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This briefing paper deals mainly with the position in England and Wales except where otherwise stated. Section 5 sets out information about the system in Scotland.

Death certification

The present system of death certification in England and Wales requires certification of the cause of death by a registered medical practitioner, to the best of their knowledge and belief. Alternatively, the death must have been reported to the coroner and the appropriate certificate provided by them.

Temporary changes introduced by the Coronavirus Act 2020 are currently in place, including the suspension of the requirement for a confirmatory certificate from a second registered medical practitioner before a body may be cremated.

Medical examiners

A new medical examiner system is being rolled out across England and Wales to provide greater scrutiny of deaths.

The Coroners and Justice Act 2009 provides for a system of death certification under which all deaths in England and Wales that do not require investigation by a coroner will be subject to scrutiny by independent medical examiners. The statutory scheme (as amended) provides for local authorities in England and Local Health Boards in Wales to appoint the medical examiners. The legislative provisions are not yet fully implemented.

The Government now intends that the system will be within the NHS. In 2018, the Government announced that it would amend the Coroners and Justice Act 2009, when an opportunity arose, and that, meanwhile, a non-statutory medical examiner system would be introduced. The stated aim of this system is to:

  • provide a better service for the bereaved and an opportunity for them to raise concerns about care with a doctor not involved in that care
  • enhance patient safety by ensuring that all deaths are scrutinised by an independent medical examiner so that any issues with the quality of care can be identified and acted on
  • ensure the appropriate direction of deaths to the coroner
  • improve the quality of death certification.

In February 2021, the Department of Health and Social Care published a white paper, Integration and Innovation: working together to improve health and social care for all. Among other things, the Government said that it intends to amend the provisions in the Coroners and Justice Act 2009 to allow for NHS bodies, rather than local authorities, to appoint medical examiners. It said it wanted to ensure that every death in England and Wales is scrutinised either by a coroner or by a medical examiner.

The introduction of a system of medical examiners follows a long period of policy development, including pilot schemes, which originated, at least in part, as a response to Harold Shipman’s murder of his patients. For many years, Shipman managed to escape detection by certifying patients he murdered as having died from natural causes, avoiding scrutiny by a coroner. In 2003, the Shipman Inquiry, chaired by Dame Janet Smith, proposed that there should be an effective cross-check of the account of events given by the doctor who treated the deceased and who claimed to be able to identify the cause of death, regardless of whether the death was followed by burial or cremation. Similar recommendations have also been made by others.

Scotland

Different arrangements for death certification and registration apply in Scotland. The Death Certification Review Service, which is run by Healthcare Improvement Scotland, checks on the accuracy of a sample of medical certificates of cause of death (MCCDs) with the aim of improving:

  • the quality and accuracy of MCCDs
  • public health information about causes of death in Scotland, and
  • clinical governance issues identified during the death certification review process.

Temporary changes to the Death Certification Review Service have been made because of the pandemic.


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