Bereavement (patient leaflet)

Introduction

Due to the COVID-19 pandemic any remaining government modifications to the processes following a death have been described in this booklet. Please see each specific section for relevant changes.

If you have received this booklet, you have experienced the death of someone close to you. We are sorry for your loss and we understand that this can be a very difficult and distressing time.

This booklet is designed to help people who are bereaved when a death happens in the hospital. The booklet explains procedures such as registering a death and arranging a funeral. The information is not intended to replace personal help and advice but to offer a practical guide to what has to be done. It also gives advice on how to raise any concerns you might have around the circumstances of death or about the care your family member or friend received.

Part 1: Advice on making practical arrangements

At the hospital

With some social distancing rules still in place it might not be possible for you to be able to visit the hospital and collect property in the normal way. The Bereavement Officers will be able to explain how and where you can collect property.

You may be asked to provide identification when collecting the property.

When someone dies in hospital, the closest known relatives or next of kin are informed by the ward staff. The medical staff will be available to offer help and answer any of your immediate questions over the telephone.

The Bereavement Office will be given details of the death and they will arrange for the Medical Certificate of Cause of Death (MCCD) to be completed by a doctor as soon as possible. In certain cases, the death will need to be discussed with the coroner. This may result in a delay in being able to register the death.

Relatives will be advised to telephone the Bereavement Office at the hospital.

Cheltenham General Hospital

Tel: 0300 422 4753
Monday to Friday, 10:00am to 4:00pm

Gloucestershire Royal Hospital

Telephone 0300 422 6742
Monday to Friday, 10:00am to 4:00pm

You will not need to come to the Bereavement Office to collect paperwork while changes to the registration processes are in place. You will liaise with the Bereavement Service by telephone only. During these conversations you will be asked if the deceased person is to receive a cremation or burial. In the case of a cremation, extra forms are needed which the funeral director will arrange to collect from the hospital when authorised. Please be advised that the hospitals will expect the appointed funeral director to collect your relative in a timely manner once the paperwork is completed. If you have any concerns please do not hesitate to ask the Bereavement Officer for help and advice.

When a doctor has completed the Medical Certificate of Cause of Death the Bereavement Office will email a scanned copy of the document to the Registration Service. The Registration Service will require this to be able to issue the death certificates you will need for legal and financial purposes.

The Medical Examiner

The Medical Examiner is an independent senior doctor who was not involved in the care of the patient but understands the circumstances surrounding the cause of death.

They aim to make it easier for you to understand the wording on the medical certificate and to address any questions you might have. This means that you will receive a call from the medical examiner, or their officer, to discuss the wording on the medical certificate before it is issued to the Registration Service.

Raising concerns

The Bereavement Officers and the Medical Examiner are available to listen to any concerns you might have about the hospital care leading up to the death. They can help you to speak with senior staff or raise a formal complaint. Clinical staff, in all medical specialties, routinely review a selection of cases where patients have died. This is in order to learn, develop and improve healthcare. You can request such a review and, if so, you will be kept informed of discussions and outcomes.

Registration of Death

To arrange an appointment to register a death please visit Gloucestershire County Council's Register a death service.

You may register the death at any of the following Registration Offices by appointment only:

• Cheltenham
• Cinderford
• Cirencester
• Gloucester
• Moreton-in-Marsh
• Stroud

The Registration Service will be able to provide copies of the death certificate during your appointment. Please allow up to 45 minutes for this appointment.

If a death has been referred to the Coroner, the procedure will be different – please see the section ‘The Coroner’ on page 5.

During your discussion with the Registrar the following information will be required where possible:

• The date and place of death
• The date and place of birth (town and county if born in the UK otherwise the country of birth)
• The deceased’s full name (and any other names by which the deceased has been known, including the maiden name if applicable)
• The deceased’s last address
• If the deceased was married or in a Registered Civil Partnership, the date of birth of any surviving widow, widower or civil partner
• The deceased’s occupation and the name and occupation of the husband, wife or civil partner
• Any details relating to pensions or benefits received

The Registrar will be able to provide copies of the death certificate during your appointment. There will be a charge for the death certificate. If, at a later date, you require further copies you can request these via Gloucestershire Registration Service. Certified copies will be needed for banks, insurance companies, private pensions, premium bonds, share certificates etc.

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 in more detail during your appointment.

The Coroner

Occasionally, the doctor will need to discuss a death with the Coroner but no further investigation is needed. To confirm their intent, the coroner will issue a supporting document (100A) to the registrar confirming the cause of death and allowing the registration process to take place. This may cause a delay in the registration but you will be advised at the time of booking your appointment.

Coroner’s post mortems

If the death has been reported to the Coroner you will be informed by the coroner’s office when they have sent the necessary paperwork to the registration office. You will then be able to make an appointment to register the death.

To contact the countywide Coroner’s Office:

Tel: 01452 305 661
Monday to Friday, 8:00am to 4:00pm

Advise your funeral director as soon as possible that the death has been reported to the Coroner.

A post mortem examination may be carried out for the following reasons:

• Where the medical cause of death is unknown and the hospital doctor cannot sign a death certificate
• When the death was sudden and unexpected or considered potentially due to unnatural circumstances
• When the death might be due to an industrial injury or from exposure to industrial diseases, accident, violence, neglect etc.
• When the death happened during an operation or before full recovery from the effects of an anaesthetic

The Coroner may order a post mortem where deaths happen in any of the above circumstances. This can be done without the authorisation of the next of kin. If, as a result of the post mortem, the death is confirmed as being due to an unnatural cause, the coroner is obliged by law to hold an inquest.

If a death becomes the subject of an inquest, full details of the procedures to be followed, will be provided to the next of kin. The Coroner’s Office will do this as soon as practical after the cause of death is confirmed by the post mortem.

Inquest

An inquest is a public hearing which takes evidence relating to who the deceased person was, where, when and how he/she came by his/her death. The inquest does not answer questions of compensation or blame; it simply establishes the facts.

In some cases (especially where accidents have happened) it may be best to seek legal advice in advance of the hearing.

When an inquest is held, the death cannot be registered until the conclusion. However, the coroner may give your funeral director an order for burial or certificate for cremation so that the funeral can take place.

Furthermore, an interim death certificate can be issued which will normally enable all legal formalities relating to a death to be attended to.

The Coroner will send to the registrar a ‘Certificate after Inquest’ stating the cause of death, which will allow the death to be registered, without an informant.

Organ and tissue donation

When a person dies in hospital, it may be possible for them to donate organs and/or tissue. If the deceased was suitable for organ donation the specialist nurse will have already discussed the option with you.

Tissue donation (eyes, heart valves, skin, bone and tendons) normally happens 24 to 48 hours after someone has died.

If you would like more information about tissue donation please contact the specialist nurses at the:

National Referral Centre

Tel: 0800 4320 559

Donation may improve the quality of life for others; as many as 50 people can be helped by the donation from one person.

Visiting the deceased

We advise families to arrange to visit their loved one at their chosen funeral home. However, if this is not possible, we may be able to accommodate a visit at the hospital mortuary. Please contact the mortuary offices to establish if an appointment can be arranged.

Cheltenham General Hospital Tel: 0300 422 3653

Gloucestershire Royal Hospital Tel: 0300 422 5271

The offices are open between the hours of 10:00am and 3:00pm, Monday to Friday.

The funeral

There are currently no restrictions on how a funeral takes place but the number of people who can attend the service and how they are able to be organised may have restrictions imposed.

The Quaker Social Action’s ‘Down to Earth’ project has a number of suggestions on organising meaningful funerals. The contact details are in the Support Organisations section of this booklet.

It is advisable to establish if the deceased has made a Will as this may include specific wishes about the funeral arrangements. Most funerals are arranged by funeral directors of your choice.

If you arrange a funeral, you are responsible for paying the bill, so it is advisable to check where the money will come from.

The costs are usually met by the assets of the deceased person.

If relatives cannot be traced, the hospital in which the death happened may arrange and pay for a simple burial or cremation.

We understand that planning a funeral can be difficult so we would like to offer some suggestions that you might want to consider when making your selection:

• Do you wish to view your loved one in a funeral home before the service? Not all funeral directors have access to a funeral home. Viewings within the Hospital Mortuaries are not available once the funeral director has been appointed and the paperwork for the release of the deceased is complete.
• Do you want to have a funeral service and if so, would you need help arranging it?
• Would you want help with completing the necessary crematorium paperwork?

Not all funeral directors/companies offer the above services and it is important to understand their pricing structure and associated support you will receive. All funeral directors should be able to provide a full list of their costs in advance so that you can check that your wishes and those of your loved one are being met.

Funeral directors will be charged by the hospital if they do not collect your relative in a timely manner once the paperwork has been completed. We recommend that you check that these costs are not passed on to you for payment.

A list of local funeral directors for your area can be found on the internet and specific supporting agencies listed below may also be of help:

National Association of Funeral Directors (NAFD)

Tel: 01217 111 343

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

Tel: 0345 230 6777

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

The Quaker Social Action

The following website has resources on organising funerals in ways to make them meaningful during the social distancing measures:

Website: https://quakersocialaction.org.uk/we-can-help/helping- funerals/down-earth/coronavirus-organising-meaningful-funeral

The Good Funeral Guide

Website: www.goodfuneralguide.co.uk

For a list of Funeral Directors in your area visit:

Website: www.yourfuneralchoice.com

Probate

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.

For all general enquires and Probate Application Packs please call:

The Probate and Inheritance Tax Helpline

Tel: 0300 123 1072

Do not, in the meantime, sell any of the deceased’s property.

If there is a Will, any of the executors can apply for probate. If there is no 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

To apply you will need:

• The death certificate
• Any Will or other wishes of the deceased
• Full details of the estate – everything owed or due to the deceased when he/she died, any liabilities or debts

After a grant 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.

Solicitor

If you are employing a solicitor, you are entitled to pay him/her out of the deceased’s estate. The solicitor will give you help and advice and can obtain probate or letter of administration for you.

Part 2: Grief and loss during exceptionally difficult times

Coping with feelings when someone dies

Bereavement is something which all people will experience at some time in their lives. Whether someone has been ill for some time, or the death is very sudden and unexpected, the news that a person has died may come as a shock.

While no two people experience grief in the same way, the feelings described in the next section are the most common reactions.

People come from a variety of cultural, social and religious backgrounds so have different ways of mourning and supporting each other, however, several experiences are common to everyone when grieving.

The feelings described are just a sample of many that can happen.

Suggestions for supporting yourself during this very difficult time

Remember to eat regularly and keep yourself hydrated, keeping some form of routine may help. Try to limit how much news and social media you follow as this can increase feelings of sadness which may cause additional anxieties and distress.

In the early stages of grief, you will probably feel moments of sharp intense grief combined with a more constant sense of dull loss. You may be feeling very lost in the world and simple daily chores might involve painful recollections of tasks previously done together.

Grief is such an exhausting variety of emotions that can leave you feeling tired much of the time and equally you can have trouble sleeping.

Shock

This is a natural reaction. You may feel numb and unable to believe what has happened, become quiet and withdrawn; while some people can become agitated and anxious.

Whatever you are feeling, try to bring it to the surface; do not put on a brave face.

Anger

You may feel angry at the unfairness of the death and that medical services could have done more or reacted differently. A part of you may be feeling anger towards the person who has died.

Try to avoid bottling up your feelings by talking about them to someone you trust and who is a good listener.

Anxiety

It is common to feel anxious in the early stages of grief whereby you have to face an unclear and unknown future. This may manifest itself in persistent physical sensations such as a pounding heartbeat, muscle tension and increased perspiration. It may be helpful to learn some relaxation techniques to help you with your anxiety.

Depression

Acute anxiety and anger often gradually give way to more constant feelings of depression and apathy.

This happens as you finally come to realise at a deeper level that your loved one will never return.

Unfortunately, these feelings of hopelessness often coincide with a time when all immediate friends and family who offered support at the funeral seem to have backed away. Friends are often embarrassed at not knowing what to say and sometimes, without realising it themselves, stay away.

You may often worry that you will become a burden on others and consequently avoid contacting people. Try to remember that if a friend has turned to you for support in their grief, perhaps you should feel honoured to have been asked for help.

Guilt

If you have been caring for your relative for a long time before they died, your feelings of loss may be complicated by some milder feelings of relief that both you and the deceased are released from a long painful illness. This is quite understandable and does not make you a bad person for feeling it. If the death was more sudden, it may have left you feeling guilty about things left unsaid. Perhaps you didn’t say how much you cared, or that you were sorry about things you may have said or done and maybe you didn’t have a chance to say goodbye. All such concerns are perfectly natural.

Talking to children about death

Adults may often feel the need to protect children from the facts of death; thinking children will not understand and that they will be too upset to cope. However, we can often underestimate a child’s resources and ability to cope.

Children often find it harder to cope if they are not told what is happening. They will often make up a story about what has happened which can be more frightening than the truth. When children are given information in a way they can understand it they can be remarkably strong. Even very young children will want to know what happened, how, why and what happens next.

It is often asked if children should attend funerals. It can sometimes be easier to make that decision by asking them 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, what happens during them and then ask if they would like to attend.

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

'Winston's Wish' is a Gloucestershire service for children who have had a parent or sibling die. It offers specialist help to families both prior to and following a death. The service is run by a small group of professionals and offers residential weekends, groups and help on an individual basis.

Support organisations

CRUSE Bereavement Counselling

Lower Ground Floor 31 St George’s Road Cheltenham

GL50 3DU

Tel: 01242 252 518

National Helpline: 0808 80 81 677

Sue Ryder Hospice online support

Free counselling and professional support open to all UK residents over 18.

Longfield Hospice Minchinhampton

Free counselling support for anybody over 18 who is living with, or been affected by, a life-limiting illness.

Tel: 01453 886868

Monday to Friday, 8:30am to 4:30pm

Cardiac Risk in the Young

Support and counselling for families where there has been a sudden cardiac death of an apparently fit and healthy young person

Tel: 01737 363222

TIC+ (Teens in Crisis)

Advice, support and counselling for teenagers Tel: 01594 372 777

Email: admin@ticplus.org.uk

Age UK Gloucestershire

Henley House, Barnett Way, Barnwood, Gloucester GL4 3RT

Tel: 01452 422 660

Email: Helpteam@ageukgloucestershire.org.uk

Samaritans

Gloucester and Cheltenham Tel: 0330 0945717

National Helpline from anywhere in the UK Tel: 116 123

Email: jo@samaritans.org

The Lullaby Trust

Information and bereavement support for sudden infant deaths.

Bereavement Support Line Tel: 0808 802 6868

Email: support@lullabytrust.org.uk

General Enquires Tel: 02078 023 200

Email: office@lullabytrust.org.uk

Information Line: 08088 026 869

Stillbirth and Neonatal Death Society (SANDS)

National helpline Tel: 0808 164 3332

Survivors of Bereavement by Suicide (SOBS)

Gloucestershire group

National Helpline: 0300 111 5065

Suicide Bereaved Community (SBC)

Tel: 01452 371 945

Email:info@suicidebereaved.org

Winston’s Wish

Support for bereaved children 17 Royal Crescent Cheltenham

GL50 3DA

Helpline Tel: 08088 020 021

General Enquiries Tel: 01242 515 157

Email: ask@winstonswish.org

Coney Hill Crematorium

Provide ‘Bereavement Coffee Mornings’ each Wednesday from 10:00am to 12:00 noon.

For more information:

Tel: 01452 396705

Clergy, priests, rabbis and other religious officials can be contacted through the appropriate religious organisation.

Practical support

Dept of Work & Pensions (DWP) Pension Service

Tel: 0800 731 0469

Bereavement Benefit Enquires

Tel: 0800 731 0139

Probate and Inheritance Tax Helpline

Tel: 0300 123 1072

Gloucester Job Centre Plus

Tel: 0800 169 0190

Bereavement Support Payment

If the death was due to an accident at work or a disease caused by work call:

Tel: 0800 731 0469

Adult Helpdesk all enquires at Social Services

Tel: 01452 426 868

Email: socialcare.eng@gloucestershire.gov.uk

Social Care Offices (within the hospitals)

Gloucestershire Royal Hospital Tel: 0300 422 6582

Cheltenham General Hospital Tel: 0300 422 3052

Citizens Advice Bureau

Gloucester, Cheltenham and Tewksbury Tel: 01452 527 202

Email:info@gloscab.org.uk

Stroud

Tel: 0808 800 0510

Forest of Dean (Cinderford) Tel: 01594 823937

Email: info@forestofdeancab.co.uk

PALS

Support and advice for Gloucestershire Royal and Cheltenham General Hospitals

Tel: 0800 019 3282

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

Palliative Care Teams

For families previously known to the service.

Gloucestershire Royal Hospital

Tel: 0300 422 5179

Cheltenham General Hospital

Tel: 0300 422 3447

Community Palliative Care team

Tel: 0300 422 5370

Action against Medical Accidents (AvMA)

This is an independent national charity that specialises in advising people who have been affected by lapses in patient safety. The charity offers free advice on NHS investigations; complaints; inquests; health professional regulation and legal action regarding clinical negligence.

Tel: 0845 123 2352