crematoria

 The baby ashes scandal which broke at Mortonhall crematorium quickly spread to other crematoria in Scotland. Will it develop into a UK-wide scandal? Have other crematoria been failing to recover ashes from infants despite the availability of forty-year-old science showing that a foetus as young as 17 weeks’ gestation will, if cremated gently, yield ash?

At Emstrey crematorium in Shrewsbury, where baby ashes were being successfully recovered 100% of the time as long ago as the 1960s, the technique for cremating babies seems at some stage to have been lost, because since 2004 only 1 set of ashes per 30 were recovered.

Shropshire Council has launched an enquiry and clients of Emstrey crematorium have formed a campaigning group, Action for Ashes. One of its members, Glen Perkins, whose 4-month-old daughter Olivia was cremated at Emstrey, said: “We truly believe there are other cases in England and Wales. We’re not going to go away until things have changed. We’re going to keep fighting for what is right.”

In Glasgow they are making sure that what went on can never happen again. They are applying the definition of ashes proposed by both Dame Elish Angiolini and Lord Bonomy: “all that is left in the cremator at the end of the cremation process and following the removal of any metal”.

Councillor Frank McAveety, convener of Glasgow council’s Sustainability and the Environment Committee, said: “The council, with immediate effect, began to use Dame Elish Angiolini’s definition from her report into Mortonhall and moved away from the more general definition of the Federation of Burial and ­Cremation Authorities. This clarification makes it very likely that we will return any ash to bereaved families where they request it.”

In her report into Mortonhall, Dame Elish wrote:

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.

Here was a sorry state of affairs.

When is somebody going to stand up and say sorry?

By Ken West

We are now aware that Mortonhall Crematorium cremated hundreds of babies and infants, and denied that any cremated remains existed. The recent report by Dame Elish Angiolini condemned this practice and exposed it as a scandal. More recently, the Infant Cremation Commission chaired by Lord Bonomy has reported. Anybody reading these reports can rightly ask why some crematoria produce remains and others not? How is it that good practice did not disseminate across the UK?

Lord Bonomy, unable to understand the history of this scenario, or not concerned with the past, puts in a touch of reproof when he comments:

13.1 The encouragement of communication among, and co-ordination of the work of, the various bodies with a role in infant cremation is one of the themes of this Report. Achieving clarity and consistency in communicating with families is another. It is a striking feature of cremation that so much activity is duplicated because there are two major and very active bodies which represent Cremation Authorities and staff, and that the information and Guidance they publish is not entirely consistent. Obviously the members of both bodies have the right to form and belong to whatever association they choose. However there is clearly scope for greater co-operation between the ICCM and the FBCA. The Commission have recommended that they co-operate in certain specific areas. Perhaps that may lead to more co-operation in others.

I find it annoying that the Institute of Cemetery & Crematoria Management (ICCM) is slighted in this way. The ICCM was, and remains ‘very active’. To understand that you need to go back with me and it is a long, complex journey.

Human remains or clinical waste?

In the 1960’s, Victorian principles still applied in UK cemeteries and stillborns were interred in a mass grave, one after the other. It took a few years to fill the grave which was then backfilled. The term foetal remains was unknown in cemeteries or crematoria and they were treated as clinical waste whereby the hospital disposed of them. It was time honoured practice and nobody questioned it. On rare occasions, some people, mostly the wealthy and empowered, did not leave the disposal to the hospital but took control of the stillborn and interred the baby in a family grave, or arranged cremation, with a service. Those babies who lived, even for a few minutes, were invariably given a full funeral. These were most often buried, but a rare few were cremated. I was a cremator operator at Emstrey Crematorium, Shrewsbury at that time and it never occurred to me, or the staff who trained me, that ashes would not be returned to the parent(s). To ensure that this happened, the parents or funeral director would be told to place the body in a solid wood container. The cremation was completed overnight, the hot cremator switched off, the coffin placed in a copper tray, later a steel one. This guaranteed a quantity of ash and the fact that this was mostly, if not all, wood ash rather than human remains was not considered an issue. The parents had some remains to focus their grief on, which was all that mattered.

 A grave for every stillbirth

Years later, as I took up my first managerial post in Wolverhampton, a mother was waiting to meet me. She was upset that my predecessor would not agree to exhume her stillborn baby from the mass grave. I had to reject her request, as finding one baby amongst the two hundred in the grave was impossible. I vowed to change this and in 1976 I introduced an individual small grave for each stillbirth on a plot called ‘The Babies Memorial Garden’. A memorial could be placed on the grave as well as teddies or toys. This idea was opposed by the maternity hospital administrators and, incidentally, by many of my own departmental staff, as it was seen as unnecessary. This may have been the first individual burial of stillbirths in the UK, something I cannot prove.

When I moved on to Carlisle in 1984, I immediately introduced a Baby Memorial Garden but, for the first time, prepared forms to allow for the burial of foetal remains. Sure enough, within a year or so, a woman on fertility treatment asked the maternity hospital to inter her foetus on the plot. She worked at the maternity hospital and was aware that otherwise the foetus would be put in the hospital incinerator with all other clinical waste, and the ashes sent to landfill. I had to ignore the law to permit that burial because then, as now, clinical waste cannot be lawfully interred in a cemetery or cremated. I countered the gainsayers then by arguing that no court in the land would consider the remains of a baby as not human remains.

 The psychological aftermath

At that time, in cemeteries throughout the UK, a number of older women, who had experienced a stillbirth in the preceding three decades, were making enquiries about their baby. Typically, they were experiencing psychological problems and their counsellor or psychiatrist often suggested that the loss of the baby, and absence of grieving, was an issue. Many cemetery professionals then realised that what had happened in the previous decades was wrong in that it denied the ability to grieve. Professionals working in cremation only services would not have experienced this.

It is worth considering at this point that if a decent burial facility was available, such as in Carlisle, few people resorted to cremation. The emerging charities SANDS and Compassionate Friends were also having an impact at this time, and they ensured that the cemetery manager was not as isolated as in the past when proposing improvements. Attitudes changed, not least when Esther Rantzen led a campaign to improve the way stillbirth and foetal remains were managed in 1983.

 Non-viable foetuses continued to go to landfill

As we moved into the 1990’s the individual burial of stillbirths was commonplace and the arrangements for foetal remains then took centre stage. The definition of stillbirth had been reduced from 28 week gestation to 24 weeks. Nonetheless, the fact that a 23 week baby was fully formed and yet was treated as clinical waste remained a scandal. Impetus came in the form of the Environmental Protection Act 1990 (EPA), as it demanded that hospitals upgrade their incinerators to modern standards. That was expensive and many preferred to stop incineration and use contractors to transport clinical waste to regional industrial incineration units. That created many logistical problems, not least the humane loading and storing of the bodies on a truck designed to carry hospital waste. The drivers of these vehicles, I was informally told, were deeply upset at having to identify and handle the foetal remains separately. The ashes resulting from the process continued to go to landfill. Many hospitals, perhaps under pressure from SANDS and Compassionate Friends, sought local cremation and opened dialogue. Many areas did not have burial space so cremation was essential.

The ICCM was central to finding solutions at that time. The ICCM is a member lead organisation, principally on training and management. It is not a lead authority on cremation, or burial, for that matter. The Bereavement Services manager at Warrington was appointed to head an ICCM study and she sent out a survey form to all authorities asking what they did locally with regard to foetal remains, a return I completed for Carlisle on 11 August 1995. I had to take all decisions because my chairman refused to take a report to committee, as many of the foetal remains were ‘abortions’, which offended our Catholic councillors. I developed a shared burial scheme but where a parent sought individual cremation then that was arranged.

 ICCM points the way forward

The ICCM focus, a pressure group as it were, was simple and direct; to stop foetal remains going via the clinical waste route as quickly as possible. The hospital concerns were threefold, firstly that of cost, because money spent on a dead baby was not then available for the living. Secondly, that many of the foetuses, say at twelve to fourteen weeks, were not much bigger than a pound coin and giving them an individual funeral, as such, was excessive. Thirdly, that many of the foetuses, not least the abortions, had to remain confidential and identified only by a case number. The ICCM, pragmatic as ever, felt that if individual cremation was pursued, the average crematoria might receive between thirty and forty individual coffins in a single delivery from the hospital each month. Putting these individually into a cremator by hand, and keeping each separate, was possible, but it was prohibitively expensive.

The FBCA was aware of what was happening. I first wrote to them on behalf of the City of Carlisle on the 19 October 1991 to suggest that they must agree the cremation of foetal remains in order to stop the clinical waste disposal. I know of others who wrote similar letters. It needs to be understood that the FBCA represent UK cremation authorities, and they are recognised as the lead organisation by government.  Their Code of Cremation Practice demanded that each cremation be individual. The thought of a communal (shared) cremation, that of putting many small foetuses into a single coffin, appalled them. After much consultation, the FBCA suggested that they might accept that all these coffins could be put into one cremator together and cremated, yet they opposed a shared container. The FBCA wanted to maintain the status quo and blocked every proposal we put forward. Two of the meetings I attended with their officers were the most frustrating meetings I ever experienced. Much of the work I and other ICCM officers and members did was in our own time, often evenings and weekends. This national initiative was outside our routine day to day work.

 Shared cremation

The ICCM decision on the way forward was formally agreed on the 3 May 1996 by four officers, myself included, to reflect hospital consultations, including their chaplaincy teams, as well as local SANDS and other similar groups. This was to accept shared cremation, that each foetus be separately wrapped and identified, and placed together in a single container, which would then be cremated. The larger mass involved, including the container, would then ensure that ashes remained and if these were placed in a specific part of the Garden of Remembrance, then the parent(s) could visit that spot and grieve. That was important as all the evidence showed that although the majority of women involved did not want to know what happened to the foetus at the time it was expelled, or aborted, that many made contact months or years later to ask what had happened. A further advantage was that because all the foetuses were together the hospital staff did not have to make distinctions over gestation. Those parents with a foetus of low gestation would have the benefit of, morally at least, some ashes.

 Postcode lottery

This shared cremation process was defined and the container was to be delivered to the crematorium chapel at an agreed time, any parent(s) could attend if they wished, and the hospital chaplain would take a short service. The clinical waste process would be stopped in a single stroke, and the NHS expenditure constrained.  We were aware, as early as November 1995 that a number of crematoria had already agreed with their local hospital and introduced the ICCM shared cremation process. The FBCA knew this because in a discussion with their Secretary at that time he informed me that thirteen crematoria were involved. As they were evidently not working within FBCA policy I asked him what action they would take. The answer was none, that they would ignore it. The postcode lottery as regards to what happens locally to foetal remains began at that time.

The ICCM shared cremation proposal was put to a special meeting called in London on the 29^th May 1996 between the Institute, the FBCA, nursing representatives and those of groups like SANDS. At this London meeting, the manager of one of the thirteen crematoria (Nottingham) was invited to address the meeting on the successful shared cremation process he had introduced. Subsequently, the shock was that the SANDS representative joined the three FBCA representatives to reject shared cremation, and demand individual cremation. That shattered the ICCM raison d’etre. Our protestations that this would ensure that the clinical waste process would continue were ignored. Government took no interest in the issue. Negotiations continued, on and off, and SANDS ultimately agreed to shared cremation, but generally such schemes only started where the FBCA did not have any influence. The FBCA response continually fell back on the same precepts, that the problems created for NHS staff regarding gestation, or the costs incurred by the NHS, were not their concern.

 Parting of the ways

This schism gradually worsened as ICCM proposals, not least when the Charter for the Bereaved was launched in 1996, caused increasing aggravation. The final breach was when some ICCM members, myself included, withdrew their authority from membership of the FBCA. This was because in places like my authority at Carlisle, where we routinely used coffin covers, held over cremations for up to 72 hours or completed individual foetal cremations, it was morally wrong to return the annual FBCA return stating that we had complied with their Code of Practice.

These ICCM initiatives were intended to reduce cremation emissions, energy usage and funeral costs. The FBCA resisted all change and neither did they introduce any proposals to improve the environmental performance of cremation or meet the changing needs of the bereaved. The psychology the FBCA adopted is worth considering, and is exemplified by their response to coffin covers. In the ICCM we used the term ‘reusable coffin’ and only after some years, and the introduction of such a coffin to the market by a funeral director, did the FBCA agree to their introduction. As this decision approached they asked me, as the ICCM Charter Organiser, to present the issue to one of their meetings in London. In fact, having travelled from Carlisle at some cost, they did not ask me to present but had already agreed anyway. They had changed the name to coffin covers, which has confused everybody to this day, as their way of taking ownership of the idea.

Evidence of the final break was when the historical joint conference between the ICCM and FBCA was ended. Each organisation went their separate ways and joint cooperation was effectively ended. Many times during this period ICCM officers discussed returning to the issue of foetal remains, but it did not happen. I still feel some personal guilt that I was one of those who failed to respond. The ICCM was forced to compromise on the recovery of ashes, but many of its members did not and continued to guarantee their recovery.

The road to Mortonhall

This scenario now leads us to the conditions that created the Mortonhall scandal. My direct involvement with the ICCM ended when I resigned my role as Charter Organiser upon my appointment to a new post in Cardiff in 2001. Consequently, what I now write is based on memory and not supported by my diary entries.

The secretary of the FBCA, a man who had stalled all change for some years, left under a financial cloud.

What are ashes?

The FBCA, keen to distance themselves from the ICCM, needed to justify their existence. The need for individual cremation of foetal remains, and infants, had to be formalised, an approach the ICCM members knew to be extremely difficult. I have no idea what happened in camera but I can postulate on their approach. The question of gestation will have arisen so there is a need to identify a cut off point; what gestation must the foetus be for cremated remains to exist? Perhaps they never answered that, but the solution promoted by the ICCM in the earlier consultations had to be discredited. That was to use a wood container to create ash, and not to differentiate between wood ash and human remains; done that way every baby, no matter what gestation, had recoverable ashes. Consequently, FBCA officers created this absurd argument over the definition of cremated remains. Their decision was that the true ashes could only be human remains, and the remains we had recovered for decades were the ‘total recovered remains’. I recall my disbelief at this summary and the sheer absurdity in suggesting that we could somehow separate the human and wood components of the ash.

They did, then they stopped

As the ash could not be separated, and most of the ash was from wood or items left in the coffin, it is easy to see how they decided that, in truth, no ashes actually existed. This decision also overcame the H & S issues that arose over using and handling hot infant cremation trays. That reason was blamed for stopping the use of trays at Mortonhall. But consider that Scotland is also more unionised than England and stopping the tray use neatly absolved the manager at Mortonhall from arguing the case with a shop steward. The fact is, the recovery of baby and infant remains is more complex, more laborious and more time consuming than not recovering them. The reports make clear that both Aberdeen and Mortonhall were previously recovering infant ashes but stopped that practice in the 1990’s.

 Natural burial, the alternative to cremation

Before I finish, I want to point out the difference between the ICCM and FBCA, which is subtle, but significant. The word to consider for either is their relative disinterestedness. The ICCM wear three hats, for cremation, conventional burial and natural burial. The organisation has no concern as to whether one or the other of these options outplays or dominates another. The market is allowed to rule and support given to whoever works in any of the three zones. In this they act as a disinterested party. Up to the 1990’s, with conventional burial crippled by nationwide memorial safety and grave maintenance costs, they were able to present a strong case for cremation, and virtually all UK councils supported their promotional stance. However, in recent decades, the case for cremation has been undermined through the introduction of natural burial. With its reduced grounds maintenance, no embalming and the use of an eco coffin, it is sustainable and actually benefits nature, giving the funeral a spiritual focus. Cremation, for the first time since it started in the 1880’s, has virtually no promotional opportunity. Even the USA has decided that incineration per se is harmful to the environment. It fell to the ICCM (and the ICCM Trust), through their Charter for the Bereaved, to support eco coffins, coffin covers, and to delay cremation (holding the body for up to 72 hours) in order to improve the environmental performance of cremators. The Charter was also the first and only document to highlight these issues in a transparent manner. Far from being welcomed, these proposals were seen as anti cremation by the FBCA and opposed.

How bad will it be in England and Wales?

If this analysis is correct then it suggests that this scandal will be principally limited to Scotland and be less evident in the more robust ICCM environment in England. It is only in England, and Wales that authorities cancelled their membership of the FBCA in response to what happened. As matters stand, in June 2014, only Shrewsbury (Emstrey) Crematorium appears to have a similar scenario, with no ashes recovered in 29 of 30 cases, but that relates to a long standing manager absence.

To conclude, I trust that this history illustrates why the Mortonhall situation arose.

ED’S FOOTNOTE: A non-viable foetus is any baby born before 24 weeks; a stillborn is any baby born after 24 weeks. To their parents, of course, they are all babies. Non-viable foetuses continue to be treated as clinical waste, as you can read here. 

The Federation of Burial and Cremation Authorities has received much criticism on this blog in the past week.

I have received an assurance from the FCBA Secretary that a response will be forthcoming.

There is no legal definition of ashes.

Perhaps you prefer to call them ‘cremated remains’. Or ‘tangible remains’. Or even ‘total recoverable remains’. Selecting just one term and assigning an exact definition to it was one of the jobs Lord Bonomy set himself in his report. The fact that there remains no legal definition has resulted in confused and misleading guidance to the parents of babies who have died.

Does it really matter what you call them? Yes, it does. It comes down to what you think ashes are.

Are they what remains of a dead human after cremation?

Or are they the remains of a dead human + coffin + anything that was placed in the coffin after they have been cremated?

On the one hand, the Federation of Burial and Cremation Authorities offers this directive to those who advise the parents of children who have died:

“In cases where bereaved parents desire the cremation of an infant or of fetal 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.”

The inference of this directive is that ‘tangible remains’ are the remains of the body. The ash from the coffin and anything in it don’t count.

On the other hand, the Institute of Cemetery and Crematorium Management defines ashes as both the remains of the body + coffin + anything in it. It all counts.

When this clash of definitions was pointed out to Tim Morris, chief exec of the ICCM, in 2013, he responded: “I have only heard about this distinction in the last few months.” Yup, the two representative authorities have been reading from different hymn sheets.

Everyone agrees that cremation is complete when the last flame has flickered and died. No one is suggesting that metal parts which survive cremation should be considered ashes.

And common sense tells us that the FBCA directive is nonsense. How on earth could you possibly tell skeletal remains apart from coffin ash? Only a fool would try to separate them.

Bonomy takes the view that everything that remains at the end of a cremation is ashes. His opinion is reinforced by the “widespread perception among the public” that this is so, “and that if that is not the perception among crematoria staff, then it should be.”

He identifies the conflicting perception of “representatives and staff of Cremation Authorities and Funeral Directors” who believe that “’ashes’ are what remains of the cremated baby.”

In doing so, he gets to the root cause of the misleading advice given to the public: the misguided “understanding that the bones are not sufficiently developed to produce remains led crematoria to convey to Funeral Directors, clergy and healthcare staff that there would not be, or were unlikely to be, ashes following the cremation of a baby” – because coffin ash doesn’t count.

This ‘understanding’, let us be clear, seems to have resulted from ignorance that skeletal remains can be recovered from a baby of 17 weeks’ gestation. So it is with ill-concealed understatement that Bonomy concludes:  “The extent to which that information was accepted without question by healthcare staff, as illustrated in the MIR, is surprising.^”

Bonomy wants cremation law in Scotland to define ashes as: “all that is left within the cremator at the conclusion of the cremation process and following the extraction of all metal.”

But as he points out, crematoria in Scotland comprise but 10% of the UK total. We clearly need a clarification of the law in England, Wales and Northern Ireland, too. The sooner the better.

The Bonomy report lays bare the reasons why some crematoria have been able and willing to recover ashes from infant cremations and others haven’t. Given the enduring and agonising distress and uncertainty this has caused to an uncountable number of parents, it can only be a matter of time before the media give it the treatment it deserves. The BBC has already been extremely active in Scotland and at Emstrey crematorium, Shrewsbury.

The inconsistencies of practice highlighted by Bonomy are of the gravest possible concern. Some crematoria have recovered ashes in 100% of cases, others in none: 0%. The science shows that a foetus as young as 17 weeks’ gestation will, if cremated gently, yield ash. This being so, and given the extreme sensitivity of the matter to the parents of babies who have died:

Why on earth has best practice not been applied in all crematoria in the UK?

How is it that some crematorium managers and technicians seem to have lost all sense of duty to the bereaved?

Bonomy’s recommendations are comprehensive. If applied, they will make the future a better place. If you haven’t read them, you really ought to because no one escapes criticism; everyone has something important to learn. Here are some of the most important. The bold is mine.

In legislating, devising policy, drafting information and guidance documents, and making arrangements for and conducting baby cremations, the baby and the interests of the family should be the central focus of attention. Parents and families should be given time and space to reach the correct decision for them.

“Ashes” should be defined as “all that is left in the cremator at the end of the cremation process and following the removal of any metal”.

All Cremation Authorities at whose crematoria ashes are not always recovered should liaise with a crematorium or crematoria where ashes are recovered more regularly to share their experiences and information about their respective practices. 

As an urgent interim measure, the ICCM and the Federation of Burial and Cremation Authorities (FBCA) should form a joint working group … 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 ICCM and FBCA should review their respective technical training programmes.

The power of the ICCM and the FBCA to put things right is limited. No one has to join either body. Perhaps in consideration of this, Bonomy (explosively) proposes “an independent Inspector to monitor working practices and standards at crematoria, provide feedback to Cremation Authorities on how they are performing and to report to the Scottish Ministers as required.” A national inspectorate. It makes you wonder why we don’t already have one. That would really shake things up. 

Bonomy concludes with a recommendation whose humanity shames all those who have been complicit in the shoddiness that has caused so much grief and will cause much more as the full story comes out. He asks the Scottish government to “consider whether there should be a national memorial dedicated to the babies whose ashes were mishandled or mismanaged.”

Here at the GFG we have sought responses from people of influence in the industry. We have asked the ICCM and the FBCA to respond to the following questions:

1.  I am not aware of any published figures regarding success rates for the recovery of ashes resulting from the cremation of ‘babies and infants’ (Bonomy) by crematoria in England, Wales and Northern Ireland. Have the figures been collated?

2.  If not, we are aware that in Scotland, until very recently ashes had not been recovered and returned in any of Aberdeen’s baby cremations since 2008, while in Inverness 100% were returned. In Fife, ashes were recovered in 45 out of 87 cremations of stillborn babies and those aged up to one year. Would you expect to see, or are you aware of, similar disparities in baby ash recovery rates between crematoria in the rest of the UK?

3.  Bonomy recommends that the “ICCM and FBCA should review their respective technical training programmes”. Has [your organisation] fallen short in its training provision to operators of crematorium equipment and subsequent sharing of best practice?

Tomorrow we shall publish an account by Ken West. On Wednesday we shall publish a response by Tim Morris, chief exec of the ICCM. We shall follow that with a response from the FBCA if we get one.

By Dr Clive T Chamberlain:

The cremation culture and equipment used in the UK is not the only way to dispose of human remains, although cremation in the rest of Europe is similar – driven as it is by a commonality of environmental regulation. The cremators used, and the legislation which controls their use are mostly (but not all) the same, but funeral practices do differ.

The most common cremator type in Germany has a different construction. It is called the ‘Ėtage’ or ‘Durchfall’ oven, and the chambers of the cremator are stacked vertically. The coffin is charged into the top chamber. When partly burned, the remains fall into the next lower chamber, and then finally into the third or ‘ashing’ chamber from which the completed cremated remains are retrieved. This type of cremator tends to be more energy-efficient (after coming up to normal working conditions), and is very suitable for continuous operation.

Differences in practice centre on the relationship of when the cremation takes place as opposed to when the farewell ceremonies take place, and this influences a number of details of practice.

Some countries (for example Scandinavia and German-speaking countries) have farewell ceremonies soon after death but the coffin is stored for cremation at a later date – sometimes several weeks after the farewell ceremony. Consequently, the cremation is almost a ‘production line’ operation, carried out separately from family participation. This enables the actual cremation process to be planned in an orderly manner and it also enables extended periods of operation to be used (even 24 hour operation), with more efficient use of energy and facilities.

It is not uncommon for a single cremator to carry out as many as 5,000 cremations in a year (for example in Moscow) compared to an average a few hundred per cremator per year in the UK – in the same make of cremator! There are tantalising savings of energy and greatly reduced wear of the cremator construction – there being no repeated start-up and shutdown of the unit each day. The crematorium is still operated in a most dignified and tasteful way and cremated remains are returned to families.

The remainder of Europe tends to carry out cremations as in the UK, and the family is present at the farewell ceremony at the crematorium, with cremation immediately thereafter or within the same day. There is one noticeable difference in that is common for the whole process to include family meals or refreshments in elegant and purpose-designed facilities, (whilst the cremation is taking place in the crematorium building), finishing with the presentation of the cremated remains to the family to be taken away. A solemn, dignified and effective way, which is held to assist and promote closure for the family.

There are a wider range of practices used throughout Asia with big differences according to the ethnicity of the populations. Environmental protection is an ever-growing need in Asia and modern crematoria are moving towards close regulation, with advanced cremators and emission abatement systems.

The practice in Japan is quite different, and there are more than 1,200 crematoria throughout the country. The cremator is constructed differently, and the base is removable, so it can be moved in and out of the cremator on wheels. Coffins are inserted into the cremator on ‘chariots’ on which they burn. After the completion of cremation the remains, still on the vehicle, are removed, allowed to cool and then placed in a room set aside for families who then select pieces of bone of the deceased for retention.

The Bonomy report is published today in Scotland. Its 64 recommendations will address cremation practice in that country and, by extension, throughout Britain. They will impact the NHS, funeral directors and cremation authorities, especially the ICCM and the FBCA.

Shockwaves are expected.

Lord Bonomy’s brief was to “examine the policies, practice and legislation related to the cremation of infants in Scotland and provide recommendations for the future which will ensure that no-one in Scotland ever again has to suffer the distresses that were highlighted by the Mortonhall Investigation Report.”

Reminder: 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. Hundreds of families were affected.

This is not just a Scottish problem. For a medley of muddled reasons there seems to be no mandated practice nationwide for the cremation of infant remains nor any general awareness that ashes can be recovered from foetuses as young as 17 weeks. As a result, there are probably vastly varying outcomes from crematoria everywhere. Here’s just one (Scottish) example. Until very recently ashes had not been returned in any of Aberdeen’s baby cremations since 2008, while in Inverness 100% were returned. In Fife, ashes were recovered in 45 out of 87 cremations of stillborn babies and those aged up to one year.

What would the picture look like if we had figures for the whole of the UK?

George Bell, manager in charge of Mortonhall for 30 years until 2011, has distanced himself from criticism and blamed funeral directors for giving the wrong advice to parents:

“I feel for them and apologise if [parents] have been given wrong advice which led them to choose cremation and not have the option of burial …  I tried my best to make sure that the message got out that there might not be the opportunity of recovering ashes after the cremation and we provided alternatives but unfortunately relied on frontline professionals. I must emphasise the crematorium staff didn’t make funeral arrangements.”

Bell also blames politicians:

“Sadly there’s no legal status for non-viable foetuses and as an industry we have worked hard to try and raise standards but to raise standards we need the legislation to go with that. I think the industry needs clear legislation as to what the procedures are. There’s no legal definition as to what ashes are – I think this needs to be addressed.”

The record shows that there is no agreement among cremation authorities about what ashes are, either:

“The FBCA (Federation of Burial and Cremation Authorities) consider that ashes consist of cremulated bone to the exclusion of any other source of ash obtained from the burned coffin, clothing or soft toys cremated along with the baby. The ICCM (Institute of Cemetery and Crematorium Management) considers ashes to include all ashes from the cremation, both cremulated bone as well as ash from
items which were mementos or part of the fabric of the baby’s last resting place. Tim Morris, Chief Executive of the ICCM, was interviewed on camera about this distinction by Mark Daly of the BBC in a broadcast in April 2013 when he indicated that: “I have only heard about this distinction in the last few months.” “[Source]

Things have subsequently gone from bad to worse in Aberdeen, where it is now alleged that babies were cremated together with adults — playing to the direst public misgivings about what really goes on in crematoria.

In England only one case has been reported so far but you wonder how many others might have been and may yet be. The culprit is Emstrey crematorium in Shrewsbury where only 1 in 30 sets of ashes have been given to babies’ families since 2004. The fact that it is run by Co-operative Funeralcare is at best semi-relevant. The verdict of a former Emstrey manager, Ken West, is devastating:

“I see absolutely no reason why cremated remains were not produced. The issue for me is they were not captured. They were either in the flue system or workers didn’t take the trouble to check whether there were any ashes before introducing the next cremation. So it’s very possible those babies’ ashes got mixed in with the next cremation.”

On this blog Ken West has written:

“I was a cremator operator in the 1960′s and ashes were always returned for baby or infant cremations … 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.”

If it has been demonstrated that ashes can always be retrieved, why does the ICCM continue to advise: “The hospital must inform parent(s) that ashes may not be recovered from cremation.”? And why does the FBCA advise: “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.”

Elish Angiolini’s Mortonhall Investigation report expresses impatience with this muddled thinking: “The existence or otherwise of ashes following the cremation of foetal remains ought to be a matter of fact; either there is some residue from the human tissue or there is not.”

The FBCA states that there may be no tangible remains left after cremation because of “the cartilaginous nature of the bone structure.”  This sounds scientific, but is it? Compare it with this:

Experimental research has been undertaken to quantify the percentage of bone (bone ash or calcined bone) remaining in human skeletons following cremation. Trotter and Hixon (1974) studied skeletons from an early foetal period through to old age. This included 124 male and female foetuses of American Caucasoid and Negroid ancestry, which ranged in age from 16 to 44 weeks gestational age. It was possible to record the ash in even the youngest and lightest skeletons, the lightest being a white male of 16 weeks gestation which weighed 3.4 g pre-cremation. [Source 2.8]

Note: the above research is all of forty years old.

Compare the FBCA statement also with this. In a photograph of the cremated remains of a 17-week-old foetus at Seafield crematorium:

Bones [are] identifiable on the image include the femur, humerus, mandible, ilium (pelvic bone), the pars lateralis and possibly basilaris of the occipital bone (skull), radius, ulna, clavicle and a minimum number of 12 ribs. It is likely that the fibula is also present but it is difficult to distinguish clearly. [Source 2.8]

Given the extraordinary sensitivity of this issue, the recommendations of the Bonomy report are going to make for very interesting reading. We can’t give you a link because we are without an internet connection today. We believe this will take you to it.