Death certification reform changes how England and Wales records mortality data

The reform, which came into force on 9 September 2024, means all deaths must now receive independent scrutiny — either through a coroner’s investigation or a review by a medical examiner. Before that date, medical examiner scrutiny was not a statutory requirement for every non-coronial death. The Office for National Statistics has published analysis of how the change has affected the death certification process and mortality data.

Under the new system, the attending practitioner proposes the cause of death, and a medical examiner independently reviews it before the death is registered. A new Medical Certificate of Cause of Death replaced the previous certificate from September 2024, introduced through regulations laid before Parliament in April 2024. Transitional arrangements meant a small number of deaths registered after 9 September 2024 still used the old certificate.

The estimated implementation cost was £56.5 million for England in 2024/25 and £4.3 million for Wales, according to the explanatory memorandum to the Medical Certificate of Cause of Death Regulations 2024. The Welsh figure is cited in the memorandum as covering 2024/24 — which appears to be a typographical error in the published document.

The ONS notes that changes to certification and registration procedures need to be considered when comparing mortality figures across the reform period. Put simply, a shift in how deaths are recorded can affect what the data appears to show — even if the underlying death rate hasn’t changed.

The government’s stated aims for the reform are stronger public safeguards, greater transparency for bereaved families, and improved quality of cause-of-death data. Deaths referred to a coroner remain outside the medical examiner route and continue to be handled as before.