Clause 12: Discontinuance of certification

106.     This clause makes provision in the event that a certification under clause 11 is discontinued by the Secretary of State.

107.     Where a certification has been discontinued, the Lord Chief Justice may, after consulting the Chief Coroner, make a direction terminating the nomination of the judge who conducted the investigation (subsection (2)). Where such a direction is made by the Lord Chief Justice, the Chief Coroner must then either direct the senior coroner who would otherwise have had jurisdiction to conduct the investigation to do so or direct any other senior coroner to conduct the investigation, or the Chief Coroner could conduct the investigation personally (subsection (3)) or the Chief Coroner could request that the Lord Chief Justice direct either a Circuit judge to conduct the investigation. Clause 7 (whether jury required) applies as normal and so a jury must be called if clause 7(2) applies and may be called in any other case (subsection (4)).

Clause 13: Intercept evidence

108.     This clause sets out the necessary amendments to RIPA so that if an investigation is certified by the Secretary of State any material to which RIPA applies can be disclosed to the High Court judge conducting the investigation. The clause provides that the information can be disclosed not only to the judge appointed to conduct the investigation, but also to any person appointed as independent counsel to the inquest, one of whose roles will be to represent the interests of the deceased’s family at the inquest. Counsel may probe and challenge the evidence on their behalf. The clause extends to Northern Ireland, where provision similar to that contained in clauses 11 and 12 will have effect under Schedule 10.

Clause 14 and Schedule 1: Duty or power to suspend or resume investigations

109.     This clause gives effect to Schedule 1 which contains provisions on suspending and resuming investigations in various situations. Schedule 1 sets out when a senior coroner must or is able to suspend and resume investigations

Paragraph 1: Suspension of investigation where certain criminal charges may be brought

110.     Paragraph 1 of Schedule 1 contains provision for suspending the senior coroner’s investigation in the event that it is likely that criminal proceedings will be brought in connection with the death. It is intended to avoid duplicate investigations. This is based on rules 26 and 27 of the 1984 Rules.

111.     Paragraph 1(2) requires the senior coroner to suspend an investigation if asked to do so by a prosecuting authority because someone may be charged with a homicide offence involving the death of the deceased or an offence that is alleged to be a related offence.

112.     Paragraph 1(3) requires the senior coroner to suspend an investigation if asked to do so by a Provost Marshal or the Director of Service Prosecutions because someone may be charged with the service equivalent of a homicide offence involving the death of the deceased or the service equivalent or a service offence that is alleged to be a related offence.

113.     Under paragraph 1(4), if the senior coroner has to suspend an investigation under paragraphs 1(2) or1 (3), this suspension must be for at least 28 days. The senior coroner has the power to extend (more than once if needed) the period of the suspension if asked to do so by the person who or authority which requested the original suspension (through paragraph 1(5)).

114.     Paragraph 1(6) sets out the definition of “homicide offence” and “related offence.” It also explains that a “service equivalent of a homicide offence” means an offence under the Armed Forces Act 2006 corresponding to a homicide offence.

Paragraph 2: Suspension where certain criminal proceedings are brought

115.     Paragraph 2 of Schedule 1 sets out the arrangements for suspension of the senior coroner’s investigation when criminal proceedings have been brought in connection with the death. It is developed from section 16 of the 1988 Act.

116.     Paragraph 2(2) requires a senior coroner to suspend an investigation into a death on becoming aware either that someone has appeared or been brought before a magistrates’ court charged with a homicide offence involving the death of the deceased or that they have been charged on indictment in the Crown Court with such an offence. Paragraph 2(3) requires a senior coroner to suspend an investigation into a death on becoming aware that someone has been charged with the service equivalent of a homicide offence involved the death of the deceased.

117.     Paragraph 2(4) requires a senior coroner to suspend an investigation on being informed by a prosecuting authority that someone has appeared or been brought before a magistrates’ court charged with a related offence (as defined in paragraph 1(6)) or has been charged on indictment in the Crown Court with such an offence and the prosecuting authority has asked the coroner to suspend his or her investigation.

118.     Paragraph 2(5) requires a senior coroner to suspend an investigation on being informed by the Director of Service Prosecutions that a person has been charged with the service equivalent of a related offence and the Director of Service Prosecutions has asked the senior coroner to suspend his or her investigation.

119.     The senior coroner need not suspend an investigation under paragraph 2(2), (3) or (4) where the prosecuting authority or the Director of Service Prosecutions (as the case may be) has no objection to the investigation continuing or where the senior coroner thinks that there is exceptional reason for not doing so (paragraph 2(6))

120.     Paragraph 2(7) makes provision for investigations which are already suspended under paragraph 1.

Paragraph 3: Suspension pending inquiry under Inquiries Act 2005

121.     Paragraph 3 of Schedule 1 sets out the circumstances in which a senior coroner’s investigation can be suspended where there is an inquiry under the Inquiries Act 2005. It is based on section 17A of the 1988 Act.

122.     Paragraph 3(1) requires the senior coroner to suspend an investigation into a death if requested to do so by the Lord Chancellor on the basis that there will be an inquiry under the Inquiries Act 2005 in which the cause of death is likely to be adequately investigated. The senior coroner does not have to suspend an investigation if he or she thinks there are exceptional reasons for continuing with it (Paragraph 3(2)). Paragraph 3(3) makes provision for investigations which are already suspended under paragraph 1.

Paragraph 4: General power to suspend

123.     Paragraph 4 of Schedule 1 provides a general power for a senior coroner to suspend an investigation if he or she thinks that it would be appropriate to do so. This may be appropriate if another investigation is being conducted into the death, for example, by the Independent Police Complaints Commission, the Health and Safety Executive or an Accident Investigation Board or if an investigation is being conducted in another jurisdiction, for example, if the death occurred abroad.

Paragraph 5: Effect of suspension

124.     Where an investigation is suspended under paragraphs 1, 2, 3 or 4, any inquest being held as part of that investigation must also be adjourned and if it is being held with a jury, the senior coroner may discharge the jury.

Paragraph 6: Resumption of investigation suspended under paragraph 1

125.     If the senior coroner suspends an investigation because someone may be charged with an offence, the investigation must be resumed (subject to paragraphs 2(7)(d) and 3(3)(b)) once the relevant period has expired.

Paragraph 7: Resumption of investigation suspended under paragraph 2

126.     Paragraph 7 of Schedule 1 sets out the arrangements for resuming investigations suspended because certain criminal proceedings have been brought.

127.     Under paragraph 7(1) the senior coroner can resume an investigation only if he or she thinks there is sufficient reason to do so.

128.     By paragraph 7(2), an investigation cannot be resumed (subject to sub-paragraph (3)) until the criminal proceedings which triggered the suspension have come to an end in the court of trial.

129.     Paragraph 7(3) allows a senior coroner to resume an investigation before the criminal proceedings have ended where the prosecuting authority or the Director of Service Prosecutions (as the case may be) has confirmed that it has no objection to this.

130.     Paragraph 7(4) sets out who the prosecuting authority is for the purposes of paragraph 7(3). Paragraph 7(5) makes clear that the outcome of a coroner’s investigation resumed under this clause must not be inconsistent with the result of the criminal proceedings which triggered the suspension.

131.     It could be that the senior coroner resumes the investigation because the criminal investigation did not find all the facts that the senior coroner is required to find or because it did not meet ECHR Article 2 obligations, for example because the defendant pleaded guilty. Indeed the effect of section 6(1) of the HRA is that the senior coroner, as a public authority, would be legally obliged to resume the investigation if this was necessary in order to secure compliance with Article 2.

Paragraph 8: Resumption of investigation suspended under paragraph 3

132.     Paragraph 8 of Schedule 1 sets out the arrangements for resuming investigations suspended because of an inquiry. Under paragraph 8(1) the senior coroner can resume an investigation only if he or she thinks that there is sufficient reason for resuming it. It cannot be resumed until after 28 days have passed since either the date that the Lord Chancellor has notified to the senior coroner as date of conclusion of the inquiry or, where the senior coroner has received no such notification, the date of publication of the findings of the inquiry.

133.     Paragraph 8(3), 8(5), 8(7) and 8(9) are relevant where the senior coroner becomes aware during the course of the suspension of his investigation that criminal proceedings are under way of a type that would require a suspension under paragraph 2. Under paragraph 8(4), 8(6), 8(8) and 8(10) the investigation may not be resumed before such criminal proceedings have ended unless a prosecuting authority or the Director of Service Prosecutions (as the case may be) has told the senior coroner that it has no objection to the investigation being resumed.

134.     Under paragraph 8(4) to 8(10) the investigation may not be resumed before such criminal proceedings have ended unless a prosecuting authority has told the senior coroner that it has no objection to the investigation being resumed.

135.     Paragraph 8(11) prevents the resumed senior coroner’s investigation from reaching a conclusion which is inconsistent with the outcome of the inquiry or any criminal proceedings which triggered the suspension. For example, if the outcome of an inquiry was a finding that a particular individual had committed suicide, a senior coroner’s investigation cannot conclude that the particular individual was unlawfully killed.

Paragraph 9: Resumption of investigation under paragraph 4

136.     Paragraph 9 of Schedule 1 states that where an investigation is suspended under paragraph 4, it may be resumed at any time the senior coroner thinks there is sufficient reason for resuming the investigation.

Paragraph 10: Supplemental

137.     Paragraph 10(1) of Schedule 1 requires that where a senior coroner resumes an investigation under Schedule 1, the senior coroner must resume any inquest that was adjourned under paragraph 5.

138.     Where an inquest is resumed, by paragraph 10(3) the resumed inquest may be held with a jury if the senior coroner thinks there is sufficient reason for doing so.

139.     Under paragraph 10(4), if the inquest was started with a jury and then adjourned and the senior coroner decides to hold the resumed inquest with a jury, if at least 6 members of the original jury are available to serve, then they will form the jury for the resumed inquest. If not, or the original jury was discharged, a new jury is required to be summoned.

Clause 15: Post-mortem examinations

140.     This clause sets out the arrangements for ordering post-mortem examinations, and makes slightly different provision from that contained in sections 19 and 20 of the 1988 Act.

141.     Subsection (1) gives a senior coroner power to ask a suitable practitioner to make a post-mortem examination of a body if the senior coroner is either responsible for conducting an investigation into the death or a post-mortem examination will enable the senior coroner to decide if he or she has a duty under clause 1 to conduct an investigation. This may be relevant where it is not clear whether a death occurred as a result of a notifiable disease or whether a child was stillborn - where, for example, a body is found and it is not clear whether it ever had independent life. Where it is known or established that a child was stillborn, the senior coroner will have no further responsibility to carry out an investigation.

142.     The term “post-mortem examination” is not defined but it will include any examination made of the deceased including non-invasive examinations, for example, using Magnetic Resonance Imaging (MRI).

143.     The 1988 Act makes a distinction between post-mortem and “special” examinations (the latter are a more specific kind of post-mortem examination and would include toxicology tests to establish whether, for example, alcohol or drugs were in the bloodstream). The Bill removes this distinction, enabling the senior coroner to detail the kind of examination he or she would like the practitioner to make - for example, to ask for a particular examination of a tissue or organ which seems most relevant to the cause of death if a full post-mortem is not considered necessary (subsection (2)).

144.     Subsection (3) defines a suitable practitioner as either a registered medical practitioner or where a particular form of examination is required, such as an MRI Scan, a practitioner who the Chief Coroner has designated is suitable to carry out such examinations.

145.     Subsection (4) ensures that any medical practitioner about whom there are allegations in relation to the death is not able to carry out the examination of the body, although such a person may be represented at an examination.

146.     Subsection (5) requires the person making the examination to report the result to the senior coroner as soon as is practicable.

Clause 16: Power to remove body

147.     This clause specifies the arrangements for moving a body to a different location, for example to enable a post-mortem examination to be carried out.

148.     Under subsection (1) a senior coroner who is responsible for conducting an investigation into the death or who needs to request a post-mortem examination in order to decide if he or she has a duty under clause 1 to conduct an investigation may order that the body be moved to any suitable place. (The notes to clause 15 set out when a senior coroner may need to request a post-mortem examination in order to decide if he or she has a duty under clause 1 to conduct an investigation.)

149.     This removes the restriction in section 22(1) of the 1988 Act that a body can be moved only within a senior coroner’s area or to an immediately adjoining area which has caused practical difficulties in a major incident where there have been several deaths. This power will also allow a senior coroner to make use of specialist equipment or skills available in a different part of the country and may, on occasion, mean that full post-mortems can be avoided.

150.     The body can be moved to a place which is outside the senior coroner’s area only with the consent of the person providing that place (for example, a mortuary manager and the relevant local authority). The issue of costs may be dealt with in regulations.

Clause 17: Notification by medical practitioner to senior coroner

151.     This clause enables regulations to be made by the Lord Chancellor requiring a registered medical practitioner to notify a senior coroner of deaths of which they become aware. Regulations may set out the circumstances in which the medical practitioner will have to make a referral.

Clause 18: Medical examiners

152.     This clause relates to the appointment of, and functions to be carried out by, medical examiners. It also enables regulations to be made by the Secretary of State for Health (in relation to England) and the Welsh Ministers (in relation to Wales) about the appointment, payment and training of, and functions to be carried out by, medical examiners.

153.     Subsection (1) requires Primary Care Trusts (PCTs) in England and Local Health Boards (LHBs) in Wales to appoint of medical examiners to discharge the functions given to them by this Part.

154.     Subsection (2)(a) specifies that PCTs and LHBs must appoint enough medical examiners and make available enough funds and other resources (including medical examiner’s officers) to enable the medical examiners to discharge their function in the area served by the Trust or Board.

155.     Under subsection (2)(b), medical examiners will be monitored by their PCT or LHB as to whether or not they meet expected standards or levels of performance in carrying out their work as medical examiners. This monitoring needs to be considered alongside the requirement in subsection (5) for PCTs and LHBs to take no role in relation to the way that medical examiners exercise their professional judgment as medical practitioners.

156.     Subsection (3) specifies, subject to regulations under (4)(f), that medical examiners must, at the time of appointment, be fully registered, practising, medical practitioners with at least 5 years experience.

157.     Regulations made under subsection (4)(a) will specify terms of appointment for medical examiners and allow for termination of their appointment. Whilst medical examiners will, for the most part, confirm or establish the cause of death for deaths that have occurred in the area served by the PCT or LHB by whom they have been appointed, they may be asked to scrutinise deaths in other areas.

158.     Regulations made under subsection (4)(b) will specify what payments may be made to medical examiners by way of remuneration, expenses, fees, compensation for termination of appointment, pensions, allowances or gratuities. Such payments would be in line with arrangements applying in the specific area in respect of remuneration and those applying nationally in respect of other payments.

159.     Regulations made under subsection (4)(c) will specify the training that medical examiners must have successfully completed prior to their appointment and the training that they need to undertake during the term of their appointment.

160.     Regulations made under subsection (4)(d) will make provision about procedure to be followed by medical examiners in carrying out their functions with a view to ensuring that they are able to carry out independent scrutiny of medical certificates of cause of death (MCCDs) and do so in a way that is robust, proportionate, and consistent. The regulations may also provide that, in order to help ensure their professional independence, medical examiners will not be allowed to confirm or establish the cause of death of any person to whom they are related or with whom they have had any fiduciary relationship; and that they will not be allowed to scrutinise MCCDs prepared by any doctor with whom they have a close working or professional relationship or with whom they have an established fiduciary relationship (see also clause 19).

161.     Regulations made under subsection (4)(e) may provide for the functions of the medical examiner to be extended or changed to support future developments of the service.

162.     Regulations made under subsection (4)(f) may provide for the functions of the medical examiner to be carried out during a period of emergency certified by the Secretary of State in accordance with subsection (7) by people who do not meet the criteria in subsection (3). (See also clause 19(4) for a related provision allowing the MCCD to be given during a period of emergency by a registered medical practitioner who has not attended the deceased before his or her death and is therefore not the “attending practitioner”.)

163.     Subsection (5) specifies that PCTs and LHBs must allow medical examiners to exercise their own professional judgement as medical practitioners in deciding, for example, whether to confirm individual causes of death or refer them to a senior coroner. This provision needs to be read together with the obligation on PCTs and LHBs to monitor medical examiners in subsection (2) and the procedures to be prescribed by regulations under subsection (4)(d).

164.     Subsections (8) and (9) make provision concerning periods of emergency certified by the Secretary of State under subsection (7).

Clause 19: Medical certificate of cause of death

165.     This clause enables the Secretary of State for Health to make regulations about the preparation, scrutiny and confirmation of MCCDs and about the way the confirmed MCCD is notified and given to a registrar or about how the death is referred to a senior coroner. The clause also enables regulations to be made about the payment of a fee for the service provided by a medical examiner.

166.     The independent scrutiny and confirmation of MCCDs is part of a wider process that starts with the preparation of the certificate by a registered medical practitioner who attended the deceased and ends with the certificate being returned to the medical examiner after it has been used by the registrar to register the death. The new unified process is intended to be simpler and more transparent than the current process and requires specification of activities, responsibilities and alternative scenarios that are more suited to regulations than to provisions on the face of the Bill. Subsection (1) provides the power to make the necessary regulations.

167.     The new process has been designed with the active engagement of a wide range of stakeholders and is illustrated in an overview booklet published by the Department of Health at http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_090533.

168.     Regulations made under subsection (1)(a) will require a registered medical practitioner who attended the deceased prior to death (the “attending practitioner”) to prepare an MCCD (the “attending practitioner’s certificate”) stating the cause of death to the best of the practitioner’s knowledge and belief. This duty has been transferred and adapted from section 22 of the 1953 Act (see subsections (1)(m) and (3) for the associated transfer of responsibility for prescribing forms, including the MCCD, and for making them available to medical practitioners).

169.     The attending practitioner’s certificate will be prepared using first-hand knowledge of the deceased’s condition prior to death together with information from medical notes and patient records. PCTs (in England), LHBs (in Wales) and healthcare providers (both in the NHS and the private sector) will also be encouraged to adopt local protocols relating to the verification of the fact of death that are able to provide the attending practitioner with information on circumstances leading to the death. Knowledge of these circumstances may assist the attending practitioner in establishing the cause of death or in deciding that the death needs to be referred to a senior coroner.

170.     Where the attending practitioner needs advice on how to complete an MCCD or wants to discuss the probable cause of death before preparing the certificate, he or she will be able to speak with a medical examiner. This is expected to reduce the number of deaths that are unnecessarily reported to a senior coroner.

171.     If the attending practitioner is unable to establish the cause of death, or is unable to do so in a period of time prescribed by regulations made under subsection (2)(a), then the death must be referred to a senior coroner.

172.     If the attending practitioner is not contactable within a period of time after death prescribed by regulations that may be made under subsection (2)(a), then the death must be referred to a senior coroner. This is relevant, in particular, to deaths in the community, which, even though they are apparently due to natural causes, occur at a time when the deceased’s usual doctor is not contactable.

173.     If there is no attending practitioner, for example, where the deceased person was not receiving treatment for the condition that caused the death then the provisions under subsection (1) do not apply and the death must be notified to a senior coroner as prescribed by regulations that may be made under clause 17.

174.     It is intended that regulations made under subsection (1)(a) will specify that an attending practitioner’s certificate will not be required where the death has been notified to a senior coroner in accordance with regulations made under clause 17 and is investigated by the senior coroner as specified in clause 1. This is a key change from the current process and addresses a long-standing issue in which a strict interpretation of the 1953 Act requires an attending practitioner to prepare a certificate even if he or she cannot establish the cause of death, and requires the registrar to refer this certificate to a senior coroner.

175.     Clause 17 together with regulations under subsection (1)(a)(ii) change the practice of medical practitioners to refer deaths to a senior coroner into a statutory duty.

176.     It is intended that regulations made under subsection (1)(b) will require that where an attending practitioner’s certificate has been prepared, the hospital bereavement office or GP surgery (or equivalent) must transmit a copy of it to a medical examiner’s office. The original certificate will be held by the hospital bereavement office or GP surgery (or equivalent) until it has been scrutinised and confirmed by a medical examiner. This is a key change to the current process in which, if there is no local protocol to the contrary, the attending practitioner’s certificate is given to the family immediately after it is written. The Government expects that the additional time required to complete the scrutiny will in most cases be no longer than the time taken to complete the forms currently required by the cremation regulations. These forms are removed in the new process.

177.     Regulations made under subsection (1)(c) will allow registrars to invite a medical examiner to request a fresh attending practitioner’s certificate. A fresh certificate may be required if, during registration, the informant provides new information about the death and invalidates the cause of death previously confirmed by the medical examiner. The provisions outlined here allow registrars to retain their current duty to provide a last check that a death does not need to be notified to a senior coroner. However, many registrars find it difficult to perform this role - particularly where they have to refer a substantial number of certificates - because they have to rely on knowledge gained through experience and because the delays caused to bereaved families can cause considerable stress. The new process is designed to address this issue and to reduce significantly the number of MCCDs that registrars need to refer to senior coroners.

178.     Regulations made under subsection (1)(d) will allow arrangements to be established in relation to deaths that senior coroners refer to medical examiners. These will be the deaths that were originally notified to a senior coroner under clause 17 or referred to a senior coroner under subsection (1)(a)(ii) that the senior coroner has decided not to investigate. In these cases, the senior coroner will issue a form stating that he or she has no further interest in the death and will transmit this form to the medical examiner’s office together with any relevant information about the death that he or she has used in coming to his or her decision. In some cases, this information may include advice provided by a medical examiner in response to a request from the senior coroner or coroner’s officer.

179.     Since the senior coroner can refer a death to a medical examiner only where the cause of death is known, the regulations made under subsection (1)(a)(i) will allows the attending practitioner to prepare an attending practitioner’s certificate. If there is no attending practitioner or if the attending practitioner is not available within a prescribed period after a senior coroner decides not to investigate, then a medical examiner will establish the cause of death and prepare a “medical examiner’s certificate” as specified in regulations made under subsection (1)(h)(i). These changes remove the current situation in which some deaths need to be registered as “uncertified”.

180.     Regulations may be made under subsection (1)(e) requiring a medical examiner to make whatever enquiries appear to be necessary in order to confirm or establish the cause of death. Whilst medical examiners will have full access to medical notes and patient records (as a result of the amendment to the Access to Health Records Act 1990 made by paragraph 28 of Schedule 19), they will not be able to require any individual or organisation to respond to their enquiries or provide information. If a medical examiner is not able to obtain information required to confirm or establish the cause of death, then the death will be referred to a senior coroner (as outlined below) and the senior coroner will be able to require the information to be provided.

181.     When the copy of an attending practitioner’s certificate is received by a medical examiner’s office from a hospital bereavement office or GP’s surgery (or equivalent) it should be accompanied by relevant medical notes and/or patient records. Where these cannot be transmitted or provided easily, arrangements may be made for a medical examiner to view them in situ. A medical examiner’s officer will ensure that the attending practitioner’s certificate has been completed and that the associated notes and records have been provided or are available and then, if necessary, contact the deceased person’s next of kin, or other appropriate person or people, to obtain any further information required. The medical examiner’s officer will talk with the bereaved family, usually by telephone, in a way that does not intrude on their grief or raise concerns that would otherwise not exist. As a further safeguard against unnecessary intrusion, information collected by bereavement officers or, for reported deaths that a senior coroner has decided not to investigate, by coroners’ officers, will be made available to the medical examiner’s officer.

182.     If the attending practitioner’s certificate has been completed properly, it will advise that the attending practitioner or another prescribed person has seen, identified and externally examined the deceased person’s body after death. The purpose of this examination is to confirm there are no injuries or other suspicious features that might indicate an unnatural death. If, in exceptional circumstances agreed with a medical examiner, the attending practitioner has not been able to see, identify and examine the body, then the medical examiner will need to arrange to do so during scrutiny. A medical examiner will also need to see, identify and examine the body for deaths that are referred to him or her by a senior coroner and which require a medical examiner’s certificate as set out in subsection (1)(d).

183.     Regulations may be made under subsection (1)(f) requiring a medical examiner, after scrutinising the attending practitioner’s certificate and other information prepared by the medical examiner’s officer, either to confirm the cause of death or to refer the death to the senior coroner.

184.     In order to ensure that the scrutiny carried out by the medical examiner is robust, proportionate and consistent, there will be a protocol that recognises different levels of risk depending on the setting, stated cause and circumstances. The protocol will establish the minimum level of scrutiny for specific situations but will allow a medical examiner to use professional judgement to determine the degree to which the scrutiny is pursued.

185.     If, during scrutiny, a medical examiner is unable to confirm the cause of death or decides that it meets any of the criteria prescribed in regulations made under clause 17, then the death will be referred to a senior coroner as specified in regulations made under subsection (1)(h)(ii). The medical examiner will give reasons for the referral and, where appropriate, will suggest what type of post-mortem may be necessary. If, in exceptional cases, the senior coroner decides not to investigate the death and cannot come to an agreement with the medical examiner about the cause of death then the case would need to be taken through the appeals process as set out in Chapter 6 of Part 1 of the Bill. The medical examiner has been included as an “interested person” in relation to this appeals process in clause 36.

186.     If, during scrutiny, a medical examiner forms the opinion that the cause of death stated on the attending practitioner’s certificate is either insufficient or incorrect, but the death is not reportable to a senior coroner, the medical examiner will discuss the death with the attending practitioner and invite him or her to prepare a fresh certificate. The Government intends that this will be specified in regulations made under subsection (1)(c). If, in exceptional cases, the attending practitioner and medical examiner are unable to agree on the cause of death, the medical examiner will refer the case to a senior coroner.

187.     Once any issues raised by the next of kin (or other appropriate person or people) have been resolved, they will be advised that the MCCD can be collected from the hospital bereavement office or GP Surgery (or equivalent) or, for an MCCD prepared by a medical examiner, from the medical examiner’s office. At the same time, a medical examiner’s authorisation will be transmitted to the attending practitioner (if one exists) and the registrar to notify them that the cause of death has been confirmed and that the MCCD can be issued and used to register the death.

188.     A copy of the medical examiner’s authorisation will be transmitted to funeral directors to allow them to finish preparing the body for burial or cremation where this involves changing the body in a way that might render it unsuitable for a post-mortem.

189.     Regulations may be made under subsection (1)(g) about giving the MCCD to be given to a registrar. In practice, the MCCD will be given to an informant or someone collecting it on behalf of the informant and the informant will give the MCCD to a registrar. The regulations may allow the MCCD to be given in other ways: for example, sent by secure post to the informant or sent directly to a registrar. These arrangements are intended to ensure that the new process is as fast and as convenient as possible.

190.     Regulations may be made under subsection (1)(g)) requiring that registrars must wait until they have received (or can access) a copy of the medical examiner’s authorisation before they can accept (or confirm acceptance of): a request to register a death; a request to defer registration; or a request to authorise disposal before registration.

191.     Where a medical examiner has issued a certificate by virtue of regulations under subsection (1)(h) after referral of the case to him by a senior coroner (see subsection (1)(d)), further provisions, made by regulations under subsections (1)(i) and (j), will apply. These provisions will correspond to those made under subsection (1)(c) and (g) in relation to an attending practitioner’s certificate that has been confirmed by the medical examiner in accordance with regulations under subsection (1)(f).

192.     Once scrutiny has been completed, a medical examiner or someone acting on behalf of a medical examiner (usually the medical examiner’s officer) will speak with the next of kin of the deceased person (or other appropriate person or people) to advise them of the outcome of the scrutiny. This conversation will be required by regulations made under subsection (1)(k).

193.     Where the cause of death has been confirmed, the medical examiner or person acting on his or her behalf will explain the cause of death and check that it does not raise any issues that have not yet been considered. If issues are raised and cannot be resolved during the conversation then the medical examiner may decide to re-open the scrutiny or refer the death to the senior coroner.

194.     Regulations may be made under subsection (1)(l) requiring the person nominated as the informant for the purpose of registration, or another prescribed person, to confirm in writing that a medical examiner or someone acting on his or her behalf (usually the medical examiner’s officer) has explained the confirmed cause of death as set out in subsection (1)(k). At present the Government anticipates that this written confirmation will be provided during registration; however, there are other possible options. The purpose of this written confirmation is to provide evidence that the new process is more transparent than the current process.

195.     Regulations made under subsection (1)(m) will enable the Secretary of State for Health, after consultation as set out in subsection (3), to prescribe forms, including the “MCCD” form. The regulations will also require the forms to be made available to medical examiners, registered medical practitioners and others who need to use them.

196.     Regulations made under subsection (1)(n) will require the Chief Medical Officer of the Department of Health to issue guidance as to how certificates and other forms are to be completed and to do so after consulting the person who holds the office with corresponding functions in relation to Wales, as well as the Registrar General and the Statistics Board.

197.     Regulations made under subsection (1)(o) will enable all forms, including the MCCD form, to be signed or otherwise authenticated. Authentication in this context will enable the forms to be transmitted or made available electronically.

198.     Subsection (2)(a) enables any regulation in subsection (1) that imposes a requirement to have a prescribed period within which the requirement is to be complied with.

199.     Subsection (2)(b) enables any regulation in subsection (1) that imposes a requirement to have prescribed cases or circumstances in which the requirement does, or does not, apply. This provision may need to be used, in particular, during periods of emergency as defined in clause 18 (7).

200.     Subsection (3) requires the Secretary of State for Health to consult with Welsh Ministers, the Registrar General and the Statistics Board before prescribing forms, including the MCCD form, as specified in subsection (1)(m). The Statistics Board will continue to ensure that the MCCD form complies with requirements set by the World Health Organisation.

201.     Subsection (4) allows regulations under subsection (1) to provide that functions otherwise exercisable by attending practitioners to be carried out during a period of emergency by registered medical practitioners who did not attend the deceased prior to death. The primary activities to which this would relate are the preparation of an MCCD and discussion with a medical examiner about any changes that might be required in order for the cause of death to be confirmed (see also clause 18 (4)(f) on when functions normally carried out by medical examiners may be carried out by others during a period of emergency).

202.     Subsection (5) enables regulations to be made by the Secretary of State for Health (for England) and Welsh Ministers (for Wales) to provide for a fee to be payable to a PCT or LHB in respect of a medical examiner’s scrutiny and confirmation of an attending practitioner’s certificate or the preparation and issue of a medical examiner’s certificate. The fee level will be set on the basis of full cost recovery, without any element of profit. The first such regulations, and any subsequent regulations that raise fees by more than the rate of inflation, will be subject to the affirmative resolution procedure: see subsections (4)(b) and (5) of clause 155.

203.     Funeral arrangers currently pay a total of £160.50 to individual doctors for the preparation and issue of forms required under the Cremation Regulations 2009. In the new system, the medical examiner will perform the function of all three of these doctors and will, the Government expects, be able to do so at a lower total cost. An analysis of costs and benefits is available in the Department of Health’s Impact Assessment http://www.dh.gov.uk/en/Consultations/Closedconsultations/DH_076971.