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Coroner warning over incompatible NHS systems Coroner warning over incompatible NHS systems
(about 20 hours later)
The inquest hearing took place at the coroners courts in the Guildhall in HullThe inquest hearing took place at the coroners courts in the Guildhall in Hull
A coroner has warned NHS bosses that delays to the availability of mental health assessments between different teams due to outdated IT systems could lead to future deaths.A coroner has warned NHS bosses that delays to the availability of mental health assessments between different teams due to outdated IT systems could lead to future deaths.
Prof Paul Marks, senior coroner for Hull and East Riding, issued a prevention of future deaths report following an inquest into the death of John Kirkman, who took his own life.Prof Paul Marks, senior coroner for Hull and East Riding, issued a prevention of future deaths report following an inquest into the death of John Kirkman, who took his own life.
Prof Marks said healthcare teams could encounter problems accessing "vital" information about patients as a result of incompatible computer programmes and this could lead to delays in care.Prof Marks said healthcare teams could encounter problems accessing "vital" information about patients as a result of incompatible computer programmes and this could lead to delays in care.
A spokesperson for NHS England expressed their "deepest sympathies" to Mr Kirkman's family and said the organisation would "carefully consider" the report.
The report, sent to the chief executive of NHS England, said the organisation should take action, "possibly by reviewing the compatibility of IT systems".The report, sent to the chief executive of NHS England, said the organisation should take action, "possibly by reviewing the compatibility of IT systems".
The report said Mr Kirkman, who was 36, had a long history of paranoid schizophrenia and took his own life on 27 December 2023. The document said Mr Kirkman, who was 36, had a long history of paranoid schizophrenia and took his own life on 27 December 2023.
During the inquest, the coroner said the evidence revealed matters that caused him concern.During the inquest, the coroner said the evidence revealed matters that caused him concern.
Prof Marks said that if a mental health screening assessment was carried out in one part of the country, the results and conclusions may not be immediately available elsewhere when a further assessment is carried out, due to the use of different IT systems.Prof Marks said that if a mental health screening assessment was carried out in one part of the country, the results and conclusions may not be immediately available elsewhere when a further assessment is carried out, due to the use of different IT systems.
"Absence of vital background information could result in an incorrect prioritisation for onward referral, as it did in this case," he said."Absence of vital background information could result in an incorrect prioritisation for onward referral, as it did in this case," he said.
The lack of availability of clinical information and data may "adversely influence subsequent assessments", he said.The lack of availability of clinical information and data may "adversely influence subsequent assessments", he said.
The coroner said NHS England had 56 days to respond with details of action taken or a proposed timetable of action.The coroner said NHS England had 56 days to respond with details of action taken or a proposed timetable of action.
A spokesperson for organisation said: "NHS England extends its deepest sympathies to the family and friends of John Michael Kirkman.
"We will carefully consider the Prevention of Future Deaths Report sent to us by HM Coroner and will respond in due course."
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