Coroners and Justice Bill

Amendment 67 in this group is a technical government amendment designed to avoid any unnecessary requirement to make regulations under the Cremation Act 1902. The medical examiner system will replace the system of certifying cremations in the statutory forms set out in the schedule to the Cremation (England and Wales) Regulations 2008. Currently, the doctor who attended the deceased and an independent doctor complete these forms, which are checked by a medical referee at the crematorium before cremation can be authorised. The medical referee’s role will be replaced by that of a medical examiner appointed under Clause 19. Therefore, the bulk of the current regulatory framework will be replaced. It is important, however, that the regulation-making powers contained in other legislation, including the Bill, do not have the unintended consequence of retaining what would clearly be superfluous regulation. In due course, I will move a government amendment on this matter. I turn to the other amendments so ably moved in this group. Amendment 64, in the name of the noble Lord, Lord Alton, requires the Secretary of State to consult with the Chief Coroner on the regulations set out in Clause 20 that relate to the work of medical examiners. Our thinking in relation to the noble Lord’s amendment is that it is not necessary to set out in the Bill a specific requirement for consultation. I assure the noble Lord that the Department of Health intends to consult widely on the secondary legislation required to implement the new death certification regime. I certainly expect the Chief Coroner, once appointed, to be among those who would be consulted about regulations made under this clause. Equally, there will be other important stakeholders whom it would be appropriate to consult. We do not consider it necessary or appropriate to single out the Chief Coroner as a statutory consultee. Amendment 65, tabled by the noble Lord, Lord Kingsland, introduces a general and open provision enabling an attending practitioner to issue a fresh attending practitioner certificate to replace the one he or she first issued. An attending practitioner must certify the cause of death to the best of his or her knowledge and belief at the time of death. If unable to do so, or there are reasons for further investigation of the death, he or she will have a duty under regulations made in Clause 18 to report the death to a senior coroner without completing a certificate. Under the provisions of Clause 20, a completed attending practitioner’s certificate will be scrutinised by a medical examiner before the death can be registered and documents can be issued allowing a funeral to take place. Errors, omissions or concerns about the accuracy of the information recorded on an attending practitioner’s certificate will come to light either when a medical examiner reviews the certificate and speaks to relatives of the deceased about the cause of death, or when a relative is interviewed by a registrar before the death is registered. For this reason, subsection (1)(c) of Clause 20 provides for either a medical examiner or a registrar to invite an attending practitioner to issue a fresh certificate. We think that this is preferable to a situation where the attending practitioner can change the certificate unilaterally if there is a change in circumstances. I turn to Amendment 66, the second amendment tabled by the noble Lord, Lord Alton. Under the provisions set out in Clause 20, a medical examiner will scrutinise and confirm the cause of death stated on an attending practitioner’s certificate. This requirement will be applicable to all deaths that are not subject to a coroner’s investigation, regardless of the form of disposal. For this reason, a number of cremation forms currently issued under the Cremation Regulations 2008 will cease to be used. However, the certificate issued by a registrar under the Birth and Deaths Registration Act 1953, following registration of a death and prior to disposal, is being retained for a purpose under the proposed arrangements. This is because registration provides an opportunity for relatives to raise with an independent official any issues that might require investigation before a funeral takes place, and which, for whatever reason, were not brought to the attention of a medical examiner. We propose to retain this important additional safeguard at the request of stakeholders, including registrars and the Coroners’ Society. That is why we cannot accept that aspect of the noble Lord’s amendment. The noble Lord asked about funding the medical examination service. The medical checks currently required before cremation cost families an estimated £45 million per year. The effectiveness of these checks, which are not subject to robust quality assurance, has rightly been criticised by a number of public inquiries, including the Shipman inquiry. Our preferred option for funding the proposed new system of death certification is a single fee for certification of all deaths, irrespective of whether death is followed by burial or cremation. The fee would replace the existing cremation fee of £160.50. As cremation accounts for some 70 per cent of disposals, most bereaved families would pay less under the new system. I turn finally to Amendment 72A, an important amendment that has been debated. This would introduce short death certificates, to be issued in addition to full death certificates. The first type of short certificate is intended to speed up the possibility of organ transplantation after death by confirming that life is extinct. The noble Baroness, Lady Finlay, gave us an example of that. The organs could be removed as soon as possible in this instance. The second type of certificate would be a basic death certificate for families to use when dealing with administrative matters such as closing bank accounts after a person’s death. The amendment is intended to prevent upsetting the family and executors further by revealing to others the cause of death, which might have a stigma attached to it as far as the relatives are concerned. We sympathise with the aims of the amendment, and I assure the noble Baroness that it remains our intention to make provision for short death certificates in future; but we need to prioritise. Amendments to the Births and Deaths Registration Act included in the Bill have been limited to those that are consequential to the changes to the coroner system and the new death certification provisions. These are major reforms, and there are dangers in attempting to do too much at once—not least because the introduction of short death certificates would require IT changes, which, as I have indicated, would need to be prioritised against the other changes that we are making to the death certification procedures. We will, however, keep the position under review. The noble Baroness said that perhaps she should have tabled two amendments, because she is dealing with two separate cases. She will gather in a moment that we are more sympathetic to the relatives’ side of the case than we are to the organ donation side. As I say, we will keep the position under review. The position on organ donation is rather more complex. We are not aware of any difficulties when the death is entirely from natural causes. However, if the circumstances of the death are such that the coroner may need to investigate, it will not be possible to remove organs from the body until the coroner has determined whether he or she has jurisdiction over the death. Once the coroner has decided that he or she does have such jurisdiction, a decision will need to be made as to whether particular organs may be removed without compromising the coroner’s duty to investigate the cause of death. It hardly needs saying that these are tricky, sensitive and delicate issues, but in view of the importance of ensuring a better supply of organs for transplantation, protocols between hospitals, transportation teams and coroners have been worked up, or are being worked up, across England and Wales. These will ensure that the appropriate balance is struck between the needs of families for a proper investigation into the death of a loved one—which may, in itself, reveal information to prevent future deaths—and the needs of those awaiting donated organs. I venture to think that the noble Baroness will not be entirely satisfied with my reply to the second part of Amendment 72A, but I hope she is more satisfied with the first part of my reply.