We are all acutely aware of the difficult financial position that prevails at the moment with the governments drive to reduce expenditure from the public purse.
We are all acutely aware of the difficult financial position that prevails at the moment with the governments drive to reduce expenditure from the public purse. Whether you are the manager of an NHS mortuary or a public mortuary run by the local authority it is almost certain that you are being asked to cut costs. It is also likely that you have been asked to look at charging for the services that you provide to outside agencies such as the Coroner.
What has been a grey area in the past with regard to charges relates to the activities that we carry out on behalf of the police. For those of us that run mortuaries that undertake forensic work we will be acutely aware of the additional costs that this type of work generates. One of the main reasons for these additional costs are the length of time such cases take, call-out payments and of course such cases often incur overtime payments. Indeed in my own service the unit cost of a forensic PM is over £400 more than that of a standard Coroner’s post-mortem (PM).
There is an argument of course that forensic cases are coroner’s cases and therefore it is the coroner that should pay all of the costs associated with the post-mortem examination. While it is true that such cases do fall under the remit of the coroner, but is the coroner interested in everything that happens at a forensic PM? Arguably the forensic post-mortem goes much further than the coroner requires in terms of fulfilling their primary duty of establishing who died, when they died, where they died and how they died. If the forensic PM reveals that there is indeed foul play then the coroner will defer holding an inquest until after any criminal hearing.
Who should pay?
Only the Coroner has the authority in law to be able to order a PM examination. In suspicious deaths it is the coroner that orders the PM examination and not the police. The coroner does have interest in the case because they must establish the identity of the deceased, their place, cause and time of death. The coroner must therefore pay some of the costs.
The police interest is a little more complex in that part of what they are doing is both for and on behalf of the coroner i.e. identifying the deceased, etc. When handling a suspicious death the police do however have additional duties to fulfill that go beyond what the coroner requires. There may well be a whole range of forensic samples to be collected. The primary purpose of many of these samples is to provide evidence in the identification of the perpetrator of a crime. It seems logical to suggest that in these circumstances that the police should pay part of the cost of the PM.
Local authorities have a legal duty to provide mortuary and PM facilities for HM Coroner. The legislation that actually covers this is the Public Health Act (1936). It states at section 198:
“198 Provision of mortuaries and post-mortem rooms.
(1) A local authority or a parish council may, and if required by the Minister shall, provide—
(a) a mortuary for the reception of dead bodies before interment;
(b) a post-mortem room for the reception of dead bodies during the time required to conduct any post-mortem examination ordered by a coroner or other duly authorised authority;
and may make byelaws with respect to the management, and charges for the use, of any such place provided by them.
(2) A local authority or parish council may provide for the interment of any dead body which may be received into their mortuary.”
It is interesting that over time everyone in local authorities has accepted that they must provide PM facilities for the coroner. What seems to have been overlooked is the sentence highlighted in blue. This makes it quite plain that the local authority can make charges for the use of such facilities.
Billing the Police
In the ongoing quest to generate income I looked at the possibility of making some charge for our services to the police when we facilitate forensic or so called Home Office Post-Mortems (HOPMs). The mortuary service in Hull has a rather unusual funding arrangement in that its budget is a tripartite arrangement between the hospital trust and two local authorities. The local authorities actually provide a little over 70% of revenue costs. As the local authorities are the organisations charged with the statutory duty to provide mortuary facilities for HM Coroner and therefore fund the Coroner’s activities, we make no additional charges to the Coroner for conducting his work. Indeed if we did so we could be accused of charging twice.
The first step was to establish the unit cost of a standard coroner’s PM and a HOPM. As mentioned earlier in Hull the cost of a HOPM is a little over £400 more than a standard coroner’s PM. With this in mind negotiations were initiated with the police. Naturally they were not terribly impressed at the prospect of being charge for our services but could not find an argument against what the Public Health Act states in terms of local authorities charging for use of the mortuary. Following negotiation it was agreed that that the police will pay a standard charge of £250 per HOPM. While this is not the full cost it is at least a contribution (approximately £10K per annum) and in to-days financial climate it is better than getting nothing.
I hope that this information is useful to other mortuary managers in these difficult times.
Hull and East Yorkshire Hospitals NHS Trust