Chamber
Meeting of the Parliament 16 March 2011
16 Mar 2011 · S3 · Meeting of the Parliament
Item of business
Certification of Death (Scotland) Bill
Yes. Thank you, Stewart—I have lost my train of thought now.
In the case of a sudden death where we did not know a lot about the patient and we did not have a huge amount of information, our phone call to the procurator fiscal would prompt the question whether we had any real concerns. My response would typically be, “No, I have no real concerns,” so we would then be told, “Thank you very much—go ahead and do the certificate.” That is not a review.
We will need to consider the provisions carefully. We will need to consider the training of procurators fiscal and of doctors so as to ensure that, if we are to rely on half of all reviews being undertaken by the procurator fiscal, an adequate process is followed.
I do not wish to reiterate all the arguments that I advanced in earlier debates on the electronic aspect, but I remain disappointed that, in her opening speech at this final stage of the bill, the Minister for Public Health and Sport yet again did not mention electronic certification. I urge the Government and the minister, even at this very last, dying stage of the present Government—I had to get that in—to commit civil servants to commence consideration of the electronic aspect during the forthcoming interregnum period. We have had two months already; let us have some urgency on the matter. Let us consider what currently exists in the Information Services Division and let us begin now to examine the possibilities for developing a modern system. Although the minister said in her speech that we have a modern system, it is not—it is a revised system, based on an old paper system, with all that system’s flaws.
I still have concerns about the signature on the certificates. Previously, two thirds of them would be reviewed by a second and third doctor. Now, a junior hospital doctor will be able to sign the certificates, and no further review will occur in 50 per cent of cases—although it will vary from individual to individual.
I would like the guidance or the regulations to provide for a system that specifies that no foundation year 1 or foundation year 2 doctor should be able to sign the certificates; only those with specialist training in the hospital—what used to be called registrars—should be able to do that. Alternatively, there should be a counter-signature from the responsible consultant, to make sure. Furthermore, doctors should go through a specific training module.
All of that underlies my concern about retaining public confidence, which is fundamental to the revised system. Two thirds of individuals will welcome the fact that costs will go down from £160 to £30. On the subject of costs, I ask the minister to clarify something that she said earlier when she sums up: that there will not be a charge in relation to overseas deaths. I assume that there will still be a £30 charge—or will there be no charge whatever for people who die abroad? If that is the case, we will perhaps, as with the Eskimos, start to ask our elderly relatives to go to another country, albeit briefly, so as to save some money. That will not happen, of course, but I ask about the possibility of there being no charge. The system for overseas deaths that is now being put in place is a good one, with the central review, which I think will work well.
We have dealt reasonably well with expedited certification for faith burials, particularly for Jewish and Muslim groups. As we come to scrutinise the regulations and guidance, we will have to invite the Subordinate Legislation Committee to examine the matter carefully, with our colleagues in the Jewish and Muslim faith groups, so that the regulations ensure that the post hoc review system will be appropriate.
The bill has been amended appropriately, and I am glad that the Government responded entirely appropriately to the committee’s initial serious concerns. We will now have a modern, proportionate system—except for the fact that it should have been an electronic system from the outset.
10:45
In the case of a sudden death where we did not know a lot about the patient and we did not have a huge amount of information, our phone call to the procurator fiscal would prompt the question whether we had any real concerns. My response would typically be, “No, I have no real concerns,” so we would then be told, “Thank you very much—go ahead and do the certificate.” That is not a review.
We will need to consider the provisions carefully. We will need to consider the training of procurators fiscal and of doctors so as to ensure that, if we are to rely on half of all reviews being undertaken by the procurator fiscal, an adequate process is followed.
I do not wish to reiterate all the arguments that I advanced in earlier debates on the electronic aspect, but I remain disappointed that, in her opening speech at this final stage of the bill, the Minister for Public Health and Sport yet again did not mention electronic certification. I urge the Government and the minister, even at this very last, dying stage of the present Government—I had to get that in—to commit civil servants to commence consideration of the electronic aspect during the forthcoming interregnum period. We have had two months already; let us have some urgency on the matter. Let us consider what currently exists in the Information Services Division and let us begin now to examine the possibilities for developing a modern system. Although the minister said in her speech that we have a modern system, it is not—it is a revised system, based on an old paper system, with all that system’s flaws.
I still have concerns about the signature on the certificates. Previously, two thirds of them would be reviewed by a second and third doctor. Now, a junior hospital doctor will be able to sign the certificates, and no further review will occur in 50 per cent of cases—although it will vary from individual to individual.
I would like the guidance or the regulations to provide for a system that specifies that no foundation year 1 or foundation year 2 doctor should be able to sign the certificates; only those with specialist training in the hospital—what used to be called registrars—should be able to do that. Alternatively, there should be a counter-signature from the responsible consultant, to make sure. Furthermore, doctors should go through a specific training module.
All of that underlies my concern about retaining public confidence, which is fundamental to the revised system. Two thirds of individuals will welcome the fact that costs will go down from £160 to £30. On the subject of costs, I ask the minister to clarify something that she said earlier when she sums up: that there will not be a charge in relation to overseas deaths. I assume that there will still be a £30 charge—or will there be no charge whatever for people who die abroad? If that is the case, we will perhaps, as with the Eskimos, start to ask our elderly relatives to go to another country, albeit briefly, so as to save some money. That will not happen, of course, but I ask about the possibility of there being no charge. The system for overseas deaths that is now being put in place is a good one, with the central review, which I think will work well.
We have dealt reasonably well with expedited certification for faith burials, particularly for Jewish and Muslim groups. As we come to scrutinise the regulations and guidance, we will have to invite the Subordinate Legislation Committee to examine the matter carefully, with our colleagues in the Jewish and Muslim faith groups, so that the regulations ensure that the post hoc review system will be appropriate.
The bill has been amended appropriately, and I am glad that the Government responded entirely appropriately to the committee’s initial serious concerns. We will now have a modern, proportionate system—except for the fact that it should have been an electronic system from the outset.
10:45
In the same item of business
The Deputy Presiding Officer (Alasdair Morgan)
SNP
The next item of business is a debate on motion S3M-8126, in the name of Shona Robison, on the Certification of Death (Scotland) Bill.10:32
The Minister for Public Health and Sport (Shona Robison)
SNP
We are debating a bill that will provide us with a proportionate and robust approach to the scrutiny of death certification. The proposals will lead to a mod...
Dr Richard Simpson (Mid Scotland and Fife) (Lab)
Lab
I would like to add to the minister’s thanks by thanking the witnesses who appeared before the committee. They were extremely helpful. In the Scottish Parlia...
Stewart Stevenson (Banff and Buchan) (SNP)
SNP
Committees have that effect.
Dr Simpson
Lab
Yes. Thank you, Stewart—I have lost my train of thought now.In the case of a sudden death where we did not know a lot about the patient and we did not have a...
Mary Scanlon (Highlands and Islands) (Con)
Con
I thank the witnesses, in particular Professor Stewart Fleming and Ishbel Gall, who scrutinised the bill effectively at all stages.I am pleased that we have ...
Ross Finnie (West of Scotland) (LD)
LD
The bill was interesting. When it first came before the Health and Sport Committee, there was a sense that it was a relatively simple matter and that it woul...
Ian McKee (Lothians) (SNP)
SNP
There is some belief that the bill is a dull affair and that it is just rather technical. However, information from death certification can have a major effe...
Rhoda Grant (Highlands and Islands) (Lab)
Lab
I am very pleased that we have reached stage 3 of the bill and that its consideration is coming to an end. I tend to disagree with Ian McKee, in that I think...
Stewart Stevenson (Banff and Buchan) (SNP)
SNP
I have a few observations to make, some of which pick up points that others have made and some of which are new. Dr Ian McKee talked about the importance of ...
The Deputy Presiding Officer
SNP
That would be a sensible idea.
Stewart Stevenson
SNP
In that case, I will close. Clive James’s autobiography contains the wonderful phrase,“Don’t take life seriously; you won’t get out of it alive anyway.”Today...
Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)
LD
As I am not a member of the Health and Sport Committee, I come to the bill and the debate as a comparative layman. However, I am struck by a central theme th...
Stewart Stevenson
SNP
Does the member accept that it is not possible to eliminate all doubt from death? I say that having been close to a suicide. To this day, more than a decade ...
Jamie Stone
LD
I accept that, but the point of raising Kevin McLeod’s death was to highlight a case in which the element of doubt is unacceptably high. In a proper democrac...
Mary Scanlon
Con
Despite Stewart Stevenson’s incredible experience in business, innovation and enterprise throughout Scotland, he seems to think that modern technology is inc...
Stewart Stevenson
SNP
I agree with every word that Mary Scanlon has said; I merely sound a note of caution that it is sometimes more difficult than people imagine to achieve that ...
Mary Scanlon
Con
I appreciate that, but I am sure that people around Scotland like Stewart Stevenson, working in an advisory capacity, can keep everyone right.My second point...
Dr Simpson
Lab
The bill began rather like the Patient Rights (Scotland) Bill, looking rather flawed and weary, but it has been resurrected through the useful process that w...
The Deputy Presiding Officer
SNP
Wind up, please.
Dr Simpson
Lab
We have a better bill now, although it still needs to be reviewed and we will examine the pilots as they go through. I support the passing of the bill.11:23
Shona Robison
SNP
The debate has shown that, although there are still differences of opinion on some matters, the Parliament has engaged positively with the bill and has raise...
Mary Scanlon
Con
I am trying to clarify two things. We all know that the cause of death is listed, but I have seen death certificates on which the major contributory factor i...
Shona Robison
SNP
There is a difference between that and a list of every condition, as I am sure we agree.Ross Finnie made a number of points and I am pleased that he found th...