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The mortuary at a Devon hospital has been highlighted for its use of rusty trolleys and a table with broken drainage equipment - meaning body fluids were left to create a pool - in a report from last year which has been used as an example of 'critical' failings.

The failings have been highlighted by the Human Tissue Authority (HTA), which regulates mortuaries where post-mortem examinations take place.

The hospital, which says it has made significant improvements since the changes, also failed to adequately control who can get into the mortuary, and at the time of inspection had been using temporary storage for bodies for a year because its fridges were full.

An inspection report was written last summer and has just been highlighted by the Health Service Journal.

The HTA said there has been an "increase in shortfalls" over the last two years, and gave Torbay Hospital as an example of a hospital with major and critical failings on the basis of its inspection last year.

Among the failings when the hospital was inspected was a lack of any standard operating procedure for moving bodies in the mortuary, identifying people before a post-mortem, staff working alone or restricting access to the mortuary for people who don't work there.

The report says it would have been easy for the hospital to mix up bodies when performing a post-mortem, it reads: "The establishment’s procedure for identification of deceased who have died outside of the hospital relies on only two identifiers (name and date of birth). This includes for the identification checks performed prior to PM examination, viewing and release from the mortuary. This poses a significant risk of misidentification of the deceased."

In terms of rusty equipment, the HTA described this as a 'critical' failure at Torbay.

The report reads: "Key items of equipment in the PM suite are not fit for purpose: the downdraft ventilation systems on the PM tables are not functional; the drainage system on one PM table does not function correctly, leading to pooling of body fluids on the table during PM examination and cleaning; the bases of the PM tables are not sealed with the floor, leading to difficulties cleaning these areas effectively and rusting of the bases of the PM tables; hydraulic trolleys in the PM suite are rusty, meaning that they cannot be cleaned effectively; the housing unit for the oscillating saw in the PM suite shows extensive rusting, and cannot be cleaned effectively; and the dissection board in the PM suite is in poor condition and the surface is no longer impervious.

"The poor condition of these key items of equipment poses significant risks to the dignity of the deceased and health and safety of staff working in this environment."

Lack of training at the Torbay mortuary was also found to be a major failing.

In terms of unauthorised staff, the report found 180 people could get into the morgue, it reads: "There is a risk that individuals have access to the mortuary who do not legitimately require this and have not received training in undertaking mortuary procedures."

It says visitors could get into the body store, doors are not locked and windows are not covered.

The report reads: "The door to the PM suite viewing room is not always locked during working hours. There is no covering at the window in the PM suite viewing room, which looks into the PM suite. This arrangement poses the risk of inadvertent and unauthorised viewing of PM examinations."

Dr Rob Dyer, Director for Torbay and South Devon NHS Foundation Trust said: “The Trust was inspected in May 2017 by the Human Tissue Authority (HTA) and the inspection report where a number of issues needing immediate action were identified was published and highlighted in the media shortly afterward.

“Some of the issues were ones we were already taking action on and for the others we ensured that any necessary action and recommendations were acted on rapidly.

“We pride ourselves on delivering services which are safe and to the highest standards and I am delighted to report that in the 12 months since the inspection report was published we have acted immediately on all of the actions and recommendations that were made to us. None of the issues raised are any longer a concern for the Trust and nor have they been for some time.

“Since last year the mortuary has had a complete refurbishment, and significant investment has been put into new equipment to ensure we are fully compliant. Extensive work has also taken place to review and strengthen our policies and procedures and we have recruited additional staff.

“The team involved have worked incredibly hard on the remedial actions needed and they have worked closely alongside the HTA to ensure we not only meet but exceed the standards.”

An investigation by the Health Service Journal (HSJ) found that the number of "major" and "critical" failures have risen sharply since 2015/16.

The increase has coincided with mortuaries being given new standards to adhere to. Due to the revised standards, officials expected a rise in minor shortfalls, but not as many major ones.

The figures obtained by the HSJ show that in 2015/16 there were 10 major failures. This dipped to seven the following year then rose to 151 in 2017/18.

In 2017/18 there were eight critical failures - shortfalls which pose a significant risk to human safety and/or dignity or is a breach of the Human Tissue Act 2004. None were recorded in the two previous years.

"In the last couple of years we have noted an increase in shortfalls, including major and critical, exceeding what we would have expected given the recent changes in our inspection standards," said the HTA's director of regulatory delivery Nicolette Harrison.

"We have undertaken further analysis of this trend and will be using the results of that work to produce further advice and guidance for mortuary staff, to help them better understand what is required of them, and improve compliance.

"We expect all establishments to meet our standards, to ensure public confidence that mortuaries are handling bodies with appropriate dignity and care."

Examples of major and critical failures can include identification failures which could potentially lead to the viewing or release of an incorrect body, or tissue not being disposed of in an appropriate manner.

A spokesperson from the HHTA, discussing improvements at Torbay Hospital, said: "Based on information provided by the establishment, the HTA was satisfied in June 2018 that the agreed actions from the corrective and preventative action (CAPA) plan were completed, and that there had been sufficient action to correct all of the shortfalls addressed in the inspection report from the May 2017 inspection (this is highlighted on the inspection report here - page 20).

“We acknowledge the significant work that has gone towards bringing the mortuary back to compliance with the required standards.”

What happens to your body when you die?

Not many can say it's their job to work with dead people.

And few people would probably want to enter this line of work.

But James Wilkinson has been worked at Weston Mill Crematorium since he was 18 years old.

The now 51-year-old says he has never become numb to the cremation process.

"The worst experience I ever had was my cousin died," he said. "I went to his funeral and then I came round the back and cremated him.

"But you can sit in here and listen to the services and get a lump in your throat. So you never get immune to it.

(Image: Sarah Waddington)

"You have to have a weird sense of humour though, but that's behind closed doors. When you are out of the limelight you have got to have a release, and that is ours – having a strange sense of humour. If you don't have that you will crack up."

As a fresh-faced teen, a job for a lorry driver within the crematorium was advertised.

James, known as Jim, began the job in the August and just three months later had started within the crematorium itself.

He says he has seen a lot of change in that time.

"I've seen four different types of cremators," he explains, "and I've trained lots of people.

(Image: Sarah Waddington)

"I like technology and I'm always wanting to learn. I could strip these machines down and put them back together again.

"It was all manual when I started, and I'm the last of that generation left now."

He adds: "A piece of equipment like we use now costs about £20,000, but sometimes they can break.

"This is because things are left in the coffin that shouldn't be, like glass, and that can damage the hearth. The glass melts and congeals in the hearth, and when it cools down it goes solid and you have to go in with a hammer and a chisel to get it off.

"Anything man-made in the machine is a no, no; it has to all be natural, but we are relying on the undertakers because they sign a declaration form to say everything is in order."

(Image: Sarah Waddington)

Talking about the open day and dispelling some of the myths and "old wives' tales" people have regarding cremation, James says: "Some people think we put them all in at the end of the day, but the chamber is only big enough to take one, and they all have a name plate on them.

"Most take about an hour-and-a-half, but we have had one that has taken three hours, as it all depends on the size of the person and the heat.

"Some people also think that the ashes can contaminate, but there is no way they can, because they are all in completely separate compartments where they cannot touch. It's just old wives' tales."

Cremation: What happens?

(Image: Sarah Waddington)

The funeral party arrives at the main entrance and are greeted by staff, who assist the funeral directors with taking the deceased into the chapel.

At the entrance, the funeral directors will take control and the coffin is taken in a ceremonial route into the chapel.

(Image: Sarah Waddington)

At the door, they link with the crematorium's staff to assist in the pre-ceremonial part of the service, before music or visual tributes play and people assemble and sit in the chapel itself in preparation for the service.

The coffin is laid to rest at the front and whoever is administrating the service will take over and the door is closed.

(Image: Sarah Waddington) (Image: Sarah Waddington) (Image: Sarah Waddington)

Once the service is finished, and everyone has left the chapel, the coffin will be received into the crematory area.

From this point, the coffin is received and held on a trolley in preparation for the actual cremation. The coffin is then taken through on the trolley for the full cremation.

The temperature has to be at 850C as part of environmental regulations.

The cremation is controlled in a control room by a computer programme and every cremation is monitored and recorded. It will show up things like items in coffins that shouldn't be there.

The full process usually takes about an hour and a half, and at the end of the process the actual cremulation.

Working with the dead

(Image: Sarah Waddington)

Death is not something we can ever prepare for, but these people are faced with it every day.

Crematorium technicians are not only in charge with cleaning and preparing the chapel before the service, but they also operate the cremation equipment and make sure cremated remains are identified, stored and disposed of appropriately.

I met Karen Jennings, the council's bereavement service manager, on a crisp and sunny spring morning at Weston Mill Crematorium to find out more about what happens there.

"We are not hardened to it at all," she says. "It is definitely not an easy job, but it is very rewarding."

Karen has been doing her job for 17 years and started just as the cremation equipment was being upgraded to comply with a new environmental act to prevent unnecessary pollution.

At the same time, computer technology and software was introduced to handle the operations side of the process.

(Image: Sarah Waddington)

Since then, all of Plymouth's cemeteries have seen some huge changes – which is why Karen wants to invite ordinary members of the public in to have a look behind the scenes and find out what goes on for themselves.

"The open day in May is about dispelling the myths," continues Karen. "People think, naturally, that once the coffin disappears behind the curtains the flames are instantly around it.

"People meet me out in everyday life and say, 'Oh, but don't you do them all at the end of the day?' and ask 'Do you take the handles off of the coffins?' but the guys behind the scenes are actually caring for families' loved ones until the final point.

"We install in our staff that every cremation they do they should treat as their first of the day, because to that family that is the last thing they are going to do for their loved ones. You can't afford for it to go wrong."

(Image: Sarah Waddington)

Karen has worked for Plymouth City Council for 40 years, at first in the finance department and then in a waste management role, before taking up her current job in 2000.

She tells me it is an "extremely rewarding" job – and her favourite of the three.

"I think this is because we are helping people at such a difficult and vulnerable time, and people always remember you."

The memorial garden at Weston Mill Cemetery was built in 1949 by the city engineer's department in stone from Plymouth's former municipal buildings, destroyed during the Blitz. It then became a crematorium in 1967.

Karen says there is burial space left at the site for approximately 15 to 20 years, taking into account an area which has not yet been used.

"The city does need to plan ahead to where people will be buried in the future," she says.

"Plymouth has higher than the national average of cremations, with 90 per cent of people choosing cremation and 10 per cent burial, whereas the national is 75 per cent and 25 per cent.

"One area of Weston Mill which is really popular with families is the burial plots, where there are two sets of cremated remains under each tablet."

Maintaining the site is no easy feat, Karen admits.

Due to cuts in the service, the gardening team at the cemetery is having to work much more closely with those in the council's street services team.

Karen continues: "They cut what are classed as the burial areas, which are the areas near the chapel, and we maintain what are classed as our 'high profile' areas, such as the baby garden and the garden of remembrance, where people can scatter their remains or lease a rose bush."

(Image: Sarah Waddington)

A big question for the management is whether to let older graves be claimed by nature, or to prune them more regularly.

But the team's principle responsibility is making sure headstones stay safe as part of a regular programme of health and safety inspections.

"There is two sides of the coin with overgrown graves," Karen says. "Should we clean them up? Or should we let them weather naturally when there's no one left to tend them?

(Image: Sarah Waddington)

"We want to encourage the wildlife in, as the sort of thing we want to get involved with now is school projects. There are some really good opportunities for outdoor classrooms, especially at Efford where there is an old quarry where the stones from Milehouse Cemetery were placed.

"This happened when they were extending the bus station at Milehouse and had to exhume all the graves and take them to Efford."

(Image: Sarah Waddington)

Taking me on a tour through the cemetery, we walk past an above ground vault, which Karen explains is very old and not opened very often. She says bodies would have been lowered in from the top into a burial chamber, rather than an actual grave.

Further along you will find one of the largest areas of war graves in the South West.

The graves are split into two sections, Karen explains, one for soldiers from the First World War, and the other from the Second World War.

She tells me: "Our own staff cut, maintain, weed and strim these areas, as it is quite a high specification they require.

"We also work with local schools, more recently with the 100th anniversary since the start of the First World War.

"At Efford, we also have a Blitz memorial to commemorate the 332 civilian casualties who were buried there after the period of the worst part of the bombing in March 1941. That's quite something, because everyone's name is on it.

(Image: Sarah Waddington)

"There is a memorial to Agnus Weston here too, and soon it is the 100th anniversary of her death so that needs some cleaning up."

Karen explains if somebody wants to find a grave, they would have to provide the team at the office with as much information as possible – as there are approximately 27,000 altogether.

"We do have a database they can search and they can be given a grave map of the cemetery," she adds.