Coroners and Justice Bill
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 workindeed, 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Amendment, by leave, withdrawn.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.
Power 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 circumstancesfor 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
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 onplaces 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 coroners 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 undertakers 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. Gentlemans 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 Railtrackor Network Rail, I should saywill 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
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 Smiths 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 examiners 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
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 employersI 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.
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.
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
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.
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 raremuch 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 coroners court. This issue needs to be looked into as concerns have been raised by a wide range of people.
There is potential in the Bills 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
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 reasonI hope that this answers the hon. Ladys final concernthat 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
Finally, it does not follow that the chief coroner should be head of the medical examiner service. It is the job of coronersand therefore the chief coronerto 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 Reportcertainly while the Bill is undergoing its parliamentary processI 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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