Funerals: Death Certificate Delays

Question

11:17:00

Asked by

To ask His Majesty’s Government what steps they are taking to reduce reported delays in holding funerals because of changes in the provision of death certificates.

My Lords, the death certification reforms are increasing scrutiny of deaths and patient safety, and supporting the bereaved. We are taking steps to reduce the time to register a death, through active monitoring of the reforms, using weekly data from the ONS to target the challenges and the necessary support. We are also working with faith groups and the funeral sector to identify and reduce any obstacles, and sharing any concerns we receive with NHS England so that they can be swiftly resolved.

I thank my noble friend for that Answer. When my dad died—incidentally, he was born 100 years ago today—it was possible to arrange his funeral in two weeks. That is not now possible. I have talked to the National Association of Funeral Directors, and I understand that there is a lot of confusion around the country about the new procedures, although everyone understands why they are there. Is there more that could be done in hospitals or by GPs to help families who are having to cope with the unfamiliarity of the new procedures at the time of their own grief? More widely, might it be possible for the Government to start considering regulating the funeral profession, as has happened in Scotland?

I am sure that we all wish to pay tribute to the memory of my noble friend’s late father. I appreciate the points that he has made. It is not the case that delays to funerals can be identified and formally linked with the changes in death certification. My noble friend raised a lot of points, many of which are valid. In a bereavement, it is more important than ever that any official processes—as well as the funeral sector itself—work as seamlessly and sensitively as possible. I assure my noble friend that not only are we driving improvement by implementing the death registration reforms but we are very focused on supporting the bereaved. On my noble friend’s point about regulation, I am not aware of any plans at present.

My Lords, to solve a problem, first you have to accept that it exists. Everyone involved in funerals, from the GPs doing the certification to the funeral directors, say that there is a direct link between the extra time to deal with funerals and the reforms. The reforms were needed, but can the Minister clarify the number of medical examiners required in each region—because regional variation exists—to prevent lengthy delays in funeral arrangements? What assessment have the Government made to ensure that the current number of medical examiners is sufficient to meet regional demand?

I do not have the figures to hand, but I would be very pleased to write to the noble Lord. As I said, this is a complex area. The reforms were introduced in September, and it is very difficult to make before and after comparisons. Since 2001, a long-term trend has shown an increase in the median time between death and registration, and that cannot be attributed to death certification reforms. In addition, the reforms are about the introduction of statutory medical examiners as opposed to the non-statutory arrangements that existed before—and there was even more regional variation before September than we are finding now. I assure your Lordships’ House that I am working very closely with officials to understand the reasons for this so that we can take more action.

My Lords, I thank the noble Viscount, Lord Stansgate, for the conversation we had about this Question. As we all know, when a loved one passes away, it is a distressing time, and surely delays can only add to that distress. I am sure that noble Lords understand why these reforms were brought about in the first place: they were introduced after a qualified doctor, Harold Shipman, murdered his patients and signed the death certificates himself. In a recent Written Answer on these delays, the Minister for Public Health in the other place said: “The expectation on doctors and medical examiners is clear … they should complete certification as quickly and efficiently as possible, and the Government is working with all stakeholders to make sure this is the case”. Can the Minister explain to your Lordships what that means? Is the department simply asking them to complete the certificates, or is it identifying blockages or misunderstandings in the system to help unblock them in order to speed up the process?

The noble Lord’s observations are correct. As I said, it is so important to be timely and sensitive at a time of bereavement. Governments and Ministers have been working to bring in the system over the last 50 years—in fact, it has been overdue for reform for that long, so I am very glad to have taken this action. Introducing this robust system means working with medical examiners as well as the bereaved, so that we hear from them about what has happened. We also work very closely across government, including with the MoJ and the Home Office. As the noble Lord will know, the medical examiner system is led by NHS England through the office of the National Medical Examiner. I reiterate that delays are not due solely to this introduction; it is very important to unpick this issue. We now have better data and get weekly reports, which is helping greatly.

My Lords, at the Commission on Palliative and End-of-Life Care, chaired by Professor Sir Mike Richards, we have heard from medical examiners and the bereaved. It is clear that the ability for the bereaved to speak to a medical examiner and go through things in detail is very supportive. However, the delays in notifying the cause of death and transferring the case notes seem to be from the doctor who had seen the patient. The medical examiner cannot start until both those events have happened, and at that point their work begins. So the increasing digitalisation of the health service and of notifications could speed up these processes. Does the Minister agree that the digitalisation proposals from the noble Lord, Lord Darzi, will bring about those changes and simplify the process?

I agree that those changes—the move from analogue to digital, which will be outlined in the 10-year plan—will indeed help in this area, as well as many others.

My Lords, clearly, this is a complex and difficult issue, and there does not seem to be any one reason why these delays have started to extend. Can the Minister tell the House whether there are any financial implications for people who have to wait much longer for a funeral to be arranged, given that they are not cheap to begin with?

I am not aware of the specifics around that point, but we will be very pleased to look into that because we do not want people to be inconvenienced and distressed even further.

My Lords, the Minister will know that, in the Jewish community, we bury our deceased within 24 hours. I have not noticed any change in that since September—so perhaps that fact will help her.

I am grateful to the noble Lord. He is of course aware that, as the former chief executive of the Board of Deputies of British Jews before coming to this place, I worked on this very area to ensure that there were swift responses and burials for the faith communities that require them. That continues to be a great focus of our work.

My Lords, in Northern Ireland, the practice is that funerals are held three days after death. Does the Minister think that anything can be learned from that?

We are always happy to learn from the practices of other Governments, and we will continue to work on speed and, as I said, to keep distress and delay at a minimum.

My Lords, I point to my entry in the register of interests as an Anglican priest. I am particularly glad that my noble friend the Minister mentioned the challenges for faith communities and the important role that ministers of religion have not only in conducting funerals but in supporting families with grief and loss. Obviously, a delay to those things can cause family stress and tension. What are the Government doing to engage Muslim communities, which particularly feel the stress and pressure of this issue given their obligation to have swift funerals?

I pay great attention to this area, as I mentioned in my response to the noble Lord, Lord Polak. I met faith group leaders in December, and we have worked very closely with faith groups to develop the medical examiner system. The faith groups are very supportive of the reforms, have broadly welcomed the implementation and continue to work with us to identify any issues, for which I am very grateful. Data from regional medical examiner offices in England, although unpublished, indicate that 88% of requests for urgent scrutiny—the group we are talking about in the faith communities—were met. Indeed, in Wales the corresponding figure has been assessed to be 99%. I assure all noble Lords that we are working extremely hard to make sure that the system reduces any unnecessary delays, and we will continue to do so.