Frequently Asked Questions
Answers to common questions about inquests and the coronial system
What is an inquest?
An inquest is a judicial inquiry into the circumstances of a death, conducted by a coroner. It is not a trial. The purpose is to establish who the deceased was, when they died, where they died, and how they came by their death (Coroners and Justice Act 2009, s.5). An inquest does not determine criminal or civil liability: it is a fact-finding process.
When is an inquest held?
A coroner must investigate a death where there is reason to suspect it was violent or unnatural, the cause of death is unknown, or the deceased died while in custody or state detention (Coroners and Justice Act 2009, s.1(2)). Where the coroner conducts an investigation, an inquest must be held as part of that investigation. Not every death reported to a coroner requires an inquest: many are resolved after a post-mortem examination establishes a natural cause.
Who is the coroner?
A coroner is an independent judicial officer appointed by the local authority. Coroners must be legally qualified: a solicitor, barrister, or Fellow of the Chartered Institute of Legal Executives with at least five years' standing. They act independently of both local and central government. The Chief Coroner, a judge of the High Court, provides national leadership and issues guidance.
Can I attend the inquest?
Inquests are public hearings. Members of the public may attend unless the coroner orders otherwise in exceptional circumstances. Interested persons (defined in s.47 of the Coroners and Justice Act 2009) have additional rights: they may receive disclosure of relevant documents, question witnesses (with the coroner's permission), and make submissions on the conclusion.
Who is an interested person?
Section 47 of the Coroners and Justice Act 2009 defines interested persons. They include the spouse, civil partner, or partner of the deceased; parents, children, and siblings; any person whose act or omission may have caused or contributed to the death; the personal representative; relevant public bodies (such as a prison or hospital trust); and any other person the coroner considers has a sufficient interest.
Do I need a lawyer for an inquest?
There is no requirement to have legal representation at an inquest, and many bereaved families attend without a lawyer. However, in complex cases (particularly Article 2 inquests involving deaths in state custody or deaths involving potential state failings), legal representation can be very important. Other parties (such as the NHS trust, police force, or prison service) will often have lawyers present. The charity INQUEST provides specialist advice to bereaved families.
Is legal aid available for inquests?
Legal aid for inquests was largely removed by the Legal Aid, Sentencing and Punishment of Offenders Act 2012 (LASPO). However, exceptional case funding may be available under LASPO s.10 where the failure to provide legal aid would breach Convention rights. This is most commonly granted in Article 2 inquests (deaths in custody or involving state agents). For non-Article 2 inquests, families generally must fund their own representation.
What is an Article 2 inquest?
An Article 2 inquest is one where the right to life under Article 2 of the European Convention on Human Rights (incorporated by the Human Rights Act 1998) is engaged. This occurs where a death may have resulted from state action or a failure by the state to protect life. In an Article 2 inquest, the scope of the inquiry is wider: the coroner must examine not just the immediate cause of death but the circumstances, including any systemic failures. Deaths in prison, police custody, and psychiatric detention typically engage Article 2.
When is a jury required at an inquest?
Under section 7 of the Coroners and Justice Act 2009, a jury must be summoned where the deceased died in custody or state detention, where the death resulted from police action, where the death was caused by a notifiable accident, poisoning, or disease, or where the coroner suspects the death occurred in circumstances prejudicial to public health or safety. The jury consists of between seven and eleven members.
What conclusions can an inquest reach?
The available short-form conclusions include: natural causes, accident or misadventure, suicide, unlawful killing, lawful killing, industrial disease, drug-related death, alcohol-related death, road traffic collision, stillbirth, and open conclusion. The coroner or jury may also return a narrative conclusion: a brief factual statement describing the circumstances of the death. The standard of proof is the balance of probabilities for most conclusions, but the criminal standard (beyond reasonable doubt) for unlawful killing and suicide.
What is a Prevention of Future Deaths report?
Under Regulation 28 of the Coroners (Investigations) Regulations 2013, a coroner has a duty to make a report where the coroner believes that action should be taken to prevent future deaths. The report is sent to the person, organisation, or public body with the power to take action. The recipient must respond within 56 days. Reports and responses are published by the Chief Coroner on the judiciary website. These reports are a significant mechanism for systemic change.
Can I challenge the outcome of an inquest?
There is no right of appeal from an inquest conclusion. However, an interested person may challenge the coroner's decision by judicial review in the High Court, on grounds including error of law, irrationality, or procedural unfairness. Alternatively, the Attorney General may apply under section 13 of the Coroners Act 1988 (preserved by the 2009 Act) for the inquest to be quashed and a fresh inquest ordered, where it is necessary or desirable in the interests of justice.
How long does an inquest take?
The length varies significantly. A straightforward inquest (natural causes confirmed after post-mortem, no disputed facts) may be concluded in a single short hearing. Complex inquests involving multiple witnesses, expert evidence, and systemic issues (such as deaths in custody or healthcare settings) may run for several days or weeks. The time between the death and the final inquest hearing can range from a few months to over a year, depending on the complexity of the investigation.
Where can I get help if a family member has died?
The charity INQUEST (inquest.org.uk) provides specialist advice and support to bereaved families navigating the coronial system. Cruse Bereavement Support (cruse.org.uk) offers emotional support. Citizens Advice (citizensadvice.org.uk) can help with practical questions. GOV.UK has guidance on what to do when someone dies. If you believe the death may have involved state failings and you need legal advice, contact a solicitor with experience in inquest work: the Law Society's "Find a Solicitor" service can help.
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