Death underfunded

The mortuary service needs resources not resignations

It can't be much fun working in the pathology service in the United Kingdom as it lurches from one crisis to another with regular knocks from the government and the media. There have been mistakes, notably the practice of retaining organs without consent, and it will be some time before the public is reassured.1 Apportioning blame in the latest furore to blight the pathology service—bodies being stored outside mortuaries—is, however, not so clear cut.

Last week the striking image of seven corpses stored in a hospital chapel, draped in sheets with the legs and face of one body visible, forced the resignation of Ken Williams, the chief executive of Bedford Hospital.2 A damaged door in an accessory morgue is said to have caused a shortage of suitable storage facilities. The hospital's critics in the media and the department of health blame the management. Relatives are understandably distraught, although the resignation of Mr Williams, under pressure from the government, has not ended the controversy. Ironically, Bedford Hospital is in the top 20 of a much lauded league table of hospital performance, released this month.3

The Royal College of Pathologists has no data on the state of mortuaries nationally—this needs to be rectified by an audit—but consultant pathologists from all over England have readily confirmed to the BMJ that Bedford Hospital is not an isolated case. Bodies have been stored in unrefrigerated conditions for years, especially at times when the NHS is under greatest strain, such as the Christmas and New Year holidays. Storage facilities are then full to capacity and the outflow of bodies to undertakers is slow. The problem is not simply one of local mismanagement, which is what the department of health would have us believe, but one of chronic underinvestment in mortuary facilities.

Since the Bedford incident, a second English hospital has reported storing bodies in a makeshift morgue, this time a boilerhouse.4 Indeed the government has documented a shortage in storage facilities for bodies, 5 6 and funds for updating services are available. The pathology modernisation programme, responsible for allocating the government's budget for modernisation, has been concerned by the underinvestment in the pathology service generally.7 In 1999-2000 bids from NHS trusts and health authorities oversubscribed by 10 times the programme's budget of £10m. None the less, the government diverted half the allotment to other priorities, away from pathology.

There has also been an increase in workload.8 For example, the number of histochemical stains prepared rose by about 28% from 1994-5 to 1999-2000, while the number of immunohistochemistry stains increased by 85%. Although staffing levels have gone up by around 25% in that period, there is still a shortfall of about one consultant per laboratory, if the Royal College of Pathologists' recommendations are to be followed. And, contrary to popular perception, pathology is one of the most intensely scrutinised medical specialties. The clinical pathology accreditation scheme sets standards for medical laboratories, and peer review through external quality control is standard practice.9 The Royal College of Pathologists is also one of the pioneers of revalidation.10

Just as with organ retention, hospitals all over the country will be dreading the day a scandal breaks in their backyard. If health secretary Mr Alan Milburn genuinely wants to avoid distress among relatives then he must address the root cause of the mortuary crisis—which is that the service is outdated and under-resourced. Dignity in death comes at a price that the government should pay.