‘Scandalous’ Isle of Wight NHS database not replaced
An under-fire NHS trust is still using an “unfit” patient appointment database 10 months after it was linked to a man’s death.
The “scandalous” spreadsheet system contributed to Thomas Higgins’ death at his home on the Isle of Wight, the island’s coroner concluded last June.
On Wednesday, the NHS watchdog also noted the system had deleted patient details and lost staff visits records.
The Isle of Wight NHS Trust now says a new system will be in place by autumn.
The trust was placed in special measures after inspectors from watchdog the Care Quality Commission (CQC) gave it an overall rating of “inadequate”.
It had told last June’s inquest into 96-year-old Mr Higgins’ death that the database, used by community nurses, would be replaced by the end of last year.
During her investigations following Mr Higgins’ death coroner Caroline Sumeray, said she had uncovered a “system that was unfit for purpose” and which had initially been a “temporary six-month database fix” still in use four years later.
She told the hearing: “It’s an absolute scandal… Until it’s rectified, everybody is at risk that is on the district nurse register.”
Mr Higgins broke his neck in a fall at his home in Binstead, Isle of Wight, in November 2015.
Ms Sumeray heard he had probably slipped on fluid seeping from his swollen legs.
She said the district nursing team had missed five opportunities over three days to visit him to apply bandages.
In one case, a visit was missed because the system was “inadequate to record [appointments] more than a week in advance”, she said.
Another missed visit came to light two weeks after Mr Higgins’ death, because there was “no way of picking up missed appointments”.
A nursing team leader, Jenni Edgington, told the hearing the database “collapsed frequently” and “changed data”, because of its large size and wi-fi problems in Ryde.
She said it had been an “ongoing issue” for “two to three years”, although a replacement system was anticipated by the end of 2016.
Ms Sumeray ruled Mr Higgins’ death was an accident, contributed to by “systemic and individual neglect”.
In a follow-up letter to the NHS trust in September, she said: “There does not appear to be sufficient urgency to replace this Excel database with one which is fit for purpose.”
CQC inspectors, who visited the trust in November, said they found “numerous incidents of patients being deleted, lost staff visits and even visits being given to staff for deceased patients”.
In January, the trust reported the spreadsheet was still losing about 10 patients a week, although a back-up folder was being used to detect errors.
It said the community nursing service was “taking all actions to mitigate the risk” to patients.
Mr Higgins’ niece, Christine Newland, said: “Until a replacement is up and running, how many more mistakes are going to be made?”
His nephew, Peter Brand, said: “It’s really upsetting that it was recognised as a problem but nothing was put in place.”
The trust said its new replacement database, TPP SystmOne, “should see all areas active in autumn 2017”.