Correspondence between the Chairman
of the Committee and the Department of Health in respect of post
mortem examinations in the NHS
To Rt Hon Dawn Primarolo MP, Minister of State,
Department of Health
I would be grateful if you would provide the Committee
an update on the policy for post mortem examinations in the NHS.
In particular the following issues of concern have come to my
attention:
- There is a lack of strategic
planning to provide NHS services for specialist post mortem examinations,
especially in relation to patients who die with dementia. This
hinders the research work of doctors working in neuropathology.
- A lack of clear policies and procedures regarding
the commissioning of post mortem diagnostic pathology in England
and Wales.
- The policy of funding post mortems. For example,
on occasion, families have requested a diagnosis on a known brain
disorder (commonly dementia, but including a range of other neurological
conditions) but this information has not been required by HM Coroner
and therefore the Coroner has not funded the full post mortem.
The policy determining who pays for establishing a diagnosis on
the deceased for the benefit of the family is unclear.
I would be grateful to receive your comments on the
issues raised above. In addition, I would be grateful if you would
provide figures concerning the number of post mortems carried
out in hospitals since 2000.
28 October 2008
To Kevin Barron MP, Chairman, Health Select Committee
Thank you for your letter of 28 October about post
mortem examination in the NHS.
I think it is important to understand the context
in which post mortems are carried out. The number of clinical
(otherwise known as hospital or consented) post mortems in England
is low and has been declining since at least the 1970s (in line
with experience in other countries). It is the case that hospital
post mortems have become a less rich source of data for research
as their numbers have declined. However, post mortems can cause
distress to families at a difficult time: research studies, approved
by relevant ethics procedures and designed to yield the data required,
are a more appropriate route to support the research work of neuropathologists.
Most post mortems now are carried out on behalf of
coroners. Their interest is to establish the cause of death and,
if they are satisfied that this can be done without a post mortem,
they will not order one to be carried out. In these circumstances,
it would not be appropriate for the coroner to pay for a post
mortem. The NHS will meet the costs of a clinical post mortem
if clinicians feel that this is appropriate to understand more
fully the cause of death in a patient (and obviously once the
next of kin has given consent, according to the Human Tissue Act
2004). However, where a family wants a post mortem to be carried
out, but neither the NHS nor the coroner agrees there is a need
for one, the family will have to pay for a private post mortem.
The Department of Health does not commission pathology
services centrally. Post mortems are carried out as part of the
normal range of diagnostic pathology services provided by histopathology
departments in hospitals.
You also asked for information on the number of post
mortems carried out in hospitals. Details are set out in the enclosed
annex.
I hope this reply provides useful.
18 November 2008
Annex
Data from the Office of National Statistics show
that:
