Report of the Infant Cremation Commission

Annex O - Crematoria Questionnaire Responses Summary

Infant Cremation Commission

Crematoria Questionnaire - Responses Summary

Responses received August 2013

All 27 crematoria responded to the questionnaire. Most did so relatively promptly and all responded willingly.

There was some variation in the quality of the responses, and a suggestion at points that at least two of the questions had been largely or partially misunderstood by most respondents.

The full data obtained is available at:

http://www.scotland.gov.uk/Topics/Health/Policy/BurialsCremation/CremationCommission

1 Does the crematorium accept the cremations of fetuses:

		Yes	No
a)	Individual Only	20	7
b)	Both Individual and Communal	11	16
c)	Neither Individual Nor Communal	0	27

Analysis: There is no apparent contrast between private, joint or local authority run crematoria in respect of whether these types of cremations are conducted, although more are providing individual than collective cremations.

The lower number of crematoria providing shared cremations of fetuses is almost certainly the result of two particular factors:

• that it would be extremely rare for the communal cremation of siblings (one instance of this is cited) and also
• that guidance issued by the Chief Medical Officer setting out collective cremation as the new minimum standard for pregnancy loss is not yet fully implemented across the country. SG are currently checking the exact status of this latter aspect and expect to have a detailed picture by end August / start September.

2 Does the cremation procedure in the crematorium vary depending on the gestational age of the fetus or baby? If so, provide details.

Yes	No
4	23

Analysis: Of the four who replied yes, 2 were private and 2 were local authority. The vast majority replied that there was no difference, although an obvious point was raised that collective and individual cremations would necessarily involve procedural differences.

Even where procedural differences were cited, the additional comments or information provided across the board were all very similar. This suggests that the question may have been read differently in different areas.

3 Please advise the Commission of the make and model of cremators in use at the crematorium.

Make / Model	No of Crematoria Using
Facultatieve FTIII	10
Facultatieve FTII	10
Evans (Universal) 300/2	5
Facultatieve 300/2	2
Furnace Construction Joule	2
Facultatieve 3000	1
Parkgrove 2000 Electric	1
Parkgrove Electric	1
Tabo Inex Double End	1
Newton Cremator	1

Analysis: there is no correlation between type of crematorium and type of cremator, although the population served by any crematorium is reflected in the number of cremators it uses. There was some variation in the names provided by respondents, therefore these responses may require additional checking.

4 Does the control system on the cremators have a setting for baby/infant cremations?

Yes	No
19	8

Analysis: Correlates almost directly to the make and model set out in question three, although we note that South Lanarkshire Crematorium and Kirkcaldy answered 'no' although they have the same type of FTIII that others noted as a 'yes'. This may be due to whether or not the cremator has received the relevant software upgrade.

5 Does your manufacturer's operational manual give guidance/instructions on best practice for cremating babies/infants? If so, please provide details.

Yes	No
23	4

Analysis: whilst there is the odd discrepancy which may just be down to individual error when replying, the information provided again correlates with the makes and models of cremators in use.

This question did not specifically ask whether crematoria implemented the guidance/instructions in the manuals, but a low number additionally advised that whilst such guidance exists, they have either not implemented it for health and safety reasons (Hazlehead's non-use of baby trays) or because they believe they are better meeting the needs of the bereaved through their own procedures (Seafield and Warriston not cremating overnight).

Those using the FTII/III and/or Evans cremators note a recent software upgrade that now allows an infant cremation setting.

6 Does the crematorium have a local policy, custom or practice on the cremation of babies/infants, and is that written down or documented anywhere?

Existing Policy?	Yes	No
	22	5

Is it Written Down?	Yes	No	Unclear
	17	7	3

Analysis: Everyone answered clearly the initial question as to whether there was an existing policy / practice / custom, and it was usually possible, from the details provided, to extrapolate as to whether the policies were written down or not.

'Written policy' appears, however, to be defined differently depending on the area: some refer to FBCA and / or ICCM guidance as being their written policy or forming the written basis for local policy, others reference the operational policy provided by cremator manuals; others point to general statements available via shared leaflets or on council etc websites. Most evidently, there is no single and clear policy in existence.

Where policies are unwritten, reliance appears to be placed on a shared understanding between those most closely involved in this work ie the crematorium staff. It is unclear whether this shared understanding always or generally extends to other involved staff eg funeral directors, hospital staff etc.

The few crematoria which stated there was no such policy, did so on the basis of there being one single policy which applied regardless of age.

The variation in whether policies exist and what those policies say or suggest, appears to be directly affecting the operational practices in crematoria.

7 Has the crematorium developed local practice designed to increase the likelihood of the recovery of remains (ashes) following the cremation of a baby?

And

8 If your answer to 7 is 'yes', briefly describe the technique adopted by the crematorium

Yes	No
24	3

Main methods specifically mentioned by the 24:

Method	Number Using
Baby Tray (usually plus manual monitoring)	16
Infant setting on cremator:	9
Placement in Cremator (behind door)	7
Overnight / residual heat cremation	4

Analysis: There is some blurring of responses from questions 5 to 8 (and indeed 9), most likely due to the lack of clear distinction in both questions and answers between formal cremation authority policy; representative body policy; operational / industry instructions; local crematorium policy and unwritten / informal policy and practice.

The vast majority of crematoria all appear to have some kind of practice in place to increase the likelihood of ashes retrieval, usually a combination of different approaches. The three who do not (under Aberdeen City Council and Glasgow City Council) either say they are awaiting outcomes of Commission / SG or offer no additional comment (which the question allows them to do).

9 Has the crematorium adopted national policy and guidance issued by an organisation?

Yes	No
22	5

Organisations specifically mentioned	By number of crematoria
FBCA	17
ICCM	14
ICCM/Sands	1
IPPC	1

Analysis: The five crematoria who answered 'no' are all privately or jointly run, but stated they have their own policies in place in earlier questions.

As might be expected, most are following a combination of FBCA and ICCM guidance.

In responses to this question, and to earlier questions, there is reference to earlier and then subsequent versions of guidance. Whilst nothing explicitly suggests that any crematorium is using out of date guidance, referring to eg '1992 plus subsequent updates' suggests there might be some different versions of guidance retained and/or available and which need to be standardised.

One crematorium's response of 'Yes' and 'IPPC' is unclear, but presumably relates to international pollution control directives. It is possible they misinterpreted the question.

10 Does your crematorium differentiate between 'ashes' and 'cremated remains'?

Yes	No
21	6

Analysis: A notable feature of responses to this question WAs the general lack of supplementary comment alongside the yes or no response, with 17 crematoria offering no additional detail and of the 6 that did, 4 offered only very limited comments mainly to reference the FBCA's guidance on this topic. It is understandable, however, that there may be some caution around this point given the different policies from ICCM and FBCA.

It's possible that the question could have been more explicitly worded, by asking a) whether they differentiated and then also b) how they differentiated. Only Co-Op Funeralcare and Westerleigh Group have gone so far as to provide an answer to this second question, describing a process where an individual assessment is made as to whether it is cremated remains or eg coffin ash that is leftover from the cremation process.

Even here, though, it is unclear whether this assessment then directly affects what is offered or not to the bereaved parents by the funeral director (Co-Op response) or by the crematorium (Westerleigh response).

Follow up on this question may be required if further clarification is considered necessary.

11 Who does your crematorium take signed instructions from in relation to the disposal of remains (ashes) in cases of:

a. Private individual cremation of a stillborn baby or infant
b. Private individual cremation of a fetus
c. Hospital arranged cremation of a stillborn baby or infant
d. Hospital arranged individual or communal cremation of fetuses

Analysis: This question implicitly recognises that the current statutory Form A can currently be signed by anyone (although their relationship to the deceased does require to be set down in the form).

Whilst this question was therefore effectively asking 'whose signature do you accept on Form A?', this was unclear to at least some of the respondents. Several, for example, replied that they accepted instructions from the applicant.

Only Glasgow City Council (Linn and Daldowie crematoria) explicitly stated that they used to accept signed instructions on the form from parties other than the parents but that this is no longer the case.

Follow up on this question may be required if further clarification is considered necessary.

12 Does your crematorium have a system during the application for cremation for recording the intended destination of remains (ashes)?

If your answer is yes, does that system differ according to whether a fetus, baby or infant is involved and how long has the system been in place?

System for recording the destination of cremated remains / ashes?

Yes	No	Unclear
26	0	1

Does system differ depending on whether fetus, baby or infant involved?

Yes	No	Unclear
4	18	5

Analysis: Whether explicitly stated or implied via additional comments, the system of recording appears mainly to relate to the statutory Form A 'Application for Cremation', which has a section where whoever fills in the form has to state which of 3 options will be used in respect of the ashes.

In summary the options are: collect in 1 month, disperse in garden of remembrance or disperse after 1 month if no other instruction received. This Form, however, only formally applies to neo-natal infant deaths.

Although there is no equivalent Form A for pre-24 week fetuses or an equivalent ashes section on the current Stillbirth form, the 18 crematoria who answered 'No' suggests that the majority of crematoria are applying the same principles regardless, although one or two noted that these principles cannot be applied in the case of collective cremations, as collective ashes/remains cannot be separated and therefore cannot be returned or collected by particular families.

Where the question was answered, the recording of destinations during the application process, regardless of whether fetus, baby or older infant has been in place for years if not decades.

Note: The 1 unclear reply was from a private crematorium, which appears to have misunderstood the question.

13 Does your crematorium have a system for recording the ultimate destination of remains (ashes) after cremation? If your answer is yes, does the system differ according to whether a fetus, baby or infant is involved and how long has the system been in place?

System for recording the ultimate destination of cremated remains / ashes?

Yes	No	Unclear
26	0	1

Does system differ depending on whether fetus, baby or infant involved?

Yes	No	Unclear
9	12	6

Analysis: All crematoria appear to have a system of recording the ultimate destination of ashes, although a few noted that they would clearly not know where the ashes ultimately ended up after they were collected by family.

What they record, however, is unclear from their responses although presumably it is linked to same available options as are contained on the application Form A.

Six crematoria noted specifically that they had separate registers for pre-24 week cremations, other responses did not clearly address this point, or did not address it all. Follow-up on this point may be required.

Where crematoria stated how long the system had been in place, the general recording system dated back decades or from opening: separate registers for fetal cremations are, however, more recent.

Note: The unclear response is a continuing misunderstanding from a private crematorium.

14 Does your crematorium have a system for notifying families of the ultimate destination of remains (ashes) after cremation? If your answer is yes, does the system differ according to whether a fetus, baby or infant is involved and how long has the system been in place?

System for recording the ultimate destination of cremated remains / ashes?

Yes	No	Unclear
5	18	4

Does system differ depending on whether fetus, baby or infant involved?

Yes	No	Unclear
2	4	21

Analysis: All figures above should be treated with caution as there is doubt as to whether the question was understood.

In essence, this question was asking 'Do you notify or confirm to the family what you have done with the ashes, if they haven't already collected them?'

Many instead simply responded that their actions would be carried out in accordance with Form A instructions, which suggests this aspect of providing subsequent confirmation does not appear to have been generally understood. Where it was understood, respondents said there was no such notification or confirmation provided.

Very few respondents made any reference to the question of whether procedures differed depending on whether the cremation was for a fetus, stillbirth or neo-natal/older infant.

15,16,17a Please provide the numbers of cremations, recovered ashes and collected ashes for individual cremations of fetuses

Year	Total Cremations	Ashes Recovered	Ashes Collected
2010	887	80	50
2011	714	140	58
2012	748	191	89

Where individual cremation of fetuses took place, the percentage of cases where ashes were recovered was:

	% Ashes recovered
2010	9.0%
2011	19.5%
2012	25.5%

Where individual cremation of fetuses took place and ashes were recovered, the percentage of cases where ashes were collected was:

	% Ashes Collected
2010	62.5%
2011	41.5%
2012	46.5%

Analysis: According to these figures, over the three years there were 214 instances of fetal cremations where the remains would have been scattered or interred by Scottish crematoria. As the statutory Form A 'application for cremation' is not a legal requirement for the cremation of pre 24 week pregnancy losses, it would presumably be a matter of local or industry policy as to whether and/or how parents were informed of the likelihood and availability of ashes for collection.

15,16,17b Please provide the numbers of cremations and recovered ashes for collective / communal cremations of fetuses

Year	Total Cremations	Ashes Recovered
2010	116	38
2011	118	43
2012	149	72

Where communal / collective cremation of fetuses took place, the percentage of cases where ashes were recovered was:

	% Ashes recovered
2010	32%
2011	36.5%
2012	48%

Note 1: total cremations not total number of fetuses
Note 2: as remains are not individual, collection by families is not possible

15,16,17c Please provide the numbers of cremations and recovered ashes for stillbirths

Year	Total Cremations	Ashes Recovered	Ashes Collected
2010	89	68	49
2011	103	88	77
2012	89	81	62

Where the cremation of stillbirths took place, the percentage of cases where ashes were recovered was:

	% Ashes recovered
2010	76.5%
2011	85.5%
2012	91.0%

Where ashes were recovered, the percentage subsequently collected from the crematorium was:

	% Ashes Collected
2010	72.0%
2011	87.5%
2012	76.5%

Analysis: According to these figures, there were 49 instances where ashes were recovered but not collected from Scottish crematoria over the three years. Whilst there is a statutory cremation form for stillbirths, it is basic and does not include any section on options in relation to any ashes retrieved from the cremation process. As with pre 24 week cremations, options would appear to be dependent on local or industry policy and guidance.

15,16,17d Please provide the numbers of cremations and recovered ashes for infants up to 2 years of age

Year	Total Cremations	Ashes Recovered	Ashes Collected
2010	61	55	49
2011	58	49	45
2012	59	51	45

Where the cremation of infants up to 2 years took place, the percentage of cases where ashes were recovered was:

	% Ashes recovered
2010	90.0%
2011	84.5%
2012	86.5%

Where ashes were recovered, the percentage subsequently collected from the crematorium was:

	% Ashes Collected
2010	89.0%
2011	92.0%
2012	88.0%

Analysis: According to these figures, there were 16 instances over the three years where ashes were available, but not collected. Statutory Form A would apply in these cases, which asks 'the applicant' (who need not necessarily be a parent or relative) to indicate which of 3 options they wish.

18 Does the crematorium charge a fee for:
a) individual cremations of fetuses
b) communal / collective cremations of fetuses
c) cremations of stillborn babies
d) cremations of infants

Analysis: responses to this question confirm that most crematoria are generally charging nothing or very little for these cremations. Although most put a zero against the communal / collective cremations of fetuses, this may either be because they are not yet offering this service or chose not to specify the charges they may have negotiated with NHS boards for this service. Follow up on this point with Health Boards may be something for the Commission to consider.

There is some slight tendency to charge more depending on the age of the infant eg no charge up to one or two years, but with an applicable charge after that up to age five or seven. This, however, is only the stated practice in two or three crematoria.

19 Has the crematorium provided a dedicated 'Children's Area/Garden' within the garden of remembrance at the crematorium?

If yes, does the crematorium provide memorial options for bereaved parents within the children's area/garden?

Yes	No
15	12

Analysis: Just over half of the crematoria state they have a dedicated children's area within their garden of remembrance, and some of those who don't state that plans for this are in progress or that other alternatives are available eg a Babies Book of Remembrance or an annual memorial service.

20 Is there significant variation in the nature (i.e. materials used in the construction) and dimensions of the container used for the cremation of fetuses and babies? Please provide details.

Yes	No
20	7

Analysis: Most noted that dimensions varied depending on the age of the infant, and materials include wood, cardboard, waxed cardboard and MDF. Cotton wool and plastics are also mentioned.

Where crematoria said there was no variation, this was usually caveated with additional comments eg no variation for individual cremations, but that arrangements for collective cremations involved variation.