National Committee on Infant Cremation: code of practice (second edition)

Code of Practice Level 2 - NHS

These Guidelines form part of, and align with, the content and structure of the national Code of Practice documents developed and maintained by the National Committee on Infant Cremation: http://www.gov.scot/Topics/Health/Policy/BurialsCremation/NCIC/CoP

These Guidelines are applicable to:

• all pregnancy losses< 24 weeks occurring in hospital, stillbirths and infant deaths (tcirca 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 (eg 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 tthe different circumstances in which, in particular, a pregnancy loss may occur.
• Patients, parents and next of kin must be able tmake fully-informed decisions on the cremation options available tthem, although additional steps aligned with person-centred care may be required tminimise any additional distress this may cause, acknowledging that these will be difficult conversations.

2. Contracts

• Arrangements between NHS, funeral director and/or crematoriums must be set out within a formal written agreement that should be made available tanyone on request. At a minimum, the agreement must include:
  • confirmation that all parties adhere tNational Committee Code of Practice documentation (Levels 1 and 2) and Chief Medical Officer ( CMO) and Chief Nursing Officer ( CNO) guidance.
  • any / all applicable costs tall parties.
  • timescales in relation ttransportation and cremation.
  • for shared cremations, maximum number of pregnancy losses per container and per cremation.
  • Suggested good practice would be thave 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) twhich 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 tmaximise the recovery of ashes, whilst noting that in exceptional circumstances ashes may not be available and parents may therefore wish tmake their own private burial arrangements.
• All documentation should include any other appropriate extracts from the applicable cremation authority's policy statement, in order tsupport and maintain consistency of information available tpatients / families.
• A copy of any such documentation must be offered / provided tthe patient / parent ttake 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 CMO and CNO Guidance on the Disposal of Pregnancy Loss Up Tand 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.

5. Training, Monitoring and Continuing Professional Development

• Every health board must designate a lead officer twork with other health boards tsupport, 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 tthe National Committee on Infant Cremations, on request, regarding their health board's progress.
• All staff must undertake relevant training tensure their own knowledge and skills remain up-to-date.
• All health boards and staff must ensure they adhere tthe National Committee's Code of Practice Level 2 Guidelines on Training and Communication.