Recommendation F281: Appropriate and sensitive contact with bereaved families
From Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, published 6 February 2013.
Recommendation
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.
In brief (written by this site)
The Inquiry recommended training for medical examiners and others who approach bereaved families. In commentary of September 2024, published in February 2026, the Department of Health and Social Care (DHSC) and NHS England described training for medical examiners, stating that regulations require periodic training and that examiners must complete 24 core online modules before starting work and face-to-face training within six months (DHSC and NHS England, Feb 2026). Earlier, the Thirlwall Inquiry legal team noted in May 2024 that primary legislation establishing the statutory framework came into force in October 2023 (The Thirlwall Inquiry legal team, May 2024).
AI-generated summary of the record on this page, checked by a second model and automatic checks, 5 Oct 2026. The record below is the sources' own words.
About this summary
This recommendation applies across many organisations. The record reflects central policy activity; adoption in individual organisations may vary.
Government response
Accepted.
The Royal College of Pathologists and e-Learning for Healthcare have produced an online learning module to help those involved in the certification of death. The training is open to all NHS staff along with all prospective medical examiners.
This training consists of 91 sessions within 11 modules that fully trained Medical Examiners will be expected to complete. This training includes a module on interacting with the bereaved and covers topics on the bereavement office; the psychology of bereavement and loss and the medical examiner’s role; and supporting the bereaved.
Prior to application, all candidates are required to complete a core component of the 91 sessions and present the local appointing panel with a certification of its completion as part of the application process.
Where an application is successful, the medical examiner will receive face-to-face training organised by the Royal College of Pathologists and must complete the remaining e-Learning within a year.
The e-Learning is currently being reviewed and Royal College of Pathologists and e-Learning for Healthcare will consider recommendations 277, 278, 280 in taking that forward.
How this response relates to the recommendation
Site note: This is volume two of "Hard Truths: The Journey to Putting Patients First" (Cm 8777-II), the government's response to the Inquiry's 290 recommendations, published by the Department of Health on GOV.UK on 19 November 2013 and dated to that day here. The PDF the row links to is the accessible edition, whose title page reads "January 2014". The Department of Health has been the Department of Health and Social Care since January 2018. The volume says it includes accounts from each of the national organisations the recommendations name, but it does not mark which passage each organisation wrote, so every row is filed under the Department that published it.
Blanket government agreement does not establish acceptance or delivery by each addressee. Some response passages cover groups of recommendations.
Scope of the government response
Government responded via "Hard Truths: The Journey to Putting Patients First" (2014), a single document covering all 290 recommendations with a blanket acceptance. Individual recommendation responses were not broken out.
Delivery
DHSC and NHS England say in progress (27 February 2026)
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.
Site note: DHSC and NHS England's own account of progress, supplied to the Thirlwall Inquiry in September 2024 and printed in the Inquiry legal team's Review of Implementation of Recommendations from Previous Inquiries into Healthcare Issues (version dated April 2025, published 27 February 2026). It is not a finding of the Inquiry. Their reviewed extent of implementation reads “Implemented - Ongoing”. Table row: section 18.2 No. 281, PDF page 575.
Department of Health and Social Care says in progress (11 February 2015)
A number of the recommendations in Sir Robert’s Mid Staffordshire Inquiry report refer to our planned reform of the death certification system and the introduction of the role of medical examiner in England and Wales. A new system of medical examiners has been trialled successfully in a number of areas across the country. The work of the two flagship sites in Gloucestershire and Sheffield has been continued and extended to operate a medical examiner service on a city and countywide basis at a scale that will be required for implementation by local authorities when legislation is introduced. We will publish shortly a report from the interim National Medical Examiner setting out the lessons learned from the pilot sites.
The government remains totally committed to the principle of these reforms. Further progress will be informed by a reconsideration of the detail of the new system in the light of other positive developments on patient safety since 2010 and by a subsequent public consultation exercise.
The medical examiner e-learning module will be refreshed following any future consultation to ensure it reflects the relevant Francis recommendations.
Site note: This is the supporting annex published on 11 February 2015 with "Culture change in the NHS: applying the lessons of the Francis Inquiries" (Cm 9009), attached to the GOV.UK page as "Culture change in the NHS supporting annex". The annex has no title page; that title is GOV.UK's and the PDF's own. Its table has four columns (No., Recommendation, Hard Truths Government response, Progress update), and the row carries the Progress update cell. No column says which organisation wrote an update, so the row is filed under the Department of Health (now the Department of Health and Social Care), which published it.
What other bodies have found
In their own words. These do not change the delivery statement above.
Thirlwall Inquiry legal team (15 May 2024)
This recommendation was accepted by the Government.
In the January 2014 Hard Truths report, the Government referred to the Royal College of Pathologists and e-Learning for Healthcare producing an online learning course, including a module on interacting with the bereaved.
In April 2023, the Government announced it intended to introduce a statutory medical examiner system from April 2024. Primary legislation by way of amendment of the Coroners and Justice Act 2009 to provide the framework for this came into force in October 2023.
Site note: The Thirlwall Inquiry legal team's own notes on implementation, from its Review of Implementation of Recommendations from Previous Inquiries into Healthcare Issues (version of 15 May 2024). The review does not colour its Extent of Implementation cell for this recommendation green; it leaves the cell uncoloured where a recommendation was rejected, where evidence of implementation was insufficient, or where steps had been taken but implementation was not yet complete. Table row: section 16.2 No. 281, PDF page 528.
Source
Responsible bodies
Themes and tags
Who has spoken
- Department of Health and Social Care
Response, delivery statement - DHSC and NHS England
Delivery statement - Thirlwall Inquiry legal team
Finding