Reforms to the coroners' system

Coroners and Justice Bill – new role of medical examiners

The Coroners and Justice Bill proposes much-needed reforms to the coroners system and creates the new role of medical examiners. This important role will ensure independent scrutiny and confirmation of medical certificates of the cause of death (MCCDs) and provide general medical advice to the coroner.

We frequently advise and represent doctors called to give evidence at inquests and, like many other organisations, believe the coroners’ system is ripe for reform. As we have waited so long for the reforms, it will be important to use the opportunity to get the systems absolutely right.

However, although we welcome the new medical examiner role, we have the following concerns:

• Appointment
  
  The Bill currently gives Primary Care Trusts (PCTs) in England and Local Health Boards (LHBs) in Wales the power to appoint medical examiners. We would like to see more detail about the envisaged appointment process. We question the justification for giving the responsibility of appointment to these local bodies, as this means that medical examiners will not be independent from the local health service.
  
  As such, we support amendments that would give the Chief Coroner in consultation with PCTs and LHBs the power to appoint medical examiners. Centrally appointing medical examiners would ensure that there is consistency in process and criteria, and that local bodies do not compromise the independence of medical examiners’ work. 
  
  
• Training and standards
  
  We would like to see greater detail about the criteria for eligibility to the appointment of medical examiner. It will be particularly important to see details of the training and support that will be available to these medical examiners, in order to ensure that doctors with the right skills, experience and background are attracted to this important role. Therefore we endorse amendments that seek to specify in regulations the type of training that medical examiners will need to have and that require the National Medical Adviser, in consultation with the Chief Coroner, to set out minimum standards for the service provided by medical examiners. 
  
  
• Clinical governance
  
  Although the Department of Health has indicated that medical examiners will forge close links with clinical governance teams to establish whether the patterns or clusters of deaths give any cause for concern, this is not reflected in the current provisions of the Bill. We strongly support the amendment, tabled by Lord Colwyn, that places a requirement on the face of the Bill for medical examiners to relate to clinical governance teams in PCTs and LHBs, as this would send a strong message to the public that lessons from the Harold Shipman case have been learned.
  
  It would also show an absolute commitment by everyone involved in this area that problems will be identified and lessons learned from deaths where that is possible.

We will be closely following the final stages of the Bill as it passes through the House. We particularly welcome the proposals for greater involvement of bereaved families in the system and also hope the reforms will improve the process for healthcare professionals and others who frequently contribute to investigations.

Key issues

• The Chief Coroner, in consultation with PCTs and LHBs, should have the power to appoint medical examiners, to ensure the independence of medical examiners.
• We would like to see detailed regulations setting out training requirements and minimum standards for the service provided by medical examiners. 
• There should be a requirement on the face of the Bill for medical examiners to relate to clinical governance teams in PCTs and LHBs.