The Birmingham Bereavement Project

1. The Birmingham Bereavement Project Dr Dawn Chaplin Project Director

2. 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

3. The end of life and Bereavement journey

4. Baseline Activity – ‘Task’ Focussed why we aimed to do it Focus Ascertaining cause of death: natural, unnatural Focus Formal registration of death and issuing application documentation for disposal Focus Issuing documentation MCCD / Cremation paper return belongings Focus Arrangement and disposal of deceased person by burial / cremation Focus Support for bereaved person HMC Focus The living / ill patient Funeral Directors Death Certification Bereavement Support Register Office Place of Death • Seen as paternalistic. • Critical. • Authoritarian. • ‘Something must have • gone wrong’. • 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. • 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

5. National Working Alliance for Bereavement The Bereavement Care Project Model Stakeholder Organisations Education & Training National Institute for Health Research Bereavement & It’s Impact on the Immune System Voluntary Bereavement Organisations HEFT UHBSHA Bereavement Research Forum Military Project Development of Bereavement Services in Acute NHS UK Written Information Verbal Information Signposting & Handing Over Faith Advocacy Group Early Adopter for Improving Death Certification Bereavement Website & Helpline Partnership Working Research into Funeral Payment Scheme Downloadable Digital App AR Code Conferences Research to provide evidence based practice Bereavement in the Abrahamic Faiths Co-ordination Consistent & Appropriate Information Bereavement Follow Up Service Route to Success Early Adopter Programme for Improving the Process of Death Certification Bereavement Care Policy HM Coroner and Coroner Officer Representative SHA / Cluster Representative When A Person Dies Early Adopter Programme Medical Examiner & Officers Bereavement Lead for Trusts Cemetery & Crematorium Representative (Council) Faith Advocacy Group Representative End of Life Care Strategy Early Adopter Personal Care After Death Care Compassion Workshops Effective Communication Key Performance Indicators Policies, procedures, standards, legislation Steering Group Funeral Director Common Goal / Vision Death Certification Review R&D Lead End Of Life & Bereavement Bands 1-4, 5, 7, 8 Bereaved Relative (Lay Representative) NICE Quality Markers Project Director Jr Doctor Training with Medical Examiner Symposia Equality & Diversity Representative Education & Training Clinical Governance Risk Representative With care and compassion delivering a high quality service to bereaved people Virtual World Training Rapid Referral (Staff & Relatives) CRUSE Bereavement Care Bereavement Support Organisation Early & Appropriate Intervention Education and Training Lead (Link to Academic Institution) Gold Standard Framework Bereavement Follow Up Service End of Life & Palliative Care Representative Rapid Response Support Team (TRIM) Co-operation Centralised Bereavement Care Services Consistency Appropriate Environment GHH Bereavement Suite Early Intervention following Complaints Nurse Led Bereavement Level 4 Service Community Support Groups Bereavement Support Feedback MEO / ME Function Voluntary Bereavement Support Organisations Bereavement Questionnaires Risk Identification Faith Advocacy Groups Complaints Compliments

6. 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/

7. 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

8. 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

9. 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

10. 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

11. 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

12. Next steps • Advisory group – with exec level leadership • Key is sustainability - Early Adopter • Close working relationships will continue • National Working Alliance for Bereavement

13. Coming together is a beginning, keeping together is progress, working together is success Henry Ford

14. Improving the Process of Death CertificationRuth O’Leary Lead Nurse Bereavement Services

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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