Bereavement-Booklet.-incorporating-information-for-families-following-a-bereavement-Dec.19

Immediate Arrangements The practical things to do following a death are contacting the Funeral Director andhospital Bereavement Office.. They will help you make arrangements tocollect th

Bereavement Booklet

Information about the process following a death at

Norfolk & Norwich University Hospital

INCORPORATING “Information for families following a

bereavement – July 2018”

Providing feedback, raising concerns and/or making a complaint 12

Information for families following a bereavement – July 2018 17

Support Organisations & Counselling Services 20

Useful telephone numbers and websites 21

Acknowledgment and thanks 22

Introduction

Many different staff will have been involved in the care of your relative or friend whilethey were a patient at the Norfolk and Norwich University Hospital On behalf of all ofthem we wish to express our condolences, sympathy and concern for you at this time

We know this can be a very difficult and distressing time and we hope this booklet willhelp you understand what you can expect from Norfolk & Norwich NHS Hospitals Trust

This booklet has been prepared to offer you guidance in making the immediatearrangements It describes the important tasks such as registering the death, andprovides other useful practical information

The booklet also aims to explain what happens next; including information about how tocomment on the care your loved one received and what happens if a death will belooked into by the Coroner It also provides details of the process involved if you havesignificant concerns about the care provided and gives you practical advice, support andinformation

In addition to this booklet, you should receive a letter from us in the post The lettershould have included the details of someone in the trust who you can contact if you want

to provide comments; ask questions; or raise any concerns If you need to speak tosomeone immediately and have not yet received a letter from us, please contact theBereavement Office

At the end of the booklet there is information on grief including contact numbers for localand national organisations that may be able to provide help and support over the daysand weeks to come Please be aware that bereavement can leave people feeling veryisolated, so don’t be afraid to ask for help and advice: any question or query isimportant

Immediate Arrangements

The practical things to do following a death are contacting the Funeral Director andhospital Bereavement Office

The Funeral Director

There is no need to wait until you have registered the death before contacting theFuneral Director as you will find they will be able to guide you in every detail in makingthe funeral arrangements and offer general advice and guidance

You may wish to approach more than one Funeral Director to get an estimate of theircosts before making your choice You can find names and contact details in the local

telephone book or via the internet e.g www.yell.com; www.yourfuneralchoice.com orwww.beyond.life/nhs Alternatively your bereavement advisor can provide you withnames of funeral directors within your chosen area, but they are not able to make anypersonal recommendations

The Hospital Bereavement Team

The Bereavement Advisors are pleased to offer help, advice and support for relativesand carers of those who have died in our care They will help you make arrangements tocollect the Medical Certificate of Cause of Death and will explain the procedures for theregistration of death and collecting personal belongings if you have not already beengiven these from the ward

Please do not come to the office without a previously arranged appointment as thismeans that the certificate may not ready for collection and a Bereavement Advisor maynot be available

The Bereavement Office is open for telephone calls and appointments from 9.00am 4.00pm, Monday to Friday except for Bank Holidays Please telephone (01603) 287165;287166; 287465; or 289440 to leave your telephone details and the name of your lovedone, together with any funeral arrangements if known If you are connected to theanswerphone it is because the advisors are either with a family or speaking on thetelephone to another family We aim to call you back on the same day as your messagehas been left, or within 2 working days

-Unless referred to a HM Coroner, the doctor responsible for the care of the patient willcomplete the Medical Certificate giving the cause of death and this process usuallytakes two or more working days Once the medical certificate is ready, yourBereavement Advisor will offer you an appointment to collect this and any property held

by the hospital

Relatives with a Bereavement Office appointment are advised to report to or EastOutpatient Reception Level 2 or East In-Patient Reception, Level 1 (Car Parks L or M).The reception staff will call the bereavement office to advise that you have arrived andthey will come and collect you

Registering a Death

All deaths, except those referred to the Coroner, must be registered within 5 days TheBereavement Advisor will explain how you should do this and who may register a death.Hospital deaths can be registered at any of the Norfolk offices and it is possible toregister a death anywhere within England & Wales Please ask for details It may bepossible to register the death at the hospital with the Duty Registrar, but these

appointments are limited Please be prepared to make alternative arrangements outside

of the hospital to register the death

The Registrar Offices operate an appointment only system To make an appointmentyou can either phone Norfolk County Council Customer Service Department 0344-800-

8020 (9am to 5pm, Monday to Friday) or via their websitewww.norfolk.gov.uk/registrationservices Their Norwich office is County Hall, TheArchive Centre, Martineau Lane, NR1 2DQ or you may wish to choose to register at alocal office to you Parking is available

Documents and information needed to register the death

The Registrars offer a Tell Us Once service which informs national & local government

of the death; when you make your appointment you will be advised what information tobring with you including:

 Medical Certificate of Cause of Death, which will be given to you by the hospitalBereavement Advisor, this includes the date and place of death

 Full name of the deceased and maiden name (if applicable)

 Date and place of birth - Birth Certificate (if available)

 Home address

 Details of occupation or last occupation, if retired

 Full name of spouse and their date of birth (if applicable)

 Medical Card (if available); passport & driving licence

You will receive from the Registrar

1 Certificate of Burial or Cremation: this certificate is green and is required by theFuneral Director before the funeral takes place

2 Social Security Certificate (Form BD8): this should be sent to the Benefits Officetogether with any other benefits cards held by the deceased

3 The Death Certificate: This is a copy of the entry in the Death Register Each copy

costs £11.00 (with effect from 16 February 2019) You should discuss how many

copies you may need with the Registrar

Other Documentation

After a death it is necessary to return certain documents and other items belonging tothe deceased

• Social Security payment cards

• Registration documents of car, to change ownership

• NHS equipment including mobility and hearing aids

• Season Tickets

The following people and organisations may need to know about the death:

• Solicitor

• Bank, Building Society, Insurance Company etc

• Employers and Trade Unions

• Schools, College, University attended

• Any other hospital the person was attending

• Gas / Electricity / Water / Telephone / TV Licence

• Professional Organisations.

Please note most organisations will not accept a photocopy of the death certificate Inaddition, it may be useful to include the National Insurance Number of yourrelative/friend in any correspondence with government departments

In the event that a death is referred to the Coroner, the Coroner’s office will advise you

on what to do Your Funeral Director will liaise with the Coroner on your behalf

You may want to discuss the funeral with your religious representative, or you mayprefer for the Funeral Director to do this on your behalf They can also arrange a non-religious funeral if this is your wish

Cremation

By law, Doctors have to follow the Cremation (England and Wales) Regulations 2008

To process the additional cremation documentation from the hospital medical staffthrough to the final check by an independent doctor at the crematorium (the medicalreferee) it can take 7 working days The Bereavement Advisors will commence thisprocess when they are advised the funeral will be a cremation

Cremation fees and guidance

The completion of cremation certificates does not fall within the NHS duties of a doctor.Advice issued by the British Medical Association (BMA), stipulates that the feesapplicable for forms completed by doctors have been agreed with the NationalAssociation of Funeral Directors, NAFD, the National Society of Allied and IndependentFuneral Directors, SAIF, and Co-operative Funeralcare) Doctors at this Trust follow theabove guidance A link to the guidance is provided below:-

https://www.bma.org.uk/advice/employment/fees/cremation

Paying for a funeral

If you arrange for a funeral, you are responsible for paying the costs involved It is

advisable to check if there are sufficient funds to cover the costs If you receive certain

kinds of benefit/s or if for any other reason you do not have enough money to pay for thefuneral, you should seek advice from the Department of Work and Pensions

Notification of a death in a newspaper

You may wish to ask the Funeral Director to guide you on wording and arrangements.Your chosen Funeral Director will be able to place the notification in a newspaper onyour behalf

Medical Examiners

Medical Examiners are independent senior doctors whose roles are to ensure that deathcertificates accurately reflect the cause of death, that cases are referred appropriately tothe Coroner and most importantly, that the family have the opportunity to ask questionsand raise any concerns about the care your loved one received You should expect theMedical Examiner or the Medical Examiners’ Officer to make contact, as this willeventually be standard practice The Medical Examiner service is being rolled out acrossthe country from 1st April 2019 The NNUH has already established a service which willdevelop over the course of time You can make an appointment to speak to one of ourMedical Examiners by contacting the Bereavement Advisors

A representative of the family may view the forms completed by the doctors Pleaseadvise your Funeral Director if you want to do this and they will ensure this is recorded

on the documentation This may cause a delay in the funeral and a charge may be madefor this option

Care in the Mortuary

When the deceased is in the care of the Mortuary staff, they will be looked after withdignity and respect in a safe environment

Viewing arrangements - Arranging to see your relative/friend within the Hospital

Some people have the opportunity to see their relative in the ward/department wherethey have died When this is not possible, the Mortuary can provide the bereavedrelative with a peaceful and private facility to view their relative/friend although manypeople prefer to view their relative when they are in the care of their chosen FuneralDirector Please discuss this with your chosen Funeral Director if this is your preference

If you would like to view your relative in the Mortuary’s viewing suite then this can bearranged by contacting the Mortuary You will also be able to view your loved one at theFuneral Director if you prefer

Please be aware that if the deceased has been referred to the Coroner a viewing is notpermitted until we receive permission from the Coroner Permission to view the patient isnot usually received until after the completion of any examination procedures In the

event that pre-examination viewing is permitted, the viewing will be supervisedthroughout by a member of the Mortuary team.

Viewing within the Mortuary’s Viewing Suite is strictly by appointment only and normallyarranged between 2pm – 4pm Monday – Friday Please telephone the Mortuarypersonnel directly on (01603) 287192 to arrange a time and date to attend Outsidenormal opening hours the department has an emergency on call service in which it may

be possible to accommodate a viewing To request this out of hours emergency servicecontact the hospital switchboard (01603 286286) and ask for the emergency on callMortuary Technologist

If you attend a viewing in the Mortuary you will be met by a member of the team andaccompanied to the Mortuary viewing suite The suite is a private, calm and quiet roomlocated within the Mortuary department Trained staff will be there to support relativesthrough this process Please understand that in some cases there may be smallchanges evident in the appearance of the deceased patient The Mortuary staff willprepare you as much as they can and will be available to answer any questions orconcerns throughout your viewing

On occasion when there have been a significant number of deaths in the community andHospital, it may not be possible to accommodate some deceased patients within thepermanent Hospital Mortuary facilities In these circumstances you should be aware that

it may be necessary for us to transfer the deceased patient to a designated FuneralDirector or other temporary facility You have our assurance that this process is carefullymanaged and that the transfer and facilities of the Funeral Directors ensure continuation

of care, dignity and respect for the deceased patient Your designated Funeral Directorwill be able to collect directly from these facilities as required

Deaths referred to HM Coroner

By law, if the doctor is not able to issue a death certificate (for example, if someone diessuddenly and unexpectedly in hospital or following an accident or other unnatural event),they are legally required to inform the Coroner The Coroner is a lawyer working with ateam of Officers to investigate unnatural, unexpected or sudden deaths

Having been informed of the death, the Coroner will decide whether the doctor can issuethe Medical Certificate of Cause of Death or whether a Post Mortem examination isrequired to establish the cause of death The Coroner does not require the consent ofrelatives or carers for this examination to be performed, but does have a duty to notifyrelatives when and where the examination will take place

If we do not refer a death to the Coroner and you have concerns about the treatment weprovided, you can ask the Coroner to consider holding an inquest It is a good idea to dothis as soon as possible after your loved one has died as delays in requesting an inquestmay mean that opportunities for the coroner to hold a post mortem are lost

Inquests and formal identification of the deceased patients

The Coroner is represented by the Coroner’s Officers, who may need to talk to youabout the circumstances leading up to your relative’s death They will advise you whenthe cause of death has been established and when they have issued theirdocumentation to the Registration Service at County Hall, Norwich, so that you canmake the appointment with the Registrar to register the death

Sometimes it is necessary to hold an inquest after a death In this case the Coroner cannormally issue a burial or cremation certificate once the post-mortem examination iscomplete A formal identification of the deceased prior to the post-mortem examination isrequired The relative assisting with this will be accompanied to the viewing and theprocedure will be explained by the mortuary staff

Some deaths are referred to the Coroner, for example where the cause of death isunknown, or the death occurred in violent or unnatural circumstances When a death isreferred to the Coroner they may request a Post Mortem examination The Coroner willthen decide whether an Inquest is required, to establish the cause of the death AnInquest is a ‘fact finding’ exercise which normally aims to determine the circumstances

of someone’s death

If you are seeking or involved in an inquest, you may wish to find further independentinformation, advice or support There are details of organisations that can advise on theprocess, including how you can obtain legal representation, at the end of this leaflet

Contacting the Coroner and Coroner’s Officers

The main telephone number for the Coroner’s office is Norwich (01603) 276493 There

is an answerphone for leaving a message if the line is busy or personal are unavailable

Contacting the Funeral Director

We recommend that you make early contact with your Funeral Director, advising themthat the death has been referred to the Coroner They will be able to liaise with theCoroner’s department about releasing the deceased patient into their care in plenty oftime before the funeral

Post Mortem Examinations

Most post mortems are requested by HM Coroner, as a legal requirement, to ascertain

an unexpected cause of death

Sometimes a request for a post-mortem examination is made by the relatives or by thedoctor treating the deceased patient This may be requested in order to increasemedical knowledge and the effect of any treatment received The relatives may alsowish to request this in order to gain a better understanding of what happened

The written permission of the next of kin will be obtained by one of the Doctors, MortuaryTeam or Bereavement Advisors who will also fully explain the nature of the procedure.The consent form is designed to be flexible and any subsequent examination of thepatient can be restricted or limited if you wish

The hospital will issue the Medical Certificate of the Cause of Death prior to the request

of a hospital/consented post-mortem examination

A post-mortem examination should not delay the funeral arrangements

Understanding what happened

As a family member, partner, friend or carer of someone who has died whilst in the care

of the Norfolk & Norwich University NHS Foundation Trust, you may have comments,questions or concerns about the care and treatment they received You may also want

to understand more about the reasons for their death The staff who were involved intreating your loved one should be able to answer your initial questions However, please

do not worry if you are not ready to ask these questions straight away, or if you think ofquestions later - you will still have the opportunity to raise these with us (the trust) whenyou are ready through your named contact at the trust (see above)

It is also important for us to know if you don’t understand any of the information weprovide Please tell us if we need to explain things more fully

The Gov.uk website (https://www.gov.uk/after-a-death) provides practical information

on what to do following a death We also know that the death of a loved one can be verytraumatic for families This can be even more so when concerns have been raised, orwhen a family is involved in an investigation process Some families have found thatcounselling or having someone else to talk to can be very beneficial You may want todiscuss this with your GP, who can refer you to local support Alternatively, there may

be other local or voluntary organisations that provide counselling support that you wouldprefer to access Some examples of organisations that may be able to help you areincluded later in this leaflet

Reviews of deaths in our care

Case note reviews (or case record reviews) are carried out in different circumstances.Firstly, case note reviews are routinely carried out by NHS trusts on a proportion of alltheir deaths to learn, develop and improve healthcare, as well as when a problem incare may be suspected

A clinician (usually a doctor), who was not directly involved in the care your loved onereceived, will look carefully at their case notes They will look at each aspect of their careand how well it was provided When a routine review finds any issues with a patient’scare, 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:(a) any concerns raised by the family that cannot be answered at the time; or

(b) anything that is not answered to the family’s satisfaction, or which does not reassurethem

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

Aside from case note reviews, there are specific processes and procedures that trustsneed to follow if your loved one had a learning disability; is a child; or died in a maternitysetting or as a result of a mental health related homicide If this is the case, we willprovide 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 isrelated to a patient safety incident A patient safety incident is any unintended orunexpected incident, which could have, or did, lead to harm for one or more patientsreceiving healthcare Where there is a concern that a patient safety incident may havecontributed to a patient’s death, a safety investigation should be undertaken Thepurpose of a safety investigation is to find out what happened and why This is to identifyany potential learning and to reduce the risk of something similar happening to any otherpatients in the future

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

In some cases, an investigation may involve more care providers than just the Norfolk &Norwich University Hospitals NHS Trust For example, your loved one may havereceived care from several organisations (that have raised potential concern) In thesecircumstances, this will be explained to you, and you will be told which organisation isacting as the lead investigator

You will be kept up to date on the progress of the investigation be invited to contribute.This includes commenting on the draft investigation report before it is signed off Yourcomments should be incorporated in the report After the report has been signed off, the