Medical Examiners under the microscope
“A work in progress.”
That was how Dr Suzi Lishman, immediate past President from the Royal College of Pathologists (RCOP), described the UK Government’s announcement in June that the Medical Examiner (ME) implementation plan will commence in April 2019.
Terry Tennens, SAIF CEO, attended the conference to gain the latest update on these long awaited reforms.
The RCOP is the lead authority to train and equip MEs across England and Wales on behalf of the Department of Health and Social Care (DHSC).
The implementation plan is in two phases, described by Jeremy Mean, Deputy Director of Health Ethics in the DHSC.
Phase 1 will take effect from April 2019. This will be a ‘non-statutory’ phase of implementation via secondary care by NHS Trusts. This is a shift from the original concept of local authorities being responsible for their implementation. Consequently, MEs will be salaried positions in NHS Trusts and in a hospital setting. At some point they will move into managing deaths in the community.
Phase 2 MEs will receive statutory authority through the Coroners and Justice Act 2009 where all deaths will be scrutinised by the Coroner and ME Officer. This will be mandatory and across all communities.
The process between phase 1 and 2 is unclear, as are the timelines for phase 2 to commence.
The DHSC has been operating a number of ME pilots in a hospital setting from Sheffield to Gloucester, in fact across England and Wales.
The purpose of MEs is to ensure independence and accountability for reporting suspicious deaths. There will be two routes from April 2019, the Coronial courts and MEs.
The success factors for the ME system include:
Improvements in the recording of certificates of death by the qualified attending physician (QAP)
Maintain the five day timetable for registration.
In phase 2 the move to primary care deaths in urban and rural settings will be paramount for the system to be comprehensive.
There will be a National ME Officer appointed by the National Patient Safety Director, Dr Aidan Fowler, who will be responsible for the system across the NHS Trusts in phase 1 and across the communities in phase 2. There will be a regional reporting structure, so it will be important for funeral directors to be aware of representatives for communication and reporting glitches that impact our clients.
The purpose of the ME
Dr Alan Fletcher has been ME from the pilot in Sheffield Hospital Trust for the past 10 years. He outlined the criteria behind successful outcomes:
- What did the patient die from?
- Accurate medical certificate of death
- Timely reporting of suspicious deaths to the Coroner
- Are there any clinical governance concerns which require detection and notification?
The ME will review the medical records of the patient; interact with the attending doctor; interact with the bereaved, to explain as well as collate background information where needed; and confirm the Medical Certification of Cause of Death (MCCD).
This will occur within 24 hours and this performance indicator will be monitored. The cremation forms part 4 and part 5 will continue with the attending doctor completing part 4 and the ME part 5.
Scrutiny is at the core of this process to prevent no foul play and improve communication between the health system and the patient’s next of kin.
Key issues for funeral directors
The appointment by the client to register the death remains a five day window. Sometimes the lack of availability by the attending doctor could cause a delay in discussing the case with the ME.
At the conference, Dr Fletcher indicated the ME process will add half a day to the current process, but in some instances it will speed up the system where potentially a case might have been referred to the coroner and clarity has been gained with the attending doctor on the cause of death.
In the pilot phase there have been instances where there are reductions in referrals to the Coroner’s office, and other pilots have increase their referrals for inquests by a few.
Some NHS Trust pilots have integrated the role of the ME with the bereavement office, but the majority have appointed ME officers. The NHS Trust will fund these salaried positions, and there will be £1 million investment into information technology platforms to speed the flow of information to a decision. An e-learning resource for MEs has also been established.
As MEs are appointed, please keep the SAIF Business Centre informed of any problems your clients experience, as there is scope during Phase 1 for the Government’s implementation team to adjust and learn from their better experience of understanding death programme.Tags: certification, Government, medical examiner, reform, SAIF, Terry Tennens