Your death rates are about to be checked

National Medical Examiner Dr Alan Fletcher has published his first report, outlining progress and next steps in the roll-out of medical examiners. But with this new system set for a statutory footing in Government health service legislation, David Hare reports on the implications for independent healthcare providers treating millions of NHS and private patients. 

As Independent Practitioner Today readers will be aware, implementation of medical examiners began in England and Wales in 2019 with the appointment of the National Medical Examiner and recruitment of national and regional teams. 

Their introduction was one of the recommendations of the Shipman Inquiry and was designed to help make it easier to detect unusual patterns of deaths. 

Indeed, a core part of the medical examiner role is to provide bereaved people with clear information about the cause of death, and an opportunity to raise any concerns they may have about the care and treatment provided to the deceased person. 

Since 2019, medical examiner offices have now been established at 130 acute trusts in England – with five still to implement their plans – and at regional hubs in Wales.

Initially, they provided scrutiny of non-coronial deaths in acute care, with this remit being expanded in 2021 and 2022 to cover non-coronial deaths in other settings such as the community. 

The first stage of rolling out this new system involved acute trusts in England and local health boards in Wales establishing medical examiner offices to certify all deaths within their own organisations.

Examiners’ increasing role 

In the next phase, medical examiners offices are starting to review deaths in their geographic region but outside of their own organisations, including deaths in the independent sector. 

Medical examiners’ offices are responsible for reaching agreement with other organisations to review their deaths and are being encouraged to work incrementally to increase the number of organisations they cover. 

And in a bid to further improve safety and quality in the health system, their role is set to strengthen with the Government’s White Paper on NHS reform published earlier this year setting out the intention to make medical examiners a statutory requirement so that all deaths not reviewed by a coroner are reviewed by a medical examiner, wherever they occur. 

But what does this mean for the independent sector? 

Chance to improve safety

Deaths in independent facilities are thankfully extremely low, but private providers should be prepared for increased scrutiny around any deaths in their organisation. There is an opportunity to further improve patient safety. 

As part of the medical examiner’s role is to speak with bereaved families, healthcare providers may want to review how they communicate with families about a death and ensure their policies are consistent with those of the medical examiners.

NHS England’s current message is that the independent sector does not need to take any formal action yet but should be ready to be contacted by the medical examiners’ office in their area. 

It recommends each medical examiner’s office covers at least 3,000 deaths and that organisations with smaller numbers of deaths work with an existing office rather than establishing their own system. 

A benefit of having medical examiners review the approximately 89% of deaths that do not go to the coroner is more accurate mortality statistics. This could change some care guidance and priorities. 

As the Government’s forthcoming legislation on the NHS makes its way through Parliament, the Ind­ependent Healthcare Prov­iders Network will be working with Parl­iamentarians across the Commons and the Lords to ensure independent providers are fully and explicitly recognised in the remit of medical examiners.

This is building on our work to ensure a truly ‘whole-systems approach’ to patient safety and guarantee our patients the best possible care.

David Hare (right) is chief executive of the Independent Healthcare Providers Network (IHPN)

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