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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

Simpson, Dr Richard Lab Mid Scotland and Fife Watch on SPTV

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 we have gone through. Nevertheless, doubts are still being expressed about whether the bill will introduce a fully robust system that will retain public confidence. The debate has been useful in suggesting that the pilot should be conducted almost as a research exercise, with not only 25 per cent of deaths being reviewed by medical reviewers, as is required by the act, and approximately 25 per cent of deaths being reviewed by procurators fiscal—accounting for 50 per cent of deaths—but 100 per cent of deaths being reviewed on a post hoc basis to determine whether the system that we are putting in place is error strewn.

If we are concerned about errors, we need look no further than two quotes from Professor Stewart Fleming. He told the committee that,

“in cases in which a post mortem was performed after a death certificate had been completed, the inaccuracy rate was about 20 to 30 per cent.”

He also said that, every year, around 30

“unnatural causes of death are picked up only at the confirmatory medical certificate on the cremation form.”—[Official Report, Health and Sport Committee, 1 December 2010; c 3756 and 3746.]

Some of those deaths might be due to road traffic accidents rather than something more serious but, nevertheless, they are missed.

Those are a few of the issues that we need to examine, apart from the general issues raised by the Harold Shipman case, which are almost a distraction. However, I should say that the care home deaths in England gave rise to considerable public concern. Therefore, an analysis on a geographic basis, which the bill provides for, is important. If there is a higher than normal proportion of deaths in one care home, that might lead to much more detailed scrutiny, which would be welcome.

I suggest to the minister that the details of the pilot should be brought before Parliament so that we have the opportunity to see precisely what is proposed. The Subordinate Legislation Committee or the committee that is responsible for health should have the opportunity to scrutinise them and make helpful comments to the minister and the team that is running the system.

Rhoda Grant raised the situation in remote and island communities. Clearly, those concerns are important. In her evidence to the committee, Ishbel Gall, from Aberdeen, gave us some classic illustrations of the practical difficulties that will need to be explored in the new system. A pilot, perhaps involving Aberdeen, that might address the issues around the island communities would be useful because a lot of people from the island communities die in hospitals on the mainland. The majority of such certifications take place in hospitals—hopefully we can change that, but it is not happening so far.

Rhoda Grant also referred to the problem of fee collection, and I will be interested to hear the minister’s comment on that when she sums up.

Ian McKee stressed the importance of accurate data. In that regard, I conclude by repeating what I said at the start of stage 1, which is that—Stewart Stevenson’s concerns notwithstanding—electronic data are the way forward, because drop-down menus allow people to be interrogated in a much more detailed way when completing the certificate and, far from adding time, can save time.

With regard to the ISD checks, which I presume will still occur, will the minister ensure that the regulations make it compulsory for there to be a response to an inquiry? In other words, if Colin Fishbacher or his successor has a query about the certificate, the doctor should be required to respond; it should not be voluntary. With regard to public confidence, it will be interesting to see whether the number of queries drops from the current level of 2,000 to a much lower level. If, under the new system of ISD checks, the number of those queries drops as a result of the accuracy of the data, it is possible that the system will have the public confidence that we all desire.