Fewer Inquests: A new trend?
Published 16 May 2018
Fewer deaths being reported to coroners and fewer inquests being opened - this is the picture painted by the recently published Coroners Statistics 2017.
The drop in reported deaths and inquests is largely explained by last year's removal of the automatic requirement for an inquest where someone has died subject to the Deprivation of Liberty Safeguards.
Even excluding DoLS cases, however, reported deaths were down in 2017 compared with the previous year. Deaths in custody were also down, driven by a significant drop in deaths of people detained under the Mental Health Act compared with 2016.
In this briefing, we look at these latest inquest stats and what we can glean from them.
Overall picture: Fewer inquests?
No longer automatically having to hold an inquest for DoLS cases after 3 April 2017 has resulted in a marked drop in inquest numbers overall, with 5% fewer deaths being reported to coroners (equating to 11,465 fewer reported deaths) and 18% fewer inquests having been opened (equating to 7,107 fewer opened inquests) in 2017 compared with the previous year.
This means the number of deaths reported and inquests opened was the lowest since 2014, which was the last year before all DoLS deaths were required to have an inquest.
Interestingly, though, even when DoLS cases are taken out of the equation, 2017 saw a 2% fall in numbers of deaths reported to coroners (equating to 3,955 fewer reported deaths), despite a 2% rise in the provisional figures for registered deaths occurring over the same period. This represents a drop in the proportion of deaths being reported to coroners, with the 2017 figure of 43% being the lowest since 2003.
What is much less clear, however, is whether these figures mark the start of a downward trend in numbers of inquests or whether they are part of the fluctuating - but broadly consistent - picture we have seen over the last decade or so.
Detained patient deaths
Deaths in 'state detention' - excluding DoLS cases but including prison, police custody and MHA patients - were down in 2017 (8% fall, equating to 46 fewer deaths) compared with 2016.
Strikingly, there was a 22% drop in deaths of patients detained under the Mental Health Act (196 such deaths in 2017, compared with 252 in 2016). Before reading too much into this, however, it is important to factor in that the figure for MHA deaths seems to have been unusually high in 2016, with the 2017 number still being higher than in any of the 5 years prior to 2016.
The figures also show a slight drop in prison deaths compared with the previous year (293 prison deaths in 2017, compared with 298 in 2016).
Looking at the longer term trend, however, there has still been a general rise in deaths in state detention since 2011.
Juries, conclusions and more...
Removing the requirement to hold inquests for all DoLS deaths has also had an significant impact on the number of 'natural causes' conclusions recorded - down 43% on 2016, when most DoLS cases concluded with 'natural causes'. Even when DoLS cases are excluded, however, there has been a clear drop (of around 50%) in 'natural causes' conclusions since 2014. This could be linked with a trend towards more 'unclassified' conclusions - including narrative conclusions - which were up 12% in 2017. 'Open' conclusions have also continued to fall in line with the long-term trend, accounting for just 4% of conclusions in 2017 compared with 10% fifteen years earlier.
The statistics also highlight some marked local variations. For example, there is wide variation in the number of cases reported to coroners as a proportion of registered deaths - e.g. 24% of deaths reported to the coroner in one area, but 79% in another. The reasons for this are unclear, although we are cautioned against reading too much into these figures because they can be affected by local factors - e.g. large hospitals near boundary lines can influence the proportions because coroner figures relate to place of death, whereas registered death figures are based on place of residence.
Some things do not really change, however - e.g. the proportion of inquests held with juries has remained stable at between 1% and 2% over the last decade.
We will have to wait and see whether the drop in numbers of inquests shown by these latest figures continues into this year and beyond.
A key factor in this going forward, however, could be the roll-out (potentially from April 2019) of the proposed medical examiner system, including the introduction of statutory criteria for referral to the coroner. It is widely thought that this new system could lead to a significant increase in cases being reported to coroners which could, in turn, translate into a rise in inquest numbers again in the future.
How we can help
Our large national team of healthcare regulatory lawyers have a wealth of experience in supporting providers and individuals across the health and social care sector through the inquest process - from relatively straightforward hospital deaths to complex Article 2/jury inquest cases involving multiple parties and deaths in state detention.
The support we can provide includes:
- Initial scoping to explore likely outcomes, level of support needed and next steps;
- Advice on Duty of Candour - thresholds and approach;
- Assisting with witness preparation, both at operational level and at strategic level to address Prevention of Future Deaths Report risks;
- Attendance at pre-inquest review hearings, which may cover matters such as inquest scope, juries and expert evidence;
- Representation at final inquest hearings, including witness support throughout.
We can also provide bespoke training on all aspects of inquests, including updates on the latest legal developments and guidance for clinicians/SI investigators on report-writing and giving evidence.