Walsall Manor Hospital 'weak leadership' led to foetus blunder

Walsall Hospital Walsall Healthcare NHS Trust said a full training plan was being put in place

Related Stories

Missing paperwork and "weak leadership" led to the remains of unborn babies being kept in a hospital mortuary for up to four years, a review has found.

Manor Hospital, in Walsall, said miscarried and aborted foetuses were not released for cremation because the correct forms were not filed by staff.

In March it emerged remains of 86 babies had been stored for too long.

The report concluded Walsall Healthcare NHS Trust had "strengthened processes" to prevent a repeat of the incidents.

'Lack of recognition'

Sandra Gray, of Buckley-Gray Consultancy, who carried out the review at the request of the trust, said many factors led to the delays.

Her findings are due to be presented to the trust's board on Wednesday.

Since 15 April, the trust has carried out 81 of the 86 cremations, three burials have been organised and separate arrangements agreed for the remaining two.

Key Findings

  • A "lack of recognition and/or appreciation of what constituted a serious incident"
  • Non-completion and separation of documents
  • A history of clinicians in the obstetric and gynaecology service not filling out this document meant responsibility fell on a single pathologist over 12 years
  • No trust-wide policy for dealing with the storage of foetal remains, just "historical customs and practices"
  • It became "the norm" for between 30 and 60 foetal remains to be held in the mortuary
  • "Evidence of weak leadership and management in the general office"
  • No evidence of regular audits of policies and practices
  • Appraisal system for staff in the general office was "non-existent" - the job description for the office manager was over 10 years old

The trust said a full training plan was being put in place to ensure lessons were learned.

The report said the trust had "taken very seriously the situation and has taken actions to strengthen... processes and systems".

It added: "The action plan now developed from the external review recommendations will be implemented at pace in order to ensure the risk of such an incident happening again is mitigated."

Hospital chief executive Richard Kirby said in March he was "sincerely sorry for distress caused" and the trust had contacted families directly to apologise.

The vast majority of the samples, 73, were below 12 weeks in gestation.

In total, 52 foetal tissue remains were recent, dating from 2013, but two dated back to 2010.

The trust said it disposed of around 700 foetal remains each year.

Mr Kirby also previously said nobody had been disciplined.

The issue came to light following a Freedom of Information request asking how many foetuses had been retained for more than a month.

More on This Story

Related Stories

The BBC is not responsible for the content of external Internet sites

BBC Birmingham & Black Country



20 °C 15 °C

BBC Local Live

    Scrap metal dealers fined 09:40: Express and Star

    Three scrap metal dealers who were caught operating without a licence or being too loud have been hit with a combined bill of more than £1,000.

    'Best possible deal' 09:33:

    Would Sutton Coldfield be better off having its own town council rather than being part of Birmingham?

    More than 730 people have signed a petition calling for it to be set-up and now Birmingham City Council is holding a review over the next 12 months to see if the option is viable.

    Councillor Anne Underwood, Sutton Coldfield chair, says: "The review will look closely at the proposal for a town council.... and obtain the best deal possible without great expense."

    Stephen's cancer fund 09:23:

    Plans for spending almost £5m raised by teenage cancer sufferer Stephen Sutton have been revealed.

    Stephen Sutton

    The 19-year-old, from Burntwood, died in May after launching an appeal in aid of the Teenage Cancer Trust.

    It said £2.9m of the £4.96m raised through donations and Gift Aid would be invested in specialist cancer units for young people.

    Hospital records pilot 09:09: Sarah Falkland BBC Midlands Today presenter

    A pilot scheme which will allow health professionals to share information about patients following the case of a Birmingham schoolgirl who was stabbed by a schizophrenic will be launched.

    Christina Edkins

    Christina Edkins was killed by Phillip Simelane, who despite being seen seen by 16 separate health agencies or professionals wasn't monitored properly or taken into care.

    From December, with patients' permission, three of the city's hospitals plan to share records with GPs.

    News on the hour 08:58: Jay Vydelingum Journalist, BBC WM

    A year long review gets under way today to see if Sutton Coldfield would be better off separating from Birmingham.

    I'll have more on this story in the news at 09:00 on BBC WM.

    Chinese experts on the rise 08:50: Midlands Today

    Exports from the West Midlands to China have risen ten fold in the last five years. That's according to government figures which reveal that so far this year more that £2.5bn worth of goods have been exported to the East.

    The Cannock based saddle maker, Black Country Saddles

    The Cannock based saddle maker, Black Country Saddles, has plans to sell products to China but says it will need to look at tackling the language barrier first.

    Top headlines
    Stephen Sutton's mother 'proud' 08:40: Birmingham Mail

    The mother of teenage cancer victim Stephen Sutton has said she is "immensely proud" of his achievements after it emerged he had raised an astonishing £5m for charity.

    Delays after accident 08:26:

    BBC Travel News says the M42 exit slip road is closed and there's slow traffic northbound at junction 7 of the M6 northbound because of an accident.

    Moseley house fire 08:14:

    A man has been rescued from a house fire in Moseley.

    Firefighters say they were called to a terrace house on Church Road at about 07:00. The man was rescued from the second floor and has been taken to hospital.

    Church Road is closed while emergency services are at the scene.

    Stephen Sutton's legacy 08:06:

    BBC Breakfast are speaking to Stephen Sutton's mum about her son's legacy and how £5m he raised for the Teenage Cancer Trust will be spent by the charity.

    Jane Sutton

    Watch the interview live on BBC One at 08:10.

    Dry day ahead 08:03: Charlie Slater Weather Presenter, BBC Midlands Today

    Some mist and murk around first thing this morning but this should lift to allow for a largely dry and bright day with a number of sunny spells throughout and maybe just a couple of isolated drizzly showers. High of 21C (70F).

    Tuesday's forecast
    Good morning 08:00: Stephanie Barnard BBC Local Live

    It's grey and murky in Birmingham city centre today, here's hoping it clears up.

    I'm in the BBC WM newsroom bringing you the very latest news, sport, travel and weather updates for Birmingham and the Black Country.



BBC © 2014 The BBC is not responsible for the content of external sites. Read more.

This page is best viewed in an up-to-date web browser with style sheets (CSS) enabled. While you will be able to view the content of this page in your current browser, you will not be able to get the full visual experience. Please consider upgrading your browser software or enabling style sheets (CSS) if you are able to do so.