Deaths are reported to the coroner for further investigation when the death is the result of an accident, suicide, violence, neglect, industrial disease or where the cause of death is unknown. In total, about 40 per cent of all deaths are reported to the coroner.

If the coroner decides not to investigate a death, it will be referred back to the reporting doctor for certification. In total, coroners certify about 21 per cent of all deaths. Under legislation introduced by the Health and Social Care Act 2012, which is due to be implemented in April 2014, all deaths that do not need to be investigated by a coroner will be referred for scrutiny by a medical examiner.  

The plan is for 170 medical examiner posts to be created in England and Wales. The medical examiners will certify the cause of all deaths which are not investigated by a coroner. They will scrutinise health records, examine the body and discuss the death with relatives. The aim of the new system is to make the process simpler and to increase the quality of certification and data about causes of deaths.  

A pilot study carried out in five areas has just been reported by the Office for National Statistics. The study covered approximately 5000 deaths and in summary the findings were as follows:  

  • In 78 per cent of cases the underlying cause of death remained unchanged
  • The broad underlying cause of death changed in 12 per cent of cases
  • In the remaining 10 per cent of cases the underlying cause of death changed but remained in the same international classification of disease chapter

The report from the pilot study makes interesting reading and of particular note, are the following points:  

  • It was most common for both medical practitioners and medical examiners to mention two conditions on the death certificate. However, medical practitioners were more likely to report just one or two underlying causes compared to medical examiners, who were more likely to state three or more underlying causes
  • Following scrutiny by a medical examiner, one per cent more death certificates gave an underlying cause of death as cancer, there was an increase of six per cent in the proportion contributed to circulatory disease and the amount attributed to a respiratory disease increased by seven per cent
  • It is interesting (and perhaps worrying) that approximately 20 per cent of death certificates had a different underlying cause of death following scrutiny by a medical examiner and the pilot study therefore, clearly demonstrates the value of the proposed system