Reporting the cause of death of registrants who have died while under fitness to practise investigation
We know that fitness to practise investigations are often a stressful experience, particularly for the dental professional who is the subject of the investigation. Only a very small number of cases result in suspension or erasure from the register – but understandably the prospect of that looms large in the minds of those whose practice is being scrutinised.
We also know that the current process is more onerous and cumbersome than it should be. That is largely the product of our over-prescriptive legislation, and so for many it is the process as much as the eventual outcome which is a cause of stress. That makes it the more important to make changes where we can which aim to avoid or minimise unnecessary stress and to help ensure that people have the support they need. In addition to making further improvements to the tone of our fitness to practise communications, we are committed to reviewing the mental health and wellbeing signposting that is offered to all participants as well as the training and support we offer to our own team. We are continuing to seek ways to improve the process and will be talking more about our plans in the coming months
Information about death during fitness to practise
A concern has been voiced that some registrants under investigation may take their own lives, and earlier this year we received a freedom of information (FOI) request seeking the number of dentists to have done so. We do not hold this information, because our primary concern is knowing if a registrant has died, so that we can take necessary practical actions, such as closing their entry in the register. If a fitness to practise case is open, it also enables us to close the case and record that we have done so.
At that point, the cause of death has not always been established. Where the person has died unexpectedly or other than as a result of natural causes, the coroner (or in Scotland, the procurator fiscal) must be notified and an inquest may be held. That is always the case for a suspected suicide and only after the completion of the inquest can a final death certificate be issued which records the cause of death. That is likely to come some considerable time after the death has occurred and, crucially for our regulatory purposes, after we have removed the person from the register and closed any open fitness to practise cases. As a result, we do not collect and record causes of death where an inquest has been required.
Collecting and reporting on cause of death information
Because there has been concern about the matter, we think it is appropriate to develop an accurate picture of the prevalence of suicide while a fitness to practise case is active.
We intend to do that in the first instance by undertaking a research project to collect data for the period 2019 - 2021 and publishing a report of this in the first half of 2023. We will aggregate data over three years to minimise the risk of identifying individuals, and we will allow a twelve-month period for inquests to be completed and final death certificates to become available. In developing our approach, we have drawn on the work the General Medical Council has undertaken to gather and publish similar data for medical registrants. We aim to publish data in a similar format to that used by the GMC and, like them, if the total number of cases is below three we will indicate that, but not disclose the specific count – again that is to protect the anonymity of individuals.
We will not provide any commentary on the results, as the fact that someone has taken their own life does not provide an explanation of why they did so. As guidance from the Samaritans puts it:
'Speculation about the ‘trigger’ or cause of a suicide can oversimplify the issue and should be avoided. Suicide is extremely complex and most of the time there is no single event or factor that leads someone to take their own life.'
Samaritans provide further information in relation to this and other important issues which are a useful guide to anyone considering reporting on, or talking more generally about, suicide.
We are still finalising the detailed methodology we will use and will need to check that the retrospective collection of data can be effective in practice. If we encounter something which prevents us from proceeding as we have planned, we will explain what has happened and how we plan to address any obstacle. When the report has been published, we will go on to assess what the most useful longer-term approach might be, and we will share the outcome of this work once it is concluded.