care homes, psychiatric wards or anti-psychotic medication or how to finance his mum’s care, Stuart felt challenged and isolated but determined to do the best for his mum. He then decided to use his skills and abilities to raise awareness, to inform and educate, and set out realistic expectations for other carers, family members and people living with dementia, and for what may lie ahead after diagnosis.

The film raises important issues and encourages conversation around the very real challenges faced by those diagnosed with dementia

It was a very new experience for me to be filmed, providing input as a psychiatrist talking about different aspects of dementia. My short role forms part of a series of interviews with key specialists who advise on the different arrangements and options that may need to be considered by carers, family members and people living with dementia to arrange for the best possible care and support for loved ones.

Challenging pre-conceptions can help to combat stigma

Even though this piece of work was part of my voluntary work, it is very relevant to the work we do within the Focus on Dementia team, which helps to raise awareness of the condition, to promote ways to live well with dementia but also to communicate that there are very difficult and very challenging aspects of the illness that need to be discussed. ‘We Need to Talk About Dementia’ touches on some of those difficult aspects.

Some excellent work is taking place to help to help support those with dementia, their families and carers. The improvement projects led by the Focus on Dementia team strive to help make the experiences of care and support for people with dementia and their families better.

Only by talking about dementia will we will be able to raise awareness and understanding and, in turn, challenge preconceptions, combat stigma and discrimination. I strongly believe that this is the way to achieve a more compassionate and caring society for all, but especially for older people, and those with dementia.

Cesar Rodriguez is a consultant in Old Age Psychiatry and Associate Medical Director for Older People in NHS Tayside. He is also the ihub National Clinical Lead (Psychiatry) for the Focus on Dementia Team

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How would you like to be treated after death? New standards for mortuary services – Professor Stewart Fleming

Posted on June 3, 2019

“How people die remains in the memory of those who live on.” Dame Cicely Saunders founder of the modern hospice movement 1918 – 2005

It is often said that the only certainty in life is death, but equally we can be sure that all of us will be touched by the loss at some point in our lives of a loved one. There are an average 230,000 – 250,000 people each year in Scotland who experience bereavement.

As a Professor of Cellular and Molecular Pathology and Director of the Centre for Forensic and Legal Medicine at the University of Dundee, I became aware of and lent my support to a campaign to improve the mortuary services in Scotland back in 2016. I have recently been Chair of the development group that has just published new draft standards for mortuary services in Scotland which are now open for consultation.

Why do we need standards?

It was due to the campaigning of the Whyte Family Trust that these standards are being developed. Maryan Whyte took action following the tragic death of her husband Frank, in a sailing accident in the Moray Firth in May 2016. Maryan and the family’s experience of the mortuary facilities, systems and practices was traumatic, they felt severely let down at a time when services should have been supporting them.

Maryan and the family’s experience of the mortuary facilities, systems and practices was traumatic, they felt severely let down at a time when services should have been supporting them.

Maryan did not want anyone else to go through a similar experience. Therefore, along with a group of committed people, started to campaign, not only to improve facilities and the whole mortuary procedures in Moray but throughout Scotland. With the support of her local MSP, Richard Lochhead, she took her campaign to the Scottish Government which subsequently convened a Mortuary Review Group which recommended in February 2018 that standards for mortuary services were developed by Healthcare Improvement Scotland.

The aim of standards is to define the model of care to be delivered by the mortuary services throughout the country, along with expected levels of service to support organisations to demonstrate that they are delivering a person-centred, safe and effective service.

Developing standards

Maryan and I have been working with colleagues from NHSScotland and local authority mortuary services, the Crown Office and Procurator Fiscal Service (COPFS), Police Scotland, universities, third sector organisations and Healthcare Improvement Scotland to develop these draft standards.

We want the public to be confident that a mortuary ensures dignity and respect for the deceased, comfort and support for those that have been bereaved and be a suitable working environment for professionals involved in care of the deceased and the investigation of death.

Although not everyone who dies will go to a mortuary, the standards will affect a large number of people. Almost half of all deaths in Scotland occur in hospital or other healthcare institutions, furthermore in 2017-18 there were 838 hospital post-mortem examinations and, of the 10,865 deaths that were reported to COPFS, 5,845 were instructed for post-mortem examination.

We want the public to be confident that a mortuary ensures dignity and respect for the deceased, comfort and support for those that have been bereaved and be a suitable working environment for professionals involved in care of the deceased and the investigation of death. The draft standards reflect these broad themes covering:

Leadership and governance
Dignified and respectful care of the deceased
Supporting the needs of people who are bereaved
Education, training and support for staff.

Can you help?

We must be sure that the standards reflect the views of the public as well as those that work in and with mortuary services, so please let us have your opinions and views. You can do this by completing the on-line survey.

Read the draft standards:
Healthcare Improvement Scotland website

Professor Stewart Fleming is Professor Emeritus of Cellular and Molecular Pathology at University of Dundee and Chair of the Standards Development Group.

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