Mortuary review group: response

Quality Improvement - Standards, Audit, monitoring and feedback

A good quality services must include:

• Dignified and respectful care and storage of the body, including identification, security and access such as safe viewing for post mortem examination, etc.
• Processes to dispose retained tissue and organs after clinical examination
• A process to return the deceased's property, as soon as feasible, where appropriate and possible, including the management of unclaimed property. ^[3]
• Addressing the needs of the bereaved to manage the practical arrangements after death such as provision of accessible, culturally sensitive, relevant information ( e.g. written and/or web based listing and describing sources of support, helplines , points of contact for different purposes)
• Provision of information for bereaved families and friends following murder or culpable homicide http://www.gov.scot/Publications/2013/03/2510
• A protocol for the management of funerals where there are no next of kin to take responsibility e.g. relatives cannot be traced, relatives cannot afford to pay for the funeral or are unwilling to take responsibility for funeral arrangements

The management and delivery of services relating to death and bereavement must be reviewed and audited annually against agreed standards. Procedures to help ensure this takes place might include:

• the use of agreed standards to audit the service
• agreeing and collecting relevant quantitative and qualitative data
• obtaining feedback from staff
• obtaining feedback from a wide range of users of the service through, for example, complaints monitoring, questionnaire surveys and one-to-one or group consultation
• involving users in discussions and decisions about service development

The results of the evaluation of services must be properly discussed with partners with an interest in the service, acted upon and published by all relevant partner organisations. An example of an audit tool (the Tayside Audit tool) is in Annex D .

Healthcare Improvement Scotland is also introducing new comprehensive assessments of the quality of healthcare. This is part of a programme of work to implement a new framework-based approach to comprehensive assessment and external quality assurance of the care provided in NHSScotland. This approach must be used to support internal self-assessment and external validation of the quality of care of the mortuary services and facilities (see Annex D ).

The framework could also inform the work of the Inspector of Funeral Directors to support Funeral Directors to improve their body storage facilities e.g. access to refrigeration and viewing facilities as required.

The option of an Inspector of Mortuaries was discussed by the group. The role and remit of the Inspector of Crematoria and newly created Inspector of Funeral Directors were seen as being a model that could be used as a model if the decision was to recommend this option. However, after consideration it was proposed that Healthcare Improvement Scotland be invited to develop a self-assessment tool and facilitate external peer review.

Recommendation:

• Healthcare Improvement Scotland ( HIS) should be commissioned to develop national mortuary standards, having regard to the NHS hospital post mortem standards and the SHPN 16-01 (revised HFS SPHN 20) advice. ^[4]
• HIS should also be asked to develop a quality framework and quality indicators, with a self-assessment tool, to enable self-assessment and external peer review of the quality of mortuary services. The remit would cover actions such as compliance with the Public Health Act, mortuary capacity, clarification of roles and responsibilities, etc.