For decades, families in England and Wales choosing cremation for a loved one were hit with a “hidden tax” that few understood and even fewer could avoid. It was known colloquially in the medical profession as “ash cash,” but officially, it was the fee for Cremation Form 4.
As of September 9, 2024, this fee—and the bureaucratic hurdle that accompanied it—has been legally abolished.
This guide explains why this form existed, how the new Medical Examiner system replaces it, and why this represents one of the most significant “Unreasonable Hospitality” shifts in modern UK bereavement law.
1. What was Cremation Form 4?
Under the old regulations, the law required an extra layer of protection for cremations because, unlike a burial, the body cannot be exhumed later if concerns are raised.
This resulted in a two-doctor requirement:
- Doctor 1 (Form 4): The attending doctor who certified the death.
- Doctor 2 (Form 5): A second, independent doctor who had to “confirm” the findings of the first.
The second doctor charged a fee for this service—typically £82.00 (the British Medical Association’s recommended rate). This was paid by the family, usually via the funeral director’s disbursements.
2. The Sept 2024 Pivot: Statutory Scrutiny
The Cremation (England and Wales) (Amendment) Regulations 2024 changed the logic of death certification.
Instead of paying a second doctor for a “confirmatory” signature, every death (whether for burial or cremation) now undergoes mandatory scrutiny by a Medical Examiner (ME). Because the ME is an independent, senior doctor provided by the NHS, their review serves the same protective purpose as the old Form 5, but without the additional cost to the family.
The Result: The need for a second doctor to sign off on a cremation is gone.
3. The Financial Impact: Where is the £82?
If you are looking at a funeral quote today, you should no longer see a line item for “Cremation Medical Fees” or “Doctor’s Fees.”
- Pre-Sept 2024: Total medical fees for cremation were often £164 (Two doctors at £82 each, though the first doctor’s fee was abolished earlier for some).
- Post-Sept 2024: The fee is £0.
Expert Tip for Executors: If a funeral director includes “Doctors’ Fees” for cremation in their quote, they may be using an outdated template. Under the new regulations, there is no statutory basis for charging a family for the medical certification of a cremation in England and Wales.
4. Why This is Better for Families (The Scrutiny Benefit)
Beyond the financial saving, the abolition of Form 4 removes a major “friction point” in the bereavement timeline.
In the old system, finding a “second doctor” often caused delays, especially on weekends or bank holidays. The new National Medical Examiner System is centralized and integrated into the hospital or community workflow.
This means:
- Faster Turnaround: The scrutiny happens as part of the standard certification process.
- Unified Logic: One office (the Medical Examiner’s) handles the paperwork for both the Registrar and the Crematorium.
- Higher Standard of Care: The ME review is more thorough than the old “second doctor” confirmatory check, providing greater peace of mind that the cause of death is accurate.
5. Frequently Asked Questions (FAQ)
Q: Does this apply to burials too? A: No, because burials never required the “second doctor” fee. However, burials do now require Medical Examiner scrutiny, which ensures the same level of accuracy in death certification across the board.
Q: Are there any medical fees left? A: For deaths in England and Wales, there are no longer fees for the standard medical certification of death for cremation. The only remaining medical fees might relate to the removal of pacemakers or other implants required by the crematorium, which requires a small procedure.
Q: What if the death occurred in Scotland or NI? A: This specific reform applies to England and Wales. Scotland has its own established review system for death certification which differs in its fee structure.
Expert Summary
The abolition of Cremation Form 4 is a rare win for the consumer in a traditionally expensive industry. It removes the “ash cash” stigma and replaces it with a robust, NHS-funded safety check.
As an Executor, your role is to ensure the estate benefits from this saving. Verify your funeral invoices and ensure you aren’t paying for a “confirmatory certificate” that no longer exists in law.
Next Step: Understanding the new timeline is crucial. Now that the “second doctor” is out of the way, your main focus should be the Medical Examiner Officer (MEO) call. Use our 72-Hour Limbo Checker to see how quickly your paperwork is likely to move through the new system.
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