- Independent medical examiner service will be introduced in England no later than April 2019
- Announcement follows delays after DH consultation closed in 2016 with no response
- Service will be funded by scrapping “ash cash” cremation fees and applying new fee to all deaths
The government has revived plans for a national independent medical examiner service to review all deaths reported to coroners.
Health minister Lord O’Shaughnessy said today the national rollout, which was originally planned for 2018 but was derailed after the Treasury had concerns over funding, will now be phased in from April 2019.
The move has been praised by experts as a major step forward for improving patient safety in the NHS. Reports for the Department of Health concluded scandals such those at Mid Staffordshire would have been identified sooner had a medical examiner service been in place.
A consultation on bringing in medical examiners closed in June 2016 with no response from ministers until now.
Speaking in the House of Lords, Lord O’Shaughnessy said: “Since the election the secretary of state for health has reaffirmed his commitment to introduce medical examiners to provide a system of effective medical scrutiny applicable to all deaths that do not require a coroner’s investigation.
“The government’s response to the consultation will be published shortly and the system will be introduced no later than April 2019. Pilot sites are already offering the bereaved the opportunity to raise concerns whilst improving safety through mortality data.”
He added: “The intention for April 2019 is that the service would cover the entire country but most like start in secondary care before moving out into primary care and community.”
Medical examiners will be employed by local authorities and will be required by law to consult with bereaved families and investigate concerns. Pilots in Sheffield and Gloucester have run for more than seven years and identified errors identifying the cause of death in 10 per cent of cases.
The pilots also highlighted issues for patient safety in the NHS such as clinical governance; patterns in deaths linked to surgical practices; a cluster of post-operative deaths caused by an infection in hospital; poor nursing and hospital care; and neglect in nursing homes.
Medical examiners were recommended by the Shipman inquiry in 2005, the 2013 Francis report and the investigation into maternity failings at Morecambe Bay in 2015. Legislation to introduce them was passed in 2009 but has never been implemented.
Under the plans set out in the consultation last year, 300 medical examiners plus staff would be funded by a new fee covering all deaths, replacing the existing cremation fees known as “ash cash”, which is paid by families. For 70 per cent of families choosing cremation, the new £100 fee would be cheaper. For families who opt for burials the fee would be an additional cost.
Suzy Lishman, president of the Royal College of Pathologists, has been pressing ministers to introduce medical examiners for years. She said: “The college has long campaigned for the implementation of this vital patient safety initiative.
“Pilot studies have shown that medical examiners ensure that death certificates are accurate and the right cases are referred to the coroner. Most importantly, they work closely with bereaved relatives giving them the opportunity to ask questions and raise concerns.
“Medical examiners are ideally placed to identify trends relating to deaths and highlight areas for further investigation, which will improve care for future patients. The college’s view is that no other patient safety initiative can provide these benefits in such a timely and truly independent way.”
She described the plans to phase in the service as “pragmatic” but added: “It is important however, that the second phase follows quickly to ensure that the benefits of the medical examiner system are applied in all healthcare settings.”