NHS computer problems put patients at risk of harm

A BBC News investigation has heard claims of a “cover up” of the scale of problems with NHS IT systems – used to manage patients’ medical records.

IT system failures have been linked to the deaths of three patients and more than 100 instances of serious harm at NHS hospital trusts in England, BBC News has found.

A Freedom of Information request also found 200,000 medical letters had gone unsent due to widespread problems with NHS computer systems.

Nearly half of hospital trusts with electronic patient systems reported issues that could affect patients.

NHS England says it has invested £900m over the past two years to help introduce new and improved systems.

Introducing computerised records and making the NHS paperless is a government priority in England. The aim is for everyone’s health information to be accessible to GPs, hospitals and care homes at the touch of a button.

But there have been numerous false starts. The latest deadline, set by the Department of Health and Social Care, is now 2026.

Some hospital trusts have spent hundreds of millions of pounds on new electronic patient record (EPR) systems, but BBC News has discovered many are experiencing major problems with how they work.

Separate to our FOI investigation, coroners have highlighted the role that hospital IT systems have played in the deaths of some patients. Twenty-two-year-old Darnell Smith’s case is one example.

“He was our rock, you know. He had a big personality. Words can’t really explain how much he was to us…” says Erroll Smith of his son, Darnell.

Darnell had sickle cell disease, cerebral palsy and was non-verbal. He was admitted to the Royal Hallamshire Hospital, in Sheffield, with a cough and cold-like symptoms and a reduced appetite, in November 2022.

He should have had his vital signs – heart rate, blood pressure and temperature – checked by staff every hour for a minimum of six hours – but there were no checks for more than 12.

Staff were not aware of Darnell’s particular needs because his personal care plan was not easily visible in the hospital’s computerised records, a coroner later concluded.

His father told BBC News: “For me, the IT system should be set up in a way where you have to see it… you know – it just doesn’t allow you to move any further until you’ve read what you’re supposed to read.”

Several hours after his care plan came to light, Darnell was admitted to critical care and was put on a ventilator the next morning. He died from pneumonia two weeks later.

Following an inquest, the coroner warned of a “real risk of further deaths” if doctors couldn’t access important information about patients’ care needs.

Sheffield Teaching Hospitals Trust has apologised for the care Darnell received. They say they have already made changes to limit the chances of this happening again and a new IT system is being introduced this year.

In September, we reported that more than 24,000 letters from Newcastle hospitals had not been sent from their EPR system and more than 400,000 letters had got lost in computer systems at hospitals in Nottingham.

A Freedom of Information request sent to all acute hospital trusts in England, of which 116 responded, found that these were not isolated incidents:

• 89 trusts confirmed they monitored and logged instances when patients could be harmed as a result of problems with their Electronic Patient Record (EPR) systems
• almost half recorded instances of potential patient harm linked to their systems
• nearly 60 trusts reported IT problems that could affect patient care
• more than 200,000 letters were not sent across 21 trusts
• there were 126 instances of serious harm linked to IT issues, across 31 trusts
• and three deaths across two trusts related to EPR problems

The failure by hospitals to send out letters to GPs and patients could mean anything from an appointment to a cancer diagnosis or change of medication being missed.

The Royal College of GPs said it was shocked and surprised by the findings.

“Now that we know there is a problem, it is crazy not to do something quickly in order to save lives and keep people safe,” said Prof Kamila Hawthorne, chairwoman of the college.

Separately, a number of clinicians contacted BBC News about electronic patient record systems. None of them wanted to be named because of fears over speaking out.

Some of their concerns about the computer systems include:

• “It makes finding critical information very difficult, or impossible”
• “Medication errors have occurred, missed doses of antibiotics have occurred”
• “Clinical information can be buried anywhere”
• “Incorrect patient details on theatre lists, incorrect operations listed, incorrect allergy status”

Professor Joe McDonald, a former NHS clinical leader, says the financial costs of the systems are huge – but there are also worrying costs for patients.

“The thing about paper is when you make a mistake you make them one at a time,” he said.

“With electronic patient record systems, it gives you the opportunity unfortunately to make the same mistake thousands of times.”

Prof McDonald says the current roll-out of electronic patient records across trusts is “a broken jigsaw” because very few are able to connect with each other, making information sharing a real challenge.

He also believes there are echoes of the Horizon scandal at the Post Office.

“There is undoubtedly a culture of cover-up in the NHS and nowhere is that stronger than in the health IT sector,” he added.

“It’s not safe. It’s really not safe.”

When 31-year-old Emily Harkleroad collapsed in December 2022, she was taken to A&E at University Hospital of North Durham, where a blood clot on her lung, known as a pulmonary embolism, was diagnosed.

But there were errors and delays in giving Emily the blood-thinning treatment she urgently needed. She died the following morning.

A coroner’s report found that Ms Harkleroad’s death could have been prevented.

A new computer system, installed just months earlier, did not clearly identify which patients were the most critically ill and needed to be prioritised by senior doctors, an inquest heard.

Clinicians had previously raised concerns about the system.

The coroner called on the hospital trust and software supplier Cerner, now owned by Oracle, to take action to prevent future deaths.

Oracle told BBC News: “We extend our condolences to the family of the deceased and others bereaved.

“While there is no suggestion that software was at fault in this case, we continue to work closely with our NHS partners to implement successful programmes that help them deliver the safest and most effective care for the 16 million citizens our systems support in the UK.”

County Durham and Darlington NHS Foundation Trust told BBC News it was taking the coroner’s report extremely seriously.

Through our Freedom of Information request, the BBC has also learned that more than 2,000 incidents of potential patient harm at the Durham trust have been connected to the new IT system, and three other serious incidents.

The Royal College of Emergency Medicine said the coroners’ findings for Emily’s and Darnell’s deaths were “shocking and deeply worrying”.

“It’s essential that our members and their colleagues have access to reliable technology and effective systems that they can trust, and that don’t risk patient safety,” said president Dr Adrian Boyle.

Systems should be designed with clinicians’ input and there should be the ability to make urgent adaptations if problems are identified, he added.

“This is a ticking time bomb,” said Clive Flashman, from the Patient Safety Learning organisation.

“If you look at the sorts of serious issues that are coming out around the country where patients are being harmed, in some cases dying, as a result of these systems not working properly, I would imagine there are tens of thousands of these that are happening that probably never get discussed.”

NHS England said electronic patient record systems had been shown to improve safety and care for patients, by helping clinicians detect those at risk from conditions such as sepsis.

“The NHS has invested nearly £900m over the past two years to help local organisations introduce new and improved systems, so they are no longer relying on paper records or patchwork systems – which carry far greater risks to safety, care delays, and patient privacy,” said Professor Erika Denton, national medical director for transformation at NHS England.

“However, like any system, it’s essential that they are introduced and operated to high standards, and NHS England is working closely with trusts to review any concerns raised and provide additional support and guidance on the safe use of their systems where required.”