Death certification reforms update: newsletter issue 2

Death certification reform (DCR): a case study on the potential impact on mortality statistics, England and Wales.


death certification reform: a case study on the potential impact on mortality statistics, England and Wales

Request an accessible format.
If you use assistive technology (such as a screen reader) and need a version of this document in a more accessible format, please email Please tell us what format you need. It will help us if you say what assistive technology you use.


There have been a number of important developments to share with you since the last newsletter.

  • the Francis Inquiry report was published on 6 February.  The report makes a number of recommendations to strengthen death certification (273-285) in chapter 14 ‘Certification and inquests relating to hospital deaths. The report can be downloaded at
  • the death certification programme has set up an implementation programme board to oversee the implementation of the reforms to the death certification system and to ensure that the Department of Health (DH) and other parties take the necessary steps for delivery in April 2014. The board will meet every other month with the first meeting scheduled for 28 February.
  • a Medical Certificate of Cause of Death (MCCD) working group has been established to advise DH on developing new guidance for attending practitioners and medical examiners on proper completion of MCCDs in advance of the implementation date for death certification reforms. The first meeting of the working group is due to take place on 20 February.
  • the National Death Certification Steering Group has changed status and has been renamed the Death Certification Reference Group. The reference group will meet bi-annually. Meetings are being arranged for June and October.

Revised date for launch of consultation

Publication of the consultation has been delayed further while work on the impact assessment is finalised. We hope to publish before the Easter break.

The consultation will be available on the DH website and will be open to everyone to respond.

Local medical examiner posts

In recent weeks, we have received a steady stream of enquiries asking when and how to apply for local medical examiner positions.

At the point of full implementation of the death certification reforms, April 2014, responsibility for appointing medical examiners will sit with local authorities.

The arrangements for recruiting and training medical examiners have yet to be agreed, but local authorities will publicise and commence this process well in advance of implementation.

Update on the proposed death certification reforms in Scotland

Our colleagues and stakeholders in Scotland are now officially working towards the full national implementation of their death certification system in April 2014.  With their 2 test sites now drawing to a close, the activities between now and launch will include technical consultation, secondary legislation and various strands of practical implementation work, utilising lessons learned from the test sites.

Death certification reform: case study

A case study on the potential impact on mortality statistics, England and Wales - attached.

In November 2012, the Office for National Statistics (ONS) published a case study looking at the potential impact of medical examiner scrutiny on mortality statistics. Data was collected from five pilot areas Sheffield, Gloucestershire, Powys, Mid Essex and Brighton and Hove. The case study analysed just over 5000 records comparing the cause of death proposed by the certifier and the cause confirmed by a medical examiner after scrutiny.

The main findings are:

  • in 78% of cases the underlying cause of death remained unchanged
  • the broad underlying cause of death (as defined by the International Classification of Diseases)  changed after medical examiner scrutiny in 12% of cases
  • in the remaining 10% of cases the underlying cause changed but remained in the same International Classification of Disease chapter
  • following scrutiny by the medical examiner, there were 1% more death certificates with an underlying cause of cancer (neoplasm), and an increase of 6% in the proportion that were attributed to diseases of the circulatory system
  • the percentage of deaths attributed to a respiratory disease underlying cause decreased by 7% after medical examiner scrutiny
  • in general, more conditions were mentioned on the death certificate as a result of scrutiny by medical examiners.

Although the case study had limitations in that the pilot areas were not a statistically representative sample of deaths that occur in England and Wales and the results are not statistically comparable across the study sample, the results of the study suggest that the introduction of the medical examiner scrutiny of all medial practitioner certified deaths will impact on mortality statistics.

Medical examiner scrutiny can change the number, sequence and type of conditions mentioned on the medical certificate of cause of death. This suggests that medical examiners’ analysis of the information relating to the cause of death, obtained both from the medical notes and in discussion with relatives, results in better understanding of the sequence of conditions that led to the death. If the conditions and sequence are recorded more fully, this may lead to a change in the underlying cause of death. The results of this case study indicate that the medical examiner scrutiny is likely to affect trends in causes of death reported in mortality statistics.

The statistical bulletin, further tables and the dataset are available from the ONS website.

ONS would like to thank the pilot areas for all their help in collating the data used in the case study.

What’s next?

The Ministry of Justice (MoJ) will shortly be consulting on the implementation reforms in Part 1 of the Coroners and Justice Act 2009 that will help to ensure a more efficient and more transparent system of coroner investigations and inquests that better meets the needs of bereaved people.

The consultation will seek views on main elements of the new framework including new coroner regulations governing the investigation process, rules governing the practice and procedure at inquests and new regulations about allowances, fees and expenses in connection with investigations and inquests.

We have been working closely with the MoJ to ensure that the death certification regime can be implemented effectively alongside the coroner reforms and we would therefore recommend that the two consultations be considered alongside each other.

Further information

Further information on the death certification programme can be obtained from the DH website.

Published 22 February 2013