Following reports of the inappropriate handing of fetal remains in hospitals in tonight's Channel 4 Dispatches, HTA Chair, Baroness Diana Warwick has written to Professor Dame Sally Davies, Chief Medical Officer.
Our response states that:
- The Human Tissue Authority will revise our codes and guidelines to make it clear that incineration of fetal tissue is not permitted
- The Human Tissue Authority will examine appropriate policies when we inspect a licensed establishment and seek evidence that the policy is followed.
If you have any concerns arising from the programme, please do contact us for advice.
Letter to Chief Medical Officer, Sally Davies, from Baroness Diana Warwick:
Dear Professor Dame Davies,
Re: incineration practices
Thank you for your letter dated 21 March drawing our attention to concerns raised by Channel 4 Dispatches about the practice of incineration of fetal remains.
As Chair of the Human Tissue Authority (HTA), the watchdog for human tissue and organs, I was deeply concerned to hear these reports. We seek to make sure that hospitals disposing of fetal remains do so sensitively and respectfully, giving parents choice and putting their wishes first. If our guidance is not followed, it could make what is often a time of extreme distress for parents even harder.
I thought it would be helpful to set out what the HTA plans to do against your suggestions to ensure the best possible practice in the disposal of fetal remains:
Revising its Code of Practice to ensure that guidance regarding fetal incineration is clear;
Establishments licensed for post mortem examination are expected to abide by our Codes of Practice on post mortem, disposal and consent. Whilst our disposal Code reflects the law and does not, at present, explicitly ban incineration, it does advise against it. The Code makes clear that burial and cremation are the most appropriate methods, and human tissue should not be incinerated with clinical waste.
We also make clear that parents should always be made aware of all options and given the opportunity to choose.
We will revise our Codes and guidance to make it clear that incineration as a method of disposal is not permitted for fetal tissue.
Greater scrutiny of procedures for the disposal of fetal remains in HTA inspections of licensed establishments in the post-mortem sector;
We expect hospitals to have a clear and sensitive policy on disposal, which considers the needs of parents. HTA regulation managers examine these policies when they inspect a licensed establishment and seek evidence that the policy is followed. If we find that hospitals’ disposal policies and procedures do not guard against the incineration of fetal remains, we will take appropriate action to address this, if necessary with referral to other regulatory agencies.
Making enquires about disposal methods in future compliance updates;
We regularly seek information from establishments (between inspections) relating to compliance with our standards – we will make sure that disposal of fetal remains is addressed explicitly in these updates.
Working with others to improve guidance in this area, including DH, the Royal Colleges, Sands and Institute of Cemetery and Crematorium Management;
The HTA has been entrusted with the responsibility for raising standards in the post mortem sector. We have a very good reputation for working collaboratively to produce guidance for establishments. We will work with all of our partners, including those mentioned above, to improve guidance in this area as a matter of urgency.
Working more closely with the CQC on how it may cover disposal of fetal remains on its inspections, including exploring how non-licensed establishments might report incidents relating to disposal of fetal remains.
As you note, there are non-HTA licensed establishments that may dispose of fetal remains, because they are not carrying out an activity that requires a licence. As a responsible regulator, we offer guidance to all hospitals on handling tissue and fetal remains, focussing on parental choice and appropriate methods of disposal. However, we cannot monitor or take action against non-HTA licensed hospitals if they fail to meet HTA standards or follow HTA guidance.
We already have a Memorandum of Understanding with the CQC. Where we do not regulate establishments that dispose of fetal remains, we will work closely with the CQC to make sure that our guidance is followed.
As you note in your letter, this is a complex ethical matter. The HTA was established to protect the public’s interest by ensuring that the removal, storage and use of human tissue and organs are undertaken safely and ethically, and with proper consent. This principle is central to the work of the HTA and our existence means that the public can be reassured that this will be upheld, and that the organisations undertaking these activities will do so to agreed standards.
We encourage anyone who is worried about the inappropriate handling of remains to contact us, the Care Quality Commission, or Department of Health.
We will look into any allegations we have received and investigate fully, referring to and working with other organisations as necessary.
I am copying this letter to the Permanent Secretary of the Department of Health, the Care Quality Commission, the Royal College of Nursing, Sands and the Royal College of Obstetricians and Gynaecologists.
Chair, Human Tissue Authority