Recommendation 277

Standard methodology for certifying cause of death

National guidance should set out standard methodologies for approaching the certification of the cause of death to ensure, so far as possible, that similar approaches are universal.

We intend to publish draft death certification regulations that states that the Chief Medical Officer of the Department of Health must issue guidance on how death certification forms are completed.  This will include a standard methodology for completing medical certificate of cause of death and replace previous guidance including that supplied with the book of medical certificates of cause of death to doctors.

In addition, medical examiners will support doctors completing medical certificates of cause of death to ensure that they are consistent and of sufficient quality and may recommend further training for doctors where that is deemed necessary.


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.