Agenda item

To receive a report from the Head of Democratic Services which presents an update from the Leeds Teaching Hospitals NHS Trust in relation to its out of hours bereavement arrangements.

The Head of Democratic Services submitted a report which presented an update report from the Leeds Teaching Hospitals NHS Trust in relation to its out of hours bereavement service.

The following were in attendance:

·  Councillor Fiona Venner, Executive Member for Children’s Social Care and Health Partnerships

·  Councillor Salma Arif, Executive Member for Adults Social Care, Public Health and Active Lifestyles

·  Caroline Baria, Interim Director of Adults and Health

·  Victoria Eaton, Director of Public Health

·  Phil Wood, Chief Executive, Leeds Teaching Hospitals NHS Trust (LTHT)

·  Stephen Bush, Medical Director Operations, LTHT

·  Ruby Ali, Associate Director of Operations, LTHT

·  John Adams, Medical Director (Governance and Risk), LTHT

·  Reece Wolfenden, Lead Service Manager for Bereavement and Medical Examiner Services, LTHT

The Chair invited the Chief Executive of Leeds Teaching Hospitals NHS Trust to give a brief introduction and in doing so, Members were reminded that in February 2023, representatives from Leeds Teaching Hospitals NHS Trust had engaged with the Scrutiny Board during the early stages of its review of the out of hours bereavement service.  Having supported the key principles of the review at that stage, the Scrutiny Board had requested to be kept informed of progress in relation to the new arrangements being put in place, as well as developments surrounding the anticipated introduction of the new national Statutory Medical Examiner System in April 2024.

To supplement the update report provided by the Trust, the Board also received a presentation.  The key points raised during this presentation were as follows:

·  The service review process had involved engagement with a number of key stakeholders, both internal and external, to look at ways of making the service more efficient.

·  Following the service review process, new arrangements were put in place on 2^nd October 2023, with the service now being managed both through the day and out of hours by the Mortuary Team in the Trust’s Pathology Clinical Service Unit.  This has helped provide a more consistent service.

·  There is now an 8am-8pm, seven days a week service, with an on-call model implemented from 4.30 pm to 8pm Monday to Friday and during weekends and bank holidays, 8am-8pm.  Exceptional requests outside these hours will be considered on a case-by-case basis.

·  Engagement sessions were held throughout November with Funeral Directors and also Elected Members to listen to initial feedback on the new arrangements.  There has also been positive feedback from representatives of Muslim and Jewish communities on the new arrangements.

·  An ongoing review of the service will be maintained to support the effective implementation of the new arrangements and refinements in response to feedback.

·  A review of paediatric and maternity out of hours arrangements is also underway to explore the opportunity to align with the new adult arrangements.

·  A new Medical Examiner Service has been introduced by the Trust on behalf of NHS England and that provides the scrutiny of all deaths not investigated by HM Coroner.

·  The introduction of the Medical Examiner Service came about following a number of key profile independent inquiries.  The more recent Lucy Letby statutory inquiry has led to this service also being extended to paediatric and neonatal deaths.

·  The key aims of the new service were outlined to the Board, which were primarily focused around driving efficiencies and providing greater assurance for the bereaved through independent review of care.

·  The team consists of 20 Medical Examiners and 6 Medical Examiner Officers who are all independent of the Trust.  They will also be independent of the case being reviewed as they will not have had any involvement in that particular patient’s care.

·  Charts were presented to the Board to help illustrate the death certification process and the complete bereavement/mortality process from verification through to registration of a death.

·  Accountability of the service is to the Director for Governance and Risk at the Trust and also to the National Medical Examiner.

·  The service has been expanding since 2021 as there were only 2 Medical Examiner Officers and 2 Medical Examiners within the Trust at that time.

·  There are 5 General Practices across Leeds that are actively referring deaths to the service.  However, the Trust has been met with challenges from several GP practices who are not willingly engaging with the service until it becomes a statutory requirement.

During the Board’s discussions on this matter, the following points were also raised:

Ø  Communication with families – It was noted that following any death, family members will need to appoint a funeral director who will guide them through the process.  When a death occurs in a community, then specific communities will have designated funeral directors who will be able to guide the bereaved family through the relevant processes and will also liaise with the Trust around expectations associated with that community.

Ø  Weekend deaths in the community and the challenge of contacting GPs – Some Members shared positive experiences of GPs willing to make themselves available during weekends to issue a medical certificate of cause of death (MCCD) for ceremonial and burial purposes for religious and cultural reasons.  However, some Members, including the Executive Member for Adults Social Care, Public Health and Active Lifestyles, also shared recent experiences of bereaved Muslim families being unable to contact their GP following a death that occurred during a weekend.  Members were informed that while there is ongoing engagement with the West Yorkshire Integrated Care Board (ICB) and the GP Confederation regarding preparations for the new national Medical Examiner System commencing in April 2024, more clarity was still being sought surrounding the implications of the new regulations.  It was expected that further national guidance would be made available in the coming weeks.  In the meantime, the Chair suggested that he writes on behalf of the Scrutiny Board to the Chair of the GP Confederation on this issue and to particularly encourage a proactive and consistent approach across local GP practices to help meet the needs of communities.

Ø  Deaths of adults with learning disabilities – It was highlighted that while there are specific lines of enquiry that need to be followed in this regard, the Medical Examiner Service will still feed into that process from an independent point of view.

Ø  Registration services – In acknowledging that the new regulations will also have implications for registration services, which are the responsibility of Leeds City Council, the Chair advised that further information surrounding the position of this service would be sought and relayed back to the Board.

The Chair thanked everyone for their contributions and welcomed the progress that has been made by the Trust regarding this service.

RESOLVED –

(a)  That the contents of the report and presentation be noted, along with Members comments.

(b)  That the Chair of the Adults, Health and Active Lifestyles Scrutiny Board writes to the Chair of the GP Confederation on this matter and particularly encourages a proactive and consistent approach across local GP practices to help meet the needs of communities.

(c)  That further information is also sought regarding the position of Registration Services on this matter.