"Reform of the death investigation process is long overdue. A national system of medical examiners was first proposed in 2005 following the Shipman Inquiry. As the lead medical royal college for medical examiners we have long campaigned for their introduction. The College welcomes the firm commitment from government to introduce the system by the end of this parliament. While the recent announcement that the planned implementation date of April 2018 has been delayed once again, to 2019, is disappointing, 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.
Seven medical examiner pilot sites in England and Wales have examined over 30,000 deaths. They found more timely and accurate referral to coroners for further investigation, improved accuracy of death certification and early detection of clinical governance issues such as infection outbreaks. Additional benefits included the establishment of a database of information collated from cases reviewed by medical examiners, which helped to audit patterns and trends of causes of death. Importantly, feedback from bereaved relatives was uniformly positive, with families appreciating the opportunity to ask questions and discuss concerns with an independent doctor at an early stage.
The College’s view is that no other patient safety initiative can provide these benefits in such a truly independent and universal way.
In 2016, the College convened a roundtable of key stakeholders who will be involved implementing the system. Among the issues discussed was the proposal to cover costs through the establishment of a fee to families of around £100 per death. While central funding was the preferred mechanism, overall participants felt implementation on the basis of a fee would be preferable to failure to implement the reform at all.
We understand concerns about the fee, both from those paying it and the local authorities who will be responsible for collecting it. It is important to recognise that for the majority of people, the new charge will represent a considerable saving compared to the existing cremation form fees. In our opinion, the medical examiner fee will represent much better value for money than cremation form fees, with potential benefits to families, improvements in patient safety and more accurate statistics on which to base health policy priorities.
Any delay in implementation delays these benefits and is regrettable. Several of the pilot sites have continued to deliver a medical examiner service, and other trusts have partially adopted the system, often funded by cremation form fees. Some of the benefits are therefore being realised despite the delays. The College is keen to start recruiting and training medical examiners and will draw heavily on the experience of the pilot sites to ensure that the transition goes smoothly and is a success."
30 March 2017
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