Rebecca Morgan, Bereavement & Business Support Officer at South Staffordshire Council, outlines her team’s approach to the thorny issue of public health funerals in the early stages of the pandemic.
For local authorities around the country, COVID-19 has meant looking at how to do radically different things across all frontline services. For Bereavement Services and dealing with Public Health Act funeral cases it was no different.
What is a Public Health Act Funeral?
For those that may not already know, here’s a brief overview of a local authorities’ responsibilities under Section 46 of the Public Health (Control of Disease) Act 1984.
We have a statutory duty to make funeral arrangements for those who die within our local authority area where no other arrangements have been or are being made. There is also a moral responsibility to treat all cases with dignity and respect and to make sure that you cannot tell the funeral apart from any other.
It is assumed, sometimes incorrectly, that people needing a Public Health funeral have no money, family or friends, when in actual fact, some people that need this type of funeral may have a lot of assets but have no one to make the arrangements for their funeral. Sometimes the deceased may have family or friends who could arrange the funeral but they may not be willing or able to do so.
Each case is very different but they are almost always complex and can be extremely time consuming.
Numbers of Cases
Our Bereavement Service was set up in 2009 when we opened the first of our two cemeteries and Public Health Act funerals were passed to us in 2011. Before this they were dealt with by our Environmental Health Team.
South Staffordshire is a rural district with a population of approximately 112,000. The district is considered to be fairly affluent and levels of unemployment and homelessness are lower than the national average, which generally means that we tend to have lower numbers of cases than a large inner-city council for example.
The number of cases we have dealt with has steadily increased from 2011 where we had just one case, to 2019 where we had seven. In 2020 so far, we have had five cases and three of them came in during the first few weeks of the pandemic.
What usually happens?
Referrals for cases can come from a variety of sources including the police, coroner, care homes, family members or friends of the deceased. At this stage it is important to find out as much information as possible about the deceased and the details surrounding the case.
A search of the deceased’s place of residence can be vitally important in helping to find out more about the deceased, their funeral wishes, who their family and friends are, whether there is a will and their financial situation.
In terms of safety during the search it is crucial to get as much detail as possible about the condition of the inside of the property. Experience has shown that in a lot of cases the property can be in a very poor state of cleanliness which can of course pose health risks before you even start to consider Covid-19.
What issues did COVID-19 present?
The two main issues that came up when thinking about COVID-19 and Public Health funerals were:
If we did do searches, what additional risks would we be facing and what additional PPE would we need (and would we be able to get hold of it whilst there was a global shortage)?
If we suspended searches, would we be doing enough to locate relatives and friends and potentially be denying them the chance to take over the arrangements or attend the funeral? Would we be doing enough to try to find out the funeral wishes of the deceased?
There was also a possible financial implication if we did not carry out searches as we would be reducing our chances of finding out if funds are available to claim our costs back.
Talking to Staffordshire Registration Services, I was told I would be able to register deaths with them by phone and after other phone conversations I found that all other paperwork and documents were going to be dealt with electronically via registrar’s and funeral directors.
At the start of the lockdown we thought it best not to carry out searches as the risks were still unknown but as the number of referrals I was getting was increasing it was decided that we should seek further advice from our Health and Safety Team.
I also made contact with the Institute of Cemetery & Crematorium Management (ICCM), used the APSE WhatsApp group and contacted other local authorities to ask for advice.
Taking into account the advice we received it was decided that we would continue to carry out searches and would assess the situation on a case by case basis.
We concluded that the following reasons outweighed what was considered to be a risk very similar to that of a property search prior to the pandemic:
We would ensure that before entering the residence a minimum of 72 hours had passed since the deceased had been removed from the property or anyone else had been inside.
In terms of PPE, our usual search kit contains disposable gloves, hand sanitiser, shoe covers, white paper suits, face masks, eye protection and anti-bac wipes so based on the advice we had it was clear that we already had all of the necessary items.
If the deceased was coronavirus positive, waste such as used PPE will be double bagged and stored securely (separate from other waste) for a period of 72 hours before disposal.
Although in the end the potential issues presented by the virus didn’t cause us too much difficulty, they certainly made us think about the way we do things, all the time weighing up possible safety risks against being able to provide the most respectful outcome for the deceased and considering the council’s potential financial implications.
We are now better prepared, with steps in place ready for a possible second wave of the virus and therefore another increase in Public Health funeral cases that it would no doubt bring.
Finally, for me, one of the good things to come out of Covid-19 across Bereavement Services is working together. I’ve had more contact with other local authority bereavement teams than ever before and I hope that it continues, leading to further sharing of resources and ideas in the future.
Knowing that others are there to call on for advice and support during these unprecedented times really has proven to be invaluable!
• Rebecca delivered a presentation on this topic at the seminar ’Continuing to provide an empathetic service whilst managing the demands of a pandemic’ on 29 July. The presentation is available for download from the APSE website here.