Citizen Participation and Public Petitions Committee
Scottish Government submission of 22 September 2021
PE1894/A: Permit a medical certificate of cause of death (MCCD) to be independently reviewed
The death of a loved one is stressful at any time. When someone dies, it is crucial that services work together in a coordinated and appropriate way to reduce the burden on bereaved people.
The Death Certification Review Service (DCRS) was established on 13 May 2015 with the aims of improving the quality and accuracy of Medical Certificates of Cause of Death (MCCD); improving public health information about causes of death in Scotland; and improving clinical governance issues identified during the death certification review process. The statutory guidance, which is published by the Scottish Government, provides information on the key operational principles for the purposes of the Certification of Death (Scotland) Act 2011 and can be found here.
To achieve its aims, each year, DCRS, part of Healthcare Improvement Scotland, checks the accuracy of approximately 12% of all Medical Certificates of Cause of Death (MCCDs) in Scotland. In addition, DCRS carries out Interested Person Reviews in cases where questions or concerns about the content of an MCCD remain after an individual has spoken to the certifying doctor, or if questions or concerns occur at a later stage. The purpose of an Interested Person Review is to check the accuracy of the information contained in the MCCD.
It is important to note that DCRS does not review the quality of care provided to the deceased prior to their death, neither does DCRS have any role in reviewing deaths where the cause of death of the deceased person has been (or is being) investigated by the Procurator Fiscal.
Investigating the quality of care that someone received prior to their death is the function of the clinical governance processes in health boards. Where an individual has a concern about the quality of care the deceased received, it is the role of the relevant health board to address and investigate the concerns about the care provided by them. The individual can also approach the Ombudsman if they are not satisfied by the processes followed by the health board.
Medical doctors are expected to report only certain deaths to the Crown Office and Procurator Fiscal Service (COPFS). The circumstances on which a death must be reported to COPFS can be found in sections 3 and 4 of Reporting deaths to the Procurator Fiscal Information and Guidance for Medical Practitioners.
COPFS is responsible for the investigation of all sudden, unexpected and unexplained deaths in Scotland. When a death is investigated by COPFS, in many cases the MCCD is provided by a pathologist, an independent doctor and specialist in causes of death. Where a medical practitioner is willing to certify a cause of death, the Procurator Fiscal will only permit that after having carried out whatever investigations are considered appropriate. It is for COPFS to decide which deaths it investigates and in how much detail, when a death is reported under the specified categories.
The role of the procurator fiscal in Scotland was not altered by the establishment of the Death Certification Review Service. The recommendations of the Burial and Cremation Review Group, chaired by Sheriff Brodie, were taken into account when developing the Certification of Death (Scotland) Act 2011. Section 17 of the report, available here, explains some of the rationale relating to the integration of any new procedures with the COPFS procedures and legislation – “The Group acknowledged that any new death certification or procedure must integrate fully and easily into the relevant legislation and the current COPFS procedures as set out in the COPFS Book of Regulations, which is constantly under review.”
The Procurator Fiscal undertakes their own review and determines whether or not the case warrants further investigation. Given that COPFS is independent and has the responsibility to investigate these cases, it would not be appropriate for DCRS to review MCCDs in cases already investigated by COPFS.
As noted above, it is not the role of DCRS to review or investigate the care provided to an individual prior to their death. The systems and process for investigating such matters are provided within the clinical governance processes of the relevant health board. When a death is investigated by COPFS, it is for COPFS to determine the level of investigation required in each specific case and it would not be appropriate for DCRS to review cases already investigated by COPFS.
The Scottish Government does not intend to amend the Certification of Death (Scotland) Act 2011 Act to enable DCRS to review cases previously investigated by COPFS.