NHS England » National Medical Examiner update March 2024

Welcome

I am certain that many of you, like me, are disappointed that we still await announcement of the date the death certification reforms will come into force. At time of writing, we understand from the Department of Health and Social Care (DHSC) that the statutory system will not come into force in the first half of April 2024, and DHSC will make further announcements in due course. I appreciate that medical examiners and officers have continued to encourage General Practitioners and healthcare providers to work with them. This is appropriate, but I realise you often face questions about the coming into force date. While it may not provide a comprehensive or satisfactory answer to such questions, it should be borne in mind that the death certification reforms span multiple government departments. The necessary legislative changes are subject to ministerial and parliamentary approval before public announcements can be made. I have highlighted that the system requires adequate time to prepare between the announcement and the implementation date.

Submissions from medical examiner offices for October – December 2023 showed excellent progress in extending scrutiny to deaths in the community, up to 41% for Quarter 3 (compared to 34% in Quarter 2). I am grateful for your hard work and the progress made.

A warm welcome to new members of our team, Bob Wilson joins us as Regional Medical Examiner Officer (RMEO) for the Northwest as well Pip Williams as RMEO for the Midlands. I am also pleased to welcome back Siobhan Costello as RMEO for the East. Siobhan and Pip will be providing maternity cover, and which leads on to offering congratulations to Danielle Wall and family on the arrival of her baby.

Jane Lawrence, Financial Analyst for the National Medical Examiner team, has now returned to her substantive role in the Southwest region. We are all very grateful for all her hard work and send our best wishes.

Since the last bulletin I have been visiting more regional teams and it was lovely to meet staff at the Norfolk and Norwich University Hospital, and at Queen Elizabeth Hospital in Kings Lynn in January.

Dr Alan Fletcher, National Medical Examiner

Good Practice Series – Palliative and End of Life Care

Our latest guide in the Good Practice Series is now available and focuses on palliative and end of life care.

Medical examiners can clearly play a key role identifying positive examples of good end-of-life care and providing feedback, and detecting when care could have been better, so that healthcare providers can prevent recurrence for future patients.

Employing General Practitioners (GPs) as medical examiners

The National Medical Examiner has previously made clear his expectation that GPs employed as medical examiners should receive equivalent recognition of their experience and seniority. The National Medical Examiner’s office contacted NHS Employers (the employers’ organisation for the NHS in England) about the options for NHS trusts employing GPs. Following our discussion, NHS Employers have updated their web page setting out the various ways in which NHS trusts can employ GPs.

Podcast

Have you listened to the podcast about changes to the death certification process and introduction of the statutory medical examiner system?

In the podcast Dr Alan Fletcher, National Medical Examiner, and Dr Suzy Lishman, Senior Advisor on Medical Examiners at the Royal College of Pathologists, discuss what the changes to death certification processes and new requirements to be introduced with the statutory medical examiner system will mean for medical examiners, medical examiner officers and others involved in death certification.

Independent Healthcare Providers Network

The Independent Healthcare Providers Network (IHPN) has discussed with the National Medical Examiner’s office how NHS medical examiners will work with independent healthcare providers when the statutory death certification reforms come into force. There are already examples of preparations at local level.

Nuffield Health, an independent provider with acute facilities, reached out to their local medical examiner office. Other independent providers have been contacted by their local medical examiner office. These are excellent examples of working in partnership and have enabled independent providers to make arrangements to share records of deceased patients with NHS medical examiners, as will be required in the statutory system.

In Nuffield’s case, Dr Charlotte Rayner has advised that local medical examiner offices in NHS trusts are now providing independent scrutiny and advising on completion of the MCCD (Medical Certificate of Cause of Death) for many of the Nuffield facilities. IHPN have commented that making early connection with the medical examiner office is an important step in supporting bereaved people and helping staff understand the new regulations.

When the death certification reforms come into force, medical examiners will have the right to access records under the Access to Healthcare Records Act 1990, amended by the Coroners and Justice Act 2009. In the non-statutory before this, section 251 support from the Confidentiality Advisory Group (CAG) provides the legal basis for healthcare providers to share records of deceased patients with medical examiner offices in both England and Wales.

Section 251 support was originally due to expire on 31 March 2024, and DHSC have clarified that death certification regulations will not commence in the first half of April 2024, so an extension was required. While we await confirmation of the date when the regulations will come into force, CAG has extended section 251 support, if needed, up to 30 September 2024. This means healthcare providers can continue to have confidence after 31 March 2024 that section 251 support continues to provide the legal basis for sharing healthcare records with medical examiner offices in the non-statutory period. If DHSC/Government announce that the death certification reforms will come into force earlier than 30 September 2024, we will inform CAG that the section 251 support will no longer required from the earlier date the death certification reforms come into force.

Implementation in Wales

The Medical Examiner Service for Wales continues to prepare for the statutory medical examiner system and is working closely with partner organisations to ensure that the requirements of the wider death certification reforms are also taken into consideration. This is quite complex, as there are many moving parts and only some of them are within our control, but the relationships that have now been built are proving invaluable in gaining a shared understanding of issues, and developing solutions that work at a system wide level.

The service is continuing to increase the number of deaths scrutinised and is ably demonstrating the importance of independent scrutiny of death in providing re-assurance for the bereaved, highlighting issues that may need further investigation by care providers, and improving the accuracy of the cause of death.

As we approach the statutory phase, we are exploring ways in which the knowledge gained by the service can feed into wider, NHS Wales level quality and safety systems, and ensuring that we are able to meet our commitments across both core and non-core periods. This will see a level of provision over weekends and bank holidays but not a full 24/7 arrangement.

We are pleased with the engagement and commitment of primary care colleagues and will continue to work with them to ensure that deaths that occur in the community can all be notified to the Medical Examiner Service, at the earliest opportunity, and that clinical records and clinician availability allow the full scrutiny process to be completed as quickly as possible.

Funding letters and quarterly reporting – England

Funding letters for 2024/25 are due to be sent out on 27 March 2024.to lead medical examiners and copied to Chief Finance Officers at Integrated Care Boards (ICBs) along with Chief Finance Officers at trusts with medical examiner offices, reflecting the new arrangements for distributing 2024/25 funding through ICBs. Please contact your regional team or funding.nme@nhs.net if you have queries.

Quarterly reports for January to March 2024 should be submitted between 2 April and 23 April 2024. For further guidance and information when completing these returns please do check the guidance in the annex.

Training and events

Over 750 colleagues joined the Royal College of Pathologists event ‘Death Certification Reforms Legislation – implications for the Medical Examiner system’ on 17 January 2024. Huge thanks and appreciation go to Dr Suzy Lishman and the Royal College of Pathologists team for all their hard work in organising such a well-run event. A recording of the event is now available.

2,167 medical examiners have been trained and 711 staff have undertaken the training to be a medical examiner officer. Please find details about future training here.

The e-learning modules for prospective medical examiners and medical examiner officers are being updated to reflect the changes to the medical examiner system once it becomes statutory. We do not expect medical examiners and medical examiner officers who have already completed their training to repeat the e-learning. Required update training will be proportionate and details will be provided after the regulations have been laid.

Contact details

We encourage you to continue to raise queries with us and share your thoughts on the introduction of medical examiners, through the contacts list.

The page contains contact details for the national medical examiner’s office, the medical examiner team in Wales, and regional medical examiner contacts in England.

Further information

Further information about the programme, including previous editions of this bulletin, can be found on the national medical examiner webpage.

NHS Wales Shared Services Partnership also has a web page for the medical examiner system in Wales.

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