Examination of Witnesses (Questions 200-209)
DR GINA
RADFORD
20 JUNE 2006
Q200 Chairman: What about individual
doctors where randomly one might pick out the previous half-dozen
death certificates to see whether or not they appear to be competently
done?
Dr Radford: We are looking at
a number of mechanisms whereby we can quality assure death certificates.
Whether it be a small proportion of them and in what way we can
do that is one of the issues at which we are looking very closely.
As you may be aware, some GP practices already regularly monitor
sudden and unexpected deaths and that would also include what
was ultimately put on the death certificates. Therefore, they
audit their own practice both in terms of clinical care and what
then happened in terms of handling the death, which includes death
certification. There are already models out there which we are
looking at.
Q201 Chairman: There has been talk
about the statistical value of death certificates and the work
of coroners as well as inquest verdicts. Is that not a case for
investment from the health side in the system because it is one
of the ways in which you have information that you must have to
plan your other decisions properly? Is it viewed in that light?
Dr Radford: We are very clear
that the information from death certificates is very important
across a number of fronts: first, on the epidemiological side
which helps us better to understand the patterns of diseases in
populations and changes over time. It also helps to plan health
services and look at the success or otherwise of intervention.
We are fully aware of the importance of information that accrues
from death certificates and, therefore, the importance of the
accuracy of those death certificates.
Q202 Chairman: Turning to a more
specific problem, where a coroner believes that action should
be taken as a result of what he has discovered and the verdict
he has reached he may report that matter to a person who has power
to take action. Under the Bill he can also report the matter to
the chief coroner. Is that enough from the public health and safety
point of view?
Dr Radford: I would hope that
we would be able to agree some consistent ways of working around
reporting concerns in terms of preventable issues or issues that
need to be further pursued. It is very important that there is
consistency so we are quite clear about what that actually means
in practice and to whom those sorts of concerns may be reported.
I believe that that will be important for the chief coroner together
with the chief medical adviser working with the appropriate organisations
or individuals who may be the recipients of any concerns to agree
some common practices.
Q203 Chairman: As a department have
you given any thought to the implication of that part of the Bill
which is about providing medical advice to coroners? It is quite
understandable that the chief medical adviser should advise the
chief coroner, but lower down the system it is not clear at this
stage where the medical advice to local coroners purchased on
an ad hoc basis will come from. Presumably, the Department would
have to be involved in discussions about that, and at the very
least it would draw on its resources within the hospital and general
practice services. The Department must have views on whether this
advice can be provided and how it can be made consistent.
Dr Radford: I think we need to
be very clear with the DCA what sort of functionality it is expecting
the local medical support to provide. We need to be very clear,
therefore, about the sorts of skills required to support that
function. Those discussions are ongoing.
Q204 Chairman: The Department is
involved in trying to develop that?
Dr Radford: Yes, because it will
be important. From previous conversations with the BMA and so
on, we need to be clear about the skills required and, therefore,
the manpower, and also that whatever medical presence is provided
can feed into the health and healthcare system.
Q205 Jessica Morden: The coroner's
officer is the interface between the coroner and reporting doctor
and therefore is in a good position to identify any wrongdoing
on the part of the reporting doctor. Would the Department look
at or offer medical training for them as a group?
Dr Radford: I think we need to
be clear about what we see as the role of the coroner's officer
and how that sits with the new medical advice that is proposed
at a local level. At this stage we are not thinking of significant
medical training for the coroner's officers, but that is something
about which we would be happy to have further discussions. I think
it would need to be very clear as to what the purpose of that
medical training or input might be and what it might look like,
because we need to be clear that coroners' officers have certain
functions. What particular skills or knowledge do we believe they
may be missing that would need to be augmented? We need to be
very clear about what issue we are trying to address and what
skills or knowledge we are trying to give them or strengthen before
we embark on medical training that may not be appropriate or properly
targeted.
Q206 Chairman: Do you recognise that
not many people outside the system, not even everybody within
it, realise the range of activities of a coroner's officer, varying
as it does between different jurisdictions?
Dr Radford: Absolutely.
Q207 Julie Morgan: There has been
criticism about the high autopsy rates in England and Wales. Some
have said that unnecessary autopsies are held, with consequential
distress to relatives. Is this caused by the precision required
by the medical certificate of cause of death?
Dr Radford: I think you have just
heard some very good and valuable opinions as to why that may
be. The honest truth is that we have only opinions, not necessarily
hard factual evidence as to why that may be. As to why that may
be, my opinion would be no better than anyone else's. That may
well be a contributory factor, but I cannot give you a better
answer than my previous colleagues.
Q208 Julie Morgan: Given the concerns
expressed about the quality of some post-mortem examinations,
is the Department taking any steps to address this? In particular,
how does it plan to address the shortage of pathologists?
Dr Radford: We have been aware
for some time of the shortage of pathologists and share the concern
expressed earlier. We have invested several million pounds in
increasing the number of training posts of pathology and recruited
quite a considerable number of people into new training posts
to increase the sheer numbers and capacity within pathology, but
clearly that will take a short time to work through the system
so we have people who are then qualified to operate at consultant
level. At the moment those people are going through the system.
There has been significant investment to improve the numbers in
training, because this was not a popular specialty some years
ago and we ran into a shortage to which previous colleagues have
alluded.
Q209 Julie Morgan: Therefore, you
believe that in future there will be enough?
Dr Radford: We are certainly trying
to address the shortfall as we see it.
Chairman: Thank you very much. We are
very grateful for your help this afternoon.
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