Medical examiners could lead to thousands more inquests

Earlier this month health secretary Jeremy Hunt announced plans to launch a medical examiner service to review all deaths from 2018. An impact assessment by the Department of Health, published alongside a consultation over the reforms, said the changes could mean an extra 20,378 inquests a year, at an extra cost of £9m a year.

However, HSJ understands another analysis for the DH has suggested a lower increase of at least 1,400 inquests a year.

According to the DH’s assessment, while medical examiners could prevent 50,300 inappropriate deaths being referred to coroners, the increase in complex cases still left a funding gap.

The document said: “Benefits arising from an increased referral of appropriate cases to coroners are at risk if this additional workload is not funded. Therefore [the preferred option] depends to a large extent on whether this funding can be secured. The DH will be discussing this issue with [Department for Communities and Local Government, Ministry of Justice] and the Chief Coroner’s Office over the consultation period.”

Suzy Lishman, president of the Royal College of Pathologists, told HSJ she feared there was a lack of capacity in the system.

She said: “With the current resourcing both in terms of finances and people, I don’t think the coronial service or the post mortem pathology service have got the capacity to meet that need at the moment. That is a real challenge.”

Dr Lishman said only 50 per cent of qualified pathologists were willing to carry out post mortems. She added that the fee of £97.20 per post mortem would need to increase alongside reforms such as regionalisation of services.

However, she said she welcomed the policy: “If this had been in place, Harold Shipman’s crimes would definitely have been picked up sooner.

“Medical examiners will have an overview that will be hugely valuable for improving patient safety for the living. The main benefit will be for future patients. Despite the challenges I am still overwhelmingly positive about the value of the reforms.”

According to the DH, 385 medical examiners, 586 medical examiner officers and 192 staff responsible for external examination of bodies will be needed. Staff will be employed by local authorities and medical examiners will largely work part-time.

Alan Fletcher, who has been leading a pilot medical examiner service in Sheffield since March 2008, reviewing 17,000 deaths, said he was confident the service would be able to cope.

Dr Fletcher, a consultant in emergency medicine at Sheffield Teaching Hospitals Foundation Trust, said: “Reviewing the records takes remarkably little time. This isn’t a forensic review of all records but a screening review to detect aspects of the case and issues that may warrant further investigation.”

The DH impact assessment said it will cost £18.6m to establish the service, with an average annual central cost of £14m. Overall the service will cost £14m less a year than the existing cremation form system, which costs £57m.

The savings will largely come from a reduction in cremation fees and a new lower fee of £81 applicable to all deaths.

“Ash cash” payments to doctors to check bodies for cremation will also no longer be paid.

Medical examiners were first proposed in 2005 by the Shipman public inquiry and legislation was introduced through the Coroners and Justice Act in 2009 but was never implemented.

Seven pilots examining 23,000 deaths have shown benefits for patient safety through the identification of trends and governance issues missed by NHS providers.

The DH said the impact on NHS litigation costs was difficult to estimate: “On the one hand, the new system is likely to detect a greater number of problematic deaths and therefore may give grounds for bereaved families to sue the NHS. On the other hand, detecting and acknowledging a greater number of mistakes should lead to an improvement in the quality of medical care and fewer mistakes taking place, which would result in a reduction in litigation.”

The consultation ends on 15 June.