• Impact assessment of medical examiner policy says line of accountability should be at least one step removed from trusts
  • Creation of medical examiner service could lead to 140 more critical conclusions by coroners per year
  • Department of Health and Social Care to invest more than £30m to get the service up and running by April 2019

New medical examiners tasked with reviewing hospital deaths from next April will not be employed by the NHS provider in which they will be based, in order to safeguard their independence, HSJ has learned.

The government has yet to set out the details of how it will guarantee the independence of medical examiners when they begin their roles next year. The Department of Health and Social Care and NHS England are discussing how to create a mechanism to give the MEs greater independence from the trusts they will work in.

An impact assessment of the new policy, announced last month, also revealed that the introduction of a medical examiner service could result in an extra 140 cases referred to inquests which would not have been under existing processes.

The assessment said it was vital that the “line of accountability be at least one step removed. Where the line of accountability will be within the NHS is being developed.”

The document added: “The certifying doctors will not be able to choose the medical examiner that will scrutinise the cause of death stated on the [medical cause of death form]. National examiner guidance will stipulate that MEs must be independent of the certifying doctor and the deceased.

“There may be a trade-off between ensuring sufficient local cover and ME independence. In rural communities, it is unlikely that GPs will not know their ME and vice versa. Bearing this in mind, ME offices will be encouraged to have reciprocal agreements with neighbouring offices to ensure that where the issue of independence arises, another ME can step in and fulfil the statutory function.”

According to an analysis of a pilot system running in Sheffield, more cases will be referred to the coroner that result in “critical” conclusions. During the first four years of the pilot, 15 critical conclusions were issued by the coroner against the Northern General Hospital.

The document added: “Expert opinion is that two of these cases would not have been referred to coroners under the current system, and a further case may not have been. If this change were representative of the country and taking into account that under this proposed option all deaths would be scrutinised under the ME system, this would result in an additional 141 critical conclusions nationally per year.”

Medical examiners were a key recommendation of the Francis report, the Shipman inquiry into serial killer GP Harold Shipman and the Morecambe Bay maternity inquiry.

To get the service up and running, the DHSC will be investing almost £20m of new money to fund the interim set up and another £15m for running the ME system until Parliament can activate legislation to bring in a new single fee for all deaths, which will replace existing cremation fees.

Once the statutory system commences, the costs for all adult deaths certified by a ME will be funded by a fee, although this won’t apply to child deaths.

The total number of headcount staff required for the system, including medical examiners and their support staff is estimated to be 1,332.

Medical examiners will mostly work part time and earn approximately £92,000. Their officers will earn around £32,000.

The initial plan for medical examiners was to have them employed by local authorities but the government has watered down this proposal and the MEs will not scrutinise primary care, community and mental health deaths immediately.

Some early adopters will be allowed to take on reviewing deaths in the community when they feel ready to do so.

The impact assessment warned the roll out could take longer than April 2019, adding: “therefore the ME system may not be able to cover all deaths in all locations. Support will be in place to help local areas get their offices fully staffed and covering all deaths as soon as possible in 2019-20.”

In total, there will be around 240 medical examiners and 1,000 officers. MEs will spend between 25 and 35 minutes per case with officers expected to spend 85 minutes. Around half of deaths will require a physical examination of the body with MEs only expected to examine 2.5 per cent.

Evidence from the pilots suggests MEs will be involved in around 89 per cent of deaths, equivalent to 436,000 cases.