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.