On April 15, 2024, the Department of Health announced a significant overhaul in the death certification process across England and Wales. This move aims to bring about a system that not only ensures rigorous scrutiny of deaths but also gives a voice to the bereaved. Set to take effect on September 9, 2024, the reforms mandate that all deaths, except those investigated by a coroner, will be reviewed by NHS medical examiners. This marks a pivotal shift in the way deaths are certified and investigated, promising a range of benefits from enhanced public safeguards to improved support for grieving families.

Introducing the Medical Examiner System

The core of this reform is the introduction of a statutory medical examiner system. Medical examiners are experienced senior medical doctors who dedicate part of their time to independently assessing the causes of death. Their role is distinct from their usual clinical duties and involves specialised training in both the legal and clinical aspects of death certification.

Key Objectives of the Medical Examiner System

The implementation of this system serves several critical purposes:

  1. Enhanced Public Safeguards: By ensuring that all non-coronial deaths undergo independent scrutiny, the medical examiner system provides a robust safeguard against errors and potential malpractices in the certification process.
  2. Appropriate Referrals to Coroner: Medical examiners will ensure that deaths warranting further investigation are promptly referred to the coroner, streamlining the process and maintaining accuracy.
  3. Support for the Bereaved: The system offers a structured channel for the bereaved to voice any concerns regarding the death of their loved ones. Having an independent doctor review the case provides an additional layer of comfort and assurance that their concerns are taken seriously.
  4. Improved Death Certification Quality: With trained professionals overseeing the certification process, the accuracy and reliability of death certificates are expected to improve significantly, addressing long-standing issues in the system.
  5. Enhanced Mortality Data: Accurate and reliable death certification contributes to better mortality data, which is crucial for public health monitoring and policy-making.

Simplified Certification Process
A notable change in the reform is the introduction of a new Medical Certificate of Cause of Death (MCCD). Previously, if a medical practitioner had not seen the patient within the 28 days preceding their death or had not seen the patient after death, the case had to be referred to a coroner. The new MCCD simplifies this by allowing any attending medical practitioner to complete the certificate, thus reducing unnecessary referrals and streamlining the process.

Learning from the Past
The need for these reforms has been underscored by past inquiries, such as those into the Shipman case and the Gosport War Memorial Hospital, which revealed significant flaws in the existing death certification system. These tragic events highlighted the need for independent scrutiny and greater transparency to prevent such incidents in the future. The new system is designed to learn from these lessons, ensuring that every death is appropriately reviewed and certified.

A Welcome Change
The death certification system in England and Wales has remained largely unchanged for over half a century. The introduction of the medical examiner system marks a welcome and necessary evolution. It promises to enhance the integrity of death certification, provide better support to the bereaved, and ensure that every death receives the appropriate level of scrutiny.

As these reforms come into effect, they herald a new era of accountability and compassion in the death certification process. The commitment to independent review and the simplification of procedures reflect a system that values accuracy, transparency, and the voices of those left behind. This reform is not just a procedural change; it is a step towards restoring trust and confidence in how deaths are certified and investigated in England and Wales.