Dr.
Iddon: Based on those reassurances, which are now on the
record, I am prepared to withdraw my amendment, but I hope that my hon.
Friend the Minister and her civil servants will try to expand the
non-invasive post-mortem service, which has been proved to work over
five years. Despite some criticisms, it does work—indeed, in
only one or two cases does it not work and a full pathological
examination follows. I thank my hon. Friend for her comments and I beg
to ask leave to withdraw the
amendment. Amendment,
by leave, withdrawn.
Clause 15
ordered to stand part of the Bill.
Clause
16Power
to remove
body Question
proposed, That the clause stand part of the
Bill.
Jenny
Willott: I have a couple of points to make about the
removal of bodies. In some cases, the body might be in difficult
circumstances—for example, on a railway line or protected land.
Some coroners insist on using their own preferred undertaker to remove
the bodies, whether or not the undertaker has been trained in, for
example, health and safety procedures if they are
dealing with a body on a railway line. That has been raised with me as a
concern, because it can threaten the safety of the site where the body
is located and of the people operating in that area. It can also lead
to longer closures and unnecessary disruption to, for example, a
railway line if the job is being done by someone who is untrained and
does not know how to work in those particularly dangerous
circumstances. There
is no obligation in the Bill or in any of the previous Acts for
undertakers to have any training or authorisation. We have tabled an
amendment to a provision later in the Bill that would require a code of
practice on the powers to be given to coroners in relation to entry to
and searching and seizure of land. It would also be helpful if the
Minister considered addressing, whether in a code of practice or in
guidance laid alongside the powers to remove the body, the training
that is available or necessary for undertakers in these cases. The
number of such cases is very limited, but they are specific examples.
We are talking not just about railway lines, but about electricity
substations, power stations, airports, motorways, major roads, zoo
enclosures and so on—places where the circumstances raise health
and safety
issues.
Mr.
Boswell: I have two comments to make. The first adverts to
something that I talked about the other day, where a former employee
died on my farm, in a field. The difficulty was that because it was
located in the county of Northamptonshire, the body was removed to
Northampton, whereas it would have been much more convenient for all
the relatives and everyone else had it gone to Banbury, which is a much
shorter distance but would have entailed crossing a boundary. I say to
the Minister that although I understand that she has made provision in
earlier clauses for the transfer of jurisdiction, it is important that
that is tied up fairly early on, particularly when there are those
borderline issues, so that the process is as unintrusive to the family
as possible. There may well be a role for training undertakers and it
may well be that the coroner’s officer has some ability at least
to make inquiries at an early stage to see what would be
appropriate. My
second point relates to the provision in subsection (3)
about removal of a
body “to
a place provided by a person who has not consented to its being removed
there.” That
seems entirely reasonable. No one, to put it crudely, wants a body
dumped on them without their knowledge or consent. I realise that there
is a saving for local authority premises in the second part of that
subsection, but if the practice in, say, an area of relatively low
coronial intensity, where there were only a few cases, was to use
private sector premises such as an undertaker’s chapel of rest
or something similar, things would be difficult if that was not easily
available on a 24/7 basis. I hope that the Minister can address that
point administratively and ensure that if outsourcing, if I may call it
that, is to be applied, it is done in a way that does not create
further delay.
The common
interest, which is also shared by the hon. Member for Cardiff, Central,
is to produce as easy, unintrusive and unobjectionable a procedure in
difficult circumstances as possible. That is important both for the
process of justice and for the interests of the family, who are bound
to be feeling low when a death has
occurred.
Bridget
Prentice: May I pick up on the hon. Gentleman’s
last sentence? He said that the procedure should be as unobjectionable,
sensitive and easy as possible, not just in public policy terms but for
the benefit of the family. Of course that is absolutely right and it is
what the Bill is about. On that basis, I hope that I can reassure him
and the hon. Member for Cardiff, Central that we will consider those
sensitivities very carefully. The whole point of clause 16 is to ensure
that, where possible, the body is removed to a place that is more
appropriate for the
family. I
have not heard of the examples that the hon. Lady outlined, so that has
sent a little bee buzzing around in my brain. I shall have
conversations with the National Association of Funeral Directors and
others as to how to take this forward, and whether it needs to be part
of a code of practice.
Jenny
Willott: The Minister will probably find that
Railtrack—or Network Rail, I should say—will be happy to
speak to her about it. I know it is
concerned.
Bridget
Prentice: I will resist the temptation to say anything
sarcastic about Railtrack, but I welcome its positive attitude in
wanting to be helpful. I assure the hon. Lady that we will do what we
can. Question
put and agreed to.
Clause
16 accordingly ordered to stand part of the
Bill.
Clause
17 ordered to stand part of the
Bill
Clause
18Medical
Examiners
Mr.
Bellingham: I beg to move amendment 360, in
clause 18, page 9, line 23, at
beginning insert ‘The Chief Coroner in consultation
with’.
The
Chairman: With this it will be convenient to discuss the
following: amendment 116, in clause 18, page 9,
line 23, after ‘Wales)’, insert
‘, after consulting the local senior
coroner,’. Amendment
361, in
clause 18, page 9, line 26, leave
out ‘Each Trust or Board’ and insert ‘The Chief
Coroner’.
Mr.
Bellingham: This very important clause introduces the new
post of medical examiner. That post is very important indeed to the
future of the coronial service. It is a crucial part of the new set of
checks and balances, especially in this post-Shipman era. Dame Janet
Smith’s 600-page report on the Shipman tragedy strongly
recommended that a new post of medical examiner be
introduced.
Resources are
an issue. Touching briefly on subsection (2)(a), the
explanatory notes state that primary care trusts and local health
boards
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
functions” correctly,
properly and efficiently. What sanctions there will be on the
Department of Health in the event of
failure to meet those commitments, and what discussions has the Minister
had with her counterparts in the Department of
Health? That
is an important preliminary point, but the key issue is the
independence of medical examiners. It is wrong that medical examiners
will be appointed by the PCTs and LHBs. Amendments 360 and 361 would
make a small but significant change so that the chief coroner would
appoint a medical examiner in consultation with the PCTs and LHBs. It
is an important change that should be made because it is vital that
such an important post remains independent of the local health
service. Let
me quote the Law Society briefing that was sent to members of the
Committee. The Law Society wanted to delete the whole of subsection (5)
and to put in extra safeguards, but I think that our alternative offers
a neater way forward. The Law Society
says: “The
new position of medical examiner is intended as the bridge between the
health services and the coroner service. However as the employee of the
Primary Care Trust or Local Health Board, the medical examiner would be
acting as the filter for the death certificates provided by colleagues
in the health service. In that case he is likely to trust the judgement
of fellow medical professionals. There could also be pressure from his
employer, and the Law Society believes there needs to be stronger
checks.” I
would not say that there is a danger that the professional integrity of
medical could be compromised if they were appointed by the PCTs, who
would also be their employers—I do not accept that. However, I
do believe that the very simple extra safeguard makes a great deal of
sense. The
Minister may be a bit battered and bruised from her recent encounter on
the “Today” programme, when she was interviewed alongside
Dame Janet Smith. I thought that the Minister was her usual courageous
self.
Bridget
Prentice: It wasn’t
me.
Mr.
Bellingham: Well, a Minister was interviewed alongside
Dame Janet Smith, the editor of the Shipman report. Dame Janet made it
clear that she was very concerned and unhappy about the post of medical
examiner not being independent enough. Although she welcomes the
appointment of medical examiners and feels that it is an important part
of moving on from the post-Shipman era and using the Bill to update the
service, her criticism of the clause was founded on her view that that
medical examiners must be independent. Our clause, and its
consequential amendment, achieve that
aim.
4.30
pm
Jenny
Willott: Amendment 116, which is in my name and that of my
hon. Friend the Member for Cambridge, is trying to achieve a similar
aim to that just highlighted by the hon. Member for North-West Norfolk.
We share his concerns about the independence of the NHS medical
examiner, but we are also looking at the link between senior coroners
and medical examiners in their local area.
One of the
most important things, which was flagged up by the Coroners Society in
its evidence to the Committee, is that by taking away the right for the
coroner to be medically trained, so that now they will be only legally
trained, a number of coroners feel that it is important that they have
that easy access to medical advice. We all welcome the creation of the
post of medical examiner—it is clearly important. However,
because of the importance of the link between the coroners and the
medical examiner, it is important that they work closely
together—preferably co-located—and have a strong local
link. Our
amendment reinforces that local link by ensuring that, before someone
is recruited as a medical examiner for a particular area, the local
senior coroner has to be consulted so that they have some sort of say
in the recruitment. We can then ensure that that working relationship
is built into the system. My concern about the amendment tabled by the
hon. Member for North-West Norfolk is that it removes the local ink
entirely by giving the recruitment of the medical examiners to the
chief
coroner.
Mr.
Bellingham: “In consultation
with”.
Jenny
Willott: Yes. “In consultation with” the
local health board and the PCT. It does the opposite of what our
amendment does, which is getting the local senior coroner involved in
the recruitment rather than taking it to the level above. It is the
local link that will be
crucial. As
the hon. Gentleman said, there will be an important role for the
medical examiners in improving the death certification process and
ensuring that we do not have any recurrence of the Shipman scenario.
However, the link between the coroners and the medical examiners is a
key omission from the Bill. That issue was also raised by the Justice
Committee, which was concerned that that aspect was not sufficiently
highlighted. Will the Minister ensure that the local link between the
two services is in the Bill?
The hon.
Gentleman also raised the independence of medical examiners, which, as
he said, has been flagged up by the Law Society. However, it is quite
telling that the Medical Protection Society, which represents the
interests of doctors, is also deeply concerned about the matter. People
from both sides are concerned about whether this ensures enough
independence for medical examiners. There have been some instances
where coroners have found that their link to the local authority has
been problematic when a local authority has been implicated in some way
in a death that the coroner is looking into. However, that is
rare—much more rare than it would be with the medical examiner
and the local NHS, as the NHS is much more often involved in cases that
come before the coroner’s court. This issue needs to be looked
into as concerns have been raised by a wide range of people.
There is
potential in the Bill’s drafting for medical examiners to feel
isolated within the system. If their funding depends entirely on the
local primary care trust or health board and they are not properly tied
in with the local coroners system, they could be isolated in difficult
cases and struggle with funding. Will the Minister respond to
that?
As a Welsh
Member of Parliament, like the right hon. Member for Cardiff, South and
Penarth, I understand that local health boards will no longer
exist— [Interruption.] Sorry; and the hon.
Member for Wrexham. I understand
that local health boards will no longer exist by the time the Bill
becomes law. I am not sure whether that needs to be flagged
up. Bridget
Prentice: Now that we know how many Welsh Members we have
in the Committee, we will proceed. This is an important debate about
the independence of medical examiners. They will be appointed by the
primary care trusts and local health boards for the very
reason—I hope that this answers the hon. Lady’s final
concern—that they will then be closely involved with clinical
governance teams and establish whether patterns or clusters of deaths,
for example, give any cause for concern. They will therefore be able to
improve medical provision locally. However, clearly, they will also
have to work closely with coroners, not least because of the important
role they will play in providing coroners with general medical
advice. The
Department of Health has made it clear in its response to the public
consultation on improving the process of death certification that
primary care trusts and local health boards will involve the local
coroner in their arrangements for the appointment of the medical
examiner. Therefore, I do not think that we need to put that provision
into the Bill, as amendment 116 would do.
On amendments
360 and 361, I agree absolutely that medical examiners need clear lines
of accountability, but I am not persuaded that the amendments’
approach is necessarily the correct one. I do not think that it is
appropriate for the chief coroner to be directly involved in the
appointment, resourcing or monitoring of medical examiners, but I see
the role of the new national medical adviser to the chief coroner as
the important bridge between the two. He or she will agree the national
job description for medical examiners as well as the protocol setting
out the minimum level of scrutiny that medical examiners must complete.
The national medical adviser will also contribute to the development of
training for medical examiners and have a role in the resolution of any
disputes that arise between medical examiners and coroners.
The provision
of the medical examiner service against clear standards of service
provision will be part of the process of auditing primary care trusts
and will be carried out by the Healthcare Commission. I was a little
concerned by the comments of the hon. Member for North-West Norfolk
about the way that the medical adviser should be appointed. His hon.
Friend the Member for South Cambridgeshire (Mr. Lansley)
said in a Westminster Hall
debate: “I
have seen that Ministers wish to embed medical examiners in primary
care trusts. I think that that is the right thing to do, as it will put
medical examiners in a position where they can link their role into
performance management of primary care providers and
commissioners.”—[Official Report, Westminster
Hall, 21 June 2007; Vol. 461, c.
534WH.] That
is exactly the right way forward. We believe that it is vital that the
public are confident that the examiners will be able to carry out
independent scrutiny. The Bill provides for that in two ways. First, we
specify that primary care trusts in England and local health boards in
Wales can have no role in how the examiners exercise their professional
judgment as medical practitioners. Secondly, we are enabling
regulations to specify what is required to demonstrate
independence. We
expect that the requirements will include the definition and two
important protocols. First, a national
protocol will be prepared in consultation with the coroners, the royal
medical colleges, the British Medical Association and others setting
out the minimum level of scrutiny that must be completed for different
combinations of care setting, stated cause of death and circumstance.
Secondly, a local protocol agreed by the PCT in consultation with the
senior coroner for the area will determine the minimum distance between
the medical examiner and a death that he or she is allowed to
scrutinise. Distance in that context could refer to the nature of any
personal, professional or fiduciary relationship that the examiner and
the deceased person might have or the attending doctor or the
consultant for whom a hospital-based attending doctor works. The
appropriate distance has to be a local matter to reflect the different
configuration of the NHS in each
community. Finally,
it does not follow that the chief coroner should be head of the medical
examiner service. It is the job of coroners—and therefore the
chief coroner—to focus on violent or unnatural deaths and deaths
of unknown causes that occur in custody or other state detention. That
amounts to 115,000 or so deaths each year where a post mortem is
carried out rather than the 350,000 deaths that require no further
action. I am not saying that there is not scope for further
clarification of the accountability and leadership arrangements for
medical examiners at a national level. The Department of Health is
actively looking at such matters in the context of the health service,
and I hope that by the time we discuss the Bill on
Report—certainly while the Bill is undergoing its parliamentary
process—I can provide further detail on what the Department of
Health envisages in that context. In the meantime, I ask Opposition
Members to withdraw the
amendment.
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