An Overview of the Death Certification Reforms

The death certification system in England and Wales is overdue for reform – it has remained largely unchanged for over 50 years. Introducing a robust system in England and Wales whereby all deaths would be subject to either a medical examiner’s scrutiny or a coroner’s investigation has been an ambition of successive governments and ministers.

The importance of death certification reform and the introduction of medical examiners has been underlined in numerous reports and inquiries including the:

It has long been established that, following a death, the case will either follow the path of medical certification by a medical practitioner or investigation by a coroner. This will remain the case in the new system, but with important differences.

NHS England and NHS Wales Shared Services Partnership started implementing the medical examiner system on a non-statutory basis in 2019. Medical examiners are now scrutinising almost all deaths in acute trusts and a growing proportion of deaths in all other healthcare settings (including the community).

It has increasingly become standard practice for medical examiners to provide independent scrutiny of deaths not taken for investigation by a coroner. Medical examiner scrutiny is not mandated in the non-statutory system. However, once the new death certification reforms come into force, there will be an independent review of all deaths in England and Wales, without exception. This will either be provided by independent scrutiny by a medical examiner or by investigation by a coroner.

This page summarises the death certification reforms planned from April 2024, and how the statutory medical examiner system will operate when these reforms come into force. It accompanies the publication of the following draft regulations:

The underpinning primary legislation is:

  • section 21 of the Coroners and Justice Act 2009, which was commenced in June 2018
  • sections 19 and 20 of the Coroners and Justice Act 2009, which was commenced on 1 October 2023
  • section 169 of the Health and Care Act 2022, also commenced on 1 October 2023

There will also be additional primary legislation commenced to support the reforms. 

The regulations are being published in draft form for information only. The draft regulations may be amended before coming into force.

The deadline to submit comments on draft legislation ended on 12 January 2024.

All comments received will be considered but will not receive an individual response.

This page includes references and links to current and relevant guidance. All guidance will be updated to reflect, and coincide with, implementation of the statutory medical examiner system.

This page primarily focuses on deaths registered after completion of a medical certificate of cause of death (MCCD) but will also reference other relevant parts of death management, including where the case is notified and/or referred to a coroner.

The full article can be found here – An overview of the death certification reforms – GOV.UK (