1. Professor Peter Furness The National Medical Examiner Past President, Royal College of Pathologists

2. We’ve been here before... Select Committee report 1893 The Wright Report 1936 The Brodrick Report 1971 The Luce Report 2003 The Shipman Report(s) 2003

3. The other problems…

4. Swift B, West K. J Clin Pathol 2002; 55:275-9. Death certification: an audit of practice entering the 21st century. 1000 ‘natural’ deaths. “Only 55% of certificates were completed to a minimally acceptable standard” Fernando D, Oxley JD & Nottingham J. J Clin Pathol 2012; 65:949- 51. Death certification: do consultant pathologists do it better? “Using the Office for National Statistics guidelines, the authors found that only 56% of the certificates were appropriately completed.”

5. The answer?

7. A more recently recognised problem:

8. Medical Examiners and clinical governance?

9. The process: Duty on doctors to refer directly to coroner Advice available from Medical Examiner (ME) Certifying doctor proposes cause of death to ME ME scrutinises records, examines body, speaks to staff and speaks to next of kin ME may refer to coroner or require amended cause of death ME provides formal confirmation of cause of death, to be delivered to Registrar by the family Coroners can refer cases to ME for a ‘Medical Examiner’s Certificate’

10. Pilot sites: Reduction in referrals to the coroner Increase in inquests Elimination of certificates rejected by Registrar Access to medical records can be achieved Process takes a few hours longer on average Requests for rapid process can be accommodated External examination of body problematic Relatives are pleased to be contacted Medical staff and bereavement office staff value support Valuable information to clinical governance systems

11. Implementation plan? Abolish cremation form fees (£175) Levy a fee for scrutiny of all non-Coronial deaths (about £100) Implementation date October 2014. General Election May 2015…

12. A senior politician commented: “So this is a reform which everyone agrees is a good thing. But there are short-term political risks in its implementation that are not matched by short-term political gains.” “Hmmmm.”

13. The current implementation plan:

14. Sequence of events: Public consultation Regulations laid before Parliament Regulations approved Get started! (General election…)

15. Embryonic implementation guidance: www.pathology.plus.com/NME/MEimplementationtoolkit

18. Training Medical Examiners… http://www.e-lfh.org.uk/programmes/medical-examiner/

19. www.pathology.plus.com/NME/MEimplementationtoolkit

20. Data storage, analysis and transmission? NO central funding for an IT solution. So I wrote one. www.pathology.plus.com/NME/MEimplementationtoolkit

23. PLEASE REMEMBER: www.pathology.plus.com/NME/MEimplementationtoolkit So please help us to get it ready!