Roundtable on the management of the deceased

Shaping the future together 

I recently chaired a roundtable on the management of the deceased that took place on 19 July 2023. It brought together stakeholders from various organisations and government bodies. The purpose was to consider current practices, confront challenges, and identify areas for improvement.  

Mapping the landscape 

We started off by discussing an in-house map that illustrated the pathways involved in caring for the deceased. Attendees provided valuable feedback on the accuracy of the map and highlighted potential issues and gaps within the system. In particular, the crucial role of General Practitioners (GPs) in verifying and certifying deaths at home and in the community. 

Further discussions delved into the transfer of the deceased to hospital mortuaries, especially when not referred to the coroner. We talked through the different models used for managing suspicious deaths or those with suspected third-party involvement.  

Pressures in the system 

I welcomed the open and frank discussion we were able to have about bottlenecks which can lead to delays and challenges within the system. Colleagues shared a range of issues are contributing to the pressures in the system.  This included: 

• Increasing death rate 

• Limited medical examiner capacity, resulting in processing delays and backlogs. 

• Challenges related to GP availability, affecting the timely issuance of Medical Certificates of Cause of Death (MCCDs). 

• Pressures within coroner services and availability of pathologists, causing further post-mortem backlogs. 

• Difficulties faced by funeral services in accommodating the deceased, leading to increased demands on mortuary storage. 

Ensuring smooth transportation of the deceased 

During the discussions, attendees shared their experiences and highlighted the different forms of transport that can be used for transporting the deceased, including contracted funeral services, emergency ambulances, and non-contracted funeral services. I found it reassuring that in a system that is clearly under pressure, there had been no known issues with transportation at this time, and existing guidelines provide adequate guidance. 

Prioritising areas for improvement and addressing challenges 

We looked at how best to prioritise areas for improvement, which could help with the safety and dignity of the deceased. Colleagues shared the following three areas:  

Statutory regulation of mortuary staff: To ensure patient safety, colleagues emphasised the role statutory regulation could play. For example, bringing Anatomical Pathology Technologists (APT) under statutory professional register could be a critical step in achieving this goal. 

Regulation of funeral directors: Acknowledging the importance of some form of regulation for all funeral directors.  

Government oversight: Better coordination across government as the lack of joined up oversight makes it difficult to drive meaningful change.  

Tackling challenges and ongoing efforts 

There was a discussion about the challenges and ongoing efforts in deceased management: 

• The health building note helps to set out clear expectations but may not help to secure adequate investment in facilities for the care of the deceased. 

• Ongoing efforts to engage with a range of funeral directors, including online funeral directors, to ensure compliance with relevant regulations. 

• The need for enhanced DBS checks for funeral directors and mortuary staff to enhance safety and accountability. 

• Managing the shortage of autopsy pathologists and establishment of a ministerial working group led by the Ministry of Justice. 

• Preparedness for upcoming winter pressures and concerns about capacity issues in the sector. 

Conclusion 

I really appreciated the openness and honesty of colleagues at the roundtable. I believe that by working together we can help to improve the management of the deceased. I’m keen that the HTA plays its role in taking forward opportunities for improvement. Over the coming months we will continue to focus on improving collaboration and will be looking at specific actions we can take forward within our remit, but also those where we can support and encourage others to act. 

Louise Dineley 

Director of Data, Technology and Development