| Previous Section | Back to Table of Contents | Lords Hansard Home Page |
6.45 pm
67: Clause 20, page 13, line 43, leave out from “consequence” to end and insert “of—
(a) provision made by regulations under this Chapter or by Coroners regulations, or
(b) provision contained in, or made by regulations under, Part 2 of the 1953 Act as amended by Part 1 of Schedule 19 to this Act.”
Clause 20, as amended, agreed.
Amendments 68 and 69 not moved.
70: After Clause 20, insert the following new Clause—
“Cooperation between coroners and inquiries by statutory regulatory bodies
(1) The Care Quality Commission and its successors may request the cooperation of a senior coroner in the course of their investigations under the following circumstances—
(a) they are fulfilling their investigatory duties in accordance with the Health and Social Care Act 2008 (c. 14);
(b) there is reason to believe that a senior coroner has conducted an investigation which may be connected to an ongoing investigation by the Care Quality Commission as authorised under the Health and Social Care Act 2008;
(c) the senior coroner has been notified of a death of which a medical practitioner is aware, under section 18, which may be connected to an ongoing investigation by the Care Quality Commission.
(2) If a senior coroner receives a request under subsection (1), the senior coroner is required to cooperate with the request, and provide information including all relevant documents, subject to regulations made under subsection (3).
(3) The Secretary of State may by regulation—
(a) prescribe a period within which the requirement is to be complied with;
(b) prescribe cases or circumstances in which the requirement does, or does not, apply, and may in particular provide for the requirement not to apply during a period of emergency.
(4) All cooperation between a senior coroner and the Care Quality Commission must include the provision of all data gathered in respect to the provision of section 20.”
Lord Alderdice: Amendments 70 and 71 relate to the relationship between coroners, medical examiners and statutory health inspection organisations. This arises because of a difficulty mentioned by the Mid Staffordshire inquiry, which said that it had not received any co-operation from the coroner. This made it difficult to carry out a thorough investigation. The inquiry said:
“We considered that information from the coroner would be useful for the investigation. We were disappointed that he declined to provide us with any”.
I do not suggest that this is common practice. Nor do I suggest that when there are new medical examiners they will, as a matter of course, take that approach.
23 Jun 2009 : Column 1519
There is no reason to believe that this would present coroners with huge extra work. These are not particularly common matters. Indeed, as I say, we do not mean by these amendments to suggest that it is common practice that coroners do not co-operate. However, the Mid Staffordshire inquiry was a case where having access to the coroner’s records would have helped to identify cases where people died of preventable or negligence-related causes, connected to the processes and understaffing that were identified in the report. For that reason, I beg to move.
Lord Bach: I thank the noble Lord for moving what I take to be a probing amendment concerned with the premature deaths at Stafford Hospital between 2000 and 2007. The Committee as a whole will want to express its regret to the families involved. At the time, as a report by the Care Quality Commission—then the Healthcare Commission—made clear, many of those deaths could and should have been avoided, frankly. The breakdown of which the noble Lord speaks between the commission, tasked with investigating the series of deaths, and the coroner, who had investigated some of the individual deaths at the time they occurred, was a perfect example of how those with related statutory responsibilities do not always work together effectively. That may be something of an understatement.
We will agree that we need to tackle that matter. One way is the enforcement route, down which the amendment might take us. However, existing measures in the Bill will address the issues raised by the case. The first important reform is that every death that is not automatically referred to the coroner will be scrutinised by one of the independent medical examiners checking the information given in the medical certificate as the cause of death. They will work closely with the clinical governance teams in primary care trusts and local health boards to collate key information on causes of death and use it to analyse trends and uncover unusual patterns. We believe that the high mortality rates among patients receiving care at Mid Staffordshire National Health Service trust would almost certainly have been identified by medical examiners.
Under current arrangements, with no medical examiners in post, it was for the doctors at Stafford Hospital to decide whether to report deaths to the coroner for investigation. Under Clause 18 there will be a duty for doctors, wherever they are based, to report certain specified deaths to the coroner so that
23 Jun 2009 : Column 1520
Secondly, the national leadership role provided by the Chief Coroner, who will be able to liaise between coroners and organisations such as the Care Quality Commission, will help investigations to proceed smoothly. The Chief Coroner may also issue guidance to all coroners in relation to requests for information and may even intervene where there are disputes. With the assistance of his or her national medical adviser, the Chief Coroner will be able to identify unusual trends and pass on that information to those with an interest as well as publishing pertinent information in an annual report. We also expect that the Chief Coroner would want to review how coroners held information. That was a related difficulty in the Stafford case and we seek to make the systems used more efficient and consistent.
Finally, coroners in particular interact with a number of investigating authorities, all of which have their own statutory responsibilities. Mostly it is the coroner who is dependent on those authorities’ reports before he or she can decide how to proceed with his or her own investigation. There are difficulties sometimes. The Coroners’ Society does its best to sort out those difficulties and has skilfully negotiated protocols that govern the relationships. That is something that we intend the Chief Coroner will take forward in the future, but the Bill does not propose to place those various interactions on a statutory footing, although I know that the amendment suggests that we should do so.
I turn to the different position of medical examiners in relation to investigations by the Care Quality Commission. The Health and Social Care Act 2008 already gives the Care Quality Commission a number of powers that it is able to use for the purpose of carrying out its regulatory functions, which include carrying out investigations. As the noble Lord is aware, medical examiners will be appointed by the primary care trusts in England. Regulations under Section 65 of the 2000 Act allow the commission to require explanations from a chair, director or employee of an English NHS body, therefore enabling the commission to require explanations from primary care trusts in respect of the work of medical examiners. We are looking at whether those regulations need to be amended to allow the commission to require an explanation directly from a medical examiner.
The 2008 Act also gives the commission the power to require any information, document and records, including personal and medical records or other items that would include the provision of data, from English NHS bodies as well as the power to enter and inspect premises. The Act makes failure to comply with a requirement imposed by the commission an offence punishable on some reconviction to a fine not exceeding level 4 on the standard scale. The commission’s remit does not extend to Wales, but similar functions are conferred on Welsh Ministers by the Care Standards Act 2000 and by another piece of legislation.
23 Jun 2009 : Column 1521
I thank the noble Lord for this short debate. We are not persuaded of the need to make express provision in the Bill for medical examiners to co-operate with inquiries conducted by the Care Quality Commission; existing powers suffice. I hope that that response will satisfy the noble Lord.
Lord Alderdice: I am grateful to the Minister for his expansion and response, and particularly for his pointing up that the existence of a Chief Coroner is in a sense a port of call for the Care Quality Commission or for an inquiry should a coroner not accede to co-operative engagement. I take it that that is the impact of what he is saying. This is one of the Bill’s important developments. If I have understood that correctly—I see that the Minister is nodding—that is an important point that we hope would not be necessary, but the fact that it is there may make it unnecessary because people know that there is that possibility.
I am grateful for the Minister’s clarification that the Government are looking at regulations, so that in respect of medical examiners the Care Quality Commission would be able to press for co-operation and for people to produce material. I want to look at what the Minister has said in some detail, but if there is already progress in regard to proposed changes of regulations I would be grateful if it were possible to have sight of it at an appropriate time. With that appreciation and response I beg leave to withdraw the amendment.
72: After Clause 20, insert the following new Clause—
(1) Where two doctors have to sign the medical certificate to allow cremation of the body or of human remains, both doctors shall retain a copy of the certificate for a minimum of 15 years, and shall supply the relevant copy or copies to the Medical Examiner on request.
(2) The second doctor signing the certificate shall have access to the clinical record that was maintained by the doctor who signed the death certificate.
(3) The Medical Examiner shall maintain a register of the first and second doctors signing certificates to authorise cremation.”
Baroness Finlay of Llandaff: I can be brief with the amendment because I have already received a lot of assurance from the Minister relating to it. The idea behind the amendment was to try to do something about the appalling quality of the examination that occurred when cremation certificates were filled out. I am delighted to see the end of what used to be called ash cash. It was completely wrong; it seemed completely inappropriate that when one had been qualified for a short number of years, one was suddenly able to graduate to receive this additional source of income. It is important that the examination of bodies to detect whether something has gone wrong is undertaken in a more appropriate and systematic way. The current
23 Jun 2009 : Column 1522
Lord Tunnicliffe: The amendment relates to the certificate signed by doctors to enable a body to be created. The system will be entirely replaced by the medical examiner system of scrutiny and medical certificates of cause of death. In the current system two separate medical certificates are required for cremation, which are checked by medical referees. These certificates will continue to be kept according to the relevant storage policy after the new medical examiner system is in place. They will remain available for inspection if required.
In future, medical examiners will scrutinise the medical certificates of cause of death for all deaths which are not referred to the coroner, whether the disposal is due to be by cremation or by burial. They will have access to clinical records as part of the scrutiny process. The full record of this process will be retained by the medical examiner’s office for clinical governance purposes. The terms and period of record keeping for this system will be determined as part of the implementation process. That is yet to be determined but I reassure the noble Baroness that it is highly likely to be for at least 15 years. In the light of my explanation, I hope that the noble Baroness, Lady Finlay, will agree to withdraw her amendment.
7 pm
Baroness Finlay of Llandaff: I appreciate the Minister’s response. However, I suggest that the Government consider that a duplicate should be kept by the doctor who has signed the certificate to form part of his or her appraisal process and appraisal folder, as the way they have filled out these certificates and undertaken examinations can be ascertained and gone into in a little more detail during the appraisal process than simply by looking at the certificate itself. In the mean time, I beg leave to withdraw the amendment.
Clause 21 : Investigations concerning treasure
Debate on whether Clause 21 should stand part of the Bill.
Lord Bach: I oppose Clause 21 standing part of the Bill.
The investigation of treasure finds is a small but historic part of a coroner’s responsibilities, dating back to the 13th century. It is carried out on behalf of our national museums, those enthusiasts who spend their weekends scouring the countryside with their metal detectors, and very occasionally those people who have been lucky enough to find objects of value when digging in their own garden. Many areas in England and Wales are particularly rich in treasure
23 Jun 2009 : Column 1523
The government amendments that I intend to move in due course introduce a national coroner for treasure for England and Wales, which will help to improve the efficiency of the treasure investigation system. These amendments largely replicate the provisions for a coroner for treasure that were contained in the draft Coroners Bill, published in 2006. Following the consultation on those draft clauses and further reflection we have made a number of changes to the original proposals, and I hope the House will agree that the package set out here will achieve the best results for both treasure finders and the coroner system as a whole.
To put the amendments in context, in 2008 there were 610 treasure cases reported to local coroners: 610 investigations where the local coroner could have been investigating deaths. As my noble friend Lord Howarth of Newport and the noble Lord, Lord Redesdale, indicated at Second Reading, there have been areas around England and Wales where treasure cases have taken a particularly long time to resolve, falling outside the target time of 12 months to complete all aspects of the process in the Treasure Act 1996 code of practice. Establishing a coroner for treasure will help to expedite treasure cases but also enable local coroners to concentrate on their core responsibility for the investigation of deaths. The coroner for treasure, with his or her assistants, will be able to investigate each treasure case more expeditiously than a local coroner can, which will reduce the time taken for each investigation as well as improve the confidence that finders and landowners have in the system.
The new clauses introduce the distinction between investigations and inquests, so that treasure investigations have a similar structure to the reformed death investigations. It will still be possible for the coroner for treasure to summon a jury for a treasure inquest, although the starting position will be that one is not required, as I understand is almost always the case at present.
The new clause to be inserted by Amendment 84 provides for an exception on the duty of the coroner for treasure to investigate an item under the Treasure Act. This would be where the Crown, or the franchisee, if appropriate, did not want the item, even if it were found to be treasure or treasure trove. At present, although an item may be disclaimed at any time, there is no power for a coroner not to proceed with an inquest. Since the coroner will return the item to the person who found it, it effectively means that an investigation has been wasted. In the reformed system, the Secretary of State would need to certify to the coroner for treasure that the item is disclaimed, and the coroner will then return the item in accordance with the treasure code of practice.
The new clause inserted by Amendment 85 allows the code of practice made under the Treasure Act to cover situations where items are disclaimed, and closes the loophole where the coroner for treasure—the local
23 Jun 2009 : Column 1524
We believe that government Amendments 84 and 85 cover similar ground to Amendment 73 in this group in the name of the noble Lord, Lord Brooke of Sutton Mandeville. In view of this, I hope that the noble Lord will be satisfied with the outcome and will agree to withdraw his amendment.
One of the reforms in the draft Coroners Bill, published in 2006, was that there would be a duty to deliver an object to the coroner for treasure if a person was in possession of it. This was to prevent cases where a proportion of the find was kept for the finder’s own gain; failure to deliver the object would have been an offence under the Treasure Act. Our Amendments 86, 88 and 89 tackle this issue in another way.
The coroner for treasure is given the power to order a person to give evidence at an inquest, provide a written statement, produce documents, and produce other items for inspection, examination or testing. This will include not only the item being investigated but any supporting evidence. This will ensure that the investigation is as thorough as possible. Finally, Amendment 212 extends the time limit for prosecutions under the Treasure Act.
I am aware that there have been difficulties with the usual six-month time limit, given the time taken to complete treasure investigations. I believe that the reforms will speed up the investigation process, but I am persuaded that there is a need for the time limit to be extended, by way of a certificate from the prosecutor, to a maximum of three years. This will allow any determinations of whether the item is treasure to take place where necessary.
Other government amendments in this group make provision for, inter alia, the appointment of the coroner for treasure and assistant coroners for treasure, for their training and inspection and for appeals against their decisions.
I hope that noble Lords who are involved in heritage issues—I see that a number of them are present—and interested in treasure will agree that this package of reforms is comprehensive and addresses the issues which currently affect the system. The reforms will encourage better reporting of finds, but more importantly they will help treasure investigations to be concluded more expeditiously, to the benefit of the finder, the landowner, and not least the general public, who may see the item on display in a museum.
When the Question that Clause 21 stand part is put, I shall invite the Committee to vote against it.
Lord Redesdale: I rise to speak to Amendment 74 standing in my name and that of the noble Lord, Lord Howarth of Newport. I welcome seeing so many members of the All-Party Parliamentary Archaeology Group present. This issue is of particular concern to the archaeological community. It would be churlish of me not to welcome the government amendments concerning the coroner for treasure. I believe this provision will make life a great deal easier throughout the country and cut costs for local authorities, which
23 Jun 2009 : Column 1525
I am, of course, particularly grateful for Amendment 212, which increases the time during which these issues can be dealt with. When the scheme was not working as well as I hope it will, the six-month limit was far too short. There would be a slight problem with six months even in some cases where there is disputed ownership between the landowner and the metal detectorist. The longer period is welcome.
| Next Section | Back to Table of Contents | Lords Hansard Home Page |