Board oversight of licensed mortuary activity

Today I am updating the House on the response to those recommendations. The Trust published an assurance statement in February 2024 on the implementation of the recommendations from the Phase 1 report. This sets out the progress made to implement the Inquiry’s recommendations.

The range of actions taken by the Trust include requiring that non-mortuary staff and contractors are always accompanied by another staff member when visiting the mortuaries; controlling access to mortuaries using swipe cards; mandating contractors to renew security clearances every three years; and installing CCTV coverage monitoring access to and from mortuary areas. The Trust Board is also providing greater oversight and assurance of legally regulated activity in the mortuary.

I am also reassured that NHS England’s South East regional team held monthly oversight meetings with the Trust between November 2023 and April 2024 (in partnership with Kent and Medway Integrated Care Board) to ensure progress against the Inquiry’s recommendations and to review evidence of the Trust’s progress in delivering their action plan. Ongoing compliance with the Inquiry's recommendations will be monitored by NHS England through regular regional oversight meetings with the Trust, and through other channels as appropriate.

The Trust now complies with this recommendation in full on the following basis:

• The Trust Board has received regular updates on the mortuary and HTA activity since the Police informed the Trust of the mortuary-related crimes of David Fuller in December 2020.

• The Trust Board received the first “Monthly update on the implementation of the recommendations from the Phase 1 report of the Independent Inquiry into the issues raised by the David Fuller case” report at its meeting in December 2023, and will continue to receive a “Six monthly update on mortuary issues” report for the foreseeable future. These reports will commence in May 2024. The report will be presented jointly by the Chief Operating Officer (who has the executive responsibility for the mortuary service), the Chief Nurse (who is responsible for assuring the Trust Board that mortuary management is delivered in such a way that it protects the security and dignity of the deceased - see recommendation 16 below), the HTA DI and the Head of Service for the Care After Death Directorate. That report will also be considered by the Executive Team, and the Quality Committee, before being submitted to the Trust Board.

• It is proposed that ongoing compliance with the recommendations of the Independent Inquiry (not just those relating to the mortuary) is reviewed annually and reported to the Board. The first annual review, in 2025, should be undertaken as part of the internal audit programme and thereafter by the End of Life Committee.

• HTA inspection reports are received by the Board and Quality Committee. The End of Life Committee (which reports to the Quality Committee) proactively looks at Mortuary and HTA issues.

• The Trust’s HTA DI has several routes to reporting to the Trust Board:

o Via their line management structure through the Core Clinical Services Division. The HTA DI is also the Clinical Director for the Care After Death Directorate, and they have direct access to the Chief of Service for the Core Clinical Services Division, who is a member of the ETM (which is chaired by the Chief Operating Officer).

o The DI will contribute to the “Care After Death (Security and Dignity of deceased patients)” workstream that has been established under the End of Life Care Steering Committee (which is chaired by the Chief Nurse) (see Recommendation 16).

o The DI has direct access to the Trust’s Chief Executive, who is the official representative for the Trust’s HTA Corporate Licence, so they can escalate any matters they wish to via that route.

No statement on delivery from Maidstone and Tunbridge Wells NHS Trust has been found in the sources searched. This is separate from the response above.