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Noble Lords will be aware that we have until now used the term "national medical adviser" to refer to this role. I hope noble Lords will agree that the term "medical adviser to the Chief Coroner" makes the nature of the role clearer. In addition, it distinguishes the role clearly from that of the national medical examiner. I beg to move.
Baroness Finlay of Llandaff: I thank the Government for having incorporated in the Bill something that I think is absolutely essential for the smooth functioning of the new coronial service. I congratulate them on the wording of the amendment, for which all of us who spoke before are most grateful.
Lord Alderdice: I, too, thank the Minister, who has responded not only positively and constructively but in some detail, in the amendments and in his detailed description of them, about how the posts will come into being, qualifications, consultations and so on. I go along with the terminology that he has identified. I welcome the amendment and appreciate the Minister's positive response.
Lord Thomas of Gresford:The amendment introduces short death certificates, which omit the cause of death, to be used alongside the current system of medical certificates with cause of death. They would simply record the fact of death. The noble Lord, Lord Bach, outlined the Government's objections to including short death certificates in Committee, on IT changes and the cost implications. However, since that time I have had a Written Question answered by the noble Lord, Lord West of Spithead-in green ink; I shall consult my noble friend about that. He told me that the high-level forecast of the cost of introducing short death certificates indicated costs in the order of £130,000,
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The Government stated their intention to introduce them in their 2002 report, Civil Registration: Vital Change: Birth, Marriage and Death Registration in the 21st Century. In that report, they said that the revised arrangements for access to registration information meant that there would be a certificate that omitted the cause of death. The document mentioned that the short death certificates were a particularly popular idea among respondents to the public consultation and had been advocated by the British Medical Association since 1995.
It is important that there is an accurate record of the cause of death and that that be kept, for all sorts of purposes. But it is important to remember the position of bereaved people. There may be reasons why people would not want to share their relative's medical cause of death. Perhaps the person died of a hereditary disease, or the death may be sensitive, such as suicide, the consequence of drug addiction or alcoholism. For understandable reasons, the family may not wish to disclose these matters to others. A vast number of companies require a death certificate when they are notified of a termination, for example of a bank account. In some circumstances, when informing an insurance company, it is obviously important to give the cause of death, but telling banks, utility companies and other financial services that a person has died does not require telling them why. Ethically the obligation of confidentiality extends beyond the patient's death.
There is a balance to be struck between society's need for accurate data, which can be used for statistics and so on, and the duty of confidentiality owed to deceased people and the bereaved. Those are the circumstances that lie behind this amendment. I beg to move.
Lord Tunnicliffe: It may be in the best interests of the House if I give the Government's response now. The amendment is about the death registration system, and would oblige the Lord Chancellor to make provision in regulations for short death certificates. I fully understand the reasons for this amendment. The cause of death of a loved one is a private matter unless it is clearly necessary for an organisation, such as an insurance company, to have that information. I can well understand that its unwarranted disclosure can cause the bereaved family unnecessary hurt.
In principle, the Government have accepted the case for the introduction of a short death certificate. That remains our position. But we need to prioritise the reforms to the death registration system. Our priority in this Bill is to address the deficiencies in the current arrangements for scrutinising deaths identified by the Shipman inquiry. Implementing the reforms in the Bill will be a major undertaking. The introduction of a short death certificate would require changes to
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The difficulty that I have with the wording of this amendment is that it places an absolute duty on the Lord Chancellor to make regulations. As an aside, it is worth pointing out that the regulations should properly be made by the Registrar-General. We need some flexibility to allow us properly to sequence reforms to the death certification arrangements. If the noble Lord would agree to withdraw his amendment, I will see what I can do about bringing forward an appropriately worded amendment at Third Reading that would confer a power to introduce a short death certificate, but afford some greater flexibility as to the timing. Of course, it will be open to the noble Lord to reintroduce his amendment at Third Reading if he is not satisfied. I hope on that basis that he will agree to withdraw his amendment.
Lord Thomas of Gresford: I am most grateful for the undertaking given by the Minister. Clearly an amendment in the terms he describes would be acceptable, giving a power for it to be introduced at an appropriate moment. However, I warn him that I am sure both the BMA and I will be on the case. If that power is not exercised within a reasonable time we will return to the matter at a subsequent date. I look forward to Third Reading and the amendment that the Minister proposes, and thank him for the consideration that he and his department have given this matter. I beg leave to withdraw the amendment.
Lord Ramsbotham: I apologise for bringing this amendment forward so late in the proceedings but, I suspect like other noble Lords, I have been very concerned about the general content and tone of this Bill which seemed rather more to be a sort of patch-up rather than a new or more inspired coverage of the coroner system, bearing in mind the fact that it is 130 years since the system as a whole was last renewed.
When the Ministry of Justice issued its coroner briefing system note in January this year, it said that the Government were committed to improving the system and reforms would introduce national leadership to ensure greater consistency between areas. Paragraph 15 of the Explanatory Notes states:
The reference to "effective, transparent and responsive" caused me some concern. Looking at the history, the post-Shipman inquiries initiated by the Home Office in 2004 have already been mentioned. At that time, the Home Office brought forward proposals to create a new unified coroner and death certificate agency, which would work out of local offices but be centrally financed and managed. It would replace local authorities in the appointment and support of coroners. It appeared at that time that the Home Office was aiming at something more centralised.
However, between 2004 and 2006, responsibility passed to the Ministry of Justice, where a rethink was carried out and, instead of the centrally-financed agency envisaged by the Home Office, it stated that coroners would continue to be appointed and supported by local authorities. This prompted a sharply critical report from the Constitutional Affairs Committee, particularly on the Government's retreat from the centralised agency. This led to another rethink and to this Bill, which is really a hybrid because, if you like, it establishes a national service with local delivery. It will provide for a new national leadership but local authorities will still appoint and support coroners. I have wondered about this because, frankly, a hybrid never works as well as something which is centrally directed and run.
My next port of call was to look at the rather inadequate impact statement which came with the Bill. In that there were four options, two of which were dismissed. Option three, which is the one we have before us-the enhanced service locally based-lists a summary of savings and benefits, including greater rights for bereaved people, improvements in case handling, more effective handling of cross-district major emergencies and greater accountability through inspection arrangements. There is nothing very significant in that. However, option four-the unified national service- includes all those savings and benefits and adds effective introduction and enforcement of good practice, common standards for the public, a charter for bereaved people and a complaints/appeals process, leadership and public accountability; it would enable comprehensive, co-ordinated forward planning, resource management and efficiency savings; it would provide a single career structure for coroners and staff and allow for management of personnel; there would be a single system of medical expertise to support the service; and it would allow streamlining and modernising of investigations and inquests for greater efficiency and with more focus on bereaved people. In other words, the Government acknowledged that a unified national service actually met all the aims they were trying to achieve and I suggest, was far better than anything else that had been suggested before.
Along with a number of other people, I wondered how I could suggest that we should not accept option three just because it is the recommended option but should look seriously at option four because we are considering, for the first time for 130 years, the reform of something fundamental. I was very interested to find that among my supporters was the Local Government Association, which believes that the coroner and service should be a national service under the control of the Ministry of Justice and that councils should not be expected to manage a service where the national standards
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I also found that Mr Tom Luce, who was responsible for the first inquiry initiated by the Home Office, says that he was one of those who would have preferred a new, centralised structure as the best solution-or, at least, that support of the coroners service should have been transferred to the Courts Service, which already exists. The service would then be completely independent of the public service's responsibility for the facilities in which deaths occur, while a national agency or other centralised arrangement should be able to equalise standards and practices between different areas.
If the coroners service was transferred to the Courts Service, it would be under the aegis of the Lord Chancellor or of the Secretary of State for Justice. I then looked at the Bill again, to see whether in fact such a service would be directed by the Lord Chancellor, and provision for that is already effectively made. Clause 22, with Schedule 2, allows,
Her Majesty's court inspections are carried out by an agency that reports to the Lord Chancellor, so everything is already in place for what would seem a logical outcome with better impact, without having to go too far.
However, one has to consider the coroners themselves. I consulted one senior coroner who had always felt that coroners were in a difficult and hybrid position, because they were not part of the court system as a whole. He also commented that, unlike the remainder of the court service, coroners do not get a pension until they have been coroners for 40 years, which makes life pretty difficult for somebody who is appointed one at age 50. He also pointed out that, currently, being funded by local authorities meant a postcode lottery-because some authorities were less supportive than others-and that different coroners being paid different salaries by different local authorities was thoroughly unsatisfactory. Like other coroners, he is concerned about the clout that the Chief Coroner would have without funding.
Finally-and this was the most important part of all-he mentioned the fact that were they part of the Courts Service, they would have access to all of its facilities, the courts and other support. That would be a major factor in reducing delay, which is one of the prime objects of the Bill. Of course, it is not surprising that the Government have shied away from something which has the centralisation of responsibility and is financing a system that probably requires more cost,
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However, my purpose in tabling this amendment now is because in a Bill of such magnitude, it is unfortunate that the one issue being ducked is whether, rather than a hybrid being presented as the answer, with all the problems associated with that, the House should not have considered the other option; that is, of going for what is clearly the best solution in efficiency of outcome while being absolutely open and clear that there are limitations to this which must be borne in mind. It is therefore probably not the right time to press this any further than a discussion, with the suggestion that, perhaps having also discussed the matter with the Ministers, we might reconsider the matter at Third Reading. I beg to move.
Baroness Butler-Sloss: My Lords, I very much support the amendment moved by the noble Lord, Lord Ramsbotham. It is odd that the Ministry of Justice and its predecessors have been engaged in bringing all the different groups of those who are either judges, tribunal chairmen or judicial officers under one roof. The Leggatt reforms and the legislation passed by this House not so long ago have meant that tribunal chairmen now become judges. The tribunals right across the country which were not part of the Courts Service are now part of the Courts Service. The magistrates were a separate service; they are now, partly at least, run by the Courts Service. I believe I am right in saying that the only group of judicial officers with judicial functions who are sitting in a situation similar to a judge-except that their work is inquisitorial rather than largely adversarial-are not under the Courts Service. As far as I know, there is no other group of judicial officers that is not in the Courts Service.
There are obviously practical reasons why the Government do not want to do it. Presumably it would cost more money, but I know from personal experience that when there are very big inquests the Government foot the bill anyway. I would have thought that it was not beyond the wit of the Government-particularly the Ministry of Justice-to think of the importance of having all judges, all tribunal chairmen, all magistrates and all coroners operating under the same system. It would be a great advantage for the coroners. It would give them and their Chief Coroner added clout, as the noble Lord, Lord Ramsbotham, said. It would also be a very tidy way of dealing with every aspect of the judicial work that goes on in this country.
Lord Thomas of Gresford: My Lords, I wholly support this series of amendments. I find it quite extraordinary that the coroners service should be outside the Courts Service. I have previously told your Lordships that I spent part of my youth in a coroner's office, where I was articled, and that my principal was the coroner for Denbighshire. He sat on the Gresford
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In north Wales, we had for a period a full-time north Wales coroner. I think, although I am not sure, that there are now two-one for north-east Wales and one for north-west Wales. There are some eight local government organisations and, of course, they are subject to the Welsh Assembly. Local government is devolved, so we have a position in my part of the world whereby the coroner is selected, paid, controlled, disciplined and so on by the Lord Chancellor's department, but is also paid for by a devolved organisation. I do not know how they split it, but it is an extraordinary muddle. The only reason for this can be that the Ministry of Justice simply does not want to take on the expense of court buildings. However, magistrates' courts are closed all over the place. There are plenty of buildings and plenty of empty courts today in the Crown Court, as I am told. Certainly, in north Wales there are ample opportunities for a proper coroner service to be given to the people.
I look forward to hearing from the Minister whether there is any reason, save that of cost and budgets, which would prevent the very sensible reform proposed by the noble Lord, Lord Ramsbotham, being accepted. He has our full support.
Lord Henley: My Lords, the noble Lord, Lord Ramsbotham, asked for a discussion on this issue, so I offer my thoughts from this Front Bench. As always, I hate to be the spoiler or wet blanket-that is the Government's role on these occasions-but I cannot fully support what the noble Lord had to say, although I frequently agree with him, just as I frequently agree with the noble and learned Baroness, Lady Butler-Sloss.
The noble Lord made his case very well. Much of what he said has merit and his ideas are certainly worth considering. There are practical and logistical reasons for a merger. I know from speaking to coroners that they are concerned about pressures of space. Managing to get hold of a suitable venue can be troublesome. No doubt, the Minister will comment on that. Coroners have to take the courtrooms they can get. Many of the services, experts and facilities on which they draw are the same as those used by the Courts Service. But-from our point of view, this is a very big "but", and I think the noble Lord knows that we cannot fully support his proposals-we believe that one of the strengths of the coronial system, which is unique in many ways, is its independence. We value a service that is renowned for its tireless investigation into the cause of deaths and its deep well of practice and expertise established over many centuries. Speaking as a good Conservative, I think that is worth preserving, and I would not want to make the change for the sake of it.
That is not to say that such experience would be diminished or destroyed by implementing the changes suggested by the noble Lord, but there is always a danger of that occurring, as could be the case if a massive upheaval occurred in the way that the coroners service and the Courts Service were organised, funded
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It was good to have this brief discussion. We cannot support the proposal at this stage but, as I said, the real spoilers have to be the Government. It is their job to respond and I look forward to hearing the Minister's comments. He will do the proper hatchet job.
Lord Bach: It is much too late to do a proper hatchet job. However, there is a nice irony about this debate-I am very grateful to the noble Lord for initiating it-namely, that a Government who have been falsely accused of centralist tendencies will defend localism and a local response as opposed to showing centralist tendencies.
The amendments would make Her Majesty's Courts Service, rather than local authorities, responsible for coroner areas and appointments. In other words, they would make coroners part of a national organisation, and move away from the model of central leadership with local delivery that the Bill proposes. Our thinking on this issue has developed in a certain way. Following the reports of Tom Luce and Dame Janet Smith in 2003, we explored the option of a national coroner organisation in great detail. However, we were not persuaded that a centrally funded and operated service would significantly improve the coroners service and people's experience of it. The Bill instead preserves the existing locally delivered and funded service but strengthens it through the introduction of national leadership and national standards.
The cost of a national organisation, whether part of the Courts Service or a separate entity, would be disproportionate to the benefits it would bring, and perhaps even unaffordable. As the impact assessment published alongside the Bill shows-I do not think it is one that impressed the noble Lord particularly-we estimate that a national organisation would cost three times more than our proposed model. The approximate figures are £10 million additional funding for running costs under the Bill's scheme and at least £30 million additional funding for a more centralist model. The other argument is that the nationalised structure would take years to set up. We hope that our model will take only two to three years. Joking apart, it would also be out of step with the Government's moves in recent years towards bringing services closer to the local communities which they serve.
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