Conduct

The Coroner and their staff will treat the bereaved and members of the public with courtesy and sympathy at all times. They will have regard to religious faiths and cultural traditions of the deceased when carrying out their duties, but they must adhere to the constraints of their statutory duties at all times.

When dealing with the bereaved and members of the public, duties will be discharged impartially and without judgment. The Coroner and their officers will work with a view to establishing the facts surrounding a death for the purpose of complying with the Coroner’s legal responsibilities.

Confidentiality will, as far as possible, be preserved within Court hearings – which are open to members of the public.

Correspondence

It is the intention of the Coroner and their staff that written enquiries will be replied to within ten working days, although sometimes this may not be possible due to unforeseen events or demands on the office’s resources.

If you are sent an acknowledgement in the interim, this will include an estimate of when you can expect to receive a full reply.

Deaths that do not require an inquest (Discontinued enquiries)

If a death is reported to the Coroner, which does not need to be the subject of a full inquest hearing, a certificate giving the medical cause of death will be sent to the registrar within five working days of the Coroner completing their enquiries.

Post-mortem

Where the Coroner, in their sole discretion and judgment, considers that a post-mortem is necessary the immediate next of kin (if known) or personal representative (if any) will, where possible, be provided with

  • an explanation of why a post-mortem is considered necessary and what this process involves (if requested)
  • advance notice of the arrangements, so that they may be represented at the procedure by a doctor if they wish. However, because post-mortems must be undertaken as soon as reasonably practicable (usually within 24 hours of the discovery of the death), then such notice may not always be possible. The Coroner will also notify relevant people or organisations who have a proper interest
  • a copy of the post-mortem report (if requested)

Release of a body

While the Coroner is carrying out their functions, the body of the deceased is under the control of the Coroner. The Coroner will endeavour to release the deceased for a funeral at the earliest opportunity.

Release of the body will normally be within four working days of the Coroner receiving a preliminary medical cause of death from a pathologist – if a post-mortem was considered necessary. However, where there are uncertainties as to the cause of death, or where the death is deemed suspicious then it may be necessary for the Coroner to retain control over the body for a longer period to allow them to investigate further.

Interviews

The Coroner and their staff may need to interview someone about a death that has been referred. The aim will be to do this no more than once, but in certain circumstances it may be that additional conversations are required. It is the intention that any required interview will be at a time and place convenient to the person concerned – but this must be during standard working hours. If the person wishes, they may be accompanied by a friend or relative.

Special assistance or adjustments will be offered if the person suffers from any form of disability.

Every effort will be made to avoid causing additional distress to the close relatives or friends of the deceased.

The Coroner will provide a copy of any statement to be used at an inquest in advance to the person who made it, if they receive a written request for one, unless the Coroner has a good reason to withhold releasing it.

Disclosure of Information

If a request from an Interested Person is received requesting disclosure of the post-mortem and documents and evidence that will be used at the Inquest, the Coroner will provide this in advance – not less than ten working days before the hearing.

The Coroner is not obliged to provide a full copy of their file – only documents considered relevant to the investigation.

People required to attend an Inquest

The Coroner will inform those who are required to attend an Inquest of:

  • the date, time and place of the hearing at least seven working days in advance. Please note that the formal Opening of the Inquest in Court – during which evidence is taken as to the identity of the deceased and the medical cause of death – will often take place at shorter notice
  • details of the Court in which the Inquest is to be held along with details of the facilities available there
  • details of the Coroner’s Officer to which enquiries should be directed

The Coroner will also:

  • explain to called witnesses and jurors how to claim for travel and subsistence expenses and for any loss of earnings allowance – if applicable. It is the local authority, not the office of the Coroner, that is responsible for paying expenses claims of witnesses and jurors, but payment will only be made after they receive a properly completed application
  • endeavour to ascertain any preference for swearing evidence – in accordance with religious beliefs, or on affirmation

Timing of an Inquest

The Coroner will endeavour to hold any Inquest at the earliest possible opportunity. There may, however, be factors outside the Coroner’s control which may cause some delay. Where a delay is likely, the Coroner will notify interested persons of the position. Such notification will include the reasons for the delay and the expected time when the Inquest may be heard – if known.

Reasons for delay can include, but are not limited to

  • papers and information may be required from abroad if the death occurred abroad
  • another organisation or regulatory body – such as the Health and Safety Executive or Independent Office for Police Conduct – may be carrying out an investigation
  • the Police are investigating a criminal prosecution in relation to the death. In these circumstances, the Inquest may be suspended indefinitely pending the outcome of any criminal trial

Serving a Witness Summons

The Coroner can send a summons to formally request the attendance of a witness at the Inquest – usually in the form of a Schedule 5 Notice. Usually, people called to attend have already provided a witness statement, or some other report or evidence that is to form part of the hearing.

If you receive a Schedule 5 Notice attendance is not optional. The person must attend at the date, time and place detailed on the Summons or face a fine of up to £1000. The Notice will contain a time limit for making representations to the Coroner if the recipient witness feels that they cannot comply. It falls to the sole discretion of the Coroner as to whether to vary or revoke the Notice.

The Coroner also has the power to ask for the production of documents they consider relevant to their investigation and can request these with a Schedule 5 Notice.

The Coroner is sensitive to the distress that it can cause family or friends to receive a Schedule 5 Notice, so the Coroner will endeavour to seek an agreement to attend in the first instance and will only serve a Schedule 5 as a last resort. It is incredibly distressing and upsetting for families to attend Court for a planned Inquest only to find that a witness has not attended, as this means the Coroner many need to consider adjourning the hearing to a later date until the witness’s attendance can be guaranteed. The Coroner would wish to avoid this situation for families where possible.

After the Inquest has been concluded

Once the inquest has been concluded, the next of kin will be provided with a written explanation about where, when and how a copy of the final death certificate may be obtained – before the Inquest an Interim Death Certificate, to confirm the fact of death, will have been issued.

The Coroner will, when they receive a written request, provide to any Interested Person a copy of the Record of Inquest, which will contain a copy of the Conclusion along with answers to the four statutory questions – ‘Who the deceased was?’, ‘When they died?’, ‘Where they died?’ and ‘How they died?’

A written request may be made by an Interested Person for a copy of the recording of the Inquest, and copies of the documents used in evidence. The Coroner will endeavour to provide these – unless they are of the opinion that there is a justification for non-disclosure of the same – within seven working days of receipt of the prescribed fee. The fee for documents will vary depending on the volume and size of the documents to be copied. Recordings are £5 for each disc.

Last reviewed: February 5, 2024 by Sophie

Next review due: August 5, 2024

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