Ash Cash
Our main story this week came to us via listener Pauline Levey. She emailed to suggest we take a look at 'ash cash'. This is a fee that's required in order for doctors to release a body for cremation. It's currently set at a level of £71 each for two doctors, paid in cash on top of the doctors' NHS salaries. Pauline - whose mother was cremated a year ago - says the charge is unfair and cruel. Here she explains why.
| Add Ash Cash to your page |
Since the Shipman Inquiry the Department of Health and Ministry of Justice have been jointly working on overhauling the system of death certification. No ministers were available for interview, but the Department of Health did issue us an interesting statement promising that their planned reforms would:
...introduce a single system of effective medical scrutiny ... and replace the existing cremation certification process.
The British Medical Association negotiates the level of cremation fees on behalf of doctors. Dr George Fernie chairs the BMA's forensic medicine committee, which might be expected to defend the system. In fact, he's keen to see change:
| Add Ash Cash to your page |
Finally, we spoke to Rohin Francis, a blogging junior doctor at St. George's Hospital in London. As a first year House Officer in 2006, he wrote the following:
Ash cash. The sixty two pounds a doctor pockets every time a patient they have certified pops their clogs and is burnt to a crisp is nothing short of infamous. Known as the house officer's privilege, it is the fund for Thursday night drinks all over the country.
A colleague working on care of the elderly has effectively gone up a banding due to the vast amounts of ash cash he rakes in. No comment on his quality as a doctor, of course. Ahem.
Yet when we are filling in the form, we all answer 'no' to the question 'Do you have any pecuniary interest in the patient's death?'
Despite some noble souls donating their cheques to charity, the rest of us catch ourselves secretly hoping that families opt for cremation.
| Add Ash Cash to your page |
Email us
Our Twitter
Join our Facebook group
Listen to iPM
Technorati
Google
Ice Rocket
© MMIX~RS~q~RS~~RS~z~RS~53~RS~)
Comments
Sign in or register to comment.
Just another example of a whacking great fee the goverment charges for diddly-squat. OK, I know it's paid to the doctors, but I thought we had a National Health Service paid for out of National Insurance. Other examples: the enormous fee you're now charged for a passport, the high cost of putting a will through probate, the enormous fee (Stamp Duty) you're charged just for having the cheek to buy a house. It goes on and on. What happened to "paying according to your means" or "paying a fee in proportion to the cost involved". Seems if you're a bank you're dragged into a select committee and asked to explain yourself, if you're the government you can charge what the hell you like.
Complain about this comment
Very unhappy with your story on ash cash. normally an avid fan, but your facts are wrong. Ash cash is paid for undertaking that a body can be cremated or buried, this is not part of the normal duties of a doctor and would otherwise be unpaid work. Our hospital doctors are already over worked, underpaid and over burdened, please don't add to the confusion about the difference between the hospital doctors and the very well paid GPs. The poster above is also incorrect, the charge is not made by the Government, but by doctors for their time.
Complain about this comment
Interesting to hear Eddie ask the junior doctor if the 'ash cash' was regarded as 'a little bonus'. I'd have to work for 10 hours to earn £71.
A couple of years ago when i was on housing benefit and very hard up due to chronic illness, i had to pay a 'small fee' for a doctor's note. this turned out to be a flat fee of £12 - a significant proportion of my weekly income for a note that would have taken less than a minute to write.
Complain about this comment
My dad is a retired GP and regularly examines the body and signs the certificate in return for his 'ash cash'. The reason as i understand it is to a) ensure the patient is dead and b) to ensure that the patient hasn't been poisoned/done away with either by the family or the GP. This is the reason why 2 doctors are needed to do it. Needless to say as my dad is retired it is not done on NHS time also he is available quickly so families are not kept waiting and frees up the other GP's time so they can do their job seeing patients - also it keeps dad out of mischief.
My dad keeps a book into which he enters all his ash cash payments for the purposes of his tax return so to suggest that all GPs are putting this money into their back pocket is tarring everyone with the same brush - although this may just be that Yorkshire people are more honest?.
I feel the public is wanting it both ways: they want to be protected from illegal deaths by lay or medical folk but they don't want to pay for it.
Complain about this comment
There are some inaccuracies in this report. Cremation certification has different implication for hospital doctors and GP's. Hospital doctors are employees of the hospital trust whereas GP's are self employed. Cremation certificates are not part of NHS work, but are required before the crematorium medical officer can allow the cremation. Signing the certificate can involve for GP's considerable travelling to view the body and to organise a second independent doctor to sign the second part of the certificate. This can be time consuming. The second doctor in particular must undertake some investigation of the circumstances of the death before satisfying himself sufficiently to be able to sign the second part. Again this can involve travel. I personally would prefer some other mechanism to allow this certificate to be signed other than involving a GP but it is difficult to see who else would be in a position to do it.
Complain about this comment
You've failed to mention that these fees are charged automatically to the deceased's estate. Doctors do not request the fees - they are automatically issued on our behalf and those of us who feel uncomfortable about the whole thing do not have an opt-out from the charging. If we don't cash our cheques, it is the funeral directors who benefit, not the family, who have already paid and will not be refunded. I quite often don't cash my cheques - but it doesn't do anybody any good - and I do object to the 'greedy doctor' label.
Complain about this comment
I was a junior doctor at a time when salaries were not high: during my first year I was paid around £6k for a working week that averaged 110 hours. 'Ash Cash' then was a bonus, as later were the family planning fees that were charged for both surgery and anaesthesia for sterilisation procedures. Even then I felt very uneasy about this charge on patients' relatives at a time when they were most vulnerable. At least when signing the Part 1 form I was filling in details about a patient whom I knew, but when it came to the Part 2 there were many doctors who would sign the affirmation that they had seen and made a detailed inspection of the body when in fact (in hospital at least) they had been nowhere near it.
Current medical salaries - including mine - are not meagre and I do not think that it is appropriate for doctors to receive cash in hand for this service. Because it is a service, and one which can take time, although rarely enough in hospital practice to justify the high fee. I would advocate a reduction in the fee, say to £50 per form which would then be paid directly into a scrutinised educational fund for medical staff. That might ameliorate some relatives resentment at the practice and remove the disreputable taint that currently surrounds it.
Complain about this comment
There was no mention in your broadcast of tax. If doctors are regarding this as cash in hand presumably they are not declaring these payments in their accounts or tax returns.
Complain about this comment
I've often wondered what would happen if one refused to claim the useless husk that is all which is left after the death of a family member?
Complain about this comment
We are two doctors and were surprised to hear the views expressed on this piece. I used to dread going to the mortuary and, with no disrespect to the deceased, often used to find it quite upsetting particlualry if the death had been traumatic or was a child or young person. I would have happily not done this and waived the fee but there is a clear obligation from the hospital that this is done. There is no choice. Only the most cynical would view this as a "perk". I also struggle to see how charging for this differs from GPs signing insurance application etc. In addition, the fees were also delcared for tax purposes.
Complain about this comment
When I was studying for a health profession, (not a doctor), my best friend was engaged to a junior doctor. This was about 15 years ago. I remember that they used to laugh about 'ash cash' and that it was a nice little 'earner' for the junior doctors. I assumed that it was a payment made to them via the NHS. I had no idea that the payment was ultimately made by the family of the deceased.....When qualifying, I discoved that it was very common for patients to 'tip' clinicians within my profession - in NHS clinics! I have found this to be a very touchy subject in the profession and just not talked about. If a patient insists on tipping me, (ie. leaves the money on the table and will not take it back), I give it to charity but I could make about £10 to £15 pounds a week tax free if I did not do this. Tipping is not covered by the Trust's protocols - presumably as it is not acknowledged that it actually happens!I find it hard to understand why clinicians go along with things like this, (ie ash cash and tips) when it should be obvious to us how short of money so many of our patients are.
Complain about this comment
Whilst 'ash cash' is a fee for non-NHS work, and some doctors will incur expense (time and or money) in completing it, it needs to be abolished. £71x2 is excessive no matter how you attempt to justify it, especially for poor families. If any expense in completing the form were to be claimed for in the normal way (receipts etc.), this would begin to introduce transparency to a murky process- after all we are basically doing the polices/coroners job by saying no foul play/its alright to 'burn the evidence'! Personally I waive all my fees and would like to see more doctors do the same.
Complain about this comment
Thanks for the comments so far. To address a few points raised:
@2: 'Ash cash' isn't paid if a body is buried. It's only when a body is cremated (or in Pauline Levey's words, 'the evidence is burned') that extra checks of the case notes are considered necessary to rule out foul play.
@4: As I think Pauline mentions in the interview, the cremation fees come after and are separate from the death certificate, so doctors wouldn't be expected to examine the body before signing the form. Your point is taken though that this can require quite some work and - as spinningdoc (5) points out - travelling time to see the case notes. George Fernie and Rohin Francis did air these points on the programme. Was our explanation clear enough? What do people think?
Complain about this comment
Just to pick up on comment 13...... the body has to be identifed and checked to ensure that no pacemaker is in-situ (these must be removed prior to a cremation), it is not just sufficient to check the case-notes.
Complain about this comment
May I point out that if doctors are required to travel in order to sign these forms they are entitled to claim for their mileage. May I refer you to the BMA web site?
http://www.bma.org.uk/ap.nsf/Content/mafees~cremation?OpenDocument&Highlight=2,cremation
Complain about this comment
Hi, I am the junior doc from today's programme.
A few things (some understandably edited out due to time):
As said below, we don't charge the fee - the undertakers do.
First year doctors earn around £21,000 basic now. This year the traditionally-provided free hospital digs are being removed, so house officers are effectively taking a £3000 pay cut. They're hardly rolling in cash. This is not meant to be justifying an 'entitlement' to ash cash, but to put in perspective the pay scale.
The purpose of the crem form is legal - to ensure no doubt about cause of death exists as cremation negates later examination of the body (which is why no fee is levied on burial). Hence, just as a lawyer charges a fee for a legal document, a fee is charged for the responsibility of completing the form accurately.
And the piece quoted was aimed at medics and supposed to be a bit tongue-in-cheek, if you read the rest my views become clearer.
Complain about this comment
Travel expenses are claimed separately from the certificate. Pacemaker removal also attracts a separate fee, but in my experience it is generally the undertaker who performs this task. In sudden unexpected deaths where a coroners or procurator fiscal office is involved, the GP is usually not involved in the issue of cremation certificate.
Complain about this comment
Amandadoctor (13), you're right, I meant there's no need to examine the body to confirm the death, as the earlier poster suggested. Of the two doctors, one should be the practitioner who attended the deceased during their last illness, and he or she must confirm that no pacemaker or radioactive implant has been left in the body -- and of course this could entail significant work and a visit to the mortuary. For the second doctor there'd be no requirement to view the body -- or am I missing something?
Complain about this comment
Why is a doctor charging a fee any more cruel than an undertaker doing so? Or a lawyer charging a fee to act an executor of an estate? The public's expectations are skewed by the 'free at the point of delivery' mantra. They will have a rude awakening when the Government finishes privatising healthcare. A classic case of: "You don't know what you've got until it's gone."
Complain about this comment
Wow, £21,000 is supposed to be a low salary? I dream of the day i could make that much - and yes, I am a graduate and owe around £15000 in student loans.
Complain about this comment
In response to the last comment for newly qualified doctor's salry to have kept pace with the equivalent salary of the bad old days of 1979 the basic pay would require to be 29000 and if one adds in the contribution for the loss of accomodation 33 k total would be nearer the mark. Of course in those bad old days junior doctors could work upto 120 hours a week so they didn't have a life outside medicine.
As for the Cremation Fees , the form is a statutory legal document and the Part B many of which I filled in my career required me to read the notes, examine the body and then discuss the case with the doctor signing part A. That is the process required by statute and sometimes could take an hour of one's time looking for evidence of notifiable industrial diseases that would require notification to the coroner. For GPs they may have to attend a funeral parlour and take an hour out of their schedule.
As for taxation well HMRC has been well aware of the Cremation fees for over thirty years and most doctors check with the mortuary attendant to check the number of fees they have collected so as they can make the appropriate entry on their tax return.
If the process was handed over to HMG I have little doubt we would have cases of the wrong body and the wrong form given HMG's capacity for data mishandling and a new stealth tax as well.
Complain about this comment
I listened with horror to this broadcast, especially the cheerful reference to "notes at the back of the bar" to pay for booze for young doctors who might never have come within a hundred yards of the Deceased.
I have been given to understand (please confirm) that all such occasional tips are declarable for Income Tax purposes. Can someone please confirm?
I am seriously concerned about the far larger standard fees paid (by cheque, with no more than a Remittance Advice)for "routine" post mortems to "pathologists;" they may never have examined the Deceased on whom they "report". (Almost invariably"Natural Causes,"of course - so much more convenient for everyone).
HMRC shows no interest whatsoever in any of this.
Can anyone assist?
Complain about this comment
It is incorrect and disingenuous to suggest that 'Ash Cash' is undeclared and untaxed.
I have been a hospital doctor and GP for in excess of 30 years. This money is routinely paid by cheque to the practice. In all my professional life, this income has been declared. The Inland Revenue has been alive to this for as long as I can remember, as one would expect. My daughter is currently a junior doctor and has always declared such income, as I understand they all do!
With respect to NHS time, undertakers are generally only open during office hours. Like all professionals, we work the hours required, not prescribed. This is routinely in excess of 12 hours a day, 55 - 60hrs per week (as opposed to the 80hrs+ when we were responsible for out of hours). This certification often requires significant travel. We are also (rightly) expected to speak to professionals and/or family regarding final illness, particularly if we are the second signatory. This delicate business is often time consuming.
Junior doctors, though paid for some of their overtime, rarely claim it all. The Government has done such a good job of running us down, one wonders if they want us to look after patients at all.
Complain about this comment
I heard the original interviewee say it was all processed as cash in hand, this has never been the case at our practice and I'm sure almost all GP practices. The undertaker writes a cheque and all is processed in the accounts like every other fee the practice may charge. I wouldn't call it a perk, in the community I would get a call from a neighbouring practice, be told the details of a patients death, would go to identify and examine the body (briefly - the second doctor does have to examine/identify the body), call the nursing home or relatives to confirm the cause/mode of death. All this takes a lot of time out of my day, I have declined in the past, but this just causes problems for the GP whose patient it is as he has to keep phoning round for a doctor qualified for 5 years to do the work. I wonder what fee the original person would suggest be appropriate or that it be done for "free".
Complain about this comment
The issues here are simple, and are being clouded in this blog by peripheral issues that are interesting in themselves, but not relevant to the main issues.
1 Are NHS doctors carrying out this work (and being paid for it), while they are on duty with the NHS, and also being paid for work that they cannot do whilst ash cashing? If they are this practice must stop. After all any other employer would summarily dismiss an employee doing another job whilst on duty. Doctors pay rates, traveling times, the question of how much work is involved, how onerous the job is, whether the service is value for money, or whether a doctor gets drunk on the proceeds to numb his or her conscience, is interesting but irrelevant.
2 Should the family, or the deceased' estate pay for this service? No. this service is compulsory and is for the benefit and protection of society as a whole, and therefore should be paid for by society as a whole, and not coerced out of a bereaved family by the long standing social pressure of not
wanting to make a fuss at such a time.
3 If income tax is not being paid by any significant proportion of doctors carrying out this service, it should be stopped by the inland revenue by auditing the funeral homes, and other organizations that are paying out these fees, whether actually in cash, cheque or any other form, as they do with any other business.
These are the central issues of the IPM item, and all the other issues are excuses and distractions to cover immoral and illegal practices. The doctors who have responded in defense of the system, are out of touch with how much most people who heard this item are shocked and disgusted by the practice on many levels, especially those who have recently suffered a bereavement and not even realized the profiteering that they have been the victims of.
Come on doctors are you really the caring profession or is it just your bulging bank accounts you care about. Sort this out yourselves, you are after all the most highly educated and influential professionals in our society. Show some gumption and leadership on this issue, and show us you do care about your patients even when they are dead.
Complain about this comment
There is no obligation on any doctor to fill a cremation form it is done as a service for which a fee is payable in the same way as a fee would be payable for a passport or driving licence.
With regards to post mortems most are performed at the request of HM coroner and the fee barely covers the time, effort and sample processing carried. There has been an extensive review of the Coroner's PM process in 2007 and recommendation made. When sections and samples are taken they have to be discussed with the coroner and the objective of the PM is to establish the cause of death within the limits set by the funding available by the Coronial system.
Complain about this comment
Crem forms are not part of NHS work. They take time to complete (30mins is a likely estimate for a part2) and since Shipman are treated with slight trepidation by a lot of GPs. I was earlier reading a thread about this on a doctors web site and you know what? Most GPs would prefer not to have the hassle of doing crem forms, they are certainly not looking forward to the money.
I don't know any doctor who doesn't declare them on their tax return but if they don't they are heading for a big legal problem.
Shockedanddisgusted- can't speak for all GPs but do remember last year driving up to Brum from Somerset and back, after work, just to see pts body (for death cert, not crem fee)- declined to demand undertaker who moved body prematurely bring her back 'cos £200 cost would just have been passed on to family apparently (ok this was v v unusual and I hope it never recurs). Most GPs are not greedy- I know plenty.
I am surprised to hear of patients "tipping" in clinic- first time I have ever heard of it in my life (working 16 years hospital/GPland).
As for the comments quoted by Rohen Francis- Yes, doctor, it is just you. I had a fierce complaint made by multiple members of a family against me in my 2nd week as a junior doctor, regarding a death cert I had filled in(correctly, as I was legally obliged to do). It took a hell of a lot of sorting out. If you are going to fill in crem forms, treat them with the respect they deserve.
Complain about this comment
Response to "Shockedanddisgusted"
The hospital's "Consultant Pathologist" signing a "standard fee" (coroner's) post mortem "report", takes good care not to take specimens for analysis - analysis might bring to light information about the real cause of death (in the hospital, by the agency of the hospital's employees) and that would never do, would it!
Of course the consultant addshis signature in hospital time and on hospital premises. All the other work was done by hospital employees (mortuary attendants and secretaries) on minimum hospital pay.
The consultant gets all the cash. For doing nothing, and for uttering falsehoods which pervert the course of justice.
I say again, HMRC resolutely refuses to take an interest in the financial gains made by such individuals.
I ask again, how do we the Bereaved get any action?
Complain about this comment
If like me you are unhappy with the current arrangement of "ASH CASH" please sign the petition http://www.petition.co.uk/ban_ash_cash
and write to your MP.
Complain about this comment
Some of you just don't get it do you?
Crem forms are not part of a doctor's paid NHS duties. If this additional service is required, it needs to be paid for. OK, argue for payment from some central pot if you like, but those who don't cremate their relatives might object to their contribution. (Why is it only doctors who are supposed to provide free favours to sociey?)
Cramation forms are only filled in "on NHS time" insofar as you do them while at work. The work you would otherwise have done in that time does not just go away -- it still has to be done. So filling in crem forms is "over and above".
I have not received crem form payments for many years. When I did, they were virtually always in the form of a cheque. Whatever, the form of payment, the implication that tax is habitually avoided on these payments is a bloody insult. This would easily be found out as, even cash payments would leave a clear paper trail going back to the undertaker. Doctots avoiding tax in this way would soon find themselves in trouble with the GMC and their registration could be in jeopardy. As a profession, we are probably more conscientious in our tax returns than most. Pauline Levey -- you should be ashamed of this slur and should retract it.
May you all have the doctors you deserve.
Complain about this comment
These are the facts.
a/ Doctors are paid by the NHS (the taxpayer).
b/ Doctors get paid overtime.
c/ Doctors can claim 54p per mile for work related travel.
d/ Some payments ARE made 'cash in hand'.
e/ It is the doctor who requests this money, not the undertaker.
The central argument is that doctors get paid to do 'private work' on company time. This is wrong, and I as a taxpayer, and therefore employer, would be happy to dismiss any doctor who did this. I guess the BMA is just too powerful for this to happen at the moment. With the influx of doctors from Europe I'm sure it won't be too long untill the balance of power has swung in favour of the employer!
Everyone desrves to be paid for the work that they do, just not twice!
The reasons for the double checking of the medical records is a sound one. So my parting question would be;
Were any of the doctors who countersigned the Shippman related forms ever struck off or investigated (did they return the fee?)........
Complain about this comment
Andymullard- get your "facts" straightened out.
Not all doctors get paid overtime. For GPs it simply doesn't exist. As per any professional- you complete your tasks needed to do the job professionally. How long it takes is up to you. Therefore what ArchieB says about the time taken filling a crem form is entirely correct. Whether I choose to do it at 12noon or 8pm is none of your business.
If you've any evidence of cash payments occurring I'd like to see it. Even if they do it would be a foolish doctor who tried to cheat the tax office in this way- the record of payment will exist at the undertakers and a nasty prosecution by Inland Revenue would be followed by a nastier GMC conduct commitee hearing about your probity. I do about 2 crem forms a year- I'd be risking my registration for £50 illegal tax savings.
Doctors don't ask families for fees. A doctor is contacted by the undertaker and paid by them. They have presumably already charged the family requesting the cremation. I'm not sure why people being paid to complete crem forms is in principle any more shocking or wrong than undertakers charging for the rest of their services.
Small amt googling should help you with the Drs who signed Shipman's part2s.
Complain about this comment
Andymullard:
These are the facts.
a/ Doctors are paid by the NHS (the taxpayer) - agreed
b/ Doctors get paid overtime - WRONG, I and no other hospital junior is paid for the extra hours we routinely put in. In fact our pay has been reduced due to European directives on how many hours we can work per week, but the hours worked have broadly remained unchanged.
c/ Doctors can claim 54p per mile for work related travel - no idea, my travel to the mortuary is a flight of stairs.
d/ Some payments ARE made 'cash in hand' - I have never heard of this, where the 'brown paper envelope' myth came from I have no idea. It is always a cheque paid by the undertaker to the doctor, always.
e/ It is the doctor who requests this money, not the undertaker - complete and utter tosh, no doctor requests ash cash.
Good homework, well done.
@docdeegs - zzzzz, I'm getting thoroughly bored of telling people, both here and at NHS Blog Doc to read the whole article.
Here are the actual facts:
1. Junior doctors are normal people that spend their money on normal things, including rent, food and yes (horror) booze. Do you expect us to separate money earned from cremation forms (for me - £62 since April 07) and use it for sanctioned purposes?
2. Junior doctors make jokes in bad taste. This does not mean they do not care about their patients. Speaking for myself, if one does read more of what I have written this would be patently obvious. The bad humour is a mechanism of coping with the death and morbidity we deal with on a daily basis.
3. No doctor requests a fee, the undertaker does. If we don't cash a cheque, the family does not keep the money.
4. Forms are completed on NHS time as the bereavement offices are only open 9-5 and we want to do the forms asap so the families do not have to wait for all paperwork. When I am working nights and the only person eligible to complete a form, I stay on until the office opens.
5. Cremation forms are not NHS work, it is, if anything, legal.
6. Funeral homes charge for funerals. Let's start a petition to ban them.
Complain about this comment
Draw what you will from this article, suffice to say that it disputes your claim that doctors do not get paid overtime.
Also, in Rohins interview at time 2.03-
Eddie '.... but at the same time it's cash in hand'
Rohin 'it is'
and further on 2.22
Rohin 'you're right, it is cash in hand'
how much of what Rohin says are we to take as 'tongue in cheek' ?
I only learnt of this issue when an undertaker pointed out the charge on a bill for a recent family funeral. He said 'I'm not happy about this and I want you to know what this item is for and where it goes. I have no choice and have to charge you as it's something we have to pay the doctors'.
Can any undertakers clear up just who enforces the charge? Doctors seem to suggest that if they didn't cash the cheque you'd keep the money rather than hand it back!
Complain about this comment
to be clear on my last post-
I'm not questioning the amount of hours doctors work, how much thay get paid, or what they spend it on. Those things are not relavent to this discussion and I don't have an issue with any of them.
Complain about this comment
The link that got missed off my earlier post-
http://news.bbc.co.uk/1/hi/health/1108441.stm
after some more research it seems that doctors may not get paid 'overtime', but a 'suppliment' or up to 100% of their salary extra.
[Unsuitable/Broken URL removed by Moderator]
I have no way of knowing if this was/is implimented.
Complain about this comment
Andymullard, you and others seem to have a problem more with Drs pay and how much more they get than you. Drs (and I'm not one) study for 5 yrs at undergraduate level and for more years than I would to have the honour of looking down your throat or up your bottom. Enough of this social and financial jealousy please.
Complain about this comment
andydullard: Junior doctors work shifts. They receive a basic salary which covers 9-5 M-F, and a supplement depending on the number of nights/weekends they work. They get paid nothing if, as they frequently do, they stay in the hospital outside of contractual hours to ensure that patients get the best possible care. settlegirl if right, you do seem to have jealousy issues - are you sure you're not a journalist or a politician? They have the same problem when it comes to doctors.
Complain about this comment
andydullard,
As you assert that as a tax payer, you are my employer - then may I thank you for once again awarding me and my colleagues a real terms pay cut. It is much appreciated.
The issue here is that completing cremation forms is NOT an NHS service - as a result, the NHS does not indemnify doctors against mistakes - ie, If I certify that the body does not contain a potentially explosive implant, and then the crematorium goes bang, they coming looking to re-coup their £X,000,000 to rebuild the thing! I also have to certify that I do not think any further examination of the body will be needed/wanted. ie - they are asking me to do the work of the police/coroner - ensuring that there were no suspicious circumnstance surrounding the death.
For me to take that responsibility is worth a lot more than the statutory fee, in my opinion.
For what it's worth - I don't think doctors shoudl do crem forms - there should be an independant investigatory body which ensures no further examination is needed (ie, the coroner), and the crematorium itself is responsible for implants.
You can bet that if the doctors feed dissapear from the bill then the alternatives will cost more!
Complain about this comment
I am a UK Junior doctor and I agree Ash Cash is a disgrace, but not in the way you think.
Filling out the form, taking time to speak to the part 2 doctor, performing a check of the deceased and checking for pacemakers and medical devices so they are removed by mortuary staff takes time, and there is a time pressure to do it quickly, regardless of if there are 20 people waiting to see in clinic.
Still, it is the least we can do for bereaved relatives.
However, I refuse to do Cremation forms unless there is no one else available who can legally sign them.
The form exists for 2 reasons - 1) to make sure a pacemaker etc is removed so we don't cause 20ok of damage to a crematorium.
http://www.medicalprotection.org/uk/factsheets/medicalequipment
2) - we are essentially saying we are satisfied the patient died of natural causes - before the "evidence" is destroyed. Seems straightforward enough, after all, who would kill a poorly patient?
Still, we've heard of Harold Shipman, Beverley Allitt, and more recently Colin Norris:
http://news.bbc.co.uk/1/hi/england/west_yorkshire/7267409.stm
If I sign a cremation form I am saying I am certain that nothing untoward has happened - how can I be? The cases above show that. Even worse, after the whole Shipman debacle the doctors signing the forms were suspended and accused of collusion when they had no reason to imagine their respected colleague was busy killing hundreds of patients:
http://www.bmj.com/cgi/content/abridged/329/7477/1256
So, for all the black humour every time we sign a form we are stating a certainty that makes me uncomfortable. That is why a fee is payable, and the fee reflects the involvement neccessary to do it properly. You would not expect a lawyer to produce a will for nothing, yet you expect us to benchmark that your relative definately died of natural causes before their body is forever destroyed?
Ash cash is not immoral, but it does ask doctors to take a risk that in this litigious and blame seeking society I personally wont take.
Oh, and if we didn't take it the relatives wouldn't see it again - its part of the funeral package and Mr Undertaker would just pocket it. Just like some mortuary staff who skim a fee off the top for signing nothing, just as a perk.
Lets realise exactly what these forms mean before accusing people of some kind of moral bankruptcy - every form signed could come back to bite you later.
Complain about this comment
I've read a lot of rubbish in my time, but not as much as has been written on this site.
1) Cremation form fees are the fee paid for filling in a legal document, certifying that the doctor concerned is happy that there are no suspicious circumstances. The doctors who signed Dr Shipman's forms were all investigated by the GMC, so it is not a task undertaken lightly.
2) Cremation work is not part of the NHS, so it is not paid for out of taxes. Neither are services such as checking passport forms, doing travel vaccinations, doing insurance medicals and so forth. Just because one does not pay for the NHS at the point of care does not mean it is free - someone somewhere has to pay for the service. Where services are not provided by the NHS the individual consumer has to pay for it. I'm not sure doctors should be expected to give their services for free, do you ask your builder to do work without paying them?
3) If you think referring to bereaved families as individual consumers is harsh perhaps you should be petitioning the government for a state run funeral service to avoid the upset of being asked to pay for a funeral.
4) Funeral homes charge the cremation fee whether the doctor waives their fee or not, I know as a colleague of mine waived the fee when a friend of their's parent had died - and the friend in question was still charged the fee by the funeral home. The crocdile tears of the funeral director reported by Andy Mullard are beyond a joke -I trust said funeral director also apologised for charing you several thousand pounds for arranging the funeral too?
5) I'm glad Jack the Bear considers himself to be well paid, as he worked during the time of 110 hour weeks I think we can safely assume he is senior enough to be paid pretty well. Junior house officers have a starting salary of £21,000 and an average of £18,000 debt - it is they who receive the bulk of cremation fees.
Whilst I agree with the principle of an NHS free at the point of delivery it does make some people think that all services provided by a doctor should not cost them a penny. Sorry that you have been disabused of this notion at a time when you feel vulnerable and upset.
Complain about this comment
Pauline Levey - perhaps you should post blogs about which you have sufficient knowledge to engage in an intelligent debate.
Why not choose another element of an undertaker's fee...who knows, before long perhaps you could just cut-out the middle-man, take your relative home and do your own!
As has been said, the fee is not paid by the NHS, nor the government, and is taxable. It is a legal requirement, and as the document is needed by the undertaker, it has to be completed as soon as possible. If it were done outside of NHS working time (approximately 8am-7pm for most hospital doctors) then the undertaker would never receive the form (as the office is closed usually outside of 9am-5pm).
Can you imagine a solicitor not charging for a single document to be signed, out of kindness? Why doctors are seen as people who do not like to be paid for their work is beyond me. Lots of jobs that doctors undertake daily are unpleasant, but that does not mean we are not entitled to a fair pay system.
FYI, the crem fee is a far better reflection of a fair hourly rate than the £10 an hour the rest of our work averages out at...perhaps the NHS should take note.
Complain about this comment
My colleagues have made all the relevant points well and there is little to add. 'Ash cash' is an important concept and, as pointed out, it is not an NHS service but HAS to be done during NHS time because that is when the bereavement office/coroner's office is open, and you can't do a crem form without at least one of these!
As a junior doctor, I stay until that day's work is done. If I would otherwise have left work at 5pm, but doing a form took me away from other duties for 30 minutes, then that's 30 minutes longer for me to stay at the end of the day - and we DO NOT GET PAID FOR OVERTIME. Next time you see a junior doctor in the hospital after 5pm (which is more often than not), assuming they are not the designated on-call person, then they are there out of a sense of duty and wanting to get the job done properly.
I remember being on nights not so long ago, and a lady came in at the end of a terminal illness and died. I was the only person who had had enough involvement to do the form. The cause of death was quite apparent, but because in these circumstances the coroner routinely needs to be consulted (short period of time from admission to death) and the GP proved hard to contact, I didn't go home until 11am, although my shift had finished at 8am and I was due back in at 7pm that night. This is an example of how this fee is not for mindlessly signing a piece of paper, but rather for rigorously ensuring that all is as it should be and putting one's name and professional registration to that. It often takes plenty of time to do it right, and NO-ONE wants to do it wrong.
People will get upset about the existence of this fee (it takes very little to upset the mob, it seems) but they'd be a lot more upset if things weren't done properly and as a result granny was cremated when she really shouldn't have been. And as for complaining about us doing it on 'company time', apart from the reasons given above, us getting it done promptly allows the relatives to register the death and get on with the funeral arrangements - and that is why I always try and get it done sooner rather than later (I've also been on the receiving end).
Finally, if there's one thing that annoys me it's being told 'I pay your wages' by someone and thus I should do whatever is demanded of me. The average individual taxpayer over their lifetime pays me, over my entire career, about 2p. If you don't like my service, I'll refund you that.
:)
Complain about this comment
1) When working at the John Radcliffe Hospital my ash cash was payed with my salary, appearing on my payslip minus the appropriate deductions
2) Now working elsewhere and ash cash is paid sometimes in cash, sometimes cheque - I have no control over payment method
3) Whether I declare this income or not is my own business, the same as anyone in any industry who receives payments in cash.
4) I do declare my ash cash as do all of my friends
5) Ash cash is a professional fee, the form can only be signed by someone with my qualifications, can you imagine a lawyer probating an estate for free?
6) Doctors receive these professional fees for any number of forms, why single this one out?
7) As a junior doctor I could walk into a highly paid City job
8) Instead I choose to spend 80 hours a week (paid for 40 of them) working in a highly stressful and demanding job with precious few perks. I find it insulting that anyone should question the alturism of our junior doctors.
9) The family will pay the fee whether I claim it or not, yet I hear no protest against the funeral directors who keep the unclaimed fees to themselves
10) Perhaps you (joe public) would care to reflect on the 12 hour days that I and my colleagues routinely put in looking after you as best we possibly can, teh uncertainty that we face in finding a training job and the fact that that job may be hundreds of miles from our families. Last Christmas I worked a week of night shifts, during the Bank Holiday nights I was paid less per hour than the cleaners as it was on my rota, there is no double time or time in lieu for doctors. Frankly I feel we deserve a little support, and maybe even a little appreciation.
11) And to the lady who appeared on the radio programme, your comments were often factually incorrect and absurdly biased. No doubt the doctor who signed the form for your mother's cremation would have been more than happy to discuss it with you if you had any concerns, did you try to contacrt him/her?
12) City job is awfully tempting...
Complain about this comment
Please forgive typos, its been a long day!
Complain about this comment
What a bunch of crazy insinuations. I've never been paid in a brown paper envelope with cash and a wink unlike the requests by almost every tradesman that has come to my house to do jobs. Neither can I imagine any doctor endagering their career to save a relatively small amout of money on tax.
This lady is really misguided as to who makes money in a death. My father was a muslim. When he died, I only paid about 100 pounds to bury him as funerals are organised by the local mosque free of charge. Fees are only to the council. Compare that to the charges demanded by undertakers and you quibble about the legal fee to ensure that nothing crimanal has occurred?
The next time you buy a house, how about asking the solicitors, the banks the removal men etc to waive their fees? Personally I'd rather not pay for loads of things like the healthcare of those with self-inflicated illness such as smoking related illness or those who do not wish to work but claim every benefit available. That's not a realistic option though.
Complain about this comment
"Whether I declare this income or not is my own business"
No it's not, it's the law.
"As a junior doctor I could walk into a highly paid City job"
Absolute rubbish.
Complain about this comment
There is nothing immoral about cremation fees. The comparison with lawyers fees is the most useful. Don't forget doctors aren't slaves, we are professionals (or at least used to).
As regards filling the forms in during NHS time I think you will find that most doctors, like myself, fill them in during lunchtime or other breaks - which we don't normally get anyway. Often for me to fill a cremation form in during the day (the only possible time as that's when the office is open) means my day becomes difficult and I therefore have to stay late.
The tax payer gets more than its money worth out of doctors. Next time you are in hospital with a relative waiting to be seen, and you decide to have a go at the junior doctor for the length of your wait, why not first ask if that doctor has been there 12 hours without going to the toilet or having eaten? Why not ask how many people they have already seen that day? Why not ask them if Modernising Medical Careers pushed them hundreds of miles form their children and family, and when they last saw their loved ones? And then after doing that why not tell them how much you begrudge them a cremation fee for doing even more work on top of all that?
The answer given the posters attitude is for junior doctors to refuse to complete part I of cremation forms, thereby in many cases forcing the case to be referred to the coroner, delaying the funeral and more than likely precipitation a postmortem. As far as I am concerned you can keep your money.
Complain about this comment
The outcry of "not fair" from doctors and the justification given by them for receiving ex-gratia payments for a range of so called "non-NHS" services is not matched or championed by them for "lesser" mortals working in the NHS. In many cases work is done on behalf of doctors and consultants by "lesser" staff - the work also being way beyond these workers own NHS duties - but who are not given the same protection, sympathy or recognition afforded by management to doctors, nurses and consultants because of their "professional"status. The cry of "not fair" is in fact much more appropriate for these staff than to relatively highly paid "professional" NHS medical staff. It would be interesting to compare the actual income i.e. salary+shift and "other" payments, paid to NHS medical staff such as doctors, consultants and "trained" nursing staff, compared to actual income for the wide range of "non-medical" staff who provide the technical and caring skills that actually contribute to patients treatment and recovery.
Complain about this comment
In response to TruthBroadcaster newly qualified junior doctor in August 2008 will earn the same as a newly qualified staff nurse which considering the fact that the junior doctor has had 5-6 years training and carries responsibilities that the nurse will never bear suggests a loss of priorities. The average doctor qualifies with debts of 25k. Most doctors work beyond their contracted hours it is the nature of the vocation; the doctor's lot 'to cure sometimes, reassure often and comfort always'. One sometimes wonders why given the inadequacies, petty jealousies and ignorance of those with an axe to grind; that said 90% of the public love and trust us.
To return to widowed and shocked and disgusted on the subject of PMs no tests can be carried out without the consent of the Coroner and must aid specifically in determining the cause of death. If a cause of death is easily established after discussion between coroner and pathologist then often the coroner will not permit further test to be performed.
I would state that not enough non-coronial autopsies are performed.
Complain about this comment
Well, the intelligent argument of changing my name to 'Dullard' certainly put me in my place.
I don't have an overinflated ego that needs me to say any more about that. Lets have a sensible debate shall we?
I notice one doctor(?) was erked at the fact that mortuary staff were 'skimming off part of the fee' (post 40). Why shouldn't they get a cut of the cash if, as you say, it's a justified payment for work done?
Complain about this comment
"As a junior doctor I could walk into a highly paid City job"
Bit off-topic, but as a former Dr now working in the city I have to tell you that this is patently untrue. It is also a prime example of the sort of arrogance that provides the tabloid press with all the ammunition they need to continue undermining doctors in general.
Complain about this comment
andmullard
The mortuary attendants should absolutely not be skimming from the fee. The fee is a nationally agreed on for the doctors professional responsibilitites. The mortuary attendant may skim off the top only if accepting the same proportion of the liability - something they are simply not qualified to do.
If they wish to charge a fee for handling the secretarial side of the cremation form, then the invoice should be sent to the undertaker, who can pay the invoice, and in turn can pass on the costs.
Complain about this comment
Yes Andy, I am annoyed if someone skims a part off the fee.
The fee is payable to me, if I chose to sign the form and take the time and risk.
The mortuary staff do not have any part to play in that. They have their own duties which they carry out but do not form part of this process.
So, if they illegally take a deduction from a fee payable to me, that is theft, illegal & could be reported to the police. However, it has been widespread, despite clear statements from the BMA that it should not be tolerated.
The tax man expects the Doctor to bear the weight of the full fee & the mortuary staff certainly don't declare this little perk.
Of course, if you do a piece of work, I am sure you wont mind the post man taking some of your pay from your pay packet - after all, he delivered it!
Unauthorised deductions from all or part of a payment is, and will always remain against the law. If you wish to take the moral high ground then at least display a little common sense.
If you remember I pointed out I'd rather not sign the forms anyway, but if I do, I expect my professional fee to be paid, just like anyone else in the process.
Complain about this comment
doctorangrygasman (post 41)
I assume that when and if you (any employed doctor) do 'travel vaccinations' or 'insurance medicals' that you do this in your own time, that the vaccines used, consumables, and the facilities, are paid for by the private funds?
This is the same as I would expect regarding crem form fees.
Complain about this comment
I find it scandalous that doctors might be enjoying a night out at the expense of a recently deceased person. I am pleased that Ms Levey has bought this subject to the nation's attention. In any case, I think it scandalous that such a high fee has to be paid by the loved one of a deceased person.
Complain about this comment
I feel I must add my voice to this debate as doctors are being unfairly maligned here.
Conflict of interest: I am a hospital doctor.
My experience of filling in cremation forms as a junior doctor is that the first part is often filled in by the junior-most doctor on the team that looked after the patient, usually an F1 doctor (formerly known as house officer). However it can be filled in by any doctor on the team that looked after the patient. The second part is filled in by a consultant (not necessarily one who looked after the patient) who double checks that everything in the first part is correct. Both of these doctors will get £71. I do not know how the system works in the community with GPs, my experience is with hospital medicine only.
The first part is usually filled in in conjunction with the death certificate which is a completely separate form and for which no fee is paid to the doctor. This is because certain details on the cremation form must match the death certificate such as the cause of death. It should be made clear that if the cause of death is not known or is suspicious in any way, the case is referred to the coroner for an inquest and the doctor must not complete the cremation form at this time. In these cases I do not know who ultimately does these forms. Anyone making a false statement on these forms would be in serious trouble and could be struck off so I doubt anyone would 'make up' a cause of death just to get their hands on £71.
Where the cause of death is known and the case will not go to the coroner, the doctors filling in the forms must sift through the notes and ensure the cause of death (and factors contributing to the cause of death) are accurately entered on both forms. The cremation form needs extra information not found on the death certificate. This includes whether or not the patient has a pacemaker. This involves actually going to the morgue and inspecting the chest wall of the deceased. The reason for this is that the batteries in pacemakers can explode in the furnace and cause damage to the crematorium's equipment or even staff - the cremation staff would be very unhappy with doctors if this part was incorrectly filled in.
The most important reason for the extra details on the cremation form is that once the body is burned, all forensic evidence is lost. If it later came to light that the patient had been murdered for example, there would be no body to exhume to obtain further evidence. Therefore there is a great responsibility on the doctor to ensure the details on the form are correct and that it is OK to incinerate the body. If there is any suspicious circumstance, the doctor must not sign the form.
The juniors are required to take time out of their day (when they could be looking after patients who are alive) to fill in the cremation form and death certificate and to visit the deceased in the morgue, so in fact this is a job the doctor does not relish as there are often plenty of other important jobs to be getting on with. However I understand from a grieving relative's point of view that it is best for the form to be done as quickly as possible.
I doubt you could say that cremation is within the remit of the NHS. Therefore I think it is right that a fee should be paid on top of the doctor's NHS salary, especially given the legal burden the doctor is placed in should details on the form be incorrect. As for the method of payment, this is down to the hospital trust, not the doctors. I have been paid in the past by cheque from the crematorium. I know of other hospitals where doctors are paid in cash or directly into their bank accounts. I also know of hospital trusts which take some of the fee for themselves as an administrative fee before passing it on to the doctor.
Finally it must be noted that the family pays the crematorium and the crematorium pays the doctor. If the doctor refuses to be paid, the crematorium still collects the cash (£142 - 71x2). I am not aware if any crematorium offers a refund to the relatives in this case - please correct me if I am wrong. So this is a cost that the relatives would pay anyway.
Sadat Quoraishi
Complain about this comment
Andy, if you want a 'debate' why don't you respond to the many excellent points made by doctors here? Until you do we can only assume that you cannot.
Slickblog, I've spent all day in the hospital looking after the sick. Now I'm going to the boozer. Should I feel guilty about it? No. Do I or any other doctor feel guilty about it? Hell no.
You people are living in a cloud cuckoo land of 'rights' 'entitlement' and hypocritical righteous indignation that are absolutely typical of noughties UK society. You need to open your eyes.
Complain about this comment
The comparison to lawyers fees by "glasgowmedic" is a “useful” one. Lawyers perform duties and complete forms for which their employer (the law firm) invoices the client. However, the similarity ends there. Unlike junior doctors, a graduate lawyer does not directly receive fees for each form they fill out. Instead, as professionals, lawyers receive a salary that reflects their overall performance in all aspects of their job. If the NHS decrees that checking to ensure that there is no evidence of a suspicious cause of death is not a necessary part of their service, the hospital should charge this fee to the estate of the deceased through the hospital system in and open and transparent manner. However, given that due to a lack of burial space in most parts of the country cremation is almost compulsory, not supporting what is regarded as an essential part completing the care of a patient within the public health service in most other developed countries seems unwise from the point of view of the nation.
Either way, the current system whereby the transaction effectively takes place directly between individual doctors and the family of the deceased and the money is paid “on the side” is unsavoury, unnecessary and unfair. If it is necessary then the work should instead be incorporated into the prescribed workload of hospital doctors. The current “ash cash” system financially favours junior doctors in hospitals with greater portions of palliative patients such as geriatric or oncology wards and in that sense is unfair to those who work in dermatology or paediatric orthopaedics, for example. This system is also very messy as it means that so-called “private work” has to be performed within normal working hours and on NHS premises. There are not many other salaried professionals who are allowed to do this at their place of employment – particularly without any effect on their base salary!
While I sympathise with the fact that some junior doctors may struggle financially, continuing to receive money from bereaved pensioners and people frequently less well off than themselves is not the appropriate way to deal with it. If they feel that their pay is insufficient, then their unions should take up the issue with the NHS and such discussion is not relevant to this blog.
Anyway, well done to Pauline Levey for bringing up a topic which this blog has demonstrated to be clearly worthy of debate.
Complain about this comment
COI: junior doctor
Personally this is an aspect of my job that I do not enjoy. I certainly do not see i as an easy 'bonus'. Before I sign my name and GMC registration to the form I spend a great deal of time reading the patients notes and sometimes discussing them with colleagues/coroner and satisfying myself that the cause of death needs no further investigation.
I use the money to fund my own training courses and professional exams because the NHS doesn't provide this for doctors.
Complain about this comment
1Forjustice, you should be aware that the junior doctors' obligation is to fill out a death certificate in order to rule out suspicious circumstances concerning the death. If there is any cause for concern then they must refer the death to the coroner. The cremation form is ADDITIONAL paperwork and is not obligatory. Therefore whoever fill it in is entitled to a fee. The level of that fee is decided by the hospital and not the junior doctor, and in my experience varies from trust to trust. The most I ever got as a houseman was 40 quid. Unfortunately doctors get saddled with loads of additional paperwork which requires them to stay late UNPAID. For examplr I fill in 3 or 4 disability claims for the Dept of Working Pensions a week. Each of these forms takes 30-45mins of searching through a foot high stack of notes on a patient I have never seen. I am notpaid for this and get lumbered with it because GPs charge 50 pounds.
Complain about this comment
Well said by IforJustice. At last a view that understands the moral point of the matter. I would still like an answer to my question about the comparative pay of medical and non-medical staff. One doctor responded by comparing a junior doctors pay to that of a staff nurse, so, how much is that? Does this include all other payments? I would like doctors to be paid properly and treated decently by their employer. Maybe the extreme reaction from most of them indicates their frustration. I wonder if they could find it in themselves to support their co-workers who are paid very poorly in comparison to them. Who was it that said "First they came for the......then they came for me."?
Complain about this comment
1ForJustice - your assumption is incorrect. The doctor is paid by the crematorium, not by the family. It is the crematorium which charges the family. The doctor will be paid by default by the crematorium, we actually have to refuse it if we do not want it. Even if the doctor does not accept the fee, the crematorium will keep the money. It makes absolutely no material difference to the family whether or not the doctor accepts the fee.
Complain about this comment
Funny, when one has just read 60+ postings one gets an overwhelming impression - and you blog docs do yourselves no favours
What a bunch of whinging, self pitying, over worked and underpaid doctors we have in our NHS - I sincerely hope that this is not representative of the poor state of all doctors in the NHS.
Ash Cash - Should not be paid in order to enable the basic human right of the grieving to recover their deceased loved one from the British health care system they have financially contributed to all of their lives.
Doc whingers - dont blame the undertakers, neither of you should have it as a point of principle. The signing off of the deceased should be the last NHS provided service the deceased pays for after what may be 50+ years of NI contributions. To suggest it is not a core part of the NHS cradle to grave (oven) service we all pay for is an utter deception. If you cant see that you need to get a grip with the reality of how people outside the NHS feel about this.
All you hard done by public sector workers, do you think we private sector workers can make 70 quid in our tea breaks? on top of our salaries - I do pity you. If you think the grass is greener outside of the NHS for the majority of us, then you are deceived, hours just and long (if not longer) pay just as bad (if not worse)
Get a grip - If you want to continue a caring vocation under a shoddy buraeucratic NHS system (thanks to big government) then I commend you but if your one of the hard 'done bys' then come and join the rest of us and let some one else take on your vocation
MS Levey - well done to you for highlighting what many people only ever discover at a traumatic and upsetting time, especially if it's an HIA that puts you in that position in the first place.
Complain about this comment
F1 doctor 2008-9 21, 862 for 40 hours , but if unpaid overtime added in 44-46
D Grade Staff nurse just qualified 22, 205 ( 2008-2009) for 35 hr week
Complain about this comment
Why conveniently quote £21,862 when http://www.nhscareers.nhs.uk/details/Default.aspx?Id=553 says that usually junior doctors receive a supplement most commonly bringing their salary up to £32,087 in their first year after graduating. This does involve working extra hours above a standard working week but how many other professionals work 40 hour a week anyway? I am sure that the "highly paid City job" that annoyeddoctor is confident he or she could walk into would involve extra hours without "overtime". While factory workers expect to be paid overtime, in a professional job, getting the work done is usually considered to be part of the job description.
Anyway, I don't see why it is necessary for this debate to deteriorate into a slanging match over doctor’s salaries and their morals – I personally commend the great work the fast majority of doctors do in this country. This issue is not about an attack on doctors, it is an attack on the current system. All of the hospital doctors I have personally spoken to about this since listening to the program are morally uncomfortable with the way things work at the moment, even if some of them profit from it.
There are two main issues to address:
1) Should NHS-employed doctors be able to perform non-NHS work (cremation certificates) within their NHS working day on NHS premises in addition to their NHS workload? As Rohin Francis and several other doctors have pointed out, SOME junior doctors DO exploit this.
2) If the NHS decides that cremation certification is not within their remit, who will they charge for it and how? If the NHS is controlling the charging, they could reduce or waive the fee for low income earners.
Please junior doctors, do not see this as attack on you. See it as attempt to reform a legal dinosaur and, although you currently profit this system, it is not fair overall. Don’t degrade the whole profession by behaving venomously and childishly just to get yourself some extra cash.
Complain about this comment
Going a bit off topic but this supplement is not guaranteed - it is set by the hospital trust and the doctor has no say in this and often does not know the banding prior to starting the job making financial planning difficult. The banding described by 1ForJustice is 1A - 50% on top of basic salary for working a 48 week (averaged over a 13 week period) with a high proportion out of hours (ie nights and weekends). The banding can also be 1B - 40% on top of basic for a 48 hour average week with a high proportion within normal working hours. The 2A (80%) and 2B (50%) bandings apply to 56 hour weeks and will unfortunately be phased out by August 2009. More worryingly there could be no banding at all in some specialties where there is no on-call or out of hours requirement , meaning the doctor does get just the basic rate (around £22000 for an F1 doctor - similar to a staff nurse).
The reality is that most if not all hospital doctors work more than their contracted hours and will stay late to ensure that sick patients are sorted out before leaving. We are not paid overtime for doing this.
As many doctors have spent at least five years at uni (therefore having more debt) and started work later in their lives (therefore having less savings) and are thus poorer during the first work year than many of their year group who did other shorter subjects, I would not begrudge the F1 doctor the occasional £71 for work over and above their NHS duties.
Bear in mind that the crematorium charges the family much more than this for burning a body. The suggestion here appears to be that cremation should be an NHS service. Should the taxpayer pay the crematorium running costs and staff salaries too?
COI - junior hospital doctor
Complain about this comment
To address 1forjustice's first point:
"Should NHS-employed doctors be able to perform non-NHS work (cremation certificates) within their NHS working day on NHS premises in addition to their NHS workload? As Rohin Francis and several other doctors have pointed out, SOME junior doctors DO exploit this."
Within the hospital setting, the stuff you need to complete this task are within the hospital, in the patient affairs office normally. Were doctors not allowed to do this during their NHS hours, then the patient affairs office would have to open before 8am or after 5pm and stay open for as long as it takes the doctor to complete the form - never gonna happen.
Your point is valid from a moralistic point of view, but in the real World it is simply not practical or sensible.
Put another way, it is not totally uncommon for a junior doctor to have a quiet day, have no jobs left after 3pm, perhaps they are doing admin or audit. If they know a crem form is going to take 4 hours, are you suggesting they wait till 5pm to start, or should they start at 3pm, bearing in mind they will still be in the hospital, carrying a bleep, and therefore very contactable??
I am not going to address your second point as I have no idea what the answer is.
COI - ex-doctor, now work in an office.
Complain about this comment
I don't get this moral argument. If an undertaker can profit from death why shouldn't a doctor, or any other citizen? Your argument is profoundly flawed.
Anyway given the ingratitude of the public - the people on this forum - I have decided I will NOT fill out further cremation forms, regardless of whether there is nobody else available to fill out the form or not. So I will not profit, but families will wait longer for funerals, and suffer the trauma of a postmortem.
Complain about this comment
Hi All
Have come into this debate quite late but what strikes me from the majority of the comments (doctors and non doctors alike) is that not many people particularly agree with it and most doctors have said on this blog that they feel uncomfortable with it.
If you keep the discussions about doctors salaries separate, it seems that most people on this blog are in agreement that this system of "ash cash" should be reviewed and possibly overhauled/amended.
An independent review could solve a lot of the issues here and more importantly could make it easier for the bereaved.
Complain about this comment
Dear Sirs, What can I say so much has been written on this I'm amazed Dr's have the time and for those who have used this medium to have a pop at Ms Levey who opened the debate you should hold your head in shame. Freedom of speech is much of what this counties made of some of you have also missed the sensitivity of how this came to light originally, excellent bed side manner!
In bringing this to the attention of an associated he pointed out that some DR's also charge for signing passport photographs
Is this true? does this have a name? "Flash Cash" maybe?
Complain about this comment
I would like to congratulate Ms Levey on publicising the so-called ASH CASH. It is interesting (and telling) to see how some doctors have responded to this-as has been mentioned on this blog before it should not be seen as a personal attack but a much needed step towards reform of the current system. At the very least, this charge needs to be made consistently transparent-to families of the bereaved and the tax-man.
Complain about this comment
Methinks the doctors doth protest too much! Having lost two close relatives in a short period of time, I was completely unaware of how this particular fee was paid.so thankyou Pauline Levy for bringing it to light, but what a can of worms it has opened. I am in total agreement with Therationalhoss Doctors can complain all they like, but the fact is although they may not ask for the fee, they take the fee directly from the public (whom many appear to regard with contempt) As far as i know, no other health worker gets a fee like this for doing any part of their job and it must cause hardship to many people. Am i wrong in thinking that one of the NHS policies is to be totally transparent ? This seems kinda frosted to me.
Complain about this comment
What a pathetic case the junior docs have presented you all knew the terms and conditions attached to this totally money orientated profession. Not one mention of the hardship caused to the bereaved.You should all be ashamed given that within 8-10 years of qualifying some of you will be earning 5 times your starting salary plus 'merit' awards and very lucrative 'private' work. and some will still be claiming ash cash. Where are the morticians views on this subject? They must just take their 'cut' and stay quiet. Is their involvment in this business part of their NHS duties? Lets bring the ash cash debate to a wider audience those who may not listen to Radio 4 and who certainly are not aware of this forum.(The elderly who can least afford this payment) Roll on the review supported by the BMA and hope that the result will mean the end of this immoral payment, after all the system failed the relatives of Dr. Shipman's victims.
Complain about this comment
Pauline... thanks for bringing this to light. I was very shocked to hear about this charge and judging by the comments here from doctors who feel the need to defend themselves (a touch of guilt perhaps?) the system need a complete overhaul!
Complain about this comment
Hi every one
I am an APT Anatomical Pathology Technician (Mortuary). In response to the question of skimming the Doctor's fees.
I feel in house that the Doctor's signing part 1 or B of the form are having a hard time from their Consultants.
It is in our Standard Operating Procedures, that the 1st part Doctors must state if a cardiac pacemaker is fitted, or if it has been removed. A fee can be charged by the Doctor for the removal of this pacemaker. It has been common practice that the Doctor's ask the APT to remove the pacemaker on their behalf, as this can take a few minutes. I have told my staff that this procedure must be undertaken by the Doctor, and not the APT, as we do not have the authority to sign the Cremation form, for which the Doctor charges the family. A consent form must be signed by the family to remove the pacemaker, as the procedure is an invasive one, and without consent, could lead to a claim for assault on the patient.The cremation form is a private document that is paid for by the family, one way or another. Some Mortuary Technicians keep bookwork for the Doctors fees, a small amount may be paid by the Doctor for administration, in order to ensure their fees are received from Funeral Directors, and paid to the them. This book keeping is non- NHS work, and like the Doctors claiming no overtime, this is done outside of normal hours.
In my position, the Consultants are telling the Junior Doctors that the APT must remove the pacemaker, or defibrillator. Wrong, it is not NHS work,we have other priorities in the department, not a Junior Doctor's skivvy.
So please make sure you are fully aware of the APT's role in the NHS before accusing hard working Technicians, in a thankless position, who care for the loved ones of the people whom you fleece. We do not skim your fees. We handle no fees here, and you do not work in your lunch times, and you very rarely waive your fee, the undertaker will charge the family regardless, because the family will be unaware the Doctor may have waived the fee. It is the Doctor who charges, not the Crematorium. There are seperate fees for the Crematorium. Caring profession?? I hope so.
Complain about this comment
> 'So please make sure you are fully aware of the APT's role in the NHS before accusing hard working Technicians, in a thankless position, who care for the loved ones of the people whom you fleece'
Initially I was worried that some doctors were doubling up their ash-cash by signing cremation forms for sheep but it seems you are implying that doctors are charging an exhorbitant amount for a service provided - as I understand it from the comments below the fee is automatically paid to the doctor for the completion of a mandatory legal document.
> 'It is the Doctor who charges, not the Crematorium. There are seperate fees for the Crematorium. Caring profession?? I hope so'
Why are the sepArate fees for the crematorium not subject to the same scrutiny here as the payments to doctors? As for hoping that it is a caring profession; here are examples of some of the opinions expressed in this forum regarding doctors in the NHS, please use them to consider why it might be that you have to hope that anyone cares about the general public:
> 'What a pathetic case the junior docs have presented you all knew the terms and conditions attached to this totally money orientated profession'
Nice.
> 'hope that the result will mean the end of this immoral payment, after all the system failed the relatives of Dr. Shipman's victims'
Natural selection failed to stop this poster from diluting the gene pool but it doesn't mean that it's system is wrong.
> 'the fact is although they may not ask for the fee, they take the fee directly from the public (whom many appear to regard with contempt) As far as i know, no other health worker gets a fee like this for doing any part of their job and it must cause hardship to many people'
Contempt? Ha! I'm surprised you know the meaning of the word. But seriously, the reason no other health care workers get paid for this service (a service which is extra to a doctor's day-to-day working responsibilities) is that they are not qualified to by law. As an aside the average cost of a funeral inthe UK in 2007 was £2,160 so I find it difficult to believe that it is the £72 paid to doctors that is causing the hardship.
> 'Freedom of speech is much of what this counties made of some of you have also missed the sensitivity of how this came to light originally, excellent bed side manner!'
Make your mind up - either you want doctors to be polite even when they are writing on the internet on their own time or you want freedom of speech.
> 'he pointed out that some DR's also charge for signing passport photographs'
So? If you don't want to pay them for that get someone else to do it. I personally think they were charging you in the hope that it would deter you from going to see them AND WASTING THEIR LIMITED TIME SIGNING YOUR STUPID PICTURE.
> 'What a bunch of whinging, self pitying, over worked and underpaid doctors we have in our NHS'
So they are overworked and underpaid but you would be happier if they just didn't mention it. Oh, and isn't it funny that when you want to criticise doctors it is 'our NHS' but when there is a problem with the system it is 'your [the doctor's] NHS'
> 'if they could find it in themselves to support their co-workers who are paid very poorly in comparison to them. Who was it that said "First they came for the......then they came for me."?'
Ignoring the tastelessness of your comment (you seem to be implying that the plight of some hospital staff mirrors experiences in concentration camps) I think the fact that public political apathy could lead to the insiduous privatisation of the NHS might be better served by the comparison with Nazi Germany. [The poem quoted was written by Martin Niemöller].
> 'I find it scandalous that doctors might be enjoying a night out at the expense of a recently deceased person…I think it scandalous that such a high fee has to be paid by the loved one of a deceased person'
Despite comments to the contrary I don't think any doctors are actually bumping off patients to collect the £72 bounty and go binge-drinking. Also, technically, the night-out would be at the expense of the loved one. Also, as mentioned earlier, cremations cost a lot more than £72. Finally I am concerned that this poster appears to spend much of their time in a state of scandal.
> 'a prime example of the sort of arrogance that provides the tabloid press with all the ammunition they need to continue undermining doctors in general'
Indeed. Why bother providing any ammunition when the weight of public opinion appears so heavily in their favour. And how dare a doctor show a shred of self-confidence - if the system hasn't worn you down to a point where you doubt your ability to do any job, especially medicine, then it clearly isn't working.
> 'non-medical staff who provide the technical and caring skills that actually contribute to patients treatment and recovery'
If it all the same to you could I please have the person with the medical degree looking after me when I am critically ill. And that is in no way meant to disparage any other member of the health care team but, if possible, could I please see a doctor?
> 'These are the facts.
a/ Doctors are paid by the NHS (the taxpayer).
b/ Doctors get paid overtime.
c/ Doctors can claim 54p per mile for work related travel.
d/ Some payments ARE made 'cash in hand'.
e/ It is the doctor who requests this money, not the undertaker
They were some facts (and some other stuff):
a/True
b/Sometimes true
c/All doctors? Everywhere? What is the relevence of this 'fact'?
d/Some payments? To who? Where? Are you aware that cash can still be declared as income?
e/It is the doctor who is paid the money as they are providing the service (for which they are exclusively qualified but that is not covered under the terms of their NHS contract) that is a legal requirement for the bereaved to proceed with a cremation.
> 'especially those who have recently suffered a bereavement and not even realized the profiteering that they have been the victims of'
If I was to suspect anyone of profiteering it would be the person charging £2,000+ to burn a dead body. However, the only undertakers I have dealt with have seemed very honest and trustworthy people so that is probably unfair. As for the fee payable to doctors it seems that there is a legal requirement that this process is performed and that the (set) cost of this is being passed on to the person requesting the cremation. I can see why the NHS don't pay for it, as the patient is rather beyond the help that is within their remit to provide, but I can also see why the bereaved could feel aggrieved at having to finance it. I wonder if perhaps there could be some sort of means-tested benefit payable by the Department of Work and Pensions on behalf of the deceased to cover the cost of this service when required.
> 'doctors are you really the caring profession or is it just your bulging bank accounts you care about'
Again it seems that wanting to get paid for the services you provide is inherently wrong. I think it is important to remember that when doctors are paid by the NHS it is to provide a service as laid out in the terms of their contract. As these cremation forms do not come under the terms of that contract they are an additional service and, as is customary in most professions, additional financial recompense is received for that service. If people do not want to pay this out of their pocket then it is up to them to elect a government that will either agree to fund this out of the public purse or abolish the requirement (but abolition would mean removing a process that is supposed to help prevent another Shipman occuring so that might not be ideal).
> '£21,000 is supposed to be a low salary? I dream of the day i could make that much - and yes, I am a graduate and owe around £15,000 in student loans
Who would have guessed that doing a PhD in Media Studies should turn out like this.
> 'presumably they are not declaring these payments in their accounts or tax returns'
Why would you say that? You don't have to automatically assume that doctors are dishonest, tax-dodging criminals - you just choose to.
So I guess I didn't like the tone of much of this discussion and I just wanted to add my two-penneth worth.
At least I feel better for it.
Complain about this comment
One always wants to compare doctor’s form filling fees to a lawyer’s fee and junior doctor salaries with nurse salaries and make arguments based on this. It is difficult to portray an entire profession as trusting, caring philanthropists in one breath only to squeal in outrage when someone dares question your guiding principles and actions. Whether or not the doctors deserve their salary, should have an increase in salary or work hard for their salary is not the issue at hand. Ash cash is immoral. Frankly, I would expect my doctor to know whether or not I had a pacemaker fitted when s/he examined me when I was alive, not dead and to suspect an infectious disease and start appropriate treatments before it killed me, not after, thank you very much. If anyone should financially benefit from my death I should hope it won’t be a hospital doctor who didn’t know me well enough to know if I’d needed a pacemaker or not.
How loud would the outrage be if when you hired the services of a plumber, a CORGI registered professional plumber, to come and install a boiler and this plumber told you that before s/he could get the manufacturer to release the boiler to the plumber a form had to be filled out and the cost to fill out the form would be 10% of the total bill. To top it all of the employee required to complete this form at the manufacturer may have had nothing whatsoever to do with the making of this boiler, in fact may never have even laid hands on the boiler until it was ready for dispatch, but this employee would receive 10% of the total bill maybe in cash, or maybe on a wage slip, maybe as a cheque or the employee might be good enough to deposit this fee into a fund for the manufacturers Christmas party. That would be called a bribe and it would be immoral. When my boiler breaks down and I need a new one and it’s cold outside plumbers can’t add an extra fee for not dragging their feet and doing a job straight away, so why should doctors need an extra incentive or bribe to get motivated?
Not all lawyers defend criminals as I’m sure not all doctors are comfortable with taking this fee; yet some of you are very comfortable taking this fee or you, the trusting, caring philanthropists would have lobbied government to change this yourselves, already, on behalf of your own profession and without the public outcry. Thank you Pauline Levey for being brave enough to bring this issue forward.
Complain about this comment
View these comments in RSS