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                         Bereavement Services Association
                              Newsletter January 2008

A Happy New Year to all our readers, although the nature of our roles means that it is also the
busiest time of year for many of us.

Welcome to the second newsletter of the Bereavement Services Association. I would like to thank
those of you who made such encouraging comments on the Summer ’07 edition but would very
much value more feedback including constructive criticism. As this edition has expanded by 8
pages we have included a List of Contents on page 3.

What are the challenges that face people working in bereavement services as we move into a
new year? Professor Margaret Holloway states that ‘Bereavement support is unlikely to become a
public policy priority in the health and social care systems of the twenty-first century.’ This is a
prescient remark given the recent failure of the government to include a Coroner’s Reform Bill in
the Queen’s Speech. Ms Holloway is Professor of Social Work at the University of Hull and her
book, Negotiating Death in contemporary health and social care*, is specifically written to be
accessible to those of us who are not naturally academic. This is one of two recently published
books that I would recommend all of us to try and read one of during this next year. The other is
by Glennys Howarth of the Centre for Death and Society at Bath University. The team at Bath are
also very aware of real workplace issues and are not at all ‘ivory tower’ like and Glennys’ Death &
Dying A Sociological Introduction** sets out to demystify the terminology that so many of us find
off-putting when we try and increase our knowledge. Both books are important as much of the
new knowledge about bereavement has come from social rather than psychological scientists,
looking at death and its consequences in a larger context than just the individual or the family.
The two approaches are complementary, sometimes challenging us re-evaluate the conclusions
drawn from our own personal and professional experience and sometimes validating the ideas
we have formulated over time.

I believe that the divide between academics and practitioners is diminishing and we are
fortunate to have members in the BSA who combine both roles but those of us who work with
people in the immediate post-death period have to recognise that as yet there is no secure
evidence base for what we do. Intuitively we believe what we do is the right and proper service
to offer and the bereaved often express great gratitude. I recently ran a focus group of
bereaved people for another purpose entirely and was quite shocked at the amount of basic
information they had not been given, lack of understanding of processes or even benefits they
might have missed out on – and this was a group that felt that they had been given good care
and were grateful.
We have to do better to justify the investment of public funds in complex healthcare systems. If
we aspire to be recognised as genuine professionals we have to be prepared to make the effort
that accompanies such status including reading in our own time if necessary and perhaps, dare I
say, investing some of the generous annual leave in the NHS to attend conferences such as the
ones listed later in this newsletter.                                                 1
The BSA itself provides the When A Patient Dies training - earlier courses have been extremely well

If we belong to organisations that are still able to support people to attend such events then so
much the better. I have had a number of encounters recently when academics have expressed
their need of the experience that practitioners have to guide and test their hypotheses and
areas of study. There is a genuine exchange needed in which we need to be prepared to
A good bereavement service is not just of benefit to the bereaved but can also play an
important role for the organisation (I am thinking particularly of the health sector here). Relations
with coroner’s officers, registrars and funeral directors can be considerably enhanced and it is
also to the benefit of the bereaved as well as making our own work easier, if bereavement staff
understand the role and needs of other services. There are two articles here which highlight other
roles which work to support the bereaved in very different ways.

Do we seek to demonstrate our value in our relations with colleagues; medical staff, managers,
PALS and the complaints team, the clinical governance department? How do we manage the
occasional tussle for access to medical notes with clinical coding colleagues? Have we thought
about how our practice sits within existing and emerging bereavement theory? Do we have a
coherent ethos for what we do? What about key performance indicators so we can
demonstrate value for money? Do we know how many potential complaints we have prevented
through the provision of simple information and by giving a distressed and angry family the
opportunity to be listened to?

I don’t think any of us have fully worked out all the answers to these questions – and the new
ones emerging such as how existing bereavement services will dovetail with new end of life care
initiatives. In the meantime a bench marking exercise such as the one Elizabeth Hawden
mentions is a good way to make your membership of the BSA very practical and also start to
network with someone else near you. Have they worked out a way to tackle a common problem
from which you could benefit or maybe you have the answer to something that is really
bothering them – for too long we have worked in isolatation from each other and expended vast
amounts of time and energy duplicating solutions that could have been shared, adapted,
enhanced and perhaps begin to become the basis of standardised practice.

This was the initial vision of the founders of the BSA and remains at its heart but cannot be
achieved by committee. This needs all of us to get involved to make the Association a real entity.

The space on the next-to-back page for your contributions remains empty – contact me at or on 07765 88270. I look forward to hearing from you.


* Holloway, M (2007) Negotiating Death in contemporary health and social care Policy Press, Bristol

** Howarth, G (2007) Death & Dying A Sociological Introduction Polity Press, Cambridge

PS I should perhaps confess that I have not yet completed either book – but I am in process of reading
them and am happy to recommend them on what I have read so far.
I would be delighted to receive book reviews for future editions – they do not have to be learned tomes –
autobiography and fiction can reveal many insights about dying and bereavement .


Editorial                                                                 1

List of contents                                                          3

Executive committee news                                                  4

Meet the executive committee: Elizabeth Hawden                            5

Training Opportunities                                                    7

Government Watch                                                          9

A Day in the Life of a Coroner‟s Officer                                 11

Coroner‟s Society Response to the Queen‟s Speech                         13

Update of the Cruse/BSA Bereavement Pathways Project                     15

Useful websites                                                          15

Introduction to Civil Funerals                                           16

About the Bereavement Services Association                               18

Miscellany                                                               19

Application form for „When A Patient Dies‟ Training                      20


As we went to print the Health Secretary announced the Government‟s support for
the recommendations of the Organ Donation Taskforce although the Taskforce‟s
report was not yet available. The aim will be to change the current situation in
which the UK has one of the lowest organ donor rates in Europe.

Who’s Who on the Executive Committee
Chair                              Tony Brookes

Vice-Chair                         Dawn Chaplin
                                   Heart of England NHS Foundation Trust

Secretary                          Vacant

Treasurer                          Yvette Adams
                                   University Hospitals of Leicester NHS Trust

Membership Secretary               Ian Eady
                                   Sheffield Teaching Hospitals NHS Foundation Trust

Newsletter Editor                  Anne Wadey
                                   Bereavement Advice Centre

Derek Fraser                                            Paul Benson
Cambridge University Hospitals NHS                      Swansea NHS Trust
Foundation Trust
                                                        Elizabeth Hawden
Mark Green                                              Taunton & Somerset NHS Foundation Trust
Southampton University Hospitals NHS Trust

Recent Changes to the
Executive Committee                                     Tony Brookes, our Chair, has very recently
                                                        been made redundant from his post as
There have been a number of changes to the              Bereavement Services Manager at North
Executive Committee over the last few                   Staffordshire NHS Trust; although a modified
months. Sadly we have said goodbye to                   bereavement service will continue at the
Helen Rickard as secretary as her other                 Trust. Tony is taking some time to reflect on
commitments now preclude her continuing                 his next move so will continue his
with this role. Helen is a brilliant organisation       involvement with BSA for the time being at
and detail person (amongst her many                     the same time making sure there will be a
attributes) and we will miss her and thank her          smooth handover should he no longer be
for her contribution over the last year.                able to continue as Chair in the longer term.

We are very fortunate to have been joined by            Congratulations to Dawn Chaplin who has
Elizabeth Hawden. A full profile appears                been appointed to the newly created post of
below. If any of you are in the early stages of         Head of Bereavement Services at the Heart
establishing a bereavement service Elizabeth            of England Trust with a remit to look at the
has experience of both the highs and                    whole bereavement journey.
inevitable occasional lows of doing this and it
is well worth getting in touch with her.

                0845 833 1153
                0845 833 1153

                                                       MEET THE
                                                       Next in our series of introductions is
                                                       our newest committee member:

                                                           Elizabeth with her colleague, Lyn Laver,
                                                            in the Bereavement Meeting Room at
                                                                   Musgrove Park Hospital

Elizabeth Hawden, RGN, BA in Guidance Counselling, BACP accredited Advanced
Diploma in Integrative Counselling.

Introduction: Elizabeth Hawden has had a varied career working both in this country and
abroad using her nursing and counselling skills to work with all ages and socioeconomic
groups. Life experience, her „maturity of age‟, energy and passion to be an advocate for the
bereaved, are some of the things that she has drawn upon to set up and run a busy
Bereavement Support Service for Musgrove Park Hospital in Taunton Somerset.

Background: Elizabeth was employed in August 2005 within Chaplaincy and the Clinical
Support Division. The lead Chaplain Eric Holdstock had been the enthusiastic lead to
ensure that the Trust employed someone to set up the much needed service. He had
already done some bench marking to suggest the need for a centralised service and
ascertain the qualifications necessary for the post.

The Vision: The service is in the process of being „rolled out‟ across the Trust. At times this
has seemed slow and frustrating to Elizabeth but her vision of excellence and her tenacity
has helped her to be patient. A second member of staff, Lyn Laver RGN, was employed at
the end of October 2007. This post is 22.5 hours a week and has to provide consistency
across the Trust. Elizabeth was creative when discovering the total hours available and the
need to provide a service of excellence for around 1,000 deaths annually. She created the
post around annualised hours. This means Lyn works Mondays and Tuesdays 6 hours a
day. The rest of Lyn‟s hours are full time when Elizabeth is out of the office for a large
proportion of a day or days, on annual leave, engaged in education of staff, meetings or
personal education.

The Service: The service provides bereavement support and information to the Next of Kin
of Deceased Patients, most commonly in the days immediately after death. An informal
bereavement assessment is done during the contact with the bereaved over the „phone and
face to face. Those likely to encounter a complicated grief journey are followed up by „phone
after approximately 6 weeks.
At this time they are given support if needed and signposted on to community support if they
agree they would benefit from additional ongoing support. Elizabeth has a vision that this
service will be available for all Next of Kin by using volunteers. Bereavement assessment
and support is also available for In-Patients experiencing loss and bereavement issues

The team: When a patient dies the ward informs the Bereavement Department by „phone
and then the property and medical notes are brought to the office by 9.30. Elizabeth/Lyn then
check the medical notes to discover the probable pathway for the documentation and contact
medical staff to agree a time they will attend the department to contact the Coroner‟s
department/complete necessary documentation. When the medical staff get to the
department they are given a warm welcome and the offer of tea or coffee. They complete the
Medical Certificate of Cause of Death, Cremation form if necessary, and Notification of
Inpatient Death which is immediately faxed to the GP. The documentation is scrutinised by
Lyn/Elizabeth who are able to offer support/education to medical staff.

The Next of Kin: The Next of Kin are given a Bereavement Information Pack by the ward or
by Lyn/Elizabeth. They are asked to contact Bereavement Support after 10.00. By the time
they call the department Lyn/Elizabeth can give initial information/support and give an
individualised service which means the bereaved usually choose to have an appointment on
the same or following day at the Bereavement Department followed by a Registrar‟s
appointment in Taunton (booked by Lyn/Elizabeth).

The Gold Standard: The „Gold Service‟, that is achieved most of the time, is that both the
Medical Certificate of Cause of Death and Cremation form (if required) are completed the
same or following working day, depending on whether the death is in or out of office hours.
Each appointment with the bereaved is 30 minutes. During this time people sign for, and
collect the property, sign the Body Release Form and Consent for Removal of Pacemaker
Form (if applicable). There is also an opportunity for people to see the Medical Certificate of
Cause of Death and discuss anything about it, including care before death, why something is
or isn‟t on the form and explanations regarding the terminology used. Very occasionally there
is a need for people to speak to PALS or make a formal complaint and these processes are
discussed and facilitated. Sometimes appointments with medical staff are arranged to
provide greater understanding and clarity for the bereaved. There is free parking on double
yellow lines outside the department which is immediately through the large back entrance to
the main hospital buildings.

Facilitation and glue: Elizabeth also provides education for all hospital staff who have
contact with the bereaved and she is responsible for writing/updating policies and guidelines
pertaining to death. She also facilitates post mortem consent for Hospital Post Mortems.

Elizabeth sees the service as the „glue that holds everything together‟. Having a good
working relationship with ward and mortuary staff, the Coroner‟s department, Registrars and
Funeral Directors‟ is of paramount importance to facilitate the smoothest pathway possible
for the bereaved.

                                        TRAINING OPPORTUNITIES

                                           Pathways Through Grief
                       1st National Conference on Bereavement in a Healthcare Setting

NHS Tayside is hosting this exciting conference in Dundee on 1 and 2 September. The programme will centre on three
important areas:
     Bereavement as a healthcare condition - presented by Professor Margaret Stroebe and Dr Henk Schut from
        Utrecht University, who are world leaders in bereavement research, this session will consider the international
        research around the health effects of grief, diagnostic criteria, and effective interventions
     Bereavement care as a responsibility of health services - presented by Dr Derek Fraser, head of chaplaincy and
        bereavement care at Addenbrookes Hospital in Cambridge. This session will look at the work in
        England following the publication of "When a Patient Dies" and the development of bereavement care services
        within NHS trusts
     Bereavement as it affects healthcare staff - presented by Dr Janice Genevro of the US Health Department and
        John Hopkins University. This session will concentrate on the way staff experience the death of their patients, and
        how they cope, or do not cope, with the (often disenfranchised) grief following the death of a patient.
The conference includes symposia, papers and seminars, a poster exhibition, a debate and a civic reception followed by a
conference dinner. The conference is to be held at Westpark Conference Centre in Dundee, which is a comfortable venue,
in beautiful grounds and known for its good food.

Bookings and a call for papers will open shortly – in the meantime check out the website at where you can register your interest to be sure of receiving early notice of the
registration for early bird rates.

                                 Postgraduate Certificate: Working with Bereaved Adults
 Applications can still be made for this new course offered by St Christopher‟s Hospice, Help the Hospices and Sir Michael
 Sobell House, Oxford, and validated by Middlesex University.

 The course provides a critical study of the organisation and delivery of bereavement services for adults. It begins in April
 2008 and consists of two modules each lasting one working week. Aimed at experienced personnel who wish to develop a
 career in bereavement care, applicants should have a first degree or equivalent qualification.

 For more details, contact Katy Elton at Help the Hospices Tel: 020 7520 8200; email:

                                                                     MSc Death, Bereavement and
                                                                       Human Tissue Studies
 Conceived by the National Bereavement Partnership and designed in partnership with Staffordshire University, this MSc is
 the first of its kind. The MSc is designed for individuals who have a professional, managerial or voluntary involvement with
 caring for the deceased and their relatives and friends at the time of death.
 Modules include:
  Post Mortem: exploring rationale and need for change
  Understanding death, its causes and its certification
  Understanding bereavement and communication
  Post Mortem: the ethical dimension – application of theory to practice
  Tissue and organ donation for therapeutic use, research and anatomical examination
  Issues and methods in health research
 Delivery is part time over 3 years with modules delivered in blocks of 4 days. Modules are also available for Continuing
 Professional Development.

 For further information please contact Helen Sutton, Faculty of Health, Staffordshire University, Blackheath Lane, Stafford,
 ST18 0AD. Tel: 01785 353756 or Email:                                             7
                          provided by the Bereavement Services Association
             Workshop 1 – Tuesday 8 April 2008 Workshop 2 – Tuesday 29 April 2008
              Directory of Social Change, Charity Centre, 24 Stephenson Way, London

             Workshop 1 – Tuesday 17 June 2008 Workshop 2 – Tuesday 15 July 2008
               The Education Centre, Birmingham Children’s Hospital, Birmingham
      Workshop 1 – Tuesday 23 September 2008 Workshop 2 – Tuesday 14 October 2008
                                  Venue to be confirmed
     Workshop 1 – Tuesday 18 November 2008 Workshop 2 – Tuesday 9 December 2008
                                 Venue to be confirmed

Workshop 1 will concentrate on the experience of loss and bereavement, exploring ways of being with,
talking to and supporting bereaved people. This will include using and applying principles of good practice in
our work and looking at how our own experiences and attitudes to loss might either help or hinder our
relationships with bereaved people.
Workshop 2 will focus more on identifying, developing and practising the skills we need when working with
bereaved people. This will include work on active listening, empathy, facilitating informed choice and dealing
with bad news.
 “The two days were value for money – lots of areas about bereavement were covered. Useful course for
anyone dealing with death/bereavement.”
Maggie Harris, Patient Experience / PALS Manager, Yorkshire Ambulance Service NHS Trust
“Having the chance to learn from those working in a similar field as well as the facilitators was really useful
and the relaxed and reflective nature of the course means I got a lot more out of it than other more
traditional courses I have attended.”
Victoria Henderson, Patient Complaints Officer, King’s College Hospital

The purpose of the training is to improve the awareness and understanding of those who come into contact with recently bereaved
people and to develop and enhance the skills that they need to work sensitively and empathically. A key aim of the training is to
enable staff to improve and practice their skills in a safe environment, acknowledging that this can be difficult but emphasising that it
is important to practice in a safe environment rather than on wards with dying patients and their relatives.
Although originally designed for people working in the NHS, the material is highly adaptable so these workshops will be helpful for
anyone working in the field of bereavement in the NHS or elsewhere whatever their role, enhancing participants’ own resilience for
working in this demanding area as well as focusing on skills.
CPD accreditation is being applied for.
Due to the emotive nature of the workshops all participants are required to attend the feedback and closing session at the end of the
day. Please ensure you arrange your travel arrangements to accommodate this session.

Anne Wadey, Bereavement Advice Centre, Ryon Hill House, Ryon Hill Park, Warwick Road,
Stratford-upon-Avon, CV37 0UX or email 07796 888270
Paper booking form on last page of newsletter.

Government Watch
The major recent news is the failure of government to include a Coroner Reform Bill in the
Queen‟s Speech. Even though many of us felt the draft Bill that had been put out to consultation fell
far short of the degree of reform needed, the failure to act in any way has been a severe
disappointment. The Editor heard the Minister responsible speak in public just a few weeks earlier
and she was certainly expecting it to go ahead at that time. There seems no doubt that this was an
issue of political priorities and „parliamentary time‟.
It is certainly not the fault of civil servants in the Coroner‟s Unit at the Ministry of Justice and they
remain committed to the reform process and are trying to bring in as much improvement as possible
that does not require primary legislation. We are grateful to André Rebello, Secretary of the
Coroners‟ Society for permission to reproduce the Society‟s formal response to this event which
appears below.

The recent publicity about the illegal movement of children’s bodies to enable them to undergo
post mortem examination by specialist paediatric pathologists is, in part, a direct consequence of
the absence of coronial reform. The desperate shortage of paediatric pathologists is a serious
concern but the fact that such movements are illegal is because coroners are not allowed to move
bodies between jurisdictions for specialist examination. It is a law that many have ignored for some
time but it highlights the utter foolishness of the current situation where those whose remit is to
uphold the law are required to ignore it to be able to carry out their role to the highest possible
From April 2008 every unexpected death of a child will be reviewed by a panel of experts in
cooperation with police and the coroner if required, ensuring that all appropriate measures are
taken to support the family including other children and learn any lessons needed from the death.
The website below gives access to the full document Working Together to Safeguard Children
published by HM Government in 2006 together with supporting resources. Chapter 7 of this
document should be read by anyone working in bereavement who may encounter the death of a
child. It is too detailed to effectively summarise here but should eliminate the inconsistent responses
to a child‟s death that many us have experienced in the past. One excellent feature is the principle
that there should be an appropriate lead individual to liaise with the bereaved family. Although these
Child Death Overview Panels are mandatory from April of this year but some areas have been
early implementers. If anyone has experience of a how a bereavement service relates to these new
structures it would be helpful if these could be shared in these pages.

Many of us responded to the recent consultation of reform of Death Certification. I understand
that, subject to ministerial approval, the formal response to the consultation will be published
around the end of February. A number of pilot schemes to trial a new system will take place later in
the year. This is so central to the working practice of many of us, and certainly those of us who work
in large acute trusts felt that the proposals were unworkable as originally stated without introducing
severe delays.

Sometimes one picks up a report because it seems interesting rather than essential but then words
leap off the page. Burial Law and Policy in the 21 Century The Way Forward was such a
document. This is also the work of the Coroner‟s Unit and is a response to a consultation on burial
issues. Section 10 reports that there was general support for the creation of a statutory duty for
the disposal of the dead and that the Government believes „there would be benefits in making
clearer the responsibilities of the family and/or executor of the estate of the deceased, although
further work would be required to determine what those responsibilities should be and how they
might be enforced.‟
If, like me, your mind goes immediately to those next of kin who are traced after many years of no
contact with the deceased or those who are desperately distressed because they have no means to
arrange the funeral of the person who has died, such a possibility rings distinct alarm bells.

2                                                      st
    Ministry of Justice Burial Law and Policy in the 21 Century – The Way Forward

On a much more positive note, the London Local Authorities Act 2007 included provision for
London’s public cemeteries to begin to re-use graves over 75 years old. It is probable that most
re-use will consist of reburial of the existing remains at much greater depth to allow new interments
to take place. New legislation will be required to allow this development to be extended to the rest
of England and Wales but it is certain that this will eventually follow. This will reduce the present
pressure on space and hopefully put a brake on the use of high prices as a deterrent against burial.

It may be useful to know that the Health Protection Agency has issued advice to funeral directors
that bodies infected with Clostridium difficile may be safely embalmed using normal procedures
and precautions. In common with our colleagues who work in autopsy suites, funeral directors have
a high risk of exposure to body fluids and their caution is understandable.

The Chief Medical Officer has written to all doctors reminding them of their duties with regard to the
inclusion of Healthcare Associated Infections on Medical Certificates of Cause of Death. This can
be problematic in meetings with bereaved families both if such an infection is included and they had
not previously been aware of its significance and if such an infection was present but it is not
included on the certificate but they feel it should have been. Sir Liam Donaldson states in his letter
„Not only does the credibility of doctors (and the health service) and the validity of official data
depend upon accurate and reliable death certification, but also the confidence of relatives and the
population at large in the honesty and transparency of the profession and service.‟
Bereavement staff may find it very useful to have a copy of this letter in their offices for medical staff
to refer to and should certainly be familiar with its contents. In my last trust, deaths where C.Diff was
recorded on the medical certificate would then include any other infection which had been treated
as part of the sequence of events. Statistics were collected from all certificates including infection
within the cause of death and forwarded to the medical director and infection control committee on
a monthly basis.

Another serendipitous find when I did one of my regular „bereavement‟ searches on the Dept of
Health website was A Guide for Transsexual, Transgender people and their loved ones This
is extremely informative and very clearly and helpfully explains, for example, the legal position
around death certification and registration for people who are living with an acquired gender but
have not yet undergone medical body modification or hold a Gender Recognition Certificate or new
birth certificate. There are estimated to be between 5000-15000 transsexual people in the UK and
many more who have not undergone the demanding medical treatment required for formal gender
reassignment but who may choose to live some or all of the time as a different gender from that of
their birth.

Most of us who work in acute trusts with busy Accident and Emergency Departments will find
themselves dealing with the death of someone who has been in police custody at the time of
their collapse or there has been police contact of some kind. In fact, if headlines were to be
believed one might be believe that police are involved in deaths all of the time. The Independent
Police Complaints Commission (IPCC) has just published their statistics for England & Wales for
2006/07. This includes very helpful definitions of when deaths have to be referred to the IPCC. In
that year there were 82 deaths of this type. For those which the cause has been confirmed 16 i.e.
nearly a fifth were found to be from natural causes. Half of these deaths actually occurred in
hospital rather than at the scene of the incident or in a police station. The total number of deaths
was down by 38 from the previous year.

  Department of Health, Chief Medical Officer Healthcare Associated Infections and Death
Certification 3 October 2007
  Department of Health Bereavement: A Guide for Transsexual, Transgender people and their loved
ones April 2007
  Docking, M & Menin, S (2007) Deaths During or Following Police Contact: Statistics for England
and Wales 2006/07 Independent Police Complaints Commission, London

The following ‘diary’ is a fiction but based on real experience (anonymised & with certain details
changed) as it is unlikely that any coroner’s officer would experience all of this in one day. It also
can only be an example – there is no ‘typical’ coroner’s office as each one varies according to the
area – urban or rural, the Coroner and the funding available to him or her (some have no dedicated
office and have to work from home with no support staff), and the way the office is organized. Some
are based in a public mortuary or a hospital, others have stand alone offices. Some are civilians
managed by the police, others by local authorities and some are serving police officers. Some
jurisdictions have particular problems to contend with – Oxfordshire & Wiltshire have carried the
additional workload of the military deaths from Iraq and Afghanistan, other counties have more than
the average number of prisons. Some coroner’s officers no longer do ‘on call’ but for our example
officer the day starts very early. Therefore the example cases quoted here cannot be used as a
guide to practice.

06.00 The pager goes – the police control room tells me of a death in paediatric intensive care of a
toddler who was initially resuscitated following a near drowning in a garden pond the previous day.
Police attended the home at the time and there are no suspicions at present of anything other than
a tragic accident. I call the unit and reassure them that there is no reason why the child cannot
remain there for some time to allow other family members to travel to the hospital to say goodbye.
The consultant, who I know well, assures me no evidence of non-accidental injury has been
observed and the child has been previously well with normal development. While still on the „phone
my alarm goes off. My long commute gives me time to mentally prepare for the day ahead and also
greatly reduces the chances of me meeting former clients in the supermarket!
8.15 Arrive in the office and enjoy a few moments of peace before the ringing of the „phones
become relentless. Review the two inquest files I have to give to the coroner today and reflect on
the difference in the two cases. One an old man who was discovered when neighbours noticed the
smell and number of flies coming from the garden. He was a recluse and actively unfriendly so was
unmissed. He appears to have died of heart disease but the council bereavement service has been
unable to trace any next of kin so there was no-one but council officials at his funeral and no-one
but the coroner, myself, a council official and perhaps a local journalist to attend his inquest.
The second case is of a young single woman. The family had a wait of several weeks for toxicology
results to confirm that her death was as suspected due to an overdose of heroin probably
accidental. The Coroner takes particular care over the evidence that will be made public during the
inquest as local journalists are usually present. It will probably not be necessary for her occupation
as a sex worker to be referred to in open court. Her elderly parents already feel devastated and
guilty at her untimely death and have expressed embarrassment and shock at her occupation –
they had thought she was working in a department store.
It is impossible to give a definite estimate for how long it takes to prepare an inquest but what the
public see in court is just the end of a long process for coronial staff. I have probably spent six
hours even before the opening for the young woman and longer for the man because of the search
for relatives. Between the opening to take identification evidence and allow the release of the
bodies for funerals has needed at least another ten hours of work each. Both inquests will probably
take under an hour. Neither needs a jury and there are no controversial facets and none of the
parties giving evidence have legal representation. Any of these factors can make an inquest last
many hours or even several days if it has been a complex medical case or when there has been a
homicide but no-one has been successfully convicted.
8.45 The „phone lines open and the hospital bereavement service is on the line to report two deaths
in the emergency department overnight. We speculate that one is probably a ruptured aneurysm
following a history of back pain followed by sudden collapse with loss of blood pressure and
unsuccessful resuscitation. The other was a man in his early forties who collapsed during a game of
squash with a work colleague. I take details and promise to contact the next of kin by early
afternoon to confirm when post mortems will take place. Our usual mortuary facility will be closed
for minor building work the following day and so I contact the pathologist at the hospital where they
were admitted to ask if they can do the examinations for the coroner. They are scheduled for the
following day pending my faxing through history sheets by way of confirmation of the coroner‟s

authorisation. In this jurisdiction this authority is delegated to the officers when the case appears
straight forward.
9.10 It turns out that the family of the man with the suspected aneurysm has remained at the
hospital and has now arrived at the bereavement office without an appointment. I speak to them on
the telephone there and they leave reassured that they will get an answer to why he died.
9.30 I get a call from the local Jewish burial society. The squash player was Jewish and the family
would like the burial to take place today. The burial society understands English law and will explain
the need for the post mortem to the family but I say I will try and bring the examination forward.
This is the third generation in which a man has died in his forties of heart disease so I hope the
family will feel the post mortem has been worthwhile despite their extreme reluctance and the
brothers will seek screening. One of the hospital‟s pathologists is also Jewish and the postmortem
is done by the end of the morning and we are able to process the documentation so the family can
register in the early afternoon and the burial takes place before sunset.
10.30 Now it‟s time to take the cases to the Coroner so he can familiarise himself with them and
decide whether to confirm my suggestions for witnesses to be called. I also check whether he has
any last minute instructions with regard to the inquest opening which will take place this afternoon. I
am not very familiar with it as a colleague worked on it but he is off sick. He gives me a signed „Out
of England‟ authority for an elderly Irish lady who is to be buried in County Cork. I call the funeral
director to confirm they can collect both her and the documentation.
As I return to my office a police officer here to attend one of my colleague‟s inquests comments that
he has just heard news of a major traffic collision involving several vehicles on the ring road. There
is no news yet about casualties. We are all tense as we await further information. Road traffic
deaths are always untimely and often involve different generations in the same family. A good
police family liaison officer can be a huge help in supporting such families as they have more
resources at their disposal for giving emotional support. However I always insist on speaking to
families myself to ensure they understand the role of the coroner. When it is clear that death is from
major trauma the need for an autopsy is often not understood until we explain that it can help
understand how the collision happened and also exclude natural causes of death. This is essential
if someone may later face prosecution for causing the deaths.
Fortunately we do not have long to wait before we hear that although a number of people have
been seriously injured (perhaps meaning weeks or months of suffering and treatment for them)
there are no fatalities and we breath a rather selfish collective sigh of relief. We are all experienced
having trained between us as police officers, nurses and paramedics and even one medical
11.00 More paperwork on other cases and calls to families to update them on progress. Calls to
doctors chasing statements for future inquests. Dash out to the sandwich shop across the road –
lunch-making time this morning used up by the „phone calls.
14.15 I am finally able to speak with a specialist paediatric pathologist and am able to arrange the
post mortem of the drowned toddler although it cannot take place until the day after tomorrow. I
arrange with the hospital for the child and medical notes to be ready to be collected by our
contracted funeral director for transfer to the hospital where the pathologist is based. This is
technically illegal and has received recent media coverage but is the only way for the child to
receive the expert attention she deserves. There is no need to move the child until tomorrow
afternoon and as I have no inquests tomorrow I arrange to meet the family at the hospital in the
morning when they revisit the chapel of rest. I will take an identification statement and enough
background history to enable the inquest to be opened and adjourned quickly so a funeral can be
I make a mental note that it will be a good opportunity to return the pile of medical notes due go
back to the hospital and hopefully there will be time for a quick coffee with the bereavement staff
while I am there.
14.30 I go into court to present the identification evidence for my colleague‟s case. A post mortem
has taken place and was inconclusive and the history suggests that toxicology will provide the vital
information on cause of death. Meanwhile the pathologist has indicated that no further examination
of the body is required, toxicology and possibly specialist histology stains are all that will be needed
so the Coroner is able to authorise the holding of the funeral. I am the only person required to
present evidence, but even as a coroner‟s officer I have to give my evidence on oath.

14.45 Back to the office and I am determined that this month I will submit my overtime claim sheet
in good time. At least we have the opportunity for overtime although it is carefully scrutinised. I have
no idea even what coroner‟s officers earn in other jurisdictions but the starting salary in our area is
£21,000 per year. I suspect this may be rather more than some people get.
14.55 I take a call from Accident & Emergency. A young woman has presented with a dead
newborn. She has claimed that the baby was stillborn. The placenta was delivered in the
department and the woman then slipped away without anyone noticing. Mainly because of concern
for her medical welfare police have visited the address she gave and it has turned out to be false
and it is thought she may also have given a false name. I speak with both an obstetrician and a
neonatal paediatrician who state that the baby was pre-term although over 24 weeks gestation had
congenital abnormalities incompatible with life and associated with early delivery so there is no
reason to think she induced the delivery herself. I confer with the Coroner who decides that if the
obstetrician feels able to issue a stillbirth certificate he will have no interest in the case. This is done
and I speak with the bereavement team who will register the stillbirth. One of the medical team has
mentioned that the mother was sub-Saharan African and so they will arrange a burial in deference
to the child‟s ethnicity.
16.00 This case has taken the remainder of the day and I decide that for once I am leaving on time
after yet another demanding but also deeply satisfying day. I have done my best in ensuring respect
and proper process for the deceased and the bereaved and, I hope, always with compassion. The
journey home will give me the chance to reflect and emotionally close the door to work and look
forward to evening with family and friends.



We are very grateful to Mr André Rebello, Honorary Secretary of the Coroners’ Society for
permission to reproduce the Society’s response to the absence of a Coroner Reform Bill in
the 2007 Queens Speech.

The Coroners‟ Society had expected a Coroners Bill in the Queen‟s Speech in this session
of Parliament. The bill was announced in the draft Queen‟s speech earlier this year. It is a
disappointment that the legislative planners have not understood the need for significant
reform to the law and structure in which coroners have to deliver or services. We
appreciate that the Minister and her coroner law reform team at the MoJ will share this
disappointment as they have worked hard (within extremely limited resources) to formulate
answers to the legislative problems that coroners face on a day by day basis.

Coroners have served our society since 1194. The last major reform of the coroners
jurisdiction was in 1887 (there was some reform in 1926). There has been much scrutiny
of the coroners system over the years, but even with this analysis the system has in the
main been neglected. Our jurisdictions are local judicial services relying on the
infrastructure and resources available from the local authority. Coroners work under the
Coroners Act 1988 (CA 1988) which was a consolidating Act stemming from the 1887 and
1860 law.

The importance of the coroners work should not be underestimated; through our work we
support the bereaved and all affected by sudden or unnatural death by searching for the
truth of how the death has occurred. This is for the benefit of society and the bereaved.

Over many years, but particularly in the past eight years or so, the coroners‟ services have
become blighted. The Society fully accepts the difficult decisions that local authorities have

in planning spending between the various essential services for which they have
responsibility; however some local authorities and police authorities have not made
adequate provision for a coroner‟s service and as a result many coroners are working with
inadequate court facilities, offices and support staff all of which in turn and most tragically
neglects the bereaved. This is not the way it needs to be as some authorities (such as my
own in Liverpool) have fully recognised their responsibility and the importance of the
coroner‟s work to the local community. All Coroners should be enabled to deliver a service
from a similar infrastructure. It is fair to add that there has been little national guidance and
support and it is not surprising that there is a perception of a postcode lottery given the
varying resources available to coroners.

The Society has highlighted several areas which are in need of reform, these include,
          The ability to transfer cases to other jurisdictions (even after a body has been
      released) – this also assists with multi-fatality disasters which can occur across
      jurisdictions s14 CA 1988
          The ability to transfer a body for post-mortem examination beyond a contiguous
      jurisdiction to enable in particular forensic, neurological and paediatric speciality to
      be resourced. This last speciality in particular is essential for the investigation of
      sudden unexpected deaths in infancy and children. s22 CA 1988
          The facility to be able to hear cases anywhere to make use of appropriate
      available accommodation even outside a coroner‟s own jurisdiction s 5(2) CA 1988
          Amendments to s16 CA 1988 giving to reflect changes to procedure in the
      criminal justice system

These basic examples of essential legal changes are in addition to the basic provision of a
consistent infrastructure referred to above but particularised as,
            Funding to provide resources for administrative and investigative staff and their
            Provision of appropriate office and court accommodation
            Provision of regularly available medical and nursing advice for all cases
            Additional deputy cover to meet the needs of more complex and longer cases
        as a result of the Human Rights Act
            There is also the implementation of other legislation which will have an impact
        on coroners, these include,
                  The Corporate Manslaughter and Homicide Act 2007
                  The Road Safety Act 2006
Though the Society are disappointed at this missed opportunity to enable coroners to deal
with today‟s demands; and though any bill would have remedied some of the out of date
legal provisions, it is not believed that the Ministry of Justice had got to grips with the
parlous resourcing predicament and funding of jurisdictions. This delay in legislation is an
opportunity to carry out further work particularly in this later regard.

The Society would also like to place on record its thanks to the Minister and her team for
the attention they have given to comments and advice from our officers as the reform
process has developed. The Society will continue to work with the Minister and her team
on delivery of the reform.

André Rebello, Hon. Secretary of the Coroners’ Society of England and Wales, Tues, 6
Nov 2007

Update on the Bereavement Pathways Project
The Bereavement Pathways Project, a partnership between the Bereavement Services
Association and Cruse Bereavement Care is funded by the Department of Health to help
identify a clearer pathway from NHS based bereavement services into support services in
the community, for the benefit of all bereaved people. As part of this three year project we
will be holding two free events early in 2008: at Birmingham Children‟s Hospital on 12
February, and at Help the Hospices, King‟s Cross, London, on 5 March. Both will run from
10.30am - 4pm with speakers, workshops, a question and answer session and
opportunities for networking and sharing good practice. If you are interested in attending
either of these events, please contact Jill Sanders at, or call on
020 8939 9534.

Also planned for the project in 2008 is the testing and development of the Bereavement
Care Pathway across a small number of 'pilot sites' - work to identify these sites is
currently under way. News about the project is updated regularly. You can find out more,
contact the project team and download the invitation and booking form for the 2008
events, at Do bookmark this address and keep an
eye on it for regular updates as the project progresses.

Information Officer, Cruse Bereavement Care, 020 8939 9534 or 07920 843494


Over time it would be good to share news of websites or other electronic resources which members
have found useful. Here Derek Fraser introduces an initiative begun by him.

Let me begin, I am at Addenbrooke's Hospital, Cambridge and chair the hospital's
bereavement care group which is seeking to develop good quality bereavement care
across the whole of the hospital. I have also been keen to develop a regional network for
those involved with bereavement care in East Anglia so there can be a sharing of good
practice across the health economy. The development of this discussion site moves that
concept out to a broader audience and hopefully enables a greater engagement with the
topic for the benefit of all those involved with bereavement.

The purpose of this list is to create a network for practitioners, educationalists and
researchers involved with the bereavement care process to share information on
requirements and provision around practice, education, training and research.

The title has been deliberately chosen to encompass a wide range of individuals in this
sphere. Bereavement-Care has been used to emphasise the need to consider the persons
affected by bereavement rather than just focus on the process of bereavement. It is easy
to think about death and dying or a bereavement service but ideologically individuals are
affected by bereavement and hence the emphasis on the care aspect. You may disagree
with the above, but I hope it will be graciously since I have used the terms very loosely to
give a handle so that a discussion forum is able to be created.
Editor’s note – if all this is new to you and seems scary, it’s a lot easier than all the technical
language at the beginning makes it seem and all sorts on interesting stuff then pops up in one’s in
box – but no spam.

Families arranging a funeral now have more and more choices available. A recent arrival
on the scene has been Civil Funeral Celebrants.

                         Anne Barber, pictured left, is an advocate of civil funerals and
                         trains celebrants. She also carries out naming ceremonies,
                         celebration of vows – in fact she can provide a ceremony for
                         most significant life events.
                         This interview tries to address all the FAQs (frequently asked
                         questions for those of you not familiar with rummaging around
                         on the internet) about civil funerals.

    1. What is a civil funeral ceremony?
‘A funeral, which is driven by the wishes, beliefs and values of the deceased and their family, not by
the beliefs or ideology of the person conducting the funeral.‟

This means that a professional celebrant, who is happy to include religious material as well as
carrying out non-religious ceremonies, creates and leads the ceremony.

    2. How is it different to a humanist funeral?
The main difference is that Humanist funerals should not include any religious references, whereas
a Civil Funeral Celebrant may read a prayer or include hymns or religious music and religious
references. This can reflect something of the spirituality of those people who do not identify with a
church yet do not regard themselves as atheists. It is also very helpful for those families who are not
religious to recognise that some religious content might be appropriate for those attending.

    3. How much does it cost compared with a vicar?
The recommended fee for a Civil Funeral is £155 and involves at least 10 hours of work for the
Celebrant. The Celebrant will meet the family and ask them a great deal about the deceased. They
will then draft the ceremony, including a highly personal tribute. This is checked with the family and
amendments made if needed before used for conducting the ceremony at the funeral. The fee for a
Church of England funeral service in church is £96 from 1 January 2008.

    4. How did you become involved in civil funerals?
Back in the year 2000 I was setting up a Local Authority working party to look at Naming
Ceremonies when a member of the working party accosted me saying that his Crematorium
Manager was unhappy with the standard of funeral ceremony that bereaved families were getting
and something had to be done!

Professor Malcolm Johnson at Bristol University, who was heading up the National Funerals
College, introduced me to Tony Walter, then at Reading University. They were so supportive but
even so it took 18 months and the help of John Pearce, a highly experienced Funeral Celebrant, to
develop the training course, manual and materials for Celebrants. In January 2002 the first course
was held and 16 Celebrants went off into the funeral industry wilderness – the rest is history as they

    5. You are involved in 2 organisations – what are they and how are they
I am the Managing Director of my own business, Civil Ceremonies Ltd, which started in 2002 and
also the Chair of the Institute of Civil Funerals, which I founded in 2004.
Civil Ceremonies provides Naming Ceremonies, Renewal of Marriage Vows, Wedding Celebration
Ceremonies and same sex ceremonies. Civil Ceremonies Ltd was organising Civil Funerals, and

still does conduct the training course, but we realised that a Professional Association was needed
for Civil Funeral Celebrants. So we set up the Institute with the support of the funeral industry,
which had become aware of what Civil Funerals offered to bereaved families. It was extremely hard
to get Institute status, as Companies House could only seem to focus on us being Funeral
Directors. We also won a fight with Customs and Excise trying to explain that bereaved families
should not be paying vat on funeral ceremonies!

The Institute has developed greatly in the past three years and will continue to do so. Members are
identified by a distinctive badge, which Funeral Directors now recognise. They receive further
training and are part of a CPD scheme.

    6. How does someone go about finding a civil celebrant?
They need to make sure they get hold of a member of the Institute of Civil Funerals and the easiest
way is to look at the list of Celebrants under ‘find a celebrant’ on Alternatively
call us on 0845 0048608

    7. What are current trends in funerals?
The three trends that occur to me first are:
a. ‘Green’ funerals in woodland burial sites. There are now over 200 sites in the UK. They are
growing rapidly in number and popularity!
b. Colourful coffins! Just look at the website, cardboard coffins, wicker,
bamboo and all manner of materials are now used.
c. Participation in funerals. We undertook a study of Civil Funeral Scripts earlier this year and
found that in 60% of the funerals studied, the mourners took some part. This may have been
repeating something after the Celebrant, delivering a reading or the tribute or part of it, but this is a
significant percentage indicating a strong trend in mourner participation in funerals.

    8. Do many people plan their own funeral?
Interestingly, pre-planning of funerals is commonplace in the US, where more than 60% of funerals
are funded this way, but in Britain fewer than 2% are paid for in advance.
Our Celebrants offer a service to those wishing to pre plan their ceremony. They work with the client
to produce a ceremony script that they are happy with and the client keeps the script with their
important documents. There have been many cases where those who are terminally ill have
requested this service and the Celebrant providing the planning service has later conducted the
actual funeral. The fee for this service is usually around £125.

    9. What do you think about this? Does it meet the needs of the bereaved?
Nothing can meet the needs of the bereaved better, in my opinion, than knowing that they are
carrying out the express wishes of the person who has died. Compared with the heartache of
difficult decision making about funeral content and style, even deciding whether to opt for a
cremation or a burial, this makes the difficult pre-funeral time period far less painful.
I just wish that more individuals would have the foresight and courage to make such arrangements.

    10. How can people working with the dying and the newly bereaved in the health
        service help people thinking ahead to funerals?
In our experience, the actual process of talking through the life they have lived with our Celebrant is
both pleasurable and comforting. So health professionals can really help by pointing out how much
easier it makes it for families when there has been some thought and planning. It is a difficult
subject to broach but our experience is that people who are satisfied that their wishes have been
expressly stated and will be followed, are generally happier in this knowledge.

                       Promoting excellence in the delivery of
                         bereavement care in the statutory,
                          voluntary and commercial sector


       To provide a national network for all those who work in providing
        bereavement support services.
       To provide a national forum for discussion and training for those providing
        bereavement support services, particularly in the NHS.
       To contribute to the improvement of the quality of bereavement services
       To raise the profile and seek recognition from stakeholders of the role of
        those who provide bereavement support services.
       To raise awareness of the role and availability of bereavement support


       Representation of your professional interests with government and other national
       Networking with colleagues working in the same field
       Reduced rates for BSA conferences
       BSA newsletter
       Early notification of relevant conferences, training opportunities and publications
       Early notification of changes in legislation and government and professional bodies‟
        guidance on bereavement related issues
       Opportunities to develop and share best practice
       Opportunities to help develop and share in role specific training

The easiest way to join the BSA is via the website and complete your
details on the contact page with the option of „join the BSA‟ in the drop down box.

Membership is open to anyone providing bereavement care within the statutory, voluntary
and commercial sector.

   £30        individual membership
   £120       up to 5 members
   £210       up to 10 members

Alternatively contact Ian Eady, Bereavement Services Manager,
Vickers Corridor Northern General Hospital, Herries Road, Sheffield, S5 7A

For general enquiries to the Bereavement Services Association please call
0845 833 1153

   In pursuit of its aims, the BSA has invested in a web site to enable communication about the
   organisation and its activities as effectively as possible.
   The web site was professionally designed and has taken a while to manage efficiently.
   Therefore we apologise if you have visited the site recently and not found what you are
   looking for.

   The opportunities for development are being gradually explored and we hope that you will
   find the site a useful addition for your work.

   If you have any ideas or suggestions do let us know. The BSA is very keen to keep
   connected with its membership base and effectively develop new ways of working and

                                                      Thank you once more to
              WANTED                                  Bereavement Publications for their
BSA members interested in forming                     support in printing this newsletter
regional groups in their area to help
   local networking, support and
  sharing of good practice. Please             In the last letter we promised an article on
 email the editor, who will forward            how the BSA has been involved in the End
your details to the appropriate Exec           of Life Care programme. This has been
       Committee members.                      held over to the next edition which will also
                                               include a report on the AGM which
                                               coincides with the publication of this
                                               newsletter and at which Professor Mike
                                               Richards will speak about the End of Life
                                               Care work which he has been leading.

         Your letters, book reviews, news
           of useful websites, ideas for
          articles, who should we try and
                  interview, etc etc

                     BOOKING FORM - WHEN A PATIENT DIES
          Cost to non-BSA members                                     Cost to BSA Members
         £395 per person attending two days                  £340 per person attending two days

          £200 per person attending one day                  £175 per person attending one day

               Cost includes refreshments and a light lunch (vegetarian choices available)
                                   All programmes run 09.30 – 16.30

Please indicate which date(s) you wish to attend

 Tues 8 April 2008  Tues 29 April 2008  Both  /Tues 17 June 2008  Tues 15 July 2008  Both

 Tues 23 Sept 2008  Tues 14 Oct 2008  Both /  Tues 18 Nov 2008              Thurs 9 Dec 2008  Both


Title:………. First Name:……………………………. Surname……………………………………….

Job Title:……………………………………………………………………………………………..

NHS Trust/Organisation:…………………………………………………………………………….






Please indicate your method of payment:
 Invoice: Please note a Purchase Order Number is required for all NHS bookings

        Purchase Order Number: …………………………………………………………………..

 Cheque: Please enclose full payment payable to the Bereavement Services Association

Places are limited and will be allocated on a first come first serve basis. Confirmation details will be sent
on receipt of your booking. The organisers reserve the right to change the programme without notice.

Please complete the registration form and return to:
Anne Wadey, Bereavement Advice Centre, Ryon Hill House, Ryon Hill Park, Warwick Road,
Stratford-upon-Avon, CV37 0AL or email equivalent information to Telephone enquiries to 07796 888270.

Terms & Conditions
1     All fees must be paid in full 14 days prior to attendance to guarantee your place
2     Fees are not refundable within 28 days of the event
3     Fees will be refunded for cancellations less a £15 administration charge
4     Delegate places are transferable but will incur a £15 administration charge


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