Directorate of Chief Medical Office and Procurator …

1 St Andrew s House, Regent Road, Edinburgh EH1 3DG Directorate of Chief Medical Office Crown Agent and Chief Executive of Crown Office and Procurator Fiscal Service Dear Colleague MANAGEMENT OF DEATHS IN THE COMMUNITY (In hours and out of hours) Purpose 1. This communication is to provide guidance to colleagues in NHSS cotland and Police Scotland, clarifying the roles and responsibilities of individuals and organisations in the management of deaths in the community. 2. This supersedes the instruction sent by Police Scotland in December 2014, 2014-12 Communications on attendance at sudden death for NHS Boards . The guidance will come into effect from 9am on the 29 February 2016.

2 Background 3. Death of a loved one is stressful at any time. Several anecdotes have provided examples of situations where the distress to all concerned, including the staff, has increased when there is a lack of co-ordination of the process at this sensitive time. This is particularly so when there needs to be an investigation by the Crown Office and Procurator Fiscal Service, assisted by Police Scotland. Sometimes Police are called by relatives/friends/neighbours to attend the death. Police attendance does not mean Police involvement investigations of suspicious circumstances. Principles 4. The primary aim of the Emergency Services is to preserve life.

3 Any preservation of the scene where death occurred, and consequential Police investigation is secondary to this aim. From the Chief Medical Officer Dr Catherine Calderwood Crown Agent, Chief Executive Catherine Dyer and ACC Malcolm Graham, Police Scotland _____ Enquiries to: Crown Office and Procurator Fiscal Service issues David Green Head of the Scottish Fatalities Investigation Unit (SFIU) COPFS Police Scotland issues Steven Cartwright Detective Inspector, Forensic Improvement Project, SCD _____ 21 January 2016 _____ SGHD/CMO(2016)2 _____ Addresses For action NHS Board Medical Directors to cascade to all doctors, including GPs NHS Board Directors of Nursing NHS Board and Special Board Chief Executives to cascade to Medical Fecords Managers Police Scotland For information NHS Board Directors of Public Health NHS Board and Special Board Chairs NHS Board primary care Leads to cascade to OOH.

4 Forensic Medical Services and Integration Joint Boards Bereavement Co-ordinators of Health Boards British Medical Association General Medical Council Medical and Dental Defence Union of Scotland Medical Protection Society Medical Defence Union Academy of Medical Royal Colleges and Faculties in Scotland COPFS to cascade to Forensic Pathologists care Inspectorate Chief Executive Local Authorities National Association of Funeral Directors The National Society Of Allied And Independent Funeral Directors _____ Further Enquiries For clinical issues Dr Mini Mishra Senior Medical Officer St Andrew s House EDINBURGH EH1 3DG St Andrew s House, Regent Road, Edinburgh EH1 3DG 5.

5 Formal verification of the fact of death/pronouncing life extinct (PLE) is not required in all cases of deaths where the Police are involved. 6. Unnecessary interference and delays should be avoided. In order to minimise any additional distress and maximise the efficiency, effectiveness and quality of care , individuals and organisations need to understand their roles and responsibilities and agree which service(s) are most appropriate to attend. 7. Appropriate tailored support should be provided to the bereaved where required in the event of suspicious or non-suspicious deaths. Supporting the bereaved is a legitimate business of NHS healthcare services.

6 8. The attached guidance in the Appendix is not prescriptive and provides a framework within which organisations should jointly agree processes in their local areas together and also within their own organisations, to suit their circumstances. Action 9. We would be grateful if you could bring this guidance to the attention of relevant colleagues in your organisations. 10. Finally, we are very grateful for the on-going support and commitment of all staff involved in continuing to jointly implement this challenging process in a sensitive area. Yours sincerely Catherine Calderwood Catherine Dyer ACC Malcolm Graham 1 APPENDIX Guidance for deaths in and out of hospital setting, in hours and out of hours (latter covered by primary care Out of Hours services) Background The management of deaths in the community is a challenge for all the professionals concerned, as the responses required may be complex, and come at a very sensitive and difficult time for the bereaved.

7 Empathetic handling, tailored to each situation, can reduce unnecessary stress for all concerned, including the professionals involved. For the emergency service preservation of life is paramount. Subsequent considerations of verifying the fact of death (VoD)/pronouncing life extinct (PLE) and preserving evidence must be secondary to this primary role. PLE will include references to both PLE and VoD in this document. In circumstances where death is clearly evident, such as decapitation or advanced decomposition, there is no requirement for a formal PLE by a healthcare professional. In these circumstances the Police will record Time Found and remove the deceased to a relevant mortuary.

8 To assist in determining some of the numbers involved, Police Scotland have recently undertaken analysis of death related incidents reported to them, in the West and East regions of Scotland, covering over half of the population in Scotland. In summary: 134 deaths were reported to Police Scotland during a 7 day period in June 2015, half of which were reported by Scottish Ambulance Service (SAS). SAS were not requested to attend in 13 incidents, in circumstances where their attendance should have been considered. A forensic physician (FP) was in attendance at 5 of those 134 occasions, and was requested to PLE. On 4 of those 134 occasions, primary care Out of Hours Services (OOH) were requested to attend.

9 Of these, there were 2 cases where SAS was also in attendance, and PLE done by them. 25 of these 134 deaths were suspicious and/or within the responsibility of the Police, yet on 107 occasions Police removed the deceased to a mortuary and reported the circumstances of the death to Crown Office and Procurator Fiscal Service (COPFS). This brief analysis undertaken by Police Scotland recently, reveals that out of 134 cases SAS were not summoned in around 10% of those cases but that in most cases their attendance or clinical advice would have been valuable, in the interests of preservation of life. It also indicates that the majority of deaths that the Police are currently attending and managing are not within their scope of work or responsibility.

10 2 This can lead to a disproportionate response and inefficiencies in the process, which can combine to add to the bereaved relatives distress. For example, only 25 out of the 134 of the above cases were suspicious and/or within the responsibility of the Police, yet on 107 occasions the Police removed the deceased to a mortuary and reported the death to the COPFS. It would appear reasonable to consider which service(s) are the most appropriate to attend a death in the community, recognising the duty of care to the deceased and the needs of the bereaved when a possible death is reported, including the preservation of life wherever possible.