Changes in death certification
V. Charles Ward examines recent changes to death certification following the statutory adoption of the medical examiner system, and outlines their implications for local authorities.
Obtaining formal proof of death is critical for anyone intending to have dealings with the estate of someone who is believed to have died.
The biggest change to death certification for more than a century happened on 9 September 2024 with the coming into force of The Medical Certificate of Cause of Death Regulations 2024 on 9th September. The change has implications not only for local authority conveyancers but also housing and social services authorities, not forgetting anyone having responsibilities for burial or cremation.
The most significant change is that, going forward, a death certificate, now formally described as a Medical Certificate of Cause of Death (MCCD), will require two signatures to ensure its validity. In most cases, the first signature will be the person now described as ‘the attending medical practitioner’. The second confirmatory signature will be that of the relevant Medical Examiner.
The new MCCDs also look different from the old short- form death certificates, as they will contain much more detailed information and run to several pages. Additional information will include the presence of medical implants, such as heart pacemakers, requiring removal before cremation; whether the deceased was pregnant; and with details of any secondary contributory causes of death. A consequence of the new expanded MCCD is the withdrawal of the old Cremation Form 4, to avoid duplicating what is already contained in the MCCD.
A smaller change is that it is no longer a legal requirement that the attending medical practitioner attended the deceased within their last 6 months of life. It is now sufficient that the attending medical practitioner attended the deceased at any time during their life.
Nor do the Medical Certificate of Cause of Death Regulations exist in isolation, as they are part of the raft of regulations taking effect in 2024 which not only change the way deaths are formally recorded, but also the laws relating to cremation. This related legislation can be listed as:
- The Cremation and Notification of Deaths (England and Wales) Amendment Regulations 2024, which also took effect on 9th September 2024;
- Section 169 of the Health and Care Act 2022 as well as Schedule 21 of the Coroners and Justice Act 2009, which were both commenced on 15 April 2024
Medical examiners themselves are nothing new, as the scheme had previously been adopted for several years on a non-statutory basis. The impetus for the setting up of a medical examiner system came out of the recommendations made at the Shipman Inquiry. It is intended to offer a point of contact for bereaved families to raise concerns about the care provided prior to the death of a loved one. Acute NHS trusts in England and local health boards in Wales were asked to set up medical examiner offices to initially focus only on certification of deaths occurring in their own organisations. The purpose of the new medical examiner system is to:
- Provide greater safeguards for the public by ensuring proper scrutiny of all non-coronial deaths;
- Ensure the appropriate direction of deaths to the coroner;
- Provide a better service for the bereaved and an opportunity for them to raise concerns to a doctor not involved in the care of the deceased;
- Improve the quality of death certification;
- Improve the quality of mortality data.
The role of the medical examiner is then to:
- Agree the cause of death and the overall accuracy of the attending practitioner’s certificate;
- Discuss the cause of death with the next of kin/ informant and establish if they have any concerns with regard to the care that could have impacted or led to death;
- Act as a medical advice resource for the local coroner;
- Inform the selection of cases for further review under local mortality arrangements and contribute to other clinical governance procedures.
V, Charles Ward is Company Solicitor with the Institute of Cemetery and Crematorium Management and the author of Essential Law for Cemetery and Crematorium Managers 2025
