Evidence submitted by the British Medical
Association (BMA)
I am writing on behalf of the British Medical
Association with regard to the Inquiry being conducted by the
Constitutional Affairs Committee into the reform of the coroners'
system and death certification in England and Wales.
The BMA is a voluntary, professional association
representing doctors of all branches of medicine across the UK.
Our current membership of over 134,000 includes over 16,500 medical
students and nearly 4,000 overseas members. We are also an independent
trade union and have represented doctors in negotiations since
the beginning of the NHS in 1948. Therefore the BMA have a direct
interest in the coroner reform process and hope that this response
will be considered as being representative of the medical profession
as a whole. The purpose of this submission is to outline the position
of the Association on coroner reform.
The BMA welcomed the opportunity to comment
on the 2003 Home Office position paper, which constituted the
Government's response to the Fundamental Review of Death Certification
and Coroner Services (undertaken by Tom Luce) and the third report
of the Shipman Inquiry. In the response to the Home Office position
paper it was noted that the BMA had been calling for reform of
the death certification system since the Brodrick Report of 1971.
We agreed with the statement in the position paper that "Shipman's
activities, which went undetected for years, highlighted the weaknesses
in the death certification system". The Association broadly
supported the key proposals for change listed in the position
paper, but we emphasised that no system could ever provide complete
protection against those intent on covering up criminal activity.
We believe the medical examiner role previously
proposed in the Home Office position paper has merits; in particular,
there is a need to bring together currently fragmented functions
into a single organisational structure with clear accountabilities,
to provide training and support in the certification process,
and to encourage the assessment and audit of the certification
processes. Our main reservations about the proposed medical examiner
service are whether the medical profession could provide enough
suitably qualified candidates for the full time medical examiner
role, given current medical workforce shortages, and whether the
service would provide an attractive career for doctors.
More fundamentally, we cannot see how a reformed
structure could operate successfully without significant additional
resources. We agree that any new system must be affordable and
properly costed, but we do not believe it will be possible to
introduce significant changes to the coroner and death certification
service on a resource neutral basis. The Association supports
the Government's aim to provide a unified, coherent system of
death registration and investigation. We believe that there should
be a common approach whether death occurs in Hospital or in the
community. It is hoped that the new legislation being planned
by the Government will provide one seamless, accessible service,
very much as we had hoped and in part proposed.
The Association feels the Government should
explain its assumption that the service improvements in the coroner
system can be delivered within current cost envelopes. One key
objective of the new service is to improve detection of unnatural
deaths. However this is likely to require consultant level expertise
more often than previously, and hence have significant cost implications.
I recently met with officials from the DCA Coroners
Division and we continue to maintain a constructive dialogue with
this unit who are taking forward the coroner reform process. The
BMA acknowledges the circumstances that have led to a delay in
the reform process but would also wish to note the strong desire
of the medical profession for progress. The current coroner and
death certification system is no longer fit for purpose and doctors
are increasingly bringing to our attention the difficulties with
the uncertainty and delay in the reform process.
If the practical issues can be resolved then
the reforms outlined previously by the Government could indeed
deliver a world class coroner and death certification system.
The position of the BMA on coroner reform was
clearly laid out in the detailed response by the BMA to the Home
Office position paper issued in March 2004. There have been no
substantial developments on coroner reform since the Home Office
position paper was originally issued and the BMA response submitted.
Therefore I would ask you to consider the original BMA response
attached (not printed) which outlines our views of the
current problems with the existing system and our responses to
the existing proposals for reform.
Dr George Fernie
Chairman
BMA Forensic Medicine Committee
February 2006
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