When should a hospital assist with the funeral costs of a patient? What role does the Local Authority play in funeral costs? It is, of course, a difficult time following the death of a patient, and a sensitive approach must be balanced with the need to obtain the necessary information and make decisions about appropriate funding. Relevant guidance was issued by the Department of Health in October 2005: 'When a patient dies: Advice on Developing Bereavement Services in the NHS' (the Guidance).
Where the deceased is a still-born baby, the responsibility for paying for the funeral falls to the hospital, unless the parents offer to fund this themselves. Where the deceased is not a still-born baby, the key issues will be whether the patient has a next of kin, and whether they are able and willing to meet the funeral expenses.
Next of Kin who are unable or unwilling to meet funeral costs
Identification of the patient's next of kin will often be unchallenging, if family members have visited the patient or been in contact during any admission. The hospital is obliged to provide support and advice to families at the time of bereavement. If the next of kin is able and willing to pay for the funeral, they should be supported, provided with a consent form and assisted with information such as local funeral directors and the process for registering the death.
If the next of kin indicates that they are not able to pay for the funeral, staff should remain supportive and empathetic but advise that ordinarily it is the next of kin's duty to pay for the funeral. If they indicate on the consent form that they cannot pay for the funeral, but they are in receipt of welfare benefits, they may be eligible for a Social Fund Funeral payment from the Department for Work and Pensions. In these circumstances, the hospital would not be responsible for making funeral arrangements, including meeting any costs.
For a next of kin not in receipt of welfare benefits, reasonable enquiries consistent with the sensitivity of the situation should be made in order to ascertain whether the next of kin can afford to pay for the funeral. The costs of a simple, respectful, low-cost funeral should be explained, and they should be asked if they can afford this given their income or any savings they have. If they are unable to afford this, the hospital could pay for the funeral. If the next of kin can afford to pay for the funeral, they must do so. If they remain unwilling, the matter should be referred to the local authority.
Where there is no Next of Kin
In the event that no next of kin is readily available, the hospital is obliged to make 'reasonably detailed enquiries' to ascertain whether the deceased had any relatives. Such enquiries may include contacting the patient's GP, or contacting social services for example.
If no next of kin can be identified despite these enquiries, the hospital must arrange and fund the funeral. Any social contacts of the patient, such as friends, the landlord or carers, can be contacted and advised of the time and location of the funeral.
The local authority may arrange the funeral under the auspices of Section 46(1) Public Health (Control of Disease) Act 1984. Local practice will vary however, as this provision applies when no arrangements are being made and therefore when the hospital is obliged to act the local authority will not share this responsibility.
If a hospital is arranging the funeral what steps should be taken?
A funeral arranged by the hospital must adhere to the central principles of respecting the dignity of the patient, including any religious beliefs or cultural background. Arrangements should be made by a funeral director. The views of others may be informative of the patient's wishes and should be respected in their own right. These views will be of particular importance when making initial decisions such as the timescale for the funeral and whether a cremation or burial is appropriate. Cremation is the default option when no other preference is given. It may be appropriate for the hospital chaplain, religious representative or adviser to provide information to assist in making these decisions, as well as conducting a funeral service.
Hospitals should have regard to the Department of Health Guidance and may wish to consider incorporating the overarching principles of the Guidance into a more local policy, particularly if the hospital wishes to retain the discretion to make contributions or fund funerals where they are not legally obliged to do so.