HM Inspector of Anatomy for Scotland: annual report 2021 to 2022

Inspections

4. Due to the COVID-19 pandemic, no inspections were carried out from the submission of the report in October 2019 until April/May 2021 when reduced inspections of licensed premises were undertaken. All however, were asked to make amendments to their report from 2018-19 and it is a summary of these that is reported here. Information was received from:

• University of Aberdeen
• Dundee:
  • Centre of Anatomy and Human Identification (CAHID), University of Dundee
  • Dundee Institute for Healthcare Simulation Surgical Skills Centre (DIHS), Ninewells Hospital
  • Institute for Medical Science and Technology (IMSaT), Ninewells Hospital
  • ENT Temporal Bone Laboratory, Ninewells Hospital
• University of Edinburgh
• Royal College of Surgeons of Edinburgh
• University of Glasgow
• Royal College of Physicians and Surgeons of Glasgow
• University of St Andrews

Aberdeen

5. Head of Anatomy: Professor Simon Parson, Regius Professor of Anatomy, University of Aberdeen.

6. There are three licensed teachers, all academic staff with no technical staff licensed. A recommendation was made that the chief technician be considered for a license.

Action point from 2018 -2019 inspection: suggest that the principal technician should be considered for a personal licence.

Action taken: As of 31^st March 2022, this has yet to be actioned.

Licensed Areas:

7. No change since 2018 – 2019 inspection. Licence renewal date - 17^th May 2028.

Access to Licensed Areas:

8. During 2018 – 2019 inspection, all internal doors were either propped open or unlocked.

Action point from 2018 – 2019 inspection: all internal doors, with the exception of doors leading into the teaching space, should be closed and where necessary, locked to restrict access to only those requiring entry.

Action taken: This practice has now ceased. Access through all internal doors is by swipe card; access to teaching space is unlocked when in use but locked at all other times.

Record Keeping:

9. All records are kept locally in a fireproof cabinet and offsite on a server. However, during the 2018 – 2019 inspection, when a check was made of the record keeping system for the tracking of bodies/body parts as they were moved around the department, found it to be complicated and difficult to use.

Action point from 2018 – 2019 inspection: to consider a simpler and more user-friendly record keeping system.

Action taken: as of 31^st March 2022 a new electronic record keeping system is being developed.

Code of Practice/Signed Agreements

10. Under normal circumstances, a signed Code of Practice is required before access is granted to a licensed area. The same Code of Practice is given to everyone whether they be students or surgeons. Additionally all students are given a talk and receive a booklet at the start of the year about their responsibilities and behaviour when working with cadavers. These activities were carried out online with extra emphasis on the imaging code of conduct. Students have 'signed' electronically, and securely to allow monitoring.

Bequest Information (as at 31^st March 2021)

• Bequest forms requested: 245
• Bequest forms returned: 157
• Bequests accepted: 40
• Bequests rejected: 16
• Redirected bequests accepted: 2 (Dundee)
• Total number of bequests on file: 2600

No defined limits on body size for rejection of a bequest. Will accept a BMI > 30 due to requirements from clinicians for bodies to reflect all sizes in the population.

Bodies Currently Held in Licensed Areas (as at 31^st March 2021)

• Un-dissected embalmed: 11
• Dissected embalmed: 39
• Number of fresh/ frozen: 15
• Total: 65

University Courses Using Anatomy Facilities (as at 31^st March 2021)

• Medicine
• Dentistry
• Sports Science
• Archaeology
• BSc Courses Medical Humanities
• G2M (Gateway to medicine)

External Courses Using Anatomy Facilities

11. Eight external courses were run, varying from emergency thoracotomy, through plastic surgical flap raising to white matter tract tracing. Facilities were also provided for a colorectal surgeon to rehearse surgeries and for several consultants to train their own trainees using prosecutions.

12. Anyone requesting to run a course has to complete a course proposal form for consideration by Head of Anatomy.

13. The majority of external courses are carried out in the Suttie Centre although there is an increasing demand for bodies to be relocated to other clinical spaces in the Foresterhill Hospital or other University of Aberdeen campus sites. At all times, bodies/material is either accompanied by a licensed teacher or the licensed teacher is onsite (Suttie Centre) and remains contactable by phone for the time that the material is outside the licensed area. All material is returned to the Suttie Centre on the day of use i.e. no bodies/material is ever stored off site.

14. There is a Standard Operating Procedure with the NHS for the transport of material to and from the Suttie Centre and its use for research. SOPs are also in place for transport to pre-clinical (research) scanning sites at Foresterhill and Old Aberdeen campuses.

15. One course - plastic surgery - used 11 imported upper limbs from the USA due to the lack of availability locally. These were subsequently held and then cremated as per the Centre's procedures.

Dundee

Centre of Anatomy and Human Identification (CAHID), University of Dundee

16. Head of Anatomy and Director of the Centre: Professor Tracey Wilkinson.

17. There are 7 licensed teachers this being made up of both academic and technical staff.

Licensed Areas:

18. A premises licence was available for inspection as was a map of the licensed areas within the department. At the 2018 – 2019 inspection, a new proposed teaching area was viewed and it was agreed that this area could now be licensed.

Action point from 2018 – 2019 inspection: to apply for an extension to the licensed area to include the new teaching space.

Action taken: extension to licensed area applied for and duly granted.

Records/Paperwork

19. Records and copies of all paperwork, are kept in a fireproof cabinet and offsite on a remote server. All information is stored on a readily accessible spreadsheet which is updated as bodies/body parts are moved around the department.

20. CAHID receives all bodies for embalming which are then distributed to other licensed sites (see below) as required. All bodies are embalmed using the Thiel method; there are no frozen bodies on site.

21. Information sent to potential donors:

Action Point from 2018 – 2019 Inspection: In addition to the information presently sent out and online, it was agreed that all information sent to potential donors should include a statement to the effect that occasionally non-anatomy/ healthcare professionals may have access to bodies for teaching and learning.

Action taken: This is now included in the information notes sent to donors.

Codes of Practice/Signed Agreements

22. There are three different Codes of Practice which have to be signed by:

• all students before being allowed access to the dissecting room
• all those attending external courses
• all tour groups (art students, etc.) before being allowed access, under escort, to licensed areas.

23. These have been updated with information about the new protocols that have been introduced due to the COVID-19 pandemic.

Bequest Information (as at 31^st March 2021)

• Bequest forms requested: 451
• Bequest forms returned: 250
• Bequests accepted: 76
• Bequests rejected: 22
• Bequests redirected: 7
• Redirected bequests accepted: 6

University Course Using Anatomy Facilities (as at 31^st March 2021)

• Medicine – years 1-3
• Dentistry – years 1-3
• BSc and MSc Anatomy, Forensic Anthropology, Forensic Art and Medical Art
• BEng/MEng Biomedical Engineering
• BSc Medical Imaging

External Courses Using Anatomy Facilities (as at 31^st March 2021)

24. Thirty-six courses made use of CAHID facilities. Two courses in March were cancelled due to low numbers. Due to the COVID-19 pandemic, no courses took place between March and September 2020.

Bodies Currently Held by CAHID and their Location

• BSc/MSc Teaching (Dissecting Room): 24
• Medical/Dental Teaching (Dissecting Room): 20
• Mortuary Embalming Tanks: 25
• Mortuary Immersion Tank: 0
• Mortuary General: 7
• Tank Room Racking: 33
• Side Room Racking: 0
• DIHS: 9*
• IMSaT: 5*
• Angela Ruskin: 5*
• RCSEd: 3*
• Total: 131

* These bodies off site

25. All bodies are Thiel embalmed; there are no fresh frozen cadavers or parts on site. All bodies are tagged in 6 places. Whiteboards are marked up to correspond to body locations on racks.

COVID-19 Health and Safety

26. CAHID laboratory and teaching spaces are required to follow new Government and University COVID-19 guidelines in order for face-to-face teaching to be carried out. There is a one-way system in place through the Centre. Additionally, the Anatomy Museum is used as a PPE room for all students entering the dissecting room, where they acquire disposable facemasks and gloves. In all dissection classes students are required to wear lab coats, gloves, disposable facemasks and safety glasses. The laboratory space layouts and person limits have been adjusted to allow for physical distancing during all face-to-face sessions. The student code of conduct has been edited to reflect the changes in access, movement, and PPE required by the pandemic, and they have updated or produced new Health and Safety documentation as required to facilitate face-to-face teaching and activities.

Further Points Arising from 2018 – 2019 Inspection of CAHID

27. The question was raised as to what to do with historical, plastinated specimens, which at some point in the past had been mislabelled. As they cannot be cremated, it was suggested that they could possibly be disposed of by burial. It was also pointed out that in future, all historical, non-plastinated remains after the 4th April could be disposed of by cremation using Form A7.

Action taken: This process was delayed by COVID-19 but is currently in progress.

28. Use of images. As elsewhere, a question was asked about what images could be taken and recorded and how they can be used. It was suggested that this was an issue that could be put to the next meeting of the Scottish Anatomists for discussion.

Action taken: This meeting subsequently took place and guidelines on imaging were issued.

29. Clinical Research Imaging Centre (CRIF). This is a facility to which bodies are taken from time to time for CT scanning. The query was raised as to the procedure to be followed in the unlikely event of a radiation leak when a body was being scanned and patients were present in an adjacent area (normally when a body is being scanned, the public are not present). It was decided that it would be best practice for the body to be removed from the area as soon as possible and returned to CAHID rather than leave it in an unlicensed area for an indefinite period. The Inspector is to put this recommendation in writing to CAHID.

Action taken: This has now been sent.

30. Body size simulation/ blood clot simulation. In order to simulate obese individuals, the query was raised as to whether it was acceptable to transplant human fat from one body to another. Although the legislation allows this to be done, the problem arises as to how to separate the transplanted fat from the fat of the cadaver. Likewise, the use of simulated blood clots using synthetic material was also raised. It was acknowledged that at no time could animal material be used in these simulations.

Action taken: a solution for this issue has subsequently been found: a synthetic clot that is successfully being used as a model.

Dundee Institute for Healthcare Simulation Surgical Skills Centre (DIHS), Ninewells Hospital

31. There are 2 personal licence holders responsible for this area.

Licensed Areas

32. Access to the skills centre is controlled by a buzzer system to reception, otherwise access is restricted to staff only.

33. There are 2 licensed areas, the Anatomy Lab and Wet Lab 1 the latter which can be partitioned into two separate working areas. Both of these areas are accessed by key entry; key holders for the Anatomy Lab are the Senior Technician and the Senior Technical Assistant only whereas Wet Lab 1 can be accessed by all technical and centre staff.

34. There is now an additional lab, Wet Lab 2 which now requires to be licensed. At present there is a locked door from the lab for which no key can be located. Although a sign on the door says that the door is alarmed, it is not.

Action point from 2018 – 2019 inspection: Before a licence could be issued for this area, a lock change is required with key access restricted to the personal licence holders. Additionally, as it opens into a public area, an audible alarm is required to be fitted to indicate when the door is open.

Action Taken: As of 31 March 2022, this had been put on hold. The room continues to be used as a dry lab only with no stored human material.

35. Premises Licence expiry date - 5th September 2022. This has been renewed.

Bodies Currently Held in DIHS

36. All bodies/body parts held in the Skills Centre are controlled by CAHID. The Skills Centre has the capacity to store 12 bodies. Bodies are usually stored at CAHID, and transported to the Skills Centre when needed, where they may be kept for short periods. All body movements between CAHID and the Skills Centre are tracked on the CAHID database.

Courses Run at DIHS

37. A comprehensive list of all courses run in the Skills Centre plus cadavers used, etc. is available for inspection.

38. Thirty-seven courses are run at DIHS.

Institute for Medical Sciences and Technology (IMSaT), Ninewells Hospital

39. There are 2 personal licence holders responsible for this area which has just one licensed space.

Bodies Currently Held in IMSaT

40. There are currently 5 bodies on site which are used as and when required for research projects. Since the 2018 – 2019 inspection, there have been no NHS patient sessions hosted at IMSaT. During 2021, there were plans to renovate IGTRF (Image Guided Therapy Research Facility) with the removal of the MRI equipment. This will end any possibility of this area being used for NHS patient scanning and associated security/public contact issues. The area will be devoted entirely to medical device testing, training in image guided medical interventions and associated research activities. As of 31^st March, 2022 this has still not occurred.

ENT Temporal Bone Lab, Ninewells Hospital

41. Three named licence holders responsible for this single licensed area.

42. Access to the space is via an office which connects to a main outside corridor. At the time of the 2018 – 2019 inspection there was no door between the bone lab and the adjacent office where temporal bones were stored which allowed, potentially, unrestricted access to the licensed space. Consequently it was requested that all the temporal bones should be removed from the area and relocated temporarily to CAHID until a secure door was fitted between the office and the bone lab which was done.

Action point from 2018 – 2019 inspection: Before further work is undertaken in the lab, a physical barrier needs to be in place between the adjacent office and the bone lab. Once this is in place, the inspector should be informed of this and a further inspection of the area carried out.

Action taken: a door has been installed since the 2019 inspection – this has been viewed and approved by HMIAS.

43. All material held in the bone lab is under the control of CAHID and is recorded on their database.

Edinburgh

44. Head of Anatomy: Professor Tom Gillingwater

45. There are 7 personal licence holders, 5 of which are academic staff and 2 technical staff member.

Licensed Areas

46. No change from 2018 – 2019 inspection.

47. Premises Licence expiry date - 10 October, 2022. This has been renewed.

Public Display Licence

48. A Public Display Licence was requested and duly granted for the running of anatomy workshops for the public in 2019. Workshops were put on hold for 2020, but hope to resume in 2021 or 2022 (depending on the COVID-19 situation). As of the 31^st March, 2022, these have yet to restart.

Record Keeping

49. A comprehensive record keeping system is in place; this is held both as a paper copy and backed up on a university server to which only Iain Campbell and Laura Sheils has access. As the paper copy was only stored in a filing cabinet it was recommended that these be stored in a fireproof cabinet.

Action point from 2018 – 2019 inspection: It is suggested that all confidential files are kept in a fireproof cabinet and not just in an ordinary filing cabinet as is the case at present.

Action taken: all confidential files are now locked in a fireproof cabinet.

Bequest Information (as at 31^st March 2021)

• Bequest forms requested: 415
• Bequest forms returned: 261
• Bequests accepted: 35
• Bequests rejected: 80*
• Bequests redirected:
  • 5 (Dundee)
  • 8 (Glasgow)
  • 4 (St Andrews)
  • 1 (Aberdeen)
• Redirected bequests accepted: 0

*Although this is a high number of rejections, a comprehensive list of all bodies rejected and why can be provided.

Additionally 2 bodies were declined due to the lack of completion of a bequest form plus a further 13 had their bequest withdrawn for a variety of reasons.

Bodies Currently Held in the Department (as at 31^st March 2021)

• Embalmed: 25 (15 male, 10 female)
• Frozen: 47 (22 male, 25 female)
• Total: 72
• Oldest body: no. 1801, received 19th January 2018 (frozen female)

At present, are 561 retained parts, 41 of which are plastinated the remaining 520 being embalmed. There are currently no frozen retained parts.

University Course Using Anatomy Facilities (as at 31^st March 2021)

50. Nine university courses plus 5 public workshops have used the anatomy facilities organised by the anatomy department itself.

External Courses Using Anatomy Facilities (as at 31^st March 2021)

51. A wide range of non-university courses (16 in total) used the anatomy facilities ranging from prosthetic joint manufacturers (Acumed) to student run courses (student anatomy society).

52. A licensed teacher is present at all times when courses are run in the teaching lab.

53. Bodies and body parts are transferred between the anatomy department and the College of Surgeons of Edinburgh for courses run by the College. A tracking system is in place to monitor the movement of specimens between the two establishments.

Museum

54. From April 2019 to March 2020 there were approximately 8,000 public/ external visitors to the museum. From March 2020 – until the 31^st March 2021, the museum was shut to the public due to COVID-19. This is till the situation as of the 31^st March 2022.

Further Points Arising From 2018 – 2019 Inspection

55. A walk around the department found the receiving room was in need of upgrading. It was lagging well behind the standard of that found in other Scottish medical schools all of which have been substantially upgraded in recent years. To meet the increasing demand for new courses and other anatomy related activities, it was recommended that consideration should be given to upgrading the facilities at Edinburgh.

Action Taken: a formal request had been submitted for the receiving and embalming facilities to be upgraded. This has been delayed by the COVID-19 pandemic and was still not complete as of 31^st March, 2022.

Royal College of Surgeons of Edinburgh

56. Lab Manager: Lynsey Forbes

57. There are 3 personal licence holders at present. All licences were made available for inspection.

58. Since the 2018 – 2019 inspection, one licence holder has left.

Access to Licensed Areas

59. Since the 2018 – 2019 inspection, there has been a major upgrading to the security system with a corresponding updating of access to licensed areas. A new Paxton networked access control system has been installed throughout the Skills Centre. This has replaced the card entry system that was previously in place. A floor plan showing all the doors secured using the system was provided. The new system allows real-time monitoring and control of who has access to different areas and can be used to restrict access to a specific timeframe. A comprehensive table showing all groups, group members and what access each group had was also made available for inspection.

60. A very clear outline of how the system was used and who had access to it was provided by the lab manager. I am very happy with the new system which is a significant upgrade to what was in place previously.

Record Keeping/Signed Agreements

61. Code of Conduct: a copy of the Code of Conduct for those participating in College examinations must be signed and returned to the Skills Centre Manager before anyone is permitted to enter the Skills Centre.

62. Course attendees and faculty members are issued with a Health & Safety form, which must be read and signed at the beginning of the course. This form includes information and guidance on working with cadaveric material.

63. Bodies are received from the University of Edinburgh, the University of Dundee, the National Repository, Nottingham and from *Science Care, USA. In all cases there is a clearly defined checking process with corresponding documentation which I am satisfied meets the requirements of the Anatomy Act 1984 as amended by the Human Tissue (Scotland) Act 2006.

* Arrangements are made for body parts from Science Care to be cremated at a local Crematorium, in accordance with the relevant regulations. Copies of all required paperwork are retained, and the original documents are sent by recorded delivery to the crematorium in advance of the scheduled cremation. Afterwards the crematorium provides a certificate of cremation to confirm final disposition of the cadaveric specimens.

Courses Run in the College using Cadaveric Material

64. Between 1^st April 2019 and 31^st March 2020, a total of 18 courses were run in the Skills Centre using cadaveric material.

65. Material for these courses and events came from:

• Edinburgh Anatomy Department (17)
• Dundee (Centre for Anatomy and Human Identification) (2)
• National Repository, Nottingham (1)
• Science Care, USA (1)

N.B. Several courses required specimens from more than one source institution.

66. The issues previously raised regarding the use of formaldehyde when embalmed cadaver material is being used in the lab, the concerns about the adequacy of the ventilation system, and appropriate changes to processes in order to mitigate the problems are currently being investigated by the Skills Centre team.

67. Since the last inspection there have been several staff changes but I am happy to say that the staffing situation is now very satisfactory.

Glasgow

68. Head of Anatomy: Position currently vacant.

69. Professor Simon Guild, Head of the School of Life Sciences, is standing in as temporary Head of Anatomy until a new appointment has been made.

70. There are 3 personal licence holders all academic.

Licensed Areas

71. No change since 2018 – 2019 inspection.

72. Premises licence expiry date: 13^th November 2027

Access to Licensed Areas

73. At the moment, the public has access to the anatomy museum which puts limitations on how the licensed space can be used. As a consequence plans are in place to restrict public access by extending the licensed area to include the corridors around the museum. Once appropriate security measures are in place a new premises licence will be required.

Action point from 2018 – 2019 inspection: There are no intruder alarms fitted anywhere in the licensed areas. This needs to be addressed with some urgency.

Action taken: work is underway with Estates and Buildings at the University of Glasgow to design an intruder alarm to the specifications requested by HMIAS. Preliminary works for the installation started just as lockdown came in to effect and works had to be put on hold. As of 31^st March 2022, this is now completed.

Record Keeping/Signed Agreements

74. A comprehensive record keeping system is in place with all records being kept both locally in a fireproof cabinet and on a server. Additionally they have in place a printed and bound standard operating procedure for the handling of cadavers from the receipt of a body into the department until its final disposal by cremation. This is an excellent document and one which should be considered being put in place by other anatomy departments.

75. Code of Conduct: a copy of 'Rules and Regulations' is given out in advance to all those attending courses using cadaver material. This must be signed and returned before access to the teaching lab is granted. These forms are then scanned and saved on a database.

Bequest Information (as at 31^st March 2021)

• Bequest forms requested: ~600
• Bequest forms returned: 359
• Bequests accepted: 96
• Bequests rejected: 78 (various reasons, no one particular reason)
• Bequests redirected: 1 (Dundee)
• Redirected bequests accepted: 11 Total: 8 bequests accepted from Edinburgh and 3 bequests accepted from Dundee.

Bodies Currently Held in Department (as at 31^st March 2021)

• Embalmed: 54
• Fresh/frozen: 47
• Total: 101

Internal/External Courses using Anatomy Facilities (as at 31^st March 2021)

76. There are 32 internal and 34 external courses using anatomy facilities. A comprehensive list of all these courses was available for inspection.

Royal College of Physicians and Surgeons of Glasgow

77. Director of Clinical Skills: Mr Ian Colquhoun

78. There are 3 licensed teachers: 2 academic and 1 technical member of staff.

Licensed Areas:

79. No change since 2018 – 2019 inspection.

80. Premises Licence expiry date – 4^th February 2028.

Record Keeping/Signed Agreements

81. All requests for cadaveric material from the Anatomy Department, University of Glasgow are emailed to a licensed teacher who then logs the specimens out of the department and logs them back in on their return.

82. Code of Conduct: A Code of Conduct and information sheet is given to all those attending courses in the College which is signed and returned to the licensed teacher.

83. No bodies on site.

St Andrews

84. Head of Anatomy: Dr Enis Cezayirli

85. There are 3 licensed teachers all academic staff members.

Licensed Areas

86. No change since 2018 – 2019 inspection.

Record Keeping/Signed Agreements

87. A user friendly, computer based record keeping system is in place which is first class in its operation. Access to the system is by licensed teachers, the bequest co-ordinator and IT staff who maintain the system.

88. Code of Practice: A copy of the Code of Practice is given to all attending courses in the licensed space which must be signed and returned before access is granted.

• Bequest Information (as at 31^st March 2021)
• Bequest forms requested: 81
• Bequest forms returned: 23
• Bequests accepted: 32
• Bequests rejected*: 13
• Bequests redirected: 0

Redirected requests accepted: 7 (4 from Edinburgh, 1 from Glasgow, 2 from Dundee)

*A copy of reasons for rejection was received.

Bodies Currently Held in Department (as at 31st March 2021)

• Embalmed: 20
• Fresh/frozen: 0

Internal/External Courses Using Anatomy Facilities (as at 31st March 2021)

89. These are used for 5 university organised courses and 5 externally run courses.

Other Points Arising from 2018 – 2019 Inspection Requiring Action

90. During a discussion about the use of personal devices in the dissecting room, it was mentioned that students were allowed to take these into the dissecting room so long as the camera on the device was taped over. Although this should prevent inappropriate images being taken it does not guarantee that this might not happen.

Action point: If students require access to an electronic device for instruction/ information for use in the dissecting room then I suggest that the school provides the means for doing this as happens elsewhere e.g. tablets with the camera disabled etc.

Action taken: It was decided not to allow students to enter the dissecting room with their laptops or tablets during private study. However because of the Scottish Government's recommendation of the use of Protect Scotland app, and after consultation with HMIAS, it was decided that students could have their mobile phones on themselves but were reminded once again not to take them out at any time.