The media frenzy over the 'corpses in the chapel' led to the resignation of the trust chief executive. But mortuary facility crises are not confined to Bedford. Ann McGauran reports

Dead men do not tell tales.

Except perhaps in Bedford, where one photograph led a chief executive to step down and caused a national media frenzy about the way the NHS treats its dead.

Health secretary Alan Milburn's verdict in the Commons last week was damning.

'Management failures' were to blame for corpses left in the chapel rather than the mortuary.

It was not down to cash or capacity and Ken Williams, chief executive of Bedford Hospital trust, was 'right to resign', Mr Milburn added.

Eastern regional office states that the boss of Bedford Hospital trust has stepped down while its team conducts a full investigation.

HSJ sources say he had an 'order to go from the top'.

A report is expected on Mr Milburn's desk by the end of this week and the Commission for Health Improvement is due to visit the trust on Monday as part ofits current clinical governance review.

But could the chief executive simply be a victim of trial by tabloid photograph at a time of particular pre-election tension?

In an increasingly frenzied atmosphere, Newham General Hospital in east London was accused last week of leaving dead bodies on the unrefrigerated floor of a mortuary, but has rejected photographs published in the Mirror as being at least four years old.

Is it also possible that Mr Williams is a management scapegoat for growing problems in pathology services, including mortuary facilities (see box)?

We do not know the full circumstances in Bedford yet, says Nigel Edwards, policy director at the NHS Confederation.

But he asks to what extent trust chiefs can be 'held accountable to the point of resignation for administrative failures in work we have delegated'.

Mr Edwards worked with Mr Williams for 'many years' at hospitals in London, where the manager he knew well was 'conscientious about health and safety and those sorts of details'.

Describing him as a 'good, solid hospital manager', Mr Edwards says many people have spoken to him about the incident, 'and they all have said what a terrible thing this was'.

But what shocked them as much as the bodies being left where they were 'was what happened to Ken'.

He adds that with 1,629 trust staff at Bedford Hospital, a chief executive cannot be everywhere at once and has to delegate. It is possible to see how a similar incident 'could happen even in the bestregulated hospital'.

You can 'set up systems to minimise' the possibilities of bad practice and mistakes, he adds - but total control is impossible.

HSJ recently reported warnings that people are shying away from senior NHS jobs.

It is a concern that Mr Edwards echoes: 'Who would like a job as a chief executive? It is a tough job, but we run the risk of making it undesirable and impossible.'

Consultant at Bedford Hospital and member of the British Medical Association's consultants' committee Richard Rawlins says he is 'concerned at the requirement from the centre that Mr Williams should resign'.

What he calls the 'knee-jerk' reaction of seeking management heads is 'not conducive to good healthcare management', he believes.

Mr Milburn told Parliament that government guidance on the treatment of the dead had not been followed at Bedford.

According to Mr Rawlins, the guidelines refer in general terms to treating patients with dignity.

'If you are to interpret that as bodies not being left on the floor, then it means many other chief executives will have to resign for not meeting the standard.'

In his view, Mr Williams stood down 'because of the photograph', and that is 'not enough of a reason' to lose a chief executive.

Bodies on the floor are 'all over the bloody country', he adds.

The guidance issued in a May circular says that 'temporary mortuary facilities must meet minimum standards and respect patients' dignity'.

Unlike previous years, 'refrigerated vehicles or trailers must not be used'.

North Staffordshire Hospital trust is investigating after it confirmed media reports that it had left 12 corpses on rows of tables in an unrefrigerated and unused boilerhouse between boxing day and new year's eve.

Set up in case of incidents during the millennium celebrations, chief executive of the trust David Fillingham said last week that he did not realise the emergency measure was still in operation.

But could a clamp-down on the use of refrigerated lorries mean that trusts have no choice but to use chapels of rest and other locations?

Eastern regional director Peter Houghton rejects this. 'People have tended to buy purpose-built temporary mortuary facilities.'

According to the regional office, the hospital had recently spent£20,000 buying the purpose-built temporary mortuary facility which was unused when the bodies were left on the floor in the chapel of rest.

'It was functioning perfectly, apart from a problem with the doors.'

What happened in Bedford represents a 'very complex' area in terms of management accountability, admits Mr Houghton.

He is clear that the initial investigation found that guidance on treating patients with respect and dignity had been breached, 'but more importantly, there were no policies in place about what to do if the mortuary had problems'.

It came down to 'a whole series of systems failures and the normal general manager reporting lines were not in place'.

He says that by last Monday, the 'public temperature had been very high' and 'Ken, being an honourable man and an experienced chief executive, had offered to stand down'.

'I acknowledge that the pressure that was building publicly was a real contributor to this.'

But there is also a recognition that the case raises questions about a chief executive's responsibility for setting up lines of accountability. 'It is a very grey area and the whole incident is very regrettable.'