Support following a bereavement

Patient affairs

The patient affairs office will aim to call you by midday on the first working day after the death of your loved one. They will explain the process at the hospital and what will happen before the medical certificate of cause of death (MCCD) is issued for registration of the death. They will also offer practical advice on matters such as the collection of your loved one’s belongings and contacting a funeral director.

The patient affairs officer will explain the medical examiner’s involvement and also ask you some questions to ensure we have accurate information. This also gives you an opportunity to let us know if you have any requirements we need to consider.

Management of the bereavement pathway will depend on the circumstances leading up to, and the cause of, your loved one’s death, so some of the information provided may not be applicable to you. The patient affairs officer will explain the relevant information sections and will be your point of contact. Please follow the advice given by the patient affairs officer. 

While every effort is made to issue paperwork promptly, sometimes there are unavoidable delays; this process normally takes 48 hours to complete but may be longer, if the coroner is involved, for example. Once this is ready, a member of the team will call you and let you know that the medical certificate of cause of death (MCCD) has been sent to the registrar.

The gov.uk website also provides practical information on what to do following a death.

Out of hours service, weekends and bank holidays

In certain circumstances, your loved one’s body can be collected from the hospital out of hours (outside Monday to Friday). If there are religious or legal reasons, the hospital may be able to issue the death certificate. Please tell the ward staff/doctor who will be able to contact the site nurse practitioner for advice. 

Please note: 

• the register office offers a reduced service out of hours to issue the certificate for burial or cremation
• hospital staff will be unable to release your loved one’s body out of hours if it is likely that the death will need to be referred to the coroner’s office

Paying your respects

When your loved one has died, the ward concerned may be able to allow you to spend some time with them before they are transferred to the care of the hospital mortuary. You will then be able to liaise with your funeral director to make arrangements for relatives to see the deceased in their place of rest, if needed.

Medical examiner service

Deaths that occur within our hospitals are reviewed by the medical examiner service. This independent service aims to:

• confirm your loved one’s cause of death
• ensure that appropriate referrals are made to the coroner, and 
• notify the Trust of any significant concerns about the care given 

If your loved one’s death is not being referred to the coroner then the service will contact you and advise you of the proposed cause of death that will be written on the medical certificate. You will be able to ask questions, clarify the cause of death and discuss the care given. If you don’t understand any of the information we give you please tell us.

You can find out more about the medical examiner service here.

Coroner's referrals

Coroners investigate all deaths where the cause is unknown, where there is reason to think the death may not be due to natural causes, or which need an inquiry for some other reason. The Trust has a legal duty to report any death that meets the coroner’s referral criteria. The patient affairs or medical examiner’s officer will tell you if the death of your loved one has to be referred.

The coroner will investigate each case in an appropriate way. It may be as simple as consulting with the doctor who last treated the person who has died, or a post mortem examination may be needed. 

In some cases, the coroner may open an inquest, which is a judicial inquiry into the death. Coroners have the power to have a body brought into the public mortuary and keep it there while they carry out investigations.

For further advice please visit the gov.uk website.

Hospital post mortem examination and biopsies

The hospital doctor may ask your permission to perform a post mortem examination, to help you and clinical staff to understand your loved one’s illness in greater detail or to help increase medical knowledge. Alternatively, you and your family may ask for this service yourselves.

If you decide to proceed with a post mortem examination, the doctor will discuss it with you, explain what is involved and ask you to sign a consent form. The consent form states the nature and extent of the post mortem examination, and your explicit permission is needed for retention of any organ or tissue for any purpose.

You can discuss your options with the patient affairs officer or contact imperial.postmortem.services@nhs.net. They will be able to provide you with further information about this process.

Chaplaincy service

The hospital chaplaincy service can offer support to all. They will be able to help you contact the most appropriate representative for your needs.

If you are feeling distressed and think it would help to have a chaplain alongside you, please contact our chaplaincy team. 

Appointing a funeral director

Within 48 hours of your loved one’s death, you will need to contact the funeral director that you wish to use. If you do not have a funeral director, you can find an industry-inspected one via the following websites:

• The National Association of Funeral Directors
• The National Society of Allied and Independent Funeral Directors

When selecting a funeral director, you can contact more than one company and ask for details of their charges and the services they provide before making your selection.

The funeral director will make arrangements for relatives to see the deceased in their place of rest if this is needed. Please let the bereavement team know if the funeral service is to be a burial or cremation so that the relevant documents can be completed.

The registrar will also need your funeral director’s details so they can send them the Green Certificate for the purposes of burial or cremation.

Registering a death

Who can register the death?

A relative should register the death. If a relative cannot register the death, the informant (person registering the death) must meet the following criteria:

• they were there at the time of death
• they are an administrator from the hospital (if the person died in hospital)
• they are in charge of making funeral arrangements
  
  

How to register a death

To get a death certificate, your loved one’s death needs to be registered. You will have to attend the register office in person to register the death. The patient affairs office will tell you once the medical certificate has been sent to the register office so you can book an appointment. You can buy death certificates when you register.

Further details about how to get the certificate can be found from your local council.

The register office will issue the form for burial or cremation – this needs to be forwarded to your appointed funeral director. 

The death needs to be legally registered within five working days (not counting weekends). This period may be extended in certain circumstances, for example, if the coroner has been consulted. 

When you attend your registration appointment, you will need to tell the registrar:

• your loved one’s full name at the time of death
• any names previously used, e.g. maiden name
• their date and place of birth
• their last address
• their occupation (job)
• the full name, date of birth and occupation of a surviving or late spouse or civil partner
• whether they were getting a State Pension or any other benefits
  
  

The registrar will ask you how many copies of the certificate you need. You must pay for all copies. You may need a copy of the death certificate for the will and for any pension claims, insurance policies, savings certificates, premium bonds and banks or building societies. 

Tell Us Once service

The register office will also tell you about the Tell Us Once service which enables bereaved relatives to inform a range of government departments that a death has occurred, either with a single phone call or by using a dedicated, secure website. The system covers both local and national government departments, including pensions and benefits, tax, council tax, passports, driving licences, blue badges and others.

During the registration process, the registrar will log some details on the Tell Us Once system, and give you a sheet with a unique reference number on it, together with contact details for the Tell Us Once team. You will then have 28 days to either telephone or use their website to complete the process and send notifications to the relevant organisations.

If you choose not to use Tell Us Once, the information the registrar has entered will be automatically removed from the system after 28 days. The system is completely secure and information is only shared with your consent.

Funeral arrangements

It is important to confirm if your loved one made any arrangements or left instructions in a will for their funeral. You should check to see whether they had a prepaid funeral plan.

Repatriation (burials abroad)
If you wish to repatriate your loved one’s body – for example, move them to another country (including Scotland, Wales, Northern Ireland and the Republic of Ireland) – it is vital that you discuss this with the register office and also your chosen funeral director, as various additional papers have to be issued. 

Most commonly, a Free From Infection (FFI) certificate has to be issued by the hospital, and an Out of England Order, which must be issued by the coroner’s office.

Paying for the funeral
The cost of the funeral can vary. It is usually met from the assets of the person who has died, but if there is no estate, the cost may be the responsibility of the person making the funeral arrangements. 

You can discuss ways of reducing the costs with the funeral director. If you receive certain benefits, you may be entitled to help with the cost of the funeral. You can apply using form SF200 Funeral Payment from the Social Fund. You can also get a copy from your local Department for Work & Pensions (DWP) office. Alternatively, please discuss this with the patient affairs office.

People and organisations to contact

Beyond immediate family and friends, the following checklist will give you a starting point for people and organisations you will need to tell about the death of your loved one.

• Bank/building society
• Credit card companies
• Royal Mail
• Department for Work and Pensions
• Utility companies
• Life insurance company
• Car insurance company
• Housing department
• Employer
• School/university
• Landlord
• Inland Revenue
• Council office
• TV licence authority
• Meals on wheels etc.
• Social services
  
  

Stopping junk mail
Stop Mail is a service to reduce the amount of direct mail sent to those who have died, as this can cause considerable distress to bereaved families. The service is designed to remove names and addresses of those who have died from databases and mailing files. You can contact the service directly at www.stopmail.co.uk or on 0333 2400 343.

Other things to be done

• Returning the passport and driving licence of the person who has died
• Returning pension and allowance books
• Sending back registration documents for vehicles
• Returning any NHS equipment

Reviews of deaths in our care

Case note reviews (or case record reviews) are carried out in different circumstances. Case note reviews are routinely carried out by our Trust on all deaths to learn, develop and improve healthcare, as well as when a problem in care may be suspected.

A clinician (usually a doctor), who was not directly involved in the care of your loved one will look carefully at their case notes. They will look at each aspect of their care and how well it was provided. When a routine review finds any issues with a patient’s care, we contact their family to discuss this further.

Secondly, we also carry out case note reviews when a significant concern is raised with us about the care we provided to a patient. We consider a ‘significant concern’ to mean:

• any concerns raised by the family that cannot be answered at the time, or
• anything that is not answered to the family’s satisfaction or which does not reassure them

This may happen when a death is sudden, unexpected, untoward or accidental. When a significant concern has been raised, we will undertake a case note review for your loved one and share our findings with you.

Aside from case note reviews, there are specific processes and procedures that Trusts need to follow if your loved one had a learning disability, is a child, or died in a maternity setting or as a result of a mental health-related homicide. If this is the case, we will provide you with the relevant details on these processes.

Investigations

In a small percentage of cases, there may be concerns that the death could be, or is related to, a patient safety incident. A patient safety incident is any unintended or unexpected incident, which could have, or did, lead to harm for one or more patients receiving healthcare. 

When there is a concern that a patient safety incident may have contributed to a patient’s death, a safety investigation should be undertaken. The purpose of a safety investigation is to find out what happened and why. This is to identify any potential learning and to reduce the risk of something similar happening to other patients in the future.

If an investigation is to be held, we will tell you and explain the process to you. We will also ask you about how and when you would like to be involved. We will explain how we will include you in setting the terms of reference (the topics that will be looked at) for the investigation. Investigations may be carried out internally or by external investigators, depending on the circumstances.

In some cases, an investigation may involve more care providers than just our Trust. For example, your loved one may have received care from several organisations (that have raised a potential concern). In these circumstances, this will be explained to you, and we will tell you which organisation is acting as the lead investigator.

You may find it helpful to get independent advice about taking part in investigations and other options open to you. Some people will also benefit from having an independent advocate to accompany them to meetings. You are welcome to bring a friend, relative or advocate with you to any meetings.

Where the death of a patient is associated with an unexpected or unintended incident during a patient’s care, staff must follow the duty of candour regulation/policy which is available on the Care Quality Commission’s website.

Action Against Medical Accidents (AvMA) has produced information for families on duty of candour which is endorsed by the Care Quality Commission.

Donating to medical science

The London Anatomy Office handles donations for all London medical schools. If your loved one completed the relevant paperwork for their body to be donated to medical science, you will need to contact the School of Anatomy as a matter of urgency after the death has taken place. 
You can contact the donation coordinator on 020 7848 8042 or The NHS Organ Donor Register

The anatomy office address is:
 Room 5.8
 5th Floor
 Hodgkin Building
 Kings College London
 Guy’s Campus
 London
 SE1 1UL

Please note: The School of Anatomy may not be able to accept all requests due to excluding medical factors. The consent for donation has to have come directly from the potential donor. Having power of attorney does not qualify you to make a decision to donate a body even if you believe it was what the deceased wanted.

Tissue donation
Tissue donation can help transform the lives of thousands of people every year. Many tissues can be donated after death, including:

• Heart valves – within 48 hours of death
• Eyes – within 24 hours of death
• Bone – within 48 hours of death
• Skin – within 48 hours of death

To read more about organ and tissue donation at our Trust please click here.

For further advice and to find out more about the The NHS Organ Donor Register click here. 

Providing feedback, raising concerns and/or making a complaint

Bereavement survey
Your experience of the care we provide to your loved one is very important to us; it enables us to learn from what we have done well and understand what we can improve. The patient affairs officer will discuss this with you. If you wish to participate, we will email you a link to the survey approximately six weeks after the death of your loved one. This is a completely anonymous survey and you are under no obligation to complete it.

Raising concerns
It is also very important to us that you feel able to ask any questions or raise any concerns regarding the care your loved one received. In the first instance, the team who cared for your loved one should be able to respond to these. If you would prefer to speak to someone who was not directly involved in your loved one’s care, our patient advice and liaison service (PALS) team can help.

Independent advice and support

External advice and support
Everyone has their own individual coping mechanism to deal with loss and there is no right or wrong way to feel or act. The turmoil of emotions that may be felt is often confusing and bewildering and sometimes it can be difficult to process these feelings. Relatives and friends are an invaluable source of support and help at this time. However, sometimes it can be easier to discuss problems with a stranger, especially if they understand what you are going through. We have listed people and organisations that may be able to give either practical or emotional support later in this booklet.

Local/UK-wide support organisations

• Age UK
  A national organisation for the elderly
  T: 0800 169 6565
  W: www.ageuk.org.uk/
• Bereavement Advice Centre
  T: 0800 634 9494
  W: www.bereavementadvice.org
• Child Bereavement UK: supports families and educates professionals when a baby or child of any age dies or is dying, or when a child or young person (up to age 25) is facing bereavement. This includes supporting adults to support a bereaved child or young person. All support is free, confidential, has no time limit and includes face-to-face sessions and booked telephone support. Visit www.childbereavementuk.org/ or call 0800 028 8840 for more information.
• Child Death Helpline: provides a freephone helpline for anyone affected by a child’s death, from pre-birth to the death of an adult child, however recently or long ago and whatever the circumstances of the death – a translation service is available to support those for whom English is not a first language. Volunteers who staff the helpline are all bereaved parents who are supported and trained by professionals. Visit www.childdeathhelpline.org.uk or call 0800 282 986 or 0808 800 6019 for more information.
• Cruse Bereavement Care: offers free confidential support for adults and children when someone dies, by telephone, email or face-to-face. Visit www.cruse.org.uk or call 0808 808 1677 for more information.
• Samaritans
  T: 116 123
  W: www.samaritans.org/
• The Loss Foundation: The only UK charity dedicated solely to providing bereavement support after the loss of a loved one to cancer. The charity provides a range of support events, both in-person and online, facilitating connections among individuals navigating grief. Additionally, they engage in educating and empowering others to offer support to the grieving through workshops and training programs.
  https://thelossfoundation.org/
  
  

This information has been produced in parallel with Learning from Deaths: Guidance for NHS trusts on working with bereaved families and carers, which can be found at www.england.nhs.uk

Which other organisations can help?

• Clinical commissioning groups (CCGs): CCGs pay for and monitor services provided by NHS trusts. Complaints can be made to the relevant CCG instead of us, if you prefer. Please ask us for contact details of the relevant CCG(s) or visit www.england.nhs.uk/ccg-details for more information.
• Parliamentary and Health Service Ombudsman (PHSO): The PHSO makes final decisions on complaints that have not been resolved by the NHS in England and UK government departments. They share findings from their casework to help Parliament scrutinise public service providers. They also share their findings more widely to help drive improvements in public services and complaint handling. If you are not satisfied with the response to a complaint, you can ask the PHSO to investigate. Visit www.ombudsman.org.uk or call 0345 015 4033 for more information.
• Care Quality Commission (CQC): The CQC is the regulator for health and social care in England. The CQC is interested in hearing about concerns as general intelligence on the quality of services but they do not investigate individual complaints. See www.cqc.org.uk for more information.
• National Reporting and Learning System (NRLS): Members of the public can report patient safety incidents to the NRLS. This is a database of incidents administered by NHS Improvement, which is used to identify patient safety issues that need to be addressed. Please note that reports are not investigated or responded to. Visit www.improvement.nhs.uk for more information.
• Nursing and Midwifery Council (NMC): The NMC is the nursing and midwifery regulator for England, Wales, Scotland and Northern Ireland. It has introduced a new public support service that puts patients, families and the public at the centre of their work. More information can be found at www.nmc.org.uk in the ‘Concerns about nurses or midwives’ section.
• NHS England specialised services: Specialised services support people with a range of rare and complex conditions, such as rare cancers, genetic disorders or complex medical or surgical conditions. Unlike most healthcare, which is planned and arranged locally, specialised services are planned nationally and regionally by NHS England. If you wish to raise a concern about any specialised services commissioned in your area, please contact NHS England in the first instance by emailing england.contactus@nhs.net or calling 0300 311 22 33.
• General Medical Council (GMC): The GMC maintains the official register of medical practitioners within the United Kingdom. Its statutory purpose is to protect, promote and maintain the health and safety of the public. It controls entry to the register and suspends or removes members when necessary. Its website includes guides for patients and the public, which can help you decide which organisation is best placed to help you. More information can be found at www.gmc-uk.org in the ‘Concerns’ section.
• Healthcare Safety Investigations Branch (HSIB): The HSIB’s purpose is to improve safety through effective and independent investigations that don’t apportion blame or liability. HSIB investigations are for patient safety learning purposes. Anyone can share cases with HSIB for potential investigation – but an investigation is not guaranteed. Visit www.hsib.org.uk for more information.