Coroners and Justice Bill

I have added my name to the amendment that has already been discussed by my noble friend Lord Alton, and I should like to add a little more to the points that he made. We have been told that the role of the medical examiners will be to feed into the governance processes and to detect failings in care and drive up standards of care within the jurisdiction of a PCT area. However, one problem is how to define a natural death and how to decide whether the death is natural but has been brought forward in time or whether it has occurred because of clinical non-responsiveness—I shall not say "negligence", as that is too strong a word, but I am referring to whether something could have been done to avoid the death. A classic example is death in childbirth. Medical science now means that very few women, but still too many, die in childbirth in this country, but of course in many other parts of the world a catastrophically large number of women still die in that way. When these deaths are investigated, some of them are, sadly, found to be due to medical negligence. Examples are where, for whatever reason, a woman has not been oxygenated during a caesarean section under anaesthesia, where the response to something such as a catastrophic haemorrhage has been too slow or where the management of labour has led to some complication which, although rare, does occur, such as a ruptured uterus and the catastrophic events that follow that. These are so-called natural deaths but certainly they are totally unexpected and potentially avoidable. I can of course understand why you cannot define "natural" or "unnatural" clearly in the Bill; it is understood in the way that you speak about things. The other reason for having a public interest test is that deaths which are due to, for example, infection or environmental issues gradually come to light as a clustering of deaths occurs. As these deaths unroll, the investigation focuses not so much on one individual but on a group of individuals. We have recently heard about swine flu in Mexico, where the mortality rate has been particularly high. It seems that that may be due to the high arsenic levels in the groundwater. That has meant that there is a degree of subliminal arsenic poisoning in the population which inhibits people’s immune system and makes them more vulnerable to the severe effects of swine flu. Therefore, they have died whereas others who have not been so exposed have come through the infection fine, with no adverse sequelae. Where there is a clustering of deaths, the coroner has to be able to investigate them, not so much for the individual but because of the public interest. With time, we may well find that something such as environmental toxins causes a clustering of deaths, because we do not know what lies ahead. I am sure the Minister will say that there is great sense in not putting lists in legislation. If you make a list, there is always the problem of what is to be left out. I would simply commend to him the concept of public interest. It would underline the governance role that has been emphasised in some of the reforms of the coronial system.