Death certification reform

Changes to the death certification process in England and Wales have been outlined and are set to be enforced on September 9th, 2024. These reforms aim to strengthen safeguards, improve public protection, and better support bereaved families.

Following the Shipman inquiry in 2005 and the Lucy Letby case, calls were made for major changes in death certification. Modifications were proposed as a result of these cases to ensure they don’t occur again; with many questioning the suitability of the protocols for confirming sudden death.

A key change is the mandatory review of all deaths not already investigated by a coroner. Previously, some deaths were certified solely by doctors. Now, all such cases will be reviewed by medical examiners who are senior, independent doctors ensuring a more rigorous examination of the cause of death.  A new Medical Certificate of Cause of Death (MCCD) will replace the current certificate to improve the efficiency of the death certification system and mortality data for use at local and national levels. In the event of an attending practitioner being unavailable, the death will be referred to the senior coroner.

There will be the opportunity for the bereaved family or representatives of the deceased to raise concerns directly with the medical examiner. These changes recognise the importance of involving families in the process allowing for a more transparent and inclusive process during a difficult time.

The timeframe for registering a death remains five days. However, this period won’t begin until the medical examiner or coroner provides notification of the cause of death. This ensures families have time to understand the cause of death before proceeding with registration. Additionally, the reforms expand the categories of people who can register a death, allowing partners or representatives to do so alongside close relatives.

These changes have been brought in to prevent criminal activity, improve patient safety through better data collection, and offer greater support to bereaved families. The Government guidance on the Death certification reform and the introduction of medical examiners can be viewed here.