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Coroners: Terminally Ill Patients

Volume 721: debated on Wednesday 3 November 2010


Asked By

To ask Her Majesty’s Government what steps they plan to take to decrease the variation in coroners’ responses to the anticipated deaths of terminally ill patients at home.

My Lords, the Government are committed to improving the coroner system. In taking forward the changes outlined in my Written Statement of 14 October, we shall be considering the secondary legislation and guidance which governs coroner investigations. The issue that the noble Baroness raises will be included as part of that work.

I thank the Minister for that reply, but how will the Government detect, evaluate and deal with the poor performance of a coroner without the long awaited chief coroner? Quite specifically, what powers are in place to influence Greater Manchester’s coroners’ anomalous ruling that the expected deaths of terminally ill patients at home must be referred to the police if the GP is unavailable to write the death certificate, tying up between 4,000 and 8,000 hours of police time annually, and causing unnecessary distress to families who have complied with the patient’s wishes to be cared for and die at home?

My Lords, as the noble Baroness will be aware, the coroners’ service is under local jurisdiction and the protocol established in Manchester is something that has been decided between the coroner’s office and the police in Manchester. It does give us concern and the department intends to issue guidance under its new powers which we hope will smooth out some of the variants in how coroners apply their powers. This is one of those that will be looked at.

The Minister will know that the director of the Royal British Legion, no less, has said that the Government’s decision to scrap the new post of chief coroner is a deep betrayal of bereaved service families. Does he agree that during the passage of the Coroners and Justice Bill all sides of this House were as one in believing that not only was the reform of the coronial system an urgent necessity but also that the establishment of a chief coroner, along side a chief medical officer, with powers to set national standards, to lead, and to hear the new system of appeals, was at the heart of the reforms? Why have the Government taken the absurd and counterproductive step which, in the words of the co-director of INQUEST, renders the new model “completely hollow” before it has even started, and a step that has, moreover, managed so deeply to upset bereaved service families and the Royal British Legion?

My Lords, I am sorry that the Royal British Legion has made that judgment. The decision not to go ahead with the chief coroner was made, as the noble Lord knows, mainly on financial grounds. The setting up of the post would have been expensive. The alternative that was put forward in my Written Statement is that we are going to take much of what was in the legislation in-house in the Ministry of Justice and do the tasks ourselves. I am well aware that in so doing we set ourselves a pretty important task because, as the noble Lord rightly said, when the Coroners and Justice Bill was going through this House all sides wanted to see an improvement in consistency in the coroners’ service. That is what we intend to do in-house and we will be judged on our performance.

Can the Minister tell me how lawyer coroners—I understand that most will be legally qualified but they will no longer be obliged to be medically qualified—will obtain assurance of the standards of the post-mortems that they commission?

I understand that my noble friend in the Department of Health will be establishing the post of medical examiner. Medical examiners will be able to give this advice.

Does the Minister accept that very rarely at the time of a coroner’s post-mortem is permission sought for the retention of tissue samples and slides after the post-mortem? Such archive material is invaluable for research into human genetics and into the management of human disease. Will the Minister ensure that coroners are advised to seek such permission when coroners’ post-mortems are undertaken or at least consider amending the Human Tissue Act to make such retention of material obligatory?

My Lords, as I said in my initial reply, my department is looking at comprehensive guidance to coroners. I note what the noble Lord has suggested, and I will make sure that that is considered as part of the guidance.

My Lords, will this review include some clarification on what is admissible as evidence in an inquest? I am aware of a very unfortunate case of a death where there had been a settlement and admission of responsibility, but the coroner would not allow evidence to that effect to be given.

My Lords, I note what the noble Lord asks. I think I will have to take legal advice about how we should respond to that matter. I know that in looking at this review and at our powers, we are in contact with the Lord Chief Justice.

My Lords, I declare an interest as having been, a long time past, a coroner’s officer and having occasionally deputised for a coroner. I ask the Government to be very careful not to trench upon the independence of coroners who are judicial officers. All the advice and the rest of it that is being recommended should have respect for that crucial independence.

I do not think there is any question of us trampling on the independence of coroners. What slightly surprised me when coming to this and looking at the file is the wide variation in the behaviour of coroners, which is not likely to produce public confidence. That was one of the reasons why the idea of a chief coroner was put forward. As I explained at the beginning of this exchange, when we looked at it, it proved to be too expensive, but the bulk of the suggestions and of the content of that Act will now be brought in-house. Judge us by what we do. We will follow the guidance of the Act in bringing consistency to the coroner system, but not on the basis of a rather expensive, at this stage in our careers, chief coroner.