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Coroners Bill

I, too, want to thank the noble Baroness for introducing this matter for debate. We owe her a considerable debt. My enthusiasm for legislation on coroners is tempered by the contents of the Government’s draft Bill, published in June 2006; and I hope that when at last the Government do introduce this matter into the Queen’s Speech, they will have thought again about aligning the legislation with their March 2004 position paper. As a number of noble Lords have said, the issue of coroners’ reform has been with us for a long time, ever since the Brodrick report. It is true that the Government have taken a number of initiatives in the last seven or eight years. In 2000, there was a Home Office review of death certification, and the then Home Secretary, Mr Blunkett, set up a fundamental and independent review of coroners’ services under Mr Tom Luce, who found that the system was not fit for purpose. In July 2003, we had the third report of the Shipman inquiry, which also recommended serious reform; the Government position paper with proposals for reform was published in March 2004. I must say that I am really astonished that the draft Bill of 2006 does not deal with the most important issue of all, which is that of aligning death certification with the coronial system. It will always be hard to forget the appalling evil of Dr Shipman. The consequences of that were very well put by Dame Janet Smith in her foreword to the third report. She said: "““In the First Report of the Shipman Inquiry I disclosed my finding that Shipman had killed at least 215 of his patients over a period of 24 years. It was clear that the current arrangements for death registration, cremation certification and coronial investigation in England and Wales had failed both to deter Shipman from killing his patients and to detect his crimes after they had been committed. The failure of the existing system prompted Parliament to set up the Shipman Inquiry””." Later she goes on to say: "““If there is a risk that a doctor might kill in the future and if, as is now clear, the present system would neither deter nor detect such conduct, surely the system must be changed””." A year later, in March 2004, the Government brought forward their position paper with proposals for reform. That paper quite rightly sought to integrate the death certification system with the coronial system. In the future, every time a death occurred, what followed from that death would immediately be within the purview of the coronial system and proper checks would be made on the doctor’s certification of death. It is amazing to think that of the more than 200 people who died under Dr Shipman’s care, not a single one of those was double-checked by a medical practitioner. It is also the case that the 2004 position paper proposed not just a centralised system for reform of the structure of the coronial service, but also a centralised system for financing it. But the draft Bill contains neither of these things. Given what Dame Janet Smith said, how can the Government possibly justify not integrating the death certification system with the coronial system? It bewilders me because Dame Janet Smith has put us on notice that unless there is that integration, then another Shipman could strike, or even more than just one. I therefore ask the Minister: what is the justification for this? What happened between March 2004 and June 2006 that made the Government change their mind on this issue—in flagrant breach of what Dame Janet Smith said? She looked at this issue in depth over a long period of time, is better informed than anyone else in the country, and thus in a much better position to make a judgment. The Government initially accepted what she said, but then subsequently spurned it. I share in the views of those who have spoken before me, and I would particularly like to underline the contributions of the noble Baroness, Lady Dean, and my noble friend Lord Attlee. This is a terrible human problem, but it is one that would be so easy to resolve through legislation. I hope the Government have taken that on board. Although I want to see legislation on this matter as quickly as possible, I do not want to see just any old legislation. I want to see legislation which confronts the human problems as well as confronting the real dangers to our society. It seems that this draft Bill does not meet either test, and I hope that when the Government do legislation, they will have thought again about these issues.