Examination of Witnesses (Questions 40-51)
RT HON
HARRIET HARMAN,
MP AND LORD
HUNT OF
KINGS HEATH,
OBE
8 MAY 2007
Q40 Chairman: A national court service
runs the courts system, thanks to a decision of the Government,
and that was a system which was, at least, broadly uniform around
the country before it was changed, in that there was a magistrates'
court for each area and that was a body responsible for managing
the courts system. In the case of the coroners' system there are
many differences from area to area as to who is providing the
money, on what basis officers such as coroners' officers are being
provided—whether they are seconded, lent or actually police
officers dealing with cases who also carry out the duties of coroners'
officers in the course of it. There is a very curious mismatch
here. Why is it not felt important to have the degree of common
ground, if you like, which was the reason for the creation of
a unified court service?
Ms Harman: The common ground is
the national framework that we are seeking to establish and that
we think can be moved towards with a Chief Coroner, with a charter
for bereaved relatives and with a national inspection system.
We think that will make the progress we need to see in terms of
improving all up to the level of the best.
Q41 Keith Vaz: Minister, you invented
the charter for bereaved people, did you? Was it your idea, the
charter for bereaved people?
Ms Harman: It had come from the
many organisations working with the bereaved. It had come, basically,
from the voluntary sector who my officials had been working with.
In a way you need a national framework. Some coroners themselves
have developed their own charter in their own local area with
their own local voluntary sector organisations. So we have been
really building on that. I think it is very, very important.
Q42 Keith Vaz: It is currently in
a draft stage; it is not an adopted charter.
Ms Harman: Yes; and it was in
the back of the Bill.
Q43 Keith Vaz: When do you think
you will have received your representations on it and decided
to have it as a proper charter rather than a draft?
Ms Harman: It goes with the Bill,
so it is a question of the legislative programme.
Q44 Keith Vaz: You do not think you
could publish it now as a charter on its own?
Ms Harman: It is something that
the shadow Chief Coroner could publish, as a shadow charter, and
it could be paving the way. So, yes, that is something that the
shadow Chief Coroner, were one to be appointed, could actually
do.
Q45 Keith Vaz: Do you think it, perhaps,
raises unrealistic expectations amongst the bereaved families
who will obviously want to bury their deceased bodies as quickly
as possible, bearing in mind that the overriding emphasis for
a coroner is to establish the cause of death? I am thinking, for
example, of groups like the Brethren Christian Fellowship—or
indeed the Muslim community, or the Jewish faith. They all want
to bury very quickly after death.
Ms Harman: Absolutely.
Q46 Keith Vaz: Do you think the expectations
are too high, because the coroner is under a duty to establish
cause of death, is he not—or she?
Ms Harman: The right way to go
about it is to put the focus on the bereaved and then give the
bereaved a right to complain, or appeal, if necessary, and if
they do complain or it is clear who they should be raising their
concerns with. Then the response might need to be, on some occasions:
"I am sorry we cannot release the body yet because we need
to have a further post-mortem"—perhaps for a criminal
case. There will be recognition that in some communities that
might be a very difficult thing to bear indeed, but at least it
provides a mechanism for the expectation to be there and the system
will respond, and if it is not able to do what the family wishes
then it will behove the system to actually explain why. I am always
against the idea that you should not raise expectations; I think
we should raise expectations and the system should be prepared
to respond to those expectations with sometimes saying: "No,
I cannot allow the body to be released" or "I cannot
refuse your request for a post-mortem, I am afraid it has got
to go ahead in the public interest, and this is why." Otherwise,
the expectations are there, it is just that they have got no focus
and they are not addressed. Then it is very dismaying for the
relatives. I think get it surfaced.
Q47 Keith Vaz: Presumably you would
only need to have a post-mortem examination when it is necessary,
so it is a question, also, of training the coroners to make sure
that they are only ordered in those circumstances.
Ms Harman: That is right. One
of the things that my colleague Lord Hunt and I were discussing
earlier was the fact that medical advice being available to the
coroner, I can anticipate, might sometimes give the coroner more
confidence to order that there is not a post-mortem because they
have been able to get medical advice which gives them a sense
of confidence that that is the order that they can make. That
will be a benefit from the medical advice available to coroners
at local level.
Q48 Keith Vaz: What about cultural
advice and the training of coroners in the different various religions?
Obviously, if you are a coroner in Leicester you will know that
the Muslim community will want to bury immediately; if you are
a coroner in North London, Golders Green, you will know the same
applies to the Jewish community. I do not know where the Brethren
of Christian Fellowship have their headquarters—I do not
know whether it is Berwick-upon-Tweed (because I know the Chairman
wrote a letter about this)—but how are we going to train
our coroners to understand the cultural sensitivities of different
communities?
Ms Harman: This will be a useful
role for the coronial advisory committee, which the Chief Coroner
will have. We know that there need to be bereaved relatives on
the coronial advisory committee, and I think faith groups with
particular concerns—it might be useful for them to be represented
there. You have mentioned the coroner for Leicester, there is
also the coroner for Birmingham, who has completely different
sitting hours from other coroners because of the need to respond
with earlier disposals, so that he starts at something like 8.30
in the morning and carries on sitting till late in the evening,
specifically because this is such a key issue. Being fully aware
of this and finding ways of responding to it will be something
for which, actually, the sharing of best practice through national
service will be very important. If you happen to be having a strong
religious belief which pertains to how you deal with the deceased
but you are not in an area of a high minority, black or Asian
minority, ethnic community you do not want to lose out just because
you happen to be a small minority. So that sort of information,
through the coronial advisory committee and through the Chief
Coroner, will be very important indeed.
Lord Hunt of Kings Heath: Can
I add to that, because, clearly, the question is relevant to the
responsibility of medical examiners in terms of some of the time
factors that relate to relatives from traditions who do want a
quick burial or cremation—if cremation is appropriate—and
we will be tackling that issue in the consultative paper and talking
to representatives of the communities you have mentioned. Clearly,
at the end of the day, you want the medical examiner service to
be as effective as possible but, also, to reflect the needs that
we have heard about.
Q49 Chairman: The Programme Board
that was carrying the legislation forward was suspended earlier
this year, we are told in the evidence submitted to us, and work
that continued relied on the stakeholder forum. Is that an adequate
mechanism to make sure the two departments work together? If not,
how are you ensuring that the two departments actually move forward
in addressing some of the concerns that we have expressed?
Ms Harman: The Department of Health
Programme Board is still existing on these post-Shipman issues,
and Department for Constitutional Affairs officials are represented
on that Board, which meets monthly. That is the connection which
is ongoing on a monthly basis anyway, so that work is under way.
Q50 Chairman: Have you not, really,
dodged two of the biggest issues (I do not mean in your evidence
today but in your general decisions about how to move forward):
the key issue about where the medical examiner is located and
the link between death registration and the coroners' work, on
the one hand, and the resource issue, on the other—the lack
of, still, with all your proposals, any clear and consistent system
for the resourcing of the coronial system? I am not saying it
has to be central but there is no clear and consistent pattern
by which the coroners' system would be resourced if all your proposals
are carried out. These are two central issues. Does it not look
as if, on both of them—in one case the two departments and
in the resources case, primarily the DCA—they have said:
"Oh dear, we can't really tackle this; we will have to make
do with something less"?
Ms Harman: We are not starting
off with an attempt to get uniformity of employer; we are trying
to get high standards in terms of investigating sudden, unexplained
or violent deaths in the public interest and we are trying to
get high standards for the bereaved. That has been my focus and
my department's focus. Where we are now compared with where we
will be with the bill, with a chief coroner, with a proper appointments
system, with legislation allowing there to be movement between
jurisdictions in order to avoid backlogs, with a charter, I think
all of those things in my mind when I am sitting at my desk and
I am seeing problems going wrong, those are the things I think
that we need. We need a chief coroner, we need a charter, we need
a complaints and appeals system, we need a proper appointments
system and that is my assessment from where I sit of the things
that need to happen as soon as.
Lord Hunt of Kings Heath: Can
I comment on the question of medical examiners? The work that
has been done on death certification has to be seen in the context
of our post Shipman work altogether which has been hugely important;
it has very wide ramifications, it includes drug safety, it includes
better complaints procedures, it includes stronger clinical governance
and it includes for the first time the re-licensing of doctors.
Traditionally, once the doctor had the certificate they could
carry on practising for years and years. We are now proposing
to introduce a system of re-licensing once every five years, that
will be based on annual appraisals based on strong clinical governance.
We do see strong advantages for the medical examiners to be placed
within that clinical governance process but providing a very effective
service to coroners. I understand the issue about immediate conflict
of interest, which we will deal with within the consultation paper
we will produce in June, but I would say I do think the huge advantage
of getting an absolutely direct relationship between medical examiners,
the coroner and the health service in terms of the wider lessons
to be learned: the epidemiological statistics will become available,
the issues around patterns of poor performance which hopefully
would lead to early intervention, all of these things in terms
of patient safety and quality are hugely important and basing
it within clinical governance teams within primary care trusts
gives us a huge advantage in that respect.
Q51 Chairman: We know that you cannot
tell us whether a Bill will be in the Queen's speech, it is not
within your power to do so, but is the Bill ready for you to formally
introduce it now?
Ms Harman: There are a number
of issues which still need to be sorted out, but I think it would
be a very good thing if it was in the forthcoming legislative
programme and I would not like to see the problems that are currently
in the system which we cannot sort out without legislation remaining
unaddressed.
Chairman: Thank you very much indeed.
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