Extending medical examiner scrutiny to deaths in non-acute settings

According to a system letter sent to NHS leaders earlier this month, all health settings now need to implement medical examiner systems for scrutiny of all non-coronial deaths as early as possible in 2021/22, so that all deaths are scrutinised by the end of March 2022.

Since 2019 acute trusts in England have set up medical examiner offices to initially focus on the certification of all deaths that occurred in their own organisation that were not referred to the coroner. Trusts were supported to set up medical examiner offices on hospital sites.

The Government’s White Paper, Integration and innovation: working together to improve health and social care for all confirms its intention to put the medical examiners system on a statutory footing in the forthcoming Health and Care Bill.

The Royal College of Pathologists has confirmed that it has now trained 1,200 plus medical examiners.

The letter explains that the National Medical Examiner’s office has established the legal basis for providers to share records of deceased patients for medical examiner scrutiny, and The National Health Service (Scrutiny of Deaths) (England) Order (which came into force on 1 May 2021) confirms NHS trusts’ legal basis for scrutinising any relevant deaths.

Medical examiner offices will need to work with GP practices, chief executives and medical directors at specialist, mental health and community trusts to plan how they will facilitate medical examiner scrutiny of deaths of their patients. Each organisation will need to work with one established medical examiner office. Regional medical examiners will support medical examiner offices and health providers through implementation. Annexes A and B of NHS England/Improvement’s letter sets out suggested processes for GP practices, and specialist, mental health and community trusts, respectively. An additional webpage has been created providing specific information for colleagues working in primary care.

Integrated Care Systems and Clinical Commissioning Groups will be important partners in the implementation of independent scrutiny by medical examiners and should facilitate working across systems, according to the letter.

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