MCCDs are selected randomly for review either at the point of registration (for paper MCCDs) or when electronically completed and transferred to the registrar (eMCCDs).
Types of review
There are two main types of review - level 1 and level 2. Both levels of review have the same aim: to improve the quality of the MCCD process, to reassure the public and to deter poor practice. It is anticipated that approximately 10% of all deaths, not reported to the Procurator Fiscal, will be subject to a level 1 review per year and a minimum of 1,000 deaths to a level 2 review.
In the shorter level 1 review the Medical Reviewer will check the MCCD cause of death and speak to the certifying doctor about anything unusual. If the certifying doctor is unavailable or incapacitated, the Medical Reviewer will discuss the MCCD with the consultant in charge of the case or another member of the team who knew the deceased and / or has access to the clinical records.
A level 2 review is similar to a level 1 in that the Medical Reviewer will check the MCCD and speak to the certifying doctor. However, in addition, for a level 2 review the Medical Reviewer will also consider relevant documents associated with the death, including appropriate health records and the results of any clinical investigations with this being done electronically if at all possible. The Medical Reviewer may also discuss the case with other relevant clinical and health care staff and the family or informal carer of the deceased. Other evidence may also rarely be considered, such as viewing the body.
These review types will be conducted through a random selection process, will be available on request in certain circumstances from interested persons, or may be targeted by Medical Reviewers in response to any emerging pattern that requires further checks.
Interested Person Reviews
The term ‘interested person’ refers to:
- Any relative of the deceased
- Any person present at death
- The deceased’s executor or other legal representative
- Any other person having knowledge of the particulars to be registered (if there is no-one in the first four categories)
- Healthcare professionals or carers involved with the deceased
- Funeral Directors
- A person having charge of the place of disposal of the body
An interested person review exists to provide a further measure of public and professional reassurance, over and above the randomised review selection process.
Such reviews:
- Cannot be conducted where the death pre-dated the implementation of the 2011 Act (or where the death has been referred to the Procurator Fiscal).
- Must be requested within three years of the date of death.
- Can only be conducted if a review has not already taken place.
Requests for an interested person review are expected to be a rare occurrence and should be raised by the interested person directly with the MR Service, rather than via the Registrar of Births, Deaths and Marriages.
Targeted review
A targeted review may be conducted in response to any identified pattern that raises concern.
Information from the DCRS, providing guidance on an Interested Person review, is available here.
Both interested person and targeted reviews can be a trigger for a Level 2 Review.