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Medical Examiners and Death Certification

Volume 785: debated on Wednesday 18 October 2017


Asked by

To ask Her Majesty's Government when they expect to report the outcome of the consultation on the introduction of medical examiners and reforms to death certification launched in March 2016; and whether they still intend to introduce those reforms in 2018.

My Lords, since the election the Secretary of State for Health has reaffirmed his commitment to introduce medical examiners to provide a system of effective medical scrutiny applicable to all deaths that do not require a coroner’s investigation. The Government’s response to the consultation will be published shortly and the system will be introduced no later than April 2019. Pilot sites are already offering the bereaved an opportunity to raise concerns while improving patient safety through mortality data.

My Lords, I thank the Minister for that reply. While welcoming the Government’s commitment to introduce the medical examiners scheme by April 2019, the president of the Royal College of Pathologists said in March that,

“it is vital to ensure that implementation is properly planned. There is still much work to be done in adapting the current system and recruiting and training medical examiners and officers”.

Given all the delay to which the introduction of the scheme has been subject already, are the Government satisfied that it will be ready in time?

The noble Lord is quite right to highlight this point. There have been calls for medical examiners since the Shipman inquiry; those were also endorsed following the inquiry into Mid-Staffordshire. Our intention is to ensure that, with planning time, the system can be introduced by April 2019, which is why the consultation and the regulations needed to underpin the planning for the system will be produced in short order.

My Lords, I chaired a foundation trust where we trialled the medical examiner role. I commend to the House the value of having a senior consultant able to talk to relatives about concerns, drawing the attention of fellow clinicians to issues relating to practice but, above all, safeguarding the public against tragic and appalling actions such as those taken by Harold Shipman. Does the Minister expect every part of the NHS to be covered by medical examiners by April 2019, or is that the start of the rollout? I hope that it can be extended throughout the NHS by that date.

The noble Lord is quite right to highlight the pilots; indeed, early adopters have followed in their wake and have provided a much better service. The intention from April 2019 is for the service to cover the entire country, but it is most likely to start in secondary care and then move out into primary and community care.

Changes to death certification are welcome and will impact on bereaved families. How were the general public involved in the consultation?

I think I missed the critical word in the noble Baroness’s question. Did she ask whether the public were involved?

In 2009, a certain amount of work was done on how we would handle mass deaths should they occur because of some crisis or emergency. Does any of the current work affect that? Does that work still stand, so that we can handle such events properly?

I think that the difference here is between handling mass deaths, which would obviously be an emergency situation—so we are talking about contingency and resilience planning—and looking at all deaths. About half a million people die each year. At the moment, only those who go through coroners receive that additional level of investigation, except in those pilot sites and early adopter areas that I mentioned. The new arrangements are about making sure that there is a system of verifying deaths from normal causes.

My Lords, when considering these issues will the Minister look at the proposal made by bereaved parents and raised by the chief coroner in his report in 2016 that there should be coroners’ investigations of cases of stillbirth, so that the causes of stillbirths could be better understood and such tragedies could be averted in the future?

The noble Baroness is quite right to highlight this point. Medical examiners are not involved in stillbirths, because the cause of death is before the point of birth. However, there is clearly a need for the involvement of coroners. I will look into the detail of that. I can tell the noble Baroness that the Government are taking the issue of stillbirths seriously. A new perinatal mortality review tool is looking at that and it is integrated into the learning from deaths scheme now going on in the NHS.

My Lords, this is a very welcome initiative, but in view of the incredible shortage of medical staff in the NHS, is the Minister confident that there are sufficient staff to cover it? Are the Government looking at other ways of making staff available—for example, people may be brought back from retirement—to handle it in the initial years?

That is a very good question because we are talking about a greater workload. The pilots and the early adopters have demonstrated that it is possible to do this with existing staff loads. As it is rolled out across the country, there may be a need for additional staff. I reassure the noble Lord, and indeed others including bereaved families, that any staff who are used will be registered practitioners and would be regulated by the GMC.