Introduction
Bereavement is highly personal and the death of someone close to you can be one of the most distressing events in your life.
Our staff are very sorry for the loss of your loved one. We know that this can be a very difficult and distressing time and we offer our sympathy and condolences.
At the moment, you may feel daunted by the prospect of finding yourself responsible for making all of the necessary arrangements for your loved one. We understand this and want to make this time a little more bearable and help you through the next few weeks. This booklet includes practical advice about coping with grief and information to support decisions and issues that you and your family may have to deal with at this time.
We hope that you find this booklet helpful, however please do not hesitate to ask any of our staff if you need any further help or support.
Yours sincerely Ian Joy,
Executive Director of Nursing
Newcastle upon Tyne Hospitals NHS Foundation Trust
Immediately after the death
Following the death of a person at home, please call the community nursing team, who are available 24 hours a day. Their number is 0191 282 3664.
The community nursing team will visit and ensure that you and your family have as much time as you need. If the person’s death is expected and the community nursing team have been involved they will be able to verify that death has occurred and inform the GP, this involves a simple set of observations. The community nursing team will liaise with other health care providers to inform them that the person has died and arrange for collection of any equipment from the Loan Equipment Department.
The community nursing team will provide personal care to the patient considering any advance wishes of the patient or any preferences of those important to the patient. You and/or your family may wish to be involved in this personal care and staff can explain what to do and any moving and handling or infection control measures in place.
What happens next?
When the death is expected and referral to the coroner is NOT anticipated
Before they leave, the community nursing team will explain to you what will need to happen next. The following notes are a reminder of some of the things you may be told.
The community nursing team will advise you; if referral to the Coroner is not anticipated, then you can contact your chosen undertaker/funeral director to arrange for the person to be collected. This applies both in and out of normal working hours.
The Medical Examiner
This service has been introduced across England and Wales to ensure deaths are independently reviewed and provide a better service to the bereaved.
The Medical Examiners are experienced, independent senior doctors who have been trained in the legal and clinical elements of the death certification process.
Their role is to review the care and treatment the patient received and ensure the information contained on the Medical Certificate of Cause of Death (MCCD) is correct. The Medical Examiner will also advise if a referral to the Coroner is needed.
The Medical Examiner or the Medical Examiner Officer will contact the next of kin or representative to make sure you understand the cause of death. This discussion will also provide you with an opportunity to raise any questions or concerns you may have before the Certificate is issued.
Once all the discussions have taken place, the MCCD will be completed by the GP, then sent to the Medical Examiner to sign, and then will be forwarded to the Registrar of Births, Deaths & Marriages.
You will then need to make an appointment with the Registrar.
Who can register the death?
- A relative of the deceased
- Someone who was present at the death
- The person instructing the funeral director
Information needed for the Registrar
To register a death, you will need:
- The Medical Certificate of Cause of Death, issued by the GP or Coroner, which should have been sent to the Registrar electronically
The Registrar will ask you to provide:
- Full name and address (maiden name, if appropriate)
- Date and place of birth
- Occupation and occupation of spouse, if married
- State pensions and benefits received – don’t worry if you are not sure
- The name and date of birth of any surviving widow or widower
Certificates
- The registrar can provide certified copies of the death certificate, for a fee. You may need copies for insurance, bank accounts and other purposes
- They will issue a green certificate to your funeral director to enable them to proceed with funeral arrangements
- The registrar can offer an additional service called Tell Us Once. Using this service ensures that the relevant parts of Government are informed about the death, such as Tax Credits, Inland Revenue, DVLA, Pensions Agency, Council Tax, Housing Benefits and Social Care. The Tell Us Once service limits the need for local government agencies to be provided with a copy of the death certificate
- If you are not using the Tell Us Once service, you will be issued with a white form BD8 which you may need to send to the Department of Work and Pensions
For further information, please look at the government website What to do after someone dies: Register the death.
When a referral to the Coroner is required
Medical staff are required by law to notify the Coroner in the following circumstances:
- If, to the best of their knowledge and belief, the death was due to:
- Poisoning, including by an otherwise benign substance
- Exposure to or contact with a toxic substance
- The use of a medical product, controlled drug or psychoactive substance
- Violence, trauma or injury (including historic injuries if this has caused/contributed to the death)
- Self-harm or neglect, including self-neglect
- Any treatment or procedure at any time in the past which caused or contributed to the death
- An injury or a disease attributed to any employment held by the person during the person’s lifetime
- Unnatural causes, but does not fall within any of the circumstances listed above
- If the doctor considers that the cause of death is unknown
- If the person died while in custody or otherwise in state detention
If the death occurs out of hours and the community nurse is unsure whether the GP will complete an MCCD, the patient will need to be referred to the coroner.
You will be contacted by the Coroner’s Office to inform you whether an inquest will be opened, which may include a post-mortem. The Coroner’s Officer will be responsible for issuing a certificate for burial or cremation and will give further advice. In most cases, referral to the Coroner will not unduly delay your funeral arrangements unless an inquest is opened.
Further information can be obtained from Ministry of Justice website.
In some cases, if the cause of death is clear and there are no other factors, the coroner will refer the case to the Medical Examiner’s Office to organise the MCCD so you can register the death. (See earlier section entitled ‘The Medical Examiner’).
Deaths during work hours (when referral to Coroner required)
If a patient dies Monday to Friday, 9am to 3pm, the community nursing team will contact the GP surgery to inform them that the patient has died. The doctor will contact the coroner, who will then make the decision whether to transfer the person to the mortuary or allow the person to be released to the chosen undertaker.
If the person needs to be transferred to the mortuary, the police may be involved and attend the place of death. The police will organise a nominated undertaker to transport the person to the mortuary within a hospital on behalf of the coroner. There will be no cost for this transfer to the mortuary.
Outside working hours (when referral to Coroner required)
The community nursing team will call the police to attend.
The police are attending as the deputy to the coroner. This is completely routine; however it can be upsetting as they will arrive in a police car.
When the police arrive, they will have to look at the body of the person who has died as this is the procedure for all deaths referred to the coroner. The police will also ask some questions to family / friend / carers to establish some background information before the death occurred.
The police will also need to see the verification of death documentation that the community nursing team will have completed. Any medication may be reviewed and could possibly be taken away. If medication is still in the home after the community nursing team and police leave then please return all medication to your local pharmacy.
What happens next?
Once the person you care for/family member is transferred into the coroner’s care, your chosen funeral director can then be contacted. The funeral director will then explain the next steps regarding planning your chosen funeral. The funeral director will liaise directly with the coroner’s office. The family / friend / carers will be notified once the MCCD is issued by the coroner and sent directly to the registrar. The registrar can then be contacted to register the death and arrange to obtain the MCCD. The funeral director will usually then finalise any arrangements for the funeral.
Funeral arrangements
It is important that any Will and Testament that has been made by the person who has died is read as soon as possible, as it may include their wishes regarding the funeral – e.g. burial or cremation.
You can contact the Funeral Director of your choice as soon as possible, even before you obtain the Medical Certificate of Cause of Death.
Funeral directors give a full estimate of charges at the time of taking instructions. If you are in receipt of state benefits you may be eligible for assistance with funeral costs. To find out more information, contact Jobcentre Plus Tel: 0800 169 0190 or download form SF200 Funeral Payment from the social fund.
Help with your grief
- It can be hard to accept the death of someone that you care about and you may feel confused and overwhelmed by the sadness and different emotions that overtake you. This is grieving.
- Remember that grieving is normal; people will react differently and in their own way.
- There is no time limit as to how long you may experience the feelings associated with grief – for some people it is a matter of months, for others it may take years, but you must allow yourself time to grieve and accept your loss.
- Everyone reacts differently to a death. It is normal to feel a whole range of emotions – numbness, disbelief, anger, guilt, pain and yearning for your loved one, panic or fear. Accompanying this may be loss of sleep and inability to concentrate. All of this is normal and may go on for days or months. Not everyone will experience all of these feelings, some will be felt more strongly than others and they may come in any order or be mixed up.
Reactions to grief – physical and emotional
- Accepting that someone has died can be difficult – it may feel unreal. At first you might feel numb, and experience feelings of shock and disbelief. This is a common reaction.
- Sometimes people feel ashamed of emotions such as guilt. You may have thoughts about what you think you should have done. You could have feelings of disloyalty when you find yourself enjoying old or new interests. It is alright to laugh and cry.
- You may have strong feelings of anger – anger at yourself for the things you said or always meant to say and did not have the chance to.
- Some people direct blame at others. Grieving is trying to make sense of something that often seems senseless; you may find yourself thinking “If only ……..”
- Longing can be a big part of grief, for instance, looking for your loved one in a crowd. Even though you know they have died, you could think you have seen them or heard their voice.
- It is common to experience a low mood. There could be times that you only have a short span of concentration and are easily distracted. Simple problems can be viewed out of all proportion and you may find yourself in a state of panic.
- Perhaps you feel as if you are going mad. This is a normal reaction and talking to someone about this should help.
- You may feel run down, stressed, or even experience aches and pains. Whilst this can be a normal part of the grieving process, it may be helpful to seek advice from your GP.
- You may feel hungry but at times unable to eat. People often feel tired, although find it difficult to sleep.
Coping with grief
- If someone has died who has been a part of your life, your life can seem very empty.
- Feelings of isolation could be painfully strong, and you may feel lonely or sorry for yourself.
- People can seem to avoid you. They may not know what to say or are finding it difficult to cope with their own feelings. It may be hard, but you could take the first step, letting them know that you welcome their friendship and support.
- Sometimes it may seem that life would be more bearable if you made changes to avoid painful memories. Taking time before making important decisions may be helpful.
- With time, memories usually become less painful. You should find yourself being able to remember, without becoming as upset. It is good to enjoy old or new interests, and make plans for the future.
Things to consider following a bereavement
- Allow yourself time to grieve, in the way that feels right for you. Remember, there is no right or wrong way or time limits.
- Accept help from others when offered.
- Take care of yourself, eat sensibly and rest as needed.
- Check with your doctor about health worries. It is normal to experience physical and emotional problems.
- Sharing your feelings with family and friends is not always easy to do. If this is so, the support organisations on the following pages may be able to help.
- When the time feels right, try to find new ways to enjoy yourself. Consider accepting invitations and try not to become socially isolated.
Useful contacts
Newcastle Community Nurses
Available 24 hours a day 7 days a week
0191 282 3664
Medical Examiner Office
Available 7.30am to 4.30pm Monday to Friday
Telephone: 0191 933 0279 or 0191 282 9786
Newcastle Coroner’s Office
Opening hours: 8am to 3.30pm Monday to Friday
Telephone: 0191 277 7280
Newcastle Registrars
Opening hours 8.30am to 4.30pm Monday to Friday
Telephone: 0191 278 7878 and ask for registrars
Newcastle Hospitals Bereavement Information
Macmillan Cancer Support
0808 808 00 00
www.macmillan.org.uk
Cruse Bereavement Support
(Support and counselling for bereaved adults) 0808 808 1677
www.cruse.org.uk
Samaritans
116 123 call free from any phone (24-hour service for all ages)
www.samaritans.org
rip rap
(for young people over 12 when a parent has cancer)
www.riprap.org.uk
Mind
Support line Telephone: 0300 102 1234
www.mind.org.uk
British Association for Counselling & Psychotherapy (BACP)
Telephone: 01455 883 300 (to find a therapist)
www.bacp.co.uk
Information produced by the Trust End of Life Care Subgroup
Date: September 2024
Review date: September 2027
