Anaesthetic and Intensive Care Consultant and Lead Medical Examiner for Calderdale and Greater Huddersfield, Tim Jackson

Last month we outlined that statutory changes were coming for the Medical Examiner service. These changes take effect on Monday, 9th September.

Anaesthetic and Intensive Care Consultant and Lead Medical Examiner for Calderdale and Greater Huddersfield, Tim Jackson, has provided the key changes for colleagues and what it means for bereaved relatives below.

Tim said: “The core process of ME scrutiny will not change. It’s important to know that clinicians must refer all non-coronial deaths to the ME Service and complete the Medical Certificate of Cause of Death (MCCD).

"Ward staff should also be aware that we cannot release a Medical Certificate of Cause of Death until it has been agreed by the ME service, so please don't ask relatives to go to the General Office the following day (from next Monday 9th September)."

The main practical changes are:

  • There will be a new paper Medical Certificate of Cause of Death (MCCD) format
  • There will no longer be a cremation form
  • The "28-day rule" to define a practitioner who can complete an MCCD will be removed. If you have attended the deceased at any stage in their life and are able to offer a meaningful cause of death, you are legally permitted to complete an MCCD
  • There will be no requirement for the doctor to view the body of the deceased

What this means for clinicians:

  • Your final professional act of respect for the deceased will be to take ownership of the cause of death and completion of the MCCD
  • You will need to refer the death of your patient to the ME service (unless there is suspicion that the death is unnatural, in which case it should be referred to the coroner instead. The ME service can still advise on this if you are unsure)
  • If you believe the death is natural but you are unsure as to the cause of death, you should refer the death to the ME service who may be able to support you in arriving at an acceptable cause of death
  • If you are a junior doctor and are unsure as to the cause of death, please discuss with your seniors. It is best practice that the patient's consultant is aware of the death of the patient and the discussion with the ME even if everything is deemed as straightforward
  • If you know that there are a limited number of doctors who will be able to complete the MCCD and their availability is limited (due to leave or shift patterns, for example), please let us know so we can prioritise cases accordingly
  • Please give us your best contact details so we can interact with you as effectively as possible and don't waste anybody's time
  • Failing all else above, please document your impression of the cause of death and plan for who is going to take ownership of the death certification in your patient's record. 

What this means for ward staff:

  • If you are supporting the family of a patient who has died, please help them by managing their expectations. (See section below on "what this means for bereaved relatives")
  • Please remind your doctors of their responsibility to refer the death to the ME service
  • Be mindful that an MCCD cannot be released by the Trust until the cause of death has been agreed by the ME service. Please do not tell relatives to contact General Office the following day to collect the MCCD.

What this means for bereaved relatives: This information is provided so that colleagues are aware and can help support their expectations.

  • The ME service will contact relatives when they have received the referral from the doctors involved in the care of their loved one – please make sure they know that the General Office will no longer be able to provide a MCCD the next day
  • The ME service is NOT the same as the coroner. It is here as an independent body to review all deaths, and in most cases this is a routine process aimed at agreeing the cause of death
  • The ME service will explain the agreed cause of death, or any alternative outcome as appropriate

The ME service will provide an opportunity for bereaved relatives to share any concerns they may have regarding anything leading up to the death of the patient. They are independent of the Trust and are here to advocate for their views. The way we respond to any concerns will depend on their nature, and may include:

  • Answering any unanswered questions as far as we are able
  • Further liaison with the ward/clinical teams involved if there are questions the ME is unable to answer
  • Simply listening and acknowledging them if there is no further action that needs to be taken
  • Signposting them to sharing their concerns with the Trust via the Patient Advocacy and Liaison Service (PALS)
  • Taking them forward as part of a referral to the coroner, or to any of the Trust's governance and investigation processes. 

Special circumstances:

The ME service appreciates that the needs of all bereaved relatives are important and appreciate that the needs of certain communities after the death of a loved one are specific. They aim to respond to those needs in an inclusive, respectful way as far as possible. However, they also have a statutory responsibility to do their job to the best of their ability, and if that requires them to take more time to consider the details of complex cases, then they will. They will keep the bereaved relatives up to date with the progress of our scrutiny.

There is more information about the Medical Examiner Service on the intranet.

If you need more advice or would like to know more, email medical.examiner@cht.nhs.uk