Historical Stillbirth Burials and Cremations

Tim Loughton Excerpts

Thursday 6th February 2020 Commons Chamber

[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.

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[Tim Loughton]

My right hon. Friend makes a good point about fathers. We talk a lot about the perinatal mental illness suffered by at least one in six women—and much more is being done about that—but it is less known that many fathers, particularly new fathers, suffer from perinatal mental illness as well. The impact of losing a newborn is of importance not just for the mother but equally for the father. We forget that at our peril.

[Sir John Hayes]

My hon. Friend, who served with me in the Department for Education, where he was responsible for matters concerning children, has a long track record of defending the interests of families and fathers. I pay tribute to that and entirely endorse what he has just said. Grandparents also feel these things very deeply. My children are only 19 and 15, so I am not enjoying grandparenthood yet, but those Members who are will know quite how profound their involvement is and their distress at loss can be. I entirely agree with what has been said about counselling, support and mental health.

I hope you will forgive me, Madam Deputy Speaker, for saying a word about public health funerals, a parallel but closely related matter on which the hon. Member for Swansea East and I have also co-operated. Councils in the UK spend about £4 million a year on nearly 15,000 burials or cremations for those with no next of kin or whose families are unable or unwilling to pay. They are known as public health funerals, although rather chillingly they are sometimes described as paupers’ funerals, which sounds so Dickensian, does it not? None the less, public health funerals are held for about 3% of all deaths, and there are real concerns about poor practice. The number of public health funerals has increased dramatically since 1997.

Tragically—in some cases councils are providing the bare minimum provision. Some of these funerals are held behind closed doors and families are prohibited from attending. There are instances of councils refusing to return ashes to families, even when requested. Sometimes, loved ones are not told when the funeral is going to take place, so they do not even know whether their loved one has been buried or, in most cases, cremated. I take this opportunity, with your permission, Madam Deputy Speaker, to call again on the Government to communicate with local authorities about the strict need to ensure that these funerals are dealt with in a decent, civilised and humane way. I am not confident that that is happening across the whole country, and it needs to do so without further delay.

I know that other Members want to contribute, so I shall draw my remarks to a conclusion simply by saying this. I spoke earlier of the Dickensian character of paupers’ funerals. Dickens said:

“A loving heart is the truest wisdom.”

Love is greater than life because love lasts longer and, because it does it should be at the heart of policy makers’ considerations when they deal with the highly important, very sensitive and profound issues that we debate today.

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[Tim Loughton (East Worthing and Shoreham) (Con)]

I had not intended to speak in this debate, but, as is usual with subjects brought here by the hon. Member for Swansea East (Carolyn Harris), it is difficult to resist; they are always such important and emotive issues, and the contributions we have heard have only heightened that fact. I also pay tribute to the sensitivity and real-world personal knowledge that the Minister has brought to this debate, and indeed to everything to do with children and babies generally. It greatly heightens the worth of what we do here.

Stillbirth, a hugely underappreciated subject, has been disproportionately debated in the Chamber in recent years, thanks to the brave personal testimonies of many right hon. and hon. Members whose families have been affected by baby loss in such tragic ways. Their contributions have been hugely valuable and moving, but, more importantly, have led to changes in legislation and greatly raised the profile of this important issue. It is an example of some of the great but underappreciated things we do in the House, and this is another great opportunity for us to do good on a really important issue.

My right hon. Friend the Member for South Holland and The Deepings (Sir John Hayes) was right to mention the connection with mental illness, particularly around extended family members. Too often we look at mothers in isolation, with all the problems of pregnancy and childbirth, whether it is a healthy child or a stillborn child. We need to do more, as a society and as a Government, to think of the family in the round and the implications and impact that the tragedy of stillbirth can have on others, besides the mother.

We have made great progress in legislation in recent years, but, more importantly, we have made much progress in the sensitivity with which hospitals treat bereaved parents. We have legislated for bereavement leave, for example, but we should now consider extending that to this area as well. We have maternity and paternity leave, but losing a baby is hugely traumatic and impacts on the ability of parents to work normally afterwards.

I recently visited again the new bereavement suite in Worthing Hospital, which is officially the best hospital in the country with what is officially the best maternity department in the country. The bereavement suite is a fantastic facility. It is hard to imagine that until a few years ago mothers who had sadly just given birth to a stillborn child, or a child who died soon after, would be left within hearing range of children who had fortunately been born healthy to a mother in the same ward. Greater sensitivity is now shown throughout the whole NHS. It was great to visit that example of how well we now look after parents who tragically cannot take their child home with them.

It was through Worthing Hospital’s maternity department and the experience of my constituent Hayley from Worthing that I became much more familiar with the issue of stillbirth. She came to me to say that she had given birth to a stillborn child at about 19 and a half weeks at Worthing Hospital. She had been there in labour throughout the weekend and had gone through all the pains and anguish of giving birth to a stillborn child. That led to my Civil Partnerships, Marriages and Deaths (Registration etc) Act 2019 and a debate about the whole issue of how we look at and recognise the existence of children stillborn before the 24-week threshold.

Hayley’s experience goes back to the extraordinary revelations we have heard already about how we used to deal with stillborn babies and how the parents had no involvement. Once a woman was delivered of a stillborn baby, any authority or interest the parents had in that child apparently came to an end. It was an extraordinarily brutal and inhumane approach. In the case of Hayley, she and her partner held the child, named the child, had a formal funeral for the child and now know where the child is buried and can mourn. That has been part of the grieving process for them. It is right that the parents be able to do that, if it is their wish; they got the footprint and the photographs, and that was right for them.

The tragedy still is, however, that that child never existed in the eyes of the state, because he happened to have been born before the 24-week threshold, and that is what the 2019 Act aims to address. I wish to make a plea to the Minister. Section 3 obliges the Department of Health and Social Care to conduct a review into how we can do something about pre-24-week stillbirths—they are not technically called “stillbirths”. To give him his due, the former Secretary of State, my right hon. Friend the Member for South West Surrey (Jeremy Hunt), set up the review before the Act became law—I sat on and contributed to it, along with the hon. Member for Washington and Sunderland West (Mrs Hodgson)—but it has not met since 2018 and no subsequent review has been forthcoming. We still need to sort this out, because too many babies are being born just before 24 weeks. In previous debates, I have given examples of children born at 23 weeks, six days and a few hours. In one case, twins were born either side of the 24-week threshold. One was recognised and registered and one was not. This is an anomaly and an inhumanity and it is so important that we deal with it. I urge the Minister to inquire into where we are with the review.

We talk a lot in the House about historical injustices—this debate is technically about historical injustices, although we have spoken more about the present. I think of the historical child sex abuse scandal, the inquiry into which will go on for many years, but there are also parallels with the forced adoptions that occurred many years ago, when women, in an era of different morals, were forced to give up babies born out of wedlock. Many of those children ended up in Australia. There have been many reviews into how that was allowed to happen and into helping those children to re-establish connection with their birth parents.

What downside can there be to giving every assistance, difficult though it may be, to parents who, after having a stillborn child, were given no role in what happened to the body and have no knowledge of where the child’s remains are? I acknowledge that, as the Minister said, it would be difficult, particularly going back several decades, but we must make sure that hospitals, crematoriums and other public agencies do everything they can to respond sympathetically and extensively to queries from those people, just as we have done with child sex abuse and historical forced adoption.

The point I raised with the Minister might meet with some reluctance in some hospitals where practices were not of a quality we might have expected. Another section in my Act empowers coroners for the first time to investigate stillbirths. At the moment, they cannot do that, because a child who is stillborn is deemed never to have lived, and coroners can only investigate the deaths of humans who have lived. In a minority of cases—this practice was not extensive—children born alive have been designated as stillborn to avoid investigation through the coronial system. There is no reason why, once the further regulations are passed—I hope they will be soon; the Minister is right that the consultation ended last June—that we should not get on with giving coroners the power to investigate where they have reason to suspect that a stillbirth is not as simple or straightforward as it appears and that there might have been some medical negligence, oversight or whatever. If there were clusters of unexplained stillbirths, people might be reluctant to be co-operative in tracking down the details of what happened to that child and afterwards. I would hope, in the interests of providing parents who have already suffered a loss with some degree of closure, at least on what happened to the body of that child, that everyone involved in the national health service and other public agencies would want to be as co-operative as possible.

[Sir John Hayes]

I asked the Minister to consider new guidance for local authorities about both past and present practice, and perhaps my hon. Friend might echo that call by suggesting that the Government should make direct and urgent contact with health authorities, for exactly the reasons he has described, with the same kind of vehemence.

[Tim Loughton]

That is really the point that I was looking to make, but my right hon. Friend has done it much more clearly.

If it had not been her intention already, perhaps a takeaway from this debate for the Minister might be to send a communication around maternity departments, and indeed local authorities responsible for crematoriums and others, to express the hope that they would co-operate and to set out the exact extent of the potential issue that we are dealing with.

[Patricia Gibson]

To take the hon. Gentleman back to his earlier point, does he agree that the whole thrust behind instituting coroners’ inquiries—or, in Scotland, fatal accident inquiries—when these events happen is, added to the trauma, the complete lack of co-operation or willingness by hospitals to engage with parents in the appropriate way to give them the answers they need, as was certainly my experience?

[Tim Loughton]

That is right, but again, to give the Department of Health, the NHS and Ministers their due, there have been new innovations in internal inquiries into stillbirths that have made it much easier to get a dispassionate look at exactly what happened and give a full explanation of why it was that a pregnancy apparently without complication resulted in the child being stillborn.

The issue, and the reason my Act is so important, is that in a few complicated cases where the explanation is not sufficient for parents or where not enough disclosure is forthcoming—there has been some resistance from the medical profession; some were not in favour of the relevant clause—the fallback position is that if the coroner sees that there is a case to answer, he or she can launch an investigation, regardless of the view of the hospital or, importantly, of the parents, into whether there was more to the stillbirth that merits inquiry and whether there might be wider lessons, particularly with clusters of stillbirths, as we have had with various scandals in hospitals in this country, to ensure greater transparency.

I think the point I am getting at is that it is in everybody’s interests to have greater transparency, to ensure that we reduce the level of stillbirths, which has been too big a problem for this country compared with other western countries, and we can only do that if everybody has full access to all the information about exactly what the causes might have been. That is my ask of the Minister. Can we chase the Department on why the other bits of my Act have not been introduced yet?

I again pay tribute to the hon. Member for Swansea East, who we are all looking forward to hearing, for bringing together the House on another greatly important matter—a matter that may seem of niche interest, but which is of huge interest to parents who have had their lives so affected by the trauma of a stillbirth, particularly where they do not even know what happened to the body of the baby.

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[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.