Inquiries · Recommendations

Recommendations: Fuller Inquiry

1,814 tracked recommendations 35 inquiries 92 match current filters Page 1 of 2

Recommendations issued by UK statutory and non-statutory inquiries, with their tracked government response and supporting evidence.

Recommendations

92 of 1,814 · page 1 of 2

Code	Recommendation	Inquiry	Response
P1-1	Non-mortuary staff accompanied in mortuary Maidstone and Tunbridge Wells NHS Trust must ensure that non-mortuary staff and contractors, including maintenance staff employed by the Trust's external facilities …	Fuller Inquiry (2023)	Accepted
P1-2	No deceased left out of fridges overnight Maidstone and Tunbridge Wells NHS Trust must assure itself that all regulatory requirements and standards relating to the mortuary are met and …	Fuller Inquiry (2023)	Accepted
P1-3	Criminal record checks compliance Maidstone and Tunbridge Wells NHS Trust must assure itself that it is compliant with its own current policy on criminal record checks …	Fuller Inquiry (2023)	Accepted
P1-4	Mortuary Managers qualified and supported Maidstone and Tunbridge Wells NHS Trust must assure itself that its Mortuary Managers are suitably qualified and have relevant anatomical pathology technologist …	Fuller Inquiry (2023)	Accepted
P1-5	Mortuary Manager as full-time dedicated role The role of Mortuary Manager at Maidstone and Tunbridge Wells NHS Trust should be protected as a full-time dedicated role, in recognition …	Fuller Inquiry (2023)	Accepted
P1-6	Review policies on mortuary access Maidstone and Tunbridge Wells NHS Trust must review its policies to ensure that only those with appropriate and legitimate access can enter …	Fuller Inquiry (2023)	Accepted
P1-7	Audit and monitor mortuary access Maidstone and Tunbridge Wells NHS Trust must audit implementation of any resulting new policy and must regularly monitor access to restricted areas, …	Fuller Inquiry (2023)	Accepted
P1-8	Security as corporate responsibility Maidstone and Tunbridge Wells NHS Trust should treat security as a corporate not a local departmental responsibility.	Fuller Inquiry (2023)	Accepted
P1-9	CCTV in mortuary including post-mortem room Maidstone and Tunbridge Wells NHS Trust must install CCTV cameras in the mortuary, including the post-mortem room, to monitor the security of …	Fuller Inquiry (2023)	Accepted
P1-10	Regular CCTV review with swipe card data Maidstone and Tunbridge Wells NHS Trust must ensure that footage from the CCTV is reviewed on a regular basis by appropriately trained …	Fuller Inquiry (2023)	Accepted
P1-11	Share HTA reports with reliant organisations Maidstone and Tunbridge Wells NHS Trust must proactively share Human Tissue Authority reports with organisations that rely on Human Tissue Authority licensing …	Fuller Inquiry (2023)	Accepted
P1-12	Local authorities examine contractual arrangements Kent County Council and East Sussex County Council should examine their contractual arrangements with Maidstone and Tunbridge Wells NHS Trust to ensure …	Fuller Inquiry (2023)	Accepted
P1-13	Board review governance - assurance not reassurance We have illustrated throughout this Report how Maidstone and Tunbridge Wells NHS Trust relied on reassurance rather than assurance in monitoring its …	Fuller Inquiry (2023)	Accepted
P1-14	Board oversight of licensed mortuary activity Maidstone and Tunbridge Wells NHS Trust Board must have greater oversight of licensed activity in the mortuary. It must ensure that the …	Fuller Inquiry (2023)	Accepted
P1-15	Treat HTA compliance as Trust statutory responsibility Maidstone and Tunbridge Wells NHS Trust should treat compliance with Human Tissue Authority standards as a statutory responsibility for the Trust, notwithstanding …	Fuller Inquiry (2023)	Accepted
P1-16	Chief Nurse responsible for mortuary assurance The Chief Nurse should be made explicitly responsible for assuring the Maidstone and Tunbridge Wells NHS Trust Board that mortuary management is …	Fuller Inquiry (2023)	Accepted
P1-17	Deceased treated with same dignity as patients Maidstone and Tunbridge Wells NHS Trust must treat the deceased with the same due regard to dignity and safeguarding as it does …	Fuller Inquiry (2023)	Accepted
P2-1	NHS trusts commission specialist security review All NHS trusts with mortuaries and/or body stores should commission a specialist strategic review of the systems in place to protect deceased …	Fuller Inquiry (2025)	Accepted in Part
P2-2	CCTV in all NHS mortuaries All NHS trusts should install CCTV inside the mortuary, with cameras facing all doors and access points, the reception area and the …	Fuller Inquiry (2025)	Accepted in Part
P2-3	Audit access data for deceased storage All NHS trusts should routinely audit the access data of all facilities used to store deceased people.	Fuller Inquiry (2025)	Accepted in Part
P2-4	End shared swipe cards The practice of using shared electronic swipe cards for specific staff groups should cease immediately.	Fuller Inquiry (2025)	Accepted in Part
P2-5	Operational barriers including device restrictions All NHS trusts should consider putting in place systemic operational barriers that prevent the security and dignity of deceased people being compromised. …	Fuller Inquiry (2025)	Accepted in Part
P2-6	Security breaches reviewed by expert with action plans All NHS trusts should take every breach of security in a mortuary or body store extremely seriously. Each security incident should be …	Fuller Inquiry (2025)	Accepted in Part
P2-7	Body store security standards match HTA-licensed facilities The NHS should ensure that the security standards required for body stores are the same as those required for facilities licensed by …	Fuller Inquiry (2025)	Accepted in Part
P2-8	Swipe to exit for mortuaries All NHS trusts should consider the installation of 'swipe to exit' for mortuary facilities. This would allow trusts to monitor and audit …	Fuller Inquiry (2025)	Accepted in Part
P2-9	Monitor and review staff access numbers All NHS trusts should monitor the number of staff with access to the mortuary or body store and keep this under routine …	Fuller Inquiry (2025)	Accepted in Part
P2-10	Designated Individuals adequate time and resource NHS trusts should ensure that Designated Individuals have enough time and resource to fulfil their responsibilities, including time for learning and development.	Fuller Inquiry (2025)	Accepted in Part
P2-11	Senior managers understand DI role and accountability NHS trusts should ensure that senior managers, including the Chief Executive, have a clear understanding of the role of the Designated Individual, …	Fuller Inquiry (2025)	Accepted in Part
P2-12	DI attendance at governance forums NHS trusts should ensure that Designated Individuals attend the correct governance forums. This would allow them to escalate issues and risks, as …	Fuller Inquiry (2025)	Accepted in Part
P2-13	Mortuary Manager professional background prerequisite A professional background in the field of mortuary services should be made a prerequisite for the post of Mortuary Manager.	Fuller Inquiry (2025)	Accepted in Part
P2-14	Mortuary Manager adequate resources and support NHS trusts should assure themselves that the Mortuary Manager has adequate resources and support to perform their role effectively, including meeting any …	Fuller Inquiry (2025)	Accepted in Part
P2-15	Routine mortuary reporting to trust boards All NHS trusts should establish a routine reporting system for matters relating to mortuaries and body stores. This reporting system should include …	Fuller Inquiry (2025)	Accepted in Part
P2-16	Trust boards assure recommendation implementation Trust boards should assure themselves that the recommendations in this Report have been implemented.	Fuller Inquiry (2025)	Accepted in Part
P2-17	Recommendations apply to temporary facilities Trust boards should ensure that these recommendations and governance arrangements are applied to any temporary facilities used by trusts for the storage …	Fuller Inquiry (2025)	Accepted in Part
P2-18	Mortuaries treated as regulated activity in governance Trust boards should take note of the fact that mortuary services are subject to statutory regulation and should be treated with equivalent …	Fuller Inquiry (2025)	Accepted in Part
P2-19	Deceased included in safeguarding training and policy NHS trust boards should ensure that the security and dignity of deceased people are included in safeguarding training, policies and assurance.	Fuller Inquiry (2025)	Accepted in Part
P2-20	Chief Nurse responsibility for deceased safeguarding The remit of the Chief Nurse in NHS trusts should explicitly include executive responsibility for safeguarding the security and dignity of deceased …	Fuller Inquiry (2025)	Accepted in Part
P2-21	NHS England incorporate deceased in safeguarding framework NHS England should formally incorporate the safeguarding of deceased people into its safeguarding framework for NHS trusts.	Fuller Inquiry (2025)	Accepted in Part
P2-22	Independent sector SOPs for deceased patients Independent sector healthcare providers should ensure that there are Standard Operating Procedures and policies in place to protect the security and dignity …	Fuller Inquiry (2025)	Accepted
P2-23	Independent sector accompanied access to deceased Independent sector healthcare providers should ensure that only people who have a legitimate reason to access a room that contains a deceased …	Fuller Inquiry (2025)	Accepted
P2-24	Anatomical education security and dignity policies All organisations providing anatomical education and training using donors should make sure that policies and procedures are in place to ensure the …	Fuller Inquiry (2025)	Under Consideration
P2-25	Postgraduate training governance clarity Postgraduate training providers using donors should ensure clarity in their governance and information-sharing, in particular where the providers are linked to both …	Fuller Inquiry (2025)	Under Consideration
P2-26	HTA require anatomy adverse incidents reported as HTARIs The Human Tissue Authority should change its guidance to require that relevant adverse incidents in the anatomy sector are formally reported as …	Fuller Inquiry (2025)	Accepted
P2-27	Hospice security and access controls Hospices that care for deceased people on their premises should: introduce auditable access control of the area where deceased people are kept; …	Fuller Inquiry (2025)	Accepted
P2-28	CQC guidance on hospice inspection scope To avoid confusion over its remit, the Care Quality Commission should issue clear guidance to inspectors (and others) that hospice inspections should …	Fuller Inquiry (2025)	Accepted
P2-29	Hospices in scope for new regulatory regime Hospices should be considered in scope for the regulatory measures recommended in Chapter 11.	Fuller Inquiry (2025)	Under Consideration
P2-30	Ambulance data on conveying deceased Data on how often deceased patients are conveyed in ambulances, and the reasons for this, should be routinely collected and reported to …	Fuller Inquiry (2025)	Accepted
P2-31	Ambulance policy on crew position with deceased Every NHS ambulance service should have a policy setting out where ambulance crew members should sit when conveying deceased patients. This should …	Fuller Inquiry (2025)	Accepted
P2-32	Ambulance policies on deceased security and dignity NHS ambulance services should also have policies regarding the security and dignity of the deceased, including when the deceased should be covered …	Fuller Inquiry (2025)	Accepted
P2-33	Ambulance photography policies Every NHS ambulance service must put policies in place regarding taking photographs of deceased patients, including any circumstances in which this may …	Fuller Inquiry (2025)	Accepted

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