The Emergency Department Bereavement guide

This page is divided into 6 sections:

1. What happens now?

Information to help with making arrangements

2. What else do I need to do?

Some reminders of who needs to be informed, jobs that may need to be done and information about registering a death, arranging a funeral and dealing with the deceased's affairs

3. Talking to children

Talking to children about death, advice and contact details for Winston’s Wish Child Bereavement Charity

4. Unexpected Grief

Information about the kinds of things that people may experience following a sudden death

5. Sudden Bereavement Support Service

Information and support offer by the Emergency Department

6. Other bereavement support and information services (Page 15)

Information about bereavement services, voluntary organisations and self-help groups

1. What happens now?

Visiting the deceased

The body of the deceased will lie in the hospital mortuary unless the death has been reported to the Coroner and a post mortem is needed. In this case, the deceased will be transferred to the Coroner’s facility at Barnwood, Gloucester and will remain there until the coroner gives permission for the body to be released.

Where the deceased’s body stays at the hospital, it will remain there until collected by a funeral director of your choice. During this time, should you or your family wish to spend some quiet moments with your loved one this can be arranged if social distancing rules allow.

Viewing times are limited and exclude bank holidays.

To arrange a time to see your relative, please contact the Bereavement Team between 10:00 and 4:00pm (Monday to Friday) or leave a message on the answer machine at the hospital where the death happened.

Bereavement Administration Office

Gloucestershire Royal Hospital

Tel: 0300 422 6742

Located on the ground floor of the main tower block, opposite the lift area

Cheltenham General Hospital

Tel: 0300 422 4753

Located in East Block, on the right hand side past the Blue Spa Café

At weekends and bank holidays, please arrange visits through the Emergency Department:

Gloucestershire Royal Hospital

Tel: 0300 422 6600

Cheltenham General Hospital

Tel: 0300 422 3046

Spiritual Care

The hospital has access to representatives from all denominations. If you would like some support or to speak to someone please contact:

Hospital chaplaincy

Gloucestershire Royal Hospital

Tel: 0300 422 6200

Cheltenham General Hospital

Tel: 0300 422 4286

Collection of personal effects

To arrange the collection of any personal items belonging to the deceased, please contact the Bereavement Administration Office.

The Bereavement office will also be given details of the death and arrange for the Medical Certificate of cause of Death (MCCD) as soon as possible.

Please note that any uncollected property will be disposed of after a month.

If the police have been involved with investigations relating to the death, they may hold the personal property at a police station. In this case, the Coroner’s Office can advise you on how to obtain the property. The contact details are referenced later on this page.

Organ/tissue donation

In May 2020, the law around organ donation in England was changed, now everyone has automatically agreed to become an organ donor when they die unless they have opted not to.

Staff at the Emergency Department can discuss organ/tissue donation further with you and will make arrangements for your wishes to be carried out, if necessary.

If the death has been referred to the coroner, by law the coroner’s permission must also be obtained before the removal of any tissue or organs.

The coroner

Many sudden and unexpected deaths have to be reported by law, to the coroner. He or she may be a qualified lawyer, doctor or both, and is responsible to the Crown. The coroner has a legal duty to inquire into deaths in a variety of circumstances, these include:

• sudden deaths (in certain circumstances)
• deaths where the cause is unknown or uncertain unnatural deaths, such as those caused by an accident or injury
• where the deceased had not been seen or treated by a doctor within the last 14 days before death
• death caused by an industrial injury or disease
• death caused as a result of violence, neglect or poisoning
• death occurred under suspicious circumstances
• deaths which occurred while the patient was undergoing an operation or did not recover from an anaesthetic
• death which occurred in prison
• death remains uncertain after a post-mortem

Some deaths that are referred to the coroner require a post-mortem. This is a medical examination of the body to determine the cause of death; it is a legal requirement and does not need the consent of the next of kin.

The coroner and the Bereavement Administration Office will always advise the next of kin of the proceedings.

Death due to natural causes

If a post mortem shows the death to be due to natural causes, the coroner will issue the appropriate form stating the cause of death (known as a Pink Form 100 B). This form is usually sent directly to the registrar by the coroner rarely it may be given to the next of kin to deliver. If the body of the deceased is to be cremated, the coroner will also issue a Certificate for Cremation or Form 6.

Unnatural deaths - deaths that are a result of an accident or injury

If a post mortem shows that the death was due to unnatural causes, the coroner must hold an inquest.

The coroner will usually allow the body of the deceased to be released for the funeral to take place, once a formal inquest has been opened.

Inquest

An inquest is an enquiry to find out who the deceased was and how and when they died. It is a formal public enquiry and is held when the cause of death is confirmed as:

• Violent or unnatural such as a road traffic incident
• Caused by an industrial disease
• Happened in prison
• Remains uncertain after a post-mortem

Families can attend the inquest if they wish and ask questions of any witnesses that relate to the medical cause of death and/or about the circumstances surrounding the death.

If an inquest is to be held, the death cannot be registered until the inquest has finished. However, on request, a temporary death certificate can be issued by the coroner. This certificate is acceptable for the majority of administrative requirements, while waiting for the issue of a full death certificate on conclusion of the inquest.

Relatives can also ask a lawyer to represent them. This may be advisable in some circumstances, for example when the death was the result of a road accident, work injury or any other cause that could possibly lead to a claim for compensation.

After the inquest the coroner will issue ‘Certificate after Inquest’ Form 99, stating the cause of death and inquest verdict. This certificate is usually forwarded to the registrar by the coroner.

The registrar will then notify the next of kin that the death has been registered so that they can then collect the full death certificate.

Where to find the coroner’s office

The Coroner’s office is located at:

Corinium Avenue, Barnwood, Gloucester GL4 3DJ

Tel: 01452 305 661

The office is open Monday to Friday, 8:00am to 4:00pm

Email: coroner@gloucestershire.gov.uk

2. What else do I need to do?

How to register a death

All deaths need to be registered and to do this you must have a death certificate. Registering a death must be done within 5 days in England and Wales, including weekends and Bank Holidays.

The death normally needs to be registered in the county where it happened.

To register a death, you will need to contact the registrar’s office by telephone or online. You may need to know the following information during this phone call

• The deceased’s full name and any previous names
• Date and place of birth and death of deceased
• Proof of address for the deceased, for example a utility bill
• The deceased’s occupation and name and occupation of any surviving widow, widower or civil partner
• The date of birth of the surviving widow or widower, or civil partner
• Details of any state or housing benefits, tax credits or pensions received

The Tell Us Once Service

The Gloucestershire Registration Service is working with the Department of Work and Pensions to simplify the process of notifying other government departments and local authority services on your behalf. The Registration Officer will explain this free service fully during your telephone appointment.

The registrar will supply:

• A form which authorises the burial or application for cremation to give the funeral director
• A Certificate of Registration of the death (BD8 - White form) which is a certified copy of the entry in the death register

You may need additional copies for the will, pension claims, insurance policies, premium bonds and savings bank certificates.

Obtaining copies at a later date will incur an additional cost. The Registrar can advise you of these fees and how many copies you are likely to need at the time of registering the death.

Gloucestershire Registrar’s Office

Tel: 01452 425060

Monday to Friday, 9:00am to 4:00pm

Website: www.gloucestershire.gov.uk/births-marriages-deaths-and-civil-partnerships/register-a-birth/

This is a central number where you will be able to select from the available options to book an appointment for your local office and/or order further copies of the death certificates. Further information is available on the website.

Arranging the funeral

If appropriate, find out if there is a will, as this may give requests about the wishes of the deceased for burial or cremation. Where the death has been reported to the coroner, you should tell your funeral director of this fact. The funeral director will be able to advise and help you in arranging the funeral and will normally communicate with the coroner to determine the date when the funeral can take place.

If you are arranging the funeral, you will be responsible for paying the bill, so check where the money will come from and if there will be enough to cover the costs.

Help with funeral costs

Funerals can be expensive. The cost is usually met from the assets of the deceased’s estate although this may not cover the cost of a basic funeral or things such as, the church, flowers, crematorium fees or notices in the local paper. The links below will provide additional information.

National Association of Funeral Directors (NAFD)

Provides a code of practice and complaints procedure

Tel: 0121 711 1343

Website: https://nafd.org.uk/

The National Society of Allied and Independent Funeral Directors (SAIF)

Provides a code of practice and complaints procedure

Tel: 0345 230 6777

Monday to Friday, 9:00am to 5:00pm

Website: https://saif.org.uk/

The Good Funeral Guide is a not for profit independent information resource

Website: www.goodfuneralguide.co.uk

Before the deceased’s estate (belongings, money and property) can be divided between the people entitled to share it, a grant of probate or letters of administration must be obtained.

It is worth noting that if there is any inheritance tax due on the deceased's estate that some or all of this must be paid before a Grant of Administration will be issued. For further information regarding what to do contact:

HM Revenue & Customs (HMRC)

Probate and Inheritance Tax Helpline

Tel: 0300 123 1072

Website: www.gov.uk/applying-for-probate

Dealing with the deceased’s affairs

Do not sell any of the deceased’s property. If there is a Will, an application should be made by the closest relative in the following order of priority:

Widow, widower or civil partner

Children

Parent

Brother or sister

After the Grant of Administration has been made, the personal representative of the deceased should settle any debts, obtain life insurance where applicable and transfer the ownership of any property, shares etc accordingly.

Possible things that may need to be returned:

• Driving license, parking permits, travel cards, car insurance certificates (if applicable)
• Vehicle registration documents (for recording change of ownership)
• Any blue badges (if the deceased was disabled)
• Any season tickets, membership cards claiming any refunds due.
• Return any local authority appliances or equipment borrowed (where applicable)
• Any library books and tickets

3. Talking to children about death

Adults may often feel they need to protect children from the facts of death, or fear that children will be too upset. However, we can often underestimate a child’s ability to cope. Children often find it harder to cope if they are not told what is happening and will often make up a story about what has happened. This can be more frightening than the truth.

When children are given information in a way that they can understand, they are remarkably tough. Even very young children will want to know what happened, how it happened, why it happened and what happens next.

When talking to children about death, it is helpful to find a time as soon as possible after the death, give the child the facts in a simple manner, use appropriate words, for example dead and death rather than lost or sleeping, and give the child permission to ask questions.

It is helpful for adults to share their feelings with children, for example feelings of sadness. By doing this children learn that it is usual to cry when someone dies and they know that it is okay for them to cry too. When a child is told about the death, they may not react in a way you would expect them to. The main difference between children and adults grieving is that for children, the periods of intense grieving are shorter, so that 1 minute a child may cry about the news, and the next continue to play. However, as children reach new levels of understanding, new experiences arouse fresh feelings of grief.

People often ask if children should attend funerals. It can sometimes be easier to make that decision by asking the child what they would like to do.

As most children will not have had to make this decision before, it can be helpful to explain why we hold funerals and what happens at a funeral, and then ask a child if they would like to attend. This choice can be checked out again just before the funeral.

Like adults, children can learn to cope when someone important in their lives dies and by encouraging them to ask questions we can help them to understand the feelings they have after a death.

This is something that people can find very difficult.

Help is available through Winston's Wish, a service which helps children in Gloucestershire and their families cope with the death of a family member.

The service can help in a variety of ways, such as involving a child in the funeral, holding residential camps where bereaved families can meet others in a similar situation, as well as other groups and individual support at home, hospital or school.

For further information or help, please contact:

Winston's Wish

Local Office

Tel: 01242 515 157

National Helpline

Tel: 08088 020 021 (freephone)

Website: www.winstonswish.org.uk

4. Unexpected grief - adults

The sudden and unexpected death of a loved one can be one of the most difficult experiences a person may have to face in life. To mourn deeply for someone very special and important in our lives is quite natural. Each person will grieve their loss in their own way and the memories that they have shared together will always remain very special and unique.

While everyone reacts differently to news about their loss and will find their own way through grief, listed below are some of the more common experiences that some people who have been suddenly bereaved have expressed.

Shock and numbness

When the death has been so sudden and simply comes out of the blue, some people can feel so numb or in such a state of shock that everything just seemed so unreal, and hard to take in at the time.

Unfinished conversations

Sometimes, everything seems to happen all too quickly, leaving those left behind with little or no warning that the death was even going to happen. Often, this also denies anyone the chance of ever being able to say or do the things that they might have otherwise would have wanted to do, if only they had been given warning that the death was going to happen.

Making sense of what happened

Many people, particularly when the death has been so unexpected, are left trying to make some sense about what has just happened and have a real need to try and understand how and why their loved one died.

This can be made more difficult when things have happened all too quickly and perhaps information relating to the death may not have seemed clear enough or been available at the time. This can give way to all kinds of questions arising from grief, and perhaps leave a person to wonder ‘if only’ and to repeatedly ask if there was anything that could have been done to have changed things in some way, or perhaps, even to have prevented the death.

Experiences in grief

Many times, people have said that they have experienced some very mixed and powerful emotions in their grief such as anger, hate, guilt, panic, crying, or not being able to cry at all, yearning, helplessness, self- blame and/or perhaps, even some sense of relief. At times, they have also expressed that some of these feelings had felt so strange and unusual that it left them wondering if they were simply starting to go mad. While others have felt able to carry on, for some, their loss experience had been something so totally new to them that it left them feeling very unsure of what they should do, or even how they should react.

People can sometimes find themselves thinking that the person who has just died is still around, and this can at times feel quite confusing and distressing.

This can often happen, particularly when the death has been so sudden that people not only need time to adjust to the reality of the death but also are having to try and accept that their loved one can sadly, no longer return.

As time goes on, some of these feelings can gradually give way to feeling very low, less interested in life, or perhaps feeling less confident and unsure of themselves. This can be a time when people can find that they do not want to go out socially and may prefer to spend time only with those that they feel closest to. This again can happen while a person, through being suddenly forced to face such a devastating and life changing experience, also needs time to try and find new ways of living without their loved one.

In time, some of the strong feelings will gradually become less intense as people begin to find their own way of living with their loss. However, the path of sudden grief may not always be straight forward, even when a person is feeling stronger and more able to cope with their loss. They can, through some reminder of their loss, still shed a tear or feel some sense of sudden grief, even years later. This again, is quite normal and can only be expected since, although we know that a loved has sadly gone, they will never be forgotten.

People who have experienced the kinds of emotions mentioned have all found their own way through grief. For some, this experience has been a very private and personal time, whilst for others the support of family, friends or even professionals has made a difference to them.

5. Sudden Bereavement Support Service

The Emergency Departments at Gloucestershire Royal Hospital and Cheltenham General Hospital offer a Sudden Bereavement Support Service to people bereaved by the death of a loved one within the Emergency Department. The service is run by trained bereavement nurses who specialise in sudden grief. They work within the Emergency Departments and have supported many families who have faced a sudden bereavement.

This can be a very difficult and confusing time; it may be of help to be able ask any questions or simply be able to talk things through with someone who has an understanding of both the medical aspects relating to sudden death and about sudden grief.

The service offers support by way of telephone contact and aims to provide early support and information. This is not intended as a long term counselling service.

If you would like to use the Sudden Bereavement Service please contact the Emergency Department reception at the hospital where the death happened and ask for a Sudden Bereavement nurse to contact you.

Emergency Department (reception)

Gloucestershire Royal Hospital

Tel: 0300 422 6600

8:00am and 5:00pm (any day)

Cheltenham General Hospital (reception)

Tel: 0300 422 3046

8:00am and 5:00pm (any day)

Alternatively, the nurse who supported you on the day of the death may have offered to contact you at a later date. If you wish, you can make arrangements at this time with the nurse to use this service.

6. Other bereavement and support services

Age UK

Advice and information for senior citizens/carers

Tel: 01452 422 660

Tel: 0800 678 1602 (Freephone)

Website: www.ageuk.org.uk

British Heart Foundation

Tel: 0300 330 3322

Website: www.bhf.org.uk

Cardiac Risk in the Young

Offers support and information on cardiac risk in the young

Tel: 01737 363 222

Website: www.c-r-y.org.uk

Cardiomyopathy

Information for people/ families affected by cardiomyopathy

Tel: 0800 018 1024

Website: www.cardiomyopathy.org

Cruse

Support for bereaved people of all ages

Tel: 01242 252 518 (Gloucestershire)

Tel: 0808 808 1677 (National number)

Website: www.cruse.org.uk

Meningitis Now

Helpline offering information and support

Tel: 0808 80 10 388

Website: www.meningitisnow.org

Roadpeace

Support and information for people bereaved and injured road traffic victims

Tel: 0845 4500 355

Website: www.road-peace.org.uk

Samaritans

Offers emotional support 365 days a year

Tel: 0330 094 5717 (Gloucester and district)

Tel 116 123 (National number - free)

Website: www.samaritans.org

SAMM

Helpline: 0121 472 2912

Text: 07342 888570

Website: www.samm.org.uk

Sudden

Organisation to help people bereaved by a sudden death

Tel: 0800 2600 400

Website: https://sudden.org

Sudden Unexpected Death in Epilepsy

Tel: 01235 772 850

Website: www.sudep.org

Suicide Bereaved Community (SBC)

Tel: 01452 371 945

Email: info@suicidebereaved.org

Website: www.suicidebereaved.org

Survivors of Bereavement by Suicide (SOBS)

National Helpline: 0300 111 5065

Website: www.uk-sobs.org.uk

Victim support

Support for people bereaved by a crime or road accident

Tel: 0808 281 0112 (Local)

Tel: 08 08 16 89 111 (National Helpline)

Website: www.victimsupport.org.uk

Way Foundation

Self-help and social support for men and women under 50

Website: www.widowedandyoung.org.uk

You can also contact NHS Choices, your GP, Citizen's Advice Bureau or check your local telephone directory for support services.

Support services for when a baby or child dies

Child Death Helpline

Tel: 0800 282 986 (National helpline)

Website: www.childdeathhelpline.org.uk

Compassionate Friends

A charity to support parents, families who have lost a child at any age

Tel: 0345 123 2304 (National helpline)

Website: www.tcf.org.uk

For siblings: www.tcfsiblingsupport.org.uk

Lullaby Trust

For people who have experienced a sudden death of a baby

Free helpline Tel: 0808 802 6868

Website: www.lullabytrust.org.uk

Sands

Support for parents and anyone affected by the death of a baby

Tel: 0808 164 3332 (National helpline)

Website: www.sands.org.uk

Support services for children and young people

ChildLine

Provides telephone support for any child or young person

Tel: 0800 1111 (National 24 hour free helpline)

Website: www.childline.org.uk

Young Peoples Counselling Service

A young person’s counselling service for 11 to 25 year olds

Tel: 01277 230831

Website: www.ypcs.org.uk

Help for people with learning disabilities

Gloucestershire local community learning and disabilities team provides easy read, accessible information for people with learning disabilities on bereavement including picture books, DVDs and videos.

Freephone: 0800 019 3346

Useful information

Department for Work and Pensions (DWP)

Bereavement Benefits Service

Tel: 0800 731 0469

Website: www.gov.uk/bereavement-support-payment/how-to-claim

Probate and Inheritance Tax Helpline

Tel: 0300 123 1072

Bereavement enquiries, Income Tax

Tel: 0300 200 3300

Website: www.hmrc.gov.uk

Patient Advice and Liaison Service

PALS Office

Gloucestershire Royal Hospital, Great Western Road, GL1 3NN

Tel: 0800 019 3282 (Freephone)

Email: ghn-tr-pals.gloshospitals@nhs.net