Photo finish

Until something like this happens to you, you do not know how you will react. You could very easily roll into a foetal position and stay in bed but That is not me. I do not think you could survive for 27 years in the NHS if you were that way.'

For many NHS managers the name Ken Williams is a rallying cry. He 'stepped down' from Bedford Hospital trust on Monday 16 January - the day that a photograph of bodies being stored on the floor of the hospital's chapel of rest was published in The Daily Telegraph. The photograph showed the face of one of the dead.

The next day, health secretary Alan Milburn made a statement to the House of Commons, blaming the incident on 'a management problem in the hospital'. He said Mr Williams had done 'the right thing' by stepping down.

From that moment it seemed there was no going back. But support from colleagues across the NHS and staff at Bedford who felt Mr Williams was unfairly scapegoated has ensured that the man with the bodies-in-the-chapel tag remains with the NHS, now working on workforce issues within Eastern region.

Mr Williams is determined to draw a line under the furore which made his name. But he agreed to talk to HSJ about the days surrounding publication of the photograph which brought to an abrupt end a decade leading the trust.

Bedford Hospital, like a number of acute hospitals, particularly in the South, struggles with capacity.

In an attempt to address the problems in the short term, the previous year, the trust had bought a mortuary container to use when the mortuary was full. For about three years it had regularly been hiring a container. But on Monday 8 January the porters were having difficulty using the doors. The trust's works department tried to lubricate them, to no avail.

The next day, Mr Williams believes, hotel services managers tried to contact the company which provided the container. It agreed to send its staff out to the hospital the following day. In the meantime, bodies would be stored in the hospital's chapel of rest. At the time, there was no communication up the chain of command between hotel services and Mr Williams to alert him to the issue.

It was about 11.30am on Friday 12 January when Bedford Hospital trust received its regular call from local weekly The Beds on Sunday. The paper usually waited to see what its rival had published before contacting the trust, Mr Williams recalls.

He was off-site at the time, but was contacted immediately, and informed that the weekly newspaper had a photograph which showed exposed bodies on the floor of the hospital's chapel of rest. Investigations later established that the photograph had been taken on the night of Tuesday 9 January.

'I knew it was a major issue.

There was a debate about whether the photo would actually be used or not. Other people felt the media would not use the photo; I felt that they would. Had the photo not been used I do not think I would have had to leave.

'It says something about the way the media is moving, ' Mr Williams muses. 'Ten years ago it wouldn't have happened. Now we see the dead bodies in Bosnia on the news and so on, which before might have been ruled out on grounds of taste.

'I do not think I realised that it was a moment that would change my career. I knew it was going to be very serious. Everyone was aware of that . . . But of course the picture was terrible. There is no doubt about that.'

Over the weekend Mr Williams made sure that all members of the board were aware of the problem.

He took no action against those involved in the running of services: 'I felt I could not suspend members of staff because everyone acted in good faith.'

The Daily Telegraph used the image of the dead bodies in the chapel on Monday 15 January and the day was spent fielding calls from local and national media, radio, television and press. Mr Williams had plenty to do without thinking about the repercussions for his own career.

'The adrenaline was flowing; I had staff coming into my office to show their support. I addressed the medical staff and their support was overwhelming. Their sense of outrage was such that it gave me enormous help: it made what would normally be a very hard landing a soft one.

'I didn't get emotional about it at all. I was handling a very tricky situation; that was enough to concentrate on. I had a line for the media - and that was simply to apologise. The support kicked in so fast, I never felt alone on it.'

The furore was a media storm, rather than a matter of great public concern, Mr Williams suggests:

'The public response was not what people might have thought it was.

The picture was terrible, but there wasn't really a groundswell of concern. I got a couple of letters from members of the public who said they would rather have been stored in a chapel of rest than in a refrigerated cupboard.'

At the same time rumours about the way the photographs had been executed were beginning to surface. Questions were being asked about how photographers breached hospital security to take the pictures - and about how it was that the face of one body had come to be exposed.

But by Monday afternoon it had become clear that Bedford's chief executive would have to 'step down', at least temporarily. Mr Williams says he cannot confirm reports that the order came from the top. But he does say: 'There was no pressure [to step down] from the trust board and none from the health authority.'

Mr Williams is understandably guarded on the subject of political interference in the operations of the health service. 'To put it in context, this happened in the January when a general election was expected in May. The NHS had had a pretty good winter where everything had gone smoothly - and this [incident] was unhelpful. I think the situation could have done with some breathing space - the statement by the health secretary was made on the Tuesday. It might have been better if statements were not made until all the facts came out.

'I hope that if there was another photo or similar incident the same thing wouldn't happen. I think the health secretary is well aware of the concerns within the service. I think that what happened to me may have done some long-term good in that regard. I hope so.'

'[NHS chief executive] Nigel Crisp has worked hard to build up a much stronger relationship with chief execs so issues like this can be better handled.'

Mr Williams speaks calmly about the incident and the political response to it: 'I do not feel any anger about it at all. At the end of the day I took the decision to work in a political environment where I was the accountable officer, and therefore responsible for anything that went wrong deep in the organisation.'

He is aware that other managers may see him as a scapegoat: 'The reactions I got from other chief execs was, 'there but for the grace of God . . .'' Mr Williams struggles when asked if there is anything he believes he should have done differently. A security report out last month on the incident concluded that the bodies were likely to have been tampered with. On the topic of who was to blame, it was inconclusive. But it pointed out that three permanent night porters employed by the trust have since taken voluntary redundancy. They declined to be interviewed and failed to respond to the inquiry.

Mr Williams says that relations with staff were generally good.He points out that 900 people put together a petition supporting him after he stepped down. But hotel services managers had been in negotiations with staff for some time about reducing the number of night porters and retraining staff in security. 'I knew that this particular group of night porters were concerned about their position.

'My antennae had picked up that they were feeling upset and perhaps I should have been personally involved. But I would not normally intervene in a matter like this because I had complete confidence in the management of the service.'

If there is one lesson, he says, it is to realise the importance of incident-reporting: 'The difficulty is knowing where to draw the line though.Chief execs are bombarded - we have got to delegate otherwise we are not going to be able to do the job we are employed to do.'

While he can hardly applaud the way his career at Bedford was terminated, Mr Williams, aged 58, is remarkably sanguine on the topic: 'I think perhaps 10 years at a trust is enough, and there is a time when you need fresh blood. I never felt I was getting tired but I think perhaps you get to a point where you do.'

He is enthusiastic on the topic of his current role, as chief executive of the recently created Eastern region (west) workforce confederation.

'I have got a meaningful, exciting and demanding job in an interesting area - one of 24 chief execs - and we are right at the centre of what is going on now. It is central to the delivery of the modernisation agenda.'

'One thing I did feel - and still do - is that there is not a job which is more exciting and demanding than NHS management. It is amazingly complex and very challenging and exciting. I do still feel positive about the health service.'

But Mr Williams admits that sometimes he misses the atmosphere of a busy district general hospital: 'Starting up a new organisation is exciting. But it is very different. It is not like walking into a hospital and seeing the staff coming on and off duty where you get a real buzz. You walk in and there is no-one there and you make your own coffee.