Inconsistencies in coroner investigations across England and Wales have resulted in a ‘postcode lottery’ service which is not adequately serving bereaved families, the doctors involved or the tax payer - according to a leading medical protection organisation.

In its ‘Priorities for the new Government’ paper the Medical Protection Society (MPS) - which assisted over 1,300 doctors involved in coronial investigations last year - said the local nature of coroner services has resulted in considerable variations in practices and resources. This means that in some parts of the country a coroner’s investigation into a patient’s death would take place, when a comparable incident elsewhere may be resolved at hospital level. Similarly, for some areas, investigations will be unnecessarily prolonged and expensive when a comparable investigation elsewhere would be resolved promptly.

MPS said the creation of one national coroner service in England and Wales is needed, which would lead to a more consistent, robust coronial system and ensure better use of public resources.

Dr Rob Hendry, Medical Director at the Medical Protection Society, said:

“It should not matter whether a patient death occurs in Swansea or Sunderland, the investigation of the death by the coroner must be carried out in a consistent and robust way.

“Too often, we see prolonged investigations in some parts of the country, where a comparable incident elsewhere has been investigated swiftly.

“It equates to a postcode lottery in the coroner service, which serves no one. It is not fair on a deceased patient’s family, who can be held in the coronial system during an unnecessary or very long investigation, waiting to get the answers they deserve.

“Neither is it fair on healthcare professionals, who may be subjected to the stress of a
needlessly long or unnecessary coroner’s investigation. Finally, it is the taxpayer who too often must fund delays and unnecessary processes in these investigations.

“The Chief Coroner and his predecessor have both taken welcome steps in a bid to achieve greater consistency, but much more needs to be done. Indeed, in the Chief Coroner’s Annual Report, he leant his support to the idea of a national coroner service. We also strongly support this.

“We believe the creation of a national coroner service in England and Wales would lead to better use of resources and ensure consistent practice across the country. This is in everyone’s interests - bereaved families, healthcare professionals and the taxpayer. We would encourage the Government to consult on this.”

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About MPS

The Medical Protection Society Limited (“MPS”) is the world’s leading protection organisation for doctors, dentists and healthcare professionals. We protect and support the professional interests of more than 300,000 members around the world. Membership provides access to expert advice and support together with the right to request indemnity for complaints or claims arising from professional practice.   

Our in-house experts assist with the wide range of legal and ethical problems that arise from professional practice. This can include clinical negligence claims, complaints, medical and dental council inquiries, legal and ethical dilemmas, disciplinary procedures, inquests and fatal accident inquiries.

Our philosophy is to support safe practice in medicine and dentistry by helping to avert problems in the first place. We do this by promoting risk management through our workshops, E-learning, clinical risk assessments, publications, conferences, lectures and presentations.

MPS is not an insurance company. All the benefits of membership of MPS are discretionary as set out in the Memorandum and Articles of Association.