Historical Stillbirth Burials and Cremations
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The Parliamentary Under-Secretary of State for Health and Social Care (Ms Nadine Dorries)
I beg to move,
That this House has considered historical stillbirth burials and cremations.
Let me begin by congratulating the hon. Member for Swansea East (Carolyn Harris) on securing the debate, which was also supported by my right hon. Friend the Member for South Holland and The Deepings (Sir John Hayes).
It is a fact that anyone can be a Member of Parliament and anyone can be a Minister, but only someone who really cares can get things done, and it is without doubt that the hon. Lady has achieved much in the time she has been in the House because she cares. I have the utmost respect for her. She has done a fantastic job, and I think that her compassion has been demonstrated by the fact that she called for this debate.
Over the past few years, debates in this House have successfully raised awareness of the importance of supporting families bereaved through a stillbirth and other types of baby loss. By speaking openly and sharing their personal experiences, Members of this House have helped to stimulate improvements in bereavement care, including the development of the national bereavement care pathway for pregnancy and baby loss.
Unfortunately, in the not so distant past, people thought differently. Until the 1980s and 1990s, bereaved families of stillborn children were kept in the dark by doctors and midwives, ostensibly for their own protection. It was assumed that if a mother or father was allowed to see their stillborn baby and establish any kind of connection with it, this would only prolong and worsen their grief.
When I was preparing for this debate, I was reminded of my own experience as a nurse. In 1976, I was working on a gynae ward, and I was asked to take receipt of a cot that was coming up from the labour ward. In the cot was a baby that was still alive, which I was told was to be returned to “Rose Cottage” and put in the sluice room. The baby went there until it died a few hours later. Remembering that experience of years ago and the work I undertake now on maternity safety show just how far we have come in the way we treat maternity incidents, newborn safety and mothers.
Many parents were never consulted over funeral arrangements for babies lost through stillbirth, with individual hospitals having to set their own procedures and their own means of disposing of bodies. That makes this difficult, because it means that there is not just one answer across the country. There is not a clear picture as the situation is very piecemeal. Many parents were never told what happened to the body of their baby or the location of any burial or cremation. People thought they were doing the right thing for the parents by not inflicting more trauma on them.
That is a generous interpretation. There was a slight culture in those days in which women were not regarded with the esteem that they are today. It was almost as though this was not just about protecting them, and that they were not worthy of being given the information, either. There are question marks over the explanation, and that has a lot to do with the status of women at the time and again today.
Dame Diana Johnson (Kingston upon Hull North) (Lab)
The Minister is making an excellent point about the culture and about how women were treated. With families now coming forward wanting information about what happened, does she feel that those women and families are being treated better now? Are they, for example, being given the opportunity to find out where ashes have been strewn without their knowledge or permission?
Ms Dorries
I certainly hope so. In fact, those parents and women who are coming forward now are enabling us to move along the pathway to women being given the full, correct information about what happens when a maternity incident takes place. We still have a long way to go, but, as I said at the beginning, the hon. Member for Swansea East is part of that process. The debates that we have here about baby loss are also part of that process. There is not one answer, one sledgehammer, that comes from the Department of Health and Social Care. Everybody has a role to play, because this is an issue that is spread over decades. It is about culture, and it is about the culture in hospitals today. It is about the esteem in which women and mothers are held within society. It is a complex picture with many parts, and everybody has an opportunity to play their part, as do those women who are now coming forward to ask where their babies’ ashes are.
Some hospitals arranged for stillborn babies to be cremated and told the parents that, because the baby was small, it would not be possible to recover any ashes. Even if ashes were recovered, their parents were not told. The ashes might have been spread in a dedicated garden of remembrance, but in other cases they might simply have been disposed of or kept in storage at the crematorium.
Over the past 20 years, we have heard about the discovery of mass graves containing the remains of stillborn babies in, among other places, Lancashire, Devon, Middlesbrough and Huddersfield. The 2015 review of infant cremations at Emstrey commercial crematorium in Shrewsbury found that, by using appropriate equipment and cremation techniques, it is normally possible to preserve ashes from infant cremations.
We now recognise that parents are committed and connected to their children long before birth—I think we knew that back then—perhaps at the point of conception or even earlier, when women imagine themselves being mothers for the first time. I am happy to say that, nowadays, parents of stillborn babies are able to be as involved in decisions about what happens to their baby as they choose to be. New regulations were introduced in 2016 to ensure that parents’ wishes for the cremation of their children are respected. The regulations introduced include a new statutory definition of what constitutes ashes or remains and require cremation request forms to be amended so that family’s wishes are explicitly recorded prior to any cremation.
Thanks to tireless campaigning by the hon. Member for Swansea East, the Government launched the children’s funeral fund last July so that bereaved parents do not have to worry about meeting the cost of burying or cremating their child or stillborn baby. The fund is available regardless of a family’s income and also includes a contribution towards the cost of the coffin. We have received over 1,000 claims to date, and I am sure that the hon. Lady must be incredibly proud.
The hon. Member for Swansea East called for this debate to consider what we in Parliament can do to help bereaved parents who did not have the opportunity to bury their stillborn babies and now wish to trace their final resting places. We know that parents never forget their babies, no matter how long ago their death occurred. Unfortunately, tracing a baby’s grave or a record of cremation may not be easy, and it can be a difficult time for people, both mentally and emotionally.
Records containing information about the locations of the remains of stillborn babies are not held centrally. Parents therefore need to start their search by contacting the hospital where the baby was stillborn, as I am sure the hon. Lady knows. If records are still available, the hospital should be able to tell parents whether the baby was buried or cremated and the name of the funeral director who made the arrangements at the time—if, indeed, a funeral director was involved. Hospitals do not keep records indefinitely, and some records may not contain enough detail to be helpful. The hospital where the baby was stillborn may have closed or the funeral director involved—if one was—may no longer be in business.
Cemeteries and crematoriums, though, are legally obliged to keep permanent records. If neither the hospital nor the funeral director has a record of which cemetery or crematorium was used, parents can contact local cemeteries and crematoriums, starting with those nearest to the hospital where their baby was stillborn. As I mentioned, in many cases stillborn babies were and may still be buried in a shared grave with other babies. These graves are usually unmarked, although they do have a plot number and can be located on a cemetery plan. In many cases, several babies were cremated together. The crematorium should have a record of where the ashes are scattered or buried, but I am afraid the emphasis is on the word “should”.
My sympathies lie with families who have had to deal with the pain of not knowing what happened to their children’s remains for so many years. It is hard for many of us to imagine how long that pain must last. The Department of Health and Social Care expects all hospitals to provide as much information as they have available to any parents who inquire about what happened to their stillborn babies, no matter how long ago they died.
Tim Loughton (East Worthing and Shoreham) (Con)
I echo the Minister’s tribute to the hon. Member for Swansea East (Carolyn Harris).
It is unimaginable to think that parents who lost their child through stillbirth were not even privy to the arrangements for the cremation or burial of that child’s body—it was a completely different world.
On the Minister’s last point about urging hospitals to co-operate as much as possible, there is a bigger issue in that some of these children may not have been stillborn. Where a child lived for a while, as in the case she cited from 1976. there are greater questions to be asked about the child’s birth in that hospital. As a result of my Civil Partnerships, Marriages and Deaths (Registration etc) Act 2019, coroners will have the power, when the regulations are introduced, to look at such cases. Does she agree that there is a serious question not just on the whereabouts of a baby’s remains but on the circumstances of that baby’s birth?
Ms Dorries
That is an entirely different question but, yes, I completely agree with the substance of my hon. Friend’s point. I am sure he contributed to the Government’s consultation on the proposal for coroners to investigate stillbirths, which closed on 18 June 2019. The consultation attracted over 300 responses from a wide range of stakeholders. Officials in the Ministry of Justice and the Department of Health and Social Care have been working carefully to analyse the responses received. The question of babies who were not stillborn but who lived for a period of time before they died is possibly worth considering.
Ms Dorries
I would like to begin by paying tribute to everybody who has spoken in the debate. The hon. Member for Swansea East (Carolyn Harris) is right: there are issues we discuss in this Chamber that transcend party politics. Indeed, party politics has no place in this Chamber when issues like this are discussed, and I hope that that has been demonstrated today.
I would like to pick up on a point that the hon. Member for Swansea East made about a lady who has come to the Public Gallery to watch the debate. If she would like to leave the Gallery after I have finished and make her way downstairs, I will meet her at the back of the Chamber and have a word with her.
I will comment on Members’ individual contributions before going on to my substantive response. I thank the hon. Member for Ellesmere Port and Neston (Justin Madders) for the compassion he has shown today. It is not always easy when we discuss issues that are so emotive, but I thank him for his understanding and the points he made. He asked about HSIB’s annual report, which was published in December 2019. As he probably knows, HSIB is a particular passion of mine, and we hope to have more news about it. The thematic maternity investigation report is expected to be published soon, and I am pushing for it to be published as soon as possible.
My right hon. Friend the Member for South Holland and The Deepings (Sir John Hayes) said that love lasts longer. I think that love lasts forever. When Martin and other babies are mentioned, they have their voices here. It is love that brings them into the Chamber, and that is why we remember them; may we continue to do so.
My right hon. Friend asked whether I could do more with local authorities, as they are responsible for this. Actually, this issue is the responsibility of the Ministry of Justice. I will raise this matter with my colleagues in the MOJ. Perhaps my counterpart in the MOJ and I could send a joint letter to local authorities asking them to assist parents who are trying to trace the remains of their lost babies. That might be a way to push local authorities to be more co-operative.
I turn to the comments made by the hon. Member for Kingston upon Hull North (Dame Diana Johnson). I have the notes from the meeting that she attended last July with my predecessor my hon. Friend the Member for Thurrock (Jackie Doyle-Price), the families, the chief executives of Hull University Teaching Hospitals NHS Trust, Hull City Council and Mrs Trowhill. I am informed that the trust and council agreed to give everyone affected as much information as they had available to them and that Mrs Trowhill agreed to share contact details. Following the promise that the trust made to set out exactly what processes are now in place to ensure that similar incidents cannot happen in the future, could the hon. Lady let me know whether Mrs Trowhill is happy with how far the trust has gone and the service she has had from it?
With regard to the independent local inquiry, I imagine that there may be a sensitivity around that, because some women or girls who had babies at the time may have done so without family members or other people knowing. That may be an issue that lawyers have considered. I have no idea why it costs so much, but that may be one way to help in a particular area where there has been a problem, such as the hon. Lady’s constituency.
Dame Diana Johnson
The issue raised with me as to why a local inquiry could not take place was that the local authority did not have jurisdiction over the NHS. Could the Minister say something about the co-operation that I am sure the NHS would want to extend to any local inquiry?
Ms Dorries
The hon. Lady is right; the NHS trust has the ability and the jurisdiction to conduct its own inquiry. I believe that NHS Improvement would have a similar responsibility. As a result of today’s debate, I am going to investigate a little more deeply within the Department how we can go about having an inquiry and what the terms of reference would be. It may be that such an inquiry is not possible, but I will certainly find out whether it is.
My hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) asked for an update on the pregnancy loss review. I attended the APPG on baby loss a few weeks ago. We expect the report being done by Zoe Clark-Coates and Samantha Collinge to be published in spring/summer, and we expect to publish a Government response to the consultation in spring going into summer. Again, I will push and see how much longer that will take.
Tim Loughton
The problem is that nothing has been agreed, because the pregnancy loss review group has not met since 2018. If a report is imminent, it has not been approved by the panel members, including me and the hon. Member for Washington and Sunderland West (Mrs Hodgson). I do not know what will be presented to the Government before they can even respond. The Minister might want to investigate how the group came to conclusions of which we know little.
Ms Dorries
I will. If my hon. Friend drops me an email at my departmental address, we will look into that, and the officials will take it away. I am grateful to him for raising that, because I was not aware of it.
I do not think I have missed out anyone who made a speech. We have heard today how important it is to many parents to find the final resting place of their stillborn children’s remains. Unfortunately, that is not always easy or possible, and I have explained that such records are not currently held by the Government. Rather, they are held by local hospitals that arranged for burials or cremations with local funeral directors or crematoriums. In some cases, records no longer exist, or they may not contain enough detail to be helpful.
Nevertheless, I reiterate that the Department of Health and Social Care expects all hospitals to provide as much information as they have available to them to any parents who inquire about what happened to their stillborn babies, no matter how long ago they died. I would like to praise the 800 parents who have attempted to find out where their babies’ remains are, because they have helped to raise the profile of this issue. As the hon. Member for Swansea East said, only by raising the profile do we manage to get something done. We need to continue to do that, because that is how we will make progress.
We have also heard today about the new regulations and systems to ensure that parents are involved, as they want to be, in the burial or cremation arrangements for their stillborn children. Parents are required by law to register a stillbirth, and once registration has been completed the registrar provides parents with all the certification they need to organise their babies’ burial or cremation, and a funeral service if they so wish. The required burial and cremation forms ensure that the wishes of parents are recorded and respected. Many NHS hospitals still do make arrangements for funeral services and support parents to consider various options and to make the decisions that are right for them. Some parents may wish to arrange a private burial or cremation with a funeral director. Most funeral directors do not charge for their services for stillborn babies. Thanks to the hon. Lady’s efforts, the new children’s funeral fund supports parents, as I said in my opening speech.
A funeral can sometimes be a catalyst for people to begin processing a deeply profound loss. At such a time, parents mourning their stillborn baby need as much emotional support, compassion and understanding as possible. However, the quality of support can vary from one maternity service to another. This is why the Government have funded Sands, the stillbirth and neonatal death charity, to work with other baby loss charities and the royal colleges to produce a national bereavement care pathway. The pathway covers a range of circumstances of baby loss, including miscarriage, stillbirth, termination of a pregnancy for medical reasons, neonatal death and sudden infant death syndrome. The NBCP is now embedded in 43 sites, and a further 59 sites have formally expressed their interest in joining the programme.
I would like to talk a little bit about mental health support. The hon. Member for Kingston upon Hull North is a campaigner on this, and she raised mental health during her speech. A couple of weeks ago, I visited nurses who are delivering perinatal mental health care support. As part of the new approach to and new funding for mental health, there are now specialist perinatal mental health community services in all 44 local NHS areas in England, and further developments are planned. Just in 2018-19, this has enabled over 13,000 additional women to receive support from specialist perinatal mental health services, against a target of 9,000.
I spoke to the nurses about the perinatal services that are being delivered, and in that particular trust they have helped 700 women who previously had no assistance whatsoever. It was incredible to hear the stories of how that assistance—the mental health support—is now being given to women. As I have said, all trusts now have in place those perinatal support services, which were never there before. Again, that is a huge step on the path towards delivering services that are focused on women and their needs.
Via maternity outreach clinics, we are also providing targeted assessment and intervention for women identified with moderate or complex mental health needs arising from or related to their maternity experience who would benefit from specialist support, but where it may not be appropriate or helpful for them to accept specialist perinatal mental health services, so we are even thinking further than that. In those services we are also assisting partners and families, so it is not just for the women, but for their partners and families.
A huge amount of work is being done in this area. I am not saying that we have finished—there is more to be done—but we are making progress. This actually fits in very well with our women’s agenda in the Department of Health and Social Care. The women’s agenda is not just about periods and menopause; it is about so many things. The particular area we are discussing today is a huge part of that.
Hon. Members present for the Baby Loss Awareness Week debate last October may recall that I undertook to write to Professor Jacqueline Dunkley-Bent, the chief midwifery officer in England, to ask if those bereaved by baby death could be included in the NHS long-term plan commitment to develop maternity outreach clinics that will integrate maternity, reproductive health and psychological therapy support for women with mental health difficulties arising from or related to the maternity experience. I am delighted to tell the House that I recently received a letter from the chief midwifery officer confirming that access to these services is available to women and their partners who are experiencing moderate or complex/severe issues, so we have listened and we have addressed that need. At this point, I should pay tribute to Professor Jacqueline Dunkley-Bent for her understanding of and support for my role in helping to deliver better services to women.
As I have said, a funeral can often be a catalyst for helping people to deal with death and stillbirth death, and I believe that that is so important today. It used to be about protecting women or just not holding them in high enough esteem to inform them about what happened, but we now know that actually the opposite is true. As my hon. Friend the Member for East Worthing and Shoreham mentioned, it is important to be involved not just in the death, but in what happened before, during and just afterwards. The question parents have at a time like this is: why? That question needs to be answered, and it does not get answered in a sentence or in a minute. Parents need to know and women need to know. They can only feel as though they have fulfilled their own responsibility to their child when they have explored every avenue and know every detail of what happened.
Jim Shannon (Strangford) (DUP)
This debate has been specific to England, Scotland and Wales, and not necessarily about Northern Ireland. I congratulate everyone who has made a speech on their very valuable contributions. After this debate, could the decisions, conclusions and the way forward on the strategy be conveyed to Northern Ireland, where this is a devolved matter, so that we can all work together to help everyone?
Ms Dorries
The hon. Member is quite right that this is a devolved matter. However, this is an issue that affects all women in the United Kingdom. He is quite right, so I will ask my officials what discussions take place with the devolved Assemblies and come back to him.
The stillbirth rate in England is falling. As I am sure the hon. Member for Swansea East knows, it was our intention to reduce the 2010 rate of stillbirths by half by 2025. I am delighted to report that we are ahead of that target: in January 2020, we were already ahead of what we are trying to achieve. Since my appointment as the Minister with responsibility for both maternity and patient safety, I have seen for myself how NHS maternity services in England are working hard to ensure that the care they provide is safe and personalised to women’s individual needs.
Many measures have been introduced in maternity services that are achieving this reduction in the rate of stillbirths, and the issues raised in debates such as this on baby loss also make a contribution. We all know that applying pressure and raising the issue pushes the agenda further along.
The efforts have resulted in a 20% decrease in the stillbirth rate between 2010 and 2018. Between 2016 and 2018, there were 760 fewer stillbirths in England than in 2015. That is an enormous achievement, and something that we should be very proud of. There are 760 fewer families who have to go through the painful experience of planning a funeral for a much-loved and wanted child. I think we all know that there is nothing more painful for a woman or a couple than to go into hospital to have their baby and to leave with empty arms and broken hearts. The fact that 760 fewer families are doing that now, as a result of the measures that have been introduced, is a huge achievement.
In closing, I pay tribute to the initiatives that have been stimulated by Members of this House to improve support for families experiencing a stillbirth. These include the national bereavement care pathway, the children’s funeral fund and the Parental Bereavement (Leave and Pay) Act 2018, which provides for at least two weeks’ leave for employees following the loss of a child under the age of 18 or a stillbirth after 24 weeks of pregnancy.
I also pay tribute to the clinical professionals and support staff working in acute and community maternity services. They work incredibly hard. I visit these maternity units and meet amazing midwives who dedicate their lives to being in that room at that moment when a baby is born, to ensure a safe delivery. Through their efforts, many more women and babies are being supported to have a healthy pregnancy, labour and birth. They will be supported nationally by the maternity transformation programme, which will continue to oversee the implementation of maternity safety initiatives, including those published in the NHS long-term plan and the new NHS patient safety strategy, published last July.
I would like to conclude by thanking the hon. Member for Swansea East yet again—we are truly in her debt for the issues she raises in this place—and my right hon. Friend the Member for South Holland and The Deepings for supporting her, or for being her acolyte, as he described himself.
Question put and agreed to.
Resolved,
That this House has considered historical stillbirth burials and cremations.