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A hospital trust, at which a patient died, did not meet electronic patient record (EPR) standards under NHS England’s Frontline Digitisation Programme, a response to a coroner’s report has revealed.
In a ‘Prevention of future deaths’ (PFD) report, published on 28 September 2026, Catherine Wood, coroner for Kent and Medway, described how Adegboye Mukaila, aged 35 years, died at Darent Valley Hospital on 23 March 2024, as a result of multi-organ failure owing to sickle cell crisis.
The coroner wrote that Mukaila presented at the hospital in the early hours of 21 March 2024. Once in hospital, a referral to the haematology team took more than 24 hours to be acted upon, which was likely owing to a reliance on paper notes that were printed out, placed in a tray in the secretary’s office and checked intermittently by the haematology registrar on call, the coroner suggested.
She added: “There were also issues in being able to access records held by other organisations as the staff at Darent Valley Hospital did not have access to any previous clinical notes from other organisations to confirm his diagnosis.
“Had there been accessible notes between different NHS organisations, his medical history would have been clear and may have assisted with clinical decision-making, which in turn may have had an impact on his care and treatment.”
Access to electronic notes “at the earliest opportunity would make it far easier for clinical staff to provide appropriate care and treatment”, the coroner noted.
The coroner also wrote: “Whilst I found at the hearing that these issues did not more than minimally or trivially contribute to the death, it would undoubtedly lead to a risk of future deaths for others,” she noted.
In its response to the PFD, issued on 17 August 2026, NHS England said: “As part of the Frontline Digitisation Programme, the trust has been assessed against the Digital Capability Framework and was identified as not currently meeting the programme’s core EPR standards.”
NHS England’s digital maturity assessments report revealed that in 2025, Dartford and Gravesham NHS Trust — which Darent Valley Hospital is part of — scored 2.4 on the “ensure smart foundations” domain, which includes EPR standards. The national average in England on this domain was 2.6 in 2025.
In its response to the PFD, NHS England also said the trust was “expected to submit a business case in Q3 of 2026/2027 to seek funding for a comprehensive EPR, through the Frontline Digitisation Programme”.
Also responding to the PFD on 2 September 2026, the chief nursing, experience and quality officer at Kent and Medway integrated care board (ICB) — whose name is redacted in the response — said: “The issue identified should not be understood as meaning that clinicians at Darent Valley Hospital were unable to access any information held outside the trust.
“Rather, the review identified limitations in how information and referrals moved between systems and teams, and in how reliably those referrals were visible, received and acted upon.”
They added: “A fully integrated EPR would bring more information together in one place within the hospital, support clearer recording of clinical decisions and tasks, and help different teams see and act on information more consistently.
“Under the current arrangements, information may be available through more than one system, but it may not always appear automatically in the clinician’s usual workflow.”
The ICB had reviewed “whether existing referral and information-sharing processes are clear, safe and consistently followed”, the chief nursing, experience and quality officer continued.
