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My death might be important to you!

By Carolyn Heaney, Deputy Director Department of Health, Death Certification Reforms


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One thing is certain: we will all die. And most of us don’t like to talk about it. Or even think about it.

So, at the back end of 2015, it felt a little disconcerting to immerse myself in all the things that have to be done after someone dies. And then to consider all the things that we should be doing to make that system work better, putting real safeguards in place to catch malpractice early and to change those things that are done that accidentally lead to avoidable deaths. This is where the proposed death certification reforms come in, and why I felt it important to write to you about them today.

Since then, inquiries into the system issues that led to avoidable deaths at Mid Staffordshire and Southern Health NHS Foundation Trusts have highlighted the need for us to introduce a system of independent oversight with the expertise to notice issues and patterns quickly.

The Coroners and Justice Act 2009 has already provided the legal basis for introducing medical examiners to scrutinise those deaths that a coroner does not investigate. This means that an independent expert will consider every death in England and Wales as an assurance to bereaved people, a safeguard against wilful malpractice, and an early warning system to help the NHS improve and learn.

The system also needs to be paid for. We will be retiring the current process where doctors fill in cremation forms and medical referees check them at the crematorium – cremation is used in about 75 per cent of deaths nowadays. The usual associated costs of £184 for those forms will also be stopped. The medical examiner service replaces and enhances this system, extending safeguards to all deaths, irrespective whether the person is buried or cremated. A nationally-set fee, likely to be between £80 and £100, will apply for every death that a medical examiner scrutinises. Where a coroner investigates a death, there will not be a fee payable.

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We have tested the proposed reforms in the NHS, both in England and Wales, and medical examiners have scrutinised over 26,000 deaths. Pilot sites have demonstrated that the new system does not introduce any undue delay, that only appropriate cases are referred to coroners, that registrar rejections of cause of death certificates are all but eliminated, and bereaved people have provided uniformly positive feedback of the system in providing them with assurances.

We are very keen to listen to your perspectives on how the reforms could affect you. You can find the full details on the proposed system in the Department of Health’s consultation on the reforms at www.gov.uk/government/consultations/death-certification-reforms, and a short summary of the proposals at www.gov.uk/government/publications/changes-to-the-death-certification-process; you have until June 15 2016 to submit a response. I sincerely hope to hear from you.