At time of death
Here’s an outline of what happens upon death and in the few days after death. It explores how you might be feeling and what you need to be aware of in terms of the verification of death, getting a medical certificate, as well as how to register the death.
- It is very difficult to predict how you are going to feel immediately after the person dies. You may feel completely numb and in shock, disconnected from everyone, place and time. You may feel overcome with sadness or even anger at what has just happened. If the person has been ill for some time, with a reduced quality of life, you may even feel relief. You won’t know until it happens and there is no right or wrong way to feel.
- If the person dies in hospital, hospice or care home you may want to ask staff for some time with the body to give you the space you need to cope with how you are feeling.
- Last offices or laying out the body will mean different things to different people depending on their beliefs, faith and preferences. For the purposes of this resource, it will refer to the care of the person once they have died. The person’s religion or your own preferences may dictate how this is carried out, for example carrying out such tasks yourself or preferring to leave to others. Ideally this should be discussed with the person prior to death as part of their advance care plan.
Verification of death
Although you will be feeling very emotional, the person’s death must be confirmed by a doctor or health professional trained to formally verify death within two to three hours. This is called ‘verifying the death’.
- If the person dies at home and there is no health care professional qualified to verify death present at the time of death then you will need to ring the person’s GP surgery. The regular GP who has treated them during their illness and visited them during their last two week’s of life will check the person has died. It is best not to move the body or any equipment, such as a syringe driver, until this has happened.
- If the person dies out of surgery hours call the GP surgery and you will be given a number to phone for out of hours doctor. You may find you will be asked what time the person died. A doctor will come out to confirm death as soon as possible.
- If the person dies in hospital or hospice, the staff will arrange for death to be verified. Once this has happened, the person’s body may be moved to the mortuary if there is one on site. If there is no mortuary on site, or the body is in your own home, the funeral director will collect the body. If the person has died at home, you can keep the body at home until the funeral if you choose, and the funeral director can help you look after the body there. You can also have the body cared for at the funeral home and you can visit them there.
Things to think about
- If providing near end of life care at home ensure their GP visits the person regularly and at least every two weeks so that they can verify death when it happens.
- There are some things that need to be done to confirm the death such as checking the person’s pupils for reaction, checking for breathing and listening to the heart using a stethoscope. Think about whether you would prefer to leave the room whilst this is done.
- Although staff should check the person’s advance care plan to see if there are any religious or cultural preferences that need to be observed it is still worth telling them of these to make sure the person and your wishes are respected.
- If caring at home, think in advance (or as part of the person’s advance care plan) about which funeral director to contact upon the person’s death.
Getting a medical certificate
- Only a registered doctor can certify the cause of death. This is usually the GP or doctor who has verified death. They will complete a medical certificate of cause of death (MCCD) if the death was expected and they are sure of the cause(s).
- In an emergency period of the Covid-19 pandemic there is a relaxation of previous legislation concerning completion of the medical certificate cause of death by medical practitioners.
- In all cases it would be advisable to contact the Surgery where the deceased was a patient or contact the hospital bereavement office who will advise regarding the certificate being scanned and issued to the required Register Office.
- Sometimes they will verify and certify the death at the same time, but if a different healthcare professional verifies death in the home you may have to go to the surgery the next day. If the person dies in hospital or a hospice you may also find you have to go back to the hospital or hospice to collect the medical certificate the next day.
- In the emergency period it is not necessary for the next of kin to attend the surgery or hospital to collect the medical certificate cause of death.
- In the emergency period, the registrar will accept a scanned (or photographed) and emailed copy of the completed MCCD. The email must be sent from a secure email address (for example NHS.net) to a secure email address (for example .gov.uk). If the MCCD is scanned and emailed the original signed form should be securely retained and delivered to the registrar as soon as possible which should be by the surgery or hospital responsible for issuing the certificate.
- If the person’s regular GP hasn’t seen the person within 28 days of death and/or isn’t available to verify death, or there are questions about the cause of death, the death may need to be reported to the coroner. The coroner may then decide whether a post mortem is needed. The death may also be reported if the person died from an industrial disease (an illness that has arisen because of their work) and this may result in an investigation, called ‘an inquest’, to find out the cause of death.
- In an emergency period, any doctor can complete the MCCD, when it is impractical for the attending doctor to do so. This may, for example, be when the attending doctor is self-isolating, unwell, or has pressure to attend patients. In these circumstances, it may be practical to allow a medical examiner or recently retired doctor returning to work to complete the MCCD.
- In general practice, more than one GP may have been involved in the patient’s care and so be able to certify the death. In the emergency period, the same provisions to enable any doctor to certify the death prevail in general practice.
- If a post mortem is needed this will be carried out by a pathologist, a doctor working for the coroner’s office. Once the cause of death has been established by the pathologist the coroner will issue the medical certificate directly to the local registration service and you will not need to collect it yourself.
- If the cause of death is clear or expected, or the person has been seen by a registered doctor within 28 days of their death, and this can include a video call consultation, then a post mortem is usually not needed.
Registering the death
- Normally, the doctor providing you with a medical certificate of cause of death will also give you a ‘notice to informant’ which they will attach to the medical certificate. This tells you how to register the death. However, during the emergency period the notice to informant is not issued. The information on how to register the death is given at the time of an appointment being made, either by email or by a telephone booking.
- Normally, the medical certificate has to be taken to the local register offices in the local council where the death occurred. Details of your local office can be found by visiting www.gov.uk. However, all deaths are currently being registered via the telephone.
- The death must be registered within five days of the medical certificate being issued (including weekends and bank holidays). Many register offices will only see someone by appointment. Current appointment times are at the moment allowing up to one hour (in normal circumstances a 40 minute appointment is allowed to include the Tell Us Once service). There is no cost to register a death.
- Most deaths are registered by a relative but the death can be registered by specified others. The person registering the death needs to take the medical certificate and other documentation such as the person’s birth certificate, NHS medical card, proof of address, passport etc. The registrar will want to know certain details about the person and will issue a “Certificate for Burial and Cremation”, which gives permission for funeral arrangements to take place. Visit the Bereavement Advice Centre to find out more about who can register the death, what documentation needs to be taken and the forms the registrar will provide.
- During the current pandemic, it is advisable to have documentation about the deceased available at the time of the telephone appointment to ensure that the correct details are given.
- Tell Us Once is a government service that allows you to report a death to most government services all in one go. When registering the death the registrar will either fill in the form for the Tells Us Once service or give you a unique reference number to access it online. If your local register office doesn’t offer the Tell Us Once service or you choose not to use it, you’ll have to let the relevant organisations know about the death yourself. The registrar will give you a letter and reference number to help with this.
- Some offices will only generate the unique reference number and instructions of how to complete the service either online or by a free call telephone number. The Tell Us Once service is currently issued either by email or if by post it is sent out with any death certificates of the registration that the informant requests. These are at a cost of £11.00 each. The Registrar at the time of registration will advise of those financial institutions that may require to see them and discuss a number required. Additional certified copies can be obtained after the registration at no extra costs. These can be applied for online or via the telephone on a secure website from the registration service responsible for the registration of the death.
Things to think about
- As your register office will only see someone by appointment, call in advance to book an appointment.
- Normally, as well as taking the medical certificate to your appointment, you need to check with the registrar office or online as to what else you need to take. However, this is not applicable under the current pandemic.
- It is only necessary to purchase a certain number death certificates and this may vary on the number of financial institutions that the deceased personally has. Most institutions only require to see sight of the certificate which should then be returned to the next of kin or informant. The registrar can help you work out how many copies you might need.
- When the person dies, a person appointed as attorney must stop any action under the Lasting Power Attorney immediately and send the original LPA document and a copy of the donor’s death certificate to the Office of the Public Guardian.