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8 Mar 2007 : Column 518WH—continued
Coroners experience various difficulties with autopsies or post-mortems. There are legal difficulties with the use of facilities outside their jurisdiction that need to be dealt with urgently. I have referred those issues to the Minister. Post-mortems might be actively sought by families who are anxious to be certain about the cause of death, but for many families they are a source of delay and additional distress. We recommended the abolition of the rule that the certifying doctor must
have seen the patient within the 14 days prior to their death, and we recommended consideration of the Scottish view-and-grant procedure for appropriate cases.
We have two to three times more post-mortems than other countries. Dame Janet Smith pointed out that many of them might be unnecessary as well as distressing. Some religious groups object to post- mortem examinations. Surely, there should be a strong case, such as the possibility of crime or neglect, to justify such intervention when it is against the wishes or convictions of the family and, probably, the deceased. The Luce review made recommendations along those lines, but the Government have not, as far as I know, settled their view on that.
Simon Hughes: This question derives from the same issue. One of the most distressing aspects of the sinking of the Marchioness was that, before the families knew anything about the treatment of the bodies of their dead relatives, hands had been chopped off. The first time that the families saw the bodies, they were bodies with no hands, despite no permission having been sought and no information having been given. Is it the view of my right hon. Friend and his Committee that, once death has occurred and the next of kin has been identified, requests should be made and agreement given at all stages in respect of any invasive or surgical procedures on any dead body?
Mr. Beith: That is my view. I do not recall the Committee discussing the matter in such detail, although I remember the circumstances to which my hon. Friend refers. He dealt closely with the families involved. Most families have sensitivities about this; some have very strong views and some religious groups have deep objections of principle. On occasion, those may have to be overridden, but that should not be done without consultation. The process must have consultation built into it. This comes back to the resources at the disposal of the coroner and the coroner’s officers, as well as the training that they receive.
I turn now to death certification, which was central to the Shipman cases. We felt strongly that the two areas of reform that I have mentioned must go together, and we referred to the evasive and vague answers from departmental witnesses on the matter. We criticised the tinkering at the edges of a system that has already been deemed unsafe and unsatisfactory by two Government-commissioned reviews. At last, we now have proposals. They appear to be a very significant improvement; but, as far as I know, no coroners were consulted on them. That does not bode well for the achievement of an integrated solution.
What is now proposed is that each national health service trust—whether a hospital trust or a primary care trust—would have its own medical examiner in the clinical governance team. In addition, all medical certificates of cause of death—MCCDs, which I referred to loosely, but incorrectly, as death certificates—would be subject to scrutiny by the examiner, who would also decide whether to refer the case to the coroner and would set out the reasons for doing so. Medical examiners would have full access to medical records.
The new proposal goes a long way to meeting the Shipman inquiry concerns except, perhaps, in one respect: it is not clear that the medical examiner would be seen as fully independent of the treating doctor. The trust employing the medical examiner would usually have been the trust that supplied the medical treatment. The same trust could have liability if negligence were proved. Families who think that treatment contributed to, or failed to prevent, avoidable death are likely to think that the trust’s doctors will close ranks.
Why not site the medical examiner in the coroner’s office, rather than have a perceived lack of independence, and a potential third stage in which the coroner’s medical adviser considers the medical examiner’s report into the certifying doctor’s certification of the cause of death? Nobody asked for a three-stage medical checking process, but that could be the cumbersome result of siting the medical examiner in the employing trust and not in the coroner’s office. I hope that both the Departments involved will look again at why the medical examiner is being located within the NHS structure. Tom Luce, whom I have consulted, shares my concern. That aside, the proposal seems to be a significant improvement. It needs to proceed alongside, and in step with, reform of the structure of the coroner’s system.
There is clearly a case for much closer co-ordination of coroners’ and registrars’ offices. We would not want a reduction in the local registrar’s office networks, which need to be located as close as possible to where bereaved people live. In centres where co-location is possible, that has significant advantages for families and for the efficiency of the service.
There are many other aspects of our report and of the Government’s proposals that time does not allow me to address. I merely mention in passing that the Government appear to accept our view that public inquests should remain the standard forum for those cases where an inquest is necessary. The charter for the bereaved is a good idea, but it will be of no use if gaps in the reform proposals mean that the expectations that it creates are not met.
Many coroners have great difficulty in getting the use of suitable courts for inquests. Apart from in those cities where a dedicated court in coroners’ offices is the best solution, the Court Service must recognise a responsibility to assist coroners in providing court space, and coroners’ needs should be considered whenever court closures are under consideration, because coroners are users of court premises. Some of those premises are being closed.
We also had concerns that the proposed appeals might overburden the system unless scope were provided and those who could undertake an appeal were more clearly defined. The Government are still considering their view on several issues, including the role of juries, deaths abroad and the legal status of coroner’s officers. I should like coroner’s officers to have a status conferred by statute in the Bill.
I conclude by asking the Government some questions. When will the revised Bill be published? Will it resolve the wide range of issues that the Committee and others have identified? What is the timetable for the remaining decisions? The coroners and death certification systems affect families at their most vulnerable moments when they have lost a loved one. I have experienced such situations extensively. We need
to get these hugely important matters right. My Committee and I, along with most coroners, still have serious concerns about gaps in the scheme, but we all want to see progress—surely it can be achieved. If the Minister brings forward a revised Bill to which all the key stakeholders can give their support, I think her chances of getting the Government’s business managers to give it the necessary parliamentary time will be much greater than they were the last time she tried.
2.56 pm
Dr. Alan Whitehead (Southampton, Test) (Lab): I, too, welcome the debate, and I concur with the right hon. Member for Berwick-upon-Tweed (Mr. Beith), who is Chair of the Constitutional Affairs Committee, about the need for a wide-ranging examination of how a draft Bill becomes a Bill and of the particular issues that need to be addressed when that happens.
The draft Bill made great strides forward in several areas, and I hope that the Committee’s report will be read on that basis. The Committee recognised the substantial nature of the changes proposed and how well thought out many of them were in terms of the situation that we face. As the right hon. Gentleman mentioned, it expressed a number of concerns about structural issues relating to those changes. I want to concentrate my remarks on one such area.
The Committee’s inquiry originally wanted to undertake pre-legislative scrutiny of the Bill, but, as has been set out in various documents, the publication date of the original draft Bill made that difficult. Instead, it concentrated on several aspects of the draft Bill, particularly the relationship of its proposals to the inquiries that had preceded it—the Shipman inquiry and the Luce review on death certification.
During the inquiry, a number of issues about the structure and accountability of the coroner service became apparent; in truth, they might not have been as apparent had the inquiry simply consisted of pre-legislative scrutiny. The late publication of the draft Bill perhaps did us a service, in that respect at least. I want to concentrate my remarks on those issues of structure and accountability.
The coroner service occupies a curious position in the structures of local government, central Government and the judiciary, as it always has. It is perhaps because the coronial system generally works well that it has not been much of a matter for attention hitherto. The Committee examined not whether coroners in their actions over the years had or had not been conscientious, professional and expeditious, but whether those conscientious, professional and generally expeditious proceedings needed elements adding to them in the light of what we know from the Shipman inquiry, and whether the coronial system could work in a better way both to expedite justice and, among other things, to take account of the interests and concerns of bereaved relatives. The draft Bill does much to address both those factors.
Coroners have life-time tenure of their position, as do judges. How they conduct their coroner’s court is up to them, but that is where the similarity with the judicial system ends. Coroners are appointed by local authorities, which is a relatively occasional process
without clear guidelines. It is undertaken by a panel that probably makes one appointment, and then goes on to other activities. The coroner’s officers are normally provided by the police authority. The accommodation for coroners’ courts may be provided by the local authority or the police authority, perhaps by both, and sometimes by neither. Those facts alone mean that the staffing, accommodation and capacity of coroners’ courts varies throughout the country.
Above all, the proceedings, except for informal arrangements, are effectively paid for by the local authority, but with no hold on the expenses to which they contribute—that is up to the coroner. Not only does the local authority have no say in the expenses that it underwrites, but those expenses may vary if, for example, the police authority decides that it no longer wants to underwrite the informal arrangements that have provided staff or accommodation. If that happens, an additional and unanticipated expense falls on the local authority. Conversely, the coroner has no hold over the expenses that the local authority provides because there is no direct relationship between the two. Likewise, the local authority has no hold over what the coroner does, or how effectively he or she does it. That is generally not an issue, but it can be, and there have recent instances when the ability of the coroner to undertake his or her duties has been called into question.
Mr. Kevan Jones: Does my hon. Friend agree that most elected councillors would be surprised to hear that they are in charge of the local coroner service?
Dr. Whitehead: I agree; that would be a great surprise. Most local authorities are unaware of what they provide, except when it comes to budget time and one or two lines turn up. That is the sort of relationship that exists.
Mr. Beith: A colleague discovered that he had that responsibility when he found himself having to appoint a coroner. He got into trouble with other councillors because he supported the appointment of someone who did not belong to the solicitors’ practice from which the county traditionally chose its coroner.
Dr. Whitehead: A number of issues arise in that instance, and another important point to bear in mind is that because such assistance is written into budgets in one or two lines, and, by and large, the level of assistance is not part of a statutory function, it is not entirely beyond the bounds of reason to speculate that if a local authority finds itself strapped for cash in its budget settlement, the eyes of the treasurer might alight on those lines when considering the budget. Again, because there is no formal arrangement, other than the general assumption that the local authority pays the coroner’s bills, there is not much that either side can do about it.
When a coroner’s ability to undertake their duties is called into question, it is not the local authority, as the court’s paymaster, that considers the matter—it is the Lord Chancellor. That problem arose in 2004, when the Teesside coroner, Michael Sheffield, was investigated by a judicial commission because there was concern about the huge backlog of cases that he
was presiding over—some 200, 49 of which had been outstanding for six months. Among other things, there were implications of great concern for relatives who awaited the results of inquests, a matter that was assiduously considered during the pre-legislative scrutiny of the draft Bill. The Lord Chancellor issued a severe reprimand, and that might have been that, but a group of local MPs called for the coroner to be sacked. Among them was my hon. and learned Friend the Member for Redcar (Vera Baird), before she became the distinguished Under-Secretary of State for Constitutional Affairs. She wrote to the Lord Chancellor expressing concern at the outcome and said:
“Being reprimanded has bounced off him and the situation is just as bad as it always was”.
In short, as the Select Committee report states:
“Coroners undertake their statutory function in a fragmented and localised system that has remained largely unchanged since the time of Queen Victoria.”
That Victorian status quo is not widely supported. Dame Janet Smith suggested in the third Shipman inquiry report that the coroner service should
“be administered nationally by an executive non-departmental public body associated with the Department of Constitutional Affairs.”
The Luce inquiry also concurred that the system should be based on consistently appointed and trained personnel to operate to national standards across the country.
When the Local Government Association gave evidence to the Committee, it was unhappy about the strange set of arrangements under which local government works in relation to coroners’ courts. It said that
“an independent legal function, accountable to the head of the judiciary yet funded through local taxation, sitting alongside a local authority’s democratic role is an outdated anomaly in a political environment where council leaders, supported by—
Ministers from the then Office of the Deputy Prime Minister—
“are calling for local people to be given more control of public services through devolution of power to communities.”
It expressed a preference for responsibility for coroners’ courts to be devolved to local authorities, and suggested they should either
“be brought fully into the judiciary as set out in the government’s 2004 position paper, or, become a fully integrated part of the local authority, working alongside other statutory agencies, accountable to the local strategic partnership.”
The Association of Chief Police Officers observed:
“It clearly does not make sense that police authorities employ and pay for staff when they have no influence on how these...staff are deployed”,
and favoured making the coroners service a local authority function.
The Committee said that although there were benefits to be obtained from a clear local authority connection, the establishment of a chief coroner, unified training and appointment arrangements, the need to match financial accountability and funding with organisational responsibility meant that a national service was desirable if all the other reforms were to work in the best way. It concluded:
“It is difficult to see how a Chief Coroner can function effectively as a force for standardisation without being part of a national service.”
In the light of what the LGA suggested, a fully integrated local authority service could undertake effectively a number of the roles of a national service, although in many ways it is hard to see exactly what that would produce as a benefit for the local authority if it was effectively operating as an accountable paymaster, but working on the basis of the sort of national accountability, training and organisational arrangements that the draft Bill envisages.
The Department for Constitutional Affairs has, to date, turned away from that powerful logic. It wants to retain the status quo, but at the same time it wants to create a partnership between the chief coroner and local authorities, which it suggests will ensure responsiveness to local circumstances and help to build strong local partnerships with other services, while at the same time providing national leadership and national standards. Those are admirable sentiments, but it is difficult to see how those partnerships could be well forged with the retention of current arrangements. I would go so far as to say that retention of the current arrangements overall is directly inimical to the achievement of the goals of national leadership and national standards to which the Government rightly aspire, notwithstanding the very good standards and good quality partnerships that exist in some parts of the country.
If the coroners’ courts system is to be given the fresh start and modern approach that the Bill promises, it seems odd for the edifice to remain unchanged and, as was described recently,
“fragmented, non-accountable, variable in its processes and its quality, ineffective in part, archaic in its statutory basis, and very much dependent on the good people working in, or resourcing it.”
That statement is a description of the current structure of the service by the Secretary of State in the foreword to the draft Bill.
To go so far in changing the responsiveness and effectiveness of the system, and yet to leave it clothed in administrative arrangements that substantially contribute to the difficulties that the service has encountered in the past, and which is loved by very few, seems, to mangle a phrase, a bridge not far enough. I hope that the Government will reconsider that when the Bill is brought to the House.
3.9 pm
Nia Griffith (Llanelli) (Lab): It gives me great pleasure to speak in the debate. I very much welcome the draft Bill and the draft charter for bereaved people who come into contact with the coroner service. Those who lose a family member or close friend are in a state of shock, but in addition to coping with the trauma of that loss, they must often also deal for the first time with procedures of which they have no personal experience and of which they know little. There are often also additional pressures, such as the media, the police and perhaps the need to sort out complicated personal business.
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