Coroners and Justice Bill

I am grateful to all noble Lords who have spoken, particularly the noble Lord, Lord Alderdice, for welcoming the principle of having medical examiners in this field. I think that other noble Lords have agreed with him on that. I say straightaway that the amendments would be acceptable had the Government chosen a model or system of coroner and death certification reform which had led to the introduction of a unified death investigation service. But, in fact, such amendments would not have been required as they would have been important parts of the policy and therefore already reflected in the Bill. However, those of you who studied the 2006 draft Coroners Bill will know that, although the Government very carefully considered this recommendation made in broad terms by two parallel independent inquiries, our preferred approach is to have two independent services with close and clear links between the two. It is in that context that my reply will continue on the basis of considering each of the amendments. I understand that the noble Lord, Lord Alderdice, and the noble Baroness, Lady Finlay, want to increase the accountability for medical examiners. The amendments provide for the appointment of a statutory national medical adviser to the Chief Coroner as a way to achieve this. In doing so, the amendments seek to confer on the national medical adviser the power to make regulations on the training of medical examiners and to set down minimum standards as to the service which should be provided by medical examiners. In effect, they provide the national medical adviser with a leadership role in relation to medical examiners. We do not believe that the medical adviser to the Chief Coroner is the appropriate person to undertake that role. That is because the Chief Coroner will have jurisdiction only for deaths which are violent, unnatural, in custody or other state detention, or from unknown causes. Like senior coroners, the Chief Coroner will have no responsibility over natural deaths unless they have occurred in custody or other state detention. It follows that the remit of the medical adviser to the Chief Coroner should not stray into the generality of deaths except to the extent that I will describe shortly. The national medical adviser, who we believe should be appointed on a non-statutory basis along with the other staff to support the work of the Chief Coroner—it is not suggested that they should be in the Bill—will advise the Chief Coroner on policy and practice in relation to post-mortems, on issues relating to the prompt release of bodies for funerals and related issues about the retention of organs and tissues, including liaison with faith groups and others with an interest. We also envisage that another role for the national medical adviser will be to develop training for coroners and coroners’ officers on medical issues, and to advise the Chief Coroner on medical aspects of appeals by interested persons. In relation to medical examiners, it is intended that the national medical adviser will be involved in agreeing job descriptions, agreeing protocols setting out the scrutiny that medical examiners must complete, how they interact with coroners and agreeing the curriculum for the training they require. He or she will also be involved in resolving any disputes which arise between coroners and medical examiners about a conflict of views in particular cases. The Department of Health intends to bring forward secondary legislation on these matters, as set out in Clauses 19 and 20, and the role of the national medical adviser in relation to medical examiners will be better, more fully defined there. Amendment 63A, in the name of the noble Lord, Lord Colwyn, requires that medical examiners must work with clinical governance teams in primary care trusts and local health wards to establish whether patterns of deaths give cause for concern. We agree that this aspect of the work of medical examiners is vital. The Department of Health has made clear in its consultation on improving the process of death certification, and in response to the consultation itself, that this will be one of the main responsibilities of medical examiners. As such, this responsibility will be set out by the Department of Health in secondary legislation brought forward under Clause 19. I hope that goes some way towards satisfying the noble Lord. Amendments 51 and 53, in the name of the noble Lord, Lord Alton, would give the Chief Coroner responsibility for the appointment, resourcing and monitoring of medical examiners. Given the model that we have adopted—we know it is not the model preferred by a number of noble Lords—and the role that we envisage for the Chief Coroner, we are not persuaded that he or she is the appropriate person to appoint and oversee the work of medical examiners. As I have said, the Chief Coroner will be responsible only for deaths referred to coroners, not for the totality of deaths, whether from natural causes or otherwise. I hope the Committee will accept our reform model and agree that it is much more appropriate for Health Ministers to identify and appoint a leader for the medical examiner system. Amendment 50, in the name of the noble Lord, Lord Kingsland, has similarities to the ones to which I have just referred. It suggests that the Chief Coroner should appoint the medical examiners but that this should be in consultation with primary care trusts and local health boards. Once again I emphasise that the Chief Coroner will be appointed for his or her qualities and skills for leading the coroner system in England and Wales for deaths which are not considered natural, not for the scrutiny of certificates of causes of death where the death is entirely uncontentious; that will be the role of the medical examiner. I come back to Amendment 49, in the name of the noble Lord, Lord Alderdice, which would require the Chief Coroner also to appoint the national medical adviser, with the requirement that he or she should be an experienced forensic pathologist. We consider that it would be unduly restrictive to require the national medical adviser to be a forensic pathologist. Of course a forensic pathologist might be suitable for the position, but coroners deal with a broad range of types and causes of death. A registered medical practitioner with experience of treating or diagnosing industrial diseases might also have useful skills to bring to the role of the national medical adviser. We believe that the skills and experience required for the role of national medical adviser to the Chief Coroner is best left to the Chief Coroner to decide and should not be unduly constrained by the Bill. Amendment 55 seeks to remove the requirement for primary care trusts and local health boards to monitor the performance of medical examiners, to ensure that they meet appropriate standards or required levels of performance. We understand that what the noble Baroness, Lady Finlay, intends is to distance medical examiners from the trusts and boards which appoint them. Of course, as other noble Lords have stressed, it is vital that the public can be confident that medical examiners will carry out independent scrutiny, which includes the requirement in the Bill that trusts and boards have no role in the way that medical examiners exercise their professional judgment. Medical examiners will also need to be sensitive to the needs of the bereaved and provide an effective and responsive service to the communities in which they work. Requiring medical examiners to be accountable to trusts and boards for the standard of service they provide is not incompatible with the need for medical examiners to be independent in the way they use their professional judgment to scrutinise cause of death. Amendments 48 and 57 to 63, in the name of the noble Baroness, Lady Finlay, seek to create a statutory post of chief medical adviser. As she explained, the intention is to provide leadership for the new cadre of medical examiners. The Department of Health is currently considering the whole issue of clinical leadership for medical examiners with key stakeholders. Clearly there are a number of options for ensuring appropriate accountability and leadership arrangements, including the appointment of a chief medical examiner or adviser. However, in our view, it is not necessary for it to be a statutory role and that this position is consistent with the approach taken by the Department of Health in appointing national clinical directors; for example, the national director for heart disease and stroke and the national cancer director. I hope to provide further details of these arrangements while the Bill is still going through Parliament. I appreciate the strength of feeling in regard to the inclusion in the Bill of the statutory post of chief medical adviser and I would like to consider in a little more detail, perhaps outside the Chamber, the arguments for and against such a course. I am not rejecting them utterly today but—I make this absolutely clear—neither am I in a position to say that eventually I will accept them. Amendment 56, in the name of the noble Lord, Lord Alderdice, would require medical examiners to have completed an accredited course of study before they can be appointed. Again, we are not persuaded this needs to be in the Bill, as regulations made under Clause 19(4)(c) will specify the training which medical examiners must have successfully completed prior to their appointment and the ongoing training that they will need to undertake during the term of their appointment. A detailed medical examiner training curriculum has been developed by an intercollegiate group established by the Academy of Medical Royal Colleges. The group is being led on the academy’s behalf by Professor Peter Furness, who is president of the Royal College of Pathologists. As I said, we will expect the Chief Coroner to consult his or her non-statutory national medical adviser as well as the head of the medical examiner service, both throughout the year and when preparing the annual report. This is bound to happen given the national medical adviser’s role in supporting the Chief Coroner on the medical aspects of coroners’ cases, as well as in the training of coroners and officers on those issues. The consultation will enable the Chief Coroner to provide the Lord Chancellor with a pertinent report covering the key issues in the coroners’ system over the previous year. However, we believe that the precise nature of the consultation with the national medical adviser should be left to the discretion of the Chief Coroner. I have no doubt that we will return to some of these matters in due course, but those are the Government’s observations on the amendments tabled for Committee. I should say to the noble Lord, Lord Walton, that when the GMC introduces licences and arrangements for revalidating medical practitioners, I understand there will be a requirement for medical examiners to be licensed as well as registered practitioners—that is, to have a licence to practise. I hope the amendment will be withdrawn.