Coroners and Justice Bill

I, too, stand amazed at the expertise that we have heard from so far in this debate. I am very grateful to the noble Baroness, Lady Finlay, and other speakers for leading this important discussion on post-mortems. It may help if I start by giving a few broad, crude figures. In England and Wales in 2008, there was a total of 108, 360 post-mortems out of a total of 234,784 deaths reported to coroners; that is, 46.2 per cent. In those cases where an inquest was held, 92 per cent involved a post-mortem being conducted. In those cases where an inquest was not held, 39.2 per cent involved a post-mortem being conducted. I shall do my best to explain how the system for post-mortems is expected to work under the Bill and to respond to the points raised by these serious amendments. The decision whether to request a post-mortem examination will continue to remain a matter for the coroner’s judicial discretion. A coroner will also have discretion over whether a particular kind of examination is needed, including non-invasive examinations. I recognise straightaway how important the possibility of non-invasive examinations is to some faith groups, and I shall say a little more about those examinations later. Clause 35(1)(b ) sets out that the Lord Chancellor may make regulations, ""for regulating the practice and procedure at or in connection with examinations under section 16"," which deals with post-mortems. These regulations will be drafted with input from all those with an interest and will cover procedural matters connected to requests for post-mortems, including with whom the coroner should consult before requesting a post-mortem—for example, the pathologist or particular specialist, the medical examiner, and not least the bereaved family. While respecting the judicial independence of the coroner, the chief coroner may also issue guidance to address the considerable variations in the number of post-mortems commissioned by individual coroners regarding the deaths that are reported to them, which range from 26 per cent in some areas to 69 per cent in others. There are considerable variations in the types of deaths reported to coroners, which we shall address in Clause 18. Therefore, these figures should be treated with caution. We anticipate that guidance about post-mortems would address the circumstances in which a non-invasive post-mortem might be appropriate and those cases which might warrant a kind of "post-mortem plus". This might be appropriate when family members have concerns about a possible congenital defect if one or more family members die at an unexpectedly young age, which a routine post-mortem may not reveal. It is expected that the new medical examiners, whose primary responsibility is to confirm the cause of death entered by doctors on medical certificates of cause of death, will contribute to the decision-making process in the following ways. First, a coroner may be unsure whether a post-mortem or a related scientific examination is required in a particular case. In this circumstance, the coroner will be able to consult the local medical examiner for advice in the same way that he or she may consult the medical examiner about other issues relating to the deceased person’s medical cause of death. Alternatively, a medical examiner may refer one of their own cases to a coroner because, after consulting the treating doctor, he or she is unable to confirm the cause of death given on the death certificate. In making the referral, the medical examiner may suggest a particular kind of scientific examination which may assist, or may be consulted by the coroner about the sort of examination that the medical examiner would recommend. We agree with the noble Lord, Lord Alderdice, that there needs to be a close working partnership between coroners and medical examiners. The difficulty we have with his Amendment 44 is that it would require the coroner to consult with the medical examiner in certain circumstances. We believe that on balance such an approach would be unnecessarily rigid and could lead to delays in arranging post-mortem examinations, which could in turn lead to delays for families in making funeral arrangements. Everyone agrees that such delays would be undesirable and that accordingly it might be better to leave such matters to the discretion of the coroner. I shall set out in more detail the relationship between the coroner and the medical examiner systems during the debate on the next group of amendments on medical examiners. To attempt further to reassure the noble Lord about the improvements we expect in post-mortems, I shall say a brief word about training, on which the noble Baroness, Lady Finlay, concentrated in her remarks. At present, coroners receive training on the medical aspects of their role, particularly when they first take up post. This will continue in a reformed system. Once the new regulations in respect of post-mortems have been devised, training for coroners will be arranged to ensure that these regulations are understood and are properly applied under the reformed system. Given these intentions, and notwithstanding that coroners will retain their discretionary powers, we would expect over time to see greater consistency in the commissioning of scientific examinations. Bereaved families and those who represent their views and interests have told us that this reduction in the postcode lottery is particularly important for them. I turn to some of the specific points raised in the amendments tabled by the noble Baroness, Lady Finlay. We are concerned that her Amendment 42 would place restrictions on which members of the medical profession could carry out post-mortem examinations. Frankly, this could be wasteful of pathologists’ time by requiring them to supervise procedures that they have no need to supervise. The noble Baroness will be more aware than I that there is already a shortage of pathologists in some parts of the country, particularly in some specialisms. This proposal would spread their resources even more thinly. I listened of course to her comments on the phrase "registered medical practitioner", which she believes is a loose description, and I hope that can offer some reassurance. It is absolutely not intended that the standard of post-mortems will decline, or that those who are not properly qualified will conduct examinations, whatever form they take. I must emphasise that in most circumstances it is expected that a pathologist would conduct a post-mortem, particularly if it were a traditional invasive post-mortem; but we have heard that there are other types of post-mortem examination which it would be appropriate for a registered medical practitioner who is not a pathologist to carry out—for example, radiologists who carry out MRI scans. In our view, it would be an inefficient use of valuable pathologist resources to require, for example, the presence of a pathologist to supervise a qualified radiologist carrying out a post-mortem by way of MRI scan. Post-mortems are certainly not tasks that we would envisage being carried out by someone fresh out of medical school, although it is of course possible that some routine functions of assistance to the pathologist could be carried out by someone recently qualified, particularly as part of further training. Noble Lords may point to subsection (3)(b) of Clause 16 as a way of enabling persons other than pathologists to carry out post-mortem examinations. However, this provision is not designed to enable the Chief Coroner to designate registered medical practitioners to carry out particular kinds of examination; it is certainly not intended to use the provision to enable a range of persons with no suitable qualifications or relevant skills to carry out examinations or tests on the body of a deceased person. The provision is there to enable the Chief Coroner to designate practitioners from outside the medical profession who may be called upon to provide expert advice, such as toxicological scientists or forensic archaeologists. I want to reassure the House that post-mortem examinations will be carried out only by someone who has the necessary medical qualifications or has been approved by the Chief Coroner. I turn to Amendment 43. We can see value in making provision in the underpinning regulations or the guidance mentioned earlier about training provisions for trainee pathologists, perhaps based around their attendance at and participation in post-mortem examinations. I agree that this should be considered further in the context of that work. On Amendment 45, about which the noble Lord, Lord Walton, also addressed the Committee, I am of course aware of the noble Baroness’s very long interest and expertise in the subject of tissue retention, and I acknowledge her reference to the different approach that is taken in Scotland. However, we do not believe that this is the time or the legislative vehicle in which to bring about the changes that she may wish to see, all of which were debated in this House some five years ago when the Human Tissue Bill was before us. As noble Lords may be aware, the Human Tissue Authority is currently preparing new codes of practice dealing with the handling and retention of human tissue, including the handling and retention of samples taken during coronial post-mortems conducted by pathologists. Officials from the Ministry of Justice have contributed to the review of the codes and we would prefer to see how the revised codes of practice bed down before we take any action. I refer noble Lords to paragraph 37 of our published draft charter for bereaved people: ""Sometimes, organs or tissues are retained for additional examination. In this instance, the coroner should reach advance agreement with the appropriate next of kin as to what should happen when they are no longer required for coroners’ purposes. The coroner should convey the wishes of the next of kin to the relevant pathologist"." We believe that such a statement is Human Tissue Act compliant and that it provides scope for families to agree to organs or tissues being retained indefinitely. We will also be making regulations under Clause 35(3)(g) in respect of the preservation, retention, release or disposal of bodies, including body parts. There will therefore be ample opportunity to consider these issues further with everyone who has an interest, and this debate will be taken into full account as part of that process. I move on to the amendments tabled by the noble Lord, Lord Kingsland, and I hope I can put his mind at rest that they are already catered for in the Bill. His Amendment 41A seeks to add radiologists to the list of persons who are automatically allowed to conduct post-mortem examinations under Clause 16(3)(a). My understanding is that all practising radiologists should be registered medical practitioners and therefore I reassure him that they are already covered by that clause. Moving on to the noble Lord’s second amendment, we do not believe it necessary to state in the legislation that a post-mortem examination includes both invasive and non-invasive procedures. This is permissible under the Bill as drafted. However, for the record, the provisions that refer to post-mortems do indeed apply to both invasive and non-invasive procedures. More generally, as noble Lords will be aware, the Government are committed to pursuing the increased use of non-invasive MRI scans as a method of carrying out post-mortem examinations. This measure has been particularly welcomed by members of the Jewish and Muslim faiths, both of which require the body not to be tampered with after death and for burial to take place, wherever possible, within 24 hours of death. At present, scanning facilities for those who have died are available in only small pockets of the country, and under the current system coroners are prevented from moving the body outside their jurisdiction or an adjoining jurisdiction. Clause 17 allows bodies to be moved anywhere to enable the appropriate examination to take place. I am pleased to say that in the current system coroners in the Manchester area have led the way, in conjunction with local health providers, in making non-invasive post-mortems available to the communities they serve. We await the outcome of Department of Health research into the full effectiveness of such procedures, especially in the detection of particular causes of death, but we are already encouraging coroners in other parts of the country to engage with their local health services to establish whether there is a possibility of making use of local scanning facilities. I hope that I have been able to give some reassurance to noble Lords whose amendments we have debated this afternoon and I look forward to hearing from them now.