Welcome to the third meeting in 2016 of the Health and Sport Committee. I usually do at this point or remind everyone to switch off mobile phones, as it can often, at least sometimes, interfere with the sound system. However, you will note, as IMR, that some of you will see at the committee using tablet devices, and this is, instead of hard copies of our papers. My first item on the agenda today is a decision on where the committee will consider draft letter to the finance committee in private at this meeting and any future meetings, as we would normally do. Can I have the committee's agreement? Thank you. Now, I've got trouble with my technology here, I can't move on that. So I can introduce people. In fact, what we normally do is we move to our second item, which is a third evidence session in Byron and Cremation Scotland Bill. First of all, regretfully, I have to announce apologies from Dr Gillian Smith, the Royal College of Midwives, who has unavoidably been unable to be with us this morning. As opposed to the other thing that I need to say, which I said last week, that the bill that we're examining and bills by their nature have to be very precise in their meaning and in the language that they use. And as such, there may be some language or terminology used this morning for those who are with us, and indeed watching and listening to these proceedings in relation to the Byron and Cremation Bill that they may find upsetting. We wish to apologise in advance if this is the case. It's not intention to do so, but we have to work with the precise terms of the bill and how it's phrased. As we normally do, Tim, we should be surprised. We go round and introduce ourselves at the winners' round table. My name's Duncan McNeill. I'm the convener of the Health and Sport Committee and the MSP for Greenland and Inverclyde. My name's Tim Morris, chief executive institute of cemetery and crematorium management, and the institute represents burial and cremational authorities throughout the UK and provides training and educational opportunities to those working within the services. Good morning. I'm Bob Doris, member of the Scottish Palant for Glasgow, and I'm also deputy convener of the Health and Sport Committee. Good morning. I'm Andrew Brown. I'm the operations manager for Scotland in Northern Ireland for co-op funeral care, and I'm here today representing the National Association of Funal Directors. Good morning. I'm Dennis Robertson, MSP for Aberdeenshire West. I'm Nanette Milne MSP for North East Scotland, and in view of the fact that the association's funeral directors state that one of the groups that they've been involved with is the cross-party group for funals and bereavements, I should say that I'm a co-convener of that group. Good morning. My name is Igem Rody. Apologies, I have a slight estamour. That's why they send somebody like me to these meetings to slow things down. I'm an independent private funeral director based in West Lothian. I am here representing the Scottish Society of Allied and Independent Funal Directors, funeral director for over 30 years, third generation. Good morning. I'm Colin Kear, MSP for Edinburgh, Westham. Good morning, Richard Loyall, MSP for Central Region. My name's Sandy Young. I'm head of service for NHS Lothian for spiritual care and bereavement. In particular, in my own bereavement casework, that has been for many years in helping those bereaved in the context of pregnancy loss and baby loss. Hello, I'm Caroline Pretie. I'm bereavement service co-ordinator for NHS Lothian and also work for the particular focus within the organisation in women's and children's services. Rhoda Grant MSP for the Highlands and Islands. Natalie McHale, I'm the senior manager within City of Edinburgh Council and have responsibility for the Mortonhall Improvement programme, working to the chief executive's working group. Malcolm Chisholm MSP for Edinburgh, Northern and Leith. Mike Mackenzie MSP for Highlands and Islands region. Thank you all for that. Now that that's done, just before we move to open up the session, for the benefit of witnesses, I say that we're covering a wide range of topics here today. Some of them will be applicable to you, some of you feel you can answer some. So there's no pressure to respond to every subject if it's not in your area of interest. Although the whole point of having a panel here today is to get your input, so when the area of your interests are, then please, if you feel it appropriate, to participate and you do that just by catching my eye and I'll bring you in and I've given Tim the information that he's got to disnudge me because he's out my eyesight. So just to get things going, can we have a question from Malcolm Chisholm and then we'll take it from there, folks? Thank you. I'd like to thank you very much for your very useful evidence. I thought trying to break it down into different areas if we could start with the disposing of remains from pregnancy loss at or before the 24th week. I thought there were many interesting comments there but I'm just focusing at the moment on NHS Lothian because I think they raised some important concerns in general which we need to think about but certainly in that section they've got a couple of concerns, one of which is to do with the seven day period which is also an issue that came up when we met some of the parents who have been affected by this informally last week. So if we could think in that particular area to begin with that would be particularly useful and there's one other issue that came up in that informal meeting as well which some of you may want to comment on. People seem to think in terms of the way the bill was worded that before 24 weeks the mother was allowed to arrange the funeral herself and could leave the hospital with the baby or the fetus up to the 24 week point. So there's a whole range of issues there. I don't know if NHS Lothian want to start off with their concerns that they've raised about the period up to 24 weeks. I think within that sort of under 24 week period there's such a huge range of circumstances of loss so the current guidance from the Scottish Government on disposable losses under 24 weeks covers everything from a very early miscarriage, terminations of pregnancy for medical and non-medical reasons, later miscarriages, ectopic pregnancies. So huge range of different circumstances where it's very difficult to sort of navigate that complicated territory in terms of clinical care, in terms of the medical support to women as well as the different sort of emotional and psychological interpretations of the women involved and I think we were just concerned in terms of some of the timescales in terms of some of the process side of things that if, as I think was discussed in the meeting last week, there might be a robustness in asking people to come back and confirm their authorisation for disposal at a later date or in holding off from signing any final authorisation until a later point. Whilst on the one hand that serves the purpose of allowing people space and time to make an informed decision at a point where perhaps they're not so emotionally vulnerable, on the other hand for some women it's not an issue that they want to think necessarily long and hard about so in many of these procedures disposal will be authorised prior to a termination or a medical management of a miscarriage and it's not necessarily something that those women involved want to revisit or want to be followed up about. The current guidance allows a seven-day cooling off period for want of a better term and that does seem to work quite effectively in terms of allowing those individuals who either want to leave the hospital undecided and get back to us with a decision at a later date to do so or to have a period of time where they can revisit, change their decision, contact a designated person to discuss things in more detail. It's worrying for me to put a routine seven-day delay into legislation when perhaps that wouldn't best serve a person-centred and flexible approach to care of women in these varying circumstances. We'd also create particular difficulties for us because the draft legislation as framed for early loss focuses on what we would think of as a minimum good practice but not necessarily best practice. In some health boards at under 24 weeks and also with those who have suffered a stillbirth, the hospital's concern will offer to people an individual hospital arrangement for a funeral with or without a ceremony rather than simply the group default arrangement. While we welcome the recommendations of the Motton Hall report and the Scottish Government's commission feeding into the legislation, focusing on things such as giving time and space for decision making and the opportunity to reconnect, that is a different matter when the choices one thing either let the health board continue with a group arrangement or opt out for an individual private process. That's a fairly simple, sad and tragic circumstance but a fairly simple choice. However, when a health board is trying to offer a range of possibilities for people both up to 24 weeks and also for those who have suffered a stillbirth, that becomes a much more complicated process. The legislation so far seems to address in detail the healthcare provider's responsibility under 24 weeks but lets the stillbirth group sit alongside those who have suffered a perinatal or anianatal death with the assumption of private family responsibility. That's not currently how it's done under the auspices of many health boards in Scotland. Can you give us a sort of for example sort of consequence of that to help us you understand the difficulties around that? A for example would be to talk about a very difficult group of bereaved families with very difficult decisions and circumstances. Those who have made a decision about the termination of a pregnancy for medical reasons perhaps with a little one who has a condition which is incompatible with life outside the womb for example. In NHS Lothian when that happens in the second trimester so up to 12 to 24 weeks sort of period the majority at the moment opt for the hospital to help make an individual arrangement. Some make a private arrangement but the majority opt for the hospital either hospital in Lothian when both options private and hospital supported are offered the majority ask currently the hospital to help make that arrangement. There are also rare circumstances where different pieces of legislation have friction points between them and we have to work with people who are caught in those circumstances. The three pieces of legislation I'm thinking about in particular is the abortion act and also the legislation which covers the registration of birth deaths and marriages. So for example the abortion act allows for a person in rare but certainly occurring circumstances to have a medical termination in the third trimester of pregnancy but the legislation governing the registration of birth deaths and marriages also requires that person to register a stillbirth. So that is a particularly challenging situation and if health boards staff do not continue to offer support for people for individual hospital arrangement towards funeral then they will also, as well as having the difficult decisions about the loss and also to have to register a stillbirth of that little one they will also have to make private arrangements for their funeral. So our question is can we have more consideration of third trimester circumstances of loss and the complexities that go with them and the question considered of whether those suffering a stillbirth should be treated in an entirely analogous way to those who have suffered perinatal or neonatal death of a baby. We think there are different circumstances with a range of complexity or nuance within them and that currently what we think is best practised allows hospital staff to help people towards an individual arrangement whether or not it's private. If the legislation goes forward as it currently stands we would find no legislative framework supporting that work in the third trimester. Your worst case scenario would be that following a stillbirth we could be left with no means to arrange a funeral. If either the woman who experienced the stillbirth was unable or unwilling to make arrangements for the funeral bearing in mind if this is a termination in the third trimester it's likely if it's not a medical abnormality that it is her own health medical or physical or psychiatric that's at grave risk then we could be left in those circumstances with no means to arrange a funeral or disposal for a stillborn baby in those circumstances because the list of nearest relatives in the bill as drafted doesn't include anybody unrelated to that stillborn baby to make arrangements. Would it be helpful to me but about all the different terms I suppose through to you know I think there's an opportunity to ask some of these questions today in terms of there was a campaign today about you know the extent of miscarriages in the United Kingdom of the 250,000 or something because you've got miscarriages, you've got stillbirth, you've got infant mortality you know what are the different what is the different terminology it is used that I think we need to understand the neither of us is a clinician so we have to we have to we have to and the services that you said you provided earlier Mr Eolio to right across the board so yes within NHS Lothian once a lady is booked in as a maternity patient so that's going to be the beginning of the second trimester stops being a gynaecology patient begins to be a maternity patient at that point if she suffers a loss of any sort that will be support offered for an individualised process currently so in the period of 12 to 24 weeks the basic government guidance would allow a minimum standard of hospital group arrangements or a private opt out for an individual funeral within NHS Lothian the individual option for hospital supported arrangement hospital funded arrangement continues through the second trimester this the circumstances of loss which a person may suffer this is where my clinical knowledge is obviously lacking but miscarriage is more common in first trimester becomes less common in second trimester and in second trimester and in third trimester not all there are many tragic unanticipated circumstances of loss but most losses are known about sometime before the delivery of the fetus or baby either because there's a planned medical termination of a pregnancy or because a test have shown that there is no fetal heartbeat in the fetus has died in the womb and and that means that in our context most often midwives are talking to people in a context of a shared understanding that a loss has already occurred and that the little one is going to be delivered and that's also a question for us in relation to when we consult with people in the seven day period because it would be good practice for a midwife speaking to a woman who's about to go through a procedure which will lead to the birth of a stillborn child or a fetus earlier to tell her and discuss with her what's going to happen afterwards and some of that discussion will be around does she want to see the baby and spend some time with the baby or not and also some explanation of how they may proceed with final act of care choices and decisions so I think the range of circumstance there in a hospital setting and the nuance that comes with that is not yet provided for in this free not providing for us a legislative framework now and the risk is which should be tragic given the genesis of all this work in recent years the risk is that a risk a very safe approach to practice would be for us to minimise what we do and go back to simply observing the government standard under 20 under 24 weeks which would be group arrangement or you proceed privately yeah but just one final patient I just said to get it how you know you know for that 12 to 24 weeks and right through do we know how many and can we anticipate how many women would would find themselves in that situation you know what what are the national figures for for this you know the how many people how many women families would find themselves affected by this legislation do we know we can ask the minister when they come along no it's not current knowledge but but the last time I looked at that was two to two and a half percent of pregnancies that get to the beginning of the second semester end in some form of loss so in hospitals where there are many thousands of births of little ones in an annual basis there will be a few hundred circumstances of loss bob I was kind of we got some evidence in relation to this last week as well off of impacted parents I'm just wondering the reality on the ground in relation to NHS staff who have to deal with the pregnancy loss unfortunately sometimes very early stages on a daily basis I suppose across the country and whether it's a miscarriage and sometimes miscarriages are predicted so you know mum and dad will will know that the baby won't survive and they may go home and the miscarriage may take place at home or may have to be brought into hospital sometimes planned sometimes unexpectedly if things don't go according to plan I'm just wondering how NHS staff on the ground how aware they are of what they should currently do in relation to dealing sensitively say with that a mum who appears at A&E with severe pain because the you know the the the feeling pregnancy at home is is not going as it was anticipated or or they go into hospital because it's not always specialist who deal with this thing at the coalface on the NHS so I know there are systems in place across the country with the NHS boards to try and deal with this sensitively at the moment but I suspect maybe they can't always do that because they don't have the experience or the training so what's the situation like at the moment and is this bill an opportunity to raise awareness within the NHS to deal more sensitively with them and I'm thinking more particularly about you know mums before 24 weeks will be dealt with differently within the NHS so where are we just now and is this an opportunity maybe to improve what we do I think it's a significant challenge to ensure that midwives in particular on the ground are up to date well informed as confident as one can be going into such a difficult and sensitive situation with individuals experiencing pregnancy loss and still birth and there probably is a lot more that could be done clearly concerns about previous practice has brought a lot of focus to this area and there's been some really good work going on to improve staff development to improve development of resources and information and processes but necessarily it's going to be difficult and it's going to be complicated and I think it will always be hard for generalist staff to hold the degree of detail in their minds for those occasions which are common but but not everyday occurrences where they will be supporting women and their partners experiencing pregnancy loss and death of a baby so that's the challenge with any type of specialist knowledge I think that that needs to be delivered by generalist staff we could probably do more to develop specialist roles within midwifery and within maternity services and bereavement services in NHS in Scotland generally which I think we recognise maybe some way behind what's provided for south of the border in major hospitals where it's far more routine to have a bereavement department to have specialist staff that's not the case across the NHS in Scotland and I think given this legislation given recent changes to death certification cultural change social issues around funeral poverty that I know this bill and this committee are also interested in as you say Bob it might be an opportunity here to use this to improve and develop how the NHS supports bereave families both in relation to these types of loss and generally in relation to bereavement and death of patients. Yes please. Briefly I'm also part of the infant commission's steering group they have an education part and we're quite far advanced there with having advanced information and training modules to go through the whole of the NHS in Scotland regarding a code of practice but also education and modules for all staff in the NHS to go through as part of their continuous professional development. Yes please Natalie. I think there's also another opportunity through the focus that we have following on from the day militia investigation and also the Lord Bonomy report and the contents of the bill to ensure that there's significant collaboration across the different agencies who are involved in supporting the bereaved in Scotland that's certainly something that we've been focusing on given the expressed loss of confidence from some midwives in relation to explaining the process of cremation here in Edinburgh and that's certainly something that we're working very closely with NHS colleagues to address. Thanks for that, no other panel members there. Is this the Dennis and the thanks for our question? Thank you convener it really is just a bit of clarification on some of the points that have been mentioned so far. We hear about offering support and I think what I'm gathering is that it's generally midwives but is that across the board, is that across all health boards that is the midwife or do we have specialist nurses whether it be midwives or not providing that support and at what point does the offer of meeting with a funeral director take place because sometimes cremation may not be the preferred choice, it could be burial and I'm just wondering how sensitively we sort of approach that and at what point can the funeral director actually come in as well? I think it varies in terms of different health boards and the processes that they follow so Sandy alluded to some have for some time now provided the model in the current Scottish Government guidance for under 24 weeks offering a shared cremation or an opt-out to make private arrangements. Others as we say NHS Lothian for example offer a range of different options depending on circumstances of loss and the woman or the parents choice. It would generally be within maternity services midwives that we would expect to have most of those conversations however often chaplins, specialist midwives or those with a particular interest in bereavement or in some cases bereavement services individuals such as myself. We're also thinking about these are women and their partnership in incredibly vulnerable times so whilst you want people to have good detailed knowledge and access to specialist resource to answer any detailed questions you also don't necessarily want even more unfamiliar faces parachuting in at a time when people feel very vulnerable and in what's really very difficult an intimate experience so it's getting that balance between having frontline staff able, confident to provide necessary information but also having the specialist resource that they or that families can draw on as required. I think there's some Anne Mcmurray said in the previous session there's maybe one designated specialist midwife in the NHS in Scotland at the moment. That type of role I think can bring benefits in terms of staff support, training, development, role modelling it's not necessarily the answer to having a resource available at all times because it is person dependent, that person will probably be allowed to go on holiday or be sick or have other things going on so it's not necessarily the panacea for all health boards to have a specialist role but maybe to think more broadly about what specialist resource is required for bereavement in a range of circumstances. Chairman, you want to respond to that? As from an independent funeral rector's point of view, the vast majority of families that we handle are help with infant loss it's usually for a burial. As an independent funeral rector we do very few infant cremations and we quite often find it's when there's been a breakdown in trust between the family and the NHS and that can happen so we do tend to find quite a lot that the infants that we handle are usually for a burial. Most of the hospital-organised cremations are done through a contracts or agreements with the different funeral rectors and it's usually the larger hospitals in the metropolitan area but say in my 30 years I have probably handled a thousand infant deaths of which 900-950 easily would be for an earth burial, very few cremations. Just to very briefly make the point that many of the members of the National Association of Funal Directors will carry out in contract funals on behalf of the NHS boards but there is quite a variety in the way that that is treated and I know both Caroline and Sandy have already made the point about the arrangements in Lothian where you can through the hospital arrange for an individual cremation irrespective of the gestation period and I think it would be a shame to lose that flexibility because currently as I say it varies from one place to another whether the only thing that's on offer is a sheared cremation or whether there is in fact an individual hospital contract funeral available but we experience families who would not want to have a sheared cremation but also would not want to take the full responsibility of going to a funeral director of choice to arrange the entire funeral so I think it would be important that that is allowed for within the legislation going forward. In the Lothians the hospitals offer the possibility of individual cremation but also individual burial where there is a designated baby area and a cemetery so that's very much working in consultation with local authorities. Speaking from being at the informal meeting last week as well it came across I think that there's a lot of good practice going on within Lothian which is not necessarily repeated across the rest of the country but the concerns would express that in a busy unit with busy midwives there may not be just the physical time for midwives to give the support that's really necessary and I think that there's felt maybe a need for someone whose role is purely counselling in these sort of situations and I know that some people from SANS are actually being trained or training us as counsellors just to cope with this sort of situation. I just wondered what the view was on perhaps trying to have a counselling service within hospitals across the country and not just for the support and deciding what to do but naturally completing the forms because I think there was some concern that our form was put in front of parents and more or less filled in for them and signed here and they really weren't terribly sure at the end of the day because of the emotional turmoil and just exactly what they were signing up to and I just wondered any comments around that sort of area. Until we get to that natural progress, until we get to the you know the events happened and we can move on to that there's just two other things well one other thing really that we could cover is that while we understand the vast majority of these situations will happen within hospitals on the NHS the issue of prison and residential settings it's also been raised with a very good just to tidy that up in terms of the arrangements that would apply in these settings which to is anyone aware of you know I mean I think we can visualise it in a hospital setting it may be that it wouldn't happen in a prison setting I don't know they would be taken to the hospital of a situation but there's no knowledge around about the table about the arrangement funeral indicators I know similar arrangements there in terms of prisons or a residential setting I don't know but it's maybe something we can raise with the minister but just going on now to maybe some of the issues that arise around the events happened that engagement has begun to take place and then we're into the issues of if you like and using the negative bureaucracy forum filling we're into areas about time religious and cultural issues that arise there about when a burial or a commensure or any service should take place so I think if we can start picking up on some of some of these issues Sandy it's helpful to understand how a lady's care is managed in terms of time in hospital after a pregnancy loss or for the stillbirth for example most ladies if the lady is fit and well physically after the delivery of the little one will go home in one or two days so here we'd want to make a clear distinction between counselling which is grief and bereavement counselling which belongs some way after a loss in most circumstances of loss rather than at the moment of and and accurate clear information given to facilitate decisions find like to hear the sounds and a good thing which is in the new legislation as it currently stands is time for decision making which we would absolutely support but obviously time for decision making and health boards where that could be individual reconnection with health board staff in the majority of cases is a different matter from time for reconsideration a simple sad but simple choice between are you going to proceed privately or go to a default group arrangement system so how we manage that effectively within NHS Lothian or any other health board where they choose to in my view continue to exceed a basic standard then there's a significant challenge in that how do we create a single point of contact for somebody who's reconnecting with a hospital after that seven days has passed wants to meet somebody if it's one bereavement counsellor employed by a board how does that work in terms actual practical terms of meeting needs of people so generalist approaches need to continue so that the staff who are actually working with people in the little time periods when they're actually there are able to engage effectively with them and specialist roles are helpful but we do not currently exist in a world where we are resourced to get that specialist role to somebody in that eight hours, 12 hours, 24 hours that they may be in hospital. I'm talking to when you're now presented with the forms that you have to fill up that sort of thing and that there did seem to be a gap there that not everyone was coming with but you might say the appropriate clinical attitude to form filling it was just very much a business like thing you know do you want this do you want that and then a form to sign and some of them felt they hadn't really time to think about it and that's understandable in a busy maternity unit and I just wondered if there's a way around that sort of problem. Again we're coming from the infant cremations steering group there is a new code of practice where the parents will be well be handed a copy of everything that they have assigned so no matter what is filled out they will get a copy okay now this is a code of practice which has been adopted but it hasn't been erled out yet so there's a huge amount of work being completed there that you will find that what you're talking about yes will start to fade the problem you have is that the forms they're not conducive to making it easy for a parent who's who just went through a loss the holding off for one week is helpful because it gives them a chance to get their head around what's happened but I say the most important thing is there has got to be transparency which is coming through slowly gradually but it is coming through so the code of practice is going to address quite a lot of what you were actually talking about. As a cremation authority or a burial authority we would want to be assured that the individual and the family around that individual have been afforded appropriate levels of support because one of the things that came through strongly in the Mortonhall response and on-going engagement with affected parents was just as you've described they felt that they didn't really understand on occasion what was being asked of them and the potential consequences of completing the paperwork so that's certainly something in order for us to be reassured that we are carrying out the appropriate final act of care on behalf of these individuals that due time and support has been put in place because ultimately it is a final act of care. The information given to bereaved parents is vitally important it needs to be consistent and the same information needs to be delivered by all involved and I believe that that's also going to come out of the national committee so it sets a level standard and provides bereaved parents with the information that they need in order to make decisions that are correct for themselves. I think there's a balance as well between recognising that for some women they may want to make a decision yes have a period of time to maybe revisit that and change it but may be quite secure in what they've decided whereas for others it's perfectly understandable to go away undecided to reconnect my concern would be if we have to routinely wait seven weeks some women may be particularly difficult to re-engage with and then you have the issue of not having any authorisation whatsoever my preference would be to take authorisation where a woman is able to do so around about the time of the loss but allow absolutely robust processes to reconnect to revisit that and to change it if necessary but that does at least mean that for those women who will not come back a week later to go through paperwork we have something authorised in their name and then we know after a week that we can presume that they've decided to remain with that decision rather than saying have they not signed because someone didn't give them the form have they not signed because the form wasn't well explained at the time it again the code of practice there is a provision there that if there is no engagement after a period of a time from the parent then the health board will have the right to carry on but again this is code of practice this isn't legislation right the thing that's also a little worrying that the legislation as it's drafted as we've mentioned in the written feedback is that it's not a right to proceed as it's written in the current bill it is a duty to arrange the funeral or the final act of care after the initial period and the relevant period has expired so essentially six weeks after the loss the board in this version has a duty to proceed I think we would be familiar with circumstances where actually a woman might want to make her own arrangements but hasn't been able to do so within that timeframe now that might be due to waiting for genetic testing for confirmation of gender for example which can take several weeks results of post mortem examinations if they don't want to use a baby area where typically a layer would be provided free of charge they might want to arrange a burial in a paid for layer there's a significant cost attached to that in in most areas they may need to apply for a funeral payment which can take several weeks there's all sorts of reasons why I'd be concerned about the six week cut off putting a duty on a health board to act I'm happier with the the wording gyms described that you then have a right to act or a duty to act unless there's cause shown as to why you should hold off or try to reconnect with the woman but a six week cut off and then you have to arrange the final act of care I wouldn't be comfortable with on the back of that is in relation to the fact that the the bill has a rank list of relatives who would be able to make a decision this is this helpful are there any problems about the ranking of relatives so to speak if they were coming into a decision and given the fact that after 24 weeks terminations are considered as still births there's the issues of possible cons or confidentiality issues that may spring up and I was looking just on the back of where you've taken the discussion so far as to how you would would be thinking in terms of these issues yeah I'd like to comment on that just in very general terms when people are bereaved in pregnancy the earlier the loss the smaller the circle of people who will be in the know potentially and obviously with later loss we much greater knowledge within a family so yes of course it's helpful to to have that list of responsible people but it still remains for the woman herself and partner if there's a partner involved at the time to make their own decisions about how much of their personal experience they want to share with those relatives and it could be the case that particular in particular in the earlier loss where the circle of those in the family who have already been included in knowledge about the loss is relatively small then the use of that list would be difficult as it would also be where for other sad and difficult circumstances people have disordered or chaotic lives yes sorry I was going to say I think in general the list of nearest relatives is helpful from a healthcare perspective the fact that it mirrors the human tissue act or human tissue Scotland act it is useful because it will be a framework people will be familiar with in terms of post mortem examination authorisation mostly sort of out with the error of maternity and obstetric loss that we've been thinking about in terms of adult deaths or sadly some child deaths there will sometimes be disputes within a family and having that type of hierarchy is useful it would be useful if other relevant areas of legislation like registration of deaths had the same hierarchy because otherwise we'll have this anomaly that a qualified informant would be a relative but only a nearest relative could then go on to organise the funeral so that would be an anomaly that would be useful to resolve but leaving that hierarchy of nearest relatives for an adult death or a baby or stillbirth without recourse to other arrangements being made is a bit of a problem for me particularly in the circumstances we've described where it's a stillbirth and particularly where it may be a termination for medical reasons after 24 weeks so the abortion act and regulations would preclude us from contacting any other nearest relative we wouldn't be able to register and proceed with a funeral in that case the regulations in england and wales from 2008 which i know are under review at the moment are quite useful in terms of putting a kind of fallback position in in regulation so that aside from the list of nearest relatives there is also a form of words about another individual can approach a cremation authority and apply to arrange a funeral on cause shown and that might be something useful to think about because you'll also have circumstances where it might not be a blood relative or an executor or a friend of long standing so i'm thinking about perhaps people who die in care homes or nursing homes where management of that facility may organise funerals for residents who die in their care who don't have any known next of kin and haven't left instructions that seems an appropriate arrangement and one that's not covered in this legislation jim did you want to supplement that in any way right that's fine that's fine and no one else on that that that area nope yes go on just to say that we as funeral directors would would agree with that because it's rare but we do occasionally come up with situations where there is a dispute in the family and there's uncertainty from our perspective as to who to take instruction from but that would certainly assist and likewise when there are no family members so in the circumstances Caroline was was describing about people who are in some sort of care facility and that that would certainly be to our benefit as well you're going to go on to something is it in light of something else yes in regards to forums is it forum no that's good no that's what i was i think the forums please thank you kundunia we've heard from two separate well i the committee's heard from two separate types of witnesses who basically were on about the number of forms one witness suggested that there should be quite a number of forms coping with all the different situations and let me say that there are so many different situations of of of death both child and elderly and and ordinary situations but basically the bill explains that a single application forum will be used to record all applications for crematorium including cremations or remains from pregnancy loss but NHS Lothian and their submission raised some concerns about a single form to cover all cremations arguing that maybe the distressing to parents to see irrelevant questions such as a marital status or an occupation of the sea stored or even a form that's basically you know warden peace situation and tick that and don't tick that and that can be very distressing for for for people the institute of cemetery and cremation also suggested that separate forms for infants still born at pregnancy losses are preferable so as to remove inappropriate questions so i can ask two people who know exactly what's happening what would you prefer one form or multiple forms where we can be very supportive of the people who sadly have just had a loss my opposition to the proposed new a form has been noted several times i know why the one form means it's one form for everybody it's standard it's ideal but what i have to say is that 99.9% of all cremation forms filled out for every cremation in scotland is completed by the field director asking the client the questions explaining it through clients are not interested in looking at these questions they've lost someone they just wanted to happen the forms go back to 1902 i believe where cremation was extremely rare now cremation is probably 75 80% of the method of disposal in scotland people look at these forms as a necessary pain i'll be very honest there are i mean no matter how much we educate and train vectors there are guys who are or funeral just who will just rattle through it recently if i can just to digress recently at one of the last meetings an affected parent she had vented her frustration that nothing seems to have happened since the scandal broke and my answer to her was actually everything has changed dramatically within a matter of months of the scandal virtually every crematorium in britain well scotland especially changed their own forms non statutory forms where ashes instruction was very very clear and we had to go through it very carefully with the client to get the information and even then most crematoriums will not dispose of ashes until 28 days after the cremation has taken place so people can still change their mind so a huge amount has already happened even before the infant cremation steam group has started my major problem with the form is that the vast majority of cremations in scotland are adult i walk into a family home there's a lady there who's lost her husband she's got arthritis or whatever and i've got to get to sign a form sometimes six times then i have another form from the crematorium their own non statutory forms basically asking the same questions so it does make it a lot harder for the clients i've spent a lot of time in america and believe it or not in a lot of states in america you get a death certificate the fuel director is actually a registrar he's licensed by the state so he's a registrar you can do what you want if you've got a death certificate there's no application forms for cremation burial anything i'm not in favour of that but times have changed so much the cremation is now the norm i had a chat with several crematorium staff over the past few months and asked them what do they need on the application form what they've said to me is what they need is obviously the basic information about the person who has died but they don't need a lot of medical stuff because we don't have a medical referee these people are superintendents of the crematorium they have no medical expertise so a lot of the medical questions are a waste of time they just need to know that the death has been legally registered they have a form 14 from the registrar which allows the cremation to take place but they also need clear instructions regarding the disposal or retention of ashes and they also need a clear affidavid from the funeral director that the construction of the coffin meets the requirements for the environmental protection so long and short of it one form for adults one form for children one form for infants and a determination i would say because otherwise it's going to be massive and it's cumbersome if it goes to a digital format slightly different you answer one question it misses a lot out but at the moment you're talking about five or six pages of paying that the family really don't want to go through and that's my personal opinion i think that the key important factor about the application form for cremation is that it is the same across all crematoria at the moment we have a wide variety and as jim spoke about crematoria have introduced supplementary forms which many of them are asking exactly the same questions i do understand that some crematoria have specific questions you know they may perhaps have an alternative music system they may offer the opportunity to webcast the funeral those are things that are not offered by every crematorium and therefore they would require a separate document for that but i think the key thing is that the the questions and the forms are the same across all crematoria one of the concerns we have is about having the same form for adult stillborn and non-viable fetus and the the nfd would certainly prefer that there were either three separate forms or if it is one form that is one form with selectable parts to it so we as the funeral director could print off the relevant part of that form so we're not presenting someone who's just lost an elderly member of their family with a form that contains detail about infant death which is irrelevant to that family it may upset them further so that that would be our preference and likewise the intention of the bill of having a standard application for burials would be extremely helpful i think that the population of scotland are becoming more mobile there are more people who will perhaps be arranging a funeral in one part of the country for a service and cremation of burial taking place in another part of the country so there are all sorts of practical reasons why having the same form for every burial authority and every cremation authority would be would be useful but as i say we would still be preferential for us to have individual forms for the three categories of cremation the institute obviously supports separate forms if i can just just dwell on the application form for pre-24 week babies as Andrew has said a statutory form for those instances will promote standardisation across all cremation authorities which i think is vitally important just one word on burial forms i would also agree a statutory burial form because a layer purchase a purchase is a right of burial and that's registered in a statutory register then you know the proper information needs to be transferred from the application to the statutory register and when it comes to reopening a layer for a second or subsequent burial then the authority would have to ensure that the registered owners rights were being maintained so that a statutory form for both initial purchase of a layer and subsequent use of a layer we think is ideal reiterate the points that have already been made in relation to on behalf of a cremation and burial authority we would like to see a consistency of approach across scotland and we made the point in relation to our customers being very mobile but also to make sure that the expectations that we have on staff whether it's within the private or public sector are very clearly articulated and i think a consistency of approach and documentation terms actually reinforces that and so we will have the same type of practice across scotland and hopefully through changes down south so that creates a network of common practice across the united kingdom yesh and the consistency would be such a great help in our setting because health board areas are not coterminous with single local authorities so in the low theme we're talking about four local authorities a small example would be that in some set-aside baby areas the local authority will treat the bereave woman or family as a layer holder and give them layer papers of ownership and in some local authorities they won't so the amount of information that people who are having first consultations in a health board context need to know currently where there isn't consistency of practice because the country is potentially quite quite quite vast and that's why increasingly the midwife working directly with the person concerned needs to call for additional help because questions are asked that relate to all that complexity and playful of possibilities because there is not a standard approach across the country bob thanks it's not an evidence session yeah i won't i won't ask about whether we won two or three forums what i took to another evidence session we had was that whatever key questions have to be asked should be asked very sensitively they should be asked consistently and that family should properly understand what it is they're agreeing or not agreeing to and that led on to the idea about the paperwork could all be perfect or we could go and check the paperwork to call beside properly indeed with the baby's ashes scandal quite often the paperwork would appear to be perfect the issue was about people didn't know what they were signing up to or if they'd signed up to something so no matter how fantastic we make the forum whether it's one forum or three forums or five forums in one respect that's powerful and important but another respect that's not the issue for i suspect many parents it will be knowing that their wishes are clearly requested and they're clearly carried out and they can trust that convener so i suppose what i would ask and what this was raised in evidence last week was how do we make sure that just because it says something on the forum that is what has happened and that parents that have suffered loss are very very clear that that is what's happened so how do we put checks and balances into the system without retraumatising bereaved parents and that that seems to be a significant challenge and it was unclear there were some suggestions last week in how we'd do that but i think it was unclear what the best way ahead was so i've been interested to know what people think about that because it's difficult to legislate for a sensitive sympathetic empathetic conversation between a funeral director or a nurse at hospital or at the funeral directors themselves so how do you build that into the system but have a check and balance to make sure it's not just the paperwork that's right but there was proper comprehension shown at the time where it was signed Jim is quite well handled by the courier practice i have to say because it covers all three parties the hospital the funeral director and the crematoria as they say it's we can you know we could train people to their nth degree but you can't train care you can't train empathy the vast vast majority of directors that's what we do you know and i'm pretty sure that every funeral director will explain to every client that the scattering of ashes is an irreversible act as is the process of cremation part of the part of the arguments with the new a-form because i was arguing against less amount of signatures but the most important thing is on the disposal of the ashes that we do have it clearly clearly explained and assigned for now currently it's not it's not on the form on the a-form but it's on just it's on every crematorium it's a supplementary forms which has to be clearly signed for so i would say a lot of the errors mistakes of the past wouldn't happen again even if we didn't change a thing i have to say that excuse me nackley i'll give tim the floor here and i'll bring him in to early tim has been discussed at the national committee level consistent information and an audit trial of decisions made is probably the nearest that that could be achieved nackley just in relation to that the openness and transparency around record keeping and decision making i think is proposed to be much improved so for example having a copy of the form that you completed at the time so that you can perhaps at a later stage consult with friends and family around you know the documentation to ensure that the register is open and publicly accessible for whatever final act of care you have chosen i think these are really important steps for individuals who perhaps want to be reassured that that final act of care has been carried out according to their wishes so i know that documentation isn't the be all and end all of of this scenario but with additional training collaboration across the different agencies allowing a supportive decision to be made and then those checks and balances can be made through review of the documentation i think that provides a much more supportive and open atmosphere for individuals the documentation itself doesn't prove that those conversations have taken place i think by having a statutory document for pre 24 weeks forces that many of the issues around the yashi scandal were pre 24 weeks and it was because there is no statutory document and there were documents submitted to crematoria with minimal information and clearly the questions hadn't been asked the documents will force those questions to be asked either by a funeral director or by someone in a hospital setting and yes as jim said the code of practice insists on adequate training being in place and certainly from the funeral director's perspective it's not unique to infant funals but any funeral we arrange is with bereaved people who are not perhaps taken in all the information that you're giving them so the documentation for everything around funals is critical having copies of everything that has been agreed is important so that they can reflect on decisions that have been made once they're perhaps in a better frame of mind to do so just to cover some of the other areas that we hadn't been covered this year that i suppose some of them would send to the various in terms of we understand that the vast majority will be burials but there are in terms of child that that's what you said earlier wasn't it the children we tend to deal with are mostly burial it's the most of the corporates that handle the hospitals yes in terms of the the recovery of ashes and things there's a presumption now that ashes will be recovered in every case although there's a matter my 30 years i have never had a case where i didn't get ashes if i asked for them okay but now the code of practice means that every effort will be made to retain ashes and if there isn't the imaginary story the inspector kind of tutorial will do an investigation as to why there wasn't any ashes in what circumstance it could possibly be that there wouldn't be a recovery of ashes as opposed to the yes please on a very rare occasion it could be that that's a pregnancy loss of a very low gestational age that's perhaps cremated in a cardboard container in some circumstances although very rare there might not be any ash in those circumstances but certainly where a wooden coffin is used there will always be ash right okay yes Natalie from a crematorium perspective we would indicate that all of our infant or nvf cremations have resulted in ash and one of the things that i know that we've been discussing through the national committee in the subgroups is all operators ensuring that we maximise the recovery and that's certainly something that's been championed by willy reed in particular and i know he gave evidence to this committee so that all efforts all efforts of our operatives are around maximising the recovery of those ashes and that's certainly something that i know is happening across scotland so it's happening now and there's a very expectation when they're requested to be available there's nothing to prevent that happening other than what you've described willy very very very rarely would there be no ashes and did i read in the briefing the evidence it was written that there are other methods now being developed a bit yes Tim yeah again from the national committee there is operational guidance that's coming out of the committee that sets the conditions for cremation that are ideal for maximising the recovery of ashes and the the the bill specifies that ashes should exclude metal should the bill specify what should happen in these circumstances tim you're on a you're on a run i'll take others if they feel the need yeah the the recovery of metal although the the definition of ashes says following the removal of metal law bonomy made the comment that that doesn't preclude the recycling of that metal for charitable purposes at the present time 60 percent of uk crematoria and only five out of the 28 in scotland currently recycle metal recovered with the consent with the specific consent of the applicant for cremation at the present time a scheme administered by the institute in the last 12 months generated 700 000 pounds for local charities and those are charities nominated by the scheme member crematoria now those 40 percent of uk crematoria and the 23 in scotland that don't recycle are probably burying that metal within the grounds of the crematoria without consent so the institute feels that whatever the method of disposal of that metal consent should be obtained from the applicant for cremation and that would be from bereave parents or adult cremations in other words all cremations consent for the disposal of that metal and those applicants should be given the options available to them any other comments anybody wish to add anything to Tim's response there i think we've in the main covered you know net fascist because there seemed a little bit of disagreement about what's in the bill and what Lord Bonomy actually said i just wondered what the viewer and the table was on that it has been agreed that you know that that has been agreed and adopted by just about everyone that we were we would use the Lord Bonomy definition of the ashes as all that is left in the cremator after removal of metal anybody add that name of Caroline yep Tim yeah that whilst there's a need for the legal definition if there could be some sort of a explanatory note within the bill just stating that the legal definition contained in the bill and the definition might by Lord Bonomy are one on the side yeah okay Carly do you wish yeah just i was interested NHS Lothian i'd endorsed the the wording within the bill um from the point of view of clarity but i noticed some of the other written feedback asked the question about whether the grinding or cremulation part of the definition was required and that that may offend the sensibilities of certain faiths or cultural groups who wouldn't normally apply that process following cremation and it just seemed a question about whether it would be necessary to include that or whether to use the more simplified bonomy definition of everything that's left without putting the the cremulation part of the process into legislation within the definition of cremation and ashes okay i think i think we've covered all of the points at being i'm i'm looking at you bob i'm looking at some of the others um what i want to do first of all we will know if you've got a wee point there that needs clarity then we'll do that then i'll ask the panel members if there's any of the areas that they feel that we haven't covered this one and given them a last chance and then we'll wrap it up we'll get the minister now i think and apologies to those given evidence it wasn't a question i was going to ask but i just spotted it from my briefings and we should ask it for completeness for the evidence session i think convener it's obvious that there's going to be a new criminal offence potentially created by negative instrument in relation to those who fail to meet their obligations under under the terms of of this new act and that would be looking at my briefing here that that would be punishable by a fine not extinct level three on the standard scale and i don't want to finish off on a negative note because so much positive has come out of this but i suppose it's only right to ask the question that if that negative instrument is passed what those around this table think would be an appropriate sanction or fine or imprisonment or whatever what the consequence should be for those who may be prosecuted and let's hope they never are because this system is already changing and will continue to improve fellow by the passage of this act but it is a potential provision within the bill so it would be good to get something on record in relation to that convener tim yeah the the level of punishment isn't something that really sort of springs to mind i think from i can only speak speak from from for crematoria but anyone who willfully flouts the law deserves punishment fine apart i think a person working in a crematoria i'm losing their job for breaking the law would be more significant than a fine Natalie the only thing i would say in relation to that is around the expectations of individuals who are affected by the services that we provide one of the things in Edinburgh that we've been doing over the last few years is building trust and respect with those that we serve and i think you know i won't necessarily comment on the the nature of the sanction or the level of the sanction but i think it affords those individuals a reassurance that that's a real legacy that if in the future there was any wrongdoing that appropriate action would be taken Nanette sorry can't line first and then we'll get a response all the responses sorry it was just a general concern about those negative instruments except in so far as they may apply to private burial and we've said in the written response that there's a lack of definition perhaps around human remains within the bill except that it excludes cremated remains and also a lack of definition of pregnancy losses under 24 weeks in some of those circumstances for example a medically managed early miscarriage or an early medical termination it may be that the woman pregnant passes the pregnancy tissue at home outside the hospital setting and in those circumstances you know sometimes informal arrangements are made which may in some circumstances include burying the tissue in private ground or under a tree or things like that happen i want to sort of be sure whether or not the definition of human remains as it pertains to private burial would include pregnancy tissue because that may have a sort of unintended consequence of bringing these sorts of informal private arrangements within an area of legislation where there is potentially a penalty or a year's imprisonment for not following the correct procedure to have that type of burial approved by the local authority there's a criminality of new people breaching the law is it right do you think that that is done by regulation or should that be in the face of the bill i think that i think there was some concern about one of the committees any views in my mind so long as it's clearly articulated for those who are working in the industry what they're expected to perform in terms of their duties and also the consequences i don't think city of Edinburgh council would have a specific preference as to whether it was in the the main legislation or by regulation okay do any of the parallel wish to say anything on the areas that maybe was not covered in in the question because it's a huge area we haven't even touched upon the the the the the regulation or and or licensing the phone directors which obviously is like trying to knit fog huge areas there as i say obviously when i read your when i read the comments of the committee i did notice that you had spotted that you know there's a lot of holes there in defense of the government because we've had a lot of conversations with the government regarding this because it is such a complicated thing and so many different factors involved they are looking at it in the way that we agree with to look at as a whole over a period of time to put it on the bill right here now would be virtually impossible the only thing i can say is that the government seems to have taken the recommendations of Lord Barnaby as written in stone and i would say that it would be a slightly haste to meet all the recommendations as quickly as possible there's a reason these laws haven't been looked at for 150 years because they're extremely complicated and they affect so many different areas of scotland different traditions different ideas i'm wholeheartedly in favour of the bill i say the fact that it has quite a few holes that can be addressed at a later period but i say we really do need to have a chat with with the powers that be about the licensing stroke regulation of your own directors because say there are there are many pro and against that's all i think it is useful jimmy if you have you've put that on the record there is as you well know that there are more than one committee looking at this and obviously there's a different focus from the local government committee in respect to some of this as well and they have focused on some of some of these issues if there's no one else yes natalie one final comment and it's more i suppose a thought for committee members in relation to the bill moving forward one of the thing that's been very clear in my mind that we need to continuously improve is the collaboration across different agencies who are supporting the briefed at a very very difficult time and i wondered whether there was an opportunity to almost require public agencies and statutory agencies to continue that collaboration in the future because this is a fairly significant opportunity for us to revise the legislation and i would really want to see the legacy from this as being part of us working together effectively in the future so it's maybe just a thought for committee members that she's full tim can i just endorse that i think yeah it's it would be good for continuation even after the committees the national committee has finished its work that that collaboration continues and from a from a cremation authorities point of view the crematorium rarely sees a bereaved family before the funeral so it does rely on you know that consistent information based on the considerations by the crematoria the funeral director and the hospital so consistent information please thanks for that no one else can i thank you all for your time this morning and the evidence provided both at this morning's session and indeed the evidence we've received hope we can reflect it in our final report thank you very much we suspended at this point and set up for the minister now move to the continuation of our evidence taking and welcome to the committee boring what minister for public health welcome minister dr simon cupott care burial and cremation bill team leader and graeme mclashan principal legal officer all from the scolish government welcome to you all and can i invite them minister to make some opening remarks and then we'll move to questions thanks minister thank you very much convener and thank you for the opportunity to speak to the committee today about the burial and cremation scotland bill i'll focus my opening remarks on the part of the bill that the that this committee is considering the bill contains a range of provisions which address the issues identified by lord bonomy to ensure that previous mistakes are not repeated the bill provides a consistent legal process for the burial and cremation of all human remains including those of a pregnancy loss in the case of a pregnancy loss the woman who has experienced the loss is placed at the centre of the decision making process the bill requires her oh requires that our options are explained to her and that she will have the sole right to make key decisions each key decision must be recorded and the bill provides for forms to be prescribed so that the processes followed and the information recorded are the same each time excuse me the bill will ensure a clear audit trail of decisions made and actions taken registers where the information is recorded will be open to the public but in the case of pregnancy loss the woman who experienced the loss will not be identifiable these provisions will introduce important consistency and accountability the bill also defines ashes removing any uncertainty that what remains after a cremation will be regarded as ashes people who apply for a cremation of any sort will be required to state on the application form what they want to happen to the ashes a cremation will not be allowed to take place without this information the bill also sets out what may be done with assages which are not collected while Lord Bonway's work was concerned with infant cremation we're taking the opportunity to make improvements to the cremation process generally this will ensure that in every cremation there will be clarity about what is being done what is expected and what will happen to ashes the bill delivers a strong package of measures that fully reform the legislative framework for cremation making it fit for purpose for today's needs this will implement Lord Bonway's recommendations and make important changes to the processes involved in the cremation of pregnancy losses and babies as well as bringing about improvements in the cremation process as a whole I look forward to the committee's questions minister we move directly to Bob Doris thank you good morning minister so there's a lot of positive things that come out of our evidence sessions so far but I hope you forgive me I want to focus on what issues are being particularly raised where maybe the bill needs more clarity or or may have to be improved one of the things that was welcome was the fact that when tragedy happens in mums lose their baby there's a seven day period by which hospital should should within seek to try and establish what the wishes would be of mum but after that if no decision has been made there's another six weeks by which mum has to to make arrangements as well as another seven days on top of that where there can be a change of mind and now the bill says that after six weeks there would be a duty to proceed in relation to the NHS in terms of how how how the baby's remains would would would be handled after that in evidence this morning we got the idea that perhaps that shouldn't be a duty perhaps that should be a right to proceed because there could be reasons for why six weeks was was not enough time to proceed and make very firm decisions in relation to that all the suggestion was made that it could be a duty to proceed unless there were stated reasons for why a decision could not be made by that time I suppose what I'm getting at minister is I'm just wondering if you've given consideration as to whether putting on the face of the bill a duty to proceed without caveatting it somewhat is too firm to set in stone and there maybe the need to be a bit more bit more discretion and a bit more flexibility in relation to that first of all you know this is a very sensitive subject and for anyone listening you know my heart goes out to some of the witnesses that you have already had it's very sensitive and we've been very careful in drafting this bill to consult widely as you know and all of it has been done with in conjunction with people who have been in this situation and bodies like sans charities like sans so that we have as far as possible I hope reflected their concerns and their wishes so in terms of I think it's absolutely right that we put the woman at the heart of this it's her loss and you know it's a terribly traumatic time and we have got to realise that a person may change their minds during that time there may also be examinations that have to be done to the tissue or the fetus and the six weeks was decided to be around about the right time but of course we would expect health officials to deal very sensitively with it and if further time was required then you know that would be perfectly allowable. You know there as well considering about if it's a duty maybe consideration has to be given about how some NHS boards don't kick in automatically that duty after six weeks without that discretion flexibility which I'm delighted to hear that as minister you would you would like to be sure about common sense to to prevail at that point so that's something you might consider on reflection. The duty is to make sure that it is the length of time at six weeks and not less so that you know a woman is given the right to change her mind if you know after the initial trauma she perhaps reflects and then decides that she'd actually want to do something different with her remains so you know it's making sure that they have that length of time six weeks but if that's not enough then we would expect the authorities to be sympathetic. That's very helpful. A second issue that arose from evidence this morning was a welcoming about to clear options in relation to how hospitals would seek to support a mum who's maybe lost her unborn child in relation to that choice they have about whether or not to deal privately with how they would handle that or whether the NHS would make arrangements quite often they would be group arrangements in relation to how babies were handled and dealt with in relation to those tragic circumstances but we heard from NHS Lothian that just now they're a little bit more nuanced in relation to that and they're actually very supportive in relation to supporting mums, supporting families having maybe bespoke private arrangements but not left to their own devices to go and do that themselves but the NHS provides support in relation to that so again it's just to make sure that the bill doesn't lead to unintended consequences so both those options of the NHS taking care of that matter at a time of distress if that's what mum wants or mum going off privately and arranging something but the spectrum in between that where NHS boards can sensitively help and support we just want to make sure that this bill doesn't squeeze out what could be best practice or might be emerging best practice in NHS Lothian and I would hope another NHS boards across the country as well. I think the bill and you know I'm open to obviously to other suggestions but I think it does set out the options available for a woman and you know there will be those who choose to take the remains and dispose of them privately through a funeral director and I think you've heard that funeral directors in the main are very experienced not very experienced but experienced in dealing with this situation too so I think it is important that post the event that women have the chance to talk and reflect with midwives or the doctors and pastors you know hospital chaplins and you know as I say up to six weeks have that flexibility to choose themselves what they want to do. My final question correct I know what other members want to come in and ask more questions but it's just I suppose that NHS Lothian in part is seeking the reassurance that the legislation doesn't preclude them from providing additional support to mums that have lost their babies and I see Dr Cuthbert-Kerr agreeing that that's not the intention but it's just to get some of that on the record to reassure the NHS which you've now got the opportunity to do minister. If Simon is nodding I'll let him answer this one then but yes. Thanks minister. I think that's absolutely right as the minister says the key to the bill is to allow the flexibility of approaches it's a reality I think that not all health boards necessarily have the same procedures in place as NHS Lothian do however nothing in the bill would prevent a health board from offering that sort of situation that you describe whereby essentially there's a private cremation carried out but the family is supported in doing that by the health board and we very much would expect all health boards when they begin to discuss the options with the women who has experienced the loss to explain to her the various options that are open to her and what they all mean. There is chief medical officer guidelines and advice and that has been updated regularly and of course will be updated again as a result of this bill. The point was raised by Lothian who if you like are doing a lot of good work in this area that that duty that was being placed on him doesn't give them that flexibility so it's not you know that it comes from Lothian who feel that that is a duty in the bill that they must act upon at that six weeks point. The other issues that have been raised in evidence is the other the early stage as well with the seven day and time to reflect and whatever there are some issues that come out of that in terms of religious and cultural beliefs that would impact on that as well and that you know applying the standards would you know would be based served by you know some flexibility in and around that as well. I think we are very mindful of that and I think in the guidance the flexibility will be in built you know there are I've you know Simon and I were talking recently about you know we now live in a multicultural society and as you said convener some faiths will want to dispose of remains as quickly as possible and we're mindful of that in drawing up the guidance and the forms we have and will continue to consult widely. So that would be addressed in the the forums but but the bill would say that there's an requirement to. I think that most people want to have people buried as quickly as possible but the six weeks gives the woman who's at the centre of this the flexibility to because of the trauma of the situation reflect and have that time to to decide what to do but I don't think anybody would want to to drag the process out unnecessarily. The earlier stage you know that places are you're a duty and everybody to wait until seven days after the decisions to reflect and whether that decision is what they really want so I think it was described it's not very up but it's a cooling off period almost for seven days which would impact on the those religious or cultural practices that would that would require a disposal you know a ceremony very very quickly which would apply to everyone then would you know it and the legislation? I mean it's not set in stone that you must wait seven days if well Simon do you want to answer this? Thanks minister I mean the the reason for the seven-day period is really in response to engagement we've had with pregnancy loss charities like sands who the minister mentioned earlier and others where the experience is often that a woman may make a decision about how she wants the remains to be handled but then having reflected on it may choose to make a different decision so we felt that it was important that there was a period whereby nothing would happen and that would allow the women to change her mind however we've subsequently had representation from the likes of the muslim council of scotland who have noted that that would potentially prevent a burial or a cremation well burial in that case taking place sooner rather than later so we're now going to consider a stage two amendment so that a woman for whatever reason whether that's a religious belief a cultured belief or simply just because she's clearing her own mind that she knows what's going to happen can wave that seven-day period. That's very helpful. We heard this morning that in these cases that a woman who's suffering a pregnancy loss will be in that hospital environment maybe for 24 or 48 hours one or two days we know that there's one midwife in the whole of Scotland who's got some training here and the minister placed some responsibility on that bereavement process on the basis of doctors maybe nurses or hospital pastors now that's all going it's all you know the success of this is about good communication you know are we are we confident that we've got the capacity to deal with us that we've got the people in place the training the expertise and if not how how we how we're going to practically implement this to make a difference to people who are suffering a pregnancy loss in the future. In some cases, convener, we can always do better but this is on-going at the moment and I'm not aware of any complaints about what happens at the moment so I think you know as I said we can always do better but and the training is already there in the hospital setting and obviously a woman will be discharged to her own GP practice and they will be aware of of the situation and will be able to follow up. I think maybe some of the others might want to refer to it but I mean I think when we had an engagement with women parents who who had suffered this loss they they describe experiences in a busy maternity ward Nanette, can you describe some of us? I think it was I was going to ask a question about the application forms anyway but in relation to to basically filling up the forms some of the busy parents had felt that you know they had lost had a stillbirth or or whatever and then they were presented by a member of staff with the form and asked various questions and that the form was essentially filled up for them and they really hadn't any real idea what they'd signed up to. They felt the process was a little bit rushed and some of them felt that they should perhaps be sort of counselling at that stage where someone had the time to sit down with them. I appreciate in a busy maternity ward midwives don't really have time they might be dealing with a brief parent and then rushing to do a delivery and I can see how these situations could arise and there was a concern expressed at that point in time and when it came to actually filling up some of these fairly complicated forms and other questions about forms familiar. I think you know in other situations we hear of funeral directors filling in forms for bereaved relatives without necessarily really delving into what the form and the questions actually means and we want to make sure that the forms are streamlined as possible and have sections specifically where a child is involved and specifically where an adult is involved. The fact that we'll have this period of delay will mean that if the forms filled in, if women feel that it's filled in in a rush, that they can ask to go to back over it but there will be CMO guidance and will be further CMO guidance on this particular part of a death. How many women will benefit from this legislation? I suppose what I'm asking is how many people currently find themselves in a situation pre-24 weeks right through suffering in the broadest term pregnancy loss? I can certainly give you the figures of pregnancy loss and stillbirth figures that are out there. It is declining and I'm currently having a review of infant mortality and maternal health, maternity review, so that will also help with that. The CMO is very experienced in this area and we're determined to get the numbers down still further but in terms of how many people are affected, we can certainly get you those figures. The reason I'm asking that question is because to pass the legislation, places are a lot of requirements and a lot of different organisations, including record keeping, counselling, whatever, whatever. There's a great demand there and an expectation that people will be communicated effectively with and their wishes will be respected. If we don't know the actual number of women who need to have access to that type of new regime, how do we understand the resources that we need to make it effective? It's not a new regime. There are regimes in place at the moment. As I've said, there is CMO guidance at the moment. However, what we want to do—this is the result of Lord Bonami's report and the baby ashes scandal—is to reflect what happened there and make sure that it never happens again. Richard Lyle Can we return to the fact that the bill explains that a single application form will be used to record all applications for a cremation, including any cremations of remains from pregnancy loss, stillborn or loss of a baby? We've had evidence from several people that it would be preferred to have rather than one form. To me, a single application form is an A4 piece of paper. We've all experienced death during our lives and births. To have a single form that could be actually explained to a booklet won't become a single form then. It's a situation where we could be asking questions of people who have, sadly, experienced in their past life, whether they're burying their husband. They may have experienced a pregnancy loss many years ago and going through that form with anyone will traumatise them. Why aren't we suggesting or why aren't we going down the situation of having three separate forms that have been suggested by NHS Lothian? They have raised concerns about a single form and the Institute of Cemetery and Crematorium have raised concerns about a single form. Basically, they're suggesting that it would be three forms, one for infant, stillbirths—pre-24 weeks—stillbirths and pregnancy losses. Are we considering changing or what was your original perception of just one form to encapsulate everything? In terms of the form, it's not been decided yet what the form will look like or how long it will be. That will be decided in consultation with organisations and health boards and funeral directors. However, you can rest assured, Mr Lyle, that we want to keep it as sensitive and precise as we possibly can but to make sure that we have enough to have accurate records and consistent records and that there is, as I say, consistency across Scotland, which I don't think there is at the moment. Do you know that a crematorium has introduced its own form, which could be wide-ranging all over the number of crematoriums in Scotland? That's why we want to get consistency of the form so that every organisation is using the same form. I know that other members may want to ask those questions, so I'll leave it until the end. I'll have a chance to come back in. I asked some questions around confidentiality, especially post-24 weeks for stillbirth and the like. The bill seems not to afford the same levels of confidentiality as was previously the case. I wonder whether the minister has given any thought to that, especially with regard to late terminations. There is already a guidance on that. Post-24 weeks is regarded as a stillbirth and has to be recorded, whereas pre-23 weeks and six days do not have to be recorded. However, the forms will ensure that the person is not identifiable. In all cases, the person will not be identifiable. Can I also ask about arrangements for the person who makes arrangements must be 16 years or over. What regard is taken of a mother who is under 16 and how wishes with regard to disposal? That again is a very sensitive situation, but we hope that either a very close relative would be involved or if the under-16 does not want relatives to be involved, that the NHS service would provide that. That does not seem to be in the legislation. I think that we can check, but we have said generally that if a woman does not want relatives to be involved, that is her wish and that should be respected and that the NHS should provide the service. I might need to look at that again, because for people younger than 16, that was not the case. My question is about the forms that have been answered already, but I have to go on with the meaning and treatment of ashes. The definition in the bill of ashes differs slightly from Lord Bonamy's definition. Asking a previous panel about it, it felt that the definition of the bill was fine, but it should perhaps be clarified by Lord Bonamy's definition for absolute clarity. There was also a thought as to whether the means of grinding or whatever means of dealing with ashes, whether that needed necessarily to be in the bill might upset such people. It is a very sensitive area. I visited a crematoria so that I was a crematorium, so that I knew what exactly happened. Among the stakeholders, the definition of ashes in Lord Bonamy's report was not quite what they expected. That is why we have redefined it with the agreement of the stakeholders. In terms of the crematorium, there is the idea that there will be separate trees in a crematorium, or that we can opt to have a completely separate cremation in a small cremator. Those options are available for people and should be explained to them what the options are. The connection with that was the fact of ashes being available. The people on the table this morning said that, in the vast majority of cases, there would be recoverable ashes. It would be very rare for there not to be. That was accepted. The other thing was that both definitions exclude metal within the remains. It was what should happen to that metal thereafter. I cannot remember if I find in the bill what should happen to it or not, but I welcome the thoughts on that. Metal can be separately taken out of the ashes. In your previous session, somebody said that there was £700,000 worth of metal recovered. I do not know over what period that is, but clearly, if that is the case, then there is a good use to which that could be put to, maybe even in terms of counselling charities. That sounds like a good idea, which we will definitely take away after this morning's session and have a look at it. I will follow up on that. Just very specifically, this morning's session, that was a really interesting idea. I have seen a really positive thing, but one of the things that all come out in relation to the recovery of metal, if it is not deemed to be part of the ashes, is still about relatives giving authority for how that metal is. It is not used or to be informed that metal was recovered and they would intend to dispose of it and hear how it is signing up to that within the process. It is just whether the Government would give consideration as to whether, on the face of the bill or in regulations, best practice by statute or otherwise would be considered about how the cremation authority or the funeral directors, whoever that would fall with, would make sure that families knew what was happening, because the metal could keep sakes that were within the coffin when loved ones were being cremated, so maybe they might want some of that back or they might be keen to have it buried in a garden of remembrance, or they might sign up to a recovery scheme, but it is about empowering the families to have a choice in that matter. It is wider probably than infants and babies, so whether it would be considered elsewhere rather as part of the bill, I do not know, but it definitely has to be considered, I would say Minister. Yes, and this is one of the things that will be, there will be a question on the forms, so you can already see the forms getting larger when you take into account things like this, so yes, this will definitely be a question on the forms. The only other one that we have in the brief and this ever longer forum, should the bill specify how crematoria should dispose of ashes that are unclaimed? Yes, this is a big problem and certainly when I visited Seafield crematoria, I was taken to a room where there were urns unclaimed. Yes, the bill will specify what crematoria or funeral directors should do with ashes if they remain unclaimed. We would expect them to be taken back to crematoria and crematoria would dispose of ashes periodically, but in all cases we would still try to contact the relatives and I think that that is an on-going thing at the moment and will continue to be with crematoria and funeral directors, but sometimes you can understand people just not wanting, but they should be able to say that and let the crematoria or the funeral directors deal sensitively with them after having kept them for a while. I have not asked the question, but I wish to ask the question at this point. Most of the questions that I was going to ask have been answered. There was a suggestion made in my experience of bringing loved ones. I have come across some wonderful undertakers who have been very sensitive and working with the family. What position is the Government looking at in relation to the licensing of undertakers? If someone knowingly breaks the law, what can the courts or anyone do in order to take that person to court? I think that we do want to regulate more the funeral industry. I think that there are increasing concerns about the funeral industry and people thinking that it is an easy thing to do to just set up being an undertaker. It is clearly not. The bill will give the minister powers to regulate the industry. That is something that I would consider in relation to the community's minister and the whole cost of funerals, but costs are not dealt with in this bill. It is not appropriate that it is dealt with in this bill, but it is some work that Alec Neill is taking on. We have all seen the Citizens Advice Scotland's cost of dying report, so it is clearly something that is to the forefront at the moment. I will go into the cost of journals, but we know that they are very expensive. One of the other points that has been made by one witness in particular was the fact that we will only have an inspector who will go out, but would that person have any someone to help them if they wanted particular? There are so many crematoria, I think that it is 24 or more in Scotland. Basically, would it just be a one-man band or alternative? Would they be able to have appointees, such as prison visitors, who used to be appointed by local agencies? Can the inspector find or recommend somebody to be found if they find that they have broken the law or the new laws that are coming in? On the inspector, we have clearly one inspector at the moment, but the bill will allow the appointment of me or my subsequent ministers of public health to appoint as many inspectors as required. I hope that we would not have a situation where we needed a whole lot of inspectors, but maybe one is not enough. We will certainly make sure that people feel confident that crematoria is all working well and that it is a good standard in terms of penalties. I suppose that there are two different approaches. The bill sets out a range of specific offences that attract particular penalties if those are breached. An inspector could report that breach or an individual member of the public could report that breach. There are various routes whereby those formal penalties can come into force. More generally, however, we would see the role of the inspector very much to ensure that whatever business organisation he or she was inspecting was doing what was expected of them. We intend—in sections in the bill, about the inspector's powers—to range from providing advice to a particular crematorium about how to come into compliance with the law through to recommending to ministers that operation of that crematorium was suspended. That is a decision that would be taken by ministers, but we certainly would view that as being one of the options that an inspector could recommend. I want to ask a little bit more about how we deal with pregnancy loss before 24 weeks. Of course, there are various distinctions that kick in in terms of timescale and terminology. For the word fetus, it could be implied that it is a pregnancy that ends eight weeks or earlier, but 11 weeks kicks in at a certain point in the bill. Maybe at that point you are booked in for your 12-week scan and how our pregnancy losses dealt with by midwives and specialists would kick in at that point. I am wondering whether the thought has been given or further thought to be given to the very early miscarriages or pregnancies that end where maybe mums told that the pregnancy is likely to be unsuccessful. It is still at very early stages. Go home, go through what you have to go through for that to happen, maybe baby's remains are at home, maybe mum has to go to accident and emergency, because that does not always go to plan either. At that point you are dealt with non-specialists in the wider NHS who clearly try to do as good and sensitive a job as they possibly can, but they may not see these things very often. At what point would options be given there for how would you like your unborn child or your fetus? The terminology becomes really quite important emotionally in these situations. How would you like that to be dealt with sensitively? Is there standard in common practice across the NHS or should the bill act as a focus to improve how we deal with those situations? Perhaps the non-specialist side of NHS care for the very earliest of pregnancies that end in miscarriage? It is our intention, having studied the bill further and had more consultation, that the bill should apply to embryos and we will lodge a stage 2 amendment to make this clear. It is up section 50 brackets A that says that a woman may decide to make her own arrangements for the disposal of remains rather than authorising an individual or the health authority to make those arrangements. The woman would be given the guidance on what she can do if she wants to make her own arrangements. There are CMO guidance on pregnancy losses up to and including 23 weeks and six days, recognising that the woman already has the right to make personal arrangements, so it is possible for a woman to make her own arrangements for the disposal of those remains. However, the bill will formalise that process and provide additional clarity and consistency. I welcome that. Part of that question is reassuring that that can and can happen in practice, but it might not happen consistently across the NHS at the moment or maybe has never actually not at the moment has never been done consistently across the NHS. It is about driving up standards and it is back to that thing again about a lot of frontline NHS workers may very rarely and occasionally come face to face with a mum who has maybe recurrent miscarriage pregnancy loss and turns up at hospital. The key part of the question was what those provisions would be taking. If that would have happened via an amendment, I welcome that, but it is also about how we do wider awareness training for non-specialists within the NHS. Is that something that you would give consideration to as well? I am caution again saying that there is not consistency at the moment because there are clear CMO guidelines out there already. Obviously, there will be new CMO guidelines taking into account the provisions of the bill once they come into operation. Obviously, health boards of our duty to make sure that all those involved in this area are aware and have training in any CMO guidelines. I apologise, minister, for clarity from my question. I am not stating how significant consistency or inconsistency is within the NHS. I am merely saying that there is an opportunity to ensure that there is consistency. Is there any huge organisation by definition that there will be individual experiences where people will not be dealt with sensitively? That is just the nature of any huge organisation. It is about driving up standards and constituency, even when things are working reasonably well. The question was whether you would use the bill as an opportunity to make sure that there is consistency and that NHS workers on the front line who may not see this every day are made aware of what their duties and responsibilities are—in a supportive fashion, of course. Absolutely. I am going to be an implementation programme and training very much part of that programme. Do you pick up on that and take the ambition for the bill to regulate, to keep records, to monitor it? Who monitors the output of the guidelines that are currently in place and when do we last evaluate whether those guidelines are being implemented consistently? At the moment, particularly in terms of NHS records, there is not necessarily any external scrutiny of that. We would see that as being one of the roles for the inspectors. I guess that in the case of pregnancy laws, for example, we would look to perhaps the inspector of crematoria or perhaps burial, depending on what route the particular pregnancy law has gone. There are clearly some data protection issues there. We would need to ensure that an external inspector was able to inspect records to the extent that they were able to satisfy themselves that things were being done properly or to make recommendations where they were not being done properly, while at the same time protecting the confidentiality of individuals whose records have been scrutinised. That is one of the functions that we would view for the inspector. I will try to get one or two points here. In terms of the CMO guidelines that have been referred to by the minister, who evaluates those now? How do we know that those CMO guidelines are being implemented and are effective at this current time? The CMO herself would make sure that she currently monitors the guidelines in conjunction with people in the health boards themselves. Are not independently assessed, inspected and evaluated? Not that I am aware of, but we can certainly let you know in terms of that. If we are moving to another regime that expects all of these, I suppose what we are talking about here is what is applied in regulation and what is in the face of the bill and what becomes a legal duty. How are we going to ensure that, if we do not put some of those measures into regulation or make them legal duties, that they will use a less pejorative, establish and improve best practice as a result of that legislation? Who will monitor it? Who will inspect it? Who will tell us when it is going wrong? Who will tell us when it is going well? This is very much part of the duties of the inspectors of Crematoria to ensure that, in relation to burial and cremation, best practices are implemented. I was particularly thinking about the situations in hospitals that ensure that that discussion takes place, that discussion has taken place, that discussion has been registered to the persons. Who will ensure that all of that takes place? At the moment, for example, if anybody is not happy with a situation, there is a complaints procedure that they can go through. Things like that are often flagged up on patient opinion and they can go to the SPSO. We are dealing with this legislation because people went through a traumatic experience who, so traumatic, that they could not or did not have the will, the confidence to ensure that what was in place, their wishes, would be respected. To say that they can complain and that they will trigger a failure in the system is pretty. How do we prevent failure in the first place is more important? That is what the legislation is about, is it not? That is why there will be guidance as a result of the bill. The inspector's job is to make sure that that is adhered to. I was thinking mainly about the situation that develops in our hospital. When the event happens, who will ensure that the discussion takes place? Who will ensure that the midwife is engaged or that the designated person is engaged? On to another of my bills that is currently going through the Parliament in terms of duty of candor. We have discussed issues about that situation arising in hospitals. Will you still be for the inspector to do that in hospitals? The inspector would have the right to inspect the processes within the NHS. The process in relation to the disposition of the remains of children and ashes. We would view the whole process as being part of the same process. From the point of the loss through to either burial or cremation, we would see that as a continuation of a single process. Therefore, it is valid for the inspector of crematorium or inspector of burial to be able to have the power to go to a hospital and review their practices. That might not be something to do in isolation. It might be something to do with quality assurance staff in a particular NHS board, but we are viewing it as part of the process, not as two separate processes whereby a pregnancy loss occurs, a separate process happens in the hospital and then a second process takes over for the particular disposal. I realise that I am repeating myself, but we are very much viewing it as a single process from the point at which the loss occurs through to the point at which the disposal happens. That is a process that will happen in different contexts, both hospitals and crematoriums and burial grounds. We will bring in to play various different professionals, including crematorium staff, burial ground staff and hospital staff. It is absolutely valid that the inspector has a role. I am sorry, I did not quite catch that. The crematorium inspector will have the ultimate responsibility to pass judgment on whether he will have access to those records. As I said in my previous answer, we would expect the inspector to have access to the records in order to establish that processes were being done properly under the terms of this act. He or she will not necessarily be a medical practitioner, so parts of that record might have to be redacted, but it would be about ensuring that the process was taken place properly so that working backwards, so that forms were being completed properly, so that the options open to the women were being explained properly so that timescales were being adhered to. We will test that against people's experience and we will speak to those people who have suffered the loss to check that they were satisfied that they were given an opportunity to. That is not necessarily one thing that we have looked at the inspector doing. We have viewed very much the inspector as being looking at the process, but I do not think that there is anything in the bill that would prevent he or she from doing that. In fact, we know that the current inspector has spoken to individual members of the public about their experience of cremation, not necessarily in the context of pregnancy loss. We have heard evidence that in new experience, because it is not typical that somebody running a crematorium would be engaging at all with the public. That is done by funeral directors or doctors or whatever down the line. It is an interesting idea, but how do we know that we are making a difference with all that formfilling and doing all that? We do not speak to people who have been through the system to assess whether they felt involved, that they were empowered to make decisions and choices and that their choices were carried out and that they were satisfied with the services. Most people who have been in hospital are given the opportunity to feedback their experience if they so wish. There is an experience that they give in the hospital to the UNI as MSP's minister—sometimes a difference, but anyway. Bob, yes, the net will bring you in. Sorry, the net is on the same theme. I am just wondering if much of this is already inspected. We just do not particularly tie it together. Where I have got the new inspectorate post being is looking at individual cases and falling it through every step of that process. When an individual is falling it through to whether mums turned up at an A&E unit in significant pain all the way through to whether there is a cremation or not, that process has been fed through. This is a new post that can look through that, where problems arise or there is not actually recovered. I am clear in my head on that, but separate from that, accident and emergency units get reviewed and assessed. There is currently—I apologise if it is now completed and I have missed the conclusion of it—a review of maternity services in Scotland. I do not know whether that is on-going or complete. I would imagine that that would look at this kind of thing as part of the maternity services review. Individual maternity units also get assessed for how they are doing. There are lots of different inspection regimes at playing the NHS at the one time. What I would want to assure and so on is that, when all those inspections are kicking in, they are giving cognisance as part of those reviews going forward once we have got that piece of legislation on the statute to make sure that any future maternity review or individual maternity units or when A&E's are assessed, the whole gambat of services in the NHS, where appropriate, is also part of that assessment to make sure that we are getting obligations within the bill correct. I suppose that would be my question. Yes. We must stick to the fact that this is a burial and cremation Scotland bill, so we are actually talking about women specifically in this situation. Obviously, what we are trying to do in this bill is to make sure that the baby ashes scandal never happens again and that we have legislation in the statute as far as possible, having consulted all the people that we possibly can in relation to this. I think that stakeholders very much in the majority are in favour of what is being proposed in this bill. I agree with that. I apologise, but it is just that, in case we sit in a here's running today in relation to going back to bereave parents who can be incredibly vulnerable in May or May not, we wish to be contacted again. How can you ever know that? We have, last week's evidence as well, the issue around some parents may want that, some parents may not want that. The risk of retraumatisation, part of the baby ashes scandal, was parents who had sought to deal with move on. However, anyone can deal with and move on in these situations, being retraumatised by reading in the papers this scandal in itself, so just a slight concern that we ever were to go back at a later date to an impacted parent about how we could ever do that in a way that didn't. I'm not saying we shouldn't, but I just don't think we could get an answer to it in last week's evidence about how we could do that in a way that wouldn't risk further emotional impact and distress in that whether parents themselves, as a group, would even have a view in relation to that. I think that things have moved on greatly and I think any person who finds themselves in this situation is signposted to counselling services that are available. I wouldn't think that we would actively seek people out, but through the media, you often ask people if they want to come forward. On the keeping of registers of cremations and burials, notice the bill says that ministers can, by negative instrument, make it an offence if health authorities, crematoria or burial authorities fail to keep their registers in the form specified. I know that the fact that this is done by regulation rather than on the bill has been criticised by the Delegated Farms and Law Reform Committee, so maybe a bit of clarity on that, but what behaviour is likely to result in a criminal offence in relation to registers being kept by health authorities, cremations and burial authorities? We don't see any particular problems with the register. There are other registers such as birth deaths registers and there are already public documents. We don't see any reasons why the registers shouldn't be made public under the bill. There are obviously data protection issues to consider. In the case of a pregnancy loss, the public register, as I said previously, will not identify the woman experiencing the loss. In that case, a unique identifying number would be used. It is about having an audit trail without revealing the identity of the woman. I think that there was some concern that the registers might be used, for example, by debt recovery companies to attempt to trace money owned by the deceased. I don't think that that's going to be a big problem because there are obviously currently other ways that people can get that source of information. I don't know, Simon. Do you want to add anything? In terms of what would constitute an offence in terms of registers, the bill talks about failing to prepare or maintain a register, as prescribed. Essentially, that would be things like either not having a register at all or failing to record the information in the manner that was prescribed, either the wrong information, incomplete information or in the wrong format. That's the reason for not having that in the face of the bill. Can you have it in regulation? We have taken into account what the Delegated Powers and Law Reform Committee has said. We're looking to bring forward at stage 2 any amendments where we can specifically bring that on to the face of the bill. I think that the offences that the member is talking about are actually on the face of the bill already in sections 11 and 42, so they're not left to regulations. They are actually offences set out on the face of the bill in relation to the register. I'm familiar with the other parts of the bill. There are others, and we are reviewing those in light of the DPRC's reports with a view to nationalising them. The final thing to do is, should there be a specification that those records should be kept in electronic form, given that we're in the 21st century or not? We haven't specified that. We would like to get to that point, obviously, but different organisations are at different stages of computerisation, so we didn't want to force costs on crematoria or undertakers, but we would obviously like to get to that situation. It was good to hear from Mr McGlashan that we've heard some information earlier today about the various legislation that's in this field. I think that we've heard from the minister in terms of the register of births and legal requirements, particularly in regard to over 24 weeks in five or six days, that there's a requirement to register that birth as a character. Just to get clarity on the early assurances from the minister about the anonymous nature of that, will that apply to all births over 24 weeks or just determinations? My understanding was that all births are recorded and the name is listed over 24 weeks. Pardon? I'm sorry, I don't know where the sound is. Currently, stillbirths over 24 weeks are recorded and the name is recorded as well. That will continue? We'll look at it, but we think so, yes. Terminations at 24 weeks? I think that we'll need to look at that. Is a question about whether you can provide that privacy and... Simon, do you want to come back? I think that it's still considered as a... Yes, absolutely. I have to say that it's not something that we've particularly considered. The distinction between 23 weeks and six days and 24 weeks is set out in the Registration of Births, Death and Mages Act 1965. We've essentially taken forward the bill on that basis. Our understanding is that any pregnancy that is delivered beyond 24 weeks and is dead, regardless of how that has come about, is legally registered as a stillbirth, which is then registered as a stillbirth and records the name of the mother. We certainly could look at that to see whether we could bring about anything so that, in particular circumstances, the mother's anonymity is... Raised with us in evidence in terms of late terminations, where there may be an issue there about which that mother may wish to require some anonymity. That was when it was raised with us. Beyond that was the legal requirement to register that birth after 24 weeks, which is a abortion law. Do we see... We've had some evidence that there's a lot of law in this area which might be conflicting at this point in terms of the aims of the bill? Is that something that you have examined? I'm looking at the legal advice I'm on, sir. Certainly the members about where abortion laws are reserved at the minute, so we can't operate on anything that's currently in the 1967 act. In relation to what's recorded, we are taking on the current position with stillbirth that's in place at the minute in the 1965 act. We can certainly go away and reflect on the evidence that you've heard earlier and have a think further, but there's certainly legislative competence limits on what we, as a Parliament, we can do in terms of the abortion act at the minute. I suppose with the general question that if you were wish to consider or take on board the issue of late terminations after the 24 weeks, currently after 24 weeks irrespective of the death, that would need to be registered as a stillbirth. So, you know, how much flexibility if you got there, would that mean that the 65 act regarding the registered would need to be amended to allow you to do something different there? I mean, I can certainly go away and reflect on it. I appreciate their complex issues and I haven't been presented with an issue about late terminations. That's fine as somebody's came out of evidence, we're not arguing one way or the other, it's just an issue. Terminations after 24 weeks would be for medical reasons only. Yes, we understand that, but then we're going into hypothetical and suppositions. Well, it's all hypothetical until it happens. I just think for clarity for myself here. Some understanding is that because of the reserve nature of some of the legislation, the current practice in terms of how stillbirth are registered irrespective of whether it's a post-24 week termination or a pregnancy that didn't make it to full term, that will stay the same. That bill doesn't change that. I, for my part, wouldn't like to enter discussion about whether we should change that as a whole other discussion in a whole other area about whether stillbirth should be registered after 24 weeks via a termination. I think that the substantial issue for this committee might be the anonymity of those who have the termination. I think that that takes the other aspect of the discussion out of the equation. Currently, post-24 week individuals with a termination, do they have that right to privacy and anonymity? Will the bill change any of that? I think that that's the substantive point for my interest rather than whether it should be registered or not, because that takes us to a whole other discussion. As Simon said, at the moment, where there is a stillbirth after 24 weeks, the person is normally named in the bill, but we'll go away and have a look at it. We've got that clarity in terms of where there is a confidentiality and where there isn't, and we might take further consideration on that ourselves. It's a theme that started to emerge, not whether they should be registered or not. I think that's a whole other discussion. I think that Bob has hit on a point there, but there are aspects of this bill about notifying the nearest relative, et cetera, et cetera, so I suppose that it's more about that aspect there about confidentiality should that person want it and whether this bill changes that relationship. The other one, we've spoke a lot about these situations arising in the hospital setup, not always the case, as Bob pointed out, and actually the emergency and other aspects. Out with the hospital, I suppose, there was an issue raised in evidence about that pregnancy loss happening outside the hospital in prison, the residential setting, or indeed the home, I suppose, and have we given that any consideration? If a pregnancy loss occurs in a prison, the health authority will be involved, because as of 2011, the care of prisoners became the responsibility of the NHS, so a prisoner would receive medical care throughout the pregnancy, just like anybody else from the NHS. In terms of residential care, it would be provided by the NHS board. There would be somebody who would engage with that woman, who would take on that role. The role is clearly defined in a hospital setting, but there would be a designated person who would take on that role of dealing with that woman from the health service or the local government. I wouldn't say any discrimination between the care of a pregnant woman regardless of the setting. Regardless of the setting, there would be someone designated from the health board or local authority to inform that woman of her options and choices. The health board would be in charge of that person regardless of their setting, and they would have a midwife in the same as anybody else. Okay, thank you for that. Any other questions for my committee? Given that the bill—I'm just wondering where a residential or a prison setting becomes the same as a home setting, for instance, if medical attention wasn't required for the loss of either a miscarriage or a stillbirth, would the duties that fall on the hospital fall on whoever was employed by the state, or would it be left in the hands of the woman herself? In every situation, the health board is the authority that has the duty of care for that person. However, where a miscarriage for instance happens, a tone that the health board doesn't have to take steps. That remains in the woman's decisions, surely, but where it does happen in a hospital, the health board has it. Tracted to the health board as well, so if a person goes to the GP, it's part of the health service. However, if there is not a medical professional involved, does somebody at the prison or the residential centre take on those duties? I would have thought, and having been a prison visitor for 14 years before I came in here, that the duty of care of the prison service would probably make sure that a medical professional was called if someone was having a miscarriage, especially if it was in later stages of the pregnancy. We might need some clarity on that, I suppose, but one last one here in terms of the bill of course creates an offence for providing false or misleading information. Should I also specify in the bill whose role it is to explain the options and the forms for the cremation and burial? In terms of a woman explaining the options to a woman who has had a stillbirth or a... You know, it lays out an offence for providing false and misleading information, so should it equally lay out who should be responsible for that? If you're going to face criminal proceedings for some people who could argue that the false and misleading information was incorrect information and not necessarily, that would be for the courts to sort out, but if you're going to set that up with a consequence of somebody who at that point was filling in those forums, having that discussion, then there's quite a serious consequence if they get it right. People could get a verse to be playing a part in that process if they felt that there was a severe outcome if they get it wrong, so should it not describe who should be ultimately responsible for carrying out that collection of information completing the forms correctly, given that there's such a consequence if they get it wrong? The intention behind the offence is really in response to somebody who deliberately provides false information. For example, somebody who doesn't have the right to make the application for accremation or somebody who provides false information to cover up a crime, for example. It's intended to capture that scenario. It's not intended to capture the scenario where somebody simply accidentally or to the best of the knowledge puts in information that turns out to be incorrect. If somebody fills in an application form and they accidentally provide the deceased's middle name incorrectly, we wouldn't view that as being an offence. In terms of who provides advice on the filling out of the form, we would look very much to funeral directors, in a lot of instances, but also to NHS staff and healthcare staff generally. We'll provide guidance to both of those parties as part of the implementation process, and as part of the implementation process, we'll work with those parties to make sure that they understand what their responsibilities are. It's also worth saying that the person who completes the form should be the applicant. It shouldn't be a funeral director completing a form on behalf of somebody. It shouldn't be hospital staff completing the form on behalf of somebody unless that person has authorised the hospital to organise the cremation of the burial on their behalf. Is that a form that they'll be left with? It's not necessarily left with it. By all means, they'll be given support there and then to complete the form. Our intention and the forms haven't been finalised yet. Our intention is that the applicant will sign the form to declare that they understand the consequences of their decisions. For example, if they choose a shared cremation, they won't get ashes back and have completed the form to the best of their knowledge accurately and completely. We had a description earlier from funeral directors who see a key role in their service is to take people through that form, ask those questions and then complete the form. Will that practice change as a consequence of that? One of the issues that we're aware of, and I can speak for particular funeral directors, is funeral directors completing forms on behalf of applicants. Applicants are not necessarily being given the full choice because the funeral director has perhaps said, there you go, this is what we always do, we'll do this again. So we're trying to design the form so that it puts the onus on the applicant, the person who is applying for the funeral, to complete the form themselves, or at the very least to say, yes, I have understood everything that's been asked of me and I have given answers to all of those. By all means, funeral directors should be there to support and guide somebody through it, but it shouldn't be a funeral director who's completing the form for an applicant. On the other side, we've got midwives who might wish to help somebody through that form, but it would be uncomfortable about recommending or assisting, talking about accommodation in a burial or whatever. Given your response, do we not need some clarity in and around who should be involved in that form filling if you're clearly saying that the key person involved in this is that nearest relative or the mother? Initially, when there's a pregnancy loss, the woman is probably still going to be in a hospital setting and therefore we'll have that kind of discussion with a midwife or a doctor, but if she decides that she wants to take control of how the remains are disposed of, that may be the point at which a funeral director may come in. She's also got choices at that point whether she wants to take the remains away. We've heard this morning that they're typically in for one or two days. They're in the hospital setting for one or two days, so on the day that she suffered pregnancy loss for some people, that's when she got home and got out of the clinical situation. That's the day that we should be presented with some of these forums or some of these options and choices. The bill says that a health authority has to try and ascertain the woman's views within seven days of experience in the loss, so they have that seven-day period which is to allow the woman to recover because we have heard stories, as I'm sure you have, of women being asked to