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