Lee Gibbs and Imogen Jones
In our first blog on the causes of delays, we noted that delays in the release of deceased patients can be, and are, caused by systemic under-resourcing of the NHS. This was our first ‘economy’ – the funding of both public health and death investigation/the justice system (whether they are, or should be distinct, is a matter for another day). In this second blog, we focus on delays that occur once the body is ready for release from the mortuary. Here we are talking about a different economy – that of the private sector. But, of course, this also depends on the funds of bereaved individuals, meaning that the picture is once again complex. They say that death does not discriminate (it does), but money talks. This begins to expose the uncomfortable relationship between the public and private sectors, and the very real consequences of this for both those involved in death care and for the bereaved.
What happens once the body is released?
The focus of Imogen’s research is on those deaths have been the subject of a coronial investigation, however, many mortuaries are also dealing with the bodies of those people who have died in hospital but are not the subject of a coroner’s investigation. In these cases, once the death has been certified (i.e. got to the same point in terms of readiness for release) the same processes and issues apply.
In terms of process, once the relevant form has been completed, the next-of-kin/executor (commonly these overlap) is responsible for engaging a funeral director to collect the body with a view to disposal being arranged. However, this is not always a smooth or timely process. We discuss some, non-exhaustive, examples of how this might lead to backlogs.
1) The funeral director does not collect in a timely manner
There are a multitude of reasons that a funeral director might not collect promptly. These include lack of action by the next-of-kin, lack of storage capacity at chosen funeral directors’ and an economic model which depends on limited storage capacity/time. These can lead to major issues, leading to attempts to compel timely collection with daily charges for non-collection (see, for example, the proposed bylaw for Flax Bourton Public Mortuary in Bristol). Storage capacity issues can of course be exacerbated if crematoriums are struggling with demand (caused by refurbishment works, faults repairs, breakdowns and of course sheer volume in periods of excess death).
- FAMILY: Family may not have a funeral director in mind, may not be ready to organise a funeral, may be going on holiday or be on holiday, may not have funds, may be concerned to establish the wishes of the deceased from searching the address for wills or funeral plans etc. It is not nice to think, but in some circumstances the next-of-kin may not care or may not be inclined do anything. Communication may be between the bereaved and hospital services (such as a bereavement office) or coroner’s officers. If bereavement/the coroner’s officers are not inclined to push the family forward with this, then it may fall to the mortuary to provide the drive behind these communications.
- SAVING MONEY: Assuming a funeral agency has been engaged by the next-of-kin, the body is essentially being stored by the mortuary on behalf of this private company. As with all things, time is money, and so this comes at a cost (both financial and in terms of free capacity). Funeral agencies are businesses and operate on a for-profit basis. Once the body is in their care, until the body is disposed of, they are responsible for its storage and associate costs. This mirrors the pressure on mortuaries, except with a different source of funding i.e. the bereaved (or profit margins, or both). Of course, mortuaries may threaten – or actually – charge funeral agencies for non-collection, but as the National Association of Funeral Directors argue (see link below), they are likely to deal with this by passing these costs on to the bereaved. We return to the issue of capacity for storage at this stage in the next blog. However, for balance for now, please see recent reports of the National Association of Funeral Directors and funeral directors ‘Dignity’.
Recent years, whether due to the cost of living crisis or cultural change, has witnessed the rise of direct cremation style services. These operate on the basis of non-frills disposals, where the body is collected and disposed of without the provision of pre-disposal visiting facilities or assistance with traditional funerary practices. Anecdotal evidence from various mortuaries reflect Lee’s experience that relationships with these providers are more strained than with traditional funeral agencies, not least because they operate on the basis that they can keep costs low delaying collection until they have the ability to take the deceased for cremation.
One perhaps unanticipated cost of delays, especially in the direct cremation model, is the additional burden on mortuaries to provide the bereaved with additional viewings of the deceased person. Whilst not a measurable economic cost, this could lead to substantial emotional toll on both the mortuary staff and the bereaved of not being able to facilitate this (we say not measurable because this takes time, for which APTs are paid, and are therefore not completing other tasks). Take, for example, this quote from one of my APT interviews:
‘So, and then they’re obviously going for a direct cremation and quite a lot of the time, the relatives are like, “I’ll ring you to come and view.” And so, they come and view and they want several appointments…Because the funeral director, because what they paid for doesn’t provide these services….It’s being pushed back onto us which our time is limited as it is. There’s no way that, very much kind of gone down the line of like, yes, I would love to dress them. I’d love to be able to do all of the requests that you’d like me to do and help you out. But I don’t physically have enough time or resources.’
2) The deceased body is the object of a dispute
Unfortunately people are fractious, and legal disputes arise in death. Whilst most commonly associated with the distribution of an estate, these can also extend to how/where a person’s body is disposed of. Until resolved, this can lead to significant delays in the release of a body. In 2017 this came to the fore in the context of the body of the serial killer Ian Stewart-Brady, but unfortunately disputes also arise in relation to ‘normal’ people (see, for example, Buchanan v Milton [1999], Ibuna v Arroyo (2012),Re K (Body of a Child) (2017)). In these circumstances, the legal process may become involved in resolving the dispute. This can be a time consuming process during which the body remains in the care of the mortuary.
Furthermore, sometimes death can be so traumatic that the bereaved cannot face the idea of disposal. In such circumstances, a mortuary may be placed under an intolerable emotional (and financial) burden to retain and store a body for many months even though its release has been authorised. This is neither good for the capacity of the mortuary but I found it to be widely understood by APTs to be undignified as, despite freezing, the deceased person will inevitably deteriorate and is kept in a state of indefinite limbo – their body a pawn in the emotional cost of unexpected death.
- Unknown next-of-kin
If there are no known family, there may need to be a process of trying to establish the identify of next-of-kin. In Norfolk, in hospital deaths, the bereavement team will first try to source family using heir-hunters and place death notice in newspapers around the deceased’s family home. If no family willing to take on the funeral are found, the bereavement team organise a ‘contract’ funeral – what used to be called a pauper’s funeral. The hospital pays and tries to then recoup some of the costs from the patient’s estate. In coronial deaths, the Norfolk Council deal in a similar fashion with no input from the hospital.
Final thoughts
This blog has covered some key examples of the issues that are commonly experienced by public mortuaries leading to backlogs and delays in the collection of deceased bodies. As we outlined in the previous blog, there is a domino effect here whereby failings at one stage of the process simply shifts the problem down the chain of death care.
The next economy in this mini-series will tackle storage capacity – bringing us full circle back to the elephant in the Brennan-shaped room. That is, whilst there may have been major failings in condition checking and communication in that case, it highlighted the HTA requirement for adequate storage (via contingency agreements etc) does not always map onto the reality of estates and periods of regional/national pressure.
Before we do that however, we want to reiterate the emotional cost of these first two stages of delay. Whilst economies are usually a reference to finance, there are emotional trades taking place here. Whilst not always the case, bereaved people are often both vulnerable and compliant. They are in shock and are often embedded with a culture of stoicism. In these circumstances, the potential for abuse for financial gain is ever present. When we bring together the public and private sector like this, it is inevitable that there will be losers. It is a sad fact that the biggest causalities may those most in need of protection.
Dead Bodies and the Law 