NHS Maidstone and Tunbridge Wells NHS Trust
Following a Bereavement in the Community – What happens next?
A practical guide for family and friends
Introduction We are very sorry for your recent loss and we know this can be a difficult and distressing time coping with the death of a loved one. We hope this booklet will offer you some gentle guidance of what happens next and what you need to do first. It will also detail the support you can expect from the Medical Examiner Service who will arrange scrutiny of the death and subsequent writing of the Medical Certificate of Cause of Death (MCCD) ( please see page 2). When someone dies there are many decisions and arrangements that have to be made. Whilst it is impossible to cover every detail, we have tried to provide help and advice in this booklet on the main issues to be faced when registering a death and arranging a funeral. The booklet also contains information on how to comment, through the Medical Examiner Service, if you have any concerns or worries surrounding the care and death of your loved one.
Contents Page What to do next................................................................................................................................................................................................................. 1 What is the Medical Examiner Service............................................................................................................................ 2 How does the Medical Examiner procedure work............................................................................... 3 Registering the death........................................................................................................................................................................................... 4 The Death Certificate............................................................................................................................................................................................. 5 Tell Us Once........................................................................................................................................................................................................................ 6-7 Deaths Referred to the Coroner ................................................................................................................................................... 8 Tissue and Body donation.......................................................................................................................................................................... 9 Funerals.............................................................................................................................................................................................................................. 10-11 How Are You Feeling?......................................................................................................................................................................... 12-14 Children And Young People................................................................................................................................................. 15-17 When to seek help.................................................................................................................................................................................................. 18
What to do next If your loved one died at home and had the support of the Community Nursing Team, they should be informed. If the death was expected, they may verify the death. The team will offer you some initial guidance at this very difficult time and as the GP needs to be informed, the Community Nursing Team can do this for you or you may wish to do this yourself. If your loved one died in a care home, the staff there will give you some initial guidance and support information. They will contact the GP surgery to inform them of the death and also the Community Nursing Team if applicable. It may also be appropriate to give the care home details of your chosen funeral director so your loved one can be transferred easily when the time comes. If your loved one died in the hospice or a community hospital, the Medical Examiner Service will be contacted by these locations to inform of the death and paperwork process will begin.
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What is the Medical Examiner Service The Medical Examiner Service is a national initiative to enable independent review of all deaths by a Senior Doctor/ Consultant. This review will take place before the MCCD is raised and released to the family. The Medical Examiner Service will • Make sure the bereaved receive a better service by giving them the opportunity to raise any concerns or worries they may have about the care and/or death of their loved ones with an independent, impartial party not involved in the care of the deceased. • Provide better safeguards, ensuring complete proportionate scrutiny of all non-coronial deaths and to improve the quality of MCCD’s by making sure they are accurate and true to cause. • Ensure deaths that should be referred to the Coroner are referred appropriately in the required timescale. This service will also allow the relatives first access to the wording on the MCCD and ability to ask further questions to understand clearly what happened to their loved ones .
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How does the Medical Examiner procedure work The Medical Examiner Officers (MEOs) will make first contact with you about the death of your loved one once your information has been passed to the ME service by the GP. The Medical Examiner Officers (MEOs) will call you to make the first contact. Contact will include requesting basic admin details, email address, who is the confirmed nominated representative/person, name of chosen funeral director, whether a cremation or burial and importantly whether you have any concerns or worries over the care/death. The GP/attending doctor will complete a summary form of the death and time leading up to it and offer a proposed cause of death. The Medical Examiner will then scrutinise the death using notes or other relevant medical contacts for information regarding the case. They will then confer with the summary form received to see if there are any differences in the cause of death and if necessary will contact the GP/attending doctor to discuss this. Once the cause of death is ascertained, the MEO will contact you to discuss and confirm this. If all is acceptable, the GP/attending doctor will be requested to complete the MCCD and cremation paper if applicable. When completed, the MEO/Hospice etc. will call to let you know and send a copy of the MCCD to the register office ready for when you carry out the formal registration of death. A copy of the MCCD can be sent to you if requested. The cremation paper will be sent direct to your chosen funeral director if you have engaged one at this time. *Please note the timings for this are controlled by the availability of the GP/attending doctor to complete the initial summary form and the consequent MCCD and not the Medical Examiner Service*
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Registering the death The death should be registered within five days of death, but this is not always possible depending on the availability of the GP/ attending doctor to complete paperwork. There will not be any penalties for registering later than five days. (If the case has been referred to the Coroner, the five day ruling is waived). An appointment to register the death can be made by calling 03000 41 51 51 and then pressing Option 2. ( There is quite a long message to get to this point). Alternatively, you can book an appointment to register on the Kent County Council web page www.kent.gov.uk/registration You are advised not to make an appointment until the MEO/Hospice etc. have advised the MCCD has been completed. When you go to the registration appointment you need to take • Any War Pension order book of the deceased. • The deceased’s medical card if possible. • Blue badge, if applicable. You will also need to provide the following information • The date and place of death and the deceased’s usual address. • The deceased’s full name and maiden name if applicable • The deceased’s date and place of birth. • The deceased’s occupation, and for women the name and occupation of the husband if applicable. • Whether the deceased was receiving a pension allowance from public fund (Old Age Pension). • The deceased’s marital status and date of birth of the surviving spouse. 4
The Death Certificate This is a certified copy of the entry in the register of deaths (also known as Original Certified Copies). You may wish to discuss with the registrar how many copies you may require as most banks, building societies and insurance companies require to see an original but do not need one to keep. They will photocopy an original and return it to you. Each certified copy is charged at £11.00. You can order as many as you require and they will be produced and given to you on the day of registration. The Registrar will also give you: • A certificate known as the Green Form - this enables you to proceed and make the funeral arrangements with your chosen funeral director. They may not be able to help you without this form. • A White Form is also given to the next of kin as this acts as a death certificate for the Pension and Benefit Agencies.
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Tell-Us-Once Service This service reduces the amount of time you need to spend contacting government departments and organisations because you provide all the information to the Department of Work and Pensions (DWP) who then pass the information on to the relevant people. Once you have completed the death registration, the details of the death have been added to the Tell-Us-Once system. You then have 28 days to complete the process- you can do this in the following ways: • Online at www.gov.uk/tell-us-once • By telephone: 0800 085 7308 • Alternatively, you can book a face to face Tell-Us-Once appointment at the Registry Office. Tell-Us-Once can notify the following departments after you have registered the death.
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Tell Us Once can notify the following departments after you have registered a death: • Adult Social Services
• Employment Support Allowance
• Attendance Allowance
• Housing Benefit
• Blue Badge parking permit
• Incapacity Benefit
• Bus Passes
• Income Support
• Carer’s Allowance
• Jobseeker’s Allowance
• Child Benefit
• Library services
• Child Tax Credit
• Owe payments to council
• Children’s services
• Passport service
• Council housing
• State Pension
• Council Tax
• Tax Help for Older People
• Council Tax Benefit
• Working Tax Credit
• Disability Living Allowance
• Personal Taxation
• Driver and Vehicle Licensing Agency
• War Pension Team
• Electoral services Where applicable Tell-Us-Once will pass details to these departments on your behalf. The departments you choose to notify will contact you directly if they need any more information to process your change in circumstances. *Tell-Us-Once is a partnership between Kent County Council, the London borough of Bexley, Kent District Councils and departments across Government*
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Deaths Referred to the Coroner Occasionally, deaths will be flagged by the Medical Examiner to be referred to the Coroner. This does not always result in a post mortem. The decision for a post mortem by the Coroner is purely to ascertain the cause of death if it isn’t clear or is unknown. The MEO will inform you if a referral is required and explain the reasons why. Once in the Coroner’s hands, a Coroner’s officer will call you to explain their procedure and give you an approximate timing of completion. Once a post mortem is completed, the Coroner’s office will raise all paperwork and will call to let you know. Once you receive this call you can then make an appointment at the register office to formally register the death (The paperwork will be sent electronically to the register office). The Coroner also holds inquests where the cause of death maybe known but there are unanswered questions/ circumstances surrounding the death so further investigation is carried out. Usually in these cases an interim certificate is produced (again electronically) by the Coroner’s office so the death can be registered and the funeral service held with the final results following later. Sometimes it may be necessary for the Coroner to hold a post mortem and an inquest. The death cannot be registered until the post mortem is complete. The Coroner’s office can be contacted by email on kentandmedwaycoroners@kent.gov.uk
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Tissue and Body donation When a loved one dies at home there is possibility for donation of tissues for transplant and research. Donation of such as bone, skin, heart valves etc. can improve lives no end and also eye donation can help restore sight. For further information please contact the GP or Community Nursing Team, or you can call the NHS Blood and Transplant Tissue Donation service on 0800 432 0559 to speak to a specialist nurse. Body donation can only happen if the deceased has given written consent before death. No-one else can consent after death has occurred.
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Funerals What to do first Contact a funeral director who can advise and discuss the funeral arrangements with you. Funeral arrangements cannot be made until you have been informed that the death does not have to be reported to the Coroner. If the Coroner is involved this may affect the date when the funeral can be held. A Will may have been made by the deceased, which may include requests about his or her funeral arrangements.
Funeral Directors There are no universal standards that apply to funeral directors, however some are members of professional organisations, which operate a code of conduct. The National Association of Funeral Directors (NAFD) and the Society of Allied and Independent Funeral Directors (SAIF) are examples of these. • National Association of Funeral Directors (NAFD) Tel: 0121 711 1343 Web: www.nafd.org.uk • National Society of Allied & Independent Funeral Directors Tel: 0345 230 6777 Web: www.saif.org.uk A funeral director should be expected to give you a written quotation, which may not be exceeded without permission. This includes an estimate for a standard funeral, as well as any additional services.
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Although funeral directors are used to organising the majority of funerals, some people prefer to organise them themselves. You may also prefer to choose a Woodland Environmentally Friendly Burial. For further details please contact: • The Natural Death Centre Tel: 01962 712690 Web: www.naturaldeath.org.uk
Help with funeral costs Funerals can be expensive. If you are on Income Support, Family Credit or Housing Benefit, you may be able to get payment from the Social Fund, to help pay for the funeral. For advice please contact your local Job Centre Plus: • Tel: 0800 169 0140 Web: www.gov.uk/contact-jobcentre-plus/existingbenefit-claims Under some circumstances Benevolent Funds are available for ex-service men and women and for other services such as the Police and Fire Brigade.
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How Are You Feeling? Bereavement is a very personal and to some, a very painful life event to have to go through. It will be a time where you may be un-prepared and overwhelmed by the strength of the thoughts, feelings and emotions experienced. There is no right or wrong way to grieve as it is unique to the individual and may be influenced by many things such as age, personality, family and culture. It is not uncommon to initially feel shocked following bereavement, even if a death is expected it may still be a shock when it actually occurs. This may be followed by a sense of numbness and disbelief that the person who has died has really gone.
Symptoms and feelings you may experience Exhaustion Grief can be very tiring as it is physically and emotionally demanding; many people find they have difficulty with sleeping and concentration. People can experience mood swings and not feel like eating. It is important to look after your own well-being and not to neglect your health. If you are worried about your health, you may wish to consult your GP. Anger Sometimes people feel angry. This may be directed at healthcare professionals, at friends or family, at a religious entity, or even the person who has died. Sometimes the anger may have no specific focus. In these circumstances, sharing thoughts and feelings with friends, family or a faith leader may be helpful.
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Feelings of guilt and feelings of fear for the future People may also experience feelings of guilt or regret, and may often reflect on things they wished they had said or done. It is often helpful to share these feelings with people that you feel comfortable with and can help you understand your emotions and feelings. Whilst for some people it may be tempting to make significant changes to your life in response to your grief it is important to recognise that now may not be the best time to do so. What seems right at the moment may change in the near future. Anxiety, depression, helplessness People can spend a significant amount of time and energy in trying to understand the events leading up to a death and may go over things repeatedly in their mind to try and make sense of their loss. This is part of the grieving process. You may also feel: Sleeplessness and stress Relief that pain and suffering has ended for your loved one Aches and pains and other physical ailments. You may become withdrawn from friends and family and find daily routines hard to cope with; be lethargic and have little interest in activities once enjoyed. Grief for each person is very different and therefore you may experience any of the aforementioned symptoms which are all quite normal.
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Self-help Talking to family and friends may help. Allow them to give you support even if you feel like closing down and withdrawing from the world. They may offer to: • Help with funeral arrangements - emotional support or an extra pair of ears is very important at this time. Make the funeral arrangements when you feel ready – don’t be hurried into making any decisions. Funeral directors are very helpful. If you only have limited funds do not be embarrassed to tell them. They can help arrange a funeral within your finances. • Help with financial arrangements – if you do not understand something ask a trusted relative or friend to assist you. Don’t make any big decisions in a hurry e.g. selling/buying a house. Give yourself time. Contact your GP or local religious or faith community members don’t feel you are being a nuisance; they are used to dealing with bereaved people and usually offer good support.
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Children And Young People Children and young people may respond differently to grief and have thoughts and feelings which they may want to express in different ways. Although it is not possible to protect children and young people from feeling sad, talking openly with them will help them. If you feel you would like further support and advice on how to talk to a child or young adult, please speak to a health professional who was involved in caring for your loved one. Alternatively, you may wish to refer to the websites listed in this leaflet. The following “do’s and don’ts” may provide some useful guidance.
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Do • Let your genuine care and concern show. • Be available to listen when a child wants to talk. • Say you are sorry about what has happened. • Allow them to express as much unhappiness as they are feeling and are willing to share. • Let them know it is not shameful to cry. • Encourage them to be patient with themselves. • Tell them it is okay to talk about the person who is dying or has died, and do so yourself. • Encourage them to keep photos, paintings or letters they might have written to the person and talk about memories. • Be honest and answer questions about death and burial. • Offer practical help - this can be most important in the early stages. • Be sensitive on special days, i.e. Birthdays etc. • Remember for some children death is one of many losses they may have suffered and grieving may also be much more complicated if parents are divorced or separated. Give children permission to have fun and be happy.
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Don’t • Let your own sense of helplessness keep you from reaching out. • Avoid them because you feel uncomfortable. • Say you know how they feel - you don’t. • Say ‘you ought to be feeling better by now’. • Tell them what they should feel or do. • Change the subject when they mention the dead person or death in general. • Avoid mentioning the bereavement out of fear. • Point out that at least they have other siblings or parents. • Suggest they should be grateful for what they have left. • Make any comments which suggest the death was their fault. • Say ‘you don’t mean that’ - try and find out what they do mean.
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When to seek help Bereavement can be a painful and overwhelming experience, but grieving for the loss of a loved one is a natural process. For many people the support of friends and family may be sufficient to adjust to circumstances and start to resume normal life. But some people find it is easier to speak to a stranger rather than a loved one or close friend as they feel they may be burdening those close to them. If the person who has died was formally under the care of a hospice their bereavement service will be able to provide you with ongoing support. Your GP will also be able to assist you. If you feel you need additional or longer term emotional support, we’ve listed below some organisations in England and Wales who are able to offer you quality time to help you cope with your grief. • Compassionate Friends Nationwide Self-help organisation for bereaved parents. Tel: 0345 1232304 Web: www.tcf.org.uk • Cruse Care for the bereaved. Tel: 0808 808 1677 (Helpline) For Maidstone area Tel: 01622 671011 Web: www.cruse.org.uk • Heart of Kent Hospice Preston Hall Aylesford ME20 7PU Tel: 01622 792200 Web: www.hokh.org • Holding On Letting Go Charity for bereaved children – based in Medway Tel: 03445 611 511 Web: www.holdingonlettinggo.org.uk 18
• Hospice in the Weald Maidstone Road Tunbridge Wells Kent TN2 4TA Tel: 01892 820500 Web: www.hospiceintheweald.org.uk • Jigsaw South East Tel: 01342 313895 www.jigsawsoutheast.org.uk Email: helpline@jigsawsoutheast.org.uk • Switchboard LGBT+ helpline This group offers support and advice to lesbians and gay men who have been bereaved by the death of a partner. Tel: 0300 330 0630 • The Lullaby Trust Offers confidential support to anyone affected by the sudden and unexpected death of a baby or young toddler. Bereavement Support line Tel: 0808 802 6868 Web: www.lullabytrust.org.uk • Macmillan Nurses Macmillan nurses work with cancer patients and others with serious illness and their families. They provide support throughout the illness and during bereavement. For Maidstone area Tel: 0808 808 00 00 Web: www.macmillan.org.uk • The Miscarriage Association A group that provides support and information for all who have suffered a pregnancy loss. Tel: 01924 200799 (Monday - Friday 9am - 4pm) Web: www.miscarriageassociation.org.uk • Road Peace An organisation to help people who have experienced bereavement or injury through a road accident. Tel: 0845 4500 355 (Monday - Saturday 9am - 5pm) Web: www.roadpeace.org 19
• Samaritans A 24 hour helpline. Tel: 116 123 Web: www.samaritans.org • SANDS The Stillbirth and Neonatal Death Society which offers support and advice to the parents and families of babies who have died at or around the time of birth. Tel: 0808 164 3332 (Monday - Friday 9.30am - 5.30pm) Web: www.sands.org.uk • Slideaway Charity for children based in Maidstone Tel: 07970 597715 Web: www.slideaway.org • SUDDEN A charitable initiative to support people bereaved by sudden death. Web: www.suddendeath.org • Terence Higgins Trust A support group for those who are HIV positive and/or have AIDS and their friends and families. Tel: 0808 802 1221 (Monday - Friday 10am - 10pm) (Saturday / Sunday 12pm - 6pm) Web: www.tht.org.uk The following organisations are also available for advice: • Age UK For Maidstone area Tel: 01622 753618 For Tunbridge Wells area Tel: 01892 522591 Web: www.ageuk.org.uk
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• Citizens Advice Bureau For Maidstone area Tel: 08082 505704 Web: www.maidstonecab.org.uk For Tunbridge Wells area Tel: 0808 278 7992 Web: www.catwd.org.uk • Relate Confidential counselling on all aspects of relationships including bereavement. For Maidstone area Tel: 01892 529927 For Tunbridge Wells area Tel: 01892 529927 Web: www.relate.org.uk • Victim Support A voluntary group offering help and support for those who are victims of crime. Tel: 08 08 16 89 111 Web: www.victimsupport.org.uk • WAY Widowed and Young Web: www.widowedandyoung.org.uk • Winstons Wish Charity for bereaved children Tel: 08088 020 021 Web: www.winstonswish.org Information, advice and guidance to help support bereaved children and young people and those facing the death of a loved one. We support families across Surrey, parts of West Sussex, Kent and surrounding areas.
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Do you need help with
Probate Matters? You may need help, support or advice on what to do when someone dies in relation to probate.
Freephone: 0808 168 5181 Mobiles: 0333 240 0360 We offer free guidance and advice on the legal and
financial aspects of bereavement including your responsibilities and whether probate is required.
Calls are free from most land lines, some calls may be monitored for training purposes and all calls are confidential. This service is provided by the Bereavement Support Network Ltd.
STOPPING JUNK MAIL It is distressing to deal with a bereavement and unsolicited mail can be insensitive and destructive during a grieving process. By scanning the below QR code on your phone or visiting www.stopmail.co.uk, we are able to securely share this information with mailing organisations and under the Data Protection Act the information will not be used for any other purpose. Other benefits reduce the possibility of identity fraud, such as assumed identity and you will only have to supply the information once.
www.stopmail.co.uk 0808 168 9607 from a landline 0333 006 8114 from a mobile © Bereavement Support Network Ltd 2024
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