Coroners and Justice Bill

We have here a series of amendments tabled to address the proposals by Her Majesty’s Government for a medical adviser service, effectively—that there would be medical advisers to the various coroners. That is a welcome development building on our earlier debate on the various changes, the possibility of partial post-mortems, particular investigations and so on. The idea that we would have medical examiners seems a positive development that we welcome. It is something that in many ways has been lacking for some time. That the Government have taken a step along this road is a step very much in the right direction. However, there are a number of questions about the system being put in place. The Government have rightly found it necessary to identify the position of Chief Coroner to bring the whole service together. It would be important in the development of any service but, particularly in one that is somewhat devolved down to local authorities to address, the position of Chief Coroner seems important. There are also particular responsibilities placed on the Chief Coroner to draw together patterns of illness, disorder, disease, death and anything that will be helpful at a national level. It does not seem unreasonable that there be a national or cheap medical adviser who would assist the Chief Coroner and perform similar functions with regard to the medical examiners or advisers throughout the country. However, the Bill does not say that there shall be a national medical adviser or chief medical examiner, so I and my noble friend Lord Thomas of Gresford have tabled the amendment—not as a new idea, because it was debated substantially in the other place. Indeed, I note that the Minister in another place, responding to the proposal that there should be such a national medical adviser but that it was not in the Bill, indicated that she would be prepared to consider it and return to it, and that she had not set her face against including a national medical adviser in the Bill. Fortified by that, we return to the question to see whether the Government have thought further about this and can advise us of any good reasons for not including it in the Bill. I note some of the arguments that were adduced by the Minister in the other place; namely, that lots of people were involved, including various staff and people from different backgrounds. That is a fairly thin argument because no one else has a national service such as the medical examiner service or the medical adviser service. As regards there being lots of other people involved such as porters, and the fact that they cannot all be represented at the national level, that is absolutely true but it is hardly the point in this connection. One of the responsibilities, among many others, that we think would be appropriate to establish is to ensure certain standards and training among medical examiners throughout the country. I recall that when I raised this at Second Reading the Minister helpfully commented that there had been discussions about standards, training and courses with the relevant royal colleges. I had mentioned the Royal College of Pathologists in that regard but the Minister advised us that the Academy of Medical Royal Colleges had been involved in this and that things were well advanced in terms of producing training and courses. We would like to push this a little further to see whether the Minister can help us further. We have tabled amendments concerning regulations about the training of medical examiners and the standards that should be set for them. We are a little concerned about the consequences of not doing this although I have no doubt that the Minister will say it will be in the regulations. However, when one is trying to set up a large service such as this all round the country, certain areas will attract very high-quality people because there are people in place who could move fairly seamlessly into the new positions, which will offer more authority and more opportunity to use their skills. However, in other places such people will not exist or will not be available, or the people who have been doing the job will be past their sell-by date and will take this opportunity to step down. There may not be somebody there to take over. Therefore, we harbour concerns that people who might not be as well qualified as one would hope and who are without the necessary experience might take up these positions unless clear standards are set and clearly stated qualifications are required. Therefore, we have tabled an amendment which proposes that those appointed will have to have undertaken a course and have qualified from it. Attending a course is one thing but showing that you have learnt something from it is another matter. Some of these matters may be able to be dealt with in other ways than being included in the Bill, but we want to press that matter a little further. The standards, training and qualifications of the national medical adviser must be a substantial concern. If we are concerned about that at the local level we are even more concerned about it at the top level. Therefore, Amendment 49 proposes: ""The Chief Coroner shall appoint an experienced forensic pathologist to be the National Medical Adviser"." This goes to the heart of the matter. We need someone who has the necessary experience to give advice at a national level to the Chief Coroner on issues concerning untoward death, to see whether patterns are emerging, standards are being adhered to, people are being appropriately trained, or whether serious difficulties are emerging while the new service is being put into place which need to be raised at a national level. One way to monitor that could be to table an amendment stating that the Chief Coroner should produce a report to your Lordships’ House and the other place after a few years to see how the service is operating. However, in educational terms we are much happier with continuous assessment than with periodic examinations. Therefore the idea of having a national medical adviser is that their constant and consistent responsibility would be to observe how this new service is developing and to bring advice to the Chief Coroner, Ministers or Parliament to say, "This was a good idea but here are some flaws, hitches or problems". We welcome the Government’s move towards having medical advisers or examiners all around the country. However, we want them to be properly trained and qualified; they should be monitored and provide the required information; and there should be someone at the heart of things—a national medical adviser—to give advice to the Chief Coroner and to provide appropriate monitoring and supervision of medical advisers around the country. I beg to move.