Fewer than half of all trusts start outpatient clinics with a set of casenotes for every patient, according to an Audit Commission report published today.

And 38 trusts out of a sample of 225 were unable to hit a benchmark set four years ago specifying that 95 per cent of patient records should be available on time.

Despite this, the findings have been hailed as 'good news for patients' by Audit Commission controller Andrew Foster. He said a 1995 study found that just 18 per cent of trusts found all their records on time, while one trust in four fell below the benchmark.

In an upbeat report, the commission says many of its recommendations have been implemented, leading to higher standards of record keeping, a more secure and centralised library service and better management.

It says the higher status now enjoyed by medical records managers has helped bring about improvements.

And it says two-thirds of trusts have included a move to electronic patient records in their business plans.

Report author Anne Stuart said the situation found by the earlier study had been 'quite dismal', but warned that it was still important for trusts to get manual systems working properly before moving to electronic records.

The report also says there is 'scope for further improvements' in the quality of record keeping and speed of retrieval, and it urges trust chief executives to discuss their results with their auditors.

The report is particularly critical of trusts which are unable to locate records in time for the start of clinics, warning that even where they are later found, the delay can have a knock-on effect on appointments as staff are set the task of locating them.

'Some 17 per cent of trusts were unable to find any of the outstanding casenotes or did not have the staff time available to continue searching for missing notes, ' it says.

'The impact on patients in these trusts may be quite considerable if their notes are not available for their consultations.

'Patients may be kept waiting and, without a full set of notes, the consultation may take longer or be less effective.

'In some cases doctors may even refuse to see patients.'

Setting the Records Straight: a review of progress in health records services . Audit Commission Publications, 0800-502030.£5.