A new RSS report, published today and written by RSS fellow Professor Sheila Bird, highlights the problem of late death registrations. The RSS has long campaigned on the issue of death registrations and the need for legislative change.
Currently when deaths are referred to the coroner for investigation in England, Wales and Northern Ireland, not even the fact of death is registered until the inquest has determined cause-of-death, meaning deaths are not registered until weeks, months or even years later. In turn, this means official figures are much less useful to policymakers and public health authorities attempting to deal in a timely manner with problems such as outbreaks of disease, suicides and drug overdose deaths.
A proposed alternative solution to legislative change was for record-linkage studies to substitute the informal date-of-death, which healthcare teams notify to NHS Digital’s Personal Demographic Service (PDS), until the formal registration is made to the Office for National Statistics. The informal notification is important in its own right because it helps to prevent NHS letters from being sent to the deceased and ends payments, for example to doctors and dentists, in respect of the deceased patient.
However, this new RSS report, which looked at deaths from 2011-2016, finds the informal dates of deaths are neither sufficiently available nor sufficiently accurate (when available). Accordingly, the Society stresses again the need for legislation to resolve the issue of late registration of deaths.
The report finds:
- Informal dates of death are missing for 28% to 40% of deaths per year.
- When both dates are available, the informal date matches the formal one in only 74% of cases.
- More worryingly, when the delay in formal death registration is more than 28 days after death occurred, exact agreement between the two death-dates dropped to 67%. And, when the delay in formal death registration is more than 90 days after the date of informal registration, exact agreement between the two death-dates was 66%.
- For 34.5% of 3 536 deaths in 2011-2014 for which the informal death-date was earlier than the formal date of death by 91 days or more, the two death-dates had the same day and month of death but different death-years.
- There were age-group and gender dependencies in the proportion of deaths in 2011-2014 that lacked a formal death-date.
- At older ages (45+ years), formal death-date was decreasingly absent but was always more likely to be absent for males than females.
'This report highlights that informal death-dates are neither sufficiently present nor sufficiently accurate,' said Professor Bird. 'As a result, legislative change is essential to the end the 21st century disgrace of late registration of deaths in England, Wales and Northern Ireland. As well as being essential to exploit properly and promptly the discovery potential of record-linkage studies, legislative change is long overdue.'
'The late registration of deaths can have really serious consequences,' says Hetan Shah, RSS executive director. 'Without accurate statistics, policymakers cannot make the informed decisions needed to safeguard public health.
'We’re indebted to Professor Bird for writing this expert report and for highlighting this extremely important issue. As she says, action is both vital and long overdue.'
Professor Bird acknowledges the expertise of the NHS Digital working group which put the analysis plan into operation on behalf of NHS Digital, the Office for National Statistics and the Royal Statistical Society.