Select Committee on Constitution Minutes of Evidence


Joint memorandum submitted by the Department for Constitutional Affairs (DCA) and the Department of Health (DH)

  This paper responds to the Constitutional Affairs Select Committee's request for supplementary information following their inquiry in to coroners and death certification during 2006.

SECTION 1: BACKGROUND

  1.1 The Government's reform of the coroner system is underpinned by three main aims:

    —  An improved service for bereaved people and others who interact with the system;

    —  The introduction of national leadership and improvements to enhance the local nature of the system; and

    —  More effective coroners' investigations.

  1.2 Specific changes to meet these aims are:

    —  Charter for the Bereaved, setting out services coroners will provide and a new appeals system.

    —  Leadership from a new Chief Coroner, including the introduction of new national standards.

    —  Introduction of new independent coronial advisory council.

    —  Improved medical expertise from a Chief Medical Adviser to the Chief Coroner, and grants to coroners to buy in appropriate medical advice in their areas.

    —  Guidance for medical professionals setting out the types or characteristics of cases which should be reported to the coroner.

    —  New coroner areas with most coroners whole time appointments.

    —  Improved training provision.

    —  Greater prominence given to public protection role of coroners.

    —  Improved powers for coroners to get information to help their inquiries.

    —  Removal of rigid boundaries which hamper effective investigations, and impede efforts to tackle delays.

    —  Inspection arrangements for the first time.

  1.3   The Government has consulted extensively on these and the other more detailed proposals since the draft Bill was published. As far as coroners in particular are concerned, four regional conferences to explain the Bill were held last June and July, which were attended by 90 coroners, plus a further 15 deputy or assistant deputy coroners. More generally, DCA officials, led by an SCS member, meet on a two monthly basis with senior representatives of the Coroners Society to discuss issues of mutual interest, including reform issues. Additionally, officials regularly visit coroners—in 2006, 47 such visits were made.

  1.4  On death certification, the Government accepts the Shipman Inquiry's conclusion that the existing arrangements for scrutinising the medical cause of death (MCCD) are confusing and inadequate. It has identified the following potential weaknesses:

    —  Although there are checks by two successive doctors in cremation cases, the scrutiny is not always sufficiently independent of the doctor signing the MCCD and is not subject to effective quality assurance;

    —  There is no independent medical scrutiny of the MCCD at all in the case of burials, unless the doctor signing the MCCD specifically refers the case to the coroner, or the registrar refers to the coroner before registering the death; and

    —  There is no routine system for analysis for local clinical governance purposes of the information on MCCDs or on the additional forms completed for cremations, and no explicit link to clinical governance processes in hospitals or in Primary Care Trusts.

  1.5 The Government therefore plans to consult on creating a more rigorous, unified system covering both burials and cremations, but outside the coroner system, the purpose of which will remain to investigate violent or unnatural deaths or those of unknown cause. The proposals on certification, which are currently being worked up and which will take account of the parallel proposals on medical advice to coroners, are:

    —  MCCDs, for burials and cremations alike, would be subject to scrutiny by an independent medical examiner attached to the clinical governance team in the hospital trust (secondary care) or PCT (primary care);

    —  Where the medical examiner was not satisfied that the MCCD told the full story or felt that there were other unusual circumstances, he or she would refer the case to the coroner for further examination, along with his or her reasons for doing so;

    —  The medical examiner would have full access to medical records and would be empowered to discuss the circumstances of the death with the doctor signing the MCCD and with the family of the deceased;

    —  The clinical governance team would collate information from MCCDs and would use this to analyse trends and patterns, looking out for unusual features such as those revealed by the pattern of deaths in the Shipman case; and

    —  The clinical governance team would ensure that all unexpected deaths were treated as significant events and followed up in individual and team clinical audit.

  These proposals were announced by the DH Minister of State for Delivery and Performance [Andy Burnham] and the Chief Medical Officer at the launch in February of Learning from tragedy (Cm 7014), a paper summarising the Government's action in response to the recommendations of the Shipman Inquiry.

  1.6 The Government does not propose that this new medical examiner will act as an intermediary between the medical profession and the coroner in the generality of cases. The Coroners Bill will provide for regulations which will set out the deaths which medical professionals should refer to coroners—as now, most of these will be cases where it is not possible for the registrar to register the death and issue a certified copy of the register entry before a coroner has had the chance to investigate.

SECTION 2: RELATIONSHIP BETWEEN THE DCA, THE DH AND THE GENERAL REGISTER OFFICE (GRO) WITH RESPECT TO RESPONSIBILITIES IN RELATION TO DEATH CERTIFICATION

  2.1 The DCA, the DH and the Office for National Statistics (of which the General Register Office is a part) work together on death certification issues. There are a number of processes that contribute to the completion of a death certificate, and a body being able to be released to be either cremated or buried. The legislative framework is clear that cremation certification lies with the DCA, and responsibility for providing doctors with medical certificates of cause of death (with instructions on how to complete them) and for the registration of deaths lies with the Registrar General (through the Births and Deaths Registration Act). These responsibilities complement the Registrar General's remit, which is to record life events and compile statistics, including those for mortality, population and morbidity. The DH has an interest in the professional regulation of, and training for, doctors, and an interest in the statistical data on births and deaths needed for NHS planning and public health policy.

  2.2 To update each other on progress, officials from all three Departments meet regularly to discuss both strategic and specific issues. On the latter, ad hoc meetings take place as and when the need arises. On the former, a Coroner Reform Programme Board—which met quarterly and was chaired by a member of the SCS and attended by officials from all relevant Departments—was established in 2004 to provide direction, to discuss cross Government issues, and to monitor progress. DH and DCA ministers are kept regularly informed about progress in these discussions and in addition there was a meeting in May 2006 between Andy Burnham and Harriet Harman to review progress in responding to the challenges posed by the Shipman Inquiry.

  2.3 It was decided, in early 2007, to suspend the Programme Board until the legislative position became clearer. In its place, and to both improve current services and to maintain the dialogue and momentum on wider reform issues, a Coroners Service Stakeholder Forum was established. The Forum, also chaired by a member of the SCS, consists of members of the previous programme board, including DH and ONS, together with representatives of the main stakeholder groups who have an interest in the management of the coroners' service and its future reform. These groups include the Coroners Society, Local and Police Authorities and members of coroners' service user groups.

  2.4 The Stakeholder Forum has two main purposes. First, it will consider, discuss and identify solutions to issues that have an impact on the delivery of the current service. Second, the group will, where appropriate, consider important reform issues and emerging reform policy proposals. The Forum will meet quarterly and the first meeting will be held in May.

  2.5 In addition, and for some years, officials from the DCA (and before that the Home Office) have met approximately every 2 months with senior representatives from the Coroners Society to discuss issues, including reform, relating to the operation and Constitution of the service. These meetings will continue.

  2.6 The DCA and DH have also met jointly with the British Medical Association and with the Royal College of Pathologists to discuss death certification issues.

SECTION 3: SPECIFIC CONSULTATION BETWEEN THE THREE DEPARTMENTS IN RELATION TO THE PROPOSAL FOR AN INDEPENDENT MEDICAL EXAMINER TO SCRUTINISE DEATH CERTIFICATES

  3.1 DCA officials are represented on the DH programme board which developed the government's response to the Shipman Inquiry and is now responsible for its implementation. The programme board meets monthly. In addition, DCA and DH officials have had a number of ad hoc meetings to discuss and develop the current proposals, with almost daily telephone and e-mail contact in the final weeks leading up to publication. Further meetings are being held to work up more detailed proposals in a consultation paper to be published shortly by the Secretary of State for Health.

  3.2 Coroners have not, so far, been specifically invited to comment on the proposals. Their attention was drawn to them at the time of the publication of Learning from tragedy in February, but coroners have not chosen to comment through the normal channels, including at a meeting between senior members of the Coroners Society and the Minister of State in DCA [Harriet Harman] on 19 March. We will consult them formally both before finalising the consultation paper and through the consultation proposals themselves.

SECTION 4: COORDINATION BETWEEN THE THREE DEPARTMENTS TO USE PUBLIC HEALTH ISSUES DERIVING FROM THE CORONIAL SYSTEM

   4.1 Mortality statistics based on the information provided to registrars of deaths by coroners following inquests have always been an essential tool of public health. This statistical information includes mortality rates by cause, age, sex, occupation, social class, primary care trust and local authority of residence and place of death. They are used extensively across local and national Government and the NHS to identify priority issues and population groups at risk, develop national policy and local implementation strategies and to monitor their effectiveness. However, there is very little co-ordination of more detailed and extensive information emanating from coroners" investigations, whether about health or any other protection issue affecting the public. This is a significant weakness in the system which reform will address. DCA Ministers have a policy responsibility for coroners but no operational responsibility, although in recognition of the need to do more to provide a national perspective ahead of reform, the Minister of State [Harriet Harman] has assisted coroners to tackle specific problems, such as the delays in holding inquests into military personnel killed in Iraq.

  4.2 The Minister is also working with coroners to improve their public protection role in advance of reform. The Coroners Society is developing its website to ensure that all reports to organisations (to prevent future similar fatalities) under Rule 43 of the current Coroners Rules are accessible to all coroners, and to senior DCA officials. This will enable trends to be identified and for action, or lack of it, taken by public authorities to be monitored.

  4.3 This power will be enhanced following reform. It has been moved from the rules to primary legislation (clause 12(3) in the draft Bill), and the Minister announced on 30 January that she was going to enhance the power in the following ways:

    —  The organisation to which the report is made will have a statutory requirement to respond to the coroner;

    —  There will be a requirement for the Chief Coroner to include in his or her annual report to Parliament a summary of the reports made by coroners; and

    —  The Chief Coroner will have a responsibility to check what action has been taken by authorities to whom a report has been made, and oversee the operation of the system generally.

  4.4 The initial Bill proposal has been fully consulted on, not just within Government and with coroners, but others, like the voluntary sector, with an interest. It was as a result of the consultation process—which supported this measure—that the Minister decided to enhance the proposal in the way described in paragraph 4.3. The announcement was cleared by colleagues across Government through the usual process, and coroners were forewarned, although not specifically consulted given that the changes of substance were almost entirely related to the role of the Chief Coroner.

  4.5 Information from coroners' determinations already flows into information used for public health and planning purposes in aggregated form, through the statistics collated by the Office of National Statistics. Thus, coroners' decisions have a very direct relevance to monitoring the incidence of suicide, for example, to judge progress in reducing incidence in accordance with national targets. Ministers expect the reforms, especially the creation of the role of the Chief Coroner, to promote consistency of practice amongst coroners which should improve the accuracy of information. The proposed changes to arrangements for death certification are a key component in the move to drive up accuracy of statistics on causes of death. The improved accuracy of information from coroners will benefit work by the range of health and social care organisations with responsibilities for examining causes of death in individual cases and understanding the underlying epidemiology. These include Primary Care Trusts, Drug Action Teams, the National Patient Safety Agency, the Medicines and Healthcare Products Regulatory Agency, the Healthcare Commission, the Commission for Social Care Inspection, the National Confidential Enquiry on Perioperative Death, Confidential Enquiry on Maternal and Child Health, the Health Safety Executive, the Health Protection Agency and Local Safeguarding Children Boards.

  4.6 The reforms also provide an opportunity to promote greater co-operation between coroners and public health practitioners, at both local and national level. As mentioned in paragraph 4.3, a coroner's power to bring issues to the attention of relevant authorities is being strengthened. The improved leadership of the coroners' service, which is a central part of coroner reform, is expected to promote effective relationships between coroners and public health officials in Regional Public Health Groups and public health observatories. This should mean that trends in a locality that are identified by the coroner can be passed on and investigated, as appropriate. The Chief Coroner will also be able to make a contribution at a national level, for example in advising where coroners identify emerging public health issues with national implications.

Rt Hon Harriet Harman, MP, Minister of State, Department for Constitutional Affairs

Lord Hunt of Kings Heath, OBE, Minister of State for Quality, Department of Health

April 2007


CORONER STATISTICS

All 2006 data (oldest case and charts at B,C & D) have yet to undergo quality assurance checks so are classed as provisional.

A.  Oldest case and average time to complete

  [* denotes where an estimated average has not been given, as fewer than 20 inquests were completed in 2005 on deaths in England and Wales].

NoCounty and district Deaths reported to coroners in 2005 on which inquests were or were to be opened Oldest outstanding inquest case (as at 31/12/2006) Estimated average time (weeks) to complete inquests (2005) for deaths in England and Wales
ENGLAND AND WALES
1Avon (former county) 60018/04/199826
2Bedfordshire and Luton 21908/03/200514
3Berkshire (former county) 28817/02/200319
4Birmingham and Solihull 95001/02/199717
5Black Country290 23/07/200418
6Blackburn, Hyndburn and Ribble Valley
188
25/04/200517
7Blackpool/Fylde14 22/07/2004158
8Boston and Spalding 7015/09/200518
9Bournemouth Poole and Eastern Dorset
165
08/05/200114
10Bridgend and Glamorgan Valleys 26214/10/200230
11Brighton and Hove 19406/07/200613
12Buckinghamshire171 05/09/200522
13Cardiff and Vale of Glamorgan 32323/04/200333
14Carmarthenshire96 25/09/200512
15Central and South East Kent 18019/07/200127
16Central Hampshire 15405/08/200317
17Central North Wales 26220/11/200521
18Ceredigion28 09/12/200423
19Cheshire6 07/01/200427
20City and County of Swansea 14015/07/200236
21City of London26 12/03/2003*
22Cornwall354 15/04/200229
23Coventry168 15/07/200517
24Darlington and South Durham 13831/01/200428
25Derby and South Derbyshire 33401/07/200319
26East Lancashire158 17/09/200329
27East London455 22/10/200426
28East Riding and Hull 27222/03/200534
29East Sussex306 03/02/200427
30Eastern Somerset98 18/04/20008
31Essex and Thurrock 43702/01/200241
32Exeter and Greater Devon 38110/04/200321
33Gateshead and South Tyneside 14802/03/200322
34Gloucestershire344 22/03/200425
35Great Yarmouth41 14/02/200628
36Gwent159 19/10/200311
37Hartlepool71 02/08/200615
38Herefordshire82 11/10/200420
39Hertfordshire415 29/07/199719
40Inner North London 57324/10/200429
41Inner South London 53221/07/200125
42Inner West London 46630/04/200412
43Isle of Wight56 03/11/200445
44Isles of Scilly2 None outstanding*
45King's Lynn88 29/06/200612
46Leicester city and South Leicestershire 45323/10/200124
47Liverpool469 16/05/199910
48Manchester city515 01/04/199833
49Manchester North357 02/04/200319
50Manchester South503 25/03/200427
51Manchester West461 25/02/200327
52Mid and North Shropshire 9912/07/200326
53Mid Kent and Medway 20211/09/200328
54Milton Keynes111 01/07/200417
55Neath and Port Talbot 6903/04/200524
56Newcastle upon Tyne 34418/01/200320
57North and East Cambridgeshire 8027/10/200525
58North Derbyshire258 30/09/200514
59North Durham229 16/04/200422
60North East Cumbria 9916/10/200332
61North East Hampshire 12126/06/200612
62North East Kent228 31/01/200217
63North East Wales290 13/02/200424
64North Lincolnshire and Grimsby 11415/01/200142
65North London434 04/08/200417
66North Northumberland 13309/08/200325
67North Tyneside222 10/10/200320
68North West Kent171 19/06/200120
69North West Wales130 01/10/199927
70North Yorkshire Eastern District 13312/10/199821
71North Yorkshire Western District 14026/09/200229
72Northamptonshire250 01/03/200027
73Norwich and Central Norfolk 24224/01/200522
74Nottinghamshire458 02/10/200213
75Oxfordshire446 20/09/200038
76Pembrokeshire82 09/08/200519
77Peterborough90 09/02/200526
78Plymouth and South West Devon 42616/07/200217
79Portsmouth and South East Hampshire 29710/09/200141
80Powys81 04/08/200423
81Preston and South West Lancashire 37928/11/200321
82Rutland and North Leicestershire 17924/01/200418
83Sefton, Knowsley and St Helens 24418/08/200322
84South and West Cambridgeshire 22810/02/200619
85South Cumbria and Furness 14602/08/200218
86South London342 01/01/200421
87South Northumberland 12012/09/200218
88South Shropshire29 08/02/200231
89South Yorkshire Eastern District 30303/09/200116
90South Yorkshire Western District 43715/08/200518
91Southampton and New Forest 21817/11/200217
92Southend-on-Sea148 15/01/200321
93Spilsby and Louth 5908/08/200424
94Staffordshire South 35629/09/200421
95Stamford17 21/11/2002*
96Stoke-on-Trent and North Staffordshire
478
28/05/200217
97Suffolk267 24/04/200317
98Sunderland348 21/07/200415
99Surrey382 31/08/199728
100Teesside348 10/12/200328
101Telford and Wrekin 6403/03/200322
102The Queen's Household 031/08/1997Not applicable
103Torbay and South Devon 13026/06/200520
104Warwickshire240 18/10/200227
105West Lincolnshire 11125/05/200425
106West London759 01/09/200222
107West Sussex374 21/09/200514
108West Yorkshire Eastern District 57826/10/199828
109West Yorkshire Western District 43526/10/199825
110Western Cumbria70 27/08/200323
111Western Dorset89 03/08/200019
112Western Somerset 14319/02/200419
113Wiltshire and Swindon 25522/07/200333
114Wirral269 01/06/200416
115Wolverhampton157 01/06/199821
116Worcestershire292 16/07/200216
117York City88 31/03/200528

B.  Distribution of length of Inquest

C.  Origin of Oldest Case


Note: Although only about 2% of coroners cases are deaths abroad they account for about a third of oldest cases.

D.  Number of jurisdictions with outstanding inquest cases from each year

May 2007

        





 
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