A recently concluded inquiry has shed light on the "serious failings" in hospitals that enabled mortuary abuser David Fuller to carry out his heinous crimes unchecked for more than a decade. The investigation revealed that between 2007 and 2020, Fuller abused the bodies of at least 101 women and girls in Kent hospitals.

The inquiry, led by Sir Jonathan Michael, found that there were missed opportunities to question Fuller's working practices, indicating a failure in the system. Fuller, who is currently 69 years old, was handed two whole-life sentences in 2021 for the murders of Wendy Knell and Caroline Pierce, in addition to being sentenced to 16 years in prison for abusing corpses. This means that he will spend the remainder of his life behind bars.

Sir Jonathan Michael pointed out that there were significant management failures at Maidstone and Tunbridge Wells NHS Trust, where Fuller had been employed. He stated, "There had been a 'failure to follow standard policies and procedures, together with a persistent lack of curiosity'" regarding the mortuary's running. The senior management was aware of issues as early as 2008 but failed to take effective action to rectify the situation.

One of the key factors contributing to Fuller's ability to offend unnoticed was the lack of attention given to who accessed the mortuary. It was revealed that Fuller had visited the mortuary 444 times in one year alone, a frequency that went unnoticed and unchecked. Sir Jonathan emphasized, "In identifying such serious failings, it's clear to me that there is the question of who should be held responsible."

The inquiry further highlighted that Fuller's behavior was not easily anticipated, as it was out of the ordinary. However, proper implementation of policies, procedures, and protocols could have prevented his actions from going unnoticed for so long.

A significant portion of Fuller's offenses took place at the Tunbridge Wells Hospital at Pembury, a state-of-the-art facility that was regularly inspected. This raises questions about the adequacy of the inspection regime and whether it is fit for purpose.

The report has sparked criticism and calls for accountability within the Maidstone and Tunbridge Wells NHS Trust. Families of the victims have expressed anguish, knowing that if the hospital managers had fulfilled their responsibilities, Fuller might not have been able to continue his offenses for years.

David Fuller, a maintenance supervisor from Heathfield, East Sussex, had been working in hospitals in Tunbridge Wells, Kent, for over three decades. He gained access to morgues using his employee swipe card, targeting times when the areas were unattended by staff.

The victims of Fuller's actions ranged in age from nine to 100 years old, with at least 101 corpses being systematically abused.

Miles Scott, the chief executive of Maidstone and Tunbridge Wells NHS trust, acknowledged the inquiry's findings and stated that the majority of the recommendations had already been implemented since Fuller's arrest. He pledged to swiftly implement the remaining recommendations.

In response to the report, Health Minister Maria Caulfield expressed a profound apology on behalf of the government and the NHS. She assured that lessons would be learned, and a comprehensive response to the recommendations would be provided by spring 2024. The ultimate goal is to ensure the prevention of such horrifying experiences for any other families in the future.