Full time forensic pathology service needs to be established

Editor—The investigation of deaths in England and Wales has not been attracting positive headlines recently. Events surrounding Alan Shipman, Alder Hey, Bristol, and the Marchioness incident have all put a question mark over the processes of investigation and have prompted various inquiries, including consideration of the role of coroners.

Currently, coroners may be medical practitioners or lawyers of at least five years' standing.¹ Many work part time, with small jurisdictions. Despite this, if a complex death or a mass disaster occurs in their jurisdiction, the local coroner, no matter how inexperienced, has to both investigate and adjudicate.

The system in England and Wales has a high rate of necropsies, and 23% of all deaths are followed by a medicolegal necropsy.² Despite that, Shipman bypassed it while killing his patients. Other parts of the British Isles, not noted for concealed homicide, have a lower necropsy rate—for example, the Republic of Ireland 15%, Scotland, 10%, Northern Ireland, 9.3% (AW Clotworthy, personal communication). Germany, at 2%, has one of the lowest necropsy rates in western Europe.³

There is no doubt that there are serious deficiencies in our system. In his evidence to the Bristol inquiry, the honourable secretary of the Coroner's Society referred to the “quill pen technology” of the modern coroner. In some medicolegal systems the sole responsibility for the investigation of death is vested in a medical examiner, usually a forensic pathologist. It has been suggested that a medical examiner's system should be introduced into England and Wales.

We believe that the strengths of the coroner's system should be retained but coupled with greater medical participation. For example, the necessity for a necropsy should be decided by experienced and appropriately trained doctors who should also be responsible for collecting, correlating, and analysing data, so that any unusual trends would quickly be recognised. They might also be responsible for overseeing certification of cremation, which currently is expensive for relatives and ineffective.

Coroners should still be independent but work full time with larger jurisdictions. They should be legally qualified and concerned with legal rather than investigative matters. Their role should be mainly judicial. A full time forensic pathology service needs to be established, which can be seen to be independent of the police and the coronial service and which could function as the regional medical investigator of death.