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Concerns surrounding after-death care emerged following the distressing experience of Harriet Hawkins’ parents, whose baby was stillborn at NUH in 2016. They discovered that Harriet’s body had deteriorated so severely that it had to be placed in three separate bags for her funeral. This revelation led to an investigation which identified 17 areas of concern and triggered a wider independent maternity review focusing on the after-death care of 16 other babies and one mother.
The review uncovered serious issues, including the disposal of one early gestation baby as clinical waste, the incorrect baby being handed over to funeral directors, and a mother who had passed away deteriorating to the extent that her family was advised against viewing her before the funeral. In her report, Ockenden highlighted these profound failures, stating, “The Review found evidence of recurring examples of failure to protect the dignity of the deceased… including inadequate arrangements for undertaking paediatric post-mortems.”
Following these findings, the Human Tissue Authority (HTA), which oversees mortuary services across England, Wales, and Northern Ireland, conducted an unannounced inspection of the trust’s services in March 2026. The report, published recently, revealed serious breaches of standards at the two hospitals managed by the trust: Queen’s Medical Centre (QMC) and City Hospital. Specifically, the HTA identified three critical, six major, and one minor shortfalls.
One notable problem cited by the HTA was the insufficient freezer capacity at both hospitals, leading to some bodies being stored in refrigerated areas instead. As a result, eight bodies exhibited “advanced deterioration” due to delayed transfer to freezers. The inspection also found that certain baby post-mortem examinations took place in inadequately ventilated laboratory spaces rather than designated post-mortem suites, with staff lacking proper mortuary care training. Additionally, an audit revealed that over half of the 145 incidents that should have been reported to the regulator had not been escalated accordingly
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