15 September 2022: Missing Medical Records (Presentation) - B

The missing medical records guidance for England  was updated again in 1985 with further destruction date extensions in specific cases. The next major development was in 1999 with the publication of the “for the record” document. This included not just the nuts and bolts of how long to hold what records, but also the operational principles and consideration of the rationale for good records management. The Disposal Schedule attached was much more comprehensive and specific. “Records Management” was the next code published in 2006 and updated in 2016. The main content reverted to focussing on the timescales for particular documents being retained then destroyed. The current English guidance document is the “Records Management Code for Health and Social Care 2021”. This includes further tinkering with dates and record types.

The Welsh framework followed the English processes until the Government of Wales Act 2006. There is still a degree of mirroring with the “Management of Records Code of Practice for Health and Social Care 2022” which contains much the same provisions as those applying to England. They were intended to operate together.

The position in Scotland went back to the Public Records Scotland Act 1937, which includes authorisation for disposal of records which have “insufficient value”. In 1940 new regulations were passed. A schedule from 1958 gave more guidance, primarily on destruction dates, again. In 1993 the Scottish Office Guidance for the Retention or Destruction of Health Records publication included more on dates across the range of clinical situations and on the form of documents (on paper or in other media such as microfilm). It also included a section on the retention of records for clinical trials, connected to a European Commission Directive from 1991. Then in 2006 there was a major update to take account of related legal frameworks such as Data Protection (although it did not appear until 2008). Organisations are required to products their own retention schedule. The Code was updated in 2010 and again in 2012. The currently operant Code of Practice is the 2020 version.

In Northern Ireland the story started with the 1962 Hospital Authority Circular which was largely a set of lists of record types with retention/destruction dates. Much of the practice in NI mirrored the practices in England. An amended circular which was issued in 1983 illustrated this pattern continuing. Again, nobody saw microfilming as an option with merit. There was a further document produced in 1996, and another in 2004 (“Good Management, Good Records”). The latter was updated in 2011 with the usual tinkering with record types and dates. In 2015 there was a moratorium on destruction for the purposes of Inquiry needs.

The next sub-topic was to review some examples of policies on medical records. Glasgow was the first example. There was widespread destruction of files in the 50s, 60s and 70s. There was also a report of the shelves collapsing with records on them, but no damage was done. There were also examples from Belfast, Lancashire, Birmingham, Derbyshire and Bristol, and that material is available (so is probably too boring to review in the presentation).

The third sub-topic was that of examples of the problems faced by Core Participants to the Inquiry. It was noted that the inability to obtain records was a factor in many peoples’ witness statements. The commonest issues were the inability to locate records, the assumption of records having been destroyed, people not getting back to enquirers, and being told different things by people in the same location.

The second main theme related to environmental destruction, such as flooding and leaks resulting in records being damaged or destroyed. It was often impossible to give details of the dates of environmental incidents because the records of the incident were themselves destroyed in accordance with destruction policies related to those non-medical types of records (an example of policies eating themselves). Some damaged records were able to be cleaned up, but this was not often the case. “Destroyed in Flood” seems to have been an easy and common (convenient?) shorthand for an explanation in many cases of records which cannot be located. Counsel worked through a catalogue of examples from Core Participants. The pattern of inadequate interactions between patients seeking to secure their records and those staff receiving enquiries were commonly unsatisfactory. In some cases an environmental destruction reason was given to a patient for records non-availability but when long-standing staff reacted to such an excuse saying they could not recall any such incident of the nature given as the reason. Some evidence of actual incidents were provided, such as photographs and written records. Another problem was that stores of records had not been entered on to a list, so after being destroyed it was not even possible to say if a particular record was among those that were assumed to have been damaged by an incident. When lists of records were available, there were often errors in transcription which effectively was the same as them being lost or destroyed.

The third presentation theme related to difficulties in obtaining records. This included circumstances such as the closure or a hospital being given as the reason for non-availability. Core Participants also commonly reported that their requests were simply ignored, or they received very vague responses. Sometimes the only way to get a response was to make a complaint or to get an MP involved. Occasionally, when a politician got involved, the apparently destroyed records are suddenly available. Explanations included files being found after having fallen down the back of a cabinet. There have also been many examples of medical records being inaccurate, incomplete, or entries being just plain wrong.