What is the proposed change?

On 26 March 2019, the government launched a consultation that aims to gather opinions from respondents on the possibility of introducing coronial investigations into all full and post-term stillbirths -occurring from 37 weeks pregnancy - in England and Wales.

Currently, the responsibility of a coroner is to investigate deaths to determine how people died. Whilst considering this, the coroner has additional powers, including writing reports for the Prevention of Future Deaths to organisations or bodies who have the power to make changes to improve public safety, where a risk is identified (under Regulation 28).

Coroners do not currently investigate the deaths of stillborn babies as there is no indication of ‘independent life’ -investigations may be reviewed independently by the Health Service Investigation Branch (HSIB) as well as healthcare agencies involved in the maternity care.

Under the proposed change, these investigations would not be replaced but would be incorporated within a coronial investigation.

The government is consulting on a number of proposals which aim to:

  • bring greater independence to the way stillbirths are investigated
  • ensure transparency and enhance the involvement of bereaved parents in stillbirth investigation processes, including in the development of recommendations aimed at improving maternity care
  • effectively disseminate learning from investigations across the health system to help prevent future avoidable stillbirths.

In November 2017, Jeremy Hunt pledged to halve the number of stillbirths, neonatal and maternal deaths as well as severe birth-related brain injuries by 2025.

What are the implications?

This amendment aims to bring a new level of transparency to investigations into stillbirths. In 2017, 2,873 babies were stillborn in England and Wales. Under the proposed change, these stillbirths would be eligible for an inquest should the parents or other healthcare agencies make a request to the coroner; the coroner would then be at liberty to consider opening an investigation. This may lead to an increase in the pressure on coronial resources.