Changes to Death Certification from 9th September 2024
From Monday 9th September 2024, changes in the law come into effect that may change your experience of registering deaths.
Medical Examiners Service
A new statutory medical examiner system is being rolled out across England and Wales to provide independent scrutiny of deaths, and to give bereaved people a voice. From 9th September all deaths in any health setting that are not investigated by a coroner will be reviewed by NHS medical examiners. These are independent senior doctors trained in the legal and clinical elements of the death certification process.
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.
Medical examiner offices in England are based at acute trusts and in Calderdale and Greater Huddersfield there is an office at Calderdale Royal Hospital. They are staffed by teams of medical examiners, supported by medical examiner officers.
The role of the Medical Examiner Office 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 doctor completing it
- discuss the cause of death with bereaved families 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.
The most noticeable changes that come in on 9th September relate to the medical certificate of cause of death (MCCD) and the cremation paperwork.
New Medical Certificate of Cause of Death
The ‘medical certificate of cause of death’ is the certificate completed by the doctors who looked after the deceased. This is the certificate that goes to Calderdale or Huddersfield Registration Services and the information from this is added to the ‘Death Certificate’ that the Registrar will give you. From 9th September, medical examiners will be required in law to review every death in England & Wales that is not reviewed by a coroner. To confirm this review has been completed the medical examiner countersigns the new version of the medical certificate before it can go the Registrar.
New Point of Contact
The medical examiner office become a point of contact for families after bereavement. We can tell you if we have received notification of the death, and if we have, where we are in the process of review. There are instances where our review may indicate a referral to the coroner is required. The commonest reason for this would be because the doctors attending the deceased may not be certain of the cause of death. Other reasons might be because the deceased had a fall and fracture or was undergoing treatment. The medical examiners team will be able to explain why the referral is needed and support with contact details for the coroners office.
Registering the Death
We strongly recommend you do not book a registration or funeral date until the medical examiners office has contacted you to confirm an MCCD can be issued. There are two reasons for this:
- the medical examiner team cannot start reviewing a death until they have received all the paperwork from the attending doctor (currently 2-5 days after the death)
- review might indicate a coroner’s referral is necessary which means an MCCD may not be issued
Where it is possible to proceed with an MCCD, the medical examiners team will contact the Next of Kin as documented in the medical records, explain the certificate, answer any questions and if all is well and give them the go-ahead to make an appointment to register. We can also help with explaining next steps. Families have five days to register a death from the moment the medical cause of death certificate is completed.
MCCDs are sent to Registration Services electronically. There is no need to come into the hospitals or GP practices to collect a certificate.
Cremation paperwork
All deaths taking place after midnight on the morning of 9th September 2024 will not need cremation paperwork. This role is taken over by the new MCCD with the medical examiner review. For this reason, Calderdale and Huddersfield Registrars will be unable to accept or process a new medical certificate of cause of death unless it has both the signature of the attending doctor and the signature of the medical examiner.
Still have questions?
If you have questions or concerns about the care the deceased received, the medical examiners team will do their best to explain what they can from the medical records. If needed, we will help you access answers to your questions by linking you up with the NHS organisation who provided that care through their Patient Liaison services or Complaints process. If you feel a coroner needs to be involved, we can facilitate that for you.
Finally ...
Our medical examiner office has been working hard over the last four years, together with our local Registration Services, to minimise the impact of the change in the law on 9th September 2024. This will be a major change for healthcare professionals, registrars and funeral services but we all have the goal of creating a seamless transition for families going though bereavement. Your feedback will be invaluable in helping us to continuously improve this service.
