Health and Care Bill: medical examiners
Updated 10 March 2022
© Crown copyright 2022
This publication is licensed under the terms of the Open Government Licence v3.0 except where otherwise stated. To view this licence, visit nationalarchives.gov.uk/doc/open-government-licence/version/3 or write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email: psi@nationalarchives.gov.uk.
Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned.
This publication is available at https://www.gov.uk/government/publications/health-and-care-bill-factsheets/health-and-care-bill-medical-examiners
Dame Janet Smith, in the Shipman Inquiry third report 2003, said:
The fact that the system of death certification of the cause of death depends on a single doctor does not give rise only to the risk of concealment of crime or other wrongdoing by that doctor. There may be occasions when a doctor knows that a death may have been caused or contributed to by some misconduct, lack of care or medical error on the part of a professional colleague.
This fact sheet explains how the government plans to amend the Coroners and Justice Act 2009 in England to include a power for English NHS bodies to appoint medical examiners instead of local authorities, and to Welsh NHS bodies rather than only local health boards in Wales. Medical examiners will introduce an additional level of scrutiny to those deaths not reviewed by a coroner, improve engagement with the bereaved in the process of death certification and offer them an opportunity to raise any concerns as well as improving the quality and accuracy of Medical Certificate of Cause of Death.
Background
The death certification system in England and Wales is overdue for reform, it has remained largely unchanged for over 50 years. It has been an ambition of successive governments to introduce a robust system in England and Wales whereby all deaths would be subject to scrutiny either by a medical examiner or a coroner.
Recommendations of numerous inquiries from Shipman Inquiry third report 2003, report of the Mid Staffordshire NHS Foundation Trust Public Inquiry - Vol 2 - 2013, Morecambe Bay Investigation 2015 to more recently learning from Gosport 2018 have called for strengthening of safeguards for the public by providing additional independent scrutiny of the medical circumstances and cause of deaths.
The medical examiner system will introduce a level of independent scrutiny of the cause of death by the medical practitioner, improving the quality and accuracy of the medical certificate of cause of death and thereby informing the national data on mortality and patient safety. The medical examiner system will increase transparency and offer the bereaved the opportunity to raise concerns, providing new levels of scrutiny to help deter criminal activity and poor practice. Currently, the system for burials does not include scrutiny of the medical certificate of cause of death. After the medical examiner system has been introduced, all non-coronial deaths will be scrutinised by a medical examiner, for both burials and cremations, thus bringing the system onto an equal footing.
The introduction of a non-statutory medical examiner system began in April 2019 and medical examiner offices are now established in NHS trusts where required.
What the bill will do
The Coroners and Justice Act 2009 sets out the statutory system for medical examiners. The Health and Social Care Act 2012 transferred responsibility for appointing medical examiners from Primary Care Trusts to local authorities in England and local health boards in Wales. The relevant provisions in the Coroners and Justice Act 2009 have never been commenced.
The Health and Care Bill will amend the Coroners and Justice Act 2009 to allow NHS bodies to appoint medical examiners instead of local authorities doing so, and to Welsh NHS bodies rather than only local health boards in Wales. Not every NHS body will need to appoint its own medical examiner, so the Bill does not confer a duty on them to do so.
The Secretary of State and Welsh Ministers will have a duty to ensure there is a sufficient number of medical examiners, and that they are adequately funded and monitored. The Secretary of State will have the power to issue directions. Welsh Ministers have already been granted the power to direct Welsh NHS Bodies in the NHS (Wales) Act 2006.
How these provisions help improve public confidence
Once fully in place, we want to ensure that the cause of every non-coronial death in England and Wales is independently scrutinised by a medical examiner. The medical examiner system will improve the accuracy of the cause of death information, informing mortality statistics and public health policy. The medical examiner system will increase transparency for the bereaved and help identify and deter criminal activity and poor practice.