Last November we explained why we think it is appropriate for us to seek to identify deaths by suicide while a fitness to practise case is active, and our intention to collect data for the period 2019 to 2021 and publish a report. Considerable progress has been made, but we are not going to be able to report within the first half of this year, as previously stated, for the reasons outlined below. We also think it is important for us to share the results of the work we have done so far, and how it is helping to develop our thinking and our plans.
We are well aware that being involved in a fitness to practise case can be a difficult and stressful experience. That is why we have looked for opportunities to improve the process where we can and it is also why we undertook research to better understand the experiences of those who participate in fitness to practise investigations and hearings.
The work we have done so far has identified some additional areas of complexity in gathering and interpreting evidence. We need to consider carefully how best to address those issues, so as to be sure that we are being led by the evidence and drawing on expert advice on interpreting and presenting the data. As a result, it will take longer than we had originally anticipated to collect and review evidence, and to discuss our plans and the potential risks involved with relevant experts and stakeholders.
We do not yet have the evidence we need to report the cause of death
As we explained last year, we do not hold information on the cause of death, because our primary concern has been knowing that a registrant has died so that we can take the appropriate regulatory action, such as closing the entry on the register. However, when we are notified, we ask that person to provide us with some personal details and a copy of the death certificate because it is important that we have documentary evidence that someone has died.
Our evidence review has found that there can be considerable delays in the production of a death certificate, particularly in cases where a coroner’s inquest is required. We have accepted interim death certificates and other types of evidence for the purposes of notification in the past. Asking for more information from family members or colleagues has not been necessary, and would have been insensitive. As a result, we have not always received a death certificate or coroner’s certificate when notified of a death in the past three years. Where we have received a death certificate, the cause of death has not been recorded on our system.
That means that we would need to review all deaths recorded over the period, and obtain a copy of a death certificate or the coroner’s conclusions to record the cause of death. We also need to undertake a systematic review of our own processes to accurately record this information in future.
We need expert advice to interpret the evidence
We now plan to explore further how we may best collect the evidence we need to be able to record the cause of death accurately, including findings of suicide. Our evidence review found considerable variation in coroners’ practice around the UK, and differences in how conclusions are presented. There is more work needed to interpret and categorise the evidence we collect.
We also found that there has been a considerable increase in the use of unclassified conclusions by coroners over recent years, including narrative conclusions, which rose to around a quarter of all inquest conclusions in England and Wales in 2021. Narrative conclusions set out the facts and the main issues in more detail, but can make categorising the cause of death for the purposes of reporting challenging and subject to potential error.
Our review found that reporting organisations, such as the Office for National Statistics, tend to utilise professional expertise to reduce the risks of miscoding data for the purposes of reporting. We now need to consider if this type of expert advice is needed, to ensure the evidence we collect is correctly coded.
We will adopt best practice and engage with stakeholders
Our review has again highlighted the impact that references to suicide can have on individuals, the potential risks to wellbeing, and the need to be sensitive to those who may be affected by these issues. We are seeking further advice and views from experts and relevant stakeholders to ensure that any potential negative impacts are minimised and that we are signposting effectively to the appropriate support.
We plan to adopt best practice recommendations and follow guidelines on how we communicate information about suicide from the sources we have already identified. We will also engage with key stakeholders to ensure we are following the latest advice, signposting appropriately, and addressing any concerns to ensure we are handling information accurately and safely.
We have today published the findings of our evidence review. We now plan to complete the systematic review of our processes and collect the additional evidence we need to complete our wider review. We will be engaging with experts and stakeholders to advise on our planned approach, the coding of narrative conclusions for the purposes of providing data and learning, and how to reduce the impact of any information reported about suicide and cause of death.
We will continue to provide updates as the work progresses.
Reach out if you need some support
If you are affected by the issues discussed above, please reach out to the Samaritans.
Further information on wellbeing support for the dental team is also available online.