Birmingham Community Healthcare NHS Foundation Trust: When someone has died at home

Birmingham Community Healthcare

NHS Foundation Trust

Practical help and support for relatives and friends when someone has died at home

Best Care Healthy Communities

We would like to express our sincere condolences to you and your family at this sad time.

When someone dies, there are many decisions and arrangements to be made. This booklet aims to provide some useful help and advice during the early days of your bereavement from understanding your emotional and physical responses to the practical things you will need to do, such as register the death and arrange the funeral.

We hope this booklet will help you at this difficult time.

Please do not hesitate to ask any questions if you are unclear about any matter, our staff will always be pleased to help.

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Contents Medical Certificate of Cause of Death MCCD) and the role of the Medical Examiner Deaths reported to the Coroner

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Registering the death

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• Fast tracking / release of deceased out of hours • Repatriation / burials abroad • Arranging the funeral • Probate and legal advice

Who do I need to inform?

Stopmail Bereavement Talking to children about death Bereavement support Providing feedback/raising concerns Reviews of deaths in our care In memory donations Disposing of unwanted medicines/returning equipment Disposal of sharps bins Checklist - people you may want to notify Sample letter

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9-10 10 10-11 12 13-14 15 16 17 17-18 18 20-21 22

Medical Certificate of Cause of Death (MCCD) and the role of the Medical Examiner Before the death can be registered, a Medical Certificate of Cause of Death (MCCD) is required. This will be coordinated by the GP Practice of the person who has died and the Medical Examiner’s Office.

Medical Examiners are senior doctors who will not have looked after your loved one during their final illness. Their role is to review the clinical records about the final episode of care and give an independent view of the cause of death and the care received. The GP Practice will coordinate the sending of the clinical records to the Medical Examiner’s Office. They will also send the contact details of the next of kin to the Medical Examiner’s Office.

Following the review, the Medical Examiner’s Office will contact the next of kin within 2-3 days of the death to explain the cause of death and answer any questions you may have. This provides an opportunity to have a conversation with someone who was not involved in providing the care and ask any questions you may have, for example, understanding the medical language used or something about the care which you did not understand.

Once this has been completed, the Medical Examiner’s Office will coordinate the sending of the Medical Certificate of Cause of Death to the Register Office.

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Deaths reported to the Coroner Sometimes it is necessary for a death to be reported to the Coroner before the Medical Certificate of Cause of Death can be issued.

Should this be required, the reasons for this will be explained and you will be provided with further information on the process.

Referrals to the Coroner should not be a cause for concern, but it will delay the issuing of the Medical Certificate. After reviewing the details, the Coroner may give permission for the Medical Certificate of Cause of Death to be issued, or, if unable to establish a cause of death, the Coroner will decide what investigations are needed (such as a post mortem or Coroner’s Inquest). The Coroner’s Office will keep you informed throughout this time.

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Registering the death Once the register office has received the medical certificate of cause of death you will be able to register the death.

The death must be registered in the district where a person dies.

If the death of your loved one occurred in Birmingham, details are included below for Birmingham Register Office: You will need to complete an online ‘Preregistration of death’ form which can be found on the Birmingham City Council website via the link below: www.birmingham.gov.uk/xfp/form/706 You will need the following information to complete this form: For the person who has died: • the date and place of their death • their full name with correct spelling • their previous or alternative names, which includes a maiden name if applicable – this is the surname of a woman before her first marriage • their current or last occupation or main trade and if they are retired, for example: Carpenter (retired) • if they were married, their husband or wife or registered civil partner’s full name and occupation and if they are retired – this includes people who are separated but not divorced • their full postal address including postcode, or the name and address of their care or nursing home • Date of birth of surviving spouse • Whether they were in receipt of a pension or any other type of allowance

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About you: • your full name and postal address • a daytime contact number • an email address you have access to If you do not have access to the internet, your funeral director or a friend/family member can complete the form on your behalf, giving your details.

Registering the death is a legal requirement and should be done within five days of the death occurring unless a referral to the Coroner is required.

Contact details for the Birmingham Register Office: Birmingham Register Office Holliday Street Birmingham B1 1TJ Telephone: 0121 675 1000 If the death of your loved one occurred outside of Birmingham, we have included details below of register offices from the surrounding areas: Sandwell - www.sandwell.gov.uk/sandwell-register-office Solihull - 0121 704 8002 Staffordshire - www.staffordshire.gov.uk/Births-deaths-and- marriages/Registration-Offices/home.aspx Walsall - go.walsall.gov.uk/births-marriages-and-deaths Warwickshire - www.warwickshire.gov.uk/births-deaths- ceremonies/register-death-new-rf Worcestershire - www.worcestershire.gov.uk/council-services/ births-deaths-marriages-and-citizenship/death-registration- services

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Fast tracking / release of deceased out of hours If families require a burial to take place promptly for cultural or religious reasons and the death has occurred during a weekend or bank holiday, this may be possible, providing that the death has not been reported to the coroner and that the medical staff are able to issue the medical certificate of cause of death.

Repatriation / burials abroad If the deceased wished to be buried outside of England and Wales, they cannot be removed out of the country unless a coroner has issued the appropriate certificate. Therefore, when registering the death, you must inform the registrar of the intention to remove the deceased from the country. The registrar will then provide you with the necessary paperwork and inform you of what information will be required by the coroner.

Arranging the funeral Following a death, it is important to contact the funeral director of your choice as soon as you are able to so they can begin making preliminary arrangements on your behalf. Most funeral directors are available 7 days a week and your chosen funeral director will make all the necessary arrangements and advise you on all the procedures/documents you will require.

Funerals are expensive and although basic costs are very similar the final cost can vary considerably. Ask the funeral director for a written quote which will outline the `Disbursements` which are the fees paid to others - cremation, minister, doctor’s certificate, flowers etc.

Financial help may be available if you receive one or more of the following benefits: • Income Support • Income-based Jobseeker’s Allowance • Income-related Employment and Support Allowance • Pension Credit

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• Housing Benefit • The disability or severe disability element of Working Tax Credit • Child Tax Credit • Universal Credit If the person who has died has no next of kin, contact the Department for Work and Pensions before making any arrangements.

Website: www.gov.uk/browse/births-deaths-marriages The Trust do not recommend any particular funeral director. For more information you can contact the National Association of Funeral Directors via their website: www.nafd.org.uk or you can contact your local library or Citizens Advice Bureau.

Probate and legal advice Probate is a document issued by the Probate Registry confirming that an executor has the right to wind up the estate of the person who has died. The `estate’ is the house, money and savings someone has left. If you need any further advice on probate, contact the helpline on 0300 303 0648 or use the following link: www.gov.uk/applying-for-probate If you have any difficulty in dealing with the deceased’s property, possessions or guardianship of their children, seek advice from a solicitor or the Citizens Advice Bureau as soon as possible. If there is no will, speaking with a solicitor may be helpful.

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Who do I need to inform?

‘Tell us Once’ service This service brings together several organisations (see list below) so that people do not need to notify them individually of the death. To use ‘Tell Us Once’ the death must already have been registered. The registrar will explain the Tell Us Once service when you register the death and give you a unique reference number so you can use the service yourself online or by phone.

You can also find information at www.gov.uk/tell-us-once Tell Us Once will notify: • HM Revenue and Customs (HMRC) • Department for Work and Pensions (DWP) • Passport Office • Driver and Vehicle Licensing Agency (DVLA) • The local council • Veterans UK Tell Us Once will also contact some public sector pension schemes so that they cancel future pension payments. They’ll notify: • My Civil Service Pension • NHS Pensions for NHS staff in England and Wales • Armed Forces Pension Scheme • Scottish Public Pension Agency schemes for NHS staff, teachers, police and firefighters in Scotland • Local Government Pension Schemes (LGPS) that participate in Tell Us Once

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Note they do not inform the following organisations • Royal Mail • Utilities • TV licensing • Bank / building society • Insurance companies • Rental companies A checklist is provided within this booklet that lists the organisations you may need to notify.

Stopmail To stop unwanted junk mail, please visit www.stopmail.co.uk or call 0808 168 9607. This is a free of charge service provided by the Bereavement Support Network and will actively reduce any unwanted mail and the likelihood of identity theft following the death of someone close.

Bereavement Bereavement is a distressing experience that all of us encounter at some time in our life, yet it is something that is talked about very little in our everyday life.

We grieve after any sort of loss, but most powerfully after the death of someone special to us. It can bring about stronger emotions than most people have ever felt before. It is not just one feeling, but a whole range of feelings which take time to work through and which should not be hurried.

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People react to bereavement in many different ways; you may feel cold, numb, empty and unreal for a time. This sense of emotional numbness can be a help in getting through all the practical arrangements that have to be made. Once this period is over you may experience emotions such as anger, panic, guilt and sadness, this may be accompanied by periods of restlessness, irritability and total despair. You may experience some or none of these feelings, but they are all natural reactions to bereavement.

The sudden changes of emotions can be confusing to friends or relatives, and it may be tempting to keep away from other people who do not fully understand or share the grief. Although no one knows exactly how you are feeling at this time, there are many people who can empathise and will want to help you towards a place in time where the pain will ease, and you will be able to remember your loved one without becoming too distressed. It is important to remember that grieving isn’t about forgetting the person who has died.

Bereavement is one of the most painful experiences most of us will have to endure and there are times when you may want to talk to someone but feel unable to approach family or friends and for those who struggle there is help available, not only from doctors but from other professionals and organisations.

If you feel unable to resolve your grief help can be accessed through your GP or if you feel unable to confide in your GP and share your emotions, you may find some of the voluntary support organisations helpful.

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Talking to children about death As adults we often feel the need to protect children from death.

We may feel children will not understand or that they will be too upset. However, we can often underestimate a child’s resilience and ability to cope. Children often find it harder if they are not told what is happening, because they may be more frightened by imagined events. Children should be told the facts in a simple manner using appropriate words. Give them time to ask questions (which may be very direct). It is helpful for adults to share feelings with children, such as feelings of sadness. By doing this they learn that is it natural to feel sad when someone dies.

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Bereavement Support Cruse Bereavement Care Birmingham Branch: 0121 687 8010 Helpline: 0808 808 1677 Website: www.cruse.org.uk Cruse provide bereavement support, advice and leaflets.

The Good Grief Trust Website: www.thegoodgrieftrust.org The Good Grief Trust provides information, helplines and advice to help people find the support they need following a bereavement.

Child Bereavement UK Telephone: 0800 0288840 Website: www.childbereavementuk.org Child Bereavement UK supports families and educates professionals when a baby or child of any age dies or is dying, or when a child is facing bereavement.

National Bereavement Service Website: thenbs.org Helpline: 0800 0246 121 The National Bereavement Service helps those in need of support following a bereavement, including emotional and legal support.

The Compassionate Friends Helpline: 0345 123 2304 Website: www.tcf.org.uk The Compassionate Friends are a self help organisation for parents whose child, even adult, has died. They also provide a range of leaflets.

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Age UK National advice line: 0800 678 1602 Website: www.ageuk.org.uk Age UK offer advice, information and services for the elderly and their carers.

Samaritans Local Branch: 0121 666 6644 National Helpline: 116 123 Website: www.samaritans.org

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Providing feedback/raising concerns Birmingham Community Healthcare NHS Foundation Trust is committed to improving the quality of care we provide. One area that is very important to us is the quality of care at the end of life and the care given to families and friends during this time.

We have included a link and QR code below to a survey in which we ask for your feedback on the care your loved one received in the last days of life and the support received by family and friends from our services.

We know these questions may bring back strong memories and emotions and that looking at the survey for the first time can be difficult. The survey is completely voluntary, and you only need to complete it when/if you feel ready to do so.

You can access the survey via the QR Code below:

Or via the following link: forms.office.com/e/Z7L7ZpUn6d Should you have any questions or concerns about the care you or your loved one received and would like to speak to someone, please contact the Patient Advice and Liaison Service (PALS) on: 0800 917 2855 or email - contact.bchc@nhs.net

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Reviews of deaths in our care As a Trust, we are committed to providing a high quality service to our patients. When someone dies unexpectedly in our care, we have a responsibility to routinely conduct a review of the care provided, in an open and honest way. This is standard practice in the NHS and helps us to check if there is anything we can learn or do differently. Part of this process will allow you the opportunity to ask any questions or tell us if you have any concerns surrounding the care provided.

A review is carried out by a clinician who was not directly involved in the care provided. They review the personalised care plan looking at each aspect of care and how well it was provided.

We would also carry out case note reviews when a significant concern is raised with us about the care we provided.

We consider a ‘significant concern’ to mean: (a) (b)

any concerns raised by the family that cannot be answered at the time; or anything that is not answered to the family’s satisfaction, or which does not reassure you.

This may happen when a death is sudden, unexpected, untoward or accidental.

When a significant concern has been raised, we will undertake a review for your loved one and share our findings with you.

Aside from case note reviews, there are specific processes and procedures that Trusts need to follow if your loved one had a learning disability and / or autism. If this is the case, we will provide you with the relevant details on these processes.

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In memory donations Rather than flowers at the funeral of their loved ones, many people now ask for donations in their memory. Your funeral director can arrange for donations to go to a charity or cause of your choice.

If you would like to make a donation to the community nursing team, you can do so through our charity team. You can choose which area receives the donation so it can be used to support the team that cared for your relative through their end of life or for specific items for the comfort and care of patients.

If you require any further information on how to make a donation, please contact us on: • Telephone - 0121 466 7314 • E-mail – bchc.charity@nhs.net Website: www.bhamcommunity.nhs.uk/charity

Disposing of unwanted medicines/returning equipment Any unwanted medicines, in the form of tablets, capsules, liquids, dressings, creams and patches can be returned to a local Pharmacy, where they will be safely disposed of. If your regular Pharmacy does not accept any returned medications, they may signpost you to the nearest Pharmacy that will provide this service.

Please do not attempt to reuse any of these medications which were not prescribed to you.

Any equipment that was provided by the Trust or Birmingham City Council needs to be collected and returned.

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Contact details: Medequip (example of equipment: foam mattresses, bed frames) 0845 340 4430 Arjo (example of equipment: air mattresses) 0845 734 2000

Disposal of sharps bins Please contact Birmingham City Council on the following contact: 0121 303 1112 and press option 6 for clinical waste collection.

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Checklist - people you may want to notify Tick Council services (covered by `Tell Us Once` service) Council housing Housing and council tax benefit Council tax Libraries Blue badge Adult social care (including attendance allowance) Collection of payments for council services Electoral services

Government organisations (covered by ‘Tell Us Once’ service) Department for Work and Pensions HM Revenue and Customs HM Passport Office DVLA Ministry of Defence, personnel and veterans agency

Legal and financial Bank / building society Solicitor Insurance companies Credit card companies

Employment and pensions Department for Work and Pensions Social security office

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Employer Trade unions Inland revenue

Domestic and personal TV licensing Vehicle licensing Gas / water / electric providers Newspaper / milkman Royal Mail Telephone / internet provider Rental / housing companies Clubs and associations Cancel appointments

Items which may need returning Pensions / benefit books Passport Driving licence National Insurance card NHS equipment on loan Unwanted medicines to local pharmacy Library card / season tickets

Reference: Birmingham Community Nursing Bereavement Book Review Date: October 2026 Publication Date: October 2024

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Sample letter Here is an example of a letter you may find useful when informing people about the death.

(Your name) (Your address) (Your postcode) (Your telephone number) Date (Name to whom you are writing) (Department) (Company) (Road) (City) (Postcode) Dear Sir/Madam, I am writing to inform you of the death of (full name of deceased and date of birth).

Please find enclosed with this letter the documents / papers which need to be returned to you.

(Name of Deceased) died at (hospital name or home address) on (date).

If you require any further information please contact me at the above address.

Yours faithfully (Your Name) Please note if you are writing to a solicitor, bank, building society or insurance company, they will ask for copy of the Death Certificate.

Photocopies are not accepted for insurance or legal reasons.

You may need to include the relevant account and policy numbers if available.

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