Action plan in place after bodies found on floors of freezers and deteriorating due to lack of space at Hemel and Watford mortuaries

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AN INSPECTION of the mortuaries at Hemel Hempstead and Watford General hospitals found bodies stored on the floors of freezers due to lack of space – and corpses deteriorating due to lack of long-term storage.

The two mortuaries – which are part of the West Hertfordshire Teaching Hospitals NHS Trust – were inspected by the Human Tissue Authority (HTA) earlier this year (March).

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And on Thursday (September 7) the results of the inspection – and the steps being taken to address the ‘shortfalls’ – were reported to a meeting of the Trust’s board.

Hemel HospitalHemel Hospital
Hemel Hospital

Trust bosses stress that in the months since the inspection ‘good progress’ has been made – pointing to investments in the buildings, the purchase of new equipment and the expansion of the mortuary team.

And work on a new mortuary on the Watford General site is already underway – and due to open next year (June).

The most serious of the ‘shortfalls’ identified in the HTA report following the March visit related to the assessment of the mortuary facilities, in terms of capacity, condition and maintenance. This was rated as ‘critical’.

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Pointing to ‘insufficient internal capacity’, the inspection found mortuaries at both hospitals were using the floor space of the fridges for the storage of bodies.

And, according to the report, the inspection found ‘semi-permanent surge units’ in constant use.

The report identified bodies that had ‘deteriorated’ due to lack of long-term storage.

And it noted that there were no bariatric freezer spaces for the longer-term storage of larger bodies.

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Meanwhile it also pointed to fridges and freezers that were ‘showing signs of age’.

It highlighted ‘perished’ door seals on one freezer leading to a build-up of ice and ‘poor’ seals on one refrigerator, resulting in one door opening when another was closed

In addition the HTA inspection pointed to the condition of the mortuary premises more generally.

And although regularly cleaned, the report said age and deterioration meant there was a risk they could not be maintained, cleaned or decontaminated effectively.

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In the fridge rooms – at both Hemel and Watford – the HTA report pointed to damage to walls and ceilings and the use of porous wooden storage equipment, as well as chips and cracks on the floors.

And in the post mortem room – in Hemel – it pointed to perished floor seals with water trapped under the flooring and to a damaged drain cover that has been removed, leaving an exposed drain.

Among other issues flagged by the report were the risks of bodies being transferred to external storage units – through carpeted areas of the hospital, past wards and main reception.

“This poses a risk to infection control, dignity of the deceased due to oversight of body transfers, and accidental damage to bodies,” says the report.

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In addition the report also catalogued a number of ‘shortfalls’ relating to policies, procedures and governance.

Overall, according the Trust’s report to the board, there were found to be 20 ‘shortfalls’ at the mortuaries – one ‘critical’, 13 ‘major’ and six ‘minor’.

Nevertheless the HTA did assess the mortuaries to be suitable to be licensed – subject to corrective and preventative actions being implemented to meet the shortfalls identified during the inspection.

In the wake of the HTA inspection report, Trust bosses point to plans to replace the ‘surge’ units – which were largely brought in as part of the Covid pandemic response.

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A new mortuary is already being developed on the Watford General site, which will replace two of the external surge fridges and include seven bariatric freezer spaces.

There are plans for further ‘remedial works’, as well as for an additional three more non-medical staff at senior, middle and junior bandings.

And according to the report to the Trust board, the locks on the fridges and freezers were repaired within weeks of the visit.

The Trust has already submitted its action plan to the HTA and they say ‘good progress’ has been made since the inspection – with most outstanding actions relating to recruitment of new staff.

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Following the meeting of the board (September 7), divisional director for clinical support services Martin Keble highlighted the ‘considerable progress’ that had been made.

“We’re pleased to report that we have made considerable progress in responding to the issues raised by the HTA following the inspection of our mortuaries at Hemel and Watford General hospitals in March,” he said.

“This includes investments in improving the building fabric of the mortuaries, the purchase of new equipment and the expansion of the mortuary team.

“We have received positive feedback from the HTA on our progress to date and look forward to completing all of the outstanding actions before our next inspection in March 2024.”

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Commenting on their inspection of the mortuaries a spokesperson for the Human Tissue Authority said: “We were concerned about what we found when we inspected the mortuary facilities at Hemel Hempstead and issued several major and critical shortfalls.

“When considering the appropriate regulatory action, we must balance the risk posed by keeping the establishment open, the establishment's willingness to address the shortfalls and the capacity of alternative provision in the local area.

“We are working with the establishment to ensure the current mortuary is improved while they await the construction of new facilities.”

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