Report of the Infant Cremation Commission

Section 5 - Cremation in Scotland

5.1 The Commission's remit relates to "babies and infants". That terminology was used to enable the Commission to address all cases where it could be suggested that there might be no ashes following cremation, and has been interpreted by the Commission as covering any pregnancy loss prior to the 24^th week of gestation, stillborn children and infants up to about 2 years of age. Pregnancy losses will generally be referred to within this Report as "non-viable babies".

5.2 Cremation of deceased persons has been undertaken in Scotland since the late 19^th century^[10] .The Cremation Acts 1902 and 1952, and the Cremation (Scotland) Regulations 1935 (the 1935 Regulations), amended by later Regulations, most recently by the Cremation (Scotland) Amendment Regulations 2003, apply to this day^[11]. The long title of the Cremation Act 1902 is "An Act for the regulation of the burning of Human Remains, and to enable Burial Authorities to establish Crematoria". In section 2 of that Act "crematorium" is defined as "any building fitted with appliances for the purpose of burning human remains, and shall include everything incidental or ancillary thereto"^[12].

5.3 Specific provision for cremation of stillborn children was made by Regulation 16 of the 1935 Regulations, subsequently amended by the Cremation (Scotland) Amendment Regulations 1967^[13]. A stillborn child is defined by the Registration of Births, Stillbirths, Deaths and Marriages (Prescription of Forms) (Scotland) Regulations 1997, Regulation 2(1), as "a child which has issued forth from its mother after the twenty‑fourth week of pregnancy and which did not at any time after being completely expelled from its mother breathe or show any other signs of life"^[14].

5.4 There is no legislative provision relating to the cremation of a non-viable baby. Nevertheless, non-viable babies have been cremated throughout the United Kingdom for in excess of 30 years. That cremation may be individual or collective, that is shared with other non-viable babies. The Commission generally refer to the latter as "shared cremations" or "cremations along with others".

5.5 There are 27 crematoria in Scotland. The operator of a crematorium is the "Cremation Authority", defined in the introduction to the 1935 Regulations as "any burial authority or company or person by whom a crematorium has been established". In the case of 14 crematoria the Cremation Authority is the local council; in the case of the other 13 the Cremation Authority is a private company. All cremate adults, infants and stillborn babies. There is also provision for individual cremation of a non-viable baby at all 27 crematoria. At 9 of those 27 a non-viable baby may additionally be cremated along with others in a shared cremation arranged by the hospital (see Annex O). All Cremation Authorities but one are members of the UK-wide Federation of Burial and Cremation Authorities (FBCA). Thirteen are full corporate members of the Institute of Cemetery and Crematorium Management (ICCM). So some are members of both and one is a member of neither. There are also full individual professional members of the ICCM at 17 crematoria. Both organisations provide Guidance for crematoria and their staff, as well as Funeral Directors and the wider public.

5.6 Whilst there are two other cremation organisations in the UK and Scotland which can claim to play some part in representing those involved in cremation, namely the Cremation Society of Great Britain and the Association of Private Crematoria and Cemeteries (APCC), the FBCA and the ICCM are the principal representative bodies, given the extent of their collective policy and practice reach in Scottish crematoria. Both the FBCA and ICCM play a role in maintaining standards at crematoria throughout the United Kingdom. The FBCA arranges what are described as "critical friend" audit visits to a number of crematoria in the UK each year. These visits are made by 2 Technical Officers and the President of the FBCA, and may be attended by Scottish Government officials acting as independent observers. Crematoria which have adopted the ICCM Charter for the Bereaved^[15] complete an annual self‑assessment questionnaire that is submitted to the Institute. A gold, silver or bronze award is made to the crematorium by the Institute depending upon the score achieved. Each year, 5% of the self‑assessment questionnaires returned are verified by ICCM staff in the course of a full day visit to the crematorium which includes, where appropriate, the development of an improvement plan. The self‑assessment questionnaire is reviewed regularly and additional or revised questions added as appropriate. Neither the FBCA nor the ICCM scheme currently addresses specifically the conduct of baby cremations. The Commission think that they should.

5.7 Of the circa 55,000 deaths in Scotland each year, approximately two‑thirds of funerals involve cremation. This proportion is, however, much lower in the case of stillbirth and infant death up to 2 years of age. For example, in the years 2010, 2011 and 2012 there were 291, 299 and 274 stillbirths recorded^[16] of whom approximately one‑third were cremated whilst the others were buried. In the same years 218, 238 and 217 infants died between birth and their first birthday, and 13, 21 and 17 died between their first and second birthdays^[17]. Of these, approximately one quarter were cremated whilst the others were buried. The preference for burial cannot be explained by cost. Most funeral undertakers and Cremation Authorities do not charge for their services in the burial and cremation of children, in many instances up to the age of 18. It is likely that it is simply the result of social attitudes and practices. If anything, burial is more expensive since a lair in which to lay the baby to rest may have to be purchased^[18].

5.8 The position in regard to non‑viable babies is much less clear. Such figures as are available do not enable the ratio of cremations to pregnancy loss through termination and miscarriage to be calculated with any degree of accuracy. The figures also largely pre‑date new Guidance issued by the Chief Medical Officer and the Chief Nursing Officer for Scotland (CMO and CNO Guidance) in 2012^[19], which gave Health Boards twelve months to implement a new minimum standard of shared cremation for all non-viable babies. That Guidance was issued too late to have any impact on the statistics for the three years for which information was gathered by the Commission.

5.9 In the years 2010, 2011 and 2012 there were in Scotland 12,939, 12,554 and 12,447 terminations of pregnancy^[20]. Whilst the total number of miscarriages cannot be accurately recorded, it is currently estimated that about one in 5 pregnancies end in miscarriage across the UK as a whole^[21], which would suggest that there may be approximately 13,500 miscarriages in Scotland each year, not dissimilar to the number of terminations each year. NHS Scotland records show that between 5000 and 6000 miscarriages per annum are dealt with in hospitals.

5.10 The available statistics indicate a recent rise in the number of cremations of babies. In those figures from 2010, 2011 and 2012 there were 887, 714 and 748 individual cremations of non-viable babies and 116, 118 and 149 shared cremations of non-viable babies^[22]. The number of shared cremations refers to the cremation itself, rather than the number of non-viable babies cremated together. The FBCA compiles an annual statistical review which indicates that in 2012 there were 4000 cremations of non-viable babies. However there is some uncertainty as to the reliability of this number, as crematoria may have interpreted the question differently, some returning the number of cremations and others the numbers of babies. The FBCA figure of 6824 cremated non-viable babies in 2013 is considered more accurate. Of note is the fact that Craigton Crematorium in Glasgow appears to conduct the largest percentage of cremations of non-viable babies: 3088 in 2012 and 3542 in 2013. This overall rise in numbers, particularly from 2012 to 2013, may reflect an increase in shared cremations in general from about the end of 2012 following phasing in of the new CMO and CNO Guidance.

5.11 At the start of their work the Commission invited every Cremation Authority to provide information in response to a series of questions. All responded. Questions 15,16,17 and 17a related to the numbers of cremations of babies and infants and the recovery and collection of ashes. The responses^[23] show a wide variation in practice from recovery of ashes in every case at some crematoria handling fairly small numbers of baby cremations, to zero recovery in Mortonhall (Edinburgh), Hazlehead (Aberdeen) and Fife (Dunfermline and Kirkcaldy) and, in between, some where ashes were recovered on occasions in individual cremations but not at all in shared cremations.