Post-mortem examinations

I beg to move amendment 188, in clause 15, page 8, line 22, after ‘practitioner’, insert ‘including a radiologist’.

With this it will be convenient to discuss the following: amendment 363, in clause 15, page 8, line 25, at end insert

‘, so long as he or she is supervised by a qualified pathologist.’.

Amendment 190, in clause 23, page 13, line 31, after ‘staff’, insert

‘including staff available outside normal office hours,’.

Amendment 189, in clause 37, page 22, line 37, at end insert

‘“post mortem examination” includes both invasive and non-invasive examination;’.

I am sure that you will be pleased to hear that I have no correspondence to shuffle today, Mr. Gale, just as I did not have any correspondence to shuffle in our last sitting week, despite the fantasies of journalist Henry Porter in The Observer the Sunday before last.

The amendments are interrelated. About 10 years ago, Her Majesty’s coroner for the Manchester Central jurisdiction, Len Gorodkin, proposed that post-mortems should be possible by non-intrusive examination of bodies by magnetic resonance imaging. He had the sizeable Jewish communities in Greater Manchester in mind when he made the proposal. In the past few years, working mainly with the Bolton Council of Mosques, Her Majesty’s Manchester West coroner, Jennifer Leeming, has developed the technique into an acceptable way of carrying out post-mortems, and the so-called Bolton protocol has spread to other Greater Manchester boroughs and towns and cities throughout the country.

The Manchester West jurisdiction covers Salford, where there is a sizeable Jewish community, Bolton, where there is a sizeable Muslim community, Wigan and Leigh, but I should stress that MRI post-mortems are available for the whole community, not just the Jewish and Muslim communities. Some families have asked for MRI post-mortems because they need the procedure to be carried out in a hurry—for example, if they are visiting a loved one in this country who dies, and they need to return quickly to their own country because of their occupation.

The Manchester West jurisdiction is one of the 10 busiest in the country, with more than 4,000 deaths reported each year, costing the council tax payers in the four local authority areas £1,434,000 each year. Council tax payers in the jurisdiction therefore bear a higher cost than council tax payers in other jurisdictions.

Does the hon. Gentleman agree—he might have said this—that there is often a quite important religious and ethnic minority interest in swift burial or disposal? If formalities have to be undergone, they could extend the process and the degree of concern in those communities.

The hon. Gentleman is correct—that is the main reason why the procedure has been developed in the Manchester West jurisdiction.

The average cost of an MRI post-mortem is £885 and 50 to 60 are carried out each year. They are usually carried out overnight, when the MRI scanners are not required to scan living people, for obvious reasons. Costs are usually met by the family, but the Jewish Burial Board in Greater Manchester meets the cost of a scan for its members.

Consultant radiologists play an important role in determining whether an MRI post-mortem will reveal the cause of death, which is the reason for amendment 188. Radiologists feel strongly about their inclusion in the Bill.

Of the 50 to 60 examinations carried out in this way, perhaps one will have to be referred to a pathologist in the end because the MRI post-mortem did not reveal the actual cause of death. That is explained to the families who choose to undertake the procedure.

One advantage of an MRI post-mortem over a pathological examination is that the results can be kept on a disc for future examination, if necessary. Also, it is usually quicker than a pathological examination, especially when histology samples must be sent away for analysis, which can take several days or sometimes even weeks.

The Manchester West coroners’ jurisdiction provides a full out-of-hours service for the issue of documentation for the release of deceased persons for burial, cremation or even removal from the UK, which is common in Muslim communities. In Manchester West, not only Her Majesty’s coroner but the administrative assistant who issues such documents is available out of hours.

I am pleased that the Bill’s explanatory notes refer to such post-mortems, on page 26. The procedure is at least now recognised by this Government. The power to request a post-mortem examination by MRI scan is underpinned by clause 16, which we shall consider in a moment. The clause gives the coroner the power to move a body between jurisdictions.

Obviously, an MRI scanner might not be available in the coroner’s own jurisdiction. Non-invasive MRI post-mortems are not yet available for children in Greater Manchester, as no participating paediatric radiologist is available. In such cases, it would be necessary to move the body from Greater Manchester to Sheffield, where the nearest consultant paediatric radiologist is located. Here in the south, Great Ormond Street children’s hospital also has a specialist radiologist.

To summarise, radiologists feel strongly that MRI post-mortems are a developing technique that will spread rapidly across Britain, particularly in the communities that I have mentioned, and that will involve a considerable number of our citizens. They feel that now is the appropriate time, as an opportunity such as the Bill comes only rarely, to put radiologists on the face of legislation. That is the substance of amendment 188.

Amendment 189 is consequential. It defines a post-mortem as either invasive or non-invasive. Again, the coroners to whom I have spoken, such as Jennifer Leeming in the Manchester West jurisdiction, and radiologists feel that there should be a definition in the clause along the lines of my amendment.

Clause 23 relates to providing accommodation overnight and at weekends. I remind right hon. and hon. Members that coroners, by the nature of their employment, must make themselves available 24/7, so that is not a problem. Jennifer Leeming, in my jurisdiction, is always available if needed. Furthermore, administrative assistants are provided in the Greater Manchester West jurisdiction as well. The cost of the provision is not excessive and would be met in most cases by the charge for the MRI scan in the first place. I have pleasure in urging the Committee to accept the two amendments, particularly amendment 188.

I welcome you to this afternoon’s sitting of the Committee, Mr. Gale.

The suggestion of the hon. Member for Bolton, South-East that we put the term “radiologist” on the face of the Bill makes a great deal of sense. I rise to speak to our amendment 363, which would ensure that if a suitable practitioner is not a registered medical practitioner, he or she is supervised by a qualified pathologist.

There may well be cases when such scans are carried out by relatively junior technicians. As the hon. Gentleman suggested, the use of such highly sophisticated medical equipment will probably take place out of hours. He also alluded to the fact that in two of the great religions in this country, Judaism and Islam, there is an imperative that bodies be released for burial the following day, if at all possible. I am concerned that short cuts should not be taken and that, where fairly junior technicians are in charge, they should always be supervised by a qualified pathologist.

I did mention the consultant radiologist.

I am grateful to the hon. Gentleman for underlining that point.

Our amendment speaks for itself. I hope that the Minister understands why we are keen to put that extra safeguard in place. I agree with what the hon. Member for Bolton, South-East said in speaking to his amendments. That aside, it is a good clause, and it should command the support of the entire Committee.

This is clearly an important matter for religious reasons, and it is important for those who are suffering a bereavement in the family, for whom it is clearly a difficult time. Having to reconcile one’s religious feelings and beliefs with the British justice system can be difficult. It is appropriate that we be as sympathetic as possible.

I support the amendments tabled by the hon. Member for Bolton, South-East. The proposal seems to be a sensible way forward, particularly as it works in the jurisdiction where his constituents live. However, it has been suggested to various members of the Committee that coroners should have a duty to make families aware of the option for the non-invasive post-mortem as well as the surgical post-mortem.

In areas such as Manchester, the technique is well known; it is supported and promoted and people are aware of it. In other parts of the country, however, religious communities may be much smaller and less well represented. They may not have the support of the surrounding community, and they may not be aware of the options if they feel strongly that a post-mortem should not be carried out. Will the Minister say whether it would be possible to require information on what is possible and what is available to be spread more widely?

Welcome, Mr. Gale, to this afternoon’s discussions.

I entirely understand why my hon. Friend the Member for Bolton, South-East (Dr. Iddon) tabled the amendments, but I believe they are unnecessary for two simple reasons. First, all practising radiologists should also be registered medical practitioners; they would therefore fall within the definition of a “registered medical practitioner” under clause 15(3)(a). I suspect that we would all be a little uneasy if someone who was not a registered medical practitioner were able to carry out the post-mortem procedure—invasive or otherwise—without having been designated as suitable by the chief coroner.

Secondly, we want only those who are properly trained and qualified to carry out such procedures. In clause 15(3)(b), we provide the necessary assurance that only those who are registered medical practitioners or who are otherwise recognised by the chief coroner as possessing the relevant skills can carry out such procedures. For example, that would apply to some toxicologists, forensic scientists and forensic archaeologists as much as to radiologists.

Amendment 363, tabled by the hon. Member for North-West Norfolk, goes too far in the opposite direction. Saying that we would need a qualified pathologist to oversee people who, by definition, are already qualified medical practitioners—they would have to be so for the coroner to have allowed them to carry out the post-mortem—is over-egging the pudding. If the chief coroner had any doubt about the suitability of certain individuals, either he would not appoint them or he would take advice from the national medical adviser.

I am conscious that the General Medical Council is putting in place requirements for quinquennial recertification and demonstration of fitness to practise for general medical practitioners. Can we have an assurance that the chief coroner will at least look at a system that shadows that for persons whom he approves, so that such approval will not be lifetime approval, but will be subject to regular review?

That is a very positive and constructive suggestion, and I will certainly take it forward. That is exactly the way to ensure that we raise standards right across the coronial system.

If the medical adviser is able to advise the chief coroner that a person is suitably qualified, another qualified pathologist should not be required to be present to oversee their work and to ensure that they carry out the post-mortem in a proper fashion.

On the points raised by the hon. Member for Cardiff, Central on the availability of MRI scans, we certainly want to encourage coroners to use non-invasive post-mortems as well as invasive ones. In future, coroners should make people aware of the opportunity to use that form of post-mortem, although it is slightly more expensive. The problem at the moment is that not every area can benefit from the work of people such as Jennifer Leeming or from facilities such as those in Greater Manchester. Over time, however, I would like such facilities to become available across the country, so that non-invasive post-mortems might become more common. I say that not only because of the religious reasons that have been mentioned, but because families might have other reasons for feeling that such a post-mortem is appropriate.

On amendment 189, it is not necessary to set out in the Bill that post-mortems include invasive and non-invasive post-mortem examinations, because the drafting of the Bill outlines that. To be clear, however, let me say that the provisions that refer to post-mortems do indeed apply to both invasive and non-invasive post-mortems.

Finally, my hon. Friend the Member for Bolton, South-East talked about coronial staff being available 24 hours a day. Clause 23 makes it clear that staff have to be available to ensure that the coroner can carry out their functions properly. In effect, that means that someone has to be available 24 hours a day to ensure that a post-mortem could, for example, be carried out urgently in the middle of the night. It is implicit in clause 23 that staff will be available outside normal office hours.

On that basis, I hope that my hon. Friend will withdraw his amendment. For the reasons that I have outlined, I also ask the hon. Member for North-West Norfolk not to press his amendment.

Based on those reassurances, which are now on the record, I am prepared to withdraw my amendment, but I hope that my hon. Friend the Minister and her civil servants will try to expand the non-invasive post-mortem service, which has been proved to work over five years. Despite some criticisms, it does work—indeed, in only one or two cases does it not work and a full pathological examination follows. I thank my hon. Friend for her comments and I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 15 ordered to stand part of the Bill.