Audit fails to find misplaced Cork/Kerry area Camhs file

A community healthcare organisation offering youth mental health services in the Cork/Kerry area has failed to recover a misplaced clinical file, according to an audit commissioned by the Health Service Executive.

The Mental Health Commission has published individual reports into the provision of child and adolescent mental health services (CAMHS) in each of the nine community healthcare organisation areas of the HSE. Last month, an overall report was published which stated that the continued reliance on paper-based records across the State’s youth mental health services was a “significant burden” on already overstretched staff.

The publishing of the reports into the individual centres has revealed that a data protection breach in the community healthcare organisation (CHO) for Cork and Kerry has been reported to the Data Protection Commissioner.

The report says that in some teams in the facility, the storage of clinical files is “not safe from a data protection breach”. According to the report, files were not maintained in a “safe, coherent and logical way with potential risks in communication of clinical information, confidentiality and the danger that some vital information will be missed”.

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A similar concern was reported in the CHO for Sligo, Leitrim, Donegal, Cavan and Monaghan. According to the report, “there were concerns in some teams about safe management of clinical files, including files missing on the days of our review, loose continuation sheets being used, safe transport of files and the general condition of files”.

The report for CHO 7, which serves Kildare/West Wicklow, Dublin West, Dublin South City, and Dublin Southwest, stated that “there are no electronic clinical files” when listing the challenges facing the organisation. “Due to the low number of administration posts, clinicians carry out administrative duties, reducing their clinical time with young people,” says the report. “This contributes to a reduction in clinical time available and an increase in waiting lists.”

The report into the CHO serving the Dublin North City and County area also states that no electronic clinical files are kept by the organisation. According to the report, the CHO has no access to Healthlink11, a “a web-based application providing for the secure transfer of patient information in real time”. Its absence creates challenges in “accessing blood results and communicating with hospitals and GPs”.

In the Galway, Roscommon and Mayo CHO, “there is a lack of a suitable IT systems and electronic files, leading to inefficiency and lack of adequate auditing”, according to the report. In Limerick, Clare and North Tipperary, there are an “an unknown number of open cases that have not been reviewed”, says the report. “The current consultant psychiatrist is currently finding and reviewing these cases and expressed concern about the timely review of medication. There is little capacity on the team to follow up this cohort.”

In the CHO serving Waterford, Wexford, Carlow, Kilkenny and South Tipperary, the organisation “did not agree to carry out an audit on the clinical files as requested by the inspector following escalation of serious concerns regarding omissions in antipsychotic medication monitoring for some children/young people”. Since the review into this CHO, an audit of clinical files of all teams has taken place.

Nationwide, CHOs reported problems in both recruitment and retention of staff, leading to longer waiting times and poorer access to resources for patients. In the CHO serving South-East Dublin, East Wicklow and Dún Laoghaire, “minimal action” has been taken to address staffing issues on the core Camhs team, says the report.

According to the report, the accommodation for Laois/Offaly services is in a “190-year-old former district asylum” which is “not an appropriate location for children and young people”.

The report states that there is “no waiting room and families wait on corridors. There are soundproofing issues, peeling paint, mould on some walls and leaking roofs. There is no wheelchair access, and the number of rooms restrict expansion of the service.”