Human Tissue Authority (HTA) inspectors who visited Nottingham University Hospitals NHS Trust in March found eight bodies in advanced decomposition due to a lack of freezer space, according to a report published on Wednesday. The trust is already embroiled in a baby deaths scandal.
Critical Shortfalls Found in Mortuary Services
The HTA report identified three critical, six major, and one minor shortfall at Queen's Medical Centre, run by the trust. It highlighted insufficient long-term freezer storage, leading to routine use of hermetically sealed bags or body bags to store deteriorating deceased in a refrigerated isolation area. The inspection team noted that this had a detrimental effect on the condition and dignity of the deceased. During a body audit, inspectors identified eight bodies showing advanced deterioration due to not being transferred to a freezer within a sufficient timeframe. Establishment staff were advised to organise transfers to remaining freezer spaces at Nottingham City Hospital.
Risk of Wrong Body Released to Funeral Services
The report also found a lack of systematic checks on wristbands in the mortuary, increasing the risk of the wrong body being released to funeral services. No systematic checks were undertaken for bodies in frozen storage, those in hermetically sealed bags, or those received in an advanced state of deterioration. Checks that were carried out lacked consistency and were not conducted according to a defined schedule, with records maintained on an ad hoc basis.
Ockenden Report Exposes Systemic Failures
The HTA findings come alongside a damning report by former senior midwife Donna Ockenden, which found more than 500 mothers and babies were harmed, suffered potentially avoidable harm, or died due to deeply embedded systemic failures at the trust, described as toxic. The Ockenden report heavily criticised mortuary services, citing examples including an early gestation baby disposed as clinical waste, dehumanising language by clinicians, and poor mortuary care, including failure to comply with legal requirements. In one case, the wrong baby was released to a funeral director; in another, a stillborn baby girl remained in a fridge when she should have been taken to the mortuary.
Background of the Scandal
Problems first came to light after Jack and Sarah Hawkins, whose daughter Harriet was stillborn in 2016, discovered her body had been allowed to decompose so badly that it had to be triple-bagged for her funeral. On Monday, Nottinghamshire Police said two men had been arrested in connection with operating practices in the mortuary service provided by the trust.
