Changes to death certification from September 2024

Previous system

Non-acute deaths, where it is a natural and expected death, are certified by a doctor confirming the cause of death in a Medical Certificate of Cause of Death (“MCCD”) which is used to register the death with the Registrar of Births Deaths and Marriages. However, if the deceased has not seen a doctor within 28 days of death, the MCCD cannot be used and the case is passed to the coroner.

Where the cause of death is unknown or appears to be unnatural, violent or in state detention, then all cases are referred to the coroner. 

Additionally, since 2019, deaths in acute hospitals have been referred to a medical examiner unless they require referral to the coroner. This enables an independent review of the death, and if the medical examiner does not consider the case to be natural or believes there is some failure that may have led to the death, then the case is referred to the coroner. 

New system

The old system as summarised above did not address unnatural community deaths or deaths outside acute hospitals, and the Department of Health have therefore brought forward a new system involving an independent review by a medical examiner for all deaths in England and Wales, if it has not already been referred to the coroner. The MCCD will be signed, ultimately, by the attending doctor and a medical examiner.

Cases that have to be referred to the coroner will not change, although a coroner will be able to request that a medical examiner reviews a case. However, the changes mean that all deaths in a healthcare setting will now be reviewed by a medical examiner or the coroner: in cases which are not referred to the coroner, the attending doctor (and the definition of this is being expanded) can propose a cause of death in the MCCD and then send this to the medical examiner to scrutinise the case. If he accepts this cause of death that will complete the matter and the MCCD will be sent to the Registrar to register the death. Alternatively, the case can be referred to the coroner by the medical examiner if he does not feel that he can just complete the MCCD.

The changes, which form part of the Department of Health's Death Certification Reforms, were announced by the government on 15 April 2024 and come into force on 9 September 2024.

See the Regulations “The Medical Certificate of Cause of Death Regulations 2024” and “The Medical Examiner’s (England) Regulations 2024”.