SOAP BOX: THE NHS CRISIS

As the NHS crisis deepened in early January 2018 and Theresa May and Jeremy Hunt tried to respond to the headlines concerning around 55,000* delays in non-urgent hospital operations, where at least 12* NHS England’s Trusts were reported to be at 100 percent capacity, and the queues and waiting times at A and E were getting longer, it was no surprise to our colleagues within the funeral sector that the anxiety at the ‘rear’ of these hospitals had become equally as great as that of those at the front end. For we were being confronted with a third year of further depletion in the overall underlying body storage capacity for the deceased in the NHS across the whole of the UK. It would seem that, despite the previous requests from the National Audit Office, all the way back to 2002, (ref Facing the Challenge: NHS Emergency Planning) for all England’s Trusts to be prepared for the occasional ‘pandemic, local or regional disaster’ – yet again – for this winter and the Christmas holiday period, across the land NHS Trusts had not resourced adequate body storage facilities. For yet another year, funeral directors were being asked to increase their temporary body storage holding facilities to cope with the NHS’s inability to forecast this annual winter shutdown. This repeated failure by the NHS nationwide to recognise this requirement for mortuaries to hold the deceased for providers, burial and cremation services Christmas holiday closures seems unfathomable. Nationwide clamouring for temporary body storage facilities up and down the country, fridge manufacturers and temporary mortuary equipment providers were being inundated with requests from both hospitals and funeral directors to meet the annual chaos caused by the Christmas shut down on burial and cremations - added to a marginal (but within predictable limits) increase in the death rate. This is before any increase in the mortality rate that was fed through because of the ‘Australian Flu’ threatened pandemic. Problems arising Public Health England (PHE) reported, on the 1 February, that in week four of 2018 there were 757 influenza admissions in hospitals across English NHS. This makes a total of 4,618 cases hospitalised, for the period overall, with 193 known deaths so far being directly attributable to influenza. The same PHE National Weekly Influenza Report of 1 February stated that from week 40 2017 - week 4 four 2018 a ‘statistically significant excess in all-cause mortality by week, in the 65+ year olds in England’ and a ‘statistically significant excess in all-cause mortality for all ages in 4 2018, but not in Wales.’ Where has all the compassion gone? During this ‘medium increase in death rate’, the usual seasonal story played out. Where funeral directors had been appointed by families, they were being forced, in a number of cases, to take the deceased as soon as they were cleared with certification and paperwork by NHS mortuaries. Some families were even being called by hospitals to ensure that they had appointed a funeral director, or to let the family know that their loved one is ‘awaiting the funeral director’. Offers of hospital viewing by the next of kin became even rarer last year; the dealing with the expectations of the bereaved to see their departed loved ones at rest became a logistical nightmare focussed solely on the funeral director’s ability to juggle their resources to compensate for the NHS shortfall in their own resources and compassion. With increased demands for viewings at a time where the deceased could be in funeral director’s care for three to four weeks awaiting a burial or cremation service, funeral directors became the ‘squeezed’ professional provider of empathy and understanding to families, while families had a prolonged, enforced wait for the burial or committal service to offer some closure of grief. “This repeated failure by the NHS nationwide to recognise this requirement for mortuaries to hold the deceased for providers, burial and cremation services Christmas holiday closures seems unfathomable.” How has this come about? How has this annual rush in January and February to clear NHS mortuaries of the dearly departed come about? You could obviously blame lack of investment in NHS mortuaries, but probably, on paper, it does not look that less monies have been spent in these ‘back of house’ areas. The issue is that there are fewer local mortuaries but larger centralised ones, due to coroner, fiscal, as well as NHS mortuary consolidation into specialised Pathology Department facilities serving larger geographical areas. For the recently deceased, NHS care, just as for the living, is now down to the NHS accountants who have decided the dead need to be moved as soon as possible out of a ‘service delivery on-cost’ column and back into the community. This sounds quite familiar to the front of house issues, in that you have queues of ambulances at the front holding the living patients from bed blocking through A & E, and queues of funeral directors at the rear, summoned to empty the mortuary of the recently deceased: all this due to centralised planning initiatives which displace people - living and deceased - from their local community and families, whether they are unwell, at the point of death, or recently passed away. It’s not all down to the NHS In truth, a number of factors have given us this unpleasant annual ‘rush to find storage space for the deceased’. The following are just some: The regulatory changes in Scotland, which have shortened the certification of death time period and verification requirements. The move towards fewer post-mortem requirements and body scanning post-mortems as opposed to full surgical post-mortems. The outsourcing of NHS mortuary management, portering and body storage facilities. This in itself is not a bad thing, but ‘a service driven by the contracted goal of moving and storing remains profitably rather than as a person interested primarily in the care of that deceased and their loved ones’, has some conflict with the primary concerns of the family at this time and the role of the family funeral director. The centralising of coroner and fiscal, as well as NHS body storage facilities into centralised mortuary sites has led to the closure and the loss of innumerable community and, in some cases, better geographically placed mortuary facilities. This has also led to a loss in overall permanent body storage capacity at peak-times. The medical and death certification, as well as the cremation and burial services resource providers in many areas of the UK, have not kept pace with the obvious public requirement, through natural grief, to have a timeous closure, from date of death to date of funeral. Up to 14 days for most grieving families is a limit that we should all be aiming for, or replace with a shorter date wherever possible and if the family require this. All these factors stem from a lack of local community health and welfare planning, and it is time to take stock, in the season of the epiphany, that celebrates the family, and declare that we will not put the family of the recently bereaved through another ‘bitter winter of discontent’, whereby they have no guarantee of having a funeral date within a timescale that suits their needs. In this vein, we also need guarantees that funeral directors will not have to bring in temporary or permanent storage to supplement the lack of state funding and/or demographical planning in the design and running of hospital mortuaries. About David David Middlemiss has worked in the funeral sector for 30 years and has written a number of funeral focussed handbooks, training packages and served on numerous funeral sector, national and international Government and pan European infection control, embalming and pandemic body handling and storage initiatives.

SOAP BOX: THE NHS CRISIS

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