Her Majesty Queen Elizabeth II

Classification: Official
Publication reference: PR1991


  • NHS Provider organisations CEO
  • NHS Integrated Care Board CEO
  • Chief Accountable Officers Commissioning Support Units

11 September 2022.

Dear colleague

Her Majesty Queen Elizabeth II

We are writing to all organisations following confirmation of the death of Her Majesty Queen Elizabeth II and the activation of arrangements relating to her lying in state and subsequent funeral.

The Government has at this time confirmed that there will be a period of mourning and that 19 September will be publicly declared as a Bank Holiday. Because of this we ask that organisations:

  • ensure staff, patients, and the public are made aware of any changes to services by utilising available patient communications, websites and on-site notices. It is also important to ensure the Directory of Services is updated accordingly.
  • for patients with planned appointments that may be affected by the day of the funeral, please ensure they are informed in advance of any changes by utilising direct patient communications. Where planned appointments are going ahead it will also be important to confirm this is the case.
  • take into account the Bank Holiday in their planning for this period and amend services as they deem necessary, noting that this may result in the closure of schools and some childcare settings.
  • ensure appropriate senior representation is available to join any NHS England regional teleconferences that may be called to assess the impact of activities associated with these arrangements on the health service.
  • maintain flag protocol, which can be found on the GOV.UK website.
  • consider if they need to have a holding area for placement of flowers, or a book of condolence. A national book of condolences has been established by Buckingham Palace and is available on the royal.uk website. Public guidance on the mourning period is available on the GOV.UK website.
  • work with organisations locally to ensure that changes will not adversely impact on the delivery of service in other organisations
  • follow national communication arrangements with regards to this event.

Providers, particularly in community and mental health, are required to:

  • be aware that some patients may be destabilised by the death of Queen Elizabeth II and require additional support

Integrated Care Boards and Commissioning Support Units are required to:

  • support organisations in their area and ensure service changes are appropriately overseen

See Appendix 1 for NHS organisation planning.

Please note any media enquiries which relate to the issuing of this letter should be redirected to NHS England. NHS England will continue to work with you, the Department of Health and Social Care, and other government departments and agencies to issue further advice and guidance as required.

We thank you and your organisations in advance for the above and for your leadership in ensuring we as the NHS provide a kind and sympathetic response to our patients and our colleagues who may be experiencing distress through this time.

Yours sincerely,

Sir David Sloman, Chief Operating Officer, NHS England.

Appendix 1

Items for NHS organisations to consider in their planning:

  • The organisation has considered if it will have a holding area for flowers and other items which may be left as a mark of respect during the mourning period. Plans consider when it is appropriate to remove items and how to dispose of them.
  • The organisation (if flying any flags) is aware of the national guidance on flag flying during the period leading up to the funeral. The organisation should have plans in place to meet these requirements. The national flag protocols can be found here: Flying flags in the United Kingdom.
  • Individual organisations will decide whether to include a book of condolence at in-patient/residential healthcare settings. A national book of condolences has been established by Buckingham Palace. Should an organisation choose this option, there should be plans in place to ensure that any on-site queues for signing books of condolences are managed effectively and adhere to any COVID-19 restrictions.
  • There may be an increase in self-presenters across acute settings/primary care/social care/mental health teams and third sector organisations because of the death. The organisation has a robust mechanism which will assess and refer patients as appropriate.
  • The passing of the Queen, as former Head of the Armed Forces, is of particular significance to the Armed Forces community and has the potential to trigger mental health issues within that community. Please ensure that you familiarise yourself with referral pathways to Op COURAGE: The Veterans Mental Health and Wellbeing Service, which is available across England for serving personnel due to the leave the military, reservists and veterans. Should individuals from the Armed Forces community present, you can refer them to Op COURAGE or they can contact the service to make an appointment.  For information on Op COURAGE and contact details, please visit www.nhs.uk/opcourage
  • The organisation should assess the impact of and plan to maintain services given the public holiday declared for the day of the funeral. This will likely result in the closure of schools and childcare and staff may require time off to mourn.
  • Primary care and NHS organisations may see increased levels of appointment no shows and/or cancellations, impacting on electives and clinics during the mourning period or funeral day. The organisation should monitor these DNAs and have a plan to recover any lost activity as a result.
  • The organisation should have a method of identifying overseas visitors, including foreign dignitaries and VIPS, and has plans to manage these patients, and ensure that those not entitled to free health care at the point of use are charged appropriately.
  • Mutual Aid requests from ambulance/NHS organisations and partner agencies (e.g. support to London) which may then reduce support in the area, especially to any local events which may be arranged at short notice in relation to the funerary arrangements.
  • Any simultaneous major events in the area and or impacts in neighbouring counties.
  • Any personal or direct links the deceased had with the local resilience forum areas e.g. local connections or cortege in the county etc.
  • Support to any local planned events (e.g. large service at a cathedral or a mass gathering at a large screen event) impact on ambulance and healthcare settings if the area is gridlocked. As well as, any associated risks that come with large crowds, conflict, and the health and wellbeing of mourners.
  • Other current incidents or large scaled planned events due to fall in period of mourning.