Chamber and committees

Medical Certificates of Cause of Death (MCCD) - Death Certification Review Service (DCRS)

Letter from Maree Todd MSP - Change in way reviews of Medical Certificates of Cause of Death (MCCD) are being undertaken - 25 October 2021

Dear Gillian

I am writing to inform you of a change to the way in which reviews of Medical Certificates of Cause of Death (MCCD) are currently being undertaken by the Death Certification Review Service (DCRS).

Background

As you will be aware from previous correspondence to the Committee on this topic, DCRS was established by the Certification of Death (Scotland) Act 2011. One of its key functions is to review a random selection of MCCD in Scotland. Under normal circumstances, 10% of all eligible MCCD are randomly selected for a Level 1 review , 2% are selected for a Level 2 review , with approximately an additional 2% made up of interested person reviews .

This update follows letters sent to the Committee on 18 January 2021 by the previous Minister for Health and Sport, Ms Gougeon MSP, and 5 July 2021 by myself. The 18 January 2021 letter noted that DCRS reviews were being reduced to 8% of all eligible MCCD, and that these would be limited to hybrid Level 1 reviews . Following that date, officials continued to review available data (e.g. excess deaths, and hospitalisation and ICU numbers) every two weeks and regularly increased the reviewing rates, as appropriate and in agreement with DCRS.

The letter I sent to the Committee on 5 July 2021, highlighting that from 10 May 2021 DCRS had returned to pre-pandemic, standard levels of reviewing MCCD.
This was a positive step, and reflected the improved situation on the ground with respect to hospitalisations and deaths.

Current Position

Given the current challenges the NHS is facing, the impact of DCRS continuing to operate at normal service levels has been assessed as overly burdensome on front-line doctors delivering care to patients.

However, it is important to recognise the important role that MCCD reviews have on improving the quality and accuracy of MCCD and in maintaining public confidence in the death certification system.

To balance the burden on certifying doctors while maintaining necessary scrutiny, we have again reverted to an adjusted schedule of MCCD reviews. In discussion with DCRS, National Records of Scotland (NRS), and officials from across the Scottish Government, including primary care and unscheduled care, we decided that 8% of eligible MCCD will continue to be randomised for review. These will be limited to hybrid Level 1 reviews. Detailed Level 2 reviews, which could be more resource intensive for hospital administrative staff, will be limited to those which need escalation from Level 1 reviews and for interested person reviews.

These changes came into effect on Monday 4 October 2021 at 11:00. We believe this is a balanced and proportionate response under the current circumstances of NHS pressure; it reaches a careful balance between adequate scrutiny of MCCD and impact on certifying doctors. The position was reviewed after two weeks and a decision taken to continue at the 8% level. The position will continue to be reviewed every two weeks.

Maree Todd
Minster for Public Health, Women’s Health and Sport