October 2022

Welcome

I am pleased by the continued progress medical examiner offices in England and Wales are making ready for the statutory system. Many offices have been implementing recruitment plans – there is more detail on this later. It is vital that we use the coming months to ensure the NHS is ready for the statutory system, and medical examiner offices should seek to build relationships with all healthcare providers and stakeholders locally and agree processes.

Access to electronic patient records across healthcare settings presents challenges for medical examiner offices, particularly in England.  It’s encouraging that local solutions are emerging – medical examiner offices should explore what works for them. The national team has informed medical examiner offices about solutions, and continues to work with DHSC and NHS Digital to explore further options. The NHS England’s transformation directorate also recently published guidance regarding sharing records of deceased people. 

In coming months, I expect there will be increased focus on formal communication about the forthcoming statutory system. In July 2022, the letter, NHS England advised NHS organisations in England of the need to prepare for the statutory system, was sent from myself, Dr Aidan Fowler and Professor Sir Stephen Powis to all NHS trusts, GP practices and ICBs in England. Along with colleagues in DHSC and Welsh Government, I am continuing to engage with professional and public stakeholders about implementation and the statutory system. We know the government’s intention is to work towards commencing implementation plans for the statutory medical examiner system from April 2023, and further details will help everyone to plan for this important step with certainty.

Dr Alan Fletcher, National Medical Examiner.

What’s included in this update

• Guidance for medical examiners
• Community rollout in England
• Implementation in Wales
• Quarterly reporting in England
• Training and events
• Contact details

Guidance for medical examiners

The Royal College of Pathologists has published the latest of the National Medical Examiner’s Good Practice Series, setting out principles for out-of-hours arrangements. Further papers are planned on anti-microbial resistance, homelessness and dementia in the coming months.

Medical examiner offices have been asking how guidance might change when the statutory medical examiner system commences.  Details will be confirmed through secondary legislation which is currently being finalised.  We know that communication about these changes will be important. This will be done through NHS organisations in England and in Wales, and wider public information regarding the death certification reforms will be led by DHSC.  We will tell you more as details of the secondary legislation and plans for the statutory system become clearer.

Community rollout in England

In Quarter 1 2022/23,56 out of 129 medical examiner offices in England reported they had started scrutiny of deaths in the community, including hospices, community hospitals and primary care. Medical examiner offices in England provided independent scrutiny of around 7% of the anticipated non-acute deaths.  There has been an incremental increase in the number of community deaths that have been scrutinised during the year (including scrutiny of deaths in the community).  This has been made possible after a tremendous amount of planning, engagement and process development by medical examiner offices, and we know this stage presents additional challenges in terms of complexity and partnership working. 

As mentioned in the foreword, the national NME team is continuing to explore with DHSC wider options for sharing electronic patient records, and to collate examples of successful local solutions.  Some of these are particularly exciting, and we encourage medical examiner offices to actively consider solutions that others have used successfully.  Whenever we receive details of new options, the NME team will add details to online documents for medical examiners. 

Implementation in Wales

The Medical Examiner Service in Wales is continuing to increase the volume of deaths scrutinised in both acute and community settings, with the latter now making up around 10% of the total. The arrangements in place for directly accessing GP records in Wales are ensuring that the demand placed on general practice staff to support the scrutiny process is kept to a minimum and is not a limiting factor for them.

The latest round of recruitment has resulted in the appointment of medical examiners and medical examiner officers from a range of backgrounds, and who will provide increased capacity and resilience. It is anticipated the final round of recruitment will take place early in 2023 to bring the service up to full establishment.

The medical examiner service is analysing data and reporting themes and trends at service, site, organisation, and national levels, as part of the NHS Wales patient safety and clinical quality systems.

Quarterly reporting in England

The national team have been discussing the impact of the permanent removal of cremation form 5 and DHSC’s confirmation in May 2022 that there will not be a fee for medical examiners. This means there is an opportunity to reduce the administrative work required by medical examiner offices to complete quarterly reporting, because there is no cremation form 5 income to be considered when calculating reimbursement.  We plan to remove several questions relating to cremation income from the medical examiner quarterly reporting portal in the near future. However, it is likely to be some months before the portal administrators are able to make these changes.  

We are therefore informing medical examiner offices that with immediate effect, there is no requirement to collate data or to populate questions 6 and 7 relating to cremation form 5 income in quarterly reporting submissions and the fields for this data should be marked “0” (zero). In addition, it will not be necessary to distinguish between burials and cremations.  In questions in 5a, 5b, 5d and 5e (acute deaths), it is only necessary for medical examiner offices to provide a single total number for all relevant deaths in one of the fields (e.g., 5a).  The other fields (e.g., 5b and 5c) can be marked “0” (zero).  We will confirm this with an updated version of the guidance document, which we will send to all medical examiner offices.  In coming months, the portal will be amended to reflect this change. 

Training and events

To date, 1,655 senior doctors have completed medical examiner training, and 471 staff have completed medical examiner officer training. Future sessions are arranged.

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.