Version Control Version Number: 10.1 Ratified by: Technology, Innovation & Information Group Date of Approval: (Original Version) January 2009 Name of originator/author: Admin, Records, Child Health & Domestic Manager, Deputy Records & Child Health Manager Approving Body / Committee: Amendments approved by Information Governance Sub-Group Date issued: (Current Version) Dec 2013 August 2014 Review date: (Current Version) Dec 2014 August 2016 Target audience: All Staff, Contractors, students within LCH. Name of Lead Director / Managing Director: Gary Andrews, Director of Finance and Commerce Changes / Alterations Made To Previous Version (including date of changes) Version 10.1 – Inclusion of equality analysis tool Hybrid records and scanned documentation added. Some amendments to Core Record keeping standards. General flow of documentation and typographical amendments made Consultation Records Management Sub Group This policy should be read in conjunction with the following documents: Records Management Strategy Retention, Storage and Destruction Policy. Protocol for the Management of the Records for Adopted Children. NHS Health Record and Communication Practice Standards for Team Based Care 2004. Consent to Treatment Policy. Patient Identification Policy Transfer of Children’s Records Policy Information Governance Policy IG Guidance 05 - Tracking and Tracing Systems
You will need to search for the correct patient You will then be shown the document before filing it in the patient record Link to Referral – This allows you to link the document to a referral Add Task – This allows you to send a task Type – Add the type of document by using the magnifying glass. Once you have used an option it will appear in the dropdown list. Document to be scanned Document Type Read Code Printed laboratory result Laboratory result 9b0Q Referral Referral letter 9b0g Any other letter received about a patient that is not a referral Letter received 9N3D Source – Add the source of the document by using the magnifying glass. Once you have used an option it will appear in the dropdown list Click File at the bottom of the screen to file the document into the patient’s record
Appendix G Liverpool Community Health NHS Trust Board Meeting Date of meeting: Title of Report Corporate Records Management and Audit Agenda item: Reason for the report to be presented to Board: Approve Discuss For noting Please specify Approve Board report number: Responsible Director Job Title TBC Author Job Title Samuel Curtis Deputy Records and Child Health Manager Date report written – 03/09/2015 Recommendation/Action required by Board Paper once completed will contain the recommendations if required Engagement with patients/public/partners N/A Link to strategic objectives Link to Board Assurance Framework – what assurance is provided to the Board? Assurance of effective corporate documentation management Does this report mitigate a risk held on the corporate risk register? N/A Resource Implications None – business as usual processes for records management Has an Equality Analysis been completed? N/A Are there any legal or regulatory implications, including CQC? To comply with IGT 601 Link to NHS Constitution N/A Which Committees have received this report? None as of yet will be reported to Health Care Governance Sub Committee List of appendices Appendix A – DoH Records Management Code of Practice Corporate Record Retentions Appendix B – Record Team Responsibilities and Audit Schedule Publication: No – internal review If exempt Internal record
TYPE/SUBTYPE OF RECORD MINIMUM RETENTION PERIOD DERIVATION FINAL ACTION Accident forms (see also Litigation dossiers) 10 years Destroy under confidential conditions Accident register (Reporting of Injuries, Diseases and Dangerous Occurrences register) – see also Incident forms 10 years Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (reg. 7); Social Security (Claims and Payments) Regulations (reg. 25) Destroy under confidential conditions Adoption records (i.e. administrative records relating the adoption process) 75th anniversary of the date of birth of the child to whom it relates or, if the child dies before attaining the age of 18,15 years beginning with the date of the 18th birthday Children and Young Persons Arrangements for Placement of Children (General) (Regulations 1991,SI 1991, No. 890 regs. 8, 9, 10 – children’s records) Adoption Regulations 2004(reg. 34) Destroy under confidential conditions Advance letters (eg DH guidance) 6 years Destroy Agendas of board meetings, committees, sub-committees (master copies, including associated papers) 30 years See note 1 Agendas (other) 2 years Destroy under confidential conditions Agreements (see Contracts)
Commissioning decisions Appeal documentation– Decision documentation – 6 years from date of appeal – decision6 years from date of decision – Destroy under confidential conditions Complaints (See also litigation dossiers)Correspondence, investigation and – outcomes Returns made to DH – 8 years from completion of action– Files closed annually and kept for – 6 years following closure NB: Current policy on the handling of complaints is under review and further guidance will be issued in due course Destroy under confidential conditions Copyright declaration forms (Library Service) 6 years Copyright, Designs and Patents Act 1988 Destroy under confidential conditions Data Input Forms (where the data/information has been input to a computer system) 2 years Destroy under confidential conditions Diaries (office) 1 year after the end of the calendar year to which they refer Destroy under confidential conditions Exposure monitoring records 5 years from the date the record was made Control of Substances Hazardous to Health Regulations 2002 (reg. 10(5)) Destroy under confidential conditions ’Find-a-Doc’ records (kept by PCT’s)contact sheets and letters– assignment cases/letters– records of negotiations with GMS contract – managers re: patient registration with a GP 6 months2 years2 years Destroy under confidential conditions Flexi working hours (personal record of hours actually worked) 6 months Destroy under confidential conditions
record. If in any particular case a healthcare practitioner requires a document which forms part of the mental health act administration record to be included in a patient’s record (because he or she regards it as relevant to the patient’s healthcare), it should then be regarded as part of the patient’ health record Mortgage documents (acquisition, transfer and disposal) 6 years after repayment See note 1 Nominal rolls 6 years (maximum) Destroy under confidential conditions
TYPE/SUBTYPE OF RECORD MINIMUM RETENTION PERIOD DERIVATION FINAL ACTION Patients’ property books/registers (property handed in for safekeeping) 6 years after the end of the financial year in which the property was disposed of or 6 years after the register was closed Destroy under confidential conditions Patient Surveys (re access to services etc) 2 years Destroy under confidential conditions Phone Message Books 2 years NB Any clinical information should be transferred to the patient health record Destroy under confidential conditions Police Statements (made in the context of Accident and Emergency episodes. Statements are requested by the Police to the A&E staff in relation to alleged injuries of or by patients coming through A&E) 10 years (congruent retention period as Incident Forms) Destroy under confidential conditions Press cuttings 1 year Destroy (where bound volumes exist, see note 1) Press Releases 7 years see note 1 Project files (over £100,000) on termination, including abandoned or deferred projects 6 years See note 1 Project files (less than £100,000) on termination 2 years Destroy under confidential conditions
Contracts – financial Approval files – 15 years Approved suppliers lists – 11 years Destroy under confidential conditions Contracts – non-sealed (property) on termination 6 years after termination of contract Limitation Act 1980 Destroy under confidential conditions Contracts – non-sealed (other) on termination 6 years after termination of contract Limitation Act 1980 Destroy under confidential conditions Contracts – sealed (and associated records) Minimum of 15 years, after which they should be reviewed See note 1 Contractual arrangements with hospitals or other bodies outside the NHS, including papers relating to financial settlements made under the contract (eg waiting list initiative, private finance initiative) 6 years after end of financial year to which they relate Destroy under confidential conditions Cost accounts 3 years after end of financial year to which they relate Destroy under confidential conditions Creditor payments 3 years after end of financial year to which they relate Destroy under confidential conditions TYPE/SUBTYPE OF RECORD MINIMUM RETENTION PERIOD DERIVATION FINAL ACTION Debtors’ records – cleared 2 years from completion of audit Destroy under confidential conditions Debtors’ records – uncleared 6 years from completion of audit Destroy under confidential conditions
applicants) conditions CVs for non-executive directors (unsuccessful applicants) 2 years Destroy under confidential conditions Duty rosters i.e. organisation or departmental rosters, not the ones held on the individual’s record. 4 years after the year to which they relate Destroy under confidential conditions Industrial relations (not routine staff matters), including industrial tribunals 10 years Destroy under confidential conditions Job advertisements 1 year Destroy TYPE/SUBTYPE OF RECORD MINIMUM RETENTION PERIOD DERIVATION FINAL ACTION Job applications (successful) 3 years following termination of employment Destroy under confidential conditions Job applications (unsuccessful) 1 year Destroy under confidential conditions Job descriptions 3 years Destroy under confidential conditions Leavers’ dossiers 6 years after individual has left Summary to be retained until individual’s 70th birthday or until 6 years after cessation of employment if aged over 70 years at the time. The summary should contain everything except attendance books, annual leave records, duty rosters, clock cards, timesheets, study leave The 6 year retention period is to take into account any ET claims, or EL claims that may arise after the employee leaves NHS employment, requests for information from the NHS pensions agency etc. Claims of this nature can include periods of up to 6 Destroy under confidential conditions See note 1
applications, training plans years or more prior to the claim and where evidence could be needed from a number of sources, it is appropriate to retain as much as possible from the original file. Letters of appointment 6 years after employment has terminated or until 70th birthday, whichever is later Destroy under confidential conditions TYPE/SUBTYPE OF RECORD MINIMUM RETENTION PERIOD DERIVATION FINAL ACTION Nurse training records (from hospital-based nurse training schools prior to the introduction of academic-based training) 30 years See note 1 Pension Forms (all) 7 years HMRC Technical Pension Notes for registered pension schemes under regulation 18 of SI2006/567 – ‘RPSM12300020 – Scheme Administrator Information Requirements and Administration for General Retention of Records’ Destroy under confidential conditions
Stores records – major (eg stores ledgers) 6 years Destroy under confidential conditions Stores records – minor (eg requisitions, issue notes, transfer vouchers, goods received books) 18 months Destroy under confidential conditions TYPE/SUBTYPE OF RECORD MINIMUM RETENTION PERIOD DERIVATION FINAL ACTION Supplies records – minor (eg invitations to tender and inadmissible tenders, routine papers relating to catering and demands for furniture, equipment, stationery and other supplies) 18 months Destroy under confidential conditions Tenders (successful) Tender period plus 6 year limitation period Limitation Act 1980 Destroy under confidential conditions Tenders (unsuccessful) 6 years Limitation Act 1980 Destroy under confidential conditions