The Birmingham Bereavement Project
Dr Dawn ChaplinProject Director
Background to Project (What we aimed to do)
• 2 year joint funded project UHB/ HEFT /SHA Aim: to develop and test a model of
bereavement care across a range of services to provide an integrated and seamless service for bereaved people
The end of life and Bereavement journey
Baseline Activity – ‘Task’ Focussed why we aimed to do it
Place of DeathDeath
Certification
HMC
Register Office Funeral
DirectorsBereavement
Support
FocusThe living / ill
patient
Focus Issuing documentation
MCCD / Cremation paper return belongings
Focus Ascertaining cause of
death: natural, unnatural FocusFormal registration of death
and issuing application documentation for disposal
FocusArrangement and disposal of deceased person by burial /
cremation
Focus Support for
bereaved person
• Mixed quality of bereavement information available.
• No standardised specific training on EOL / bereavement / individual requirements.
• Little formal training on death certification.
• Death seen as failure.
•Bereavement care seen as someone else’s responsibility.
• General Office / Medical Records Officer ‘add on’ to day job.
• Little formal customer care.
• No formal training / pick up on job.
• Large responsibility: hospital funerals, patient finances, valuables, legal aspect.
• Seen as paternalistic.
• Critical.
• Authoritarian.
• ‘Something must have gone wrong’.
• Legal requirements.
• Document focussed.
• Drop in Service
• Variation in service provided.
• Disposal of deceased remains
• Not easily accessible.
• Not readily available.
• Not known about.
• Not always appropriate
Confe
renc
es
Wor
ksho
ps
Sym
posi
a
Partnership Working
Research
to provide evidence
based practice
Policies, procedures,
standards, legislation
Ear
ly &
App
ropr
iate
Inte
rven
tion
Bereavement Support
Feedback
Centralised Bereavem
ent
Care Services
Education &
Training
Effe
ctiv
eC
omm
unic
atio
nCon
sistent
&
Appro
priate
Infor
mation
Co-ordination
Com
passion
Consis
tenc
yCo-operation
Car
e
Faith
Advocacy
GroupFaith
Advocacy
Group
HEFT
UH
B SH
A
HEFT
UH
B SH
A
Voluntary
Bereavement
Organisations
Voluntary
Bereavement
Organisations
Military
Project
Military
Project
StakeholderOrganisationsStakeholderOrganisations
Education & TrainingEducation & Training
National Working Alliance for BereavementNational Working Alliance for Bereavement
Written
Information
Written
Information
Verbal Information
Signposting & Handing Over
Verbal Information
Signposting & Handing Over
Bereavement Website
& Helpline
Bereavement Website
& Helpline
Downloadable
Digital AppAR Code
Downloadable
Digital AppAR Code
Bereavement Follow
Up Service
Bereavement Follow
Up ServiceEarly Adopter Programme Medical Examiner & Officers
Early Adopter Programme Medical Examiner & Officers
Steering Group
Steering Group
End Of Life & Bereavement
Bands 1-4, 5, 7, 8
End Of Life & Bereavement
Bands 1-4, 5, 7, 8
Jr Doctor Training with Medical
Examiner
Jr Doctor Training with Medical
Examiner
Virtual World TrainingVirtual World Training
Gold Standard Framework
Gold Standard Framework
Appropriate
Environment GHH
Bereavement SuiteAppropriate
Environment GHH
Bereavement Suite
Nurse Le
d
Bereavement Level 4
ServiceNurse Le
d
Bereavement Level 4
Service
RiskIdentification
RiskIdentificationBere
avem
ent
Questi
onna
ires
Bere
avem
ent
Questi
onna
ires
ComplaintsCompliments
ComplaintsCompliments
Faith
Advocacy
Groups
Faith
Advocacy
Groups
Voluntary
Bereavement
Support
Organisations
Voluntary
Bereavement
Support
Organisations
Community
Support Groups
Community
Support Groups
Early Intervention
following Complaints
Early Intervention
following Complaints
Rapid Response
Support Team (TRIM)
Rapid Response
Support Team (TRIM)
Bereavement Follow Up Service
Bereavement Follow Up Service
Rapid Referral (Staff & Relatives) CRUSE Bereavement Care
Rapid Referral (Staff & Relatives) CRUSE Bereavement Care
Bereavement
Care PolicyBereavement
Care Policy
Early
AdopterEarly
Adopter
Key
Performance
Indicators
Key
Performance
Indicators
Route to SuccessRoute to Success
When A Person DiesWhen A Person Dies
Death
Certification
Review
Death
Certification
Review
Personal
Care
After
Death
Personal
Care
After
Death
NICE Quality
MarkersNICE Quality
Markers
End of Life Care Strategy
End of Life Care Strategy
Bere
avem
ent &
It’
s Im
pact
on
the
Imm
une
Syst
em
Bere
avem
ent &
It’
s Im
pact
on
the
Imm
une
Syst
emDe
velo
pmen
t of
Bere
avem
ent
Serv
ices i
n Ac
ute
NHS U
K
Deve
lopm
ent o
f
Bere
avem
ent
Serv
ices i
n Ac
ute
NHS U
K
Bereavement Research Forum
Bereavement Research Forum
Early
Ado
pter
for
Impr
oving
Dea
th
Certi
ficati
on
Early
Ado
pter
for
Impr
oving
Dea
th
Certi
ficati
on
Bereavement in
the Abrahamic
FaithsBereavement in
the Abrahamic
Faiths
Researc
h into
Funeral
Paymen
t
Scheme
Researc
h into
Funeral
Paymen
t
Scheme
National Institute for Health Research
National Institute for Health Research
MEO / ME Functi
on
MEO / ME Functi
on
HM Coroner and
Coroner Offi
cer
Representative
SHA / Cluster
Representative
Faith
Advocacy
Group
Representative
Equality &
Diversity
Representative
R&DLead
Bereavement
Support
Organisation
End
of L
ife &
Pa
lliati
ve C
are
Repr
esen
tativ
e
Bere
avem
ent L
ead
for T
rust
sCe
met
ery &
Crem
ator
ium
Repr
esen
tativ
e
(Cou
ncil)
Funeral Director
Bereaved Relative (LayRepresentative)
ClinicalGovernance Risk Representative
Education and
Training Lead
(Link to Academic
Institution)
Common Goal / Vision
With care and compassion delivering a high quality service to
bereaved people
Project Director
Pilots and work streams – Outcomes• Bereavement care and support (carers and staff) Follow up service Fast track support Community support involvement Military project (Teresa Griffiths) MEO service• Training and Education Multi disciplinary/ Multi professional/ Medical
Examiner role/
Pilots and work streams – Outcomes• New technologies Website and help line Digital Birmingham ‘app’ and QR code virtual training (Maggie and Soulla)• Working in Partnership Faith Advocacy Group Local hospice (Nikki and Jo) Cruse and other support agencies Early Adopter working group Child Sudden Death Conference
Pilots and work streams – Outcomes
• Research and Development Effects of bereavement on immunity; Early
Adopter; Development of acute bereavement services in the UK; Research into funeral payment ….and many more opportunities
• Check list for all service providers • Exec summary of the project will be available
Benefits
For Bereaved people
• Better care for dying deceased person and the carers
• Improved communication with, and feedback from, bereaved carers. People feel ‘listened’ to and their comments acted upon
• Integrated systems providing the right support at the right time by the right people
Benefits
For Service providers
• Access to appropriate training and education • Closer working relationships and two way channels
of communication • Understanding the significance of each role and
associated responsibility along the journey• A multi professional forum for bereavement service
representatives to inform, support and share good practice
Benefits
For organisations
• Appropriately trained and supported staff • Key performance indicators demonstrating that high
quality care is being delivered• Streamlining existing resources to provide high
quality, cost effective, person focussed bereavement care services
• A model that demonstrates how a seamless system can be implemented and sustained
Next steps
• Advisory group – with exec level leadership• Key is sustainability - Early Adopter• Close working relationships will continue• National Working Alliance for Bereavement
Coming together is a beginning,
keeping together is progress,
working together is success Henry Ford
Improving the Process of Death Certification
Ruth O’Leary Lead Nurse Bereavement Services
Background• Process unchanged since 1935
• Shipman Enquiry (2003)
• Existing arrangements were confusing
• Inadequate safeguards
• Government Response – ‘Learning from tragedy, keeping patients safe’ (2007)
• Consultation on Improving the Process of Death Certification
• Coroners and Justice Act 2009
•
Current System• Different processes for cremation and burial
• Coroners Officers / Bereavement Officers provide advice to doctors re
cause of death
• Patients examined for cremation
• No medical examination for burials
• Medical Certificates – variable quality of completion
• Causes of death sometimes imprecise
• Coroners may not be notified about the right deaths
Reasons For Change• Create single unified system
• To strengthen current arrangements
• Improve Quality & Accuracy of Causes of Death
• Provide equity of service – Cremation / Burial
• Increase communication with bereaved
• National implementation 2014
Process
• As part of the Birmingham Bereavement Project
• Commenced April 2012
• UHBFT/HEFT both have centralised Bereavement Service
• Pilot - ALL deaths
• Cremation forms still required, legal requirement
• Introduction of Medical Examiner role – senior doctors
• Introduction of Medical Examiner’s Officer – Bereavement Officers
• Training and Education
Medical Examiners (ME)
• Scrutinises the notes to find Cause of Death• Speaks to referring team and check consistency with notes • Agrees Cause of Death – referring team completes Medical
Certificate (inc Cremation Forms)• ME completes forms for Register Office and medical notes• Views the patient• Ensures Cause of Death is sufficiently precise• Authority to challenge doctors / refer to Coroner if
appropriate
• Straight forward Coroners referrals are outside of this process
Medical Examiner’s Officers (MEO)
• Bereavement Care Officers at UHBFT / HEFT
• Speak to relatives and co-ordinate process of Death Certification
• Once determined, will provide relative with Cause of Death
• Arrange collection of Medical Certificate by appointment
Benefits For Relatives• Simpler process
• Open and honest conversation regarding Cause of Death
• Easier to Raise Concerns
• Confirmed Cause of Death
• Transparency and Understanding of Cause of Death
• More Engagement with the Family by Medical Examiners Officers
• Improved Quality of Certification
Findings To Date• Beginning of the journey• Need to have robust rota of Medical Examiners• Cremation Form payments are now used within the new
process• Relatives value knowing and being able to discuss the Cause
of Death• No delays in families receiving Medical Certificates• Out of hours