The report into the Mortonhall ashes scandal was released yesterday.
To refresh your memory: from 1967 until 2011 parents of babies who had died antenatally or perinatally in Edinburgh were informed, on the authority of Mortonhall crematorium, that there would be no ashes after cremation.
All the while (since 1934, actually) two privately-owned Edinburgh crematoria, Seafield and Wariston, had been managing to achieve ashes from foetuses as young as 17 weeks.
There’s a useful summary of the findings of Dame Elish Angiolini’s report here.
You can find the full report here.
Here are some extracts of the report that interested us:
* Most meetings between managers at the crematorium and with their line managers appeared to focus on budgets and finance rather than policy or practice. The issue of the cremation of foetuses and babies and whether or not remains were recovered and returned to parents does not seem to have been discussed even though Mortonhall was operating so differently to the other crematoria in Edinburgh over so many years.
* There was little by way of formal training at Mortonhall other than in general cremation practice. When it came to the cremation of foetuses and babies, staff learned from their more experienced peers or supervisor. Likewise, notions of policy and practice were derived by word of mouth with very little other than operators’ manuals committed to writing.
* Despite the complexities and difficulties of this particular aspect of cremation operations, there has been little by way of any local or national written guidance for Cremator Operators at Mortonhall. The absence of any practical formal training to attempt to support staff in recovering remains from infants or foetuses is a significant concern given the misgivings expressed by some of the staff involved. The absence of such training is all the more surprising since the difficulties have been recognized within the professional organisations and discussed by senior members of the profession over many years.
* The official ICCM direction: “The hospital must inform parent(s) that ashes may not be recovered from cremation.”
* The official FBCA direction: “In cases where bereaved parents desire the cremation of an infant or of foetal remains, they should be warned that there are occasions when no tangible remains are left after the cremation process has been completed. This is due to the cartilaginous nature of the bone structure.”
* Dr James Dunlop, witness: “Crematoria are occasionally asked to cremate non-viable foetuses. Many doctors, especially those associated with crematoria, believe that there will be no cremated residue. However, if the cremation technique is modified, cremated remains are produced. These remains can form a focal point for the parent’s grief. Crematoria are urged to ensure their technique yields a residue … [When cremated gently] the outline of a foetal skeleton (it has been described as resembling the skeleton of a bird) can be discerned quite clearly on the base of the tray amid the ashes of the coffin.”
* It is not whether ashes can be recovered from foetuses but the degree of care and modification of the adult processes applied to the cremation of the baby which profoundly affects the outcome.
* Anne Grannum told the Investigation she had always believed there were no ashes from babies. She was not alone in that belief. This understanding was, until very recently, also held by the Chief Medical Officer, pathologists, midwives, medical referees, senior members of the professional associations and Funeral Directors. Her belief was based on the assertion that ashes were the calcined bones of the cremated individual and nothing else. Any residual remains from the process were simply refractory dust and coffin ash.
Mrs. Grannum’s failure over many years to make any enquiry about what was happening at Seafield, where she understood it was said ashes were being recovered, is also very difficult to understand. As business competitors it may have been seen as inappropriate to make a direct approach to Seafield but the matter could have been referred to her senior managers or to one of the professional organisations to pursue. She was not alone in this apparent inertia. NHS staff and Funeral Directors, amongst others, were all aware of the assertions by the staff at Seafield Crematorium of recovering ashes yet no one investigated these claims until the writer Lesley Winton visited Seafield in 2012.
* The contrast in the working practices and the approach to the cremation of babies at Mortonhall with the approach at Seafield and Warriston is stark. The obvious care taken at Seafield and Warriston to provide the very best possible outcome for the parents of the foetus or baby is exceptional. As a consequence of misunderstanding and poor advice in the NHS leaflets, many parents were led to believe that there would be a charge made for a funeral at these private crematoria where ashes were being recovered for parents. Neither of these crematoria have ever charged for such cremations.
What strikes me most storngly about this sorry tale, at first glance at least, is the ignorance and misinformation even among and between those whose job it its to know and tell. How are the public to discover the truth when professionals – “Chief Medical Officer, pathologists, midwives, medical referees, senior members of the professional associations and Funeral Directors” – are hiding it even, apparently, from themselves and from each other?
I think there is also a telling signal in this report by apparently disinterested parties; what is it about a chief medical officer, or funeral directors, that merits capital initials not granted to mere midwives, pathologists et al? I was pulled up on this blog recently for writing god instead of God, and I’m even more certain now that I was right. Too much reverence for these ordinary working folk only supports this condescending opacity in the professions, which intimidates other ordinary folk and inhibits or prevents fair, free, common grieving ritual.
As I understand the situation, put in simple terms, cremators have become more controllable over the last 50 years or so, especially with the latest computer operated versions.
With the older installations, I can quite understand how it would be an impossibility to retain any ashes. The retorts (cremators) were fierce, combined with the cartilaginous bone structure involved…..
In a busy municipal crematorium, the cremator operators would have little time to attempt to achieve the neigh (then) impossible. So I suppose it depends on the historical protocols not changing with the times.
Even with the most up to date installations, and the most dedicated staff, it is impossible to guarantee ashes in every such case.
Agree, Nick, that if you cremate a baby at the same heat (c 1000C) and with the air jets on, there’s a good chance there’ll be nothing. But the report finds that if a baby is cremated ‘carefully’ there is a good chance of recovering ashes. I wonder how widely this is appreciated by crematoria. The report finds that there is a lack of best-practice sharing. The report also says this:
“Direct evidence that foetal remains can survive the cremation process and that skeletal elements are recognisable from as early as 17 weeks gestation (15 conceptual weeks), was obtained from two private crematoria, Seafield and Warriston, currently operating in Edinburgh … [there is] direct, visual evidence that multiple individual skeletal elements can be recognised following cremation in individuals as young as 17 weeks.
“Lower temperatures of around 600 to 700 C° are recommended by both Dr Chamberlain and Dr Dunlop, a Medical referee at Hull Crematorium. Dunlop also recommends that ‘no forced air is turned on’ (2004: 341) and that the
coffin containing the foetus / young infant is placed in a preheated furnace in a
corrugated metal tray with sides.”
This report is welcomed for dispelling any myth or ill placed notion that it is not possible to cremate the remains of a foetus or infant without remains to give to the parents. The key now is to robustly educate the cremation authorities and train their staff in best practice to achieve the best outcome for the parents. The health care professionals and funeral sector must also be consistently educated. Who will take the lead on that? Otherwise this report is pointless.
Precisely, Wendy, who indeed?. Any ideas, Charles?
Who will take the lead? The FBCA and ICCM, I’d have thought. I’ll ask them to make a response.
What the report ignores is that a dispute existed for some time over whether ashes existed or not after an infant cremation. This came to a head in the mid 1990’s when the Federation of British Cremation Authorities (FBCA), the ‘received wisdom’ in the report, made that assertion. Sorry if I sound holier than thou, but I was in the ICCM faction that opposed this statement right down the line. It caused masses of arguments and no amount of consultation with the FBCA could make them see reason. Those managers who saw the FBCA as an established and sensible organisation swiched off their brains, not least the one who managed at Mortonhall.
The report does not point out that the FBCA has been a dinosaur organisation for two decades. They opposed coffin covers (reusable coffins), holding over bodies to improve the cremation process, ‘green’ coffins in general, the communal cremation of foetal remains, the Charter for the Bereaved and particularly its Guiding Principles. The Guiding Principles was intended as an improved replacement for the FBCA Code of Cremation Practice, which had existed from the 1950’s. That code was pathetically anachronistic and did not relate to a consumer related service. Unlike the Guiding Principles, it did not apply to burial. Many crematoria still work to the Code of Practice.
My particular gripe was that the FBCA persisted in referring to foetal remains as clinical waste. This meant that they could not be cremated at a crematorium typically only licensed for ‘human remains’. At that time the crematorium I managed at Carlisle was accepting foetal remains as part of an initiative with midwifery services and the hospital chaplain. Many other decent crematoria managers had taken the same action. The fact that we could not agree with FBCA policy was why many ICCM managers, myself included, withdrew our authorities from membership of the organisation. The fact is, the FBCA was irrelevant then and is irrelevant now. The report recommendation that they resolve this situation with the ICCM appears an impossible scenario. They are proven to be incompetent so what has changed?
I was a cremator operator in the 1960’s and ashes were always returned for baby or infant cremations. A tray was always used and the fact that the cremators were unsophisticated was irrelevant. At no time have I ever accepted that no ashes exist. Had I accepted that then I would have considered cremation unacceptable and advised burial as the better option. Sometimes I would advise parents or a funeral director to use a solid wood container, as that guaranteed that more ashes were present. When the argument arose from the FBCA that these ashes were just coffin dust many of us were apoplectic. Our moral argument that the existence of ashes was a grieving focus, no matter what they were composed of, was ignored. It is not the case that all the profession simply sat back and accepted the received wisdom, as they did at Mortonhall.
Ken, thank you very much for this very informative (and forthright) gloss on the report. I am especially struck by: “At no time have I ever accepted that no ashes exist. Had I accepted that then I would have considered cremation unacceptable and advised burial as the better option.”