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Introduction of medical examiners and reforms to death certification in England & Wales

22 June 2018

Following a consultation in 2016 regarding the above, the Department of Health and Social Care (DHSC) has published its response. The DHSC has confirmed that it is committed to introducing a system of medical examiners in England, as well as reforming the death certification process in England & Wales.

The Government will amend the Coroners and Justice Act 2009 to put the medical examiner system on a statutory footing and will consider further legislative requirements post-April 2019; the latter being when the medical examiner scheme is introduced.

Medical examiners will be employed within the NHS system, although lines of accountability are separate from NHS acute trusts, but will be allowed access to sensitive information in order for them to perform their functions.

The proposed regulations will require a doctor’s certification of cause of death to be scrutinised and confirmed by an independent medical examiner, taking into account concerns raised by the bereaved, and could cover the care the deceased received prior to death. Registration of the death will only be permitted once the death has been scrutinised by a medical examiner or a coroner. 

The funding of medical examiners will be in two parts whilst legislation is in progress.

Initially, medical examiners will be funded through the existing fee for completing medical cremation forms, in combination with central government funding for medical examiner work not covered by those fees. Following this interim period, when parliamentary time allows, funding of the system will be placed on a statutory footing and will be revisited. In addition, the Government proposes that all child deaths (up to the age of 18) will be exempt from the costs associated with the medical examiner system. Further details are awaited in order to understand the impact upon the NHS and practical implications.

The DHSC states that the key aims for the introduction of medical examiners are to:

  • introduce a system of effective medical scrutiny applicable to all non-coronial deaths
  • enable medical examiners to report matters of a clinical governance nature to support local learning and changes to practice and procedures
  • provide information on public health surveillance (as requested by directors of public health)
  • increase transparency for the bereaved and offer them an opportunity to raise any concerns
  • improve the quality and accuracy of medical certificates of cause of death
  • link the introduction of medical examiners with enhancements to related systems, especially data on avoidable mortality, generated from the Learning from Deaths programme.

The medical examiner system is being piloted in Gloucester and Sheffield. According to the DHSC it has demonstrated that a medical examiner system can work in a range of settings.

The DHSC has stated that Sections 18 and 21 of the Coroners and Justice Act 2009 will be implemented to provide the appointment of a National Medical Examiner and a power to introduce regulations that will require medical practitioners to report deaths to the coroner which the coroner has a duty to investigate.

It is unclear as to whether this proposed system will result in more inquests i.e. the greater scrutiny of deaths resulting in more referrals to coroners? We will monitor the situation as it unfolds.

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The content on this page is provided for the purposes of general interest and information. It contains only brief summaries of aspects of the subject matter and does not provide comprehensive statements of the law. It does not constitute legal advice and does not provide a substitute for it.

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