Hansard

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 modern Scottish death certification system that is sensitive to bereaved families’ needs.

The bill will introduce a single system of independent scrutiny of medical death certificates that will apply to deaths that do not require a procurator fiscal investigation. The system is based on one of the models that the independent expert burial and cremation review group proposed. The review group was established in 2005 and reported in 2007. Last year, I consulted on all its recommendations. The bill relates to the certification of death aspects.

Most consultation respondents supported our preferred model, which forms the basis of the bill. They included all the respondents who represented patients and consumers, as well as the majority of local authorities and of public bodies and half the medical respondents, including the Royal College of Physicians of Edinburgh, the Royal College of Physicians and Surgeons of Glasgow and the General Medical Council.

The new system will replace the current crematoria medical referee system and the associated forms and will therefore abolish all the cremation fees that families pay to doctors. The bill will remove the historical differences between cremation and burial, which were introduced when medicine was less advanced and when it was believed that more stringent measures were needed for cremations, because the evidence of the body would be destroyed.

In fact, as the independent expert review group concluded, after a body has been embalmed and buried, often little forensic information is available even when the body is exhumed, particularly if it is exhumed after a significant time. This is why we came to the view that the additional checks in cremation cases led to expenses and delays without providing benefits for families or value for money.

No death certification system can guarantee to prevent criminal activity such as that which Harold Shipman carried out, but our proposals are robust and have been designed to deter malpractice and provide public reassurance. It is important that the new death certification system will benefit bereaved families, to whom we owe a duty to ensure that any new system will minimise distress, avoid undue delay to funerals and be affordable.

Nowadays, the majority of families opt for cremation. Once the new system commences, they will no longer have to pay cremation fees, which are currently £147 plus an additional fee for the medical referee. Instead, a universal fee of about £30 will be charged. In addition, individuals will for the first time be empowered to request a review of the information in the certificate if they have concerns.

I stress that, at the heart of the future Scottish system, the emphasis will be on improving the quality of death certification. To that purpose, the independent medical reviewers will undertake 1,000 random comprehensive reviews, as well as additional targeted reviews. Actions following those reviews will be part of a quality improvement programme, and will include direct feedback to the certifying doctors, further investigations of the case, links with clinical governance, and training and educational activities.

The role of the new national statistician will be important. Regular statistical tests will be run on all death data and any unusual results will be identified and reported to the medical reviewers. Furthermore, following concerns expressed in the committee about deterrence and public reassurance, medical reviewers will also randomly scrutinise 25 per cent of all deaths—around 13,500 in all—by way of shorter level 1 reviews. That means that, when those deaths are combined with the number of cases that are reported to the procurator fiscal each year, around 50 per cent of deaths in Scotland will be subject to scrutiny. In other words, a doctor will have a 1 in 2 chance of their certificate being scrutinised.

At stage 2, we introduced amendments in response to concerns raised by the Health and Sport Committee and by stakeholders about where responsibility for checking foreign certificates associated with deaths overseas should lie. I reflected on that matter and listened to stakeholder concerns about the proposals in the bill to give that function to superintendents at local burial grounds and crematoria. The bill was then amended at stage 2 to require the medical reviewers office to carry out that function instead.

The bill’s fee provisions have been amended to allow for fees to be set below cost recovery. That follows a commitment that I made earlier, when I outlined additional reviews that will give rise to increased costs but which are to be paid for by the Scottish Government rather than through fees. The fee therefore will remain at around £30 per case, including costs for collecting the charge. We also amended the bill to clarify that we do not intend to charge a fee for the checking of foreign certificates.

If the bill is approved today, we will consult further on operational matters and the secondary legislation that will be required to implement the system. We acknowledge the need to continue to work with stakeholders, including the general public, on the test sites—which are scheduled for the following year—before the implementation of the new system, which is scheduled to take place during 2013-14. Of course, it is not just a matter of legislation and guidance; good communication and awareness raising will also be key activities in the next phases. I believe that we have a solid base on which to build and I look forward to the work coming to fruition.

I thank the Health and Sport Committee for its sterling work on this bill. As ever, the process has been very constructive. I also thank the committee’s clerks, who worked very hard, and I put on record my thanks to the bill team, who took on a significant piece of work with this bill.

I move,

That the Parliament agrees that the Certification of Death (Scotland) Bill be passed.

10:38