Nottingham University Hospitals Trust failed to send patient 400,000 letters

An NHS hospital trust in Nottingham failed to send more than 400,000 digital letters and documents to GPs and patients.

The trust says a full investigation took place in 2017 and found no significant harm to patients but it has now said it will carry out a review of that investigation and take any further necessary action.

Healthcare and care regulator the Care Quality Commission (CQC) said it was unaware of the incident and would follow up with the trust.

The failure in Nottingham is bigger than that reported in Newcastle, involving 24,000 letters, and dates from 2000 although the majority of unsent letters piled up from 2008, with up to 45,000 unsent documents a year by 2014.

As with the Newcastle case, the problems occurred when letters requiring sign-off were placed into a folder few staff knew existed.

In Nottingham, a "Level 2 Serious Incident" took place in 2017, and involved letters and medical documents that were effectively hidden within the hospital's computer system and not sent out to GPs as they should have been.

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.

She then carried out that authorisation, but also unwittingly authorised more than 1,300 old letters and documents, which came to light when a GP contacted the trust saying they had just received six letters about their patients, dating from 2013.

The incident triggered an inquiry, which revealed that 411,000 letters and crucial medical documents that senior doctors believed had been sent out to GPs and added to patient records, had not been authorized and were left sitting on computer systems.

Ms Reason told BBC News how staff struggled with using a new "paperless" system for typing letters, called Medical Office.

She said: "Not authorising the letters was everybody's and nobody's fault. Because there was a lack of training. There was a lack of responsibility or lack of expectations of responsibility."

When it was clear there was a problem, Ms Reason said it was minimised as much as possible and hidden.

She added: "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."

Healthwatch, which collects patients' experiences of health and social care, said it was "deeply concerned" to learn about the Nottingham incident.

CEO of the Nottingham and Nottinghamshire branch, Jane Laughton, 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.”

She said there was particular concern about the impact of missing treatment plans and prescriptions for those with the most complex care needs.

Chief executive at Nottingham University Hospitals, Anthony May, said: "GPs were informed, and we worked alongside representatives from primary care to agree which correspondence should be resent, which was completed. No significant patient harm has been identified following the incident."