Coroners and Justice Bill

Part of the debate – in the House of Commons at 9:28 pm on 26 January 2009.

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Photo of Richard Taylor Richard Taylor Independent, Wyre Forest 9:28, 26 January 2009

I thank the last few speakers for being so commendably brief. I am sure that I am the only person here who has ever signed a death certificate or cremation forms—both the first and second parts—so I am desperately keen to get in to speak. I think I have eight minutes, so I will cram as much as I can into them.

To prepare for the debate, I looked at the current death certificate, which is headed "Births and Deaths Registration Act 1953". I do not think that that has been changed since 1953, and it is certainly the same as the last death certificate that I signed, which was at least 13 years ago. I looked back also at Dame Janet Smith's brilliant and comprehensive third report following the Shipman inquiry. I shall remind the House of one or two things that she said.

First, the current system depends on the honesty of the doctor. Dame Janet said:

"Many of Shipman's patients died suddenly in circumstances in which no honest doctor could have claimed to know the cause of death. Yet Shipman, who had killed them, was able to certify the cause of death, avoid a report to the coroner and thus also avoid any official enquiry into the death."

She went on to stress the importance of training, observing:

"A further problem with the current system is that the quality of certification is poor. Doctors receive little training in death certification."

Certainly the training that I received was not really about the accuracy of the death certificate. It was about the terms that were acceptable to the registrar examining the certificate, who would be entirely unqualified.

The death certificate still contains some helpful notes. In very small writing at the bottom is the following advice on completing the certificate by giving the cause of death:

"This does not mean the mode of dying, such as heart failure, asphyxia, asthenia, etc: it means the disease, injury, or complication which caused death".

I do not think that anyone nowadays would use the terms "asphyxia" and "asthenia". Shipman, however, used the term "natural causes" in two of his death certificates. Dame Janet Smith draws attention to the fact that, amazingly, the registrars in Tameside did not know that "natural causes" was not acceptable as a cause of death. They had to get in touch with their superiors, who felt that it was acceptable, so Shipman got away with "natural causes".

Another unacceptable term—some of us are probably already beginning to suffer from it—is "senile decay". Even Shipman did not try to use that one. We were told that an acceptable term was "bronchopneumonia", and that as long as that condition was put first on the death certificate of any elderly person, whether he or she had had it or not, the registrar would accept it. It is clear from those examples that death certification is very inaccurate.

The form still asks whether the person certifying has arranged a post-mortem. Since Alder Hey, the rate of hospital non-coroner post-mortems has dropped remarkably. That has a tremendous downside. The first recommendation in the Health Committee's 2005 report on venous thromboembolism states:

"We are concerned that the number of post-mortems being performed has decreased since Alder Hey. As a result the true cause of death is not being determined in many cases."

I believe that it is very important to allow a number of hospital post-mortems to continue. If a senior clinician who has been looking after the patient approaches people for consent, that will not be too unacceptable. There are many good points on the certificate at present, but I want to know whether the Bill picks up Dame Janet's recommendations.

At least cremation forms have been changed. One that I saw recently was drawn up in 2008. Cremation form 4 is now the first to be filled in by the first doctor. There is much more space for details of the cause of death and the examination carried out. Form 5, the old second form filled in by the confirming doctor, contains the same questions, but places a little more emphasis on asking the referee doctor to talk to the relatives or others involved. Question 6 reads:

"Please state the date and time that you saw the body of the deceased and the examination that you made of the body."

Dame Janet Smith makes some play of that, feeling that examination at that stage is essential.

One must be realistic, and at present, all one can do at that stage is go into the mortuary and ask the mortuary attendant where the body is. If it is already wrapped up and in the fridge, all one can do is identify that it is, let us say, a white male or female with the right label on it. What examination can one conduct to help establish the cause of death? It is crucial that there is a system for the medical examiner who is to be appointed to conduct a proper examination at this stage, if no post-mortem has taken place.

Dame Janet Smith concludes with the recommendation that there should be one system of death certification applicable to all deaths, regardless of whether the death is to be followed by burial or cremation. There should be a requirement that the fact that a death has occurred be confirmed and certified. I welcome the parts of the Bill that go a good way towards fulfilling her requirements. However, along with many others, I do not welcome the parts that imply secrecy, or those that ride rather roughshod over data protection measures. And there I must finish, having used my allocated few minutes.