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Meeting of the Parliament 16 March 2011

16 Mar 2011 · S3 · Meeting of the Parliament

Item of business

Certification of Death (Scotland) Bill

McKee, Ian SNP Lothians Watch on SPTV

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 effect on future health expenditure. If a series of recordings showed that one condition or another was on the increase, but the recordings were inaccurate and the information incorrect, huge sums of money might be spent on the wrong priority.

It is important that we get things as right as we can, although, short of allowing for 100 per cent post-mortem examinations—and even then—there will always be inaccurate certificates whatever we do. From that perspective, I welcome the bill, as it aims to improve the accuracy of death certification by education and supervision and includes disposal by burial in its remit. There are some points of concern, however, which I raise in the light of my years of experience of the issue.

The bill provides for the appointment of medical reviewers and the minister has informed us that those might be part-time appointments. I think it vital that they are part-time appointments. That will mean that more individuals can be medical reviewers for the same financial outlay, so the geographical spread can be greater, meaning that the reviewer will have more local knowledge. It is important that a medical reviewer keeps up to date with clinical practice, which will be much more difficult, if not impossible, for someone who spends the entire time following up death certificates.

I have a major concern about the number and type of reviews that are implied by the financial memorandum and about which we have been informed by the minister. First, 25 per cent of deaths will be covered by a level 1 review, which seems to be little more than a telephone conversation with the certifying doctor. Although careful questioning might reveal one or two important background factors that can then be included in a certificate, we must bear it in mind that a doctor who has been rather casual in filling in a certificate—let alone one who has been negligent or worse—will have a vested interest in giving answers that back up the original certificate.

The same criticism applies to placing undue reliance on the fact that a procurator fiscal has been informed. Here, I agree entirely with Richard Simpson—I think that we are the only two people in the chamber who have practical experience of these matters—because most interchanges with a procurator fiscal are cursory telephone exchanges, with permission to go ahead with the certificate without much interviewing. There is a risk of a folie à deux in such situations, with neither professional wishing to go too deeply into the issue.

The level 2 investigations are much more comprehensive, but my concern here is about the small proportion intended—about 4 per cent, we are told. I know that the minister has reassured us that the statistics show that that figure is enough to give an accurate estimate of the total number of identifiably inaccurate certificates overall. As Ross Finnie said, that is true, but the present system for cremation, where in effect all disposals are subject to something very similar to a level 2-type procedure, identifies not only inaccurate certificates, but the deaths to which they relate. That allows the inaccuracies to be corrected, which will not be the case for at least the 50 per cent or more of certificates that are to be allowed through totally unchecked under present plans—and probably not for many of the rest.

Store is set by the two proposed pilots, but in a small pilot the number of level 2 investigations will be very small and I doubt that the evidence will be robust enough to draw accurate inferences about the reliability of the results. I agree to an extent with Mary Scanlon that it would be more informative to have two pilots, one of which reviewed 4 per cent of death certificates at level 2 while the other reviewed an increased proportion—for a small pilot, that could be 100 per cent—so that we could see the differences in results, if there were any.

We have been told that the reforms have their origin in the Shipman scandal but that no system could guarantee to prevent another such scandal. That is undoubtedly true, but that is no reason to replace the existing system of death certification with one that is less effective, simply to be able to charge smaller fees. I support the bill and will vote for it, as none of what I perceive to be defects are in the bill. If we truly wish death certificates to be more, rather than less, accurate in future, however, I am convinced that the proportion of level 2 assessments will have to be considerably increased.

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