Report of the Infant Cremation Commission

Section 8 - Securing The Recovery of Ashes

Background

8.1 Not every parent wishes to recover ashes from the cremation of their baby. However, those who do are entitled to expect that the cremation has been conducted in a way that maximises the prospects that there will be ashes which could include remains of the baby. How that can be achieved is addressed in this Section.

8.2 Until the Mortonhall Investigation and this Commission were established there was a remarkable degree of inconsistency in the recovery of ashes among the different crematoria and even at the same crematorium. The MIR highlights a difference between practice and results at Mortonhall as contrasted with those at Seafield (Edinburgh) and Warriston (Edinburgh)^[44]. It also appears that ashes were recovered and given to families following cremation of stillborn and deceased babies at Mortonhall in the early 1990s^[45]. At Hazlehead (Aberdeen) ashes were regularly recovered in the 1980s but in the 6 years or so prior to the establishment of the Commission none were recovered from 40 deceased babies of less than 18 months. Notice was given to families that there would be no ashes in such cases. The Aberdeen City Council audit covered the period 1984 and 1985. All the cases identified involved stillborn babies or babies who died shortly after birth and in some cases a matter of months after birth. That contrasted markedly with the period of over 5 years between 1 April 2007 and 31 December 2012 during which period no ashes were recovered in any of the forty cases of children dying between birth and the age of 2 years. Details of baby and infant cremations throughout Scotland between 2010 and 2012 and the extent to which ashes were recovered can be found at Annex Q.

8.3 The random nature of this inconsistency in the recovery of ashes from crematorium to crematorium was particularly highlighted by one submission to the Commission recounting how the support and guidance of Aberdeen SANDS (Aberdeen Stillbirth and Neonatal Deaths Society) made the family aware of a crematorium where they would get ashes and how the proposed cremation at Hazlehead was moved to that crematorium and ashes were returned from the crematorium by the funeral director to the family.

8.4 Against that background it was reassuring for the Commission to learn in January of this year that, following a visit by Aberdeen staff to Seafield Crematorium (Edinburgh), baby cremations including cremations of non-viable babies are now conducted at Hazlehead in a way that results in the recovery of ashes, including the use of a tray to retain the ashes. Families are advised to present their baby in a wooden casket or coffin. Ashes are now recovered and given to families at Mortonhall in the case of non- viable babies as well as stillborn babies and infants^[46] . It has been encouraging to note these improvements occurring as the work of the Commission has progressed.

8.5 A further development occurred on 27 May 2014, when Glasgow City Council announced that it would, with immediate effect, cease to apply the restricted definition of ashes as "the skeletal remains recovered following cremation" and would instead use the "broad interpretation" of ashes which was proposed by Dame Elish Angiolini in the MIR, and which is discussed and recommended in the preceding Section of this Report. The Council now considers that it is very likely that the broad interpretation will see ashes recovered in the vast majority of cases. The Council has also notified Funeral Directors in the city and NHS Greater Glasgow and Clyde of the change, to ensure that the bereaved parents are given accurate information.

8.6 The recovery of ashes in baby and infant cremations is a challenging process due to the limited quantity and the nature of the human material placed in the cremator. The problems are clearly explained in 8.2.1 of the expert report of Dr Roberts where, relying on the expert report of Dr Chamberlain, she says this:

"The aspects of cremation which are most detrimental to fetal and infant remains appear to be the jets of air introduced into the cremation chamber and direct heat in excess of 1000^oC from support burners. Whereas the weight of adult bones ensures that they are not carried out of the cremation chamber into the secondary combustion chamber, fetal bones are much lighter and so they may be carried through…so if fetal remains have been blown into the [secondary] combustion chamber then they will not be retrievable. Clearly a less vigorous method of cremation would be of benefit when dealing with fetal remains. Lower temperatures of around 600/700^oC are recommended."

8.7 There are basically three ways of conducting the cremation of a baby or infant: i) in a full-scale cremator in the course of a normal working day, with the operating conditions modified by use of the infant cremation setting or programme; ii) in a full-scale cremator overnight with the control system switched off; and iii) in a small-scale or "infant" cremator. The Commission address each in turn.

Full-scale Cremator on Infant Setting

8.8 Dr Chamberlain describes the position, so far as operating a modern cremator which is compliant with the 2012 Regulations, as follows:

"Such cremators can be controlled minutely (manually, automatically or a combination of both) to achieve the special conditions needed for infant cremation. The secondary chamber and abatement equipment can operate in conformance. The conditions of operation of the primary combustion (cremation) chamber can be said to deliver cremated remains which can be recovered. Usually, the remains for cremation will be inserted at primary chamber temperatures (but not the secondary chamber) significantly lower than for a full-size cremation."

The majority of baby and infant cremations are currently conducted in this way.

8.9 In her report, Dr Roberts refers to recommendations that no forced air should be turned on^[47] and that the coffin should be placed on a pre‑heated surface in a corrugated metal tray with sides. Dr Roberts continues:

"Recovery of fetal and infant ashes is closely linked to the issue of how the remains are contained during cremation. Clearly there is going to be a better chance of recovering all the small bones if they are kept together in a small metal tray which restricts dispersal during cremation. The other area of concern is how the ashes are removed once the cremation is complete…Usual practice is for the ashes to be raked out of the cremation chamber…A better means of recovery of fetal and infant remains would be to lift them out on a small tray once it has cooled down and then retrieve the bones by hand."

The Techniques Applied

8.10 These comments by Dr Roberts reflect what happens in practice. A number of techniques are employed in infant cremations to try to maximise the prospects of recovering ashes. What technique or combination of techniques is used varies from crematorium to crematorium. The cremator manufacturer's operational manual generally includes guidance and instruction on best practice in the use of the infant setting. The infant setting on the cremator control software programme should generally result in less frequent ignition of the cremator burner and injection of air in the main chamber of the cremator, and so control the process as to reduce turbulence and temperature within the chamber, making the process more gentle. The cremator technician monitors the progress of the cremation on a computer screen. The activity within the main chamber can also be viewed through a spy hole. In light of the information obtained from either or both sources the technician may manually override the infant setting as considered appropriate to exert greater control over the cremation process with a view to further increasing the prospect of recovering ashes which include baby remains. Placing the coffin towards the front of the cremator and thus some distance removed from the direct impact of the burner is a further technique employed.

8.11 The technique now widely used of placing the coffin in a metal tray with raised sides and ends is controversial. It is done with a view to containing the resultant ash and preventing its being spread throughout the cremator by turbulence. In addition the upright end of the tray nearest the burner further deflects the impact of the burner from the baby. The very small quantity of ashes left after cremation of the tiniest babies may not be recoverable by raking from the hearth of the cremator^[48]; on the other hand, all the ashes contained in a tray can be gently brushed from the tray and carefully preserved.

8.12 To date, some Cremation Authorities have ruled out the use of trays on health and safety grounds. The concern is that the temperature of the tray combined with the manual handling involved in removing it from the cremator gives rise to the risk of the cremation technician or anyone passing through the cremator room during that handling process being at risk of sustaining a burn injury through contact with the tray. There is also concern about the risk of sustaining a burn injury while the hot tray is resting on the cremator charger or a shelf to cool. Other Cremation Authorities are satisfied, following risk assessment, that they have adequate safeguards in place to permit a tray to be used safely. Trays have been in use since at least the mid-1980s and their use has been commended in published articles^[49]. These articles illustrate different forms of tray designed to achieve the same objective.

8.13 It is beyond the scope of the work of the Commission to address the merits of the decisions made about the use of trays at different crematoria. The Commission acknowledge that, since the hearth of a cremator is generally flat, ashes can be recovered without the use of a tray where the hearth is in excellent condition^[50]. However, that experience is far from universal, especially in the case of the smallest babies. What is important is to note that the use of trays is widely regarded as increasing the prospects of the recovery of ashes in baby and infant cremations. In view of the experience of the successful use of trays to ensure the recovery of ashes at many crematoria^[51], the Commission envisage that those crematoria which have decided against the use of trays wholly or mainly on health and safety grounds will wish to revisit the question of whether an adequately safe system for use of trays can be devised. Both Hazlehead and Mortonhall, where the use of trays was previously rejected on health and safety grounds, now use them in accordance with clearly documented safe working practices and recover ashes where previously they did not.

8.14 The Commission recommend that Cremation Authorities where trays are not currently used and ashes are not routinely recovered in baby and infant cremations should urgently consider whether trays can be introduced in a way which will ensure that no‑one is exposed to undue risk. Good practice requires that a detailed risk assessment is an essential preparation before any working procedure is implemented. The MIR records the view of the Health and Safety Executive that crematoria are "low risk undertakings". It is content for local authorities to look after the health and safety aspects of their operation^[52]. The equipment available to reduce the risk includes gloves which give full protection to hands and forearms, a fitment on the long handled cremator rake to enable the tray to be pushed into the cremator, a similar fitment for pulling it partially from the cremator to avoid exposure of the technician to the heat of the cremator, and automatic chargers. Arrangements within the cremator room can also be devised to delineate no‑go areas adjacent to the cooling tray. The tray may also be cooled in an adjacent unused cremator.

Overnight Cremation

8.15 At some crematoria the practice is followed of placing the infant coffin in the cremator after it has been turned off^[53] at the end of the day, when the residual heat within the chamber is sufficient for an infant cremation. The cremation process proceeds unattended overnight, and is concluded as usual when the flame goes out. The passage of time until the following morning cools the tray to some extent, thus reducing the health and safety risk. However, even then the tray remains extremely hot and capable of causing injury until further cooled following removal. As matters stand, as explained in paragraph 6.15 it is likely that following this procedure breaches conditions of the crematorium operating permit.

8.16 When the MIR was published the Commission decided to explore further with Dr Chamberlain his proposals for research and development. That led to discussions between Dr Chamberlain and SEPA, principally about the design and operation of small-scale cremators and the circumstances in which it might be possible for overnight cremation to be permitted. Since in the opinion of Dr Chamberlain that practice has no material adverse impact on the environment, the question arises whether SEPA should be invited to amend crematorium operating permits.

8.17 The most common reason for Cremation Authorities resorting to the practice of overnight cremation is to maximise the prospects of recovering ashes. Dr Chamberlain states the position as follows:

"The most common reason for full size cremators not achieving compliance with the current requirements for infant and fetal remains is an inability to regulate the cremation conditions in the primary chamber such that cremated remains are not transported out of the primary chamber into the secondary zones and abatement.

As a result, the simplest solution is to cremate these subjects 'overnight' after the cremator has been turned off.

The Cremation Industry has used overnight cremation for many years to try to deal with the need to have recoverable remains from infant cremation. This practice entails shutting down the burners and air supplies to the cremator at the end of the normal working day and, after allowing the cremation chamber to cool to say 700^oC, to insert the infant cremation thus enabling it to proceed slowly in quiescent conditions. Whilst this method often enables cremated remains to be recovered, it does not comply with Clause 5.29 of PG 5/2(12).

The recent and heightened concerns to do with infant cremation, and especially in Scotland, entail a demand for recoverable remains from cremation which must be met. After several discussions, it is appropriate to include the position of SEPA on derogation to do with single 'overnight cremations:

'The UK BAT Guidance as outlined and developed collaboratively with the sector group which is made up of regulators. operators, manufacturers and their representatives have not considered this option as it is currently outwith the regulatory options for the sector - as we don't know the combustion conditions within the cremator we can't comment on the likely emissions or their likely impacts however from discussions it appears that charging occurs during cooling with consequent lowered temperatures which would lead to limited thermal destruction of pollutants coupled to low efflux velocities.

Derogation is from the Industrial Emissions Directive, when transposed into MS relevant regulations it allows particular emission limit values to be broached by an agreed amount for a set period of time - as we don't know of the combustion conditions we would not be able to set relevant ELV^[54]'s in this manner. The PPC regs don't allow for "derogation" per se so SEPA would need to take a universal decision on regulation for the sector which would not be based on BAT and which could be challenged by "interested parties"'."^[55]

8.18 Dr Chamberlain also believes that it should be possible to prove that the practice is not harmful to the environment or alternatively devise a suitable set of procedures and BAT guidelines upon which reliance can be placed, by carrying out research. The key consideration, which is referred to below in connection with small-scale cremators, is that the amount / mass / weight of cremation material is so small that there is no significant environmental impact, especially if a maximum charge weight were to be specified.

8.19 However, that question only arises if the practice of overnight cremation of babies and infants meets with public approval. The Commission considered whether there is any reason to doubt that overnight cremation is an appropriate procedure. The coffin is charged in the usual way and ignites on the strength of the residual heat within the primary chamber at the end of the working day. Closing down the operating systems of the cremator does not affect the progress of the cremation. In the opinion of Dr Chamberlain the process is altogether more gentle than the usual daytime cremation in a full-scale cremator because the cremator chamber temperature is lower and there is no prospect of turbulence from either the burners of the air-jets, with the result that the prospect of the recovery of ashes which include residual elements of the baby are enhanced. The baby is cremated in exactly the same place and by effectively the same procedure as during the working day. The ashes are then dealt with as in any other baby cremation. The Commission consider that the overnight procedure just outlined is an appropriate way to conduct a baby cremation which increases the likelihood of recovering ashes and hence aims to achieve the result that parents' wish, subject to the important requirement that it should be done in the knowledge, and with the approval, of the applicant / parents.

Small‑Scale Cremators

8.20 Another method of maximising the prospects of recovering ashes is to use a small‑scale cremator, or "infant" or "fetal remains" cremator, as it is also known. In the PG Note a small‑scale cremator is defined as a cremator with a maximum door opening of 300 mm × 300 mm and a maximum length of primary chamber of 1000 mm. Not all the standards required and set for full‑scale cremators are appropriate for small‑scale cremators because of the relatively small mass of pollutants emitted.

8.21 Small‑scale cremators were introduced into England in the 1990s. Despite there being three manufacturers in England, only a small number were built and supplied. The research of the Commission has identified only eight crematoria, out of a total of around 245 in England and Wales, where small‑scale cremators have ever been in use, and only two where they are currently in use. There is also one currently in use in Jersey and one recently installed in Dublin.

8.22 The small‑scale cremators that have been installed in England have varied in size. Facultatieve Technologies Ltd state in their data sheet for the FT small‑scale cremator, (i) that it was developed to provide a low cost solution for the problems associated with the cremation of retained organs, glass microscope slides and fetal remains at crematoria and (ii) that it satisfies the requirement of a small‑scale cremator as set down in PG Note 5/2(04), now 5/2(12)^[56]. Three sizes are specified, with the largest having a chamber 400 mm deep, 235 mm high, and 196 mmm wide. The heat source is electricity. Each of the three requires to be connected to the secondary combustion zone of a full sized cremator to satisfy the requirements of the PG Note.

8.23 The small size of these cremators means that they are used only infrequently for pregnancy losses which are presented in a container small enough to fit the small chamber. Jersey have had theirs since 2004. It is used less than once a month. The one installed at Sittingbourne was purchased in 2003 along with a full size cremator. The small‑scale cremator was never used since cremations there have always involved caskets which are too big for the cremator. A third FT small‑scale cremator was installed at Derby (Markeaton) from 2001 to 2013. It was used only occasionally for a cremation of body parts remaining after a post‑mortem. It was too small for non-viable baby or infant remains. It was removed in 2013 when abatement plant was being installed.

8.24 Furnace Construction Ltd is the manufacturer and supplier of the reconditioned small‑scale cremator which has recently been installed at Mortonhall Crematorium. It is known as a "Cherub" cremator, and is designed for non-viable baby remains or a small coffin containing a stillborn child. It was previously installed at Chester Crematorium from which it was removed when they installed new full‑scale cremators with infant computer software settings. It has the maximum door opening of 300 mm x 300 mm, and a maximum chamber length of 1000 mm, and operates on both gas and electricity. It has a small secondary combustion chamber. A small‑scale cremator built by Furnace Construction was also installed at Birkenhead, but did not work satisfactorily and was removed about 2 years ago. That is the only example of unreliability that arose in the course of the Commission's enquiries.

8.25 In contrast to the foregoing, the only other Furnace Construction small‑scale cremator located by the Commission at Manchester (Chorlton‑cum‑Hardy) is a success story. It remains in regular use, usually on two successive days per month, and is perceived as efficient and cost‑effective. Manchester Crematorium has contracts with local hospitals to cremate pregnancy losses once per month. Each is cremated individually. The container is placed upon a specially devised tray which is cooled after cremation and from which the whole remains from the cremation are collected. The cremation chamber is 656 mm deep and the entrance to the chamber is 300 mm high and 295 mm wide. Each month, on the day before the cremation is undertaken, a communal cremation service is held for all to be cremated in the course of the following two days.

8.26 These arrangements are fairly similar to those at South West Middlesex where the small‑scale cremator was made and installed by J G Shelton & Co Ltd. South West Middlesex also has contractual arrangements with local hospitals and holds a monthly cremation service for those about to be cremated. The small‑scale cremator is, as in the case of the FT models, connected to the secondary combustion zone of a full‑scale cremator. The small‑scale cremator can take a container up to 534mm in length, 280mm in width and height. Larger containers are cremated in a full‑scale cremator on the hearth near the opening to the primary chamber, ie in a fashion similar to that discussed above.

8.27 A J G Shelton small‑scale cremator was also installed at Brighton but has since been decommissioned. The Commission's understanding is that it was used for the cremation of both non‑viable babies and stillborn babies. A third Shelton small‑scale cremator has recently been installed in Dublin.

8.28 The final small‑scale cremator in England located by the Commission was at Gateshead and was a TABO cremator. DM TABO Ltd was taken over by Evans Universal, which is now part of the Facultatieve Technologies Group. It was removed in the course of 2013.

8.29 Discussions with representatives of the various Cremation Authorities, which had small‑scale cremators but discontinued their use, indicated that the reasons for doing so were generally lack of financial viability because of their limited capabilities, the need to achieve financial efficiencies to help fund the installation of abatement plant, and the need to find additional space for the installation of that plant.

8.30 Small-scale cremators are of two designs. They are either provided with a connection to the secondary combustion zone of a full-scale cremator or they are built and installed as stand-alone small-scale cremators. It is plain from discussions between Dr Chamberlain and SEPA that further research is required into the potential for development of both types of installation. Dr Chamberlain is satisfied that the former type is viable in the sense that it is compliant with the requirements of PG Note 5/2(12). However, he has no experience of the stand-alone design of the small-scale cremator now being installed at Mortonhall, which has been described by the manufacturer as designed "to be very much a scaled down model of the full-scale cremator, albeit with limited emission monitoring and external process control." Again there is, in the opinion of Dr Chamberlain, considerable scope for research into, and development of, a stand-alone type of small-scale cremator.

8.31 The principal advantage of an infant cremator is that turbulence within the cremating chamber is reduced to a minimum. On the other hand, because the dimensions of the entry to the small‑scale cremator must not exceed 300 mm × 300 mm and the length of the chamber must not exceed 1000 mm, their use is largely restricted to non‑viable babies. Despite these limitations, those crematoria where infant cremators are currently employed have been generally satisfied with their operation and with the apparently high level of recovery of ashes. On balance the information gathered by the Commission indicates that, in the case of non‑viable baby cremations, the prospects of recovering ashes following cremation in a small‑scale cremator are good. However that qualified conclusion is based on limited information; much greater research would be required before a conclusive recommendation could be made. It may be that weight rather than size should be the criterion determining what might be cremated in a small-scale cremator.

8.32 In recognition of the possibility that there may be no ashes recovered, at some crematoria, such as South West Middlesex, a ceramic disc or other item which will survive the cremation is placed on the coffin or other container and is available either with ashes, or in the event of there being none, as a memento or memorial of the baby cremated^[57].

Expert Proposals in Mortonhall Investigation Report

8.33 In his initial report Dr Chamberlain stated that there has been "little development attention paid to how full‑size cremators operate with infant cremations and that, if there are to be successful infant cremations (ie with recoverable remains), changes are necessary". He noted that there are cremation practitioners who assert that there cannot be retrievable remains from infant cremations. That view must of course be read subject to the opinion of Dr Roberts to the effect that remains or ashes can be recovered from baby cremations. Her opinion is supported by the evidence she refers to and by the evidence from the returns made to the Commission's crematoria questionnaire showing the recovery of ashes in an increasing number of cases of cremations of non‑viable babies in 2010 (80), 2011 (140) and 2012 (191).

8.34 Dr Chamberlain made two suggestions which should be followed up. The first is to devise procedures using the existing stock of cremators to deliver slow gentle cremation of infant remains. He points to practices at Seafield (Edinburgh) as an example but adds that, for such procedures to become accepted throughout the industry, they must be established in a number of cremator types and at a number of Cremation Authorities and be acceptable to Cremation Authorities. He makes the particular point that, positioning the remains to be cremated away from the support burner and keeping the primary cremation chamber temperatures low (typically 600^o‑700^oC), would create the best conditions for quiescence. Dr Chamberlain's second suggestion is to design alternative cremators specifically for infant cremation.

8.35 The Commission are satisfied that there is now general awareness among Cremation Authorities in Scotland of techniques that may be employed to create conditions within a full‑scale cremator that enhance the prospects of recovering ashes, which include remains of the baby, from the earliest possible stage in a baby's development. Dr Chamberlain further suggests that, for such techniques to become accepted in the cremation industry, they must be established on a number of cremator types and be acceptable to Cremation Authorities. In light of the information conveyed to them by Lord Bonomy following visits to various crematoria and his attendance at a meeting of Scottish members of the FBCA and ICCM at which this particular issue was discussed, the Commission are confident that efforts are already being made at many crematoria in Scotland to maximise the ashes recovered. The steps being taken are illustrated at paragraph 8.4 above. Such developments are welcomed by the Commission. They are indicative of a willingness among cremation authorities to compare practices and experience. However, more must be done.

8.36 Following upon Dr Chamberlain's first suggestion, the Commission recommend that the FBCA and ICCM should form a joint working group, which should also include two laypersons nominated by the Scottish Government and a representative from a cremator manufacturer, to consider the various practices and techniques currently employed in baby and infant cremation in full-scale cremators with a view to identifying those practices which best promote the prospect of recovery of ashes inclusive of baby remains and compiling guidance for cremator operators. The working group should identify aspects of the cremation process which could conceivably be changed or improved and into which research ought to be commissioned by the Scottish Government.

8.37 The first suggestion has now been supplemented by Dr Chamberlain, following his discussions with SEPA referred to above, to include research to establish whether overnight cremation can be conducted in a way that is compliant with the regulatory framework or in a way that merits granting a permit in which the application of certain conditions is waived.

8.38 In matters of environmental protection for which SEPA is responsible and which are the subject of a PG Note and the application of Best Available Techniques (BAT), it is for the "obligated sector" - in this instance the cremation industry - to provide access to and information on installations which the sector consider would constitute BAT for the particular activity to which the PG Note applies. SEPA advises that that has not so far been done in the case of overnight cremation or small-scale cremators^[58]. They also advise that discussions are ongoing with Mortonhall about the terms of their crematorium operating permit.

8.39 In light of the foregoing the Commission recommend that the remit of the working group should include specific reference to overnight cremation and the question whether it can be carried out with the operating and monitoring equipment switched off in a way that will cause no material environmental damage and satisfy SEPA, through their participation in this work, that it should be permitted. The Commission hope that this will be dealt with as a matter of urgency and that existing practices can continue meanwhile.

8.40 That same working group should also address the second suggestion made by Dr Chamberlain, that alternative infant cremator types should be designed. That suggestion is indicative of the rather mixed reviews that existing small‑scale cremators have so far enjoyed in England. Nevertheless at both Manchester and South West Middlesex they remain an integral part of the crematorium's operations and will continue to do so for the foreseeable future. In Dr Chamberlain's opinion, attentive observance of the requirements of the PG Note 5/2(12) would, in the case of a free-standing small-scale cremator, result in a rather complex installation as regards the chimney and flue system or require a secondary combustion chamber as in the one now installed at Mortonhall. As an alternative he suggests building what is effectively a small primary chamber from which the gases from combustion are fed through the secondary chamber of a full‑scale cremator. That appears to be the configuration of both the Facultatieve and Shelton small‑scale cremators currently available. A broad review of experience to date in England and Ireland in the operation of small‑scale cremators would be appropriate to assess the costs of installation and operation, to evaluate the benefits and disadvantages of using small‑scale cremators as presently defined and designed, and to consider whether research into the potential for further development of small-scale cremators, including with a larger main chamber, should be encouraged.

Cremation Authority Policy on Ashes

8.41 Since the general public expectation is that a cremation will produce ashes, it is incumbent on any Cremation Authority, where ashes may not be recovered in particular types of case, to make it clear to any person contemplating or arranging a cremation there that it is possible that ashes may not be recovered in those cases, that the position may be different at other crematoria, and that the alternative of burial is available. That information should be included in forms of application for cremation which are dealt with later in this Report. However, in addition to providing information in the form, each Cremation Authority should publish a written policy statement including that information and explaining the scattering and interment of ashes and what happens if ashes are not collected by the applicant. That policy should also indicate a commitment to the sensitive treatment of the baby throughout, to respecting the wishes of parents and families and a commitment to the sensitive handling of ashes. Where overnight cremation is practised, that should be clearly stated. The Commission would expect the policy to be published in writing and available on the Authority's website, if any, in a section relating specifically to baby and infant cremations and the recovery of ashes.

8.42 An illustration of how some of these matters may be addressed can be seen in the following extract from such a policy statement:

"It is the Cremation Authority's policy to return all ashes resulting from the cremation of a baby to the applicant for cremation, if that is their wish. If they do not wish the ashes to be returned to them, then we will disperse them in the crematorium grounds, in the same manner as we would do with an adult. We cannot guarantee that we will always get ashes from a baby cremation but in the last 20 years we have never failed to do so. In the majority of our baby cremations, including both fetal and full term, we have visible skeletal remains. On the occasions when we do not have visible skeletal remains, we cannot be sure that the ashes contain any human remains, but we also cannot be sure that they do not."

The Commission consider the last sentence to be a good example of a sensitive way of conveying information which families may not particularly wish to know but which in this day and age should be given in the interests of transparency. The statement also explains that ashes are cremulated by hand and that, if parents wish to collect the ashes , they are placed in a white satin lined box along with a small teddy bear and rose petals.

8.43 In their responses to a questionnaire issued to them by the Commission, 22 crematoria stated that they have a local policy on the cremation of infants, 17 of which are in writing. The written policies are set out in a number of different ways. There are those which refer to Guidance from the FBCA or the ICCM as the basis for their local policy; others note the terms of the operational manuals for their cremators, as providing that basis; and some have general statements which are made available to the public in leaflets or on Council or other websites. Mostly there is no clear uniform policy in existence. Where policies are unwritten, emphasis appears to be placed by Cremation Authorities on a shared understanding of the cremation process. While there may be a shared understanding among cremation staff, it is far from clear that that extends to other closely involved personnel, including Funeral Directors and healthcare staff.

8.44 It follows that the actual policy developed and published in relation to baby and infant cremation processes may differ from crematorium to crematorium. In that situation we recommend that Cremation Authorities should exchange information about practice and experience in reviewing existing or devising new policies on baby and infant cremation in light of this Commission's report. However, bearing in mind that there is a substantial number of Cremation Authorities, this recommendation would best be addressed by the ICCM and the FBCA forming a joint working group to develop a common policy statement reflecting best practice, and allowing for variation as appropriate at individual crematoria.

8.45 Consistency in the communication of information and guidance to bereaved parents and families would be promoted if Funeral Directors and healthcare staff ensured that the crematorium policy or appropriate extracts were included within the information and guidance material given to parents. Never again should families be misled about the recovery of ashes and their disposal.