§ 11 am
§ Mr. Chris Bryant (Rhondda)Again, it is a delight to serve under your chairmanship, Mr. Deputy Speaker.
Over the past couple of days, several hon. Members have asked me why I called for a debate on such a recondite and obscure subject as the coroners' courts. I explained that there are many and good and strong reasons why we should have a full debate about the role of coroners in society, and how they operate, and I am delighted to see a former deputy coroner in the Chamber.
I wanted to raise the issue partly because of my experience as a curate in the Church of England. My first visit, which the vicar had asked me to make, was to an old lady who had been bedridden for several years. She died two minutes after I arrived. That regularly happened to me when I was a curate; people often died the moment that I visited them.
During the five years that I worked in the church, I saw how much extra and unnecessary grief the whole process of certification and dealing with inquests and post mortems can cause bereaved families. In cases of suicide, especially, when the family are already particularly distressed, a post mortem can cause even more grief when it is clear that the person has taken their own life and the family already face such complicated issues as how to explain it all to the children.
In the 20 months since I have been a Member of Parliament there have been 28 drugs-related deaths in my constituency alone. That is a very large number, by anyone's reckoning, but an accurate recording of the number of drugs-related deaths in the Rhondda. Each death was a tragedy for the person, their family and their community. In a valleys community in south Wales, unlike in a major city or conurbation, everyone in the street knows about the death of an individual, and a drugs-related death affects the whole community.
Under the current system, there is no room for the investigation of a series of deaths because there is no higher court, and the coroner stands alone and relatively unaccountable. An individual coroner might do a perfectly good job, but it is difficult to determine trends throughout the United Kingdom because there are no standard guidelines or rules on how a drugs-related death should be recorded.
In 2001, there were 532,500 deaths in England and Wales, 322,200 of which were certified by doctors without reference to the coroner, and 202,350 of which were reported to coroners. Of the cases reported to coroners, 121,100 led to post mortems but only 25,800 to inquests. In other words, 121,100 families went through the additional process of a post mortem. Almost one in four deaths in England and Wales led to a port mortem in 2001, which is a very high number in comparison with figures for other European countries. In Northern Ireland, where the coroner is allowed greater discretion as to whether to hold a post mortem, fewer than one in 10 deaths—9 per cent.—led to a post mortem.
I do not think that that is because there are more suspicious deaths in England and Wales or more deaths due to industrial disease that need greater investigation. 276WH I do not think that it is because people see their doctor less frequently or further from the moment of death. It is simply because the system in England and Wales has long been due for review. After all, most of the way in which coroners in England and Wales operate goes back to the Coroners Act 1887. The 138 coroners plus their deputies—roughly 375 individuals—operate in a miasma of fragmented legislation, which genuinely makes it difficult for people to have confidence in the system.
§ Mr. Elfyn Llwyd (Meirionnydd Nant Conwy)I congratulate the hon. Gentleman on raising this very important subject. He is right to say that far too many post mortems are ordered for no apparent reason. They should be confined to deaths in suspicious circumstances and genuinely sudden deaths for which there does not appear to be a medical cause.
On the hon. Gentleman's point about the need to bring the coroners' system up to speed, part of the reason for that, in my experience as an ex-deputy coroner, used to be that many coroners were part-time. However, that is not the case now. The situation has changed considerably, and now may be the time is right for better instruction from Government—for example, as to when post mortems should be ordered.
§ Mr. BryantI thank the hon. Gentleman for his comments. He is right about when post mortems should be held, and I shall come to that. However, a large number of coroners and deputy coroners are still part-time. I should like to see a far more professionalised service. Currently, a coroner has to have either legal or medical training. We should be able to guarantee both medical and legal training throughout the coroners' service. That is one of the issues that we need to consider.
I called for the debate because no society can truly value life unless it honours death properly. The traditional obsequies in different communities are important, and they vary enormously. Much of the 1887 law was written at a time when cremation was coming into use, but was still used by only a small minority of people in England and Wales. Now, however, 70 per cent. of funerals involve cremation. I shall deal with the three-tier certification process for cremation in a moment. In the multi-ethnic society in which we now live, and with the changing perceptions of death and how it should be honoured, it is important to review and renew the coroners' service.
Why on earth do we need a coroners' service in the first place? Obviously, we need it to detect and prevent foul play. I think that part of the reason why the Government initiated the review of the coroners' service that is being conducted at the moment—it should report finally at the end of the month—was the Harold Shipman case. It was clear that the certification process did not make it possible for us to detect and prevent further foul play in that case.
It is also important to determine trends in pathology and disease. One problem with a fragmented service is that it is difficult to provide the Office for National Statistics with clear and unambiguous reporting that is consistent throughout the United Kingdom.
An increasingly important aspect of the coroners' service is adjudication on cases of industrial disease. As a Member of Parliament for a former mining 277WH constituency, I know that for many widows what is on the death certificate is vital. A death certificate that refers to emphysema and chronic bronchitis results in a very different response from IRISC with regard to the miners' compensation process than does another certification, so it is vital that people have confidence in the process.
It is also important to adjudicate on whether a suicide has taken place, which may have significant legal and financial implications for the family concerned on mortgages, life insurance and so forth. Many implications stem from the determination that a suicide has taken place.
Finally, one important aspect of the coroner process and certification of death that is seldom mentioned is that it provides reassurance and support to families and next of kin. Knowing how and why someone died—especially after protracted illness in hospital when it has been disputed whether the treatment was right and proper, or in cases of mental illness—can be crucial for the family and the coroners' service carries out no more important role than providing secure and understandable reasons for cause of death.
At the moment the system is failing, partly because of fragmentation. To the vast majority of people, the system is incomprehensible. Until the moment when people have to go through the process of certification, they do not understand how the coroner relates to the registrar and the pathologist, or why a post mortem is carried out at some times, but not at others. Often there is no requirement to tell families that a post mortem is going to take place; sometimes they are not told about it.
Remarkably few rules and guidelines are in place to ensure consistency across the United Kingdom. One part of the country might have a meticulous and diligent coroner, but a coroner in another part of the country might work to a different set of assumptions and standards, and that must be wrong. Although a court of appeal exists in theory, in practice, few people have been able to go through the higher courts because the coroner service has no structure for appeal.
As I said earlier, too many post-mortems are carried out in England and Wales. The system is still under investigation, but the certification process seems to lead to many errors in adjudicating the cause of death. Some estimates suggest that more than 30 per cent. of deaths are incorrectly certified. The process for the certification of cremations was devised in 1887 and amended in the 1920s; it is open to abuse, not least because the second doctor is often nominated by the first doctor or by the funeral director, so is clearly not genuinely independent. Furthermore, the medical referee at the crematorium often receives the papers so late that he is deprived of the opportunity to say no and insist on reference to the coroner.
Most importantly, the current system has little sensitivity to the needs of the bereaved. A mechanistic approach is customarily adopted—a point reinforced yesterday when an hon. Member told me that families should get used to the fact of post mortems because they are important to society. However, for many people, the thought of their relatives and loved ones being dissected unnecessarily—particularly a double dissection of the bodily cavity and the skull—is profoundly upsetting. The system should be able to honour grief that naturally arises.
278WH What would I like to see happen? Above all, I would like a single national coroner service for England and Wales, responsible to the Home Office rather than to the Lord Chancellor. Superior courts should be used for contentious cases or for the review of multiple cases—for example, a raft of drug-related deaths in a particular locality. I should also like clearer rules on how coroners operate—not just the legal procedures used for an inquest or in a coroners court, but a clear set of rules governing every aspect of when there should and should not be a post mortem. Of course, there should be a presumption that there will always be a full public inquest into deaths in custody or in prison and also perhaps in psychiatric hospitals or under psychiatric care. However, there should not be a presumption that there should be a full post mortem with double dissection in as many cases as there are now.
Thirdly, there should be clear national guidelines on the recording of deaths as drug related and in particular on when to require a toxicology report. Toxicology reporting across the UK is very patchy. I pay tribute to my own local coroner who does a good job in that respect, but it is uncertain whether that is equally true around the whole country. We should have an end to the three-tier certification process for cremation, which many doctors refer to as the ash-cash system. Instead we should have a robust system to support and monitor the certification of death to ensure that we have fewer errors in the attribution of the cause of death and clearer prevention of any foul play.
The coroners' review has already suggested that there might be a medical auditor. The Government should look at that. Undoubtedly we need to move towards roughly the same processes for burial as for cremation. We also need clarification of responsibility for the disposal of human tissue. It is not just the Alder Hey case that has provoked a great deal of concern in the UK about that. There is great uncertainty about whether it is the responsibility of the NHS trust, the pathologist or the coroner. That needs clarifying. We also need the active involvement of the family in the process of post mortem and inquest. As I said earlier, sometimes families do not even know that a post mortem is taking place.
Yesterday in the Select Committee on Culture, Media and Sport we were told the tale of a couple whose son had died in a contentious case that was widely and incorrectly publicised in the media. They were required to pay £300 for a copy of the transcript of their son's post mortem. That is wholly unnecessary. We should make the full coroner's report available to the families and the next of kin in such cases, and we should interpret the concept of families or next of kin in the broadest sense to mean not just married partners but unmarried partners.
Finally, I believe that there should be training for all coroners and all their officers. Dealing with bereaved families is complex and sometimes doctors or lawyers—with all respect to the hon. Member for Meirionnydd Nant Conwy (Mr. Llwyd)—have not had training that is necessarily relevant to that process. Many coroners also need training in dealing with the media. Often in contentious cases families will be gobbled up by the media and spat out at the other end. With just a simple element of sensitivity to the issues around the media and how to respond to them, coroners could make lives much easier for the bereaved.
§ The Parliamentary Under-Secretary of State for the Home Department (Hilary Benn)I congratulate my hon. Friend on having secured this debate and more importantly on his speech. It set out in an exemplary fashion the range of issues that society needs to address in relation to the coroners' service. It has made my job of responding that much easier. I also acknowledge the expertise of the hon. Member for Meirionnydd Nant Conwy (Mr. Llwyd), of which I was unaware until this morning. I do not know of any other hon. Members with that knowledge, and it is good that he has joined us for the debate.
First, I should like to address the question that my hon. Friend touched upon, which is the purpose of the coroners' service. It is an ancient office that has existed since the middle ages and which, particularly since the early 19th century, has evolved into the current mechanism for trying to ensure that violent and unnatural deaths are properly investigated on behalf of society.
Coroners' inquests serve four main purposes. First, as my hon. Friend said, they reassure the public that any untoward or uncertain death will be investigated impartially by an independent judicial officer, and secondly, they enable any rumour or suspicion surrounding that death to be dispelled. Thirdly—I shall return to the point—they assist in maintaining the integrity of data on causes of death in the interests of public knowledge and public health. Fourthly, they underpin arrangements for detecting and deterring crime.
The coroners' service also has to answer, and rightly so, the natural questions asked by society and relatives when someone dies about what happened and why. However, in recent years, the coroners' service has also been subjected to the pressure of determining how coroners courts fit in with the other mechanisms being developed to try to answer the questions of why, how, and whether someone was to blame for what happened. That is important with respect to the review that is being undertaken. Coroners courts are only part of that overall process. However, some of the pressures on them have been due to the fact that people have sought, when they have lost a loved one, to use the coroners' service to answer some of those broader questions. We should recognise that other mechanisms, such as public inquiries, have been developed to try to deal with those broader issues, particularly when a large number of deaths have occurred.
The second issue, which my hon. Friend touched on from his experience in his former profession, is society's approach and attitude towards death. In the 19th century there was a formal system, structure and rituals for dealing with death. In the 19th century, people were much more familiar with death—one only has to walk into any graveyard and look at the ages of those who died at the time to see that that was the case. The real truth—and I speak from personal experience—is that although we now seem to be able to talk openly about a wide range of things to do with people's personal lives, society still has some difficulty in grappling with death, although it is the most natural of occurrences. Some of the issues that I will discuss later arise from that attitude.
280WH I feel strongly that we should be open about death and what it involves. For example, we need to provide open information for people on the arguments for carrying out post mortems, both in respect of the coroners' service and advances in medical knowledge. For the best of motives, people in the medical profession used to talk about taking tissue samples, but we have learned from a range of experiences since then, and that approach will not work in the modern age. People are entitled to receive information and to hear the arguments, so that they can then take decisions.
Coroners have always been local to the communities that they serve. They are still appointed and supported by their shire county councils, unitary authorities, or consortiums of metropolitan districts or London boroughs. The coroner's jurisdiction is quite different from that of the criminal or civil courts. The justice that they dispense is not one of arbitration between different parties. It is an investigation of those deaths which society rightly considers should be the subject of a judicial inquiry held in public.
Coroners are independent of the Government and are answerable in their judicial decisions only to the courts. That is an important feature of the system if they are to investigate deaths fully. Nevertheless, as a public service, coroners have to operate with many Departments and agencies that have an interest in their work, and the Home Office provides general support and direction, working closely with the Coroners' Society of England and Wales.
As my hon. Friend said, about 12 per cent. of deaths reported to coroners result in inquests. Although the inquests will report all the relevant details of how the deceased came by his or her death, much attention is of course focused on the verdict. Coroners and their juries are not restricted in the verdicts they may bring in, but for the sake of statistical consistency—a point to which my hon. Friend referred—a number of formulae have been recommended to coroners, including accident, unlawful killing, and suicide.
My hon. Friend raised the issue of drug-related deaths, in which I know he takes great interest. In 1984 new verdicts were suggested to coroners in respect of such deaths: death from dependence on drugs or nondependent abuse of drugs. The truth is that these drug-related verdicts are not entirely satisfactory. Coroners believe that accident or other verdicts may more closely reflect the circumstances of the death. It is not always easy to separate the different contributory factors in trying to reach a verdict.
In view of the need to improve our information about the number of deaths due to drugs, work has been proceeding on finding the best way to use the information from coroners' inquests in conjunction with the Department of Health and the Coroners' Society of England and Wales. I pay tribute to their contribution to this work. We aim to issue guidance to coroners in the next couple of months, although it is in part linked to the coroners review. The suggested definition will be:
deaths where the underlying cause is poisoning, drug abuse or drug dependence and where any of the substances listed under the Misuse of Drugs Act 1971, as amended, were involved".281WH As an illustration I shall give statistics published on the total number of drug-related deaths in England and Wales. In 2000 it was 2,968. Within that total only 622 were recorded by coroners' verdicts as coming within the two 1984 definitions, of which 309 resulted from a dependence and 313 from non-dependent use. Yet the Office for National Statistics information on the total number of drug-related deaths draws heavily on the further information that coroners provide. Most coroners provide it in a form that the ONS has requested, but not all, which raises questions about the data's consistency to which my hon. Friend referred. This is part of the Government's national programme on substance abuse-related deaths.
My hon. Friend made the case for change in the coroner system with great skill. It has evolved over 800 years but the need for fundamental change has been highlighted by a number of recent events, of which the Shipman case is of course one. A separate inquiry into that is being led by Dame Janet Smith. One issue for the House after the inquiry will be balancing the arising recommendations, which will be important, with a recognition of the extraordinary nature of those crimes.
The Marchioness disaster highlighted the treatment of the bereaved. As Lord Justice Clarke's inquiry showed, it was easy for professionals who in good faith considered their practice as acceptable to fail to realise that it was not acceptable, particularly when it came to the concerns of the bereaved and the need to deal sensitively with families. I am particularly concerned, and I know my right hon. Friend the Home Secretary is passionate about it, to ensure consistency of care and compassion across the board in the coroners' service. I have seen with my own eyes such care and compassion being exercised in the coroners court. I have also, as a Minister, received correspondence from families who felt that the opposite was the case. We must also take account of the issues arising from the Alder Hey affair.
The review of coroner services has been established to look at these issues. The Government are clear that we need to reform the system. In its consultation document, the inquiry said:
The prevailing impression we have is of people managing to give committed, professional, and compassionate service through obsolete and neglected structures".That sums it up. We have committed and professional people but a structure that does not necessarily work. That is why the Government established the review, and we look forward greatly to its results, which are expected shortly, so that we can put the coroners' service on a new footing for the new century and meet the objectives that my hon. Friend the Member for Rhondda so ably set out.
§ Sitting suspended until Two o'clock.