Evidence submitted by the Federation of
British Cremation Authorities (FBCA)
1. The FBCA was founded in 1924 and represents
95% of the cremation authorities in the United Kingdom. We welcome
the opportunity to submit comments to the Constitutional Affairs
Committee's Inquiry into Reform of the Coroners System and Death
Certification in England and Wales.
SUMMARY
2. In summary, the FBCA believes that:
— the Government's proposals for Reforming
the Coroner and Death Certification Service in England, Wales,
contained in the Position Paper published in March 2004 should
be implemented;
— a two-tier system for all certification,
including cremation, is preferable to the current three-tier system;
— Coroners should be required to provide
additional information to crematorium Medical Referees, including
the cause of death and the presence or otherwise of medical implants;
and
— the transition to any new arrangements
for death certification will need to be carefully managed.
BACKGROUND
3. In the year 2004 (the last year for which
the Federation has statistics), there were 245 crematoria in operation
in the United Kingdom. A summary of cremation statistics is set
out below*:
| Deaths in the United Kingdom
| 599,985 |
| Total Cremations | 424,956 |
| Percentage of Deaths | 70.8%
|
*Provisional figures at 21 March 2005.
4. In addition to the above statistics, 226 crematoria
reported carrying out 28,906 cremations of foetal remains and
98 crematoria reported carrying out 448 cremations of body parts
in 2004.
GENERAL COMMENTS
5. We welcome the Committee's Inquiry into Reform of
the Coroners System and Death Certification in England and Wales.
It will clearly be important that the Committee's recommendations
should be consistent with those of the Third Report of the Shipman
Inquiry (under Dame Janet Smith DBE) and the Report of the Fundamental
Review 2003 into Death Certification and Coroner Services (the
Luce Committee). We also welcome the Government's proposals for
Reforming the Coroner and Death Certification Service in England,
Wales and Northern Ireland contained in the Position Paper published
in March 2004 (Reforming the Coroner and Death Certification
Service: A Position Paper (CM 6159)).
6. There have been previous attempts at reforming the
system, including the recommendations of the Brodrick Committee
and the report on the coroner system (Wright 1936), which have
not been implemented. Consequently, we are concerned that the
necessary parliamentary time may not be made available to bring
the proposals into effect.
7. The comments that follow are linked to the issues
identified in Press Notice No 12 of Session 2005-06 dated 20 January
2006.
WHAT PROBLEMS
THERE ARE
WITH THE
EXISTING SYSTEM
8. We would endorse the identified shortcomings of the
current three-tier cremation certification process as described
in the Fundamental Review of Death Certification and Coroner Services
and the Shipman Inquiry. We would support a two-tier system for
all certification, including cremation.
9. We recognise that the cause of an individual death
should, for reasons of confidentiality and the protection of families,
be regarded as private information. However, at present the Coroner's
Certificate for Cremation (Form E) does not make provision for
a cause of death to be shown, but is given only in those circumstances
where a local agreement has been made between the Coroner and
a Crematorium Medical Referee. It would be of considerable assistance,
if not essential, for the Medical Referee to have this information
with the cause of death being given in all instances. Furthermore,
in the interest of health and safety of crematorium staff and
other personnel involved in the funeral process, the Coroner should
be required to provide information where the cause of death is
infectious.
10. There have been instances in the past where other
risks to crematorium staff have arisen from the explosion of cardiac
pacemakers during the cremation process. Other risks arise from
the presence within the body of cardiovascular defibrillators,
pulse implant generators and radioactive implants. In the absence
of information from relatives (who are not always in a position
to know), we believe that the Coroner should be required to confirm
the absence or removal of such items.
11. Historically, bereaved families opting for cremation
have had to bear the additional cost of medical certificates for
cremation, that are not otherwise required for burial purposes.
From 1 October 2005, fees for the completion of Medical Certificates
B and C increased from £55.50 to £62.00, representing
an increase of 12%, whilst Medical Referees' Fees increased from
£5.50 to £16.50 with effect from 1 January 2005. The
combined effect of these additional fees is to add £139.50
to the basic cost of a cremation.
EXISTING PROPOSALS
FOR REFORM
12. In our view, the Government's proposals effectively
address the shortcomings identified in Dame Janet Smith's report
and earlier reviews and herald a long-awaited reform of the death
certification system, replacing existing complex machinery with
a single medical certification procedure for burials and cremations.
We have consistently advocated that the certificates to be completed
for death should be the same, regardless of whether burial or
cremation follows.
13. We are pleased that the Government places the needs
of the bereaved at the centre of the new system and we welcome
the proposals for a family charter setting out precisely what
the deceased's family can expect from the service. However, the
transition to the new death certification procedure will need
to be very carefully managed to avoid disruption to funeral arrangements.
In particular, we are concerned that geographical access to coroner
services, particularly in rural areas, may be made more difficult
owing to the proposed reduction in the number of coroners.
14. We welcome the introduction of the second certification
in all cases by qualified Medical Examiners based in the coroner's
office and independent from the National Health Service. However,
we are concerned that there are no plans to require an independent
examination of the body in all cases. This seems to afford a new
opportunity for concealed homicide. We trust that, in the longer
term, the new medical examiner service will be adequately resourced
to avoid delays between death and disposal, which will be distressing
for the bereaved. This, we suggest, will require rigorous performance
management measures to be in place from the outset.
15. Clearly, the secure electronic transfer of confidential
patient information will be of value to the reformed system. This
raises issues of ownership of information, the legal restrictions
under which different agencies operate, identification, authentication,
security and the sharing of information between local and central
government agencies: all of which will need to be carefully resolved.
16. We note the Government's intention to "capture"
all existing resources for redirection towards the new system.
In part, these resources are currently provided by the bereaved
in terms of fees for medical certification. This creates an imbalance
between the overall costs of burial and cremation. We hope that
the new arrangements will ensure that the medical certification
expenses are recovered equitably, regardless of the choice of
disposal.
17. We are disappointed that the Briefing Note on Coroner
Service Reform, published on 6 February 2006 to coincide with
a Parliamentary Statement by Harriet Harman MP, Minister of State
for Constitutional Affairs, indicates that the Government will
not be introducing a requirement to report every death to the
coroner for a second scrutiny. This effectively means that the
critical defects in the current death certification and investigation
process are to continue. Whilst the Briefing Paper confirms that
government will be considering "affordable and proportionate
further reforms in these areas", there is no indication of
a timetable. We consider that this work should be completed as
soon as possible, preferably within a year.
THE ALTERNATIVES
TO THE
CURRENT SYSTEM
AS PRACTICED
IN OTHER
JURISDICTIONS
18. We have no particular view as to alternatives to
the current system as practiced in other jurisdictions other than
to urge compatibility with current proposals to amend the relevant
legislation in Scotland where the Scottish Executive are considering
implementing a two tier system of death certification for both
burial and cremation.
19. It is the intention that death certification in Scotland
will be more robust than at present, with the training of doctors
in the completion of statutory forms being identified as an area
requiring attention and for doctors in training grades allowed
to sign the certificates under supervision.
20. The General Register Office for Scotland will hold
information to allow an audit of information held, to identify
any trends, thus providing some reassurance to the public.
Federation of British Cremation Authorities
February 2006
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