The Royal College of Pathologists has stated that up to 10000 annual deaths which have been recorded as being due to natural causes should have been investigated.
The college said that the available data has provided ‘compelling evidence’ that the system of death certification used by doctors in England and Wales needs to be changed. However, it has fears that suitable changes may never be implemented.
The proposed reforms include the introduction of independent medical examiners to ensure that:
• Thorough external examinations of the bodies are completed
• The death certificates are checked as it is usually completed by junior doctors
• There are consultations with coroners
• Discussions regarding the deaths are discussed with relatives
These changes were asked for more than a decade ago after Harold Shipman, the serial killer GP, certified that the patients he murdered died of natural causes. It was requested again based on the care which is provided by the Mid-Staffs NHS trust.
Labour approved the legislation for medical examiners about five years ago, but it did not occur due to funding arguments under the coalition government.
The president of the Royal College of Pathologists, Archie Prentice, said that the association believes a medical examiner would have been aware of what was happening in Mid-Staffordshire long before the list of avoidable deaths reached the number it did. He said they are running out of time prior to the next election and it appears that this matter has simply been placed on the sidelines.
The estimated 10000 inquests were taken from trials of the medical examiner system. Pathologists are of the opinion that the same number of cases is unduly referred to coroners. They say that the trials discovered a group of infections in a hospital department, linked falls of unsupervised frail elderly patients in care to their deaths, and aided doctors in recognising the importance of missed treatments and observations of those patients who were critically ill prior to their deaths.
College members who participated in drafting and testing changes stated that earlier detection of medical errors would play a huge role in patient safety and save the NHS from having to pay for these expensive errors.
Prentice said if they do not know the cause of death, they are unable to assist those who are alive.
A pilot scheme introduced in Sheffield discovered that the ratio of inaccurate death certificates could be one in four, but according to the Office for National Statistics, it could be one in five.
The leader of the Sheffield pilot, Alan Fletcher, said the system was welcomed by families who were able to obtain an expert explanation regarding the potential cause of death, along with an independent authority who was prepared to listen to and act on any concerns they may have.
Colleagues involved in other pilots reported that being open about early detection and notifying the bereaved of problems with care is desperately overdue.
The Department of Health, which is currently cash-strapped, has considered charging thousands of bereaved families for these changes. Some estimates have put this amount at more than £100 per case. The suggestion from the department was for this amount to be collected either by funeral directors or local authorities, who have stated that they do not want to be part of what they called ‘tax on death’ or ‘tombstone tax’.
The charges which would be applied only to cases that are not referred to coroners and would be placed on the relatives or the estates of around 150000 people buried annually. For relatives of those who are cremated, it will replace the existing ‘ash-cash’ fee of more than £175 which is paid to the doctors checking the bodies.
The NHS collects cash via prescription charges and fees charged for the services of opticians and dentists, and critics have viewed a charge for ensuring the correct cause of death as a massive blow to the idea of a free health service.
The Department of Health has said that they want all the families to know that the cause of death of their relatives has been accurately recorded. They said that their pilots suggest that the introduction of medical examiners to the process of death certification will reduce the number of inappropriately reported deaths to coroners, but due to the sensitive nature of this issue, they are continuing to work with different organisations in a bid to ensure that this is done correctly.
Image Credit: Kenny Louie