Infant cremation code of practice: third edition (2019)

Code of Practice Level 2 - NHS

These Guidelines are applicable to:

• all pregnancy losses before 24 weeks occurring in hospital, stillbirths and infant deaths (to circa 1 year of age).
• situations where the loss/death and the cremation occurs in Scotland.
• all NHS Scotland staff and premises.
• all cremation options arranged or supported by NHS Scotland (e.g. shared cremations individual cremation without funeral service; individual cremation with funeral service; advice and support on privately arranged funerals).

These Guidelines are not applicable to:

• the clinical measures and procedures involved in pregnancy losses, stillbirths and infant deaths.
• options other than a) cremation and b) pre-24 week gestation shared burial, although it is recommended any such other options are recognised in relevant documentation.

1. Sensitivity

• The pregnancy loss/deceased infant, their family and their friends must be treated with respect, dignity and sensitivity at all times.
• All documentation and discussions on cremation must be tailored to the different circumstances in which, in particular, a pregnancy loss may occur.
• Patients, parents and next of kin must be able to make fully informed decisions on the cremation options available to them, although additional steps aligned with person-centred care may be required to minimise any additional distress this may cause, acknowledging that these will be difficult conversations.

2. Contracts

• Arrangements between the NHS, funeral directors and/or crematorium must be set out within a formal written agreement that should be made available to anyone on request. At a minimum, the agreement must include:
• Confirmation that all parties adhere to National Committee Code of Practice documentation (Levels 1 and 2), Chief Medical Officer (CMO) or Chief Nursing Officer (CNO) guidance and relevant regulations.
• Any / all applicable costs to all parties.
• Timescales in relation to transportation and cremation.
• For shared cremations, maximum number of pregnancy losses per container and per cremation.
• Suggested good practice would be to have the following representation on groups which develop the written agreement:
  • NHS clinical lead for early pregnancy care,
  • Contract/procurement representative,
  • Mortuary representative,
  • Funeral director representative,
  • Crematorium representative,
  • Spiritual advisor/bereavement/Sands/miscarriage association representative or similar.

3. Cremation-related documentation for patients/parents

• All documentation must reflect the new 'ashes' definition of 'the material (other than any metal) to which human remains are reduced by cremation'. "Human remains" includes, where remains are clothed, in a coffin or with any other things, the clothing, coffin or other thing.
• All documentation must make clear that the policy of cremation authorities is to maximise the recovery of ashes, whilst noting that in exceptional circumstances ashes may not be available and parents may therefore wish to make their own private burial arrangements.
• All documentation should include any other appropriate extracts from the applicable cremation authority's policy statement, in order to support and maintain consistency of information available to patients / families.
• A copy of any such documentation must be offered / provided to the patient / parent to take away with them, particularly any signed documentation.

4. Record Keeping

• Whilst the official record of the cremation is the responsibility of the cremation authority, patient records in respect of shared cremation must be maintained in accordance with the Burial and Cremation (Pregnancy Loss Prescribed Information and Forms) (Scotland) Regulations 2018 and the Burial and Cremation (Scotland) Act 2016 (Commencement No. 3, Transitional, Saving and Transitory Provisions) Regulations 2018 and the CMO and CNO Guidance on the Disposal of Pregnancy Loss Up To and Including 23 Weeks and 6 Days Gestation, issued 17 April 2015.
• Records must be managed in accordance with the National Committee's Code of Practice Level 2 Guidelines on Record-Keeping and all relevant NHS codes of practice and guidelines.

5. Training, Monitoring and Continuing Professional Development

• Every health board must designate a lead officer to work with other health boards to support, promote and review the regular sharing, learning and implementation of best practice in the area of infant cremation and sensitive disposal of pregnancy loss.
• Designated leads must report back to the National Committee on Burial and Cremation, on request, regarding their health board's progress.
• All staff must undertake relevant training to ensure their own knowledge and skills remain up-to-date.
• All health boards and staff must ensure they adhere to the National Committee's Code of Practice Level 2 Guidelines on Communication and Training and all relevant NHS training and communication guidelines.