The hospital team wish to offer their sincere condolences to you and your loved ones at this difficult time.
The symbolism of the butterfly is often used in end of life care and is based on the process of transformation that a butterfly may go through during a life cycle. The butterfly initiative was implemented as the hospitals commitment to improving end of life care. Our aim is to promote dignity in death by striving to make a positive impact on patient care and their loved one’s experience.
This booklet has been produced to provide some practical help and advice during the early days of bereavement.
Please ask our team for guidance as needed who can also update you on any changes that have occurred since the printing of this document.
Bereavement Services
Doncaster Royal Infirmary
Armthorpe Road
Doncaster
DN2 5LT
What do I do next?
The Bereavement Office is open Monday to Sunday from 8.00am-4.00pm. On the next working day after the death has occurred, a member of the Bereavement Services Team will contact you to guide you through the following steps.
Please note that the Medical Certificate of Cause of Death will not be available until you have been advised otherwise.
The next steps may vary depending on where the deceased person has died and their home address. For example if the person died in Doncaster but lived in the Nottinghamshire area. The Bereavement Services team will advise you of this, if applicable when you speak to them.
After a bank holiday or at other busy times our phone lines may be exceptionally busy. In the meantime we will always endeavour to make progress with making contact with the doctors to arrange for the Medical Certificate of Cause of Death to be completed. One of the team will call you to discuss next steps. There is a voicemail answering service if you wish to leave a message, we will call you back as soon as we are available.
Please note that it can take up to 72 hours for the Medical Certificate of Cause of Death to be completed.
The death certificate is needed in order to register the death; Bereavement Services will be able to advise you how to do this. However, if the death has been referred to the Coroner, there may be a delay in the certificate being issued. If this is the case, you will be kept informed. Once the cause of death has been suggested by the medical team you will be called by a Medical Examiner Officer to explain what is written on the certificate and whether you have any questions before sending it directly to the Registrar.
Further information about the duties of the Coroner are included on page 13 of this booklet.
Medical Examiners Service
Following the death of a relative you will be contacted by the bereavement team who will explain what happens next. You will be advised that the death will be reviewed by a Medical Examiner.
Who are Medical Examiners and Medical Examiner Officers?
Senior NHS doctors have received specialist training and spend some of their time working as Medical Examiners. Alongside other specially trained staff, their job is to provide an independent review of the causes of death – with the exception of deaths which have to be reviewed by a Coroner.
The Medical Examiners ensure that all deaths are reviewed by someone who is independent and who was not involved in the patient’s care. The Medical Examiner will work with the treating doctor (such as the GP or specialist doctor) to ensure that the information given on the Medical Certificate of Cause of Death (MCCD) is correct and that referrals to the Coroner are made (if needed) as soon as possible.
Medical Examiners and their staff (usually called Medical Examiner Officers) offer families and carers of the person who has died an opportunity to ask questions or raise concerns about the causes of death, or about the care the person received before their death. This will usually be through a telephone call.
Medical Examiners and their staff will provide an independent view, as they will only review cases where they, or their staff, have not provided care for your relative/friend.
What questions will I be asked?
The Medical Examiner or their staff are able to explain what is written on the Medical Certificate of Cause of Death and why, if requested. They will also discuss the Medical Examiner’s review and ask if there are any concerns or questions about the care the person received before their death. This is the best time for you to ask any questions you have about the death and to speak about anything that concerns you.
Why am I being asked if I have any concerns?
A discussion with a Medical Examiner or their staff provides you with an opportunity to have an open and honest conversation with someone who was not involved in providing care to the person who died, and anything about the care that may be worrying or of concern. It could be as simple as helping you to understand more about the treatment and causes of death or to understand the medical language used, or there may be something about the care which did not feel right or ideal. This is an opportunity to ask questions and raise concerns.
As well as answering your questions, this can help the NHS provide better care for other patients and carers in the future, for example by uncovering ways in which patient and family care could be improved.
Can I ask the Medical Examiner Team to talk to someone else if it’s too difficult for me to speak with them?
Yes of course, the Medical Examiner or their staff may contact you to ask who you would like us to talk to instead, or you can let the bereavement team know if you would rather have someone else as a first point of contact.
The Medical Examiner or Medical Examiner Officer will usually contact you by phone before sending the Medical Certificate of Cause of Death to the registrars, but we can arrange other ways of contacting you if you let us know what is best.
What if I don’t want to speak to the Medical Examiner or their team, or I don’t want to tell them about my concerns?
We understand this is likely to be a difficult time for many people, speaking to someone is completely your choice. If you are not sure, you can contact the Medical Examiner or the team at the following contact: Doncaster Medical Examiner’s Office on telephone 01302 644748 or Bassetlaw Medical Examiner’s Office on telephone 01909 572568 and ask for more information before deciding if you want to go ahead. They are trained professionals who are there to guide and help you during this difficult time and will be very understanding.
What will happen if something was not right?
The Medical Examiner and their team are here to listen to your questions and concerns and provide answers if possible. If issues are found, they will be passed onto the appropriate people to be formally investigated; if this is the case the Medical Examiner
or Officer can explain this process to you. Medical Examiners do not investigate further themselves.
Will funeral plans or release of the body take longer?
Medical Examiners make every effort to avoid any delays and work with families and carers of the person who died to meet the legal requirements for registering deaths. Each case will be dealt with individually and, when possible, the Medical Examiner’s office will give priority to those where relatives need urgent release of the deceased person or any Coroner involvement.
Your feedback is important to us and it will help the Medical Examiner service continue to improve.
Please feel free to complete this Medical Examiner questionnaire using the QR code.
Registering the death
The Medical Certificate of Cause of Death will be sent electronically (i.e. via secure email) to the Registrar. All deaths must be registered with the Registrar of Births, Deaths and Marriages within five working days.
The Registrar will contact you by telephone to make an appointment to register a death. However, if you need to contact them, you can do so at the contact details below:
The main Registry Office is located at Civic Office, Waterdale, Doncaster, DN1 3BU. You can contact Doncaster Registry Office on 01302 735222 or email them at registrars@doncaster.gov.uk
Copies of the death certificate can be purchased at the Registrars Office and they will advise you on how many copies you may require.
The Registrar will charge a fee per certificate and the Registrar will ask about:
• the date and place of death
• the full name of the person who has died (including if they have been known as any other name)
• their date and place of birth
• their home address
• their last occupation and whether they were retired
• whether the person who has died was married or a registered civil partner when they died
• name and occupation of the living or deceased spouse or registered civil partner
If it is a married woman or widow who has died, they will need to know her maiden name and her husband’s full name and occupation.
They will ask for the date of birth of any spouse or registered civil partner still living.
When the death has been registered a green form will be sent to the Funeral Director of your choice so arrangements can be made for cremation or burial. You will also receive a White form to complete for the Department for Work and Pensions.
‘Tell Us Once Service’
The ‘Tell Us Once Service’ is a free service that enables you to inform most government/council organisations of a death in one go.
When you register a death the Registrar will:
• Generate a unique reference number for you to use on the ‘Tell Us Once’ online page or by telephone
• Give you a print out with instructions on how to use the service.
The service enables you to notify the following organisations:
• The Department for Work and Pensions - to cancel state pensions, pension credit, benefits
• HM Revenue and Customs (HMRC) - to deal with personal tax
• Driver and Vehicle Licensing Agency (DVLA) - to cancel a licence and remove the person as the keeper of up to five vehicles
• Passport Office - to cancel a British passport
• Local Council - to cancel housing/council tax benefit, to inform council housing services, cancel a blue
What delays may you face?
Sometimes there are unavoidable delays in the issuing of the Medical Certificate of Cause of Death. In these circumstances the person’s body cannot be released immediately, and a delay is to be expected.
The main causes of such delays are listed here:
1. When the death takes place at the weekend or on a public holiday.
However staff will endeavour at all times to assist in the fulfilling of any particular religious requirement you may have in relation to funeral practices. If you need to proceed quickly please inform the nurse in charge of the ward.
2. When the death is reported to the Coroner: see ‘What are the Coroner’s duties’ page 13.
3. When the funeral is to take place out of England or Wales. An ‘Out of England’ order will need to be issued to you by the Coroner before proceeding.
A ‘Free from Infection’ Certificate must be issued by the hospital prior to transportation. Your Funeral Director can arrange this.
4. The body of a deceased person cannot be released from the hospital until the death has been registered, and the Funeral Director has received the green certificate from the Registrar. The Funeral Director will then be able to collect your relative/friend from the Hospital Mortuary and take them in to their care.
What are the Coroner’s Duties?
A death sometimes has to be reported to the Coroner for legal reasons and the hospital staff will advise you if this has to happen, this is usually when a Doctor is unable to issue a Medical Certificate of Cause of Death. The Coroner is appointed to investigate certain types of death.
A death will be referred to the coroner in the following circumstances:
• no precise cause of death can be established
• not thought to be from natural causes
• trauma or injury
• the person underwent a treatment or procedure of a medical or similar nature
• an injury or disease attributable to any employment held by the person during the person’s lifetime
There are other cases that may be referred to the Coroner. The Coroner’s Office will be able to help you and give you advice on any other circumstances not listed.
You will have to wait to hear from the Coroner’s Officer before registering the death. If there is a need for a post mortem, the Coroner’s Officer will explain the process and advise you when it is appropriate to register the death.
The Coroner’s Office telephone number is 01302 737136 and they are open Monday - Thursday 8.30am - 4.00pm and Friday 8.30am - 3.30pm.
Can I View the Deceased Person?
Viewings in the Mortuary are only facilitated under exceptional circumstances and would otherwise be recommended after transfer to the Funeral Directors where this would be a more comfortable environment to do this. Viewing a loved one is an individual choice and the the funeral director will be able to support you with this decision.
Exceptional circumstances will only be considered by the Bereavement staff, Lead Nurse for Specialist Palliative and End Of Life Care Services and Mortuary Lead.
Any agreed viewings will be made via the Bereavement Office and will be accompanied by a trained End Of Life Care Clinical Nurse Specialist and Bereavement Officer in order to provide sufficent support to the bereaved.
Viewings will be made with a prior appointment only and during working hours.
Organ, Tissue and Body Donation
Organ Donation- has to be considered before death occurs, and is only possible in certain hospital areas, for example, the Intensive Care Unit and Emergency Department. Please note if your loved one was known to have registered for organ donation, please notify the medical team.
Tissue Donation- is possible up to 24 hours after death, if this is something you wish to consider please inform the medical team as soon as possible.
The next of kin is always required to consent to organ and tissue donation.
More information about organ and tissue donation can be found at www.uktransplant.org.uk
Body Donation- is the giving of a body for use in teaching anatomy to medical students. It may not always be possible to accept this donation. Under the Human Tissue Act, written consent must be given by the deceased person prior to their death; consent cannot be given by anyone else after their death.
More information about body donation can be found at www.hta.gov.uk or by telephoning the University of Sheffield on 0114 222 4642.
Who can help me arrange the Funeral?
You can contact your chosen Funeral Director who can advise you on all necessary arrangements and procedures required.
The Funeral Director can arrange to meet you at your home address if you prefer. They can answer any questions that you may have regarding burial or cremation. Most Funeral Directors belong to their National Association, which has regulations and standards that must be followed.
The Hospital Chaplaincy Service may also be of great help during this difficult time. They can be contacted by ward staff or the hospital switchboard for any advice needed.
Chaplaincy Services
Doncaster Royal Infirmary: 01302 642237
Bassetlaw Hospital: 01909 572846
The person who arranges the funeral is usually responsible for meeting the costs. This can come from the deceased persons estate or any funeral scheme he/she may have opted in to.
Financial help may be available if you receive certain benefits. Contact the Department for Work and Pensions (DWP) before making any arrangements.
Who can I contact regarding State Benefits?
The Registrar of Births and Deaths will have given you a notification of death certificate (white certificate) and a pre-paid envelope, which you will need to send to the DWP Office after you have filled it in.
The free phone number for all advice regarding pensions, reporting a death and for information with regards to bereavement benefits is 0800 731 0469 or information can be found on their website www.gov.uk
Feedback on your experiences
As a Trust we are committed to ensuring that the bereaved person can feedback their and their loved ones end of life care experiences.
Please scan the QR code below if you would like to complete a survey relevant to any of the following services which you or your loved one may have experienced during this admission; Specialist Palliative Care Team, End of Life Care Team, Chaplaincy and the Bereavement Services Team.
Probate and legal advice
If you have difficulty in dealing with the deceased person’s property, possessions or guardianship of their children, get advice from a solicitor or the Citizens Advice Bureau. If there is no Will, speaking with a solicitor may be helpful. Many solicitors are prepared to offer up to half an hour of legal advice free.
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 left by someone who has died (probate may not be necessary if the estate
Who do I need to tell?
You will probably want to let the family, friends and neighbours know of the death right away. There are several other people who may also need to know.
Priest, Vicar, Minister or Faith Leader
Family Doctor
Dept. Works & Pensions
(pensions, benefits etc)
Bank, Giro, Credit Cards, Building Society
Social Services (home helps, home care)
Schools, College or University attended
Place of Work (occupational pension)
Executors of the Estate (Will)
Solicitor
Insurance Companies
Library Service
Inland Revenue
Residential or Nursing Home
Continued on page 21
Landlord, Housing Department
Council Tax Office
Electricity, Gas, Telephone, Water Companies
Post Office (redirect mail)
Driving Licence Centre (D.V.L.A.)
Careline
Cancel any appointments
The deceased person may have been living alone so you will need to ensure that their home is secure and remove all signs that indicate no-one is there. You may wish to collect spare keys from other relatives, friends and neighbours.
Sample Letters
Here is an example of a letter that you may find useful when informing people about the death:
[Your Name] [Your Address] [Your Postal Code] [Your Telephone Number]
Date:
[Name to whom you are writing] [Department] [Company] [Road] [City] [Postal Code]
Dear Sir/Madam
I wish to inform you of the death of [name of Deceased Person and date of birth].
Please find enclosed with this letter the documentation/ papers which need to be returned to you.
[Name of Deceased Person] 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]
Encs
Please note if you are writing to a Solicitor, Bank, Building Society or Insurance Company you will need to include a 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.
Stopping Junk Mail to the recently deceased person
If someone you know has died, the amount of unwanted marketing post being sent to them can be greatly reduced which helps to stop painful daily reminders.
By registering with the free service www.stopmail.co.uk the names and addresses of the deceased person are removed from mailing lists, stopping most advertising mail within as little as six weeks. If you cannot access the internet you can call 0808 168 9607, where you will be asked for very simple information that will take only a few minutes to complete. Alternatively, ask the bereavement team for a leaflet that can be returned in the post.
This free of charge service provided by the Bereavement Support Network will actively reduce the unwanted marketing mail but also can help reduce the likelihood of identity theft following the death of someone close. The information is not used
for any other purpose and you only have to complete this once. Additionally to Stop Mail a comparable service can also be accessed from the Bereavement Register or Deceased Preference Service if you would prefer to use them.
Is there any bereavement care provided by the Hospital?
The Hospital Chaplaincy Service is a multi-faith department whose role is to provide pastoral, spiritual and religious care for patients and their relatives. Chaplaincy can be contacted on: 01302 642237.
Both Bereavement Services and Chaplaincy staff are able to provide you with practical advice during the early days of your bereavement. Both can also help to signpost you to find appropriate ongoing support from a wide variety of local organisations including voluntary organisations, support groups and groups within churches and faith communities.
Some advice you may find helpful
Living through Grief
The grieving process is often described in terms of different stages. These are, shock and disbelief, sadness and depression, anger and guilt and finally acceptance.
The time it takes to go through this process can vary considerably and is sometimes longer than most people imagine. We are all different and grief is individual, and may not necessarily follow the same pattern.
Shock and Disbelief
When a death happens, even if expected, it may be a shock to your system. You may find it difficult to deal with and your mind often does not want to believe it.
People talk about feeling numb, as if the events are not real. This is a normal intrinsic reaction that allows you to cope with the situation over a period of time.
To begin with you may be surprised at how well you cope and are able to organise matters, such as the funeral. However, you may find a few weeks later that you are having difficulty making even the simplest of decisions. This may be quite common when you have more time to think about the situation and less to distract you.
Sadness and Depression
As the numbness wears off, there are often periods of intense sadness and crying, which may lead to exhaustion. You may feel that you are not in control and have days when you feel depressed. This experience will improve over time and you may recognise that you become more focused, organised and able to cope.
These changes in mood can go on for several months, although the intensity should diminish over time. Being able to express your emotions and share your feelings with someone you trust can be a great help.
Anger and guilt
Anger and guilt can also be expressions of grief and responses to the loss of somebody close.
Anger can be directed at certain events or the apparent injustice that death brings.
People often become angry when hurt and want to blame someone, even if that person is not at fault.
Guilt may occur when anger is directed at yourself. Instead of blaming others you blame yourself for what has happened. “If only I’d done this or that…..” This is all part of the wish for things to be different and to find a reason for what has happened.
Again, it helps to talk to somebody about how you are feeling as this often puts matters into perspective.
Acceptance
There will be a time when your inner resources are replenished and feelings of strength and purpose return.
Life will be different but you will be able to talk about the deceased person by name, recall happy memories, laugh over various things that have happened and all without bursting into tears or plunging into the depths of despair. All this may seem far away at the moment but that day will come.
Talking to children about death
As adults we feel the need to protect our children from things that we might find difficult. It is easy to assume children will not understand death and bereavement, or that it will be too upsetting for them.
However, we can often underestimate a child’s ability to cope. Like adults, children find it harder to cope if they are not told what is happening and can be more frightened by their own imagination.
Children should be told facts in a simple manner, using appropriate words, e.g. dead, rather than lost or asleep.
Give them plenty of time to ask questions, and offer plenty of love and reassurance. It is helpful for adults to share feelings with children, such as feelings of sadness. By doing so they learn that it is natural to feel sad when someone dies. Children often like to draw pictures or write stories as part of their way of saying goodbye. Reassure them that they are also allowed to be happy at times or play and that this is what their loved one would have wanted.
Memory Boxes
It may be possible for the Bereavement Team to put together a memory box for your child if they have lost a parent or family member they were extremely close to.
Please ask the Bereavement Officer at the hospital for more information regarding this.
Support For Children
The Bereavement Team will be able to signpost you to various support agencies if you feel your child may need some extra help dealing with their grief.
The team also hold a list of books that can be helpful when you are having discussions with your child about death and dying and feelings and emotions.
Please ask your Bereavement Officer for more information regarding this.
Advice & Support Organisations
Age UK
01302 812345
Unit 1, Ten Pound Walk, Doncaster,
DN4 5HX
Works with the elderly.
British Association of Counselling and Psychotherapy (BACP)
0145 588 3300
Help and advice finding an accredited counsellor in your area.
Macmillan-Cancer Backup
0808 808 0000
A telephone information and advice service offering support for people with cancer, their relatives and friends.
Child Death Helpline
0800 282 986/0808 800 6019
www.childdeathhelpline.org.uk
Provides a freephone helpline for anyone affected by a child’s death, from pre-birth to the death of an adult child, however recently or long ago, and whatever the circumstances of the death and uses a translation service to support those for whom English is not a first language. Volunteers who staff the helpline are all bereaved parents. Although supported and trained by professionals.
Citizens Advice Bureau
01302 243057
www.citizensadvice.org.uk
Civic Office Waterdale
Doncaster
South Yorkshire
DN1 3BU
Advice can be given on all legal and practical matters following a death.
Compassionate Friends
0345 123 2304
www.tcf.org.uk
An organisation of bereaved parents and their families offering understanding, support and encouragement to others after the death of a child or children.
CRUSE Helpline
0808 808 1677
www.cruse.org.uk
CRUSE Bereavement Care Youth Line
Freephone: 0808 808 1677
www.hopeagain.org.uk
A website for children and young people aged 12–18 who have been bereaved. Also has details of a confidential telephone for professional confidential bereavement counselling.
Department for Work and Pensions (DWP)
0800 055 6688
Provides benefits and services for a wide range of people, including the social fund funeral payment.
Healthwatch
www.healthwatch.co.uk
Help finding the information you need about services in your area.
Hundred Families
www.hundredfamilies.org
Offers support, information and practical advice for families bereaved by people with mental health problems, including information on health service investigations.
Inquest
0207 263 1111 option 1
www.inquest.org.uk
Provides free and independent advice to bereaved families on investigations, inquests, and other legal processes following a death in custody, and detention. This includes deaths in mental health settings. Further information is available on its website including a link to ‘The INQUEST Handbook’ a guide for Bereaved Families, Friends and Advisors.
Lesbian and Gay Bereavement Project
0207 833 1674
Offers advice and support to people bereaved by the death of a same-sex partner through a telephone helpline, provide advice on suitable clergy for the funeral, Funeral Directors and solicitors for any legal matters.
National Survivor User Network
www.nsun.org.uk
Is developing a network of mental health service users and survivors to strengthen user voice and campaign for improvements. It also has a useful page of links to user groups and organisations that offer counselling and support.
Roadpeace
0800 160 1069
www.roadpeace.org
3rd Floor, 3Space International House 6 Canterbury Crescent, Brixton, London SW9 7QD
Roadpeace offers a practical and emotional support service to the bereaved and injured through road traffic accidents.
SIBBS (Support in Bereavement for Brothers and Sisters)
www.tcf.org.uk/ftb-siblings
A sister organisation to Compassionate Friends. A nationwide self-help support group for people who have experienced the death of a brother or sister. Offers the same support as Compassionate Friends.
Stopmail
0808 168 9607
www.stopmail.co.uk
Stopping Junk Mail to the recently deceased. Removing the deceased person’s information from mailing lists, stopping most advertising mail within as little as six weeks.
Sudden Death Support Association www.sudden.org
Offers help to relatives and close friends of people who die suddenly. It is run by people who have experienced a sudden and tragic loss and would like to help others in their time of need.
Survivors of Bereavement by Suicide (SOBS)
0300 111 5065, 9am – 7pm every day www.uksobs.com
We exist to meet the needs and break the isolation of those bereaved by the suicide of a close relative or friend.
We offer emotional and practical support in a number of ways:
• Bereavement Packs
• Group Meetings (in a number of locations).
The Samaritans
116 123
Offers confidential telephone support for all in despair.
SANDS (Stillbirth and Neonatal Death Charity)
Helpline: 0808 164 3332
www.sands.org.uk
Offers emotional support to anyone who has lost a baby or babies during pregnancy, at birth or shortly afterwards.
Terrence Higgins Trust
0808 802 1221
10am to 6pm, Monday to Friday www.tht.org.uk
Provides practical support, help, counselling and advice for anyone who has lost someone due to AIDS.
WAY - Widowed & Young
www.widowedandyoung.org.uk
Offers support and advice and may be able to put widows in contact with people in a similar situation in their area.
Comments, Queries and Further Assistance
We hope you have found this leaflet helpful. If you would like to tell us what you think, or ask any questions please contact the Bereavement Services Department, Doncaster Royal Infirmary Hospital on telephone number 01302 642516.
Patient Advice and Liaison Service (PALS)
If you have any comments on the service you have experienced, you can make your comments to the person in charge of the ward/department.
Alternatively the Patient Advice and Liaison Service (PALS) at the hospital can provide assistance if you have cause for concern, compliments or suggestions regarding the care of your loved one or your family. They can be contacted on telephone number 01302 642764. An answer phone is available out of hours or you can email on dbth.pals.dbh@nhs.uk.
Reference: Doncaster Royal Infirmary Bereavement Booklet
Publication date: September 2024
Review date: September 2026
The Hospital would like to thank RNS Publications for publishing this information and the following pages contain some features from services o ering their help at this time.
Whilst the Hospital is grateful of their support it does not endorse or recommend any of the services that they provide.
