Patients are at risk of a missed cancer diagnosis due to a reliance on paper records, an NHS trust has admitted after a man died due to his tumour being overlooked.
Michael Lane, 50, from Shrewsbury, was “failed” by Shrewsbury and Telford Hospital Trust, his family has said after his cancer scan result was misplaced leaving him with a growing kidney tumour for 10 years.
The trust is yet to fully launch an electronic record system a year after an investigation into Mr Lane’s death warned other patients were at risk due to the gap in paper records.
Mr Lane, described as a “gentle giant” by his siblings, went into Shrewsbury and Telford Hospital for a scan following a referral for suspected cancer in 2011.
The radiographer flagged a small tumour but the scan was overlooked, placed within his paper records and never reported as being a concern.
In an investigation report carried out by the trust in May 2021, seen by The Independent, the hospital admitted that had his tumour been seen and operated on earlier he may have survived.
The report also admitted there were ongoing risks within the trust due to gaps in its electronic records system.
It said: “The implementation of an IT solution will not prevent sad cases such as that of Mr Lane where the scan report that was missed took place before the widespread availability of such systems, however, it is clear that until we have an electronic requesting and sign-off system we remain at risk of new cases of missed results and harm occurring as a result of the ongoing reliance of paper-based results.”
According to the report, the problem had been previously flagged but plans to roll out an electronic patient record system had been put on pause due to Covid.
Michael’s brother Mark Lane told The Independent: “How many people have been, misdiagnosed or not diagnosed with cancer? Who obviously haven’t been picked up.”
“It makes me feel very angry really... They’ve let us down. I don’t want this to happen again, not to anyone else.”
Mr Lane said his brother had a passion for motorbikes and enjoyed riding tours of the Isle of Man.
He added: “He had his heart set on buying a camper van and travelling and seeing all of Europe but he thought he had longer… [now] he’s just a reference number on the NHS. Another statistic where there was an error involved and died too young. This is the man who most of his life paid into a pension, but never got to see his pension never, never got time to enjoy his life and that was robbed.”
Mr Lane is calling for any patients who think they might have been affected by the same issue to come forward.
Laura Weir, a lawyer from Lanyon Bowdler who represented Mr Lane and his family, said it was “disappointing” the trust had still not implemented the potentially “life-saving system”, despite admitting the risk of not having it.
Richard Steyn, co-medical director at the Shrewsbury and Telford Hospital NHS Trust, said: “I want to offer our sincere apologies and condolences to the family of Mr Lane for failing to report the discovery of a tumour on an earlier scan.
“We carried out a thorough investigation into this case to learn lessons and are planning to introduce trust-wide electronic record systems, designed to safeguard patients from similar errors with paper-based records.”
One in 10 hospitals across the NHS in England is yet to implement a fully electronic patient records system and still rely on paper records.
Former health secretary Sajid Javid earlier this month warned about the risks of diagnostic and administrative errors in the NHS.
In response to questions from The Independent at a Policy Exchange event, Mr Javid said there were “really bad administration issues” in the NHS and “so many administration errors because all the paperwork is literally getting lost or not being acted upon sooner”
His warning came after the government published a new plan for all NHS trusts to have electronic paper records by the end of December 2023.
Earlier promises set out almost a decade ago for a paperless NHS by 2018 were never realised.
