Further to your article on missing patient records, I would like to point out that the figures released by City Hospitals Sunderland foundation trust under the Freedom of Information Act in relation to availability of records do not show a rate of 19 per cent as being routinely unavailable for clinics - but for two days beforehand, writes Ken Bremner

We monitor the availability of notes two days prior to the clinics occurring; capturing this rate enables us to chase up missing notes in a more effective manner and to ensure that our clinicians have the appropriate medical information to treat patients safely and with care.

The average rate of notes unavailable at the start of clinics from June 2007 to March 2008 was 7.9 per cent. However, since October 2007 when we employed additional staff to address the issue, the average rate of unavailability has fallen to just 0.8 per cent.

It is also important to note that when the notes are unavailable, copies of patient letters and test results are available on our hospital information system which can be accessed by clinicians in outpatient clinics. We are keen that our patients are reassured measures are in place to guarantee records are available whenever they have an appointment.

Ken Bremner, chief executive, City Hospitals Sunderland foundation trust