Coroners and Justice Bill

I thank the noble Lord for moving what I take to be a probing amendment concerned with the premature deaths at Stafford Hospital between 2000 and 2007. The Committee as a whole will want to express its regret to the families involved. At the time, as a report by the Care Quality Commission—then the Healthcare Commission—made clear, many of those deaths could and should have been avoided, frankly. The breakdown of which the noble Lord speaks between the commission, tasked with investigating the series of deaths, and the coroner, who had investigated some of the individual deaths at the time they occurred, was a perfect example of how those with related statutory responsibilities do not always work together effectively. That may be something of an understatement. We will agree that we need to tackle that matter. One way is the enforcement route, down which the amendment might take us. However, existing measures in the Bill will address the issues raised by the case. The first important reform is that every death that is not automatically referred to the coroner will be scrutinised by one of the independent medical examiners checking the information given in the medical certificate as the cause of death. They will work closely with the clinical governance teams in primary care trusts and local health boards to collate key information on causes of death and use it to analyse trends and uncover unusual patterns. We believe that the high mortality rates among patients receiving care at Mid Staffordshire National Health Service trust would almost certainly have been identified by medical examiners. Under current arrangements, with no medical examiners in post, it was for the doctors at Stafford Hospital to decide whether to report deaths to the coroner for investigation. Under Clause 18 there will be a duty for doctors, wherever they are based, to report certain specified deaths to the coroner so that no unusual, suspicious deaths pass unnoticed. Among the categories of deaths that are perhaps likely to be referred are where the death may be related to a medical procedure or treatment or where there may have been some failure of care relevant to the death. Secondly, the national leadership role provided by the Chief Coroner, who will be able to liaise between coroners and organisations such as the Care Quality Commission, will help investigations to proceed smoothly. The Chief Coroner may also issue guidance to all coroners in relation to requests for information and may even intervene where there are disputes. With the assistance of his or her national medical adviser, the Chief Coroner will be able to identify unusual trends and pass on that information to those with an interest as well as publishing pertinent information in an annual report. We also expect that the Chief Coroner would want to review how coroners held information. That was a related difficulty in the Stafford case and we seek to make the systems used more efficient and consistent. Finally, coroners in particular interact with a number of investigating authorities, all of which have their own statutory responsibilities. Mostly it is the coroner who is dependent on those authorities’ reports before he or she can decide how to proceed with his or her own investigation. There are difficulties sometimes. The Coroners’ Society does its best to sort out those difficulties and has skilfully negotiated protocols that govern the relationships. That is something that we intend the Chief Coroner will take forward in the future, but the Bill does not propose to place those various interactions on a statutory footing, although I know that the amendment suggests that we should do so. I turn to the different position of medical examiners in relation to investigations by the Care Quality Commission. The Health and Social Care Act 2008 already gives the Care Quality Commission a number of powers that it is able to use for the purpose of carrying out its regulatory functions, which include carrying out investigations. As the noble Lord is aware, medical examiners will be appointed by the primary care trusts in England. Regulations under Section 65 of the 2000 Act allow the commission to require explanations from a chair, director or employee of an English NHS body, therefore enabling the commission to require explanations from primary care trusts in respect of the work of medical examiners. We are looking at whether those regulations need to be amended to allow the commission to require an explanation directly from a medical examiner. The 2008 Act also gives the commission the power to require any information, document and records, including personal and medical records or other items that would include the provision of data, from English NHS bodies as well as the power to enter and inspect premises. The Act makes failure to comply with a requirement imposed by the commission an offence punishable on some reconviction to a fine not exceeding level 4 on the standard scale. The commission’s remit does not extend to Wales, but similar functions are conferred on Welsh Ministers by the Care Standards Act 2000 and by another piece of legislation. I thank the noble Lord for this short debate. We are not persuaded of the need to make express provision in the Bill for medical examiners to co-operate with inquiries conducted by the Care Quality Commission; existing powers suffice. I hope that that response will satisfy the noble Lord.