Coroners and Justice Bill

I speak in support of the noble Baroness, Lady Finlay of Llandaff, in respect not only of Amendment 41 but of Amendment 43 and of Amendment 44, which is in my name and the name of my noble friend Lord Thomas of Gresford and is in this group. I also declare an interest, as I have before, in that my wife is a consultant pathologist in the National Health Service, though not one who does work for the coroners. Over the last number of years there have been a number of substantial changes in pathology services and the way in which they are conducted which might not come immediately to your Lordships’ minds. The human organs inquiry was referred to earlier. I can remember before that time when I was a young doctor and the Government’s ambition was to ensure that post-mortems were conducted in 10 per cent of all deaths in hospital as a form of audit. Essentially the post-mortem is the final determinant of what has happened, at least in terms of the physical death. Since the human organs inquiry, not only has a figure like that not been remotely achieved but things have gone completely in the other direction, so that now it is extremely difficult to persuade people to have post-mortems conducted. Of course persuasion is not required in coroners’ cases because the decision is a matter for the coroner. Generally, however, the percentage of deaths in hospitals upon which post-mortems are conducted has absolutely plummeted to the point where it is now difficult for trainee pathologists to do enough post-mortems to get proper experience before they qualify as pathologists. That is why Amendment 43 is relevant. It will ensure that where post-mortems are conducted, and required to be conducted by the coroner, they can be used for training purposes. We are getting to a point where the Royal College of Pathologists has to look at whether it should require so much experience of post-mortems in pathologists’ training. If it were to change, we would not be able to train people as pathologists at all in some cases. Noble Lords may also not be aware that not all members of the Royal College of Pathologists are medically trained. Nowadays it is possible to be a member of the college with scientific training. One reason for this is that, as we become more specialised in various kinds of investigation, scientific training may enable someone to be acutely aware of particular approaches to an investigation. What they will not be aware of—in contrast to a doctor, who is trained in all aspects of the body and mind—is that various disorders may make their appearance in one part of the body, with symptoms of various kinds, when the origin of the problem is somewhere else. I suspect that a number of noble Lords will sometimes get pains in their legs, only to be told by their general practitioner that the problem is in their back, and what they have is referred pain. Sometimes there are also psychological reasons for sore backs, but that is another matter that I will not go into. It is frequently the case, in all aspects of medicine, not least pathology, that a proper, full assessment is a time-consuming business, and a medical or other professional colleague may say something like, "Would you cast your eye over this? Do not spend too much time on it, I just want your best guess". That is not good enough, which is why professional bodies have gone to considerable trouble to set out the fullness required for a proper assessment, whether a post-mortem or another kind of assessment. There is great pressure on people both to do a full assessment because it is the right thing to do, and to do things quickly and briefly because that is where financial and time-resource pressure comes. I can imagine a situation where coroners would think that they have seen a particular investigation done on a number of occasions, would decide that it is the suitable one to do and would proceed to do it. There may be a concentration on radiological investigations. However, that is not what the Bill says; it refers to a partial post-mortem or a "particular kind of examination". That could be anything—it could be a fine-needle aspiration or any other kind of investigation. The question is, how does one judge whether a partial post-mortem or another kind of investigation will give an accurate understanding or a partial and misleading understanding of what has gone on? Some noble Lords have commented that if someone, for example, has a bullet through their head, it is pretty clear how they died. Well, it may or may not be. They may have died before they got the bullet through their head—looking at the brain is not necessarily going to tell you what has happened. There are many cases of people being fished out of water, but drowning did not kill them—they were dead before they hit the water. We have to be very careful in these cases not to take a simplistic view. We ask pathologists to look at these things properly so that we get the proper answer, not just a glance at the problem. We must be careful. That is why I tabled an amendment very similar to that of the noble Baroness, Lady Finlay of Llandaff, saying that if a coroner feels that it might be appropriate to engage in a particular, lesser form of investigation—whether a partial post-mortem or another type of investigation—he or she can do so, but they should ask somebody who is medically trained and qualified. The requirement is that the investigation be conducted not by somebody who is medically qualified—that is clear in the Bill—but by somebody who is appropriately qualified. The appropriate qualification for certain kinds of investigation might be scientific rather than medical. If we are going to continue to depend on coroners to get to the root of the problem, I am encouraged by the fact that the Government have now included the idea of developing the service of medical examiners, but we must make sure that they are fully used to ensure that the particular and partial forms of investigation that are done are adequate ones that will give us the results that we need.