The bad news for Nottingham University Hospitals Trust continued over the weekend following a BBC report which has revealed that it failed to send more than 400,000 digital letters and documents to GPs and patients.
This news follows on from the latest reports concerning the maternity services at the Nottingham University Hospitals Trust.
The incident
The unsent correspondence dates back to 2000. However, the majority of the unsent letters and documents significantly increased from 2008. Almost 45,000 documents a year had been unsent by 2014.
According to the BBC, the unsent correspondence was a result of letters, which needed to be signed, being placed into a folder that only a limited number of staff knew about.
A “Level 2 Serious Incident” was identified and declared by the Nottingham University Hospitals Trust in 2017. This involved correspondence and documents effectively being hidden within the Trust’s new and paperless computer system – Medical Office – and were subsequently not sent on to GPs.
In respect of the “Level 2 Serious Incident”, the Chief Executive at Nottingham University Hospitals, Anthony May, said in a statement:
“An issue was identified in 2017 related to the authorisation and issuing of documents from our Medical Office system, which included letters to GPs amongst other documents.
“As a result, a serious incident was declared and a full investigation was undertaken to establish actions in line with the trust’s governance processes at the time.”
The statement continued:
“Following a clinically-led process, 22,963 documents related to GP correspondence were identified. GPs were informed, and we worked alongside representatives from primary care to agree which correspondence should be resent, which was completed.
“The Serious Incident Review concluded that no significant patient harm has been identified following the incident.”
However, the recent BBC inquiry has found that 411,000 letters and medical documents had not been given a final authorisation, which meant that they were not passed on to GPs or added to patient records.
The main reason for the significant difference between the number of unsent letters and documents stated by the BBC and Nottingham University Hospitals appears to be that the almost 23,000 letters and documents were those that the Trust had deemed to be of the highest risk.
In response, the Trust has stated that it will be undertaking a review of the 2017 investigation and take any further action if required.
“A lack of responsibility” over a new digitalised system
As reported by the BBC:
“A former employee at the City University Hospital in Nottingham, Emily Reason, confirmed the incident.
“She said she came across some recently written but unsent digital GP letters awaiting authorisation in September 2017.
“Ms Reason then carried out that authorisation, but by doing so she had unwittingly also authorised over 1,300 old letters and documents.
“This came to light when one GP contacted the trust. They had just received six letters about their patients, dating from 2013.
“The incident triggered an inquiry at the trust the same year.”
Ms Reason further told BBC News that staff struggled with Medical Office but that “not authorising the letters was everybody’s and nobody’s fault” and that due to a lack of training, there was also “…a lack of responsibility or lack of expectations of responsibility.”
When it was clear that there was an issue with how the paperless system was being used, Ms Reason claims that it was minimised and hidden as much as possible, commenting:
“It was assumed almost immediately that the risk to patients would be low, but the reputational risk was high.”
“I thought it would be all right now because the hospital would just handle it.”
Health and social care champion, Healthwatch, has commented that is “deeply concerned” by the scale of the incident and the impact it could have on patient care. Jane Laughton, CEO of Healthwatch Nottingham and Nottinghamshire branch, said:
“Whilst we know that sharing patient information has always been a significant challenge for different parts of the system, we cannot understand how this has happened on such a huge scale.”
Ms Laughton added that there was a significant concern about the impact of missing treatment plans and prescriptions for those who have complex care requirements and medical needs.
The Care Quality Commission (CQC) has stated that it wasn’t aware of the incident but that it will be investigating and following up with the Trust.
This BBC report is the second similar and major incident involving unsent letters and documents this past week following those reported in Newcastle.
Comment
This is another worrying episode of a hospital trust failing to send out important letters meaning that patients are unlikely to have received essential treatment and medication or that such treatment has been delayed. Such delays can result in conditions becoming worse than they otherwise would have and could lead to poorer outcomes for patients.
The scale of the problem is much worse in Nottingham than the error detected in Newcastle which we reported on last week. The events are similar though in that once again there is evidence that once the problem was identified, inadequate measures were taken to handle the problem and deal with things appropriately.
How can we help?
Carolle White is a Legal Director and Chartered Legal Executive in our Medical Negligence team, which is ranked in Tier One by the independently researched publication, The Legal 500.
If you require any advice or if you have any questions regarding the subjects discussed in this article, please get in touch with Carolle or another member of the team in Derby, Leicester, or Nottingham on 0800 024 1976 or via our online form.
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