A new process for certifying and registering deaths in England and Wales came into force on Monday, 9th September 2024. Read on to find out more.
The death certification system in England and Wales has remained largely unchanged for more than 50 years, so was overdue for reform. Concerns about the system had been highlighted by a number of high-profile cases in recent years, including the Shipman Inquiry.
The new death certification reforms and statutory Medical Examiner System introduce safeguards to ensure that an independent review is carried out for all deaths, either by a Medical Examiner or by a coroner. These changes only apply in England and Wales, so at present the procedures for Scotland and Northern Ireland remain the same.
When Did These Changes Come Into Force?
The changes came into force at one minute after midnight on Monday, 9th September 2024. There will be a transitional period whilst new forms and processes are fully implemented and embed in the system, particularly relating to deaths and certifications of deaths that straddled the launch date. Healthcare settings, funeral directors and other funeral arrangers are working hard to ensure that the changeover goes as smoothly as possible, but there may well be teething problems whilst everyone gets used to the new system.
Here we answer a few of the key questions and explain some of the most important changes that may affect the bereaved after a death. To find out more and to see the full guidance, please see the Government guidelines.
What is a Medical Examiner?
A Medical Examiner (ME) is a senior medical doctor who provides independent scrutiny of the cause of death in cases where a coroner is not involved. MEs are trained in the legal and clinical elements of the death certification process and work alongside the medical practitioner to confirm cause of death.
What is the Purpose of the new Medical Examiner System?
The NHS guidelines explain the the purpose of the Medical Examiner System is to:
- provide greater safeguards for the public by ensuring independent scrutiny of all non-coronial deaths
- ensure the appropriate direction of deaths to the coroner
- provide a better service for the bereaved and an opportunity for them to raise any concerns to a doctor not involved in the care of the deceased
- improve the quality of death certification
- improve the quality of mortality data
What Does a Medical Examiner Do?
The NHS guidelines state that the role of MEs is to examine deaths to:
- agree the proposed cause of death and the overall accuracy of the Medical Certificate of Cause of Death (MCCD) with the medical practitioner completing the certificate
- discuss the cause of death with bereaved people and establish if they have questions or any concerns with care before death
- act as a medical advice resource for the local coroner
- identify cases for further review under local mortality arrangements and contribute to other clinical governance processes
What Impact Will These Changes Have for the Bereaved?
How the changes differ from the old system:
- if they wish to do so, the bereaved will have an opportunity to raise concerns or ask questions about the death before the MCCD is completed and submitted
- once signed and approved, the MCCD will be sent by the Medical Examiner directly to the registrar, rather than by the medical practitioner
- at this point, the qualified informant (those allowed to register the death) will be notified that the registrar has received the MCCD and they can then register the death
- the death must be registered within 5 days from the date at which the registrar receives the MCCD (rather than, as previously, within 5 days from the date of death)
- new categories of qualified informants will enable the partner of the deceased and a representative of the deceased to register the death
Changes to Who Can Complete the MCCD
The old rules stated that in order to complete the MCCD the medical practitioner (or attending practitioner) must have attended the patient during their last illness, but that they must refer the case to a coroner if they have not done so within 28 days prior to the death, or had not seen them in person after the death.
In a simplification of these rules, a medical practitioner is now eligible to be an attending practitioner and complete a MCCD if they have attended the deceased in their lifetime. The medical examiner will then scrutinise the cause of death proposed by the attending practitioner. Once the cause of death is agreed and finalised, and if there is no requirement to notify the coroner, the MCCD is sent directly to the registrar by the Medical Examiner.
Changes to What is Recorded on the MCCD
Additional information will now be included and gathered on the MCCD. This is in order to streamline and simplify the passing on of essential information (eg for implantable medical devices) and also to improve processing of mortality statistics.
The new information required on the MCCD includes:
- the existence of implantable medical devices (for example, pacemakers). This information will be transferred to the Certificate for Burial or Cremation (the ‘green form’), which can then be shared with the burial authority or crematorium
- the ethnicity of the deceased
- whether the deceased was pregnant or recently pregnant
Summary
We hope that this has been helpful. It is anticipated that there will be further guidance over the coming weeks and months and we will be sure to keep everyone up to date as this is released. In the meantime, healthcare professionals, funeral directors and funeral arrangers will be able to guide the bereaved through the new system and answer any questions.