HM Inspector of Crematoria for Scotland: annual report 2015-2016

Inspections and Findings

All 29 crematoria in Scotland have been visited on a minimum of two occasions, with a number of those that featured in the complaints or the Report of the National Cremation Investigation being visited on several other occasions.

A template was drawn up for each inspection, and was divided into 16 headings.

Due to the ongoing National Cremation Investigation copies of completed Inspections were not disseminated until after publication of the Report.

Copies of all 29 completed Inspections have since been sent to the respective crematorium managers for the information of their cremation authority.

Comment is made below on the collective findings, as they appear in the order of the headings:

1. All crematoria carry out cremations Monday to Friday with 19 routinely open on Saturday mornings. Special arrangements can be made with those not routinely open on a Saturday or bank holiday, albeit this is likely to incur additional costs. A number have staff on duty on Sundays to assist and provide access to the book / garden of remembrance.

Times between services vary between 40 and 90 minutes depending on the number of cremations being carried out. The main issue highlighted by those with the shortest period between services is traffic flow and parking, particularly when back-to-back services have large attendances. As crematoria staff tend to have no direct contact with families prior to the service reliance is placed on the funeral director to advise on the expected number of attendees.

2. All staff who carry out cremations have been found to be accredited by either the FBCA or ICCM, with one crematorium no longer a member of either.

3. The majority of crematoria have their office either within the grounds or integrated within the main building. It has been observed that there was less of a delay in finalising computer records by those where the office is integrated, or within the grounds. Of note, it was seen that there was a total of 7 different computer systems currently in use throughout the 29 crematoria.

4. Statistics were obtained in respect of the total number of cremations carried out at each crematorium during the calendar years 2014 and 2015. A breakdown was requested in respect of adults, babies, infants, children, stillbirth, body parts, anatomical body parts, and pregnancy loss both individual and shared, however due to the way in which the different computer systems were populated this would have proved time consuming for many, and as the requested purpose was to give the Inspector an insight into the level of experience in the different categories, and not for an accurate statistical analysis (which can be obtained elsewhere) the results were often initially more general e.g. under or over a particular age. Overall it was seen from the figures provided that for the calendar year 2015, the lowest number of adult cremations carried out at any of the 29 crematoria was 609 with the highest being 2718.

The recording on computer of shared pregnancy loss also differed, as whilst all recorded the number of cremations not all could extract the total number of pregnancy losses without referring to manual records ( i.e. number of pregnancy loss contained within each coffin). Whilst not seen as an issue it could, without further check, indicate a much lower number of pregnancy losses cremated than was actually carried out. In almost all crematoria, there is no charge for the cremation of pregnancy loss. Whilst costs did not feature in the inspection, it is understood that where costs are levied, it is to the NHS and not bereaved families.

In respect of anatomical body parts, there were a number of queries following implementation of the Certification of Death (Scotland) Act 2011, as regards cremation of historical parts, and tissue which had been imported, however these have since been resolved.

5. Whilst all crematoria safeguard the continuity of identification throughout the process, there was a variation in the number of identity labels produced and subsequently affixed to the receptacles containing the ashes. As this was the cause of a number of the complaints referred to earlier, the Inspector highlighted these issues to management on each visit and during the inspections.

6. A check confirmed that ashes have been recovered in all cremations of infants between 1 January 2015 and 30 September 2016.

7. As the options available to the applicant as regards dispersal of ashes vary considerably between crematoria, the important point was to make sure that it was made clear to the applicant what these options were. The Inspector was satisfied that the requisite information was available either on supplementary forms and/or website, with an opportunity for the applicant to change instruction at any point prior to dispersal. The storage of ashes awaiting dispersal was also examined, particularly as this was also an area which resulted in one of the complaints referred to earlier.

8. The Inspection found there to be a total of 7 different makes (at time of purchase) of cremators in use (with 37 of the total 54 being Facultatieve) with a number of crematoria upgrading to larger cremators to facilitate increasing demand for these.

9. A dip sample of computer records and paperwork was carried out at all crematoria with checks to ensure accurate completion and that the instructions of the applicant were adhered to. There were no concerns noted in any of the 29 crematoria.

10. With one exception baby trays are in use at all crematoria. The exception being in a crematorium which operates an electric cremator and carries out a relatively small number of infant cremations, all of which resulted in the recovery of ashes. It was noted that there were a total of at least 39 baby trays in use or being trialled, with Teleshore (19) and Facultatieve (12) being the most commonly used make. The handling of the baby tray continues to cause concerns regarding Health and Safety in respect of its weight and heat retention.

11. Of the 10 crematoria which carry out shared cremations, a number had yet to finalise a contract as per the Code of Practice ^[4] . It was suggested to those that do not currently extend an invitation for families to attend a service for shared cremation to consider discussing this with NHS as the few that do have stated that a number of bereaved families have attended. It was noted that there is no standardised procedure as regards size, or number of pregnancy losses contained within each coffin. The terminology used also differs with some referring to the pregnancy loss being contained within coffins, whilst others refer to box, container or receptacle.

12. Metal extracts are only disposed of in accordance with the instructions of the applicant. Of the 29 crematoria, 17 currently are part of a recycling scheme, with a further 4 giving it consideration. Monies generated from the various recycling schemes tend to be donated annually to a charity nominated by the respective cremation authority. Metal extracts which are not recycled or collected by the applicant are interred in the gardens of remembrance. Only a small number of applicants have instructed collection of the metal extracts. Of note, it has recently been seen that there is an increase in the recovery of ceramic joints following cremation. As these tend to withstand the cremulation process intact, and by definition they are part of the ashes, (not being metal), the applicant needs to be consulted when the instruction is to scatter above ground.

13. Checks were conducted of all cremation authority websites to ensure that the Policy Statement on Infant Cremations ^[5] was publically available. In most instances they were found to be present, and where not it was brought to their attention and rectified. The Code of Practice and Cremation Practice Guidance documents were present and readily available to staff at all crematoria, with a number also including them on their website and displayed within the crematorium. Less obvious was the existence of an Operational Procedures Manual at a number of crematoria. The inspections confirmed that the crematorium's procedures were in accordance with the Policy Statement. Any minor discrepancies were dealt with by the Inspector at the time. However, as crematoria are also very much reliant upon the professionalism, good practice and co-operation of other stakeholders it is generally accepted that there is room for improvement in communication between them. There is also a view that crematoria management could / should have more direct contact with the applicant prior to the intended service, something which rarely happens at present. It is acknowledged that this may only be feasible at smaller crematoria, or for particular cremations.

14. This section related to general observations of buildings, car park, grounds, gardens of remembrance, disabled access, security and health and safety. No major issues were noted, with a brief resume of the findings in respect of each included in the Inspection Report. Where crematoria were undergoing renovation / temporary closure, contingency planning was discussed.

Of note, and perhaps surprising only a small number of crematoria had acquired a defibrillator.

15. As part of the inspection, staff were asked to comment on any issues relative to their role, which they considered could be improved on a local or national level. The majority of comments related to funeral directors (items left in the coffin (items seen during visits and inspections included aerosol cans, mobile telephone, bottles, metal belts and toe caps, and metal staplers of a type used for lining coffins), not knowing combined weight of coffin and deceased before arrival at the crematorium, and incomplete paperwork. Further comments included a lack of clarity on whether or not a Form E1 from the Procurator Fiscal was applicable to the cremation application, a request for greater consultation with staff on matters such as planned changes to statutory documentation, and several stated that they should be made aware of the cause of death (prior to the most recent change with forms this information was included). As regards the last point, there was mixed opinion on whether it was a 'need to know' or 'like to know'.

16. The final section in the Inspection Report was a summary of the findings in the preceding sections.