Beyond notification: best practices after the death of a service user

The passing of a service user is a deeply significant moment for health and social care providers, particularly those caring for elderly residents, individuals with complex medical needs, or those in palliative care. In such settings, death is an expected and frequent occurrence, yet it remains a sensitive and critical event that demands immediate and structured action. Providers must navigate legal, ethical, and practical responsibilities efficiently, ensuring that the dignity of the deceased is upheld, their loved ones are supported, and all necessary protocols are followed.

Legal basis and requirements for notification

For care providers registered with the Care Quality Commission (CQC), reporting a service user's death is not just a procedural step - it is a regulatory requirement that must be promptly adhered to.

Providers must notify the CQC as soon as possible in specific circumstances, including:

• When a service user has died while being detained (or liable to be detained) under the Mental Health Act 1983.
• If the individual passed away while receiving a regulated activity, or if their death may have resulted from the regulated activity or the way it was provided.

Each notification must include a clear and detailed account of the circumstances surrounding the death.

Failure to report such incidents is an offence, potentially leading to serious consequences for the provider.

Key considerations for providers

When a service user passes away, health and social care providers must do more than simply notify the relevant authorities. The aftermath often involves regulatory investigations, complaints, safeguarding reviews, and sensitive communication—all requiring careful management to uphold professional standards and protect both staff and service users.

Ensuring regulatory compliance

The legal framework governing care services demands that providers document the circumstances of a death thoroughly, adhere to the duty of candour, and cooperate with the CQC and the coroner’s office. CQC inspectors may scrutinise care standards leading up to the death, reviewing areas such as staffing levels, medication management, and safeguarding protocols. If deficiencies are identified, providers could face enforcement action. When a death is sudden, unexplained, or falls within specific criteria, a coroner may initiate an inquiry, requiring full transparency and cooperation from the care provider. By proactively ensuring compliance, maintaining accurate records, and engaging openly with regulatory bodies, providers can minimise legal risks and reinforce confidence in their care practices.

Managing communication and complaints effectively

Handling communications with sensitivity is also paramount. Families may seek explanations, raise concerns, or lodge formal complaints—some of which could escalate to legal disputes if negligence is suspected. Open dialogue and empathetic communication help alleviate distress and build trust. Providers should prioritise clear, honest discussions while offering support to families and affected staff members. A structured, transparent approach to complaint resolution demonstrates accountability and reduces the likelihood of legal repercussions. Timely responses and thorough investigations into concerns can also prevent escalation.

Mitigating reputational risks

Poorly managed responses to a service user’s death can lead to heightened scrutiny, reputational damage, and public distrust. In cases of high-profile incidents, providers may face legal challenges or media attention. Proactive engagement with regulators, families, and staff fosters confidence in the provider’s commitment to quality care. Demonstrating a willingness to reflect, implement improvements, and uphold professional standards reinforces trust within the sector.

By prioritising compliance, thoughtful communication, and proactive risk management, providers can navigate the complexities that arise following a service user’s passing—ensuring dignity, accountability, and continuous improvement in care standards.

Preventative steps

Integrate the following key safeguards into daily operations to significantly reduce exposure:

• Maintain accurate records and documentation - Comprehensive records detailing care provided, circumstances of the death, and related incidents are essential. Inadequate documentation can lead to regulatory sanctions, making meticulous record-keeping a fundamental safeguard.
• Uphold the duty of candour - Transparency is critical when engaging with families and regulators. Providers must ensure that concerns, incidents, and mistakes are disclosed appropriately, fostering trust while demonstrating accountability.
• Prioritise person-centred care and end-of-life wishes - Respecting service users’ preferences, cultural beliefs, and prior directives is essential, even after their passing. Ensuring dignity in end-of-life care and offering compassionate support to loved ones reinforces the provider’s commitment to ethical practice. Staff must also remain mindful of the emotional impact on other residents, ensuring sensitive communication and appropriate support.
• Ensure dignity and respect in care practices - Handling a service user’s passing requires professionalism, privacy, and sensitivity. Families must be communicated to with compassion, and personal belongings should be managed with respect. Providers must also maintain a dignified environment for other residents, fostering a supportive atmosphere.
• Engage with families and address concerns - complaint management remains a priority, even after a service user’s passing. Providers must investigate concerns fairly and transparently, ensuring timely responses.

By embedding these principles into daily practice, providers can minimise regulatory and reputational risks, reinforce trust, and ensure compassionate, high-quality care that withstands scrutiny in even the most difficult circumstances.

If you have any queries regarding the above, or need legal advice in relation to an inquest, please contact Jen Durbin on 07469 245 724 or Andrew Andrews on 07880 336 051 in our Regulatory Compliance Team.