At the end of April, senior coroner David Heming had 86 cases on his hand that remained open after more than a year. "This is significantly higher than many coronial areas," says the annual report of the coroner's service to the county council. The Coroner and Justice Act 2009 requires that all inquest cases are heard within six months and those not handled within a year must be reported to the chief coroner of England and Wales, says the report. One reason for the rise in inquests not dealt with in Cambridgeshire is their increasing complexity. "Although the total number of referrals has not increased in 2018\/19, this is due in part to the significant work that the coroner and the service has done to reduce the number of simple cases that were being referred to the coroner unnecessarily," says the report. The service is working hard to avoid "unnecessary referrals" but "there is an increase in the proportion of complex and highly complex cases. This is demonstrated to some extent by the changing percentage split of the conclusions at inquest. "The coroner service continues to face significant challenges due to several unavoidable pressures resulting in increasing workloads. "Workload increases can be attributed to three main causes: the complexity of the coronial area; the increasing complexity of the cases referred; and the historic backlog that must be tackled alongside the other pressures." The findings show that the percentage of inquests with a conclusion of a suicide or drug related death rose from 15.6 per cent in 2017 to 21.6 per cent in 2018. "These deaths are often linked to mental health issues which require significant investigation," says the report. "Inquests with an unclassified conclusion (where a narrative is required because they do not fit into the standard set of conclusions) also rose from 10.5 per cent to 19.2 per cent; these cases are often medically based, usually require significant investigation and are often highly complex." The report adds: "At the same time there was a significant reduction in the percentage of simpler natural cause conclusions (dropping from 38.3 per cent to 17.2 per cent)". The report also says considerable time has been taken up in the past two years with deaths in the four Cambridgeshire prisons. There were 15 prison deaths in this time "and all of these are deaths in state detention and require jury inquests, whilst several are also Article 2 inquests where the State or 'its agents' have 'failed to protect the deceased against a human threat or other risk'. "These are complex high profile cases that require a significant time investment." The coroner says he is also faced with increased costs on body removals, partly due to the relocation of Papworth Hospital to a shared Cambridge site with no mortuary facilities. Addenbrooke's will undertake this work, and Peterborough City Hospital will continue to provide this service, but costs are rising. The report says Peterborough requires "a significant increase immediately" with Addenbrooke's planning a rise next year. On staffing the report says the coroner's ability to meet targets for investigating cases in a complex environment sometimes be challenging. The need for the service to be able to maintain staffing levels (by taking on additional staff to cover absences) to deal with the immediate referrals received and the rising levels of inquest work "is of paramount importance" says the report. One success for the coroner last year has been a case management system that enables to doctors to use technology to refer cases 24\/7 without leaving a hospital ward. It was rolled out at Addenbrooke's last November and Papworth and Arthur Rank Hospice followed. It is now being rolled out at Peterborough City Hospital and Hinchingbrooke Hospital and GPs will also soon be able to refer cases electronically. "Cambridgeshire and Peterborough is the first jurisdiction in the country to successfully introduce this solution," says the report. "It will remove the need for our staff to re- key information as well as simplifying the referral process for our partners."