Q
107Mr.
Boswell: Is there a national IT system, or do we need one
to enable this information to be collated and
shared? André
Rebello: There is not a national IT system. Many
coroners still have manual databases. Many do not have a computer
system, but most are going towards one. There is one main system that
most coroners use. I am very enthusiastic about having a web-based
database, for which we can have a national server, mirrored several
times over, so that all coroners work to that and know, at the push of
a button, exactly where death investigations and inquest hearings are
up to at any moment in time. That will cost money. If that is provided,
there is no reason why it is not possible to introduce as soon as the
system comes in.
Q
108The
Parliamentary Under-Secretary of State for Justice (Bridget
Prentice): I just want to ask Alison whether there is
anything missing in the Bill or in the charter for the bereaved, or
does she feel that they cover the issues that concern bereaved
families? Alison
Cox: To reiterate, I should like to see some kind of
evaluation for the bereaved. That would liberate every bereaved person.
Perhaps we could have a tick box of four or five basic questions, which
I could submit to Bridget, and, if you can be brave enough—and
this is quite a big
step—
Bridget
Prentice: Try
me. Alison
Cox: An “Any other comments” section
would make a colossal difference. For example, a stamp addressed
envelope would provide a straightforward opportunity to find out how
the system was working for the bereaved. At the end of the day, that is
what the service is for. An “Any other comments” section
might be more complicated, but it would give the bereaved an
opportunity to respond. It is up to them whether they take it up. There
should not be a limitation. We cannot say that the response must come
back in six weeks; we should allow two years, for example, or perhaps
leave it open so that people can reply any time as long as they put the
date on it. That would make an enormous difference to our bereaved
families, and it is something that I would very much encourage them to
use to vocalise their feelings.
As you
mentioned, it is really important for people to come back and tell us
whether the service has been good, and I know that our bereaved
families would do that. It is very humbling to hear how much they
praise a coroner who has given them the opportunity to be part of that
whole service. It is also frightening to see how much of a service they
accept from a coroner who is perhaps questionably hanging on to his
place by his eyebrows.
Q
109The
Chairman: I am not inviting lengthy statements, but would
any of our witnesses like to make any other observations?
Helen
Shaw: We welcome the charter for bereaved families.
However, under this new system we are concerned about how families will
be given access to the support and information that they need to get
through an inquest. No national service provides support to bereaved
families. Although our expertise is in deaths in custody, we provide an
information pack for people going through any kind of inquest. It was
downloaded 15,000 times from our website last year and we are a small
charity. We hope that in the new system, some thought will be given to
what support is needed by bereaved families, short of legal support. A
lot of people just need to be given guidance and information about what
is going to happen at a very distressing time in their lives. We hope
that that does not get overlooked due to the more legal issues that
arise.
Professor
Furness: I was hoping to discuss the medical examiner
section of the Bill. Is this an appropriate point to raise
that?
Q
110The
Chairman: Absolutely. The fact that you have not been
asked a question about it does not mean that you cannot answer
it.
Professor
Furness: We are very concerned about the way that
this has been proposed. We strongly support the medical examiner system
but it needs to bridge the health services and the coroner services. At
the moment, we are not convinced that the balance is right. As
described in the Bill, medical examiners are essentially to be
appointed by primary care trusts and will be responsible to them. There
is nothing on the face of the Bill about that linking into the coronial
system.
I know that
concerns have been expressed about the independence of medical
examiners. I understand that, but we feel strongly that medical
examiners must have strong links to the national health service in
order to support clinical governance and ensure that they are linked in
and can feed material back to the NHS. We are not disagreeing with
that, but we had hoped for much better links to the coronial system. We
know that it is proposed—although it is not in the
Bill—to have a national medical adviser to the chief coroner. We
hoped that that individual could play a role in harmonising the way in
which medical examiners work, much as the chief coroner is asked to
harmonise the way in which coroners work. As we understand it, that
link has not been made.
We also hoped
that the medical examiners would have a strong role in providing a
first line of medical advice to coroners locally, and that the two
would work together and provide a seamless system. Although that may be
expressed as a wish, it does not appear to be set
out in any way. As far as I can see, coroners are not involved in the
appointment or governance of medical examiners. Another
practical point is that medical examiners will be doctors and the
General Medical Council will have to recertify their expertise. How is
that going to be achieved? We hoped that that would all be done through
the office of the national medical adviser to the chief coroner, but we
do not see anything that reassures us that those links and connections
will actually be made. Perhaps it does not need to be on the face of
the Bill, but that leaves me a little worried. The medical adviser to
the chief coroner will need powers to carry out the sort of roles that
we hope he will perform. If he needs powers, perhaps that should be
more explicit.
Q
111Mr.
Bellingham: If you look at clause 19, you will see that
the Secretary of State will be able to make a lot of regulations. In
fact, throughout chapter 2 there is a lot of talk about regulations
that can be made under statutory instruments. Maybe we have a skeleton
here, but it needs to be built on
substantially. Professor
Furness: I have had discussions with members of staff
in the Ministry of Justice, which, although informal, led me to believe
that this connection was not planned in those regulations. If that
position changes, I will be delighted. Perhaps it does not need to be
in the Bill; my concern is that the links need to be there and
functioning when the system is
working. Alison
Cox: May I make one more point, to endorse what I
said? To offer bereavement support is extremely expensive because it is
very time-consuming, and I would hate the coroners to feel that they
were going to have to offer extra services of that sort to the family.
I did not mean that when I said that things could be improved in the
coroner service. To further Helen’s point, the families could be
referred to the appropriate support groups for that
service.
Q
112Jenny
Willott: A lot of the changes to the certification of
death and so on have come in the trail of the Shipman case. Are you
satisfied that the proposals in the Bill do enough to solve the
problems highlighted in that
inquiry? Professor
Furness: I think that the development of the medical
examiner system would do more to prevent or at least catch early the
next Harold Shipman than all the work that the British Medical
Association is doing on medical re-certification, and it would cost a
lot less. I am strongly supportive of that, but I remain concerned that
there is the potential for generating great variation across the
country in how these people work, because of the lack of an overall
management system, and I would like to see that
resolved.
Q
113Jenny
Willott: So a similar system to the one proposed for the
chief coroner with, as you said earlier, enough power divested in both
the chief coroner and the national medical adviser to enforce much
clearer national
standards. Professor
Furness: I see the relationship between the chief
coroner and the coroners being paralleled by the relationship between
the national medical adviser, the chief coroner and the medical
examiners.
Q
114Mr.
Boswell: Presumably it would help if they were co-located,
or at least able to talk to one another from time to
time. Professor
Furness: The location of medical examiners will need
to be planned carefully to deliver a speedy service and not delay
burials.
Q
115Mr.
Boswell: At the national level as
well. Professor
Furness: Yes
indeed.
Q
116Mr.
Boswell: On the certification points, you referred to the
quinquennial certification of competence by the GMC as being welcome in
general terms, but you emphasised the different weight you gave to the
importance of that matter. What I am not clear about is whether you
were saying that under the present concept the GMC would look at the
person’s competence as a doctor rather than as a registered
medical officer dealing with a particular case in connection with
coroners, and that the specific expertise would not be examined
sufficiently. Professor
Furness: If I understand you correctly, in specific
relation to the Shipman case, Harold Shipman was an intelligent doctor
who was much liked by his colleagues. It was the statistics that should
have caught him much earlier, because he was doing his own
certifying.
Q
117Mr.
Boswell: So you need a bag of skills that is precise and
that is regularly renewed and testable as being
so. Professor
Furness:
Yes.
Q
118Dr.
Brian Iddon (Bolton, South-East) (Lab): May I ask the same
witness how much attention he thinks we should give to providing the
medical examiner with detailed accounts of what
medication—whether legal or controlled drugs—the person
was on immediately prior to death, bearing in mind that quite a number
of people now purchase their drugs through the
internet? Professor
Furness: I have been involved with staff in the
Department of Health and with the Academy of Medical Royal Colleges in
drawing up proposals for training medical examiners and for the
procedures that they will in general terms be expected to follow. We
have anticipated that they should have complete access to the medical
records and details of any prescribed drugs. In relation to access to
details of other sorts of drugs, if you are referring to illicit drugs
being involved in the cause of death, the medical examiner should
surely refer such a case immediately to the coroner and not try to
investigate it him or herself. Similarly, if a noxious substance may
have contributed to someone’s death, the medical examiner should
not be examining that case—it should be passed to the coroner,
and I suspect Mr Rebello would agree with
that. André
Rebello: This is a separate point but I would be
grateful if the professor would comment. I heard of a case the other
day where a family were disgruntled and dismayed. A relative had died,
and after the medical practitioner had written the cause of death down
on the death certificate, the family pushed for a post mortem. There
was one, which revealed a different cause of death. However, the
registrar could not change the original cause of death on the
certificate; he could only add an annexe or an addendum. The family
have told
me that that has caused great distress, because the post mortem revealed
that he died of a particular cause. It just completely staggers them
that the change cannot be made on the certificate. I would be grateful
if the professor could comment. Is it something we should be looking
at?
Professor
Furness: My understanding is that the proposed
reforms should resolve that sort of situation, in that the death
certificate will initially be filled out by the certifying doctor, but
will then be passed to the medical examiner for scrutiny. That scrutiny
will involve discussion with the relatives, if appropriate, so that
concerns could be raised at that point, before the certificate of the
cause of death was finalised. In terms of gathering national
statistics, there is already a route through which additional findings
as to the cause of death can be fed appropriately into the statistics.
However, I defer to your experience of what happened in terms of what
was written on the piece of
paper. Of
course, the other aspect is that if the relatives are concerned that
the cause of death is inaccurate, that could well be a good reason for
the medical examiner to refer the case to a coroner for appropriate
investigation, depending on the discussion that happened at the time. I
would hope that the medical examiner would be in a position to discuss,
mediate or resolve problems and avoid the whole scenario that you have
described, to the benefit of all concerned.
Q
119Mr.
Bellingham: That is helpful, if a certificate has already
been issued with the cause of death on it. I am talking about having
that certificate changed.
Professor
Furness: In future, the certificate would not be
issued until the relatives have had the opportunity to discuss it with
the medical examiner. One of the key questions the medical examiner
will be expected to put to the relatives is whether anything on the
proposed death certificate is a
concern. André
Rebello: Coroners since 1887 have become inventive
and imaginative, because we have had to make the law fit the era in
which we work, and not Victorian times. If that scenario happened in
Liverpool, given that I am co-located with the registration service,
once a death has been registered, the registrar’s rules say that
the registrar can only put a marginal note in if there is a correction.
What I would do in those circumstances is hold an inquest after
ordering the post mortem and before getting the result. I would then
use the result to conclude the inquest, and a new death certificate
would supersede the old one. That is possible now, and it would be even
more possible with the Coroners and Justice Bill. Those sorts of
practices will be one way to fix an error, if the registration system
is not changed so that errors of that nature can be
altered. There
is no point in giving a family an old death certificate with lines
drawn through it and marginal notes around the outside. The family want
“the” cause of death, not “any” cause of
death. It is fixable now, certainly in my jurisdiction, because of the
resources that Liverpool gives me, because I am co-located with the
registration service, and because you can be imaginative by ordering
the post mortem, not knowing the cause of death and opening an inquest.
You then get the cause of death and conclude the inquest. It is a
fiction, but it is a way of correcting the death certificate. That will
be possible in the future.
Deborah
Coles: Can I just mention something that André
touched on earlier, which is not in the Bill at all, namely the
question of public funding for families to be represented at inquests,
particularly in those cases involving public authorities or article 2
cases. I raise that because we welcome the fact that the Government
have recognised the rights of bereaved people through this process and
the importance of ensuring that families have access to information
about how to negotiate the coroners’ inquest system. But there
is nothing in the Bill about non-means-tested public funding for
families, which is in stark contrast to the situation of
Government-appointed lawyers, who represent the state at inquests all
over the country and who are paid for out of public funds. You can have
a situation such as André described where you have counsel
representing the state interests, while the family are unrepresented
and alone. Although there is exceptional public funding, it is
extremely difficult for families to access. It is means-tested, which
essentially means that anyone living in London who happens to own their
own home does not qualify. That is something that causes untold
distress. We have had families who have withdrawn from an inquest,
which, after all, is what they have been given as their opportunity to
find out what happened. But they have withdrawn from the process
because it is so intrusive and bureaucratic. I urge the Committee to
give that some attention, because we feel strongly that that would go
towards making the inquest system a much better one for bereaved
people. André
Rebello: I have three short points. The first is that
I support Professor Furness with regard to medical examiners. I am sure
that the statutory instruments, regulations and guidance will ensure
that coroners are involved in medical examiner appointments, because,
unless there is a close relationship, the new system will not
work—certainly the Coroners Society will make sure that it
works.
Secondly, I
have concerns regarding matters to be ascertained at an inquest in
clause 5, because the draftsman has taken the words of Lord Bingham in
the Middleton case and enshrined them in clause 5(2). If the House of
Lords or the European Court were to in future change what is necessary
for convention rights to be recognised in the inquest process, this law
will be out of date. It is far better to leave clause 5 as
“how”, where how means in some inquests “by what
means” and in other inquests “by what means and in what
circumstances”, if article 2 of the European convention on human
rights or other articles of the Human Rights Act 1998 are engaged, to
enable the common law to develop that area of human rights legislation.
The human rights legislation came in and by enshrining in what
circumstances in this statute, if the House of Lords found that article
2 required something different, coroners would be stuck with the
statute because of the primacy of Parliament.
The
difficulty that I see is that there would then have to be a public
inquiry in each and every case to deal with the procedural obligations
on the states to comply with treaty obligations under human rights
legislation. It would be far better to leave out clause 5(2), so that
“how” means whatever the common law says it means for the
time being. If we are now reforming the 1887 legislation, I am fairly
sure that in 2051 the law will have developed somewhat, and I do not
think it right to tie the hands of the European Court and the House of
Lords with regard to developments.
At the moment,
we have a two-tier system. It may well be that one of those is the
right system for all, and it may well be that the law needs developing.
We do not know what Europe will say. I am fairly sure that Coroners
Bills are not like buses—there will not be another one along in
a minute. I advise very strongly that clause 5(2) should be left out,
because this Bill complies with convention rights—it says so at
the front. Therefore, “how” means whatever it means for
the time being.
The other
point that I raise—it is very personal to my
jurisdiction—is that of anonymity and investigation provisions,
whereby justices of the peace can make a witness anonymity order. Rhys
Jones was killed in my jurisdiction, and a person has been convicted of
murder and is serving a life sentence. Had that person died in custody
before trial and had people giving evidence against him had one of
these orders made because they were members of a gang, where would I go
to hear the full evidence when I had to hear an inquest as to the means
and circumstances in which Rhys had died to give justice not only to
the family, but to the whole community? This provision was spotted in
the back of the Bill, and there has been no consultation with regard to
it. Once a justice of the peace has made that order, the criminal
process can stop for many reasons, including the accused dying or some
other reason why the trial cannot go ahead. Currently, under section
16, the coroner would resume the inquest and the coroner’s
jurisdiction would hear by what means and in what circumstances that
cause of death has
arisen. Are
coroners going to be designated as people involved in public
administration, so as to be able to be given that information, if such
an order has been made? At the moment, we can deal with public
privilege immunity—section 11 deals with secret inquests. There
is a sliding scale in that respect, and it is a judicial function to
decide whether such matters are heard behind closed doors and whether
some people are excluded or not excluded. In extreme cases, a full hit
will be needed, but no one has yet been able to give me one example
where that would
apply.
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