(8 years ago)
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Mark Pawsey (Rugby) (Con)
I beg to move,
That this House has considered delays between death and burial or cremation.
The purpose of this debate is to consider the increasing amount of time that is now occurring between a person dying and their subsequent burial or cremation. The subject was considered by the all-party parliamentary group on funerals and bereavement, which was founded in 2002 to examine issues of concern to parliamentarians and their constituents. Of course, the group brings together Members of both Houses, representatives of the funeral director profession and representatives of bereaved people. The report on delays originated in the previous Parliament at the instigation of Paul Goggins MP. We all remember him well as the Member for Wythenshawe and Sale East from 1997 until his untimely death in January 2014. At various meetings of the all-party group, he raised issues related to delays and their impact on people who had lost loved ones.
The report was commenced under the chairmanship of my predecessor as chair of the all-party group, Lorely Burt MP, now Baroness Burt. We held evidence sessions in July 2014 and January 2015, and we published our report in December 2015. We have had three ministerial responses since the publication of our report. The Under-Secretary of State for Health, my hon. Friend the Member for Ipswich (Ben Gummer), addressed death certification issues, including the role of the medical examiner within the national health service. The Under-Secretary of State for Communities and Local Government, my noble Friend Baroness Williams of Trafford, addressed crematoriums and burial facilities. We received an extensive reply from the Under-Secretary of State for Women and Equalities and Family Justice, my hon. Friend the Member for Gosport (Caroline Dinenage), and I am delighted that she is here today. She addressed legal issues and the provision of services that are legally required.
The objective of today’s debate is to highlight some of the issues raised in the report and, in addition, to provide an opportunity for the Minister to update the House on the measures she mentioned in her letter of three months ago. I note that she will respond purely on those matters for which the Ministry of Justice has responsibility. The all-party group will continue the dialogue it has already started with Ministers in other Departments.
At the outset, it is useful to consider why the report was necessary. It is accepted that the time taken between death and a funeral or cremation is getting longer. We received written evidence suggesting that the average time between death and burial or cremation is some 15 days, which was pretty standard in the submissions we received. Witnesses, however, noted that the time could vary significantly based on factors in the local area, whether the death was expected and whether the death occurred at home or in hospital. There was consensus among our witnesses that the time had increased in recent years. One witness suggested that the time had increased from some 10 days in 2003 to 15 days in 2013, which is an increase of five days, or half again as much, over a period of 10 years. Another witness noted that, between 2012 and 2014, an average of two days had been added to the process.
There is a problem in measuring the change in time, because central statistics are not collected. Although some funeral directors collect those data, the figures cannot easily be broken down to show which aspect of the process is causing delays. The national medical examiner told the all-party group that the new death certification system is likely to add half a day or so to the current average time. He was at pains to express it as an average so, in some instances, we can expect the process to take longer.
In 2015, the National Association of Funeral Directors surveyed its members and it identified that families were waiting increasingly long to see a registrar after a death. Almost 70% of members reported that waiting times had increased over the previous year, with 49% of families waiting at least three days for an appointment and 15% waiting more than five days. A survey of National Association of Funeral Directors members this month revealed a complex picture of the effectiveness of coronial services across England and Wales, with, regrettably, only 41% describing their local coronial service as good or very good. Thirty per cent. described their local coroner as providing a satisfactory service, and 27% described the service as unsatisfactory or very unsatisfactory. That is one area of concern.
The all-party group took evidence from a range of witnesses involved in the process, including bereavement support groups, funeral directors, faith groups and organisations representing coroners’ staff, pathologists, crematorium staff and cemetery management. There is consensus among those working in the sector on the increasing time between death and burial or cremation, and we heard a number of reasons for why that might be, including increased pressure on registration and death certification services, a lack of communication and co-ordination between the organisations involved in certifying a death, and a lack of core crematorium slots.
Our report contained 13 conclusions and recommendations, and I will pick out three key ones. First, we urged the Government to review their post-mortem arrangements. The implementation of death certification reforms provides an opportune moment to assess whether the current fee of £96.80 for a post-mortem examination is sustainable. The all-party group would welcome an assessment from the Government on whether sufficient pathologists are being trained in autopsy to cater for future demand, as the requirement to study a post-mortem module has been removed from the appropriate syllabus.
Secondly, the Government should undertake a comprehensive review of the current state of burial and cremation in the UK, including an assessment of the projected capacity needs for the next 50 years and a review of barriers to developing crematoriums and cemeteries. New crematoriums are being developed. I am proud that a new crematorium has opened in my constituency of Rugby in the past few years, and it is an excellent example of the local authority working jointly with the neighbouring authority, Daventry District Council. We have a facility in my constituency of which we can be proud, so it is possible for additional facilities to be provided.
Thirdly, we urged the Government to publish their proposals on death certification reform and to ensure that they address two key issues: reducing the number of people involved in the certification process; and enabling the provision of certification outside regular working hours. On the latter matter, since our report was published, we have held a feedback session with the various witnesses who came along to give evidence in order to review the responses we received from Ministers. Concerns were raised in that session about the comments of the national medical examiner, Professor Peter Furness, who said that, on average, the new death certification process
“is taking approximately half a day longer than the old one”.
There is a feeling that half a day is something of an underestimate. The all-party group is pleased that a number of consultations have been announced since the report’s publication. We are keen to see them resolved, particularly the consultation on death certification reform by the Department of Health and the consultation on crematorium provision and facilities by the Department for Communities and Local Government. We are also pleased that the Ministry of Justice has been consulting on an out of hours coroner service, and we are keen to see the outcome of that consultation; I hope that the Minister can provide us with an update.
As I said, we held a feedback session, which produced two conclusions. One conclusion that might be of concern to the Minister was the feeling among those in the sector that none of the ministerial responses inspired confidence that the Government understand that bereaved people, those who have lost a loved one, are at the centre of the system. The belief was that things are process-driven, that it is a matter of numbers and that there is a lack of understanding that people are affected. The feedback session’s second conclusion was that the Government must focus on ensuring that all Departments involved in the death process work together more coherently, and that that culture change must be instilled in every organisation involved, whether in central Government or local government.
We picked out one or two additional observations. In respect of the out of hours issue, we know that the NHS is moving more towards a seven-day service, and it is believed that death facilities should do the same, so that out of hours service is available for those who need it. Many attendees at our feedback meeting highlighted the lack of consistency among coroners’ offices in terms of contact practices and the ability to offer non-invasive autopsy options. In particular, some witnesses highlighted that some coroner offices would not speak to funeral directors but wanted email communication instead. They advised us that emails sometimes go unanswered.
A number of witnesses highlighted that they increasingly struggle to get access to some mortuaries when several are run by the same NHS trust. It is believed that, to save costs, some trusts reduce the opening hours for each mortuary, meaning that bodies can be unavailable for days at a time. Our attendees noted that, although 80% of deaths occur in hospitals, as far as they are aware, medical professionals are not given training in the death certification process and what best practice looks like. Our previous chair, Baroness Burt, disagreed with DWP Ministers’ assessment that the funeral payments system is fit for purpose.
I have a number of questions to which I hope the Minister can respond in the time available, particularly about improvements to the coroner out of hours service, to which I have referred and which we are interested to hear about. I understand that she has met with the Metropolitan Police Service to consider an across-London out of hours coroner service. If she cannot respond to my specific question now, perhaps she could respond in writing to the all-party group on that and on other questions in due course. Has her Department assessed how the coroner service and other organisations involved in the process will work alongside a seven-day NHS?
This issue came out of several of our meetings: would it be possible for a simple flowchart to be made available so that people could see clearly the process after death? It would give both bereaved people and policy makers a better understanding of what is going on to have some explanation of the path towards a funeral. A graphic representation may help policy makers to identify which processes are causing delay.
Our inquiry was interesting, and we came up with a number of recommendations and developments. It is clear that the delays are causing great distress to many people, not least many in our faith communities, who for faith reasons are anxious for burial or cremation to take place more promptly after death. I hope that, when the Minister rises to bring us up to date, she will be able to reassure the many people to whom we spoke that the Government take these issues seriously and that the delays that have increased in recent years might be reduced in order to minimise the distress caused to bereaved people.
Graham Stringer (in the Chair)
Before I call the hon. Member for Hendon, does he have permission to speak from both the proposer of the debate and the Minister?
Dr Offord
I am grateful to you for allowing me to speak, Mr Stringer. I am prompted by events this weekend. Both the Jewish and Muslim traditions require that burial take place as soon as possible after death, preferably within 24 hours, but the process is sometimes affected adversely by the unavailability of any coroner out of hours, the absence of an appropriate doctor or the lack of available facilities in local authorities for rapid registration. It has been a problem and a cause of concern in my constituency; I raised the issue on the Floor of the House only this January, asking what provisions the Government are making to ensure that such services are available.
In the last week, a constituent of mine has been involved in a very difficult process. Liora Rosenberg was on a life support machine in Hampstead at the Royal London hospital. Unfortunately, on Saturday night she died. To compound her untimely death at the age of 20, her parents were unable to obtain a death certificate over the weekend, meaning that burial is being delayed; the coroner for the Royal London hospital will not consider engaging with the issues surrounding Liora’s passing out of hours. It is adding to the grief of her family, who cannot commence the formal shiva—the Jewish period of mourning—until after the funeral, which can be conducted only after the coroner concludes her investigations.
I am aware that no one wants to interfere with the legal process, but we must be mindful of the problems faced by particular faith communities. As I said, I have raised specific cases in north London. Will the Minister continue with the coroner reform programme to ensure that an out of hours coroner service is available?
Within the Jewish tradition, there is a process called performing a mitzvah, a good deed on someone’s behalf. Lauren Rosenberg, Liora’s mother, has asked everyone to perform a mitzvah today. Will the Minister perform her mitzvah by ensuring that, in future, people have access to the coroner service and death certificates so that the dead can be buried appropriately and as soon as possible?
The Parliamentary Under-Secretary of State for Women and Equalities and Family Justice (Caroline Dinenage)
It is a great pleasure to serve under your chairmanship, Mr Stringer. I congratulate my hon. Friend the Member for Rugby (Mark Pawsey) on securing this important debate. As he said, he wrote to me on 16 December last year to bring my attention to the report by the all-party parliamentary group on funerals and bereavement, which set out 13 recommendations and conclusions that the all-party group wished the Government to consider and take forward. I start by commending the all-party group’s work in producing such a comprehensive report. I pay tribute to the late Paul Goggins, the former Member for Wythenshawe and Sale East, who was instrumental in instigating much of the work.
I am grateful for the opportunity to update hon. Members on the progress made since the report was published. I should probably start by saying that Members will be aware that responsibility for the period between death and burial or cremation lies across several different agencies—the Department of Health, local authorities, the police, coroners—all of which have different levels of autonomy. I think that I can safely say that if we were going to start from scratch and create a system anew, we probably would not organise it in quite that way. I certainly take on board my hon. Friend’s suggestion of a flowchart—I wish I had had one when I first took on this ministerial role—but I am keenly aware that, as he pointed out, at the heart of this process and all these authorities are people who are grieving and need to be supported through a particularly difficult time in their lives.
I will run through a few of the issues that have been raised today. My hon. Friends the Members for Rugby and for Hendon (Dr Offord) raised the issue of out of hours coroner services. As they and the all-party group are aware, the Ministry of Justice has been considering how an out of hours coroner service can be achieved. Of course, this is of concern to faith communities, particularly the Jewish and Muslim communities, because without it—as my hon. Friend the Member for Hendon has already highlighted—there can be a considerable delay, preventing the timely burial of loved ones that is required by certain faiths.
My right hon. Friend the Lord Chancellor and Secretary of State for Justice and I share that concern. Together, we have met members of the Jewish and Muslim communities, and separately I have met members of the Jewish community, and I have been working consistently with the London authorities, the Chief Coroner and the Metropolitan police to try to develop an out of hours service across London.
Some progress has been made. In particular, I sense that the Metropolitan police now appreciate the urgency of recruiting a full complement of coroner’s officers to work “in hours” in each of the seven coroner areas that it covers. However, more needs to be done to cover the out of hours service, and we are doing all that we can to bring the various constituent parties together to achieve that. It is absolutely fundamental that we allow bereaved people of whatever faith to make their funeral arrangements quickly, preventing the distress that can be caused by delay.
The all-party group drew attention to the sustainability of pathology services. I can report that the Health Education England commissioning and investment plan for 2016-17 shows a steady state of commissioning in the five pathology specialties. Health Education England is mandated by the Government to make sure that specific and targeted education and training are introduced for all pathologists, including taking forward the developments arising from the 2014 pathology quality assurance review by Dr Ian Barnes.
My hon. Friend the Member for Rugby mentioned post-mortem imaging. The all-party group recommended that the Government monitor the efficacy of post-mortem imaging, which in some cases can provide an alternative to the conventional invasive post-mortem examinations. The MOJ and the Department of Health are keeping up to date with developments in this procedure through their membership of the national post-mortem imaging board.
The all-party group highlighted the need for death certification reform. On 10 March, the Department of Health launched its consultation, which is entitled, “Introduction of Medical Examiners and Reforms to Death Certification in England and Wales: Policy and Draft Regulations”. As my hon. Friend has said, the proposed reforms will introduce, for the first time, a unified system of scrutiny by independent medical examiners of all deaths in England and Wales that are not investigated by a coroner. This development will strengthen safeguards for the public, make the process simpler and more transparent, and improve the quality of certification and mortality data. An eye is being kept on the delays that he has referred to; the Department of Health is watching that issue very closely. At the moment, it is probably too early to determine what the impact of the consultation will be, but the consultation is certainly on everyone’s horizon.
With regard to the civil registration service, the all-party group will know that the Home Office responded to its recommendations on civil registrations on 1 February, and undertook to raise awareness of the group’s report with local authorities, which it did via a circular on 1 March.
The Government are very pleased that the all-party group recognised the Government’s commitment to reviewing cremation legislation. The MOJ published our consultation on cremation on 16 December last year, seeking views on changes; the consultation was really aimed at improving cremation practice. The consultation closed on 9 March and the responses are now being analysed by a team in the MOJ. We plan to publish our response to the consultation as soon as possible.
On 16 March, the Department for Communities and Local Government published a consultation on the provision of crematoriums and related facilities, to establish whether they meet the demands and cultural requirements of all communities. This consultation closes on 26 May and DCLG will use it to establish whether the concerns that have been raised are as widespread as has been suggested.
We are aware that a number of new crematoriums have been established over the past three years—on average, one new crematorium is being built every three months—because new crematoriums have to report their opening to the Secretary of State for Justice. So we are keeping an eye on that issue, too.
With regard to coroner reforms, the need to place bereaved people at the heart of the coroner service was the key aim of the reforms implemented in 2013. One of those reforms introduced the post of Chief Coroner. Judge Peter Thornton QC was appointed as the first Chief Coroner, and he has played a central role in issuing guidance for coroners. Coroners are now required to conclude an inquest within six months of a death and they must report coroner investigations that last for more than 12 months to the Chief Coroner, so that he can refer to them in his annual report.
For bereaved people, probably the most significant development under the Coroners and Justice Act 2009 has been the “Guide to Coroner Services”, which is a booklet published by the MOJ. It sets out how a coroner’s investigation is likely to proceed, as well as the standards of service that bereaved people can expect to receive from a coroner’s office, and what they can do if those standards are not met.
As my hon. Friend the Member for Rugby generously pointed out, I have the coroners portfolio and I share his wishes that the matters he has raised are resolved as quickly as possible. However, he understands that the operational responsibility for coroners services is a matter for the appropriate local authority, while my Department has responsibility for coroner law and policy. As frustrating as that situation can sometimes be, it is for the relevant local authorities to decide how to fund and run their coroner service.
Mark Pawsey
My hon. Friend the Minister is drawing our attention to the very broad range of agencies that are involved in this area. Is there any way that these different authorities and Departments can be brought together to improve communication between them?
Caroline Dinenage
That is certainly the case in the pan-London service that we have been looking at; we have been bringing all the different constituent authorities together in one room to discuss matters. We hope that guidance on the lessons learned from that process can be rolled out to other parts of the country.
I am really very grateful to my hon. Friend, the other members of the all-party group and all those who provided evidence to the group’s report. It is a comprehensive analysis of the range of services that bereaved people may have to deal with when they are faced with the death of a loved one, and for me its recommendations underscore the need for the Government to ensure that these services meet the needs of users and bereaved families at what will always be a very difficult time. I am also very grateful to him for bringing this matter to the House today.
Question put and agreed to.