It's a case of “the dog ate my homework” - and this is one hungry dog.

An investigation by Health Service Journal (May 22) suggests that hundreds of thousands of NHS patients are seen each year without the clinician having their medical records. The analysis of more than two million outpatient appointments at 49 hospitals from 2006-08 reveals that 54,000 appointments took place without the patient's full records. If that rate is replicated across the NHS, approximately 1.2 million outpatients in England will be seen without their notes every year.

There is no national standard for the availability of patient records or agreed way to monitor performance.

Although not required to do so, most trusts carry out periodic internal audits of the availability of patient notes. Forty-nine trusts responded to HSJ's request under the Freedom of Information Act for details of their last audit. Outpatient appointments were audited more often than inpatient or emergency admissions.

Sorry record on patient notes

Over a million patients a year are seen by NHS clinicians who have not been privy to their medical records

BACKGROUND

• Profit before public interest

• Driven to sustain improvement

• A poor report for inspections

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City Hospitals Sunderland NHS Foundation Trust reported the highest rate, with 19 per cent of outpatient records unavailable at the start of the clinic. A spokeswoman for the trust says that a new post has been created to address the situation, which is improving.

Six of the 49 hospitals reported 5 per cent or more outpatient records missing when needed.

HSJ was also told that trusts may downplay the extent of missing records - for example by including scant temporary records or by cancelling appointments when records are not available - so the real rate of absent records could be even higher.

Vanessa Bourne, head of special projects at the Patients Association, says: “It reveals a dreadfully cavalier attitude to patients, their safety and their records.”

Spats of the Week

The public sector - one big happy family, right? Not exactly.

Nursing Standard (May 21) reports that some staff at Barts and The London NHS Trust had fallen out with each other and were refusing to work together.

The tensions came to light at a conference on managing poor performance. But the trust's director of nursing said that the tensions between staff with African backgrounds had crumbled in the face of a bright idea introduced by another nurse: cooking.

Apparently, cooking and sharing traditional meals from the staff's home countries at a specially arranged event helped them to sort out the problems and raise cultural awareness.

Sadly, it sounds as though the spat going on in Doncaster is too far gone to be rescued by cooking, traditional or otherwise.

The MJ (May 22) says that the elected Mayor has “turned independent” and broken away from the city's Labour group after a district auditor's report spoke of continued “deterioration in relationships between the mayor and key councillors”.

The Mayor has now formed a breakaway Independent Labour cabinet in the wake of the report's accusation that tensions were hampering the council's effectiveness.

More stew, anyone?

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