The many lessons to be learned from Mortonhall

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.