Recommendation 275

Independence of medical examiners

Accepted in principle
It is of considerable importance that independent medical examiners are independent of the organisation whose patients’ deaths are being scrutinised.

The government agrees that medical examiners must be independent of the deceased and their medical practitioner. This is because medical examiners need carry out independent scrutiny of the medical circumstances and cause of apparently natural deaths, to ensure that the right deaths are notified or referred to a coroner.

However, we also need to ensure that there are sufficient numbers of medical examiners to carry out this work (recommendation 276), particularly in rural areas, and, therefore, appointees are likely to have some sort of professional relationship with local care providers.

As such, the draft death certification regulations for medical examiners in England does not require that medical examiners are independent of the organisation whose patients’ deaths are being scrutinised.  However in order to support a greater level of independence in line with the spirit of this recommendation, the government will review how it can include further safeguards to ensure that independence is protected.

Where a medical examiner has any concern that their independence has, or will be, compromised, they are able to raise those concerns directly with the appropriate local authority and/or the National Medical Examiner as needed.  The government will consider the role of the National Medical Examiner further, and the need for best practice guidance, to ensure that medical examiners are not put under any pressure to operate where there independence is compromised.


A number of the recommendations in Sir Robert’s Mid Staffordshire Inquiry report refer to our planned reform of the death certification system and the introduction of the role of medical examiner in England and Wales. A new system of medical examiners has been trialled successfully in a number of areas across the country. The work of the two flagship sites in Gloucestershire and Sheffield has been continued and extended to operate a medical examiner service on a city and countywide basis at a scale that will be required for implementation by local authorities when legislation is introduced. We will publish shortly a report from the interim National Medical Examiner setting out the lessons learned from the pilot sites.

The government remains totally committed to the principle of these reforms. Further progress will be informed by a reconsideration of the detail of the new system in the light of other positive developments on patient safety since 2010 and by a subsequent public consultation exercise.