Mortuary failings raised risk of body mix-up

Grieving families may have been at risk of being shown the wrong body at a Sussex hospital mortuary, inspectors have found.

A report by The Human Tissue Authority (HTA) found identification procedures were not being followed consistently at Worthing Hospital, where regulators also uncovered a number of security and dignity concerns, including bodies being visible from a public footpath.

A near miss involving body identification was only discovered after staff spotted an unrelated discrepancy, the report said.

University Hospitals Sussex said it had made "immediate improvements to strengthen security and privacy" and that most issues identified during the inspection had already been addressed.

First reported in the Health Service Journal, the HTA found three identifiers were not routinely checked against the details families gave before a viewing.

It said that posed "a risk of bereaved families viewing the wrong body".

Staff disclosed that the near miss incident was not reported to the HTA.

Records failed to show if bereavement staff running viewings had been trained or assessed as competent.

During the inspection on 7 and 8 July, inspectors found a body being prepared for release in a hospital mortuary was visible from a public footpath through a fire exit door propped open in hot weather.

The HTA said the mortuary office fire exit door at Worthing Hospital was "frequently opened for ventilation during periods of hot weather" and, when propped open, gave "unrestricted access to the body store".

Inspectors could also see into the body store from the same footpath through the funeral directors' entrance, where the doors were slow to close and had been left substantially open after a release.

The report comes less than three weeks after NHS England ordered every trust to review mortuary security, CCTV, estates and staffing following "shocking" findings at Nottingham University Hospitals Trust.

The Sussex inspection found 10 major and six minor shortfalls at University Hospitals Sussex Foundation Trust, whose hub mortuary at Worthing serves satellite sites at the Royal Sussex County Hospital in Brighton, the Princess Royal in Haywards Heath and St Richard's in Chichester.

• *Twenty-one incidents over the previous two years met the HTA's reporting threshold but were never reported to it, 16 of them potential near misses.
• Seven bodies at Worthing and the Royal Sussex stayed in refrigerated storage for more than 30 days and continued to deteriorate.
• Tissue was stored with incomplete consent records, leaving the trust unable to demonstrate consent had come from the person "highest in the hierarchy of qualifying relationships" required under the Human Tissue Act.
• Live CCTV of viewing tables at Worthing and St Richard's, and of the inside of body storage fridges at St Richard's, was openly visible on monitors in the security office.
• The access control system at Worthing and St Richard's had been failing, so restrictions "could not be consistently assured".
• Fridges and freezers at the Royal Sussex and the Princess Royal were not connected to the essential power supply, leaving no backup in a power cut.

University Hospitals Sussex said: "The dignity, security, privacy and respectful care of people after death are of fundamental importance to us.

"We take the findings of the Human Tissue Authority (HTA) extremely seriously, including the areas identified by the inspection where our standards needed to improve.

"The Human Tissue Authority has not suspended or revoked the Trust's licence, and we continue to work closely with the regulator to ensure the highest standards of care, dignity and respect for deceased patients and their families."

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