Major delays to national deaths review policy

NHS Improvement told HSJ that only a “handful” of acute trusts so far had a hospital “medical examiner” in place. They are meant to oversee and scrutinise deaths in hospital which are not subject to an inquest, so there is more transparency about and learning from problems.

Ministers previously said a national examiner service would be implemented “no later than April 2019”, and a consultation by the Department of Health and Social Care made clear the system was due to be operating in acute hospitals from this month.

However, it has emerged that the DHSC and NHSI are now pursuing a “phased roll out” with all trusts expected to have a medical examiner overseeing acute deaths by 2020 and all deaths by 2021.

An NHSI spokeswoman said it could not give a definitive number of trusts which had a full examiner service in place, instead saying that only a “handful” did so, with most hospitals at earlier stages in the process.

The Royal College of Pathologists told HSJ it had carried out training days for around 100 delegates, with seven sessions still planned to take place, for between 40 and 70 delegates each.

The shift from introducing a fully operational service this month to a “phased roll out” is also detailed in a letter from Alan Fletcher, who has been appointed as the national medical examiner, to nursing and medical directors last week.

He stated that “a truly national system… won’t be achieved overnight and I know many providers have questions about setting up in the best way”. He said: “A phased roll out from the end of April 2019 makes sense to demonstrate respect for the various religious festivals occurring throughout much of April.”

Dr Fletcher, who has led a medical examiner pilot in Sheffield since 2008, also said he hoped to recruit lead regional medical examiners by the summer planned to improve communication about the scheme.

The scheme being currently introduced is not defined in law. The government has indicated it wants to introduce a statutory scheme, but it is unclear if and when legal changes will come into effect.

Explaining the planned timescales, Dr Fletcher said: “My vision is that we use the flexibility the [current] non-statutory process offers to deliver a system that will provide proportionate scrutiny to all non-coronial deaths.

“I want to enable this to be delivered for all deaths in secondary care by the end of March 2020 and for all deaths by the end of March 2021. This will enable the statutory system to come into force and deliver the system that too many reports into patient safety have rightly demanded.”

The system was first proposed by Dame Janet Smith following her inquiry into serial killer GP Harold Shipman. Inquiries into scandals at Mid Staffs, Morecambe Bay and Gosport all supported the idea.

Under the proposed system approximately 300 independent medical examiners, as well as associated staff, will review deaths not referred to a coroner. They will examine bodies and notes and determine if the stated cause of death is accurate or should be changed, and whether the death should be referred for an investigation by the coroner. They will also be required to speak to bereaved families about concerns they may have.

Under the non-statutory system, they will have an “external reporting line” to a regional examiner with the aim of ensuring independence, since they will be employed by trusts – rather than local authorities as had originally been proposed.

The DHSC has said implementing the service should be cost neutral to the NHS, and Dr Fletcher said in his letter that details on cost reimbursement would be set out in coming weeks. This will include costs not covered by the cremation form fees that many trusts are using to fund their service.