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Coroners and Justice Bill

My Lords, I welcome a Bill that addresses inadequacies in the coroners service. I am simply struck that this major aspect of our administration of justice could not justify a Bill on its own, and that it comes to your Lordships’ House so many years after the Shipman inquiry, when the Government moved with great alacrity to address the medical consequences required, while the coronial consequences have taken a much longer time. In that regard, I declare an interest as a consultant psychiatrist working in the National Health Service, and my wife is a consultant pathologist in the National Health Service in Northern Ireland, although I should point out that she does not provide and has not for many years provided services to the coroners in Northern Ireland. The noble Lord, Lord Imbert, pointed out that the coroner for Westminster was medically qualified and was a qualified barrister. It has always been my view that the ideal arrangement for coroners was that they should be dually qualified as lawyers and doctors. It seemed obvious that they needed to be legally qualified, of course, to carry through the legal and judicial aspects of their work; but if the inquest was to find out the cause of death, it was rather obvious that they needed some expertise on the medical side. However, that is neither to be, nor perhaps is entirely practical, at least in the short term. Therefore, I welcome the Government’s proposal to institute a medical examiner service. There are a number of questions to be raised. Will these examiners be properly qualified? Will they be professionally independent? Will they be appropriately accountable? Will they be adequately resourced? Without these things, they will not provide a proper service to the coroners. Will they be professionally qualified? In the Bill, all that I note is that they have to be qualified as doctors who are registered, practising and with five years’ experience. I hope that the Minister can lay my mind to rest on this; it would be welcome if there have been formal discussions with the Royal College of Pathologists to look at whether it might institute some form of qualification for medical examiners—perhaps a diploma with appropriate training. Or are we to assume that these examiners will simply have tired of their other work as general practitioners and have chosen this as part-time work? That would not be adequate. Will they be professionally independent? My noble friend Lady Williams of Crosby and the noble Baroness, Lady Finlay of Llandaff, raised this question, given that in the Bill it is clear that the examiners will be appointed by, paid by and accountable to PCTs. However, the PCTs themselves may well be at fault when it comes to any inquest into causes of death. It would be wholly inappropriate that medical examiners could be required to confront their own employers, to whom they are financially, clinically and professionally accountable. I can think of no other circumstance whereby new legislation making such a proposition would be brought in. That is not necessary; there are other ways of addressing this issue. Will the examiners be appropriately accountable? It appears that in the first instance we will see their numbers growing, but there is no indication that there will be a chief medical examiner, as there is a Chief Coroner. Yet, if there is to be accountability and establishment of standards to ensure that local medical examiners live up to their professional requirements, surely there is a strong case to include in the Bill provision for the appointment of a national medical examiner. Will the examiners be adequately resourced? My noble friend Lady Miller of Chilthorne Domer raised the question of the current delays in the provision of inquests. On 3 July 2008 a Member in another place, Mark Durkan, received an Answer from the Minister saying that there were 47 cases in Northern Ireland where the coroner had indicated a need for an inquest, but none had been commenced for five years. The deaths had occurred more than five years previously, and no inquest had yet been commenced. Given that difficulty, I welcome the notion of partial inquests—because that is what they really are—or partial post-mortems proposed in the Bill. There has been a combination of difficulties with resources and, since the human organs inquiry, a considerable resistance by many members of the public to have post-mortems conducted on their departed. The idea that there might be partial post-mortems may have some merit. It is clear that the coroner may ask a person whom he deems appropriate to conduct an investigation which he deems appropriate. That person does not have to be medically qualified; it has generally been assumed that an investigation is large, like an MRI scan, but it does not have to be that at all—there could simply be, for example, a fine needle aspiration biopsy, which might be taken by a non-medically qualified person, such as a medical laboratory scientific officer, and some kind of presentation would be provided. The only way to ensure the quality of such a thing is the medical examiner. That is why I welcome the idea of a medical examiner. However, it is not clear that the coroner has any requirement to consult the medical examiner. The coroner could say to himself: "I think it might be such and such. Let’s ask this fellow here to take a biopsy, a few cells or to check up something or other, and we will see whether or not this is appropriate". However, we all know perfectly well—for example, from the sad death of the gentlemen at the G20 disturbances—that what may initially appear to be a potential cause of death may not be the cause of death at all. One has to be very careful when conducting a less than full post-mortem that one does not head down the wrong track, doing a partial investigation that leads one to the wrong outcome. There needs to be some reassurance on serious consultation by the coroner with a medical examiner. That brings me again to the question of a chief medical examiner, because if a senior coroner can refer locally to a medical examiner, is there not a case for having a national medical examiner to whom the Chief Coroner may refer? The Chief Coroner would require someone of that stature and experience who was fully independent of any local medical examiner or the coronial service. There is another important issue. Some of these deaths, sadly, come by the hand of the deceased, and coroners are required to investigate a number of suicides. Madeleine Moon MP, in whose constituency there was a tragic rash of suicides by young people, raised this question on 26 January at cols. 76-80 in Hansard. She subsequently received some response in writing from the Minister. However, she raised the question of whether or not there could be psychological autopsies, which would, in other words, try to understand what was going on in the mind of the person, because it was what was going on in those young people’s minds—not their bodies—which led to their deaths. One of the difficulties is that if there is not some psychological sophistication on the part of the coroner or the medical examiner, the case will be difficult for them to judge and assess. For example, there were a number of deaths of young men by suicide in north and west Belfast a couple of years ago. There was a lot of talk about the psychological contagion, mentioned by the noble Baroness, Lady Finlay of Llandaff, whereby one or two young people harmed and killed themselves, and other young people followed suit. It began to come to my attention from healthcare workers in the field that many of these young men had been grossly abused by paramilitary organisations or members. I went to the police and asked whether any investigation had been done. They said, "No crime has been committed. Suicide is not a crime". I said, "No, no; the cause of the suicide might well have been a crime". The answer was that there had been no investigation, because there had been no serious understanding of the question as to why young people might commit suicide. The attitude was simply: "Well, suicide was the cause of death". No; that was the mode of death, not the cause. The cause of death was what led those young people to harm themselves. As I subsequently found on my further investigations, it was clear that "bullying" does not address what they suffered; finding no way out, they took the only way that came to their hands—to kill themselves. If there is to be a real understanding of what happens, it must not be a superficial gloss—"We have a number of young people killing themselves, so it is obviously a psychological contagion". There has to be the capacity for the coroner to look seriously at the matter, to get underneath it and to have the advice of medical examiners who will themselves have sufficient training in that regard that they will be able to address it. Like other noble Lords, I finish not because I have exhausted the possibilities of speaking on the issues here, but because my time has passed. I have to refer to Clauses 44 to 46 on provocation, which have already been referred to by my noble friend Lord Thomas of Gresford and other noble Lords. I have struggled to work out how the Bill’s clauses make sense and I would welcome what the Minister had to say. Loss of control does not have to be sudden. I find it difficult to work out how it could then be anything other than a premeditated act—one thought about in advance—because if it is not sudden, it is taking place over time. If it has happened, then it has been thought about over a period of time. I cannot for the life of me understand how one can have a premeditated loss of control. One of the things that would be most likely to produce an emotional reaction, the discovery of sexual infidelity, is to be ruled out completely. If some poor lady has the serious disadvantage of a partner who snores heavily, and she decides after many years to poison him slowly over a period, she could well call on this possibility. But if some day a similar lady was to discover that her husband was being unfaithful and she hit him over the head with a frying pan, she could not call on this. That does not make any sense. However, I will welcome any enlightenment that can be showered on us by the Minister on this or any of the Bill’s other aspects that I have raised.