Appropriate and sensitive contact with bereaved families
It is important that independent medical examiners and any others having to approach families for this purpose have careful training in how to undertake this sensitive task in a manner least likely to cause additional and unnecessary distress.
- NHS England stated in April 2025 that medical examiners must complete 24 core e-learning modules provided by the Royal College of Pathologists before starting work, followed by face-to-face training within six months (DHSC and NHS England implementation update to the Thirlwall Inquiry, April 2025).
- Martha's Rule, which allows families to trigger an urgent clinical review, was expanded to all acute trusts in April 2025 (Martha's Rule Expansion, NHS England, April 2025).
How was this evidence gathered?
Response
Accepted
Response
AcceptedThe government published "Hard Truths: the Journey to Putting Patients First" (Cm 8777) on 19 November 2013, responding to all 290 recommendations of the Francis Report. This followed an initial response "Patients First and Foremost" in March 2013. Key reforms included a new Chief Inspector of Hospitals, strengthened Care Quality Commission inspection regime, a statutory duty of candour, and the fit and proper person test for NHS directors. Volume 2 (Cm 8754) contains the government's detailed responses to each of the 290 recommendations. See: https://assets.publishing.service.gov.uk/media/5a7cd486ed915d63cc65d167/34658_Cm_8777_Vol_1_accessible.pdf
Progress Timeline
DHSC and NHS England implementation update provided to the Thirlwall Inquiry (April 2025). This is the government's own account of progress, submitted to the inquiry. Reviewed extent of implementation: Implemented - Ongoing. Medical examiners have now been introduced as set out in recommendation 45. A core objective of the medical examiner system is to support bereaved people, and all operational and strategic decisions should be considered from this perspective. Medical examiners and officers need to interact compassionately and sensitively with bereaved people and be aware that heightened emotions in those who are grieving may affect how they behave and respond. They need to communicate sensitive information with tact and sensitivity, appreciating its potential impact, avoiding jargon and explaining technical or clinical terms in ways non-clinicians will understand. The Medical Examiners (England) Regulations 2024 and The Medical Examiners (Wales) Regulations 2024 require that medical examiners undertake training from time to time to ensure that they have the experience and skills necessary to carry out their relevant functions. All medical examiners should complete 24 core e-learning modules before starting medical examiner work; and face to face training within 6 months of starting work. Training is provided by the Royal College of Pathologists In addition to the 24 core modules, there are 61 other e-learning modules. Their completion is not a mandatory requirement but will help medical examiners in performing their role. Once appointed, medical examiners should undertake continuing professional development (CPD) activities relevant to their role. Examples are completing further or updated e-learning modules, attending regional and national update meetings or further training sessions such as with local coroners. The National Medical Examiner's good practice series published by the Royal College of Pathologists provides further insight. Reflective practice is also encouraged.
Published Evidence
Published assessments of progress from inspectorates, select committees, official progress reports, and other sources. Source type badge indicates whether each assessment is independent or government self-reported.
Martha's Rule ensures patients, families and staff can access rapid review from critical care outreach team when concerned about deterioration. Phase 1 launched May 2024 at 143 pilot sites. Phase 2 expanded to all acute trusts April 2025. Early data: 9,135 calls Sep 2024-Nov 2025; 286 led to urgent critical care review.
Medical Examiner system became statutory from 9 September 2024 under Coroners and Justice Act 2009 (as amended by Health and Care Act 2022). Independent medical examiners must scrutinise all deaths not referred to a coroner. Full national rollout achieved, implementing Francis recommendations on death certification.
Research published 2023 marking ten years since the Francis Report found mixed results. Structural and legislative changes largely delivered (duty of candour, FPPR, CQC overhaul, revalidation, Freedom to Speak Up Guardians). However, cultural change not fully embedded; understaffing, fear of speaking up, and poor complaint handling persist in parts of the NHS.
Government published "Culture Change in the NHS" (Cm 9009) reporting progress on all 290 recommendations. Key achievements: 19 hospitals placed in special measures; those trusts recruited 109 additional doctors and 1,805 additional nurses; 129 board-level changes made; excess avoidable deaths fell by 450 in less than a year.
Government published "Hard Truths: The Journey to Putting Patients First" (Cm 8777) in two volumes. Vol 1 set out new actions; Vol 2 provided detailed response to each of the 290 recommendations. Approximately 204 of 290 recommendations were fully accepted.