Show patient record changes activity log

app/components/app_activity_log_component.rb

@@ -34,6 +34,13 @@ class AppActivityLogComponent < ViewComponent::Base
               <%= event[:invalidated] ? tag.s(body) : body %>
             </p></blockquote>
           <% end %>
+
+          <% if (changes = event[:changes]).present? %>
+            <%= render AppDetailsComponent.new(open: true) do |details| %>
+              <% details.with_summary { pluralize(changes.size, "field") + " updated" } %>
+              <%= changes_summary_list(changes) %>
+            <% end %>
+          <% end %>
         <% end %>
       <% end %>
     </div>
@@ -57,6 +64,7 @@ def all_events
       gillick_assessment_events,
       note_events,
       notify_events,
+      patient_change_events,
       patient_merge_events,
       patient_specific_direction_events,
       pre_screening_events,
@@ -270,6 +278,28 @@ def notify_events
     end
   end
 
+  def patient_change_events
+    patient_change_log_entries.map do |entry|
+      title =
+        case entry.source
+        when "manual_edit"
+          "Record updated manually"
+        when "cohort_import"
+          "Record updated after new details were imported in a cohort upload"
+        when "class_import"
+          "Record updated after new details were imported in a class upload"
+        else
+          raise "Unknown change source: #{entry.source}"
+        end
+      {
+        title:,
+        at: entry.created_at,
+        by: entry.user,
+        changes: entry.recorded_changes
+      }
+    end
+  end
+
   def patient_merge_events
     patient_merge_log_entries.map do |patient_merge_log_entry|
       {
@@ -435,6 +465,8 @@ def attendance_events
 
   private
 
+  delegate :format_nhs_number, :govuk_summary_list, to: :helpers
+
   def include_programme_specific_events?
     @programme_type.present? || @session.present?
   end
@@ -446,6 +478,13 @@ def archive_reasons
       @patient.archive_reasons.where(team: @team).includes(:created_by)
   end
 
+  def patient_change_log_entries
+    return [] if include_programme_specific_events?
+
+    @patient_change_log_entries ||=
+      @patient.patient_change_log_entries.includes(:user)
+  end
+
   def patient_merge_log_entries
     return [] if include_programme_specific_events?
 
@@ -615,6 +654,75 @@ def vaccination_records
         end
   end
 
+  def changes_summary_list(changes)
+    rows =
+      PatientChangeLogEntry::TRACKED_ATTRIBUTES.filter_map do |attr|
+        next unless changes.key?(attr)
+
+        old_val, new_val = changes[attr]
+        {
+          key: {
+            text: PatientChangeLogEntry.label_for(attr)
+          },
+          value: {
+            text: change_value_html(attr, old_val, new_val)
+          }
+        }
+      end
+    govuk_summary_list(rows:)
+  end
+
+  def change_value_html(attr, old_val, new_val)
+    arrow =
+      tag.svg(
+        safe_join(
+          [
+            tag.title("changed to"),
+            tag.path(
+              d:
+                "m14.7 6.3 5 5c.2.2.3.4.3.7 0 .3-.1.5-.3.7l-5 5" \
+                  "a1 1 0 0 1-1.4-1.4l3.3-3.3H5a1 1 0 0 1 0-2" \
+                  "h11.6l-3.3-3.3a1 1 0 1 1 1.4-1.4Z"
+            )
+          ]
+        ),
+        class: "nhsuk-icon nhsuk-icon--arrow-right",
+        style: "vertical-align: middle",
+        xmlns: "http://www.w3.org/2000/svg",
+        viewBox: "0 0 24 24",
+        width: "16",
+        height: "16",
+        focusable: "false",
+        role: "img",
+        "aria-label": "changed to"
+      )
+
+    safe_join(
+      [
+        format_change_value(attr, old_val),
+        " ",
+        arrow,
+        " ",
+        tag.mark(format_change_value(attr, new_val), class: "app-highlight")
+      ]
+    )
+  end
+
+  def format_change_value(attr, value)
+    return "Not provided" if value.nil? || value.to_s.empty?
+
+    case attr
+    when "date_of_birth"
+      Date.parse(value.to_s).to_fs(:long)
+    when "gender_code"
+      Patient.human_enum_name(:gender_code, value)
+    when "nhs_number"
+      format_nhs_number(value.to_s)
+    else
+      value.to_s
+    end
+  end
+
   def expired_items_for(academic_year:, programmes:)
     {
       consents:,

app/controllers/imports/issues_controller.rb

@@ -73,7 +73,12 @@ def set_form
     apply_changes = params.dig(:import_duplicate_form, :apply_changes)
 
     @form =
-      ImportDuplicateForm.new(current_team:, object: @record, apply_changes:)
+      ImportDuplicateForm.new(
+        current_team:,
+        current_user:,
+        object: @record,
+        apply_changes:
+      )
   end
 
   def set_type

app/controllers/patients/edit_controller.rb

@@ -22,6 +22,11 @@ def update_nhs_number
     @patient.invalidated_at = nil
 
     if @patient.save
+      PatientChangeLogEntry.log_saved_changes!(
+        patient: @patient,
+        user: current_user,
+        source: :manual_edit
+      )
       PatientUpdateFromPDSJob.perform_later(@patient)
 
       redirect_to edit_patient_path(@patient)

app/forms/import_duplicate_form.rb

@@ -3,7 +3,7 @@
 class ImportDuplicateForm
   include ActiveModel::Model
 
-  attr_accessor :current_team, :object, :apply_changes
+  attr_accessor :current_team, :current_user, :object, :apply_changes
 
   validates :apply_changes, inclusion: { in: :apply_changes_options }
 
@@ -55,6 +55,14 @@ def apply_pending_changes!
     object.patient.apply_pending_changes! if object.respond_to?(:patient)
 
     object.apply_pending_changes!
+
+    if object.is_a?(Patient)
+      PatientChangeLogEntry.log_saved_changes!(
+        patient: object,
+        user: current_user,
+        source: patient_import_source(object)
+      )
+    end
   end
 
   def discard_pending_changes!
@@ -68,11 +76,11 @@ def keep_both_changes!
     return unless can_apply?
 
     object.apply_pending_changes_to_new_record!(
-      changeset: changeset_for_keep_both
+      changeset: changeset_for_pending_changes
     )
   end
 
-  def changeset_for_keep_both
+  def changeset_for_pending_changes
     scope = object.changesets.includes(:import).order(:created_at)
 
     completed_import_statuses = %w[
@@ -90,4 +98,9 @@ def changeset_for_keep_both
   def reset_count!
     TeamCachedCounts.new(current_team).reset_import_issues!
   end
+
+  def patient_import_source(_patient)
+    import = changeset_for_pending_changes&.import
+    import.is_a?(ClassImport) ? :class_import : :cohort_import
+  end
 end

app/lib/patient_merger.rb

@@ -55,6 +55,10 @@ def call
         patient_id: patient_to_keep.id
       )
 
+      patient_to_destroy.patient_change_log_entries.update_all(
+        patient_id: patient_to_keep.id
+      )
+
       patient_to_destroy.patient_merge_log_entries.update_all(
         patient_id: patient_to_keep.id
       )

app/models/concerns/patient_import_concern.rb

@@ -16,6 +16,7 @@ def import_patients_and_parents(changesets, import)
     patients_with_nhs_number_changes =
       patients.select(&:nhs_number_previously_changed?)
 
+    PatientChangeLogEntry.log_import_changes!(patients: patients.to_a, import:)
     Patient.import(patients.to_a, on_duplicate_key_update: :all)
     link_records_to_import(import, Patient, patients)
 

app/models/patient.rb

@@ -82,6 +82,7 @@ class Patient < ApplicationRecord
   has_many :notify_log_entries
   has_many :parent_relationships, -> { order(:created_at) }
   has_many :patient_locations
+  has_many :patient_change_log_entries
   has_many :patient_merge_log_entries
   has_many :patient_programme_vaccinations_searches
   has_many :patient_specific_directions

app/models/patient_change_log_entry.rb

@@ -0,0 +1,78 @@
+# frozen_string_literal: true
+
+# == Schema Information
+#
+# Table name: patient_change_log_entries
+#
+#  id                :bigint           not null, primary key
+#  recorded_changes  :jsonb            not null
+#  source            :integer          not null
+#  created_at        :datetime         not null
+#  updated_at        :datetime         not null
+#  patient_id        :bigint           not null
+#  user_id           :bigint
+#
+# Indexes
+#
+#  index_patient_change_log_entries_on_patient_id  (patient_id)
+#  index_patient_change_log_entries_on_user_id     (user_id)
+#
+# Foreign Keys
+#
+#  fk_rails_...  (patient_id => patients.id)
+#  fk_rails_...  (user_id => users.id)
+#
+class PatientChangeLogEntry < ApplicationRecord
+  ATTRIBUTE_LABELS = {
+    "nhs_number" => "NHS number",
+    "given_name" => "First name",
+    "family_name" => "Last name",
+    "preferred_given_name" => "Preferred first name",
+    "preferred_family_name" => "Preferred last name",
+    "date_of_birth" => "Date of birth",
+    "gender_code" => "Gender",
+    "address_line_1" => "Address line 1",
+    "address_line_2" => "Address line 2",
+    "address_town" => "Town",
+    "address_postcode" => "Postcode"
+  }.freeze
+  private_constant :ATTRIBUTE_LABELS
+
+  TRACKED_ATTRIBUTES = ATTRIBUTE_LABELS.keys.freeze
+
+  def self.label_for(attribute)
+    ATTRIBUTE_LABELS[attribute]
+  end
+
+  belongs_to :patient
+  belongs_to :user, optional: true
+
+  enum :source, { manual_edit: 0, cohort_import: 1, class_import: 2 }
+
+  def self.log_saved_changes!(patient:, user:, source:)
+    recorded_changes = patient.saved_changes.slice(*TRACKED_ATTRIBUTES)
+    return if recorded_changes.empty?
+
+    create!(patient:, user:, source:, recorded_changes:)
+  end
+
+  def self.log_import_changes!(patients:, import:)
+    source = import.is_a?(CohortImport) ? :cohort_import : :class_import
+    user = import.uploaded_by
+
+    patients.each do |patient|
+      next if patient.id.blank?
+
+      recorded_changes =
+        patient
+          .changes
+          .slice(*TRACKED_ATTRIBUTES)
+          .reject do |_attr, (old_val, new_val)|
+            old_val.presence == new_val.presence
+          end
+      next if recorded_changes.empty?
+
+      create!(patient:, user:, source:, recorded_changes:)
+    end
+  end
+end

db/migrate/20260416130000_create_patient_change_log_entries.rb

@@ -0,0 +1,13 @@
+# frozen_string_literal: true
+
+class CreatePatientChangeLogEntries < ActiveRecord::Migration[7.2]
+  def change
+    create_table :patient_change_log_entries do |t|
+      t.references :patient, null: false, foreign_key: true
+      t.references :user, null: true, foreign_key: true
+      t.integer :source, null: false
+      t.jsonb :recorded_changes, null: false, default: {}
+      t.timestamps
+    end
+  end
+end

db/schema.rb

@@ -10,7 +10,7 @@
 #
 # It's strongly recommended that you check this file into your version control system.
 
-ActiveRecord::Schema[8.1].define(version: 2026_04_07_121005) do
+ActiveRecord::Schema[8.1].define(version: 2026_04_16_130001) do
   # These are extensions that must be enabled in order to support this database
   enable_extension "pg_catalog.plpgsql"
   enable_extension "pg_trgm"
@@ -618,6 +618,17 @@
     t.index ["email"], name: "index_parents_on_email"
   end
 
+  create_table "patient_change_log_entries", force: :cascade do |t|
+    t.datetime "created_at", null: false
+    t.bigint "patient_id", null: false
+    t.jsonb "recorded_changes", default: {}, null: false
+    t.integer "source", null: false
+    t.datetime "updated_at", null: false
+    t.bigint "user_id"
+    t.index ["patient_id"], name: "index_patient_change_log_entries_on_patient_id"
+    t.index ["user_id"], name: "index_patient_change_log_entries_on_user_id"
+  end
+
   create_table "patient_changesets", force: :cascade do |t|
     t.datetime "created_at", null: false
     t.jsonb "data"
@@ -1156,6 +1167,8 @@
   add_foreign_key "notify_log_entry_programmes", "notify_log_entries", on_delete: :cascade
   add_foreign_key "parent_relationships", "parents"
   add_foreign_key "parent_relationships", "patients"
+  add_foreign_key "patient_change_log_entries", "patients"
+  add_foreign_key "patient_change_log_entries", "users"
   add_foreign_key "patient_changesets", "locations", column: "school_id"
   add_foreign_key "patient_changesets", "patients"
   add_foreign_key "patient_locations", "locations"