Malnutrition can happen when your body does not get enough nutrients from your diet. It can also happen when you have a low body weight or have recently lost a lot of weight.

It is quite common in people with a kidney condition. 

When your kidneys are not working well, this can mean that you lose your appetite and feel nauseated. It can also affect the way food tastes.

Malnutrition increases your risk of:

• Illness, infection, and slow recovery. 
• Slow wound healing. Muscle loss (including muscles like the heart and lungs). 
• Fatigue. 
• Falls. 
• Low mood. 
• Being unable to do your usual activities.

How can I prevent malnutrition?

• Aim to eat ‘little and often’. This means trying to eat smaller meals, snacks, and drinks every 2-3 hours. This can be helpful if you are not able to eat large portions. 
• Try not to skip a meal. If you cannot manage a main meal, have a nourishing snack or drink instead. 
• If your appetite is better at a certain time of the day, aim to eat more at that time. 
• Eat what you fancy when you feel you can. See the ideas later in this information.
• When you feel well, cook extra portions of meals and freeze them for use on another day. If it is a family member who usually cooks your meals, ask them to cook extra of the meals you like and freeze them. 
• Fortify your meals and snacks. Food fortification increases the number of calories and nutrients without increasing how much you are eating. How to do this is explained later. 
• You may find it easier to have some ready meals in the freezer. Companies such as Wiltshire Farm Foods and Oakhouse Foods deliver ready meals. There is also a choice of smaller portions. 
• Do not drink a lot of fluid just before your meal. This can fill you up and reduce your appetite. Try to choose nutritious drinks if you are going to have them. 
• A few minutes of fresh air can increase your appetite. A short walk outside can be helpful too.

All the tips above are explained in more detail below.

Nutrition goals

Remember to set yourself 1-2 realistic nutrition goals when thinking about what changes you could make to your current eating habits. You can write your nutrition goals down. Writing your goals down will help you to remember what you want to do. You can also share this with your family and health care team.

It can be challenging to eat well if your appetite is poor, and you are also trying to avoid certain foods for your kidneys. 

You may not need to limit foods that are high in phosphate, potassium, or salt for now. Your dietitian can give you more guidance. 

If you take phosphate binder tablets you should continue to take these as usual. 

If your eating pattern has changed then you can ask your dietitian for advice on fitting your binders to your food.

What is food fortification?

‘Fortifying’ is another word for enriching. It means adding extra energy and nutrients to food. This is particularly important if you can only manage to eat small amounts.

How can I fortify my meals and snacks? 

Here are some ways to increase the calories and nutrients in your food:

Fortify with butters and oils

• Choose full fat butters and spreads. 
• Add butter, spread or oil to rice, pasta, potatoes and vegetables. 
• Add butter, spread or oil when cooking such as frying or oven roasting.
• Add butter or spread to scrambled egg or omelette. 
• Put butter or spread thickly on bread or toast before adding jam, marmalade, or savoury topping.

Fortify with mayonnaise and salad cream

• se full fat mayonnaise and salad cream. 
• Add generous amounts of mayonnaise or salad cream to sandwich fillings such as tuna, egg or chicken mayonnaise. 
• Have mayonnaise and salad cream on salads, baked potatoes and with potato chips. 
• Have coleslaw and other mayonnaise or salad cream- based salads as a vegetable with your meal.

Fortify with sugar, honey, and syrup 

If you have diabetes, you may be used to reducing sugar. While you are not eating well you can relax this a bit. Discuss this further with your dietitian.

• Add sugar or honey to hot drinks.
• Add sugar, honey, or syrup to porridge and breakfast cereals.
• Sprinkle or drizzle over tinned or stewed fruit, rice pudding, custard, and puddings.

Fortify with milk, full fat plain yoghurt, cream, or cheese

• Use full fat milk, yoghurts, and cheese. You could use single or double cream. 
• Add milk, yoghurt or cream to soups, scrambled egg or omelette. 
• Add milk, cream and/or cheese to mashed potato. 
• Make cream-based sauces for pasta, fish, and vegetables, such as cauliflower cheese, baked fish and cheese sauce, pasta carbonara. You could add cheese to these sauces too. 
• Add yoghurt or cream to creamy curry sauces. Sprinkle grated hard cheese on top of meals, such as beans, egg or houmous on toast, spaghetti bolognese, soup and casseroles. 
• Include cream cheese or sliced hard cheese as an extra sandwich filling, for example having ham, beef or salmon with cheese.
• Drizzle cream over tinned and stewed fruit, desserts, or puddings.

It is important to choose drinks which contain calories and nutrients.

• Try not fill up on water, tea, or coffee, particularly before meals. 
• Make hot drinks, such as tea, chai, coffee, and hot chocolate with half or full fat milk. 
• Use sugar or honey instead of sweeteners in your hot drinks. 
• Choose full sugar squash instead of ‘no added sugar’ versions. 
• If you have been given nutritional supplement drinks, have these between meals.

You may be worried that eating more fat and sugar will affect your health. As malnutrition can cause other problems, it is important to tackle this first. Once you are eating well again you can go back to your normal healthy way of eating.

To include healthy fats in your diet, choose:

• live oil or rapeseed oil (monounsaturated fats). 
• Olive oil based full fat spreads. 
• Oily fish, such as mackerel, salmon, sardines, trout, fresh tuna. 
• Oily fruit and vegetables, such as *avocado or olives in oil. 
• *Nuts and seeds: pistachio, walnuts, chestnuts, almonds, hazelnuts, peanut, pecans and sunflower seeds

*check with your dietitian before eating lots of nuts or avocados as these are high in potassium.

Protein is important for keeping your muscles strong and healing wounds. 

Protein cannot be stored by the body. When you are unwell, the amount of protein your body needs can increase. 

It is important to have enough high protein foods every day. Try to have a high protein food at each of your meals every day.

Foods that are high in protein:

• All types of meat, chicken, turkey including cold meat and processed meats such as sausages, bacon and crumbed chicken. 
• All types of fish including processed fish such as those in breadcrumbs or batter and tinned fish. 
• Eggs.
•  Beans, lentils (including dhal) and chickpeas (including hummus). 
• Quorn, soya, tofu, and tempeh. 
• Any type of milk and cheese. 
• Yoghurts, fromage frais and kefir. Choose the higher protein ones.

Choose, where possible, fresh and unprocessed meat, fish, chicken, and turkey. These are lower in salt. Choose full fat and full sugar dairy and non-dairy foods.

There are no set rules, you don’t have to eat breakfast at breakfast or dinner at dinner time. You may find some of these ideas appeal at different times of the day.

Meal pattern

It can be helpful to stick a regular mealtime routine and not skip meals. However, this is not always necessary if you are still eating every few hours over the day and eating as much as you can and when you feel hungry.

Check with your healthcare team if you are on certain medication, such as insulin or glucose lowering medications. These may need to be taken at specific times of the day with food.

Make the most of ‘good days’.

If you cannot manage a meal, have a nutritious snack or drink instead. See some of the ideas given on this page.

Remember, not eating can make you feel like not eating.

Breakfast

• Thickly spread butter and jam on bread rolls, crumpets, muffins or croissants.
• Toast with nut butter.
• Danish pastries.
• French toast / eggy bread.
• Eggs – omelettes (fortified), scrambled (fortified), boiled or fried egg on buttered toast.
• Bacon or sausage sandwich.
• Baked beans topped with grated cheese on buttered toast.
• Small cooked breakfast with your choice of fried or scrambled (fortified) egg.
• Porridge made with full fat milk, cream and sugar, honey, or syrup.
• Cereal with full cream milk, cream, sugar or honey or syrup.
• Cheese and cold meat roll.

Light meals and lunches

• Cheese and biscuits generously spread with butter or full fat spread.
• Sandwich or bagel or bread roll or pitta spread generously with butter or full fat spread and filled with a high protein filling such as:
  • Beef and horseradish, ham and cheese, chicken and pesto, turkey, cheese and pickle, tuna mayonnaise, egg or chicken mayonnaise, hummus and falafel or nut butter.
• Try different types of bread, such as ciabatta, baguettes, and paninis.
• Baked beans topped with cheese on buttered toast.
• Eggs – omelettes (fortified), scrambled (fortified), boiled or fried egg on buttered toast.
• Bacon or sausage and fried egg sandwich.
• Soup, such as cream of chicken or lentil with buttered bread/toast.
• Sausage roll, scotch egg, pasty or pork pie.
• Pizza or quiche.
• Tinned spaghetti topped with grated cheese.

Main meals

• Plain fish topped with white or parsley or cheese sauce (made with full fat milk), mashed potato (fortified).
• Fish pie or cottage pie topped with fortified mashed potato and grated cheese.
• Macaroni cheese or lasagna or creamy pasta using fortified cheese sauce.
• Meat or vegetable bolognese topped with grated cheese.
• Lentil or vegetable pie topped with fortified mashed potato and grated cheese.
• Cheesy potato, cauliflower, or broccoli bake with extra cheese topping.
• Creamy (fortified) risottos with protein foods and extra cheese topping.
• Ready-made meals from a supermarket or home delivery company such as Wiltshire Farm Foods or Oakhouse Foods.

Snacks and puddings

• Rice pudding, custard, or yoghurt (not the low fat version).
• Trifle.
• Class of full cream milk and biscuits.
• Danish pastry, doughnut, jam tart, Swiss roll, or cream cake.
• Milk jelly.

Your dietitian may recommend also nutritional supplements alongside this advice. There are milk style and fruit juice style drinks, desserts, and powders. Samples can be provided for you to try. They can be prescribed for a few months by your GP.

If you already have nutritional supplements, try the following:

• Chill them before drinking.
• Use them instead of your usual milk on cereal.
• Add them to yoghurt or custard.

If you find them too thick or sweet you can dilute juice-based supplements with fizzy drinks and milky ones with milk. You could make them into a smoothie or milk shake, jellies, sorbets, slushies or ice cream. Ask your dietitian for some recipes.

Most supplements come in multiple flavours. Ask the pharmacist for a different flavour if you don’t like the one you are usually given.

• Eat food that appeals to the senses.
• If the smell of some foods affects you then try to:
  • Avoid the kitchen during cooking.
  • Avoid cooking things with strong smells (e.g. Brussel sprouts, fish).
• Choose cold foods.
• Choose foods that are quick to prepare.
• Make food more attractive by adding a garnish.
• If you’ve lost interest in eating, try to imagine foods with appealing sights and smells, then try a small portion.

If you are able, fresh air and a small amount of exercise before a meal can help increase your appetite. Make meals sociable and in a relaxed, pleasant environment.

A small amount of alcohol before a meal can increase your appetite (check with your doctor first as alcohol can interact with some medications).

Setting yourself a nutrition goal and writing it down will help you succeed. See the example below to help you plan your goal. 

Example

What do you want to do and when?

I want to start using full fat milk on Friday after I’ve been shopping.

Why do you want to do it?

To give me extra nourishment and stop me losing weight.

How will you do it?

Every day I will add full cream milk to tea and use on cereal .

Try to answer these questions yourself and write down your goal. 

Step 1: Check Patient Eligibility 

Eligibility for these tests is determined according to the National NHS England » National genomic test directory - see rare and inherited disease eligibility criteria. If, after accessing the directory and the toolkit, you are unclear about eligibility or sample arrangements, please contact SWGLHcancer@nbt.nhs.uk and we will be glad to support you. 

(Note: these toolkits are for germline tests. For somatic tests see SWGLH Requesting a Genomic Test for Solid Tumours)

Step 2: Consent the patient

Germline genetic tests have implications for future and family health. Patients should be informed of the implications and appropriately consented, using a tool such as the Mainstreaming Consent Form to document in the patient record. The below Patient information leaflet can be used with or without local trust logo to support patient information provision. 

Patient Information Leaflet – R207 Patient Information Leaflet V1 GLH LOGO: 

Patient Information leaflet with the option to add your Trust Logo: 

Printing Guidance for Patient Information Sheets

• Print in landscape.
• Print on both sides.
• Flip on short edge.

Step 3: Arranging samples and completing the test request form

Blood samples in EDTA tubes (2 x 4ml for adults, 2-5ml for children and 1-2ml for neonates) are required for these tests. Samples should be kept at room temperature or at 4oC and not be frozen before dispatch. 

Please ensure all sample tubes are labelled and accompanied by the test request form

Complete the SWGLH Genomic Test Request form, including:

• The test required.
• Patient diagnosis (confirming eligibility).
• Any relevant family history.
• Who the result should be returned to - a shared results email account for your team is recommended .

Send the completed form with samples:

Step 4: Transportation of samples to the SWGLH

Samples should be transported to the SWGLH through your local pathology systems, unless advised otherwise. These samples should be kept at room temperature or at 4oC and should not be frozen before dispatch. They should ideally arrive within 3 days of sample collection.  

Please refer to the SWGLH Sample Requirements and Transport page for further information. 

Step 5: Results and turnaround times

Results will be returned to the email account or clinician listed on the form

• The national turnaround time for these tests is 42 working days, from sample receipt. Current turnaround times for some tests are considerably shorter than this.
• When special circumstances require a more urgent result, please flag this on the form and contact the Bristol Genetics laboratory to discuss the best approach.
• Once resultsmailto:ubh-tr.clinicalgeneticsuhb@nhs.net are received, please see your local mainstreaming guidance for information on management and Clinical Genetics involvement. If you need advice, contact your local Clinical Genetics service: 

Devon and Cornwall region: rduh.pcgreferrals@nhs.net (or via the Epic system if you are based at the Royal Devon University Healthcare NHS  Foundation Trust)

Bristol region: UHBWClinicalGenetics@uhbw.nhs.uk

Step 1: Check Patient Eligibility

Eligible tumours and the available tests are shown in the National Genomic Test Directory for Cancer (NGTD).

Step 2: Consent the patient

Germline genetic tests have implications for future and family health. Patients should be informed of the implications and be appropriately consented, using a tool such as the Mainstreaming Consent Form to document in the patient record. The below patient information leaflet can be used with or without local trust logo to support patient information giving. 

Mainstreaming R208 Consent Form: 

Patient Information Leaflet – Genomic testing Inherited cancer R208 with SWGLH logo: 

Patient Information Leaflet - Genomic testing Inherited cancer R208 with space for Trust logo:

• R208 Patient Information Leaflet V1.2 Trust Logo.pdf190.85 KB

Printing Guidance for Patient Information Sheets

• Print in landscape
• Print on both sides
• Flip on short edge

BReast CAncer Genes and Me  

‘BReast CAncer Genes and Me’ is a digital patient empowerment project that’s set to transform the experience of people with a diagnosis of breast cancer that might have implications on other family members.

The project introduces the concept of genetic testing for breast cancer in an accessible format, presented as a six-part series of colourful animations. Each video features digestible information accompanied by gentle music and a clear voiceover that takes the participant through the process and implications of genetic testing.

This project has been developed as part of a Collaborative Working initiative between the South West Genomic Medicine Service Alliance and AstraZeneca UK, and has been co-designed by clinicians and patients alike, providing an overview of the genetic testing pathway from start to finish. We have been working with Magentus Global Health Tech for our digital solution. 

BReast CAncer Genes and Me aims to streamline the consent process for breast cancer genetic testing through a digital consent pathway, supporting patients and their families through every stage and guiding them to become confident decision-makers.

View the videos on our YouTube channel.
 

Step 3: Arranging samples and completing the test request form

Blood samples in EDTA tubes (2 x 4ml for adults, 2-5ml for children and 1-2ml for neonates) are required for these tests. Samples should be kept at room temperature or at 4oC and not be frozen before dispatch. 

Please ensure all sample tubes are labelled and accompanied by the test request form

Complete the SWGLH Genomic Test Request form, including:

• The test required.
• Patient diagnosis (confirming eligibility).
• Any relevant family history.
• Who the result should be returned to - a shared results email account for your team is recommended .

Send the completed form with samples:

• GMS Test Order Form v2.3.pdf1.77 MB

Step 4: Transportation of samples and request form to the SWGLH

Samples should be transported to the SWGLH through your local pathology systems, unless advised otherwise. These samples should be kept at room temperature or at 4oC and should not be frozen before dispatch. They should ideally arrive within 3 days of sample collection.  

Please refer to the SWGLH Sample Requirements and Transport page for further information. 

Step 5: Results and turnaround times

Results will be returned to the email account or clinician listed on the form

The national turnaround time for these tests is 42 working days, from sample receipt. Current turnaround times for some tests are considerably shorter than this.

When special circumstances require a more urgent result, please flag this on the form and contact the Bristol Genetics laboratory to discuss the best approach.

Once results are received, please see your local mainstreaming guidance for information on management and Clinical Genetics involvement. If you need advice, contact your local Clinical Genetics service:

rduh.pcgreferrals@nhs.net (or via the Epic system if you are based at the Royal Devon University Healthcare NHS Foundation Trust)

UHBWClinicalGenetics@uhbw.nhs.uk

Educational resources

Competency frameworks for cancer genomics are available on the Genomics Education programme website.

Step 1: Check Patient Eligibility 

Eligible tumours and the available tests are shown in the National Genomic Test Directory for Cancer (NGTD).

Step 2: Consent the patient

Germline genetic tests have implications for future and family health. Patients should be informed of the implications and be appropriately consented, using a tool such as the Mainstreaming Consent Form to document in the patient record. The below patient information leaflet can be used with or without local trust logo to support patient information giving. 

Please use the mainstreaming R208 Consent Form: 

• Patient Information Leaflet – Patient Information Leaflet – R444 (Breast Cancer) PIS with SWGLH logo: 

• Patient Information Leaflet - Patient Information Leaflet – R444 (Breast Cancer) PIS with space for Trust logo: 

Printing Tips for Patient Information Sheets

• Print in landscape.
• Print on both sides.
• Flip on short edge.

Step 3: Arranging samples and completing the test request form

Blood samples in EDTA tubes (2 x 4ml for adults, 2-5ml for children and 1-2ml for neonates) are required for these tests. Samples should be kept at room temperature or at 4oC and not be frozen before dispatch. 

Please ensure all sample tubes are labelled and accompanied by the test request form

Complete the SWGLH Genomic Test Request form, including:

• The test required.
• Patient diagnosis (confirming eligibility).
• Any relevant family history.
• Who the result should be returned to - a shared results email account for your team is recommended.

Send the completed form with samples:

Step 4: Transportation of samples and request form to the SWGLH

Samples should be transported to the SWGLH through your local pathology systems, unless advised otherwise. These samples should be kept at room temperature or at 4oC and should not be frozen before dispatch. They should ideally arrive within 3 days of sample collection.  

Please refer to the SWGLH Sample Requirements and Transport page for further information. 

Step 5: Results and turnaround times

Results will be returned to the email account or clinician listed on the form

• The national turnaround time for these tests is 42 working days, from sample receipt. Current turnaround times for some tests are considerably shorter than this.
• When special circumstances require a more urgent result, please flag this on the form and contact the Bristol Genetics laboratory to discuss the best approach.
• Once results are received, please see your local mainstreaming guidance for information on management and Clinical Genetics involvement. If you need advice, contact your local Clinical Genetics service: 

rduh.pcgreferrals@nhs.net (or via the Epic system if you are based at the Royal Devon University Healthcare NHS Foundation Trust)

UHBWClinicalGenetics@uhbw.nhs.uk

Educational resources

Competency frameworks for cancer genomics are available on the Genomics Education programme website.

There are three different test codes depending on the reason for testing prostate patients. Please see the NGTD for eligibility criteria and select the appropriate test.
•    R430 - direct germline testing for patients who are eligible for panel testing based on personal or family history.
•    R444 - for patients being assessed for PARP inhibitor eligibility, where somatic testing has failed. 
•    R240 - for patients whose somatic test showed a gene variant. This test confirms whether the variant is present in the germline.”
 

Step 1: Check Patient Eligibility 

Eligible tumours and the available tests are shown in the National Genomic Test Directory for Cancer (NGTD).

Step 2: Consent the patient

Germline genetic tests have implications for future and family health. Patients should be informed of the implications and be appropriately consented, using a tool such as the Mainstreaming Consent Form to document in the patient record. The below patient information leaflet can be used with or without local trust logo to support patient information giving. 

Please use the generic consent form: 

• Patient Information Leaflet – Patient Information Leaflet – R444.2 NICE approved PARP Inhibitor treatment (Prostate) PIS with SWGLH logo: 

• Patient Information Leaflet – Patient Information Leaflet – R444.2 NICE approved PARP Inhibitor treatment (Prostate) PIS with SWGLH logo:

  Prostate (R444.2) PIS V1.2 TRUST LOGO.pdf285.71 KB

Printing Tips for Patient Information Sheets

• Print in landscape.
• Print on both sides.
• Flip on short edge.

Step 3: Arranging samples and completing the test request form

Blood samples in EDTA tubes (2 x 4ml for adults, 2-5ml for children and 1-2ml for neonates) are required for these tests. Samples should be kept at room temperature or at 4oC and not be frozen before dispatch. 

Please ensure all sample tubes are labelled and accompanied by the test request form

Complete the SWGLH Genomic Test Request form, including:

• The test required.
• Patient diagnosis (confirming eligibility).
• Any relevant family history.
• Who the result should be returned to - a shared results email account for your team is recommended .

Send the completed form with samples:

Step 4: Transportation of samples and request form to the SWGLH

Samples should be transported to the SWGLH through your local pathology systems, unless advised otherwise. These samples should be kept at room temperature or at 4oC and should not be frozen before dispatch. They should ideally arrive within 3 days of sample collection.  

Please refer to the SWGLH Sample Requirements and Transport page for further information. 

Step 5: Results and turnaround times

Results will be returned to the email account or clinician listed on the form

• The national turnaround time for these tests is 42 working days, from sample receipt. Current turnaround times for some tests are considerably shorter than this.
• When special circumstances require a more urgent result, please flag this on the form and contact the Bristol Genetics laboratory to discuss the best approach.
• Once results are received, please see your local mainstreaming guidance for information on management and Clinical Genetics involvement. If you need advice, contact your local Clinical Genetics service: 

rduh.pcgreferrals@nhs.net (or via the Epic system if you are based at the Royal Devon University Healthcare NHS Foundation Trust)

UHBWClinicalGenetics@uhbw.nhs.uk

Step 1: Check Patient Eligibility 

Eligible tumours and the available tests are shown in the National Genomic Test Directory for Cancer (NGTD).

Step 2: Consent the patient

Germline genetic tests have implications for future and family health. Patients should be informed of the implications and be appropriately consented, using a tool such as the Mainstreaming Consent Form to document in the patient record. The below patient information leaflet can be used with or without local trust logo to support patient information giving. 

• Mainstreaming R210 Consent Form: 

• Patient Information Leaflet –  Lynch Syndrome (R210) Patient Information Leaflet with SWGLH logo: 

• Patient Information Leaflet -  Lynch Syndrome (R210) Patient Information Leaflet with space for Trust logo: 

Printing Tips for Patient Information Sheets

• Print in landscape.
• Print on both sides.
• Flip on short edge.

Step 3: Arranging samples and completing the test request form

Blood samples in EDTA tubes (2 x 4ml for adults, 2-5ml for children and 1-2ml for neonates) are required for these tests. Samples should be kept at room temperature or at 4oC and not be frozen before dispatch. 

Please ensure all sample tubes are labelled and accompanied by the test request form

Complete the SWGLH Genomic Test Request form, including:

• The test required.
• Patient diagnosis (confirming eligibility).
• Any relevant family history.
• Who the result should be returned to - a shared results email account for your team is recommended.

Send the completed form with samples:

Step 4: Transportation of samples and request form to the SWGLH

Samples should be transported to the SWGLH through your local pathology systems, unless advised otherwise. These samples should be kept at room temperature or at 4oC and should not be frozen before dispatch. They should ideally arrive within 3 days of sample collection.  

Please refer to the SWGLH Sample Requirements and Transport page for further information. 

Step 5: Results and turnaround times

Results will be returned to the email account or clinician listed on the form

• The national turnaround time for these tests is 42 working days, from sample receipt. Current turnaround times for some tests are considerably shorter than this.
• When special circumstances require a more urgent result, please flag this on the form and contact the Bristol Genetics laboratory to discuss the best approach.
• Once results are received, please see your local mainstreaming guidance for information on management and Clinical Genetics involvement. If you need advice, contact your local Clinical Genetics service: 

rduh.pcgreferrals@nhs.net (or via the Epic system if you are based at the Royal Devon University Healthcare NHS Foundation Trust)

UHBWClinicalGenetics@uhbw.nhs.uk

Educational Resources

Competency frameworks for cancer genomics are also available on the Genomics Education programme website.

The Medical Examiner Service is an independent service that is a legal requirement in England and Wales. It reviews all deaths that are not investigated by a coroner, offering an independent check of the cause of death. 

The Medical Examiner Service aims to: 

• Increase understanding and peace of mind for families.
• Make sure that causes of death are accurate.
• Make sure that appropriate deaths are sent to HM Coroner for investigation.
• Improve learning and patient safety in hospital by providing a review of care. 

Medical Examiners (MEs) are independent senior medical doctors who will not have been involved at all in the care of your loved one.  

They carefully review the clinical notes and meet with the doctor who cared for your loved one. They discuss the person’s care and the cause of death, before the doctor completes the MCCD. 

MEs work with a team of Medical Examiner Officers (MEOs), who are specially trained in the legal and medical elements of death certification. 

A Medical Examiner or Medical Examiner Officer will call you in the next few days. They will explain the wording on the MCCD and answer any questions you have. They will also advise you how to get the death certificate and other forms from the Register Office. 

The Medical Examiner Office can share any feedback to the clinical team or hospital and may ask them to review the care given. This helps identify ways to improve patient care in the future. 

The Medical Examiner Office will do their best to contact the deceased’s next of kin. If you have any questions and have not been able to speak with the team, please contact the Patient Affairs team. 

For more information on the Medical Examiner Service, please visit The Medical Examiner Service - BNSSG Healthier Together

Once completed, the MCCD will be delivered to the Bristol Register Office from the Medical Examiner Office by email (you do not need to collect it in person). 

Sometimes, the hospital doctor must report a death to the coroner before an MCCD is issued. They are a legal expert that must investigate certain types of deaths: 

• Deaths where the cause is unknown.
• Deaths involving violence or trauma.
• Deaths caused by industrial diseases.
• Deaths from acute alcohol poisoning or drug related illnesses.
• Any other deaths thought to be unnatural.

The Coroner’s Office will gather information from the medical staff and the Medical Examiner. Then they will decide if a post-mortem and/or coroner’s inquest is needed.  

In many cases they will give permission to issue the MCCD.  

Coroner’s post-mortem 

A post-mortem (sometimes called an autopsy) is an examination of a body after death. If the death has been referred to the coroner, the MCCD cannot be released or the death registered until this is complete.  

The post-mortem usually takes place within a short time of the death, at the coroner’s mortuary in Flax Bourton. 

The Coroner’s Office will take over from the Patient Affairs Office and Medical Examiner Office. They will  keep you informed of what is happening and guide you in the next steps that you should take. 

The coroner does not require the consent of any other person for this to take place. Funeral directors are familiar with post-mortems and are usually happy to go ahead with funeral arrangements. 

The Coroner’s Office will tell you when they have sent paperwork to the Register Office. You can then make an appointment to register the death. 

The Coroner’s Office can be contacted on 01275 461 920. Opening hours: 07.30 - 15.30, Monday to Friday. 

Coroner’s inquest 

In some circumstances the coroner will proceed to open an inquest. 

The purpose of an inquest is to find out four facts. 

• Who the deceased was.
• When they died.
• Where they died.
• How they died. 

The coroner’s inquest will include: 

• Recording the medical cause of death.
• Completing a post-mortem, in some cases
• Asking you to provide a statement about your loved one, in some cases,
• Asking the team who cared for the deceased to provide statements.  

The coroner will consider this evidence, and there may be a hearing. This is a fact-finding hearing, not to place blame, but to answer the four questions above. You can attend the inquest hearing and ask questions. 

The coroner will then record a conclusion, such as  accident or suicide. The process can take many months to complete, but this does not mean you cannot have a funeral or celebration before it is finished. You will be kept up to date by the Coroner’s Office. 

If your loved one had property or clothing left with the Patient Affairs team, they will contact you to arrange its return or disposal. Jewellery is usually left on the person  and will go to the funeral director, unless the family ask for it to be removed. Please make sure you agree on what should happen with the Patient Affairs Office. Items not collected within 3 months will be disposed of. 

You may wish to come to the hospital’s viewing room to see your loved one. The viewing room is a separate room within the hospital Mortuary. 

To do this, you can make an appointment with the Mortuary Team by phoning 0117 414 0184 between 08:00 - 16:00, Monday to Friday. We do not currently offer viewings on evenings or weekends. 

Alternatively, you may prefer to wait until the deceased is transferred to the care of the chosen funeral director. 

On the rare occasions when the cause of death may be a criminal matter there will be restricted viewing. In these cases, the police will advise you. 

After someone has died it may be possible for their tissues to be donated to help others. Even if they were not a registered donor, the law in England presumes they give consent to donate their tissues. However, family or next of kin will always be consulted before this happens.  

Tissues can only be donated in certain circumstances and time frames: 

• Eyes for corneal transplantation can be donated up to 24 hours after death.
• Heart valves, bone, skin and other tissues can be donated up to 48 hours after death. 

If you choose tissue donation, your loved one will be treated with care and respect, and their appearance will be restored. It won’t delay funeral plans.  

A specialist nurse may contact you to explain the options and answer any questions. Tissue donation is completely voluntary. For more information, call NHS Blood and Transplant on 0800 432 0559 and leave your name and number. A nurse will call you back soon. 

You can register the death if you are: 

• A relative.
• Someone who was there at the death.
• An administrator from the hospital.
• The person making arrangements with the funeral directors.

• The person’s full name at the time of death.
• Any names previously used e.g., maiden name.
• The person’s date and place of birth.
• Their last address.
• Their occupation.
• The full name, date of birth and occupation of a surviving or late spouse or civil partner.
• Whether they were receiving a state pension or any other benefits. 

When you register the death, you will receive the following: 

• A legal death certificate. This is a certified copy in the register of deaths. There is an opportunity to purchase additional death certificates, and you will need to consider how many certificates are needed, as banks, private pension companies and insurance companies require certified copies. Each certificate costs £12.50.
• A Certificate for Burial or Cremation (the ‘green form’), which gives permission for burial or an application for cremation.
• A Certificate for the Department of Work and Pensions Benefit (form BD8) – you may need to fill this out and return it if the person was receiving a state pension of benefits. 

Once you have registered the death you can inform your chosen funeral director that the death is registered so that arrangements can go ahead. 

If the death has been referred to the coroner, you will not be able to register the death until the registrar has received a notification from the Coroner’s Office. 

Local councils 

• Housing Benefit Office
• Council Tax
• Collection of payment for council services
• Libraries
• Electoral Services
• Blue Badges
• Adult Services
• Children’s Services
• Council Housing 

Department for Work and Pensions (DWP) 

• Pension, Disability and Carers’ Service.
• Jobcentre Plus
• Overseas Health Team 

Revenue and Customs 

• Child Benefit
• Child Tax Credit and Working Tax Credit
• Personal Taxation 

Identity and Passport Service 

• Driver and Vehicle Licensing Agency
• Ministry of Defence
• Service Personnel and Veterans Agency
• War Pensions Scheme 

People you might need to inform 

Please ask a member of staff for a printed copy of this patient leaflet if you would like a checklist to complete. 

• Family
• Friends
• Healthcare providers, such as optician, dentist, GP
• Bank or building society, credit card providers
• Premium bonds, long term savings companies (ISAs)
• Anyone holding money for the deceased
• Social Services such as home help or care
• Previous/current place of work (occupational pension), trade unions
• Executor of the estate (will)
• Insurance Companies (car, home, life insurance)
• Residential or nursing home
• Landlord or housing agency
• Mortgage company
• Utility companies (water, electric, gas, phone, internet, TV licence, Internet)
• Hire purchase companies
• Post Office (to redirect mail)
• Cancellation of any upcoming payments
• Transport (to day centres or clubs)
• Deliveries (milk, food boxes, newspapers)
• Return of any borrowed equipment (medical or social)
• Religious organisations (faith leaders)
• Stop any junk mail 

What to do after someone dies - GOV.UK

What to do when someone dies - Age UK

Bristol City Council Bereavement Support 

Get help with funeral costs - GOV.UK