Information and advice for bereaved families and friends when a loved one has died out of hospital
What is the Medical Examiner Service? What happens next?
Introduction
We would like to offer our condolences on the loss of your relative/ friend and reassure you that there is help available should you require it. This booklet is provided to guide you through the Medical Examiner process and explain what happens next.
Following the death of a loved one you will need to contact your relative’s/ friend’s GP surgery in order that the necessary paperwork can be completed.
If the death is expected the GP will complete the Medical Certificate of Cause of Death (MCCD). However, if the death was unexpected the death may need to be referred to the Coroner for further investigation. You may be advised that the death will be reviewed by a Medical Examiner before the death can be registered.
This booklet will explain the reason you may be contacted by their office, what will be discussed and why this system has been introduced.
Who are Medical Examiners and Medical Examiner Officers, and what do they do?
Medical Examiners are senior NHS doctors who, after completing specialist training, work part time in this role. Their job is to give an independent view on causes of death and the care provided (except for those deaths which must be investigated by a Coroner).
Since 2019 Medical Examiners have been reviewing deaths that have occurred in hospital and from 9th September 2024, it has become a statutory requirement for all deaths, apart from those taken on by the Coroner, to be reviewed by a Medical Examiner before a death can be registered. Medical Examiners and their staff (usually called Medical Examiner Officers) offer families and carers of the person who died an opportunity to ask questions or raise concerns about the causes of death or about the care the person received before their death. This will usually be through a telephone call or sometimes a meeting. They can explain what medical language means and make it easier to understand what happened. Medical Examiners also look at relevant medical records and discuss the causes of death with the doctor who is completing the official form (known as the Medical Certificate of Cause of Death).
You can be confident Medical Examiners and Medical Examiner Officers will provide an independent review. They will never scrutinise the causes of death of a person they provided care for.
Why has the Medical Examiner service been introduced to review patient deaths?
Following the public enquiries into Harold Shipman, Mid-Staffordshire and Morecambe Bay, it was recommended that a national network of Medical Examiners be introduced. In all these cases, concerns were raised by various people but there was no single body to listen to these concerns and identify themes and patterns. This service will now give the bereaved an opportunity to ask questions and raise concerns to an independent body.
The Medical Examiner must always be independent of the case and cannot know, or have treated, the deceased patient on which they are carrying out the review into the circumstances of death.
Why am I being asked if I have any concerns?
You are being asked to have a conversation with an independent, specially trained person – the Medical Examiner or a Medical Examiner Officer – about anything that may be worrying you about how the person who died was cared for. You may simply want to understand why the person died including by having medical terminology explained, or you may want to raise something about the care which did not feel right or ideal.
This is your opportunity to ask questions and raise concerns.
Medical Examiners and Medical Examiner Officers will discuss your feedback, questions and concerns. If they consider any issues with care need further investigation, they will refer these to someone who can do this work.
As well as answering your questions, talking to a Medical Examiner helps the NHS provide better care for other patients and carers in future; for example, by identifying ways in which patient and family care could be improved.
Can I ask the Medical Examiner to talk to someone else if it’s too difficult for me to talk to them?
Yes, of course. The Medical Examiner or Medical Examiner Officer may contact you to ask who you would like them to speak with instead, or you can let the medical team know if you would like someone other than you to be the first point of contact. The Medical Examiner or their office will usually call you after the Medical Certificate of Cause of Death is completed – but we can arrange another way of contacting you if you let us know what you prefer by contacting our office on medical.examiner@swft.nhs.uk.
What questions will I be asked?
The Medical Examiner or Medical Examiner Officer will explain what is written on the Medical Certificate of Cause of Death and why and check if you have any questions or concerns. They will also discuss the Medical Examiner’s review and ask if you have any concerns or questions about the care the person received before their death. This is the best time for you to ask any questions and raise anything that concerns you. The Medical Examiner Office will ask whether your relative/friend had any implantable devices within their body; these include, but are not limited to, pacemakers, implantable cardioverter defibrillators (ICDs) or loop recorders, as this information will be included within the new Medical Certificate of Cause of Death.
What if I don’t want to talk to the Medical Examiner or Medical Examiner Officer, or I don’t want to tell them about my concerns?
We understand this is likely to be a difficult time for you and it is your choice whether you speak to a Medical Examiner or not. If you are unsure, you can contact the Medical Examiner or Medical Examiner Officer on 01926 495321 ext. 8141, 8140 or 8165 and ask for more information before deciding if you want to go ahead – they are trained to help bereaved people and will be very understanding.
Medical Examiners and Medical Examiner Officers provide an independent view, so if you can, we encourage you to speak to them. They can explain things to you and are specially trained to answer your questions. If Medical Examiners find any potential issues, they will be able to raise these with the people who were responsible for the care of the person who died or refer the issues to someone who can investigate further.
What will happen if something was not right?
The Medical Examiner and Medical Examiner Officer are here to listen to your concerns and answer your questions and, if necessary, contact someone who can investigate further. Medical Examiners will not investigate your concerns themselves, as they must complete their work in the time before the death has to be registered by law.
Will funeral plans or release of the body take longer?
Medical Examiners make every effort to avoid any delays and work with families and carers of the person who has died to meet the legal requirements for registering deaths. Medical Examiners and Medical Examiner Officers will try to be flexible, for example where relatives would like the body to be released quickly. An out of hours service is available for faith deaths where a burial is required within 24/48 hours. Whilst we do our best to minimise any delays, Medical Examiners will endeavour to complete their review within 24 hours of receiving the paperwork, there may be occasions where this may not be possible. This may be because the cause of death needs to be amended or clarification is needed from the certifying doctor before the Medical Examiner can authorise the release of the paperwork to the Registrars.
The next steps
Following the death of your relative/ friend, their GP will establish the cause of death and complete the Medical Certificate of Cause of Death (MCCD). This will be done in a timely manner; however, these are legal documents and a doctor who cared for your relative or friend may not always be available immediately due to working patterns.
When someone dies, the doctor must issue a medical certificate giving the cause of death. This is called the Medical Certificate of Cause of Death (MCCD), this is a legal document which must be completed in accordance with certain regulations. In order to complete the MCCD the doctor must have treated the patient previously, there is no timescale as to when the doctor saw your relative/ friend but the doctor must be able to offer a cause of death to the best of his or her medical knowledge. The doctor must complete the MCCD as soon as they are able but there is no longer the requirement to register the death within 5 days.
The MCCD and relevant medical records will then be passed on to a Medical Examiner for an independent review. Once the Medical Examiner has completed their review and approved the cause of death (occasionally the cause of death may need to be amended or the death may need to be referred to the Coroner), a Medical Examiner Officer will contact the next of kin or a nominated representative. This call will be to discuss the cause of death and answer any questions that you may have and explain any medical terminology that you may not understand. You will also be asked if you have any concerns about the care that your relative/ friend received prior to their death that the team should be aware of. Following this conversation, the MCCD will be sent electronically to the Registrar of Births and Deaths along with your contact details in order that the Registrars can contact you to make a suitable appointment for you to formally register the death. If a referral to the Coroner is required, the doctor will complete an electronic referral to the Coroner and a Coroner’s Officer will contact the next of kin or nominated representative once the case has been allocated.
We advise you not to make an appointment with the Registration Office until you have been advised that the cause of death has been received and approved as the appointment cannot proceed without the MCCD.
When the Coroner has to be involved
In certain circumstances the doctor cannot issue a Medical Certificate of Cause of Death and will need to refer the death to the Coroner’s Office. The Coroner is an independent judicial officer with statutory responsibility for the legal investigation into the cause of death in some circumstances. This does not mean that there is anything to worry about, it is purely a legal requirement. These include:
• Where the cause of death is unexpected, unknown or unnatural
• Where the patient had a fall or a fracture which needs to be included on the medical certificate
• If the death is due to an industrial disease
• Where the death occurs during or shortly after surgery, unless the surgery was deemed to be life saving and known to be high risk
If the cause of death is unclear but is natural causes the Coroner will refer the case to the Medical Examiner Service for review. If the doctor can offer a possible cause of death to the best of their medical knowledge and the Medical Examiner accepts it, the MCCD can be passed to the Registration Office in the usual way. If a cause of death cannot be offered the case will be referred back to the Coroner’s Office for a Post Mortem.
The Coroner may order a Post Mortem examination to identify the cause of death. This is a legal decision and does not require the consent of the next of kin. Once the Post Mortem has been held, the Coroner’s Office will issue the appropriate paperwork to the Registration Office to allow the death to be formally registered.
In some circumstances the Coroner may hold an inquest into the death; this is common when a fall or a fracture is included within the Medical Certificate. This can cause a small delay in registering the death so please inform your chosen Funeral Director if this is the case.
Registering the death
Registering a death takes place at a Registration Office in the area where the person has died. The formal death certificate is created at this appointment and the death is officially recorded.
From 9th September 2024, the requirement for the death to be registered within 5 days of the death will be abolished. The 5 days will now start from the date the MCCD is received by the Registrars but doctors will still be expected to complete the MCCD as quickly as possible.
• To be eligible to register the death, you must be a relative, present at the death, the Occupier (this is the occupier of the house or an official from the public building where the death occurs, e.g. the hospital or care home) or the person making the funeral arrangements. You may wish to take someone with you for support whilst you register the death. The appointment should last for approximately 40 minutes.
It is preferable that the death is registered in the registration district where the person died to avoid any delay and to enable certificates to be obtained at the time of registration. If this is not convenient due to travelling, you may register by declaration at your local Registration Office in England and Wales. Please contact your nearest office for further information and advise the Medical Examiner Office which office you wish to use.
Warwickshire Registration Offices are located at:
• Warwick
• Stratford upon Avon
• Rugby
• Nuneaton
The registrar will need to know the following information about the person who has died:
• The full names and surname (with correct spelling)
• Any previous surname used, including maiden name
• The date and place of birth (it may be useful to take their birth certificate but it is not essential)
• Occupation
• Usual Address
• The full name, date of birth and occupation of their spouse or civil partner (it may be useful to take the marriage certificate, but it is not essential)
The Registration service provide a ‘Tell us Once ‘service which informs government organisations about a death on your behalf. The Registrars will provide you with a unique reference number which is used either online at https://www.gov.uk/after-a-death/ organisations-you-need-to-contact-and-tell-us-once or by telephone.
You will need the following information for the person who has died:
• surname
• date they died
• name, address and contact details of the person or company dealing with their estate (property, belongings and money), known as their ‘executor’ or ‘administrator’
• the name, address, telephone number and the National Insurance number or date of birth of the surviving spouse or civil partner if there is one
• if there’s no surviving spouse or civil partner or their spouse or civil partner is not able to deal with their affairs, the name and address of their next of kin
• if they died in a hospital, nursing home, care home or hospice, the name and address of that institution – you will also be asked if the stay was for 28 days or more
You may also need:
• their passport number if they had one
• their driving licence number if they had one
• the vehicle registration numbers of any vehicles that they may have owned at the time of death
• if they were paying Council Tax or getting services from their local council, such as Housing Benefit payments, the name of their local council and which services they were receiving
• their Blue Badge number if they had one and you know it
• if they were getting any benefits, tax credits or State Pension, information about which ones they were getting
• if they were getting money from an Armed Forces Pension or Compensation Scheme, details of that scheme
• if they were getting money or paying into public sector pension schemes, details of those schemes
You will also need their National Insurance number if they were getting money or paying into any of the following pension schemes:
• NHS Pensions for NHS staff in England and Wales
• Scottish Public Pension Agency schemes for NHS staff, teachers, police and firefighters in Scotland
• Pension Protection Fund and Financial Assistance Scheme
• Local Government Pension Schemes (LGPS)
If you do not have their National Insurance number please do not worry, but it will help some organisations match their records faster if it is available.
