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 was 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.
The Minister is making an excellent point about the culture and about how women were treated. With families 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?
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.
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?
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.
I do not normally start with warm words about a Minister’s speech, but what we have just heard shows great empathy for and insight into an incredibly difficult subject. I thank her for her introduction.
I express our sincere condolences to all parents who have not only suffered the loss of a baby or infant but have been denied the opportunity to grieve when their child was buried or cremated in an undisclosed place or when they did not receive their child’s ashes following the cremation. That should never have happened—it was wrong—and I am sure all Members on both sides of the House will wish to join me in extending our sympathy and full support to all those bereaved parents who found themselves in that totally unacceptable situation.
Each year, thousands of people sadly experience the loss of a baby in pregnancy, soon after birth or in infancy, and the feeling of loss and isolation can be overwhelming for bereaved parents. Nothing can remove that pain and grief, of course, but we know from evidence that good bereavement care can make a very real difference to the experience of parents and families at such a tragic time, which is why what we have heard already today has been so powerful.
Not so long ago, things were very different for parents who lost a baby during pregnancy or shortly after birth. Indeed, as we have heard, many hospital staff had to quickly remove the baby, and the parents were sent home to try again. Fortunately, this is not something everyone has to think about, but the law is clear on what must now happen to babies who are stillborn after 24 weeks of pregnancy or who die in infancy: they must be buried or cremated, and cemeteries and crematoriums must keep records of those burials and cremations.
Before the mid-1980s, it was often hospitals that took care of funeral arrangements for stillborn babies and for babies who died shortly after birth, and we know that parents were often not consulted or involved in those funeral arrangements. We can all see now that that was not the right approach.
We all agree that the woman, and indeed the whole family, should receive that psychological support if they need it, but just saying it does not mean that this help is getting to the people it should be reaching. In many cases, people find it almost impossible to get that support.
I thank my right hon. Friend for his intervention, as he raises the very point: the support is not consistent across the piece. We rightly raise that issue when we discuss these matters, because we need better support, better funding and better delivery of these specialist services. As he says, this is a difficult issue and support is needed at the right time.
I am pleased to hear what our Front Bencher is saying about this important subject, but I want to develop this point about mental health support. For families who have suffered and do not know where their baby’s ashes have been strewn, asking the local council to make inquiries, as happened in Shrewsbury with the Emstrey inquiry, goes some way to seeing whether there are answers to the questions they still have. Will the shadow Minister commit his support to local authorities that want to carry out these independent inquiries, to give whatever closure they can to families by trying to get the information they seek?
I thank my hon. Friend for her intervention. I know about the work she has been doing in Hull. She has articulated in the past why it is clearly important for such inquiries to take place and how it is the most effective way for families to achieve closure on these difficult issues. I am certainly in support of what she says.
The availability of talking therapies for bereaved parents is not how it should be. Nearly nine out of 10 clinical commissioning groups do not currently commission talking therapies specifically for parents, and where the services do exist they are usually only for mothers. We need to do better than that. Of course, I acknowledge that there is much good practice out there, but Members will know that it is often reliant on charitable grants and third parties. That is one of the main reasons why provision is patchy and at risk from wider funding decisions. I therefore ask the Minister to undertake a review of the current provision, including an evaluation of the models of best practice. Will she ensure that parents and professionals are involved in that exercise? The Minister was absolutely right to identify that when she talked about the culture in the past.
We also need to acknowledge that although the culture today has definitely improved, it is still not where we would like it to be. As we know, most of the time those whose loved one has been involved in a tragedy in the health service just want to know why it has happened and how it can be prevented from happening again. The former Health Secretary, the right hon. Member for South West Surrey (Jeremy Hunt), has on several occasions addressed the need for us to move away from a blame culture and towards a learning culture, so that when things go wrong there is proper analysis of why things have happened and we understand how we can prevent those things from happening again.
Only this week, I have heard from a constituent who has lost a lot of faith in the system in terms of getting to the truth about what happened to one of their family. They commented that the trust seemed to spend more money on lawyers than on actually uncovering the truth, and that should not be happening. We need to move away from the defensive culture that we see on occasions. I hope that we can look at that issue, possibly through the Select Committee, because there is still a temptation for trusts to lawyer-up at the first sign of concern. Most of the time, parents and family members want answers.
“The real voyage of discovery consists not in seeking new landscapes, but in having new eyes.”
My eyes were opened to the subject by the hon. Member for Swansea East (Carolyn Harris), since when we have worked together to bring about the children’s funeral fund—under her leadership, by the way; I was merely her acolyte. In doing that work, I became interested not just in that subject but in the whole matter of how people are dealt with when they die and how their loved ones are treated. There is much to be said on that, but time does not permit us to say it all today, for this particular debate is of course about stillbirth and lost children.
The Minister rightly said that things have improved. Some of this issue relates to the past—what happened to those who were loved and lost in years gone by—but I implore the Minister to reflect on whether it is possible for us to do more with local authorities, which are responsible for these matters, because, as she said, cemeteries maintain records, and cemeteries lie within the purview of local government. Perhaps further work can be done to impress on local authorities the need to make information available. Furthermore, in respect of people who are stillborn now, perhaps we could be certain that all health authorities are doing their best. I agree that things have improved, but we need to make sure that that improvement is consistent throughout the country.
In respect of the support given to those who have lost, as a number of Members have said, we need to ensure that the counselling, which makes so much difference, is readily available, quickly, and to whole families. Much is made of maternal love, and rightly so, but too little is made of paternal love. It is sometimes underestimated and often under-celebrated. The love of fathers and grandparents needs to be taken into account, too. Support for whole families when these events occur is critical.
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.
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.
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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.
The bodies of the babies were cremated, buried or put in a communal plot. In some cases, the bodies were placed in a coffin with a woman who had also recently passed away. Shockingly, information was not shared with either family in that situation. Many parents were not told what happened to their baby’s body when they were buried or cremated.
If the baby had been cremated, not all parents received their baby’s ashes. Some parents were wrongly told that there would be no ashes, and in some cases when ashes were recovered, they were disposed of without the parents’ knowledge. Again, we all now find that shocking, and it is extremely hard to fathom why it was allowed to be the practice at the time.
At this juncture, I echo the Minister’s tribute to my hon. Friend the Member for Swansea East (Carolyn Harris) for calling the Government to account and securing this debate. She has been a tireless campaigner for bereaved parents and, of course, she brings her own deeply moving personal experience to this place. She articulates why this is such an important issue in a way that only those who have suffered personal tragedy can and do. She is entirely right to demand help and support to enable the parents of stillborn babies to trace their graves so that they can finally commemorate their loss. It is only right that we do all we can do to support these bereaved parents, having failed them in the past.
I also want to commend all the brave individuals and families who first brought these issues to light, and those who have taken part in inquiries and consultations, sharing their own painful experiences, which we know would have been difficult, to ensure that lessons are learned and that no other families have to go through what they have gone through. I should also mention those who have worked selflessly and tirelessly to help bereaved families to trace their lost babies, as we are grateful for their efforts and extend our gratitude to them. I think we all agree that these people should never have been put in that position.
Thankfully, since the 1980s there have been significant and positive changes in the way those families are now treated. There is a much greater understanding that the care bereaved families receive from healthcare and other professionals following the loss of a child can have long-lasting effects. Indeed, the need for psychological support following pregnancy loss and stillbirth is recognised in the National Institute for Health and Care Excellence guidance, the “Better Births” report, the maternity transformation programme and the NHS long-term plan. All those documents rightly highlight the need to improve perinatal mental health care. However, we must ensure that those plans translate into action and that the needs of bereaved parents are explicitly addressed in quality standards, national guidance, training for healthcare professionals and guidance for local services. It is important that all parents who experience pregnancy and baby loss and need specialist psychological support can access it in a timely fashion.
We know that, unfortunately, good practice is not consistent across the board and we need to aim to ensure that it is. Too often, people who experience a psychiatric illness after their loss do not receive the support they need. Most mental health support is available only to mothers and is focused on women who are pregnant or have already lost their baby. As discussed in the annual baby loss debates, we urge the Government to develop a national standard, with guidance.
Back in October we heard that the Healthcare Safety Investigation Branch annual report would share some of the learning about the more than 1,500 individual cases in which something has gone wrong in one trust. I hope that report will be available shortly. I think the quote was that it was going to be available in “early 2020”, so when she responds will the Minister update us as to when we can expect to see it?
Finally, although we rightly focus on the families in this debate, we must also not forget the impact on staff, some of whom will regularly have to deal with tragedies. The Minister set out clearly what that looks like. It is important that their voice is heard in this debate as well.
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.