Inconsistent Healthcare Data Infrastructure
Lack of a consistent and mature data infrastructure across NHS providers, hindering technological adoption and data sharing.
Strongest theme matches
Mixed across source types and ranked by classifier confidence plus text match strength.
Committee recommendation
80match
#26 - NHS still lacks consistent data infrastructure and technological maturity, delaying productivity gains.
We asked what was being done to improve productivity through the use of new technologies. NHSE told us the NHS currently lacks a consistent data infrastructure and that NHS providers varied in terms of their levels of technological maturity.50 NHSE said that it was putting modern technology into some of its providers that “have lived on paper”. While...
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terms: infrastructure
Committee recommendation
71match
#7 - Publish plans to reduce NHS paper reliance and set deadline to end fax machines.
Despite ambitions to improve productivity through the introduction of new technologies, the switch to digital in parts of the NHS has been glacially slow. Digital and technological improvements could have a transformative effect on the NHS. However, NHSE’s investment in technology over the period 2022–23 to 2024–25 stalled because funding was redirected to mitigate ICBs’ spending deficits. For...
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terms: infrastructure
PFD report
69match
Alexander Davidson
NHS 111 pathways use unsuitable language for children and cause confusion, while GP surgeries experience delays in uploading 111 notes. There is also a lack of standardized lipase/amylase testing for children and inconsistent ED return patient reviews.
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terms: inconsistent
HSSIB recommendation
69match
Access to critical patient information at the bedside
It may be beneficial for healthcare organisations to assess their information technology infrastructure needs, such as equipment availability and network coverage, to enable staff to consistently access critical patient information.
Matched on
terms: healthcare, infrastructure
Committee recommendation
66match
#9 - Department struggles monitoring sector engagement with inaccessible digital systems and inconsistent records
We asked the Department about its ability to monitor its engagement with economic sectors, given that officials do not consistently record their interactions with companies, and its digital system — DataHub — is not accessible across the whole of Whitehall.17 The Department noted the challenges of different digital platforms operating in different government departments, and that a single...
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terms: inconsistent
Committee recommendation
66match
#45 - Publish regular, transparent data on prison healthcare access and outcomes for accountability
NHS England, or its successor, should publish regular, transparent data on healthcare access and outcomes across the prison estate. This data should be used to monitor progress against the principle of equivalence and to hold both NHS England or its successor and HMPPS accountable for delivering effective, joined-up care. (Recommendation, Paragraph 204)
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terms: healthcare
HSSIB recommendation
66match
Workforce and patient safety: temporary staff - integration into healthcare providers — HSSIB
How do you ensure that temporary workers can access electronic systems and physical environments that are vital to providing safe care?
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terms: healthcare
PFD report
65match
Peter Hinchliffe
Significant delays in diagnostic investigations across both private and NHS sectors, coupled with inconsistent advice and management for young athletes experiencing syncope, pose a continuing risk.
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terms: inconsistent
PFD report
65match
Shayla Walmsley
Delays in obtaining medical device data from manufacturers, inconsistent distribution of safety notices, and a lack of post-mortem analysis of medical devices hinder investigations and timely safety interventions.
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terms: inconsistent
PFD report
65match
Lexie Harrison
A critical lack of national and local standardised policies for paediatric oesophageal varix banding procedures leads to inconsistent consultant practices. This impacts patient assessment, post-procedure care, and bleeding management.
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terms: inconsistent
PFD report
65match
Simon Costin
Inconsistent patient assessment approaches by clinicians and a lack of nationally agreed standard assessment forms hinder effective communication and care continuity for mental health patients across different trusts.
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terms: inconsistent
PFD report
65match
Paige Bell
Fragmented patient records, a lack of electronic access to all notes, and inconsistent engagement policies across trusts compromise patient care. Outdated guidance on Borderline Personality Disorder also requires updating.
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terms: inconsistent
PFD report
65match
Michael Giles
Inconsistent handover processes, lack of senior weekend patient reviews, absence of leadership during crises, and poor medical record-keeping created risks in patient care.
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terms: inconsistent
PFD report
61match
Ronald Perry
Inconsistent criteria for requesting CT scans based on time of day or weekend leads to varying levels of care and risks missed diagnoses for patients 'out of hours'.
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terms: inconsistent
PFD report
61match
Masoud Ghaderi
Inconsistent record-keeping for service user engagement and the absence of a dedicated staff member for reviewing risk assessments prevented identification of changing patient risks. Ward rounds relied on inadequate, brief summaries, risking errors and omissions in care.
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terms: inconsistent
PFD report
61match
Michael Quinn
Hospital guidance for pre-operative blood glucose levels was inconsistent with national guidelines and research, highlighting confusion about optimal levels for surgical patients and increasing infection risk.
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terms: inconsistent
PFD report
61match
Anna Masson
A new mental health referral screening pathway, conducted by junior staff, may not be robust enough to identify urgent cases, and there is inconsistent practice across the Trust's mental health teams.
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terms: inconsistent
PFD report
61match
Angela Byrne
W-CDAS staff are not applying training, leading to inadequate risk assessment for vulnerable patients, and there are poor communications between inpatient and community services with inconsistent records.
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terms: inconsistent
PFD report
61match
Janice Davies
Missing documented observations and pain scores before discharge, alongside absent formal guidance for prescribing oramorph to discharging patients, led to inconsistent and potentially inappropriate medication.
Matched on
terms: inconsistent
Inquiry recommendation
61match
F262 - Enhancing the use analysis and dissemination of healthcare information
All healthcare provider organisations, in conjunction with their healthcare professionals, should develop and maintain systems which give them: Effective real-time information on the performance of each of their services against patient safety and minimum quality standards; Effective real-time information of the performance of each of their consultants and specialist teams in relation to mortality, morbidity, outcome and patient...
Matched on
terms: healthcare
HSSIB recommendation
61match
Healthcare provision in prisons
HSSIB recommends that NHS England/Department of Health and Social Care includes within its healthcare IT procurement system specification the need to support interoperability between the operational prison IT systems and any future prison healthcare IT system. This will ensure that information which does not impinge on the confidentiality requirements of either system, relevant to the safety and wellbeing...
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terms: healthcare
Committee recommendation
61match
#2 - Recommend a trial of a centralised Secure Data Environment and simplify ethical governance
Should our successor Committee wish to explore the reform of the UK health data strategy, we recommend it considers: • Investigating the replication of the academic model of open and competitive funding to solve problems and develop Privacy Enhancing technologies (PETs) and other critical pieces of data infrastructure as an alternative to internal or contracted software development work;...
Matched on
terms: infrastructure
HSSIB recommendation
61match
Healthcare provision in prisons: data sharing and IT
HSSIB recommends that NHS England/Department of Health and Social Care includes within its healthcare IT procurement system specification the need to support interoperability between the operational prison IT systems and any future prison healthcare IT system. This will ensure that information which does not impinge on the confidentiality requirements of either system, relevant to the safety and wellbeing...
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terms: healthcare
Inquiry recommendation
57match
F267 - Enhancing the use analysis and dissemination of healthcare information
All such statistics should be made available online and accessible through provider websites, as well as other gateways such as the Care Quality Commission.
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terms: healthcare
PFD report
53match
Amy Cooper
Commissioned maternity services lacked compatible, digitally available record-keeping and scan systems, leading to inefficient paper-note transfers and hindering seamless patient care and referrals.
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PFD report
53match
Daniel Maher
Critical information sharing failures exist between inter-county mental health services, with professionals unable to access out-of-county patient records or routinely share s.136 assessment paperwork, hindering timely, comprehensive care.
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PFD report
53match
David Hamilton
Healthy Minds lacked documentation for therapy selection, clarity on referral triggers, and a formal escalation process for concerns. Limited information sharing between health professionals meant an incomplete patient picture.
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Committee recommendation
53match
#44 - Disconnected health data systems and lack of central repository hinder effective antimicrobial stewardship.
Lord O’Neill told us there is an underlying data problem in the health sphere, with many data systems not connecting properly.111 Better data in health would make it easier for clinicians making decisions on infection management and prescribing antimicrobials. The ability to link the results of diagnostic tests to prescription information could result in better antimicrobial stewardship, but...
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classifier match
Committee recommendation
53match
#4 - Require NHSE and Department to set out plans for elective care digital transformation and IT connectivity.
We are not confident that the Department is being realistic about the immense effort needed to reduce NHS elective care waiting times, and see a significant risk that digital solutions are being treated as a ‘cure- all’ as the 10 Year Plan is being implemented. While NHS England and the Department for Health and Social Care have outlined...
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classifier match
Inquiry recommendation
53match
BRIS-154 - Invest in world-class IT systems for efficient healthcare data collection and feedback
The need to invest in world-class IT systems must be recognised so that the fundamental principles of data collection, validation and management can be observed: that data be collected only once; that the data be part and parcel of systems used to support healthcare professionals in their care of patients; and that trusts and teams of healthcare professionals...
Matched on
terms: healthcare
Inquiry recommendation
53match
F266 - Enhancing the use analysis and dissemination of healthcare information
In designing the methodology for such statistics and their presentation, the Department of Health, the Information Centre, the Care Quality Commission and the specialty organisations should seek and have regard to the views of patient groups and the public about the information needed by them.
Matched on
terms: healthcare
Inquiry recommendation
53match
F265 - Enhancing the use analysis and dissemination of healthcare information
The Department of Health, the Information Centre and the Care Quality Commission should engage with each representative specialty organisation in order to consider how best to develop comparative statistics on the efficacy of treatment in that specialty, for publication and use in performance oversight, revalidation, and the promotion of patient knowledge and choice.
Matched on
terms: healthcare
Inquiry recommendation
52match
1 - Single consultant data repository
We recommend that there should be a single repository of the whole practice of consultants across England, setting out their practising privileges and other critical consultant performance data – for example, how many times a consultant has performed a particular procedure and how recently. This should be accessible and understandable to the public. It should be mandated for...
Matched on
terms: healthcare
HSSIB recommendation
52match
Management of chronic health conditions in prisons
It is recommended that the National Prison Healthcare Board for England oversees work to implement interoperability between SystmOne and the Prison-National Offender Management Information System, enabling sharing of essential information across the prison service which does not impinge on the confidentiality requirements of either system.
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terms: healthcare
HSSIB recommendation
52match
Intrapartum stillbirth: learning from maternity safety investigations that occurred during the COVID-19 pandemic 1 April to 30 June...
HSIB recommends that NHSX develops specifications for electronic patient record (EPR) systems that require adherence to national interconnectivity standards for the exchange of core maternity healthcare information. The specifications should include functionality to enable both women and pregnant people and professionals to add to the record, and also support alerting functionality.
Matched on
terms: healthcare
IMB recommendation
52match
Gartree (2024)
The Minister has previously advised that healthcare provision is monitored and reviewed by NHS England Midlands Clinical and Quality Team. Despite numerous requests by the Board, the healthcare provider has steadfastly declined to provide any meaningful quantitative data for monitoring the healthcare provision and benchmark against the community equivalent. Again, we ask the Minister to explain how the...
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terms: healthcare
IMB annual report
51match
Hewell Grange (2020)
This report covers the final six months of HMP Hewell Grange as it underwent a planned closure, ceasing to hold prisoners by 31 March 2020. The Board found the prison generally safe and praised staff for their humane management of the closure, despite unacceptable living conditions. Healthcare provision was inconsistent, and purposeful activity was curtailed due to the...
Matched on
terms: healthcare, inconsistent
PFD report
49match
Jude Augustus Gordon
Failures in calculating and escalating Early Warning Scores, alongside a lack of national standardisation and automatic alert systems, led to delayed critical care referrals for a deteriorating patient.
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PFD report
49match
Georgina Swindells
The coroner identified concerns regarding delays in image transfer, a lack of available data to investigate the issue, the absence of an image transfer backup process, and the apparently erroneous scan report, raising the possibility of misreporting in the future.
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PFD report
49match
Evelyn Smith
Inaccurate vital sign recording and lack of clinician knowledge regarding pediatric early warning and croup severity scoring systems hindered early recognition of illness and effective data entry in GP records.
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PFD report
49match
Jayne Jowett
PIC staff lack adequate training in interpreting and escalating National Early Warning Scores, and struggle to understand critical clinical signs. There's no clear protocol for GP collaboration or for communicating patient physical conditions to GPs.
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PFD report
49match
George Richardson
Lack of a consolidated catheterisation record meant staff were unaware of previous challenges, and national standards may be needed for safe catheterisation skills.
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PFD report
49match
Elizabeth Godwin
Critical issues exist in mental health care regarding incomplete information gathering for assessments, poor urgency monitoring, inadequate inter-agency communication, unclear care responsibilities, and a lack of audit trails for patient transfers.
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PFD report
49match
Harry Pryal
A significant lack of recorded medical advice between trusts, conflicting interpretations of service agreements, and failure to hold mandated liaison meetings resulted in poor inter-trust communication.
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PFD report
49match
Natalie Thornton
Inadequate monitoring and analysis of blood sugar data from insulin pumps, coupled with a lack of formal pump agreements and variable national support, posed a risk to patient safety.
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PFD report
49match
Patrick Clifford
Lack of clear patient supervision policy in toilets, difficulties transferring radiology images between hospitals, and refusal to perform requested X-rays caused treatment delays.
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PFD report
49match
Gwendoline Halfpenny
County Hospital lacked surgical cover, and there was inconsistency in MEWS systems, duty policies, and equipment between hospitals within the same Trust.
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PFD report
49match
Robert Wrinch
The pathology department lacked systems for tracking samples and documenting clinician communications, causing delays and unclear chronologies. Incompatible IT systems between trusts and national pathologist shortages also contributed to backlogs.
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PFD report
49match
Susan Longden
The NHS Pathways algorithm fails to prompt questions about recent surgery for severe abdominal pain, and NHS 111 advisors don't adequately prioritise speaking to patients directly. These systemic issues have been repeatedly raised.
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PFD report
49match
Deborah Hopkinson
Frequent equipment failures and significant delays in specialist consultant involvement due to lack of expertise and communication issues severely impacted patient diagnosis and treatment.
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