Agenda item

To receive a report from the Head of Democratic Services relating to a review of out of hours bereavement arrangements at Leeds Teaching Hospitals NHS Trust.

The Head of Democratic Services submitted a report relating to a review of out of hours bereavement arrangements at Leeds Teaching Hospitals NHS Trust (LTHT).

The following were in attendance for this item:

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

·  Cllr Salma Arif, Executive Member for Public Health and Active Lifestyles

·  Caroline Baria, Interim Director of Adults and Health

·  Victoria Eaton, Director of Public Health

·  Rob Newton, Associate Director of Policy and Partnerships, Leeds Teaching Leeds Teaching Hospitals NHS Trust (LTHT)

·  Mike Philpott, General Manager Pathology, LTHT

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

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

·  The Rev’d Ben Rhodes, Head of Chaplaincy and Spiritual Care, LTHT

In introducing this item, the Chair explained that in September 2019, the Adults, Health and Active Lifestyles Scrutiny Board had received a briefing from Leeds Teaching Hospitals NHS Trust (LTHT) regarding changes to its out of hours bereavement arrangements aimed at improving the experience of bereaved families. Such changes involved the introduction of new processes to enable the timely release of deceased adult patients for ceremonial and burial purposes for religious and cultural reasons.  However, the Chair explained that the Trust is now undertaking a further review of its out of hours bereavement arrangements and was therefore invited to today’s meeting to engage with the Scrutiny Board at this early stage of the review process.

The Board received a presentation that was led by the Medical Director (Governance and Risk) at LTHT.  The key points raised during this presentation were as follows:

Ø  The Trust currently operates a 24 hour service, with the out of hours service operating on weekday evenings (from 16:30 onwards) and at weekends.

Ø  The responsibility for releasing deceased adult patients to funeral directors out of hours is taken on by Clinical Site Managers (CSM). There is one CSM at Leeds General Infirmary and one at St James’s University Hospital.

Ø  Out of hours release requires a significant amount of resource and coordination by CSMs. During times of operational pressure, a timely service by CSMs cannot be guaranteed given other urgent needs for patient care.

Ø  While a new service model is being developed, the Trust will continue to provide an out of hours service. However, in doing so it is proposed that the Trust considers moving to a 08:00 to 20:00 service on weekends and weekdays.

Ø  The Trust is awaiting further details surrounding a new Statutory Medical Examiner System that is expected to come into force in April 2023. This system will require Medical Examiners to provide independent scrutiny of all deaths not taken for investigation by a coroner which is therefore likely to have an impact on service delivery.

Ø  Other considerations linked to making changes to the service were also outlined and included establishing clear policies and practice for out of hours during both weekdays and weekends; ensuring timely release of bodies with the potential to reduce the need of out of hours release; effective liaison and co-ordination with the Council’s bereavement services; establishing more consistent policies and practice across the West Yorkshire region, with co-ordination through the West Yorkshire Association of Acute Trusts (WYAAT); quality control and assurance measures concerning the release of bodies; better understanding of demand levels and the best use of resources; and ensuring that the needs of other patients in hospital are being met with high quality and timely service provision from CSMs, Pathology and Mortuary.

Ø  A timeline for the service review was shared with the Board which involved developing a new model, with identified responsibilities, by 31^st March 2023.  Testing and approval of the model is expected to take place during April with a view to begin implementing the final model by 1^st May 2023.

Ø  As well as engaging with the Scrutiny Board, ongoing engagement with faith and community groups, funeral directors, bereavement services, LTHT staff and West Yorkshire NHS Trusts were also deemed necessary as part of the process for change.

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

• The Board was advised that there is a significant amount of quality checks involved to ensure that the release of bodies of deceased patients is undertaken correctly and safely. During this time, Clinical Site Managers are not contactable for any other urgent site issues and under current processes, would be unable to delegate this responsibility to another individual or group of staff.
• It was highlighted that work to identify other qualified individuals or groups of staff to release the deceased was being undertaken as part of the review process.
• While it was acknowledged that some Trusts have utilised their mortuary staff to assist with out of hours releases, the Board was advised that this option is not considered feasible in Leeds due to capacity issues.
• While the physical release of deceased bodies primarily requires some administrative training, it was highlighted that the paperwork and clinical processes would require a medical examiner or senior consultant to authorise the release.
• Some Members shared their experience of having increased contacts from constituents over the last few months regarding issues of late release of deceased kin. While understanding the service pressures being placed on the CSMs, importance was placed on finding a suitable and sustainable way forward given this very difficult and sensitive matter.
• A statement was also read out on behalf of the Interfaith Director at the Leeds Jewish Representative Council which explained that the provision of out of hours bereavement services for Jewish and Muslim communities is critical. Concerns for the communities to provide timely burials for their loved ones were raised and any efforts to improve the situation were supported with the offer to meet with the Trust to consider how best to improve the situation.
• The Medical Director (Governance and Risk) apologised on behalf of the Trust for the service not being delivered to the intended level.
• In response to a question from Members, it was explained that the new Statutory Medical Examiner System is a national policy applying to all NHS organisations in England and Wales and will cover all deaths, even those in the community. However national legislation for full operation, funding and provision was still unclear.
• The Board considered the proposed move to a 08:00 to 20:00 service hours as being reasonable and practical.  However, a query was raised regarding the working arrangements of Medical Examiners and the practicality implications moving forward when the new national system is put in place.
• The Board was advised that the Trust already have 13 Medical Examiners with 4 supporting administrative officers and that these primarily work from 08:00 to 16:00.  It was highlighted that an additional 10 Medical Examiners are to be recruited to support community provision, with working hours being more aligned with registration services to provide greater flexibility.
• The Board was advised that while the government has issued guidance linked to the new system, which can be shared with the Scrutiny Board, the Trust is still awaiting further clarify surrounding the legislation to understand the full implications.  Given the tight timescales involved, it was predicted that the introduction of this new system may be delayed. However, this remained a concern for the Trust.
• A suggestion was made to address a letter to the appropriate Minister for details of the practical arrangements of the new legislation, which was agreed to be done through the Executive Member for Public Health and Active Lifestyles.
• Members highlighted that some General Practitioners (GPs) in Leeds, although not offering out of hours services, do provide telephone numbers for religious communities to provide necessary documentation enabling the deceased's next of kin to register the death.
• Work with GPs to have accessible records was noted to be ongoing to ensure Medical Examiners have essential information when certifying a death at any hour. Permission for access is through application to the given practice and not through NHS patient record management systems.
• It was highlighted that digitalised death certificates were also being progressed through the government which should also assist with issues surrounding accessibility and out of hours provision.
• As the NHS continues to recover from the Covid-19 pandemic, it was noted that there remain ongoing issues around staff recruitment and retention. Improving the position will require dedicated funding while also recognising services are unable to predict what happens clinically.
• The Board suggested that it would be helpful for the Trust to provide Elected Members with guidance of the process for the release of bodies out of hours to assist them when advising their constituents.
• As part of the ongoing engagement process, the Director of Public Health suggested that it would be helpful for the Trust to also engage with the GP Federation and other partners through the Local Care Partnerships and Primary Care Networks and would be able to assist in facilitating that engagement.

The Chair thanked everyone for their contributions and requested that the Board be kept informed of progress linked to the ongoing review process.

RESOLVED – That the contents of the report and presentation be noted, along with Members comments and requests for information.