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Coroners and Justice Bill

I have amendments in this group and I welcome all the comments of the noble Lord, Lord Alderdice; I do not dispute any of them. I completely concur with the need to stress training and agree that the exam should be the equivalent to licensing and incorporate revalidation. There is a general welcome from medical examiners but there is a concern which we need to express. If they are part-time you may find that one is working in the morning and another in the afternoon; when there is a complex case perhaps only the coroners themselves—who are, as now, on call 24/7—would effectively provide the continuity required. Partly to get around that and partly because if you have a national service you need to set national standards, my amendments use the term "Chief Medical Adviser". It is only the name that alters; however, one difference is that I have said that the chief medical adviser should be there to, ""monitor the performance of the medical examiners"," because if there is to be consistency across the UK it will be important that their performance is managed from many aspects. I did not add that this person should be there also to advise the Chief Coroner, because that is tied up in the title. If you are an adviser, your role is to advise. It would be duplicative to call a person an adviser and then state that they provide advice. I have also suggested that whoever is the chief medical adviser needs to have more experience than that required of the medical examiners, which is why I have stipulated that the chief medical adviser should have been qualified for 10 years and have had seven years in practice. I know from my very helpful discussions with the Minister before Committee that the Government are thinking of appointing two senior people—one as a medical adviser to the Chief Coroner and another to oversee the medical examiners. If I am right, I understood that the medical examiners would be overseen by someone in the Department of Health, but that the person working directly with the Chief Coroner could be employed within the Ministry of Justice. I have a slight concern about having two people at the top of the system rather than having a more vertical structure. My preference would be to have one chief medical adviser with a deputy chief medical adviser who may be the person responsible for overseeing the standards of the medical examiners around the country; so there would be some career progression. The reason for my concern is that I am slightly worried that they could inadvertently give different messages. It would be no good for anyone if they did not get on and, therefore, gave different messages. A lot of the message-giving will relate to the way in which research is interpreted and the way in which new advances in examination techniques come along and the emphasis that is put on them. We all know that someone who develops a new examination method in pathology can be very keen and slightly overegg the claim about how useful it will be. They do this in pursuit of the method’s development—not dishonestly but just because they are very keen. Therefore, it might be helpful to have someone right at the top who is able to temper whatever information comes in, and I concur with the suggestion from the noble Lord, Lord Alderdice, that that person should have training and experience in forensic pathology. Another reason for referring to this person in the Bill rather than simply in regulations is that he will need to have powers in order to deal with difficult situations. The medical examiners will be employees within the primary care trust. They will be dependent on having clear blue water between those employing them and the job that they have to do. That may include investigating and exposing poor clinical practice in their employers and therefore they will need some protection. If the chief medical adviser is referred to in the Bill and has statutory powers, that will build in a degree of protection which I fear may not be there if the appointment is made without being referred to in the Bill. That is why I have been pushing for this. It becomes particularly important in relation to possible prosecutions for corporate manslaughter and so on, which may be difficult to prove. Such cases may become very difficult and contentious, and those who give advice may require a lot of support in providing evidence to the inquest and to any subsequent proceedings. They may need to be represented by a very senior person—the chief medical adviser. My concern is that, if we leave this matter to regulations and do not put something into the Bill, we may not provide sufficient support to medical examiners on the ground to enable them to be operationally independent of those who pay their salaries.