Policy responses and statements
- Name of organisation:
- Department of Health,
Social Services and Public Safety (DHSSPS)
- Name of policy document:
- Review of Death Certification in Northern
- Deadline for response:
- 11 March 2011
Background: The purpose of this consultation
document was to set out recommendations to improve the current process
for certifying deaths in Northern Ireland, and to invite views on the
proposed options for future arrangements for death certification here.
For over sixty years the death certification process in Northern Ireland,
England, Wales, and Scotland has remained largely unchanged. In 2003,
however, the 3rd Report of the Shipman Inquiry concluded that arrangements
for death registration, cremation certification and coronial investigation
in England and Wales had failed either to deter Dr Harold Shipman from
killing his patients or to detect his crimes after they had been committed.
The Luce Review, also published in 2003, and which extended to Northern
Ireland, also made recommendations to improve death certification processes.
In 2009, an inter-Departmental Working Group was established to make
recommendations on improving death certification arrangements. It involved
representatives from three Departments (DHSSPS, DFP, DOE) as well as
a range of organisations with a particular interest or involvement
in post-death procedures. The Working Group reported to an inter-Departmental
Steering Group, jointly chaired by the Chief Medical Officer and the
Registrar General for NI.
The changes are designed to ensure that arrangements for certifying
deaths are consistent and fair to all bereaved families and are sufficiently
robust to inspire public confidence and to prevent any potential abuse
by unscrupulous individuals.
DEPARTMENT OF HEALTH, SOCIAL SERVICES AND PUBLIC
REVIEW OF DEATH CERTIFICATION IN NORTHERN IRELAND
The Royal College of Physicians of Edinburgh is pleased to respond
to the DHSSPS on its consultation on the Review of Death Certification
in Northern Ireland.
The College sought comments from four of its expert Fellows in Northern
Ireland. All respondents commented that the current system for
the certification of death in Northern Ireland could be improved. All
respondents agreed that raising the standard of certification and improved
monitoring would be important in maintaining public confidence in the
The document proposed two models for future death certification arrangements
in Northern Ireland.
The first model essentially continues current arrangements but with
enhanced training and surveillance. Three of the four respondents
preferred this option, perhaps followed by further consideration of
the alternative outlined in option two at a future date. One
respondent felt that option one would not meet the major recommendations,
but also had concerns about option two with concerns expressed that
it was not a single system and that scrutiny arrangements could still
The respondents who favoured option one did so because it would be
relatively cost neutral and would not delay the time between death
and interment, which is important for patients in Northern Ireland
who are buried quickly after death. One respondent commented
that any new governance procedures that would be deemed mandatory should
be adequately resourced, but it was not clear from the documentation
that this was the case. Further, it was not at all clear that
either option would enhance detection or reveal situations when medical
errors or incidents of misconduct or neglect directly contributed to
the death of the patient.
Option two involves the introduction of option one and the addition
of the establishment of a new post of medical examiner. The respondents
would generally welcome the opportunity to avail themselves of the
support of a medical examiner. However, there were concerns expressed
in relation to the estimated costs of establishing the service and
the proposal to finance these costs by charging a fee for certification
of all deaths. There were further concerns about inevitable delays
in completion of death certificates, especially during out-of-hours
and at weekends given the shift pattern of medical working. One
respondent referred to an additional work load which may not be properly
resourced, especially if clinicians were required to provide reports
for review by the medical examiner.
One respondent would have welcomed scrutiny of a sample of death
certificates, especially in circumstances where concerns had been raised. This
appears to be the preferred model of the working group considering
this issue in Scotland.
Whilst most respondents favoured option one, none ruled out further
consideration of option two at a future date. Given the current
political and financial climate and with the inevitable delay in certification
of death and the introduction of what may be perceived as a universal “death
tax”, it may be difficult to attract sufficient public support
to allow immediate implication of option two.
Copies of this response are available from:
Royal College of Physicians of Edinburgh,
9 Queen Street,
Tel: 0131 225 7324 ext 608
Fax: 0131 220 3939
[8 March 2011]