Roles within the Medical Examiner Service

Lead Medical Examiner for Wales: Dr Jason Shannon

The Lead Medical Examiner provides leadership and guidance to ensure that the Medical Examiner Service for Wales is set up and governed effectively, and also provides leadership and support to Medical Examiners who are employed in Wales, including providing them with an independent professional line of accountability.

The Lead Medical Examiner supports the National Medical Examiner, who has an England and Wales remit, by ensuring that relevant legislation, guidance and standards are understood and implemented effectively in Wales, and by keeping them informed of progress and issues arising.

Medical Examiners: Various

Medical Examiners are appropriately trained (typically senior) doctors who will undertake an independent scrutiny of deaths in order to establish:

An accurate cause of death, and
Whether the circumstances surrounding that death give any cause for concern that requires further investigation. This may be by an individual care organisation itself or by the Coroner’s Service.

In Wales, this scrutiny will form Stage 1 of the Universal Mortality Review Process as shown below:

Medical Examiner and Mortality Review

Medical Examiners are typically doctors, from a range of disciplines, who are employed to provide a given number of sessions to the Service rather than doctors whose only employment is with the Medical Examiner Service. This is because the knowledge and experience that they are able to provide is often enhanced by their wider remit. Medical Examiners typically provide 2 sessions per week to the Service but this can vary depending on individual circumstances.

Lead Medical Examiner Officer: Daisy Shale

The Lead Medical Examiner Officer provides support to the Lead Medical Examiner for Wales in establishing and maintaining a high-quality Medical Examiner Service.

As the professional lead for Medical Examiner Officers working in Wales, the Lead Medical Examiner Officer provides both strategic planning and operational management of Medical Examiner Officers to enable the Service in Wales to operate effectively and efficiently.

The Lead Medical Examiner Officer is responsible for assuring the quality of Medical Examiner Officer work and will be the main source of advice and guidance on the Service for key partners, including Coroner’s Offices, Registration Service Offices, Bereavement Services and local care teams/organisations.

Medical Examiner Officers: Various

Medical Examiner Officers support Medical Examiners in their role in scrutinising the circumstances and causes of death by ensuring that the appropriate information is available to the Medical Examiner via an individual Case File.

The Medical Examiner Officer’s Case File establishes the circumstances of individual deaths by performing a preliminary review of medical records to identify clinical and circumstantial information, and sourcing additional details where required. The may also assist with, under delegated authority from a Medical Examiner, two aspects of the scrutiny process: the discussion with the attending practitioner, and the discussion with the bereaved to establish if they have any concerns or questions about the death of their loved one.

As all Medical Examiner Officers are locally based, they are the local point of contact and source of advice for relatives of the deceased, healthcare professionals, and local Coroner and Registration Services. In this role they also work closely with local Bereavement Services to ensure that the process of the scrutiny of death does not cause the bereaved any undue delay or inconvenience.

Medical Examiner Operational Support Officer: Recruiting

The Medical Examiner Operational support officers provide vital support to the Medical Examiners and the Medical Examiner Officers in each office on an All Wales basis.

The Operational Support Officers provides administrative and operational support and liaises directly with stakeholders such as Health Boards, Primary Care and Coroner Services in the provision of relevant and important information. They may be the first point of contact for the service and deal with requests and provide information from external and internal sources.

They are based in each of the four locations throughout Wales and Provide efficient and effective secretarial, organisational, and administrative support for the Service.

FAQs

Why has a Medical Examiner Service been created?

The Medical Examiner Service has been created because it has been recognised that an independent scrutiny of a death, undertaken by a Medical Examiner, who is a qualified and trained doctor but who is independent of any care provided and the organisation who provided it, allows the cause of death to be more accurately identified, and the circumstances surrounding the death to be more objectively assessed in order to identify any concerns about the treatment or care provided that may require further investigation.

What does this mean for the Bereaved?

The introduction of the Medical Examiner Service means that the bereaved will have the opportunity to speak to someone who wasn’t involved in the care of their loved one but who is able to listen to any concerns there may be about the care provided and to explain in more detail the cause of death and the circumstances that led up to it.

Where the Medical Examiner believes that a more thorough and in depth investigation into a death is needed they will be able to ensure that this happens and that the results of that investigation are fed back to the bereaved. This has not always been the case before and has sometimes led to people believing that either their concerns have not been listened to at all, or that they have been listened to but have been ignored or covered up in some way.

How does it work?

The Medical Examiner Service has four Regional Hub Offices as follows:

North Wales (covering the Betsi Cadwaladr health board area)
Mid and West Wales (covering the Hywel Dda and Swansea Bay health board areas)
South Wales Central (covering Cwm Taf Morgannwg and Powys health board areas)
South East Wales (covering Cardiff & Vale and Aneurin Bevan health board areas)

Each Region has a team of Medical Examiner Officers who gather all the relevant information on a person’s death from reviewing the clinical notes, from discussions with a member of the clinical team that provided the last episode of care for the deceased, and from discussions with the bereaved. This information is then reviewed by a Medical Examiner using a structured scrutiny process, ensuring that all deaths receive the same scrutiny wherever they occur and whoever undertakes the process.

From this scrutiny process the Medical Examiner is able to:

Advise the Qualified Attending Practitioner on the most appropriate cause of death to record on the Medical Certificate of the Cause of Death (the Qualified Attending Practitioner is the person legally required to sign the certificate), and
Identify any concerns that may need further investigation, either by a coroner or by the organisation that provided care to the deceased.
Answer questions that the next of kin may have about either the cause of death or the care surrounding it.

How long does the process take?

Based on the scrutiny process the Medical Examiner will agree a cause of death with the doctor who has been involved in the care of the person who has died (the Qualified Attending Practitioner) to allow the death to be registered with the Registry Office. Typically the Medical Examiner’s scrutiny process will take between 24 and 72 hours but it will not delay registration beyond any legal requirements (currently 5 calendar days) and will not delay the release of a body where religious or cultural beliefs require it. In these circumstances there is a system in place to prioritise certain cases for fast track review.

In a small minority of cases it may not be possible to meet this timeframe (if it has been identified that further investigation by the coroner is required and that this will require access to the body for example), but every effort will be made to ensure that any delay is kept as short as possible and that the requirements of the faith and the bereaved are met.

How is the Service accessed?

In general terms there is no need to contact the Medical Examiner Service directly as a Medical Examiner Officer will contact the relevant individuals, such as the Qualified Attending Practitioner and the Next of Kin recorded in the records of the person who has died. However if you would like to speak to the team please contact them using the details at the end of the page.

Any concerns raised by the bereaved will be considered by the Medical Examiner undertaking the review and any findings or outcomes will be discussed with the bereaved by the Medical Examiner or Medical Examiner Officer when the scrutiny is complete. If the Medical Examiner feels that there were issues with care or events revealed through scrutiny of the clinical notes or from discussion with the Qualified Attending Practitioner (a doctor, on behalf of the clinical team that treated the patient before they died) this will be fed back to the Next of Kin and the relevant care organisation for further action.

The Medical Examiner Service does not undertake further investigation of cases where concerns have been identified, this is the responsibility of the care organisation concerned.

Get in Touch

If you have a query for our Medical Examiner Service. Please contact us below: